World Neurosurg
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The role of prophylactic antiepileptic drugs (AEDs) in preventing seizures and/or improving the outcomes after intracerebral hemorrhage (ICH) has remained controversial. The current guidelines have recommended against AED prophylaxis. However, these recommendations were based on older studies that had primarily used phenytoin as the AED of choice. Newer medications, such as levetiracetam, have yet to be extensively studied. ⋯ The administration of, predominantly, levetiracetam for AED prophylaxis after ICH reduced the odds of new seizure events, independently of the admission NIHSS score and the presence of cortical involvement.
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Treatment of unruptured intracranial arteriovenous malformations (AVMs) has become controversial since the ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) study was published in 2014. We sought to analyze changes in the demographics, clinical presentation, and treatment strategies in 2 patient cohorts from the same institution separated by 40 years. ⋯ Compared to 40 years ago, more patients are presenting with incidentally discovered intracranial AVMs and are undergoing interventional treatment. Better understanding of the natural history, developments in endovascular therapy, and stereotactic radiosurgery, as well as improvements in microsurgical techniques have led to a substantial increase in patients undergoing invasive treatment.
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Case Reports
COVID-19 associated encephalopathies and cerebrovascular disease: the New Orleans experience.
The coronavirus 2019 (COVID-19) pandemic has had a dramatic impact on health care systems and a variable disease course. Emerging evidence demonstrates that severe acute respiratory syndrome coronavirus 2 is associated with central nervous system disease. We describe central nervous system manifestations in critical patients with COVID-19 at our tertiary center. ⋯ Analysis of active critical COVID-19 admissions at our revealed a high percentage of patients with new neurologic disease. Although variable, presentations followed 1 of 3 broad categories. A better understanding of the neurologic sequalae and radiographic findings will help clinicians mitigate the impact of this disease.
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Publications are considered a major factor for advancement in academia. An effort has been made to study authorship trends in neurosurgery publications. The objective of this study was to investigate authorship trends in the neurosurgery literature for the last 20 years (1998-2018). ⋯ A rapid rise in female authorship positions in particular and authorship positions in general demonstrates the diversity that is slowly burgeoning to cater to perspectives and issues that require a multidimensional approach in neurosurgery. Increasing linkages among researchers in neurosurgery on a global scale are evident by the increase in multinational collaborations. Expansive efforts are needed at institutional and individual levels to eradicate sex-based pitfalls that hinder excellence in neurosurgery research.
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Many treatment options for osteoporotic vertebral fractures are available. However, limited and variable findings have been reported on the efficacy of the individual therapies. The objective of the present study was to systematically review the reported data for evidence of efficacy of spinal orthoses for osteoporotic vertebral fractures. ⋯ Limited evidence has suggested the safety of spinal orthoses for the treatment of osteoporotic compression fractures. At present, compelling evidence is not available to suggest that a rigid brace is superior to a soft brace or no brace. Kyphoplasty might be of benefit for select patients.