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Teta injury at the craniovertebral junction: A case report 颅椎骨交界处的 Teta 损伤:病例报告
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-04-25 DOI: 10.1016/j.inat.2024.101986
Shuvro Saha, Rafiqul Islam, Rashidul Hasan, Pulak Kumar Biswas

Neck or craniovertebral penetrating injury by in situ teta, used for fishing, is an extremely rare neurosurgical emergency. In this article, we present the management of such a case in Dhaka Medical College Hospital. This case report will emphasize the presentation, investigations, surgical, and other supportive management.

用于捕鱼的原位 Teta 造成颈部或颅椎穿透性损伤是一种极为罕见的神经外科急症。本文介绍了达卡医学院附属医院对此类病例的处理。本病例报告将重点介绍其表现、检查、手术和其他辅助治疗。
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引用次数: 0
Clinical characteristics and management of vertebral artery dissection without definitive imaging features: A single center cohort study 无明确影像学特征的椎动脉夹层的临床特征和处理方法:单中心队列研究
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-04-24 DOI: 10.1016/j.inat.2024.101985
Hironori Fukumoto , Takashi Morishita , Koichiro Takemoto , Hiromasa Kobayashi , Dai Kawano , Yoshinobu Horio , Mitsutoshi Iwaasa , Tooru Inoue , Hiroshi Abe

Background

Management of vertebral artery dissection (VAD), which is difficult to diagnose definitively on imaging, is a clinical concern. The aim of this study was to clarify the clinical characteristics of VAD without definitive imaging features and evaluate our clinical decisions and their consequences.

Methods

We searched our database to identify patients with VAD registered between January 2008 and December 2021. We performed a retrospective chart review to obtain detailed clinical information and compared the clinical characteristics and radiological findings between patients with definitive VAD and those with non-definitive VAD by radiological findings at the initial evaluation.

Results

Of 188 patients (mean age 52.7 ± 12.3 years, 121 male), 127 had definitive VAD. Patients in the definitive group had a younger average age and a high rate of intramural hematoma, while those in the non-definitive group were more likely to have a history of hypertension. Overall, the prognosis was good for the majority (n = 163), and there was no significant difference in the prognosis between two groups. Especially, the prognosis of non-definitive VAD patients without stroke was favorable.

Conclusions

Cases of non-definitive VAD are likely to be complicated by atherosclerotic changes. Therefore, clinicians should carefully evaluate the potential etiologies based on the clinical history and imaging data to provide patients with the optimal treatment options. Identification of IMH was an important factor to make a definitive diagnosis, and the vessel wall imaging is a useful imaging modality for the purpose.

背景椎动脉夹层(VAD)很难通过影像学明确诊断,其管理是临床关注的问题。本研究旨在明确无明确影像学特征的椎动脉夹层的临床特征,并评估我们的临床决策及其后果。方法我们在数据库中搜索了2008年1月至2021年12月期间登记的椎动脉夹层患者。我们进行了回顾性病历审查,以获得详细的临床信息,并根据初次评估时的放射学结果,比较了明确 VAD 患者和无明确 VAD 患者的临床特征和放射学结果。结果 在 188 名患者(平均年龄为 52.7 ± 12.3 岁,121 名男性)中,127 人有明确的 VAD。明确组患者的平均年龄较小,硬膜内血肿发生率较高,而非明确组患者则更可能有高血压病史。总体而言,大多数患者(163 人)的预后良好,两组患者的预后无明显差异。结论非明确性 VAD 病例很可能因动脉粥样硬化病变而变得复杂。因此,临床医生应根据临床病史和影像学资料仔细评估潜在病因,为患者提供最佳治疗方案。识别IMH是明确诊断的一个重要因素,而血管壁成像是一种有用的成像方式。
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引用次数: 0
Type Id versus type IId three-level hybrid surgery for the treatment of noncontiguous cervical spondylosis: A finite element analysis 治疗非连续性颈椎病的Id型与IId型三水平混合手术:有限元分析
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-04-09 DOI: 10.1016/j.inat.2024.101983
Jiang Huang , Xiangyao Sun , Qingming Zhang , Li Cao , Yuqi Liu , Zelong Song , Wei Tang , Siyuan Sun , Juyong Wang

