Acta neurochirurgica. Supplement
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Studying discovertebral complex anatomy is extremely important for the understanding of the pathophysiology of disc degeneration which leads to vertebral endplates signal changes, also known as Modic changes. The sequelae of disc degeneration are among the leading causes of functional incapacity in both sexes and are one of the most common sources of chronic disability in the working years. Even if the presence of degenerative changes in MRI of the spine is by no means an indicator of symptoms, we are concordant in a positive association between Modic changes and low back pain, above all as a relatively specific but insensitive sign of discogenic low back pain.
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Acta Neurochir. Suppl. · Jan 2011
Predictors analysis of symptomatic cerebral vasospasm after subarachnoid hemorrhage.
symptomatic cerebral vasospasm (SCVS) is still lacking in reliable early warning methods and often diagnosed after clinical deterioration of neurological function, making prevention and treatment extremely passive. This study investigates the risk factors relevant to SCVS after subarachnoid hemorrhage (SAH) in order to provide useful information for clinical work. ⋯ SCVS is the final result of multiple factors acting together. Age and modified Fisher grades are independent risk factors to SCVS.
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Acta Neurochir. Suppl. · Jan 2011
Clinical study of changes of cerebral microcirculation in cerebral vasospasm after SAH.
Aim to investigate the changes of cerebral microcirculation after subarachnoid hemorrhage (SAH) and its association with cerebral vasospasm (CVS) after SAH. CTP was performed in 85 patients with SAH and 35 controls. Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were recorded for final analysis. ⋯ In 46 CVS patients, sCVS group presented significantly lower CBF and more prolonged MTT than asCVS patients (P<0.05). Seven cases with MTT between 6.31 and 12.72 s showed delayed ischemic neurological deficit (DIND), two of whom had hemiplegia, and one died. Our findings suggest that CTP examination contributes to uncover the changes of cerebral microcirculation after SAH, and the changes of cerebral microcirculation are associated with CVS post SAH.
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Acta Neurochir. Suppl. · Jan 2011
Evidenced Based Guidelines for the Management of Good Grade Subarachnoid Haemorrhage Patients in Leeds, UK.
Aneurysmal Subarachnoid Haemorrhage (SAH) is a common neurosurgical condition with high morbidity and mortality, with our trust treating over 120 patients annually. Although there are recommendations for the management of some aspects of subarachnoid haemorrhage, a comprehensive guideline document has not been produced. Our guidelines seek to address all aspects of acute patient care in our neurosurgical unit, using evidence based medicine with a multi-disciplinary team to produce care pathways establishing a standard of care for our patients.
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The lack of radiation, high soft tissue contrast and capacity for multiplanar and three-dimensional imaging have made magnetic resonance imaging (MRI) the imaging modality of choice for evaluating spinal cord diseases. In diagnostic imaging of the spine, MRI is clearly superior to both conventional radiography (CR) and computed tomography (CT) and it should be preferred as first diagnostic examination when degenerative spine pathologies are suspected. ⋯ Both "container" and "contents" of the spine should be primly evaluated. Finally, a correlation between clinical and radiological features seems to be mandatory for selecting the correct therapeutic choice, since the reliability of the MRI as potential prognostic indicator has been demonstrated.