J. Turpin, N. Mouchtouris, Michael J. Lang, Kaitlyn Barkley, G. Barros, N. Chalouhi, R. Starke, P. Jabbour, Md Mba Facs Faha Robert H. Rosenwasswer, S. Tjoumakaris
{"title":"Functional Recovery and Risk of Readmission in Low-Grade aSAH Patients","authors":"J. Turpin, N. Mouchtouris, Michael J. Lang, Kaitlyn Barkley, G. Barros, N. Chalouhi, R. Starke, P. Jabbour, Md Mba Facs Faha Robert H. Rosenwasswer, S. Tjoumakaris","doi":"10.29046/JHNJ.013.2.006","DOIUrl":"https://doi.org/10.29046/JHNJ.013.2.006","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"183 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127037407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benedict Tan, Sanjay Yadla, Peter G. Campbell, M. Rosen, James J. Evans
Background: Although pituitary adenomas have been described in association with polyostotic fibrous dysplasia in McCune-Albright Syndrome, no such relationship has been described with monostotic fibrous dysplasia. The authors describe a case of monostotic fibrous dysplasia of the sphenoid bone and concomitant pituitary adenoma in a 25-year-old male. To the authors’ knowledge this is the first such case reported in the literature. Clinical presentation, pathology, and surgical approach are described in detail. Case Description: A 25-year-old male initially presented with headaches, gynecomastia, and galactorrhea. Magnetic Resonance Imaging (MRI) revealed a sellar/suprasellar mass possibly consistent with a calcified pituitary adenoma or craniopharyngioma and a cranial base lesion obstructing the sphenoid sinus consistent with fibrous dysplasia. Both lesions were accessible via an endoscopic transnasal approach. The patient underwent resection of the affected sphenoid bone which allowed appropriate exposure for subsequent resection of the pituitary lesion without major complication. Pathology and immunohistochemical studies confirmed the diagnoses and postoperative imaging revealed gross total resection of the adenoma. Conclusions: The authors describe a case of monostotic fibrous dysplasia of the sphenoid bone and pituitary adenoma. Resection of such dual lesions can be both safe and efficacious via an endoscopic endonasal transsphenoidal approach.
{"title":"Resection of Fibrous Dysplasia of the Sphenoid Bone and a Concomitant Calcified Pituitary Adenoma via an Endoscopic Endonasal Transsphenoidal Approach","authors":"Benedict Tan, Sanjay Yadla, Peter G. Campbell, M. Rosen, James J. Evans","doi":"10.29046/JHNJ.005.1.008","DOIUrl":"https://doi.org/10.29046/JHNJ.005.1.008","url":null,"abstract":"Background: Although pituitary adenomas have been described in association with polyostotic fibrous dysplasia in McCune-Albright Syndrome, no such relationship has been described with monostotic fibrous dysplasia. The authors describe a case of monostotic fibrous dysplasia of the sphenoid bone and concomitant pituitary adenoma in a 25-year-old male. To the authors’ knowledge this is the first such case reported in the literature. Clinical presentation, pathology, and surgical approach are described in detail. Case Description: A 25-year-old male initially presented with headaches, gynecomastia, and galactorrhea. Magnetic Resonance Imaging (MRI) revealed a sellar/suprasellar mass possibly consistent with a calcified pituitary adenoma or craniopharyngioma and a cranial base lesion obstructing the sphenoid sinus consistent with fibrous dysplasia. Both lesions were accessible via an endoscopic transnasal approach. The patient underwent resection of the affected sphenoid bone which allowed appropriate exposure for subsequent resection of the pituitary lesion without major complication. Pathology and immunohistochemical studies confirmed the diagnoses and postoperative imaging revealed gross total resection of the adenoma. Conclusions: The authors describe a case of monostotic fibrous dysplasia of the sphenoid bone and pituitary adenoma. Resection of such dual lesions can be both safe and efficacious via an endoscopic endonasal transsphenoidal approach.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129717871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sonia Teufack, P. Nguyen, Atul S. Rao, J. Jenoff, J. Harrop