The objective of the research is to simulate different forms of three-level hybrid surgeries, aiming to establish a foundational reference for the selection of suitable treatment strategies for multilevel noncontiguous cervical degenerative disease (CDD). For the development of precise finite element models (FEMs), this study utilized computed tomography (CT) data. Two cross-segment surgical approaches were primarily investigated: C3/4 cervical disc arthroplasty (CDA), C5/6 anterior cervical discectomy and fusion (ACDF), and C6/7 ACDF in the type Id model; C3/4 CDA, C5/6 CDA, and C6/7 ACDF in the type IId model. The follower load technique was employed to apply an initial axial load of 73.6 N at the motion center. Subsequently, a moment of 1.0 Nm was introduced at the center of the C2 vertebra to simulate the overall motion of the model. In contrast to type IId, type Id exhibited lower average intervertebral disc pressure in C4/5 across various motions. The average intervertebral disc pressure in C2/3 was higher in type Id compared to type IId in flexion and axial rotation, whereas the reverse was observed in lateral bending. Type IId exhibited notably lower facet joint contact stresses during extension in C2/3 and C4/5 when compared to type Id. Type Id has a better protective effect on IS, and can significantly reduce the average pressure of the intervertebral disc in IS compared with type IId. Type IId has a significant protective effect on the post-column structure of non-fused segments.

这项研究的目的是模拟不同形式的三水平混合手术,旨在为多水平非连续性颈椎退行性疾病(CDD)选择合适的治疗策略提供基础参考。为了建立精确的有限元模型(FEM),本研究利用了计算机断层扫描(CT)数据。主要研究了两种跨节手术方法:C3/4颈椎间盘关节成形术(CDA)、C5/6颈椎前路椎间盘切除融合术(ACDF)和C6/7 ACDF(Id型模型);C3/4 CDA、C5/6 CDA和C6/7 ACDF(IId型模型)。采用随动载荷技术在运动中心施加 73.6 N 的初始轴向载荷。随后,在 C2 椎体中心引入 1.0 牛米的力矩,以模拟模型的整体运动。与 IId 型相比,Id 型在各种运动中的 C4/5 椎间盘平均压力较低。与 IId 型相比,Id 型在屈曲和轴向旋转时 C2/3 的平均椎间盘压力较高,而在侧弯时则相反。与Id型相比,IId型在C2/3和C4/5伸展时的面关节接触应力明显较低。与 IId 型相比,Id 型对 IS 有更好的保护作用,能显著降低 IS 中椎间盘的平均压力。IId 型对未融合节段的柱后结构具有明显的保护作用。
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引用次数: 0
A large extruded L5-S1 disc causing progressive compression and neurological deficits(CES) with slow recovery after surgery L5-S1 椎间盘突出导致进行性压迫和神经功能缺损(CES),术后恢复缓慢
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-04-08 DOI: 10.1016/j.inat.2024.101982
Mehdi Mahmoodkhani, Majid Rezvani, Mehdi Shafiei, Amir Mahabadi, Navid Askariardejani

A 40-year-old male presented with progressive paresthesia and weakness of the lower limbs and sphincter dysfunction. He had a history of low back pain and disk herniation from five years ago. Magnetic resonance imaging (MRI) revealed a very large mass-like lesion at L5-S1 segments, and computed tomography (CT) showed destruction of L5 lamina. While the main diagnosis was a large extruded disc, the possibility of extradural masses such as chordoma was also considered. The patient was immediately started on corticosteroid therapy and underwent laminectomy and discectomy surgery to remove the large free fragment compressing the neural elements. The patient reported feeling improvement in his feet and perineum one day after surgery, but follow-up examinations one and three months after surgery described incomplete recovery in sphincter function. This case highlights the importance of considering other possible diagnoses based on physical examination and imaging findings, even when the initial diagnosis seems clear, and emphasizes the need for timely intervention in cases of spinal cord compression to prevent permanent damage to the neural elements.

