World Neurosurg
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Case Reports
PRES caused by Induced-Hypertension for Cerebral Vasospasm secondary to Aneurysmal SAH.
The aim of the present study was to describe the case of a patient who had presented to a university hospital with induced-hypertension (IH) posterior reversible encephalopathy syndrome (PRES). We also reviewed all other reports of such patients. ⋯ IH-PRES is a rare complication that should be remembered in the differential diagnosis for at-risk patients.
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Neurosurgical spine specialists receive considerable amounts of industry support that may impact the cost of care. The aim of this study was to evaluate the association between industry payments received by spine surgeons and the total hospital and operating room (OR) costs of an anterior cervical discectomy and fusion (ACDF) procedure among Medicare beneficiaries. ⋯ This study suggests that spine surgeons performing ACDF surgeries may receive industry support without impacting the cost of care.
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Case Reports
Atlanto-occipital dissociation in the setting of relatively normal radiological findings: A case report.
Craniocervical junction (CCJ) dislocations are often fatal. Atlanto-occipital dissociation can be challenging to diagnose, especially in patients who present with absent or subtle radiologic signs. ⋯ Normal occiput-C1 craniometric parameters in the setting of unexplained perimesencephalic subarachnoid hemorrhage does not eliminate the possibility of missed or delayed diagnosis of traumatic atlanto-occipital dissociation injuries. Cervical MRI without contrast should be considered in patients with vertebral artery dissection or perimesencephalic subarachnoid hemorrhage after a blunt injury with neck pain. When MRI shows evidence of disruption of ≥2 atlanto-occipital ligaments, surgical stabilization should be considered, as these are clinically very unstable injuries.
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Lumbar drains (LDs) are often used for temporary cerebrospinal fluid (CSF) diversion. However, limited data are available on the risk factors associated with complications. We reviewed our institutional LD data to identify the common indications and outcomes, including the risk factors associated with the occurrence of complications. ⋯ The most common complications in our institution were meningitis and low pressure headaches. Minimizing LD manipulation during CSF sampling could potentially decrease the risk of meningitis. Our protocol of continuing routine prophylactic antibiotics for patients with an indwelling LD might reduce the risk of meningitis; however, the results from a prospective cohort study would provide stronger evidence.
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Small cell neuroendocrine carcinoma of the Bartholin gland is an extremely uncommon gynecologic tumor. Brain metastasis from a malignant gynecologic lesion is rarely encountered and the prognosis for this type of metastasis is quite poor. ⋯ Different treatment options, including resection, stereotactic radiosurgery, and whole-brain radiation therapy, as well as chemotherapy, are available and should each be considered on an individual basis.