Background: In the setting of multi-system traumas, the etiology and pathophysiology of neurologic injuries can be difficult to identify. Methods: A unique case of a pedestrian struck by a motor vehicle that presented with acute paraplegia after an endovascular stent placement for a traumatic thoracic aorta dissection. The patient had no significant motor function in the lower extremities, but full preservation of all sensory modalities. Initial admission computed tomography (CT) imaging was negative for intracranial trauma, but noted an acute cranial fracture; no spinal trauma was identified. Results: The patient had a lumbar drain placed to maximize spinal perfusion pressures and was immediately evaluated with magnetic resonance imaging (MRI) of the neural axis. Acute bilateral posterior frontal contusions were identified on brain imaging, which were not present on preprocedural CT head. No spinal cord injury or ischemia was seen on spinal imaging. The patient recovered and regained use of his lower extremities following a short rehab stay. Conclusion: In the setting of multi-system trauma, a high level of suspicion should exist for alternative etiologies of neurologic injuries. Thorough neurologic examinations and imaging assessments of the nervous system should be conducted to avoid misdiagnosis and improper management of occult injuries. This is the first reported case of acute paraplegia due to vertex trauma which may be a rare mechanism of injury and/or under-recognized. INTRODUCTION Trauma is the leading cause of mortality for patients less than forty years of agecheck. Further multi-system trauma has been associated with increased mortality, especially when it involves vascular injuries.4 Therefore, prompt diagnosis and management is crucial and increases the probability of survival and a favorable outcome. Acute paraplegia is an associated complication of traumatic thoracic spinal cord and aortic injuries. Further, it can also result from open and endovascular repair of this injury due to decreased perfusion to the cord and ensuing ischemia and infarction.4,5,14 Few cases of acute lower extremity monoparesis have been reported from traumatic injury to the frontal lobe.2,10 We present the first case of acute paraplegia resulting from bilateral para-sagittal frontal contusions in a patient with concomitant thoracic aorta injury. CASE REPORT A 31 year-old male pedestrian was struck by a high velocity vehicle and thrown approximately seventy feet from the initial site of impact. The patient was intubated at the scene and transported to an outside hospital. At the time he was following commands and moving all extremities. CT of the brain revealed a bicoronal scalp laceration and underlying skull fracture with no intracranial hemorrhage or contusion; CT of the chest, abdomen and pelvis revealed an aortic isthmus tear, bilateral pneumo-hemothoraxes and pulmonary contusions, multiple ribs and right clavicle fractures, liver laceration with intr
背景:在多系统损伤的情况下，神经损伤的病因和病理生理是难以确定的。方法:一个独特的情况下，行人被一辆机动车，提出急性截瘫后血管内支架置入创伤性胸主动脉夹层。患者的下肢没有明显的运动功能，但所有感觉模式完全保留。入院时的计算机断层扫描(CT)显示颅内创伤阴性，但发现急性颅骨骨折;未发现脊髓损伤。结果:患者放置腰椎引流管以最大化脊柱灌注压力，并立即通过神经轴磁共振成像(MRI)进行评估。急性双侧后额挫伤在脑成像上被发现，这在术前CT上没有出现。脊髓显像未见脊髓损伤或缺血。在短暂的康复治疗后，患者恢复并重新使用了他的下肢。结论:在多系统损伤的情况下，对神经损伤的其他病因应保持高度的怀疑。应进行彻底的神经系统检查和影像学评估，以避免误诊和对隐匿性损伤的不当处理。这是首例报道的急性截瘫由于顶点创伤，这可能是一种罕见的损伤机制和/或未被充分认识。创伤是40岁以下患者死亡的主要原因。进一步的多系统创伤与死亡率增加有关，特别是当它涉及血管损伤时因此，及时诊断和管理是至关重要的，可以增加生存的可能性和良好的结果。急性截瘫是创伤性胸脊髓和主动脉损伤的相关并发症。此外，由于脊髓灌注减少和随后的缺血和梗死，这种损伤的开放和血管内修复也可能导致损伤。颅脑额叶外伤性损伤引起急性下肢单瘫病例报道较少。我们提出了第一例急性截瘫导致双侧矢状旁前额挫伤的患者，同时胸主动脉损伤。病例报告一名31岁的男性行人被一辆高速车辆撞倒并被甩出离最初撞击地点约70英尺的地方。患者在现场被插管，并被送往外部医院。当时他还能听从命令，四肢活动自如。脑部CT显示头皮双冠状裂伤，颅底骨折，无颅内出血或挫伤;胸部、腹部和骨盆CT显示主动脉峡部撕裂，双侧气胸血肿和肺挫伤，多根肋骨和右锁骨骨折，肝脏撕裂并腹腔内出血。在转移到我们的设施后，病人保持稳定。他会睁开眼睛听声音，瞳孔同样圆，反应灵敏，他会用四肢服从简单的命令，并努力对抗重力。患者被紧急送往手术室进行内窥镜修复胸主动脉撕裂。手术无并发症完成，植入Gore TAG 26mm x 10cm内假体。图1脑磁共振成像显示双侧矢状旁挫伤。(A) t2加权层序，轴向切割;(B) t2加权序列，冠状切面。一个B