一名 40 岁的男性因下肢进行性麻痹和无力以及括约肌功能障碍前来就诊。他在五年前曾有腰痛和椎间盘突出的病史。磁共振成像(MRI)显示 L5-S1 节段有一个非常大的肿块样病变,计算机断层扫描(CT)显示 L5 椎板受到破坏。虽然主要诊断是巨大的椎间盘突出,但也考虑了硬膜外肿块(如脊索瘤)的可能性。患者立即开始接受皮质类固醇治疗,并接受了椎板切除术和椎间盘切除术,切除了压迫神经元的大块游离碎片。术后一天,患者报告其足部和会阴部感觉有所改善,但术后一个月和三个月的随访检查显示其括约肌功能未完全恢复。本病例强调了根据体格检查和影像学检查结果考虑其他可能诊断的重要性,即使初步诊断似乎很明确,并强调了在脊髓受压病例中及时干预的必要性,以防止对神经元造成永久性损伤。
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引用次数: 0
Bone density measured on sagittal reconstructed CT is highly correlated with axial CT but both measurements are only moderately correlated with DEXA T-scores 矢状线重建 CT 测得的骨密度与轴向 CT 高度相关,但这两种测量结果与 DEXA T 分数的相关性一般
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-03-22 DOI: 10.1016/j.inat.2024.101980
Shivam N. Upadhyaya , Charles H. Crawford III , Grant O. Schmidt , Derek Arrington , John R. Dimar II , Steven D. Glassman , Jeffrey L. Gum , Amer H. Ahmad , Leah Y. Carreon

Background

During the preoperative evaluation of a patient being considered for spinal surgery, Dual-energy x-ray absorptiometry (DEXA) has been traditionally used to diagnose poor bone mineral density (BMD) as a risk factor. As ordering a DEXA can add cost and delay diagnosis, spine surgeons have more recently began to use Hounsfield Units (HU) measured on computed tomography scans (CT) as a measure of BMD. The aim of our study was to evaluate associations between DEXA and HU on lumbar spine CT scans.

Methods

Forty-two patients (32 female, 10 male, mean age = 67.7 years) with DEXA and lumbar spine CT scans performed within one year of each other were identified. DEXA T-scores were collected from the hip, forearm and L1-L4. HU was determined using the maximum region of interest within the cancellous area in the mid-vertebral body from L1-L4 in the sagittal and axial planes.

Results

Using the lowest T-score, 8 (19 %) cases were osteoporotic and 25 (60 %) were osteopenic. Statistically significant differences in HU were seen in osteoporotic cases (Axial HU = 59.2, Sagittal HU = 61.1, p = 0.006) compared to osteopenic (Axial HU = 119.8, Sagittal HU = 122.9) and normal cases (Axial HU = 141.2, Sagittal HU = 142.3). There were moderate associations between the spine T-scores and CT HUs (Axial HU:r2 = 0.50, Sagittal HU:r2 = 0.49, p < 0.001), weak associations between the Axial HU (r2 = 0.48, p < 0.000) and Sagittal HU (r2 = 0.48, p < 0.000) with hip T-scores, and no correlations with forearm T-scores. There were strong associations between Axial HU and Sagittal HU (r2 = 0.98, p < 0.001).

Clinical relevance

The results of the current study show a strong association between the sagittal and axial vertebral HU measurements, which supports the clinical use of either measurement technique. The weak correlation between T-scores and HU is consistent with prior studies and warrants future studies to determine which modality will better predict postoperative mechanical failures in patients undergoing spinal surgery.

Level of Evidence

III.

