World Neurosurg
-
Case Reports
VNS stopping Anti-NMDA receptor encephalitis triggered non-convulsive status epilepticus.
Anti-NMDA receptor encephalitis (ANRE) is a rare autoimmune neurologic disorder characterized by encephalitis and a constellational of symptoms, including seizures, psychiatric disturbances, autonomic instability, and respiratory insufficiency. It is caused by the anti-NMDA receptor antibody. The most common etiologies for ANRE include malignancy and infection. Ovarian teratoma is the most commonly associated malignancy. ⋯ This case report provides a temporal correlation suggesting that VNS significantly altered the natural history of this patient's NCSE-ANRE. As more data are collected, and the VNS treatment modality more liberally used to treat NCSE, especially in the situation of ANRE, stronger layers of evidence will emerge to fill the gaps of understanding beyond this case report.
-
The relationship of preoperative malnutrition with perioperative adverse medical events (PAMEs) has not been well studied in elderly patients undergoing spinal surgery (SS). We aimed to compare the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and Geriatric Nutritional Risk Index (GNRI) for prediction of PAMEs in elderly patients undergoing SS. ⋯ Preoperative malnutrition is associated with PAMEs in elderly patients undergoing SS. GNRI had the highest accuracy for predicting PAMEs among the nutritional indices studied.
-
Dural venous sinus thrombosis (DVST) after blunt head trauma is not rare; however, its clinical manifestations are vague, which impedes early diagnosis that is vital for its management. Prior studies have demonstrated that the presence of gas in the dural venous sinus (DVS) after blunt head trauma increases the likelihood of DVST. On nonenhanced computed tomography (CT), hyperdensity in the DVS is considered a direct sign of thrombosis, which can enable early diagnosis of traumatic DVST with high specificity but low sensitivity. We describe a case of traumatic DVST, which was diagnosed early based on the findings of gas and increasing density in the DVS on regular nonenhanced CT. ⋯ Traumatic DVST was diagnosed early through findings of gas and increasing density in DVS on different nonenhanced CTs. Finding this combination is a practical, sensitive method for early diagnosis of traumatic DVST, especially in patients with hidden skull fractures involving DVS and patients with hypocythemia.
-
The aim of this study is to determine if frailty, defined as modified frailty index (MFI) >2.7, correlated with worse postoperative outcomes in patients with chronic subdural hematomas (CSDHs). We also compare the predictive ability of the MFI with another widely used frailty measure, the Clinical Frailty Scale (CFS). ⋯ Elderly patients presenting with CSDH who are frail (MFI >0.27) have significantly worse functional outcomes following twist-drill craniostomies. Therefore assessing frailty in this population is important before managing these patients, and for this purpose the CFS is a superior predictor of postoperative function than the MFI.