Articles: treatment.
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A systematic literature review and consensus using Delphi method. ⋯ There are multiple surgical options for basilar invagination depending on the existence of compression, AAD or irreducibility. The WFNS spine committee proposed consensus recommendations based on relevant literature published after 2011 to help surgeons standardize the level of care and improve outcomes following treatment across the globe.
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Susac syndrome can resemble various disorders resulting in a delayed or missed diagnosis and subsequent delays in treatment. Here, we present how successful consideration of patient history, symptoms, and ancillary testing led to prompt diagnosis and treatment of Susac syndrome by ophthalmologists. A 27-year-old active duty infantryman presented with sudden vision loss in the right eye during strenuous exercise after experiencing similar symptoms in the left eye 5 months earlier. ⋯ Identification of branch retinal artery occlusions on fluorescein angiography and low-to-mid frequency hearing loss confirmed the diagnosis of Susac syndrome. The patient was immediately treated with high-dose oral prednisone and subsequently transitioned to rituximab infusions to preserve vision. Susac syndrome should be considered when a patient presents with vision loss, hearing deficits, and or cognitive changes, even if symptoms are separated by time and seemingly attributed to more common causes.
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To understand how breast cancer patients experience the surgical decision process and identify strategies surgeons can employ to empower patients to engage in decision-making. ⋯ Surgeons can empower patients to engage in decision-making by getting to know patients as individuals, ensuring all treatment options are presented, and integrating patient preferences into the decision process. Through these actions, surgeons can help patients with varied preferences for decision-making engage in making high quality decisions that reflect patients' priorities. These suggestions may have the greatest impact on socially disadvantaged patients and help to reduce disparities in care.
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The published literature on Cranio-vertebral Junction (CVJ) anomalies lacks a comprehensive appraisal that integrates common diagnostic, management and treatment concepts for different conditions, such as Chiari Malformation (CM), Basilar Invagination (BI), Os Odontoideum (OO) and Syndromic Malformations. The authors aimed to fill this knowledge gap offering guidelines and recommendations with a global outreach and applicability. ⋯ Despite grey zones on natural history of CVJ anomalies and controversies on timing and type of surgical treatments, whenever atlantoaxial instability is present, C1-C2 stabilization through instrumentation and fusion is necessary. If only recurrent pain and neurological dysfunction occurs, surgical decompression is appropriate. If no atlantoaxial instability is present, Down's patients can participate in competitive sports. In general, contact sports are not recommended.