背景在对考虑接受脊柱手术的患者进行术前评估时,双能 X 射线吸收测量法(DEXA)传统上一直被用来诊断骨矿密度(BMD)低下这一风险因素。由于订购 DEXA 可能会增加成本并延误诊断,脊柱外科医生最近开始使用计算机断层扫描(CT)测量的 Hounsfield 单位(HU)来衡量 BMD。我们的研究旨在评估腰椎 CT 扫描中 DEXA 和 HU 之间的关联。方法确定了 42 名在一年内接受 DEXA 和腰椎 CT 扫描的患者(32 名女性,10 名男性,平均年龄 = 67.7 岁)。从臀部、前臂和 L1-L4 采集 DEXA T 值。使用矢状面和轴向面上 L1-L4 椎体中部松质区内的最大感兴趣区来确定 HU。与骨质疏松病例(轴位 HU = 119.8,矢状位 HU = 122.9)和正常病例(轴位 HU = 141.2,矢状位 HU = 142.3)相比,骨质疏松病例的 HU 有明显的统计学差异(轴位 HU = 59.2,矢状位 HU = 61.1,p = 0.006)。脊柱 T 评分与 CT HU 之间存在中度相关性(轴位 HU:r2 = 0.50,矢状位 HU:r2 = 0.49,p <;0.001),轴位 HU(r2 = 0.48,p <;0.000)和矢状位 HU(r2 = 0.48,p <;0.000)与髋关节 T 评分之间存在微弱相关性,与前臂 T 评分没有相关性。临床相关性目前的研究结果表明,矢状位和轴位椎体HU测量值之间有很强的相关性,这支持了这两种测量技术在临床上的应用。T-scores和HU之间的弱相关性与之前的研究一致,因此有必要在未来进行研究,以确定哪种方式能更好地预测脊柱手术患者的术后机械故障。
{"title":"Bone density measured on sagittal reconstructed CT is highly correlated with axial CT but both measurements are only moderately correlated with DEXA T-scores","authors":"Shivam N. Upadhyaya ,&nbsp;Charles H. Crawford III ,&nbsp;Grant O. Schmidt ,&nbsp;Derek Arrington ,&nbsp;John R. Dimar II ,&nbsp;Steven D. Glassman ,&nbsp;Jeffrey L. Gum ,&nbsp;Amer H. Ahmad ,&nbsp;Leah Y. Carreon","doi":"10.1016/j.inat.2024.101980","DOIUrl":"https://doi.org/10.1016/j.inat.2024.101980","url":null,"abstract":"<div><h3>Background</h3><p>During the preoperative evaluation of a patient being considered for spinal surgery, Dual-energy x-ray absorptiometry (DEXA) has been traditionally used to diagnose poor bone mineral density (BMD) as a risk factor. As ordering a DEXA can add cost and delay diagnosis, spine surgeons have more recently began to use Hounsfield Units (HU) measured on computed tomography scans (CT) as a measure of BMD. The aim of our study was to evaluate associations between DEXA and HU on lumbar spine CT scans.</p></div><div><h3>Methods</h3><p>Forty-two patients (32 female, 10 male, mean age = 67.7 years) with DEXA and lumbar spine CT scans performed within one year of each other were identified. DEXA T-scores were collected from the hip, forearm and L1-L4. HU was determined using the maximum region of interest within the cancellous area in the mid-vertebral body from L1-L4 in the sagittal and axial planes.</p></div><div><h3>Results</h3><p>Using the lowest T-score, 8 (19 %) cases were osteoporotic and 25 (60 %) were osteopenic. Statistically significant differences in HU were seen in osteoporotic cases (Axial HU = 59.2, Sagittal HU = 61.1, p = 0.006) compared to osteopenic (Axial HU = 119.8, Sagittal HU = 122.9) and normal cases (Axial HU = 141.2, Sagittal HU = 142.3). There were moderate associations between the spine T-scores and CT HUs (Axial HU:r<sup>2</sup> = 0.50, Sagittal HU:r<sup>2</sup> = 0.49, p &lt; 0.001), weak associations between the Axial HU (r<sup>2</sup> = 0.48, p &lt; 0.000) and Sagittal HU (r<sup>2</sup> = 0.48, p &lt; 0.000) with hip T-scores, and no correlations with forearm T-scores. There were strong associations between Axial HU and Sagittal HU (r<sup>2</sup> = 0.98, p &lt; 0.001).</p></div><div><h3>Clinical relevance</h3><p>The results of the current study show a strong association between the sagittal and axial vertebral HU measurements, which supports the clinical use of either measurement technique. The weak correlation between T-scores and HU is consistent with prior studies and warrants future studies to determine which modality will better predict postoperative mechanical failures in patients undergoing spinal surgery.</p></div><div><h3>Level of Evidence</h3><p>III.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"37 ","pages":"Article 101980"},"PeriodicalIF":0.4,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000264/pdfft?md5=e2b2c07243c64ae65a8b312482b842bd&pid=1-s2.0-S2214751924000264-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prediction of functional outcome in supratentorial intracerebral hemorrhage patients treated with stereotactic computed tomographic-guided aspiration and recombinant tissue plasminogen activator (rt-PA) 采用立体定向计算机断层扫描引导抽吸术和重组组织纤溶酶原激活剂(rt-PA)治疗幕上脑室内出血患者的功能预后预测
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-03-18 DOI: 10.1016/j.inat.2024.101979
Lan H. Dang , Khanh N. Thach , Yen T. Nguyen , Tuyen V. Nguyen , Ha H. Dinh , Loan T. Nguyen , Cuc T. Nguyen

Background and purpose

Minimally invasive surgery for ICH has shown a significantly improved functional outcome for selected ICH patients. This study aimed to evaluate the factors influencing the outcome of supratentorial ICH patients treated with stereotactic computed tomographic (CT) guided recombinant tissue plasminogen activator (rt-PA).

Methods

We retrospectively evaluated data from 80 consecutive supratentorial ICH patients between December 2017 and July 2020, analyzing their 180-day outcomes, and identifying clinical, radiological factors for good prognosis within 180 days.

Results

The mean age was 55.6 years (SD 11.4). The median preoperative Glasgow Coma Scale (GCS) score was 9 (interquartile range - IQR 6–12). The mean final ICH volume was 26.5 ml (SD 27.5), with ICH volume reduction by an average of 66.7 %. Six months after the procedure, 40 patients (50 %) had favorable outcomes (modified Rankin Scale [mRS]) score 0–3). In multivariate analysis, age (odds ratio [OR] = 0.939, 95 % confidence interval (CI) = 0.894 – 0.986; p = 0.012), the GCS score before operation (OR = 1.525, 95 % CI = 1.008 – 2.309; p = 0.046), the initial midline shift (OR = 0.808, 95 % CI = 0.661 – 0.988; p = 0.038), and the residual volume hematoma (OR = 0.949, 95 % CI = 0.908 – 0.992, p = 0.020) were the significant predictors of a favorable 180-day outcome. Receiver operating characteristic curve analysis confirmed that the best cut-off point for predicting the good functional 180-day outcome was a GCS score of 9 before the procedure [area under the curve: 0.721, 95 % CI = 0.608 – 0.833, p = 0.001].

Conclusion

CT-guided thrombolysis and aspiration can be safe and effective in reducing ICH volume. A preoperation GCS score above or equal to 9 and younger age were associated with improved long-term outcomes in patients with supratentorial ICH.