{"title":"Transient Paraplegia in a Patient with Bilateral Posterior Frontal Contusions and Traumatic Thoracic Aortic Dissection","authors":"Sonia Teufack, P. Nguyen, Atul S. Rao, J. Jenoff, J. Harrop","doi":"10.29046/JHNJ.007.2.002","DOIUrl":"https://doi.org/10.29046/JHNJ.007.2.002","url":null,"abstract":"Background: In the setting of multi-system traumas, the etiology and pathophysiology of neurologic injuries can be difficult to identify. Methods: A unique case of a pedestrian struck by a motor vehicle that presented with acute paraplegia after an endovascular stent placement for a traumatic thoracic aorta dissection. The patient had no significant motor function in the lower extremities, but full preservation of all sensory modalities. Initial admission computed tomography (CT) imaging was negative for intracranial trauma, but noted an acute cranial fracture; no spinal trauma was identified. Results: The patient had a lumbar drain placed to maximize spinal perfusion pressures and was immediately evaluated with magnetic resonance imaging (MRI) of the neural axis. Acute bilateral posterior frontal contusions were identified on brain imaging, which were not present on preprocedural CT head. No spinal cord injury or ischemia was seen on spinal imaging. The patient recovered and regained use of his lower extremities following a short rehab stay. Conclusion: In the setting of multi-system trauma, a high level of suspicion should exist for alternative etiologies of neurologic injuries. Thorough neurologic examinations and imaging assessments of the nervous system should be conducted to avoid misdiagnosis and improper management of occult injuries. This is the first reported case of acute paraplegia due to vertex trauma which may be a rare mechanism of injury and/or under-recognized. INTRODUCTION Trauma is the leading cause of mortality for patients less than forty years of agecheck. Further multi-system trauma has been associated with increased mortality, especially when it involves vascular injuries.4 Therefore, prompt diagnosis and management is crucial and increases the probability of survival and a favorable outcome. Acute paraplegia is an associated complication of traumatic thoracic spinal cord and aortic injuries. Further, it can also result from open and endovascular repair of this injury due to decreased perfusion to the cord and ensuing ischemia and infarction.4,5,14 Few cases of acute lower extremity monoparesis have been reported from traumatic injury to the frontal lobe.2,10 We present the first case of acute paraplegia resulting from bilateral para-sagittal frontal contusions in a patient with concomitant thoracic aorta injury. CASE REPORT A 31 year-old male pedestrian was struck by a high velocity vehicle and thrown approximately seventy feet from the initial site of impact. The patient was intubated at the scene and transported to an outside hospital. At the time he was following commands and moving all extremities. CT of the brain revealed a bicoronal scalp laceration and underlying skull fracture with no intracranial hemorrhage or contusion; CT of the chest, abdomen and pelvis revealed an aortic isthmus tear, bilateral pneumo-hemothoraxes and pulmonary contusions, multiple ribs and right clavicle fractures, liver laceration with intr","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125577735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of Hypothalamic/Chiasmatic Astrocytomas in Children","authors":"P. Amenta","doi":"10.29046/JHNJ.004.3.003","DOIUrl":"https://doi.org/10.29046/JHNJ.004.3.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122154783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bs year Medical student Thana Theofanis, Nohra el-Chalouhi, S. Tjoumakaris
{"title":"Cerebrospinal Fluid Leakage and Cerebral Venous Sinus Thrombosis: A Case Report","authors":"Bs year Medical student Thana Theofanis, Nohra el-Chalouhi, S. Tjoumakaris","doi":"10.29046/JHNJ.008.1.004","DOIUrl":"https://doi.org/10.29046/JHNJ.008.1.004","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131293320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Otten, B. Petrone, G. Nyquist, M. Rosen, James J. Evans, C. Farrell
Recommended Citation Otten, MD, Marc L.; Petrone, BA, Mary; Nyquist, MD, Gurston G.; Rosen, Marc MD; Evans, MD, James J.; and Farrell, MD, Christopher J (2015) "Is Reconstruction of the Sella Necessary to Prevent Optic Chiasm Prolapse and Cerebrospinal Fluid Leakage Following Endoscopic Resection of Pituitary Macroadenomas?," JHN Journal: Vol. 10 : Iss. 2 , Article 4. DOI: https://doi.org/10.29046/JHNJ.010.2.002 Available at: https://jdc.jefferson.edu/jhnj/vol10/iss2/4
Otten, MD, Marc L.;彼得龙，文学士，玛丽;奈奎斯特，医学博士;罗森，马克医学博士;Evans, MD, James J.;法雷尔，医学博士，克里斯托弗·J (2015)在内镜下切除垂体大腺瘤后，是否有必要重建鞍区以防止视交叉脱垂和脑脊液漏?，《中华人民大学学报》第10卷第2期，第4篇。DOI: https://doi.org/10.29046/JHNJ.010.2.002可在:https://jdc.jefferson.edu/jhnj/vol10/iss2/4
{"title":"Is Reconstruction of the Sella Necessary to Prevent Optic Chiasm Prolapse and Cerebrospinal Fluid Leakage Following Endoscopic Resection of Pituitary Macroadenomas","authors":"M. Otten, B. Petrone, G. Nyquist, M. Rosen, James J. Evans, C. Farrell","doi":"10.29046/JHNJ.010.2.002","DOIUrl":"https://doi.org/10.29046/JHNJ.010.2.002","url":null,"abstract":"Recommended Citation Otten, MD, Marc L.; Petrone, BA, Mary; Nyquist, MD, Gurston G.; Rosen, Marc MD; Evans, MD, James J.; and Farrell, MD, Christopher J (2015) \"Is Reconstruction of the Sella Necessary to Prevent Optic Chiasm Prolapse and Cerebrospinal Fluid Leakage Following Endoscopic Resection of Pituitary Macroadenomas?,\" JHN Journal: Vol. 10 : Iss. 2 , Article 4. DOI: https://doi.org/10.29046/JHNJ.010.2.002 Available at: https://jdc.jefferson.edu/jhnj/vol10/iss2/4","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121889155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intramedullary Spinal Cord Metastases and Radiation Therapy: A Case Report","authors":"Daniel Ikeda, James S. Harrop","doi":"10.29046/JHNJ.004.2.005","DOIUrl":"https://doi.org/10.29046/JHNJ.004.2.005","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122050637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Managing Hyperglycemia in Critically Ill Patients: Where are We Now?","authors":"Umer Shoukat, Umer Mukhtar, Kamran Athar","doi":"10.29046/JHNJ.011.1.003","DOIUrl":"https://doi.org/10.29046/JHNJ.011.1.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"19 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126201877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jewell L. Osterholm was appointed Professor and Chairman of the Department of Neurosurgery in 1974, and left the Chairmanship in 1994. Recently, he gave a series of workshops on performing neurological examinations. These workshops are being archived on DVD so future residents can benefit from Dr. Osterholm’s training. The emphasis is on interviewing and observing the patient; the only specialized devices used are the stethoscope and the reflex hammer.
Jewell L. Osterholm于1974年被任命为神经外科教授和主席，并于1994年离开主席职位。最近，他举办了一系列关于神经系统检查的研讨会。这些工作坊都被存档成DVD，以便未来的住院医生可以从奥斯特霍尔姆博士的培训中受益。重点在于对病人的采访和观察;唯一使用的专门设备是听诊器和反射锤。
{"title":"Jewell Osterholm: Sharing Fifty Years of Insight","authors":"T. Anene-Maidoh, M. Maltenfort","doi":"10.29046/JHNJ.004.4.001","DOIUrl":"https://doi.org/10.29046/JHNJ.004.4.001","url":null,"abstract":"Jewell L. Osterholm was appointed Professor and Chairman of the Department of Neurosurgery in 1974, and left the Chairmanship in 1994. Recently, he gave a series of workshops on performing neurological examinations. These workshops are being archived on DVD so future residents can benefit from Dr. Osterholm’s training. The emphasis is on interviewing and observing the patient; the only specialized devices used are the stethoscope and the reflex hammer.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125958102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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