背景和目的微创手术治疗 ICH 已显示可显著改善部分 ICH 患者的功能预后。本研究旨在评估立体定向计算机断层扫描(CT)引导下重组组织纤溶酶原激活剂(rt-PA)治疗脑室上ICH患者预后的影响因素。方法我们回顾性评估了2017年12月至2020年7月期间80例连续脑室上ICH患者的数据,分析了他们的180天预后,并确定了180天内预后良好的临床、放射学因素。术前格拉斯哥昏迷量表(GCS)评分中位数为9(四分位距-IQR 6-12)。最终的 ICH 容量平均为 26.5 毫升(标清 27.5),ICH 容量平均减少了 66.7%。术后 6 个月,40 名患者(50%)的治疗效果良好(改良兰金量表 [mRS] 评分 0-3 分)。在多变量分析中,年龄(几率比 [OR] = 0.939,95 % 置信区间 (CI) = 0.894 - 0.986;P = 0.012)、术前 GCS 评分(OR = 1.525,95 % CI = 1.008 - 2.309;P = 0.046)、初始中线移位(OR = 0.808,95 % CI = 0.661 - 0.988;P = 0.038)和残余容积血肿(OR = 0.949,95 % CI = 0.908 - 0.992,P = 0.020)是预测 180 天良好预后的重要指标。接受者操作特征曲线分析证实,预测 180 天良好功能性结局的最佳临界点是术前 GCS 评分为 9 分[曲线下面积:0.721,95 % CI = 0.608 - 0.833,p = 0.001]。手术前 GCS 评分高于或等于 9 分和年龄较小与改善脑室上 ICH 患者的长期预后有关。
{"title":"Prediction of functional outcome in supratentorial intracerebral hemorrhage patients treated with stereotactic computed tomographic-guided aspiration and recombinant tissue plasminogen activator (rt-PA)","authors":"Lan H. Dang ,&nbsp;Khanh N. Thach ,&nbsp;Yen T. Nguyen ,&nbsp;Tuyen V. Nguyen ,&nbsp;Ha H. Dinh ,&nbsp;Loan T. Nguyen ,&nbsp;Cuc T. Nguyen","doi":"10.1016/j.inat.2024.101979","DOIUrl":"https://doi.org/10.1016/j.inat.2024.101979","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Minimally invasive surgery for ICH has shown a significantly improved functional outcome for selected ICH patients. This study aimed to evaluate the factors influencing the outcome of supratentorial ICH patients treated with stereotactic computed tomographic (CT) guided recombinant tissue plasminogen activator (rt-PA).</p></div><div><h3>Methods</h3><p>We retrospectively evaluated data from 80 consecutive supratentorial ICH patients between December 2017 and July 2020, analyzing their 180-day outcomes, and identifying clinical, radiological factors for good prognosis within 180 days.</p></div><div><h3>Results</h3><p>The mean age was 55.6 years (SD 11.4). The median preoperative Glasgow Coma Scale (GCS) score was 9 (interquartile range - IQR 6–12). The mean final ICH volume was 26.5 ml (SD 27.5), with ICH volume reduction by an average of 66.7 %. Six months after the procedure, 40 patients (50 %) had favorable outcomes (modified Rankin Scale [mRS]) score 0–3). In multivariate analysis, age (odds ratio [OR] = 0.939, 95 % confidence interval (CI) = 0.894 – 0.986; p = 0.012), the GCS score before operation (OR = 1.525, 95 % CI = 1.008 – 2.309; p = 0.046), the initial midline shift (OR = 0.808, 95 % CI = 0.661 – 0.988; p = 0.038), and the residual volume hematoma (OR = 0.949, 95 % CI = 0.908 – 0.992, p = 0.020) were the significant predictors of a favorable 180-day outcome. Receiver operating characteristic curve analysis confirmed that the best cut-off point for predicting the good functional 180-day outcome was a GCS score of 9 before the procedure [area under the curve: 0.721, 95 % CI = 0.608 – 0.833, p = 0.001].</p></div><div><h3>Conclusion</h3><p>CT-guided thrombolysis and aspiration can be safe and effective in reducing ICH volume. A preoperation GCS score above or equal to 9 and younger age were associated with improved long-term outcomes in patients with supratentorial ICH.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"37 ","pages":"Article 101979"},"PeriodicalIF":0.4,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000252/pdfft?md5=1c59750270f8908d5d55970df62a7ce0&pid=1-s2.0-S2214751924000252-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140180165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Incidence of post-operative diabetes insipidus and associated factors after pituitary surgery in two teaching hospitals, in Addis Ababa, Ethiopia: A prospective observational study 埃塞俄比亚亚的斯亚贝巴两家教学医院垂体手术后糖尿病的发病率及相关因素:前瞻性观察研究
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-03-18 DOI: 10.1016/j.inat.2024.101978
Abera Chanie , Abat Sahlu
{"title":"Incidence of post-operative diabetes insipidus and associated factors after pituitary surgery in two teaching hospitals, in Addis Ababa, Ethiopia: A prospective observational study","authors":"Abera Chanie ,&nbsp;Abat Sahlu","doi":"10.1016/j.inat.2024.101978","DOIUrl":"https://doi.org/10.1016/j.inat.2024.101978","url":null,"abstract":"","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"37 ","pages":"Article 101978"},"PeriodicalIF":0.4,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000240/pdfft?md5=b8cae076d3fc1cc2daad845e996f70cf&pid=1-s2.0-S2214751924000240-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140191768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tremor Rebound Due to a Deep Brain Stimulation Electrode Fracture with Normal Impedance Treated by Rescue Thalamotomy in a Patient with Essential Tremor: A Case Report 通过对一名重度震颤患者实施丘脑切除术进行补救治疗,脑深部刺激电极断裂导致震颤反弹且阻抗正常:病例报告
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-02-27 DOI: 10.1016/j.inat.2024.101975
Takeshi Hashikawa , Galih Indra Permana , Takashi Morishita , Takayuki Koga , Hideaki Tanaka , Hiromasa Kobayashi , Hiroshi Abe

Background

Deep brain stimulation (DBS) has been shown to be an effective treatment for essential tremor and other movement disorders. However, hardware-related complications have limited its efficacy. Lead fracture in DBS typically occurs in the cervical area in high-risk patients. Surgical revision is needed to relieve worsened tremor symptoms in these cases.

Case Report

An 89-year-old woman with a history of bilateral DBS to the ventralis intermedius nucleus for essential tremor presented with worsened tremor in the right upper limb. Examination revealed normal impedance. Increased stimulation did not improve her tremor symptoms. Radiographic examination revealed lead fracture. Given the patient’s high surgical risk we performed thalamotomy followed by extraction of the electrode lead from the left ventralis intermedius nucleus.

Conclusion

Lead fracture is a hardware-related complication of DBS and should be suspected if a patient complains of sudden-onset rebound tremor, even when electrical impedance values are within the normal range. Imaging studies should be performed, and thalamotomy may be an option for patients in whom the risks of general anaesthesia preclude surgery.

背景深部脑刺激(DBS)已被证明是治疗本质性震颤和其他运动障碍的有效方法。然而,与硬件相关的并发症限制了其疗效。DBS 中的导线断裂通常发生在高危患者的颈椎部位。病例报告:一位 89 岁的女性患者曾接受过腹侧中间核双侧 DBS 治疗,后出现右上肢震颤加重。检查显示阻抗正常。增加刺激并未改善她的震颤症状。放射检查发现导线断裂。鉴于患者的手术风险较高,我们对其进行了丘脑切开术,然后从左侧腹中核取出电极导线。结论:导线断裂是 DBS 硬件相关的并发症,如果患者主诉突然出现反跳性震颤,即使电阻抗值在正常范围内,也应怀疑该病。应进行影像学检查,对于因全身麻醉风险而无法手术的患者,可选择丘脑切开术。
{"title":"Tremor Rebound Due to a Deep Brain Stimulation Electrode Fracture with Normal Impedance Treated by Rescue Thalamotomy in a Patient with Essential Tremor: A Case Report","authors":"Takeshi Hashikawa ,&nbsp;Galih Indra Permana ,&nbsp;Takashi Morishita ,&nbsp;Takayuki Koga ,&nbsp;Hideaki Tanaka ,&nbsp;Hiromasa Kobayashi ,&nbsp;Hiroshi Abe","doi":"10.1016/j.inat.2024.101975","DOIUrl":"https://doi.org/10.1016/j.inat.2024.101975","url":null,"abstract":"<div><h3>Background</h3><p>Deep brain stimulation (DBS) has been shown to be an effective treatment for essential tremor and other movement disorders. However, hardware-related complications have limited its efficacy. Lead fracture in DBS typically occurs in the cervical area in high-risk patients. Surgical revision is needed to relieve worsened tremor symptoms in these cases.</p></div><div><h3>Case Report</h3><p>An 89-year-old woman with a history of bilateral DBS to the ventralis intermedius nucleus for essential tremor presented with worsened tremor in the right upper limb. Examination revealed normal impedance. Increased stimulation did not improve her tremor symptoms. Radiographic examination revealed lead fracture. Given the patient’s high surgical risk we performed thalamotomy followed by extraction of the electrode lead from the left ventralis intermedius nucleus.</p></div><div><h3>Conclusion</h3><p>Lead fracture is a hardware-related complication of DBS and should be suspected if a patient complains of sudden-onset rebound tremor, even when electrical impedance values are within the normal range. Imaging studies should be performed, and thalamotomy may be an option for patients in whom the risks of general anaesthesia preclude surgery.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"36 ","pages":"Article 101975"},"PeriodicalIF":0.4,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000215/pdfft?md5=549c4d0035fba3952652d7dbfdff4c04&pid=1-s2.0-S2214751924000215-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139999108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Short and long-term outcomes of decompressive craniectomy among patients with non-traumatic acute intracranial hypertension; A 5-year retrospective analysis of a referral center 非外伤性急性颅内高压患者颅骨减压术的短期和长期疗效;一家转诊中心的五年回顾性分析
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-02-24 DOI: 10.1016/j.inat.2024.101976
Reyhaneh Zarei , Mojtaba Dayyani , Saba Ahmadvand , Saba Pourali , Maryam Emadzadeh , Maliheh Sadeghnezhad , Humain Baharvahdat , Samira Zabihyan

Background

Decompressive craniectomy (DC) is performed for the management of the patients with acutely elevated intracranial pressure (ICP). Considering the paucity of the evidence regarding the outcome predictors in patients with non-traumatic raised ICP, we aimed to assess short- and long-term outcome related factors in DC subjects.

Methods

In this cross-sectional study, health records of the patients who underwent DC for non-traumatic etiologies over the five years were interrogated and demographic data, clinical features, operative findings, and follow-up notes were collected. The primary short- and long-term outcomes were in-hospital mortality and functional status, respectively. Functional status was evaluated using Glasgow Outcome Scale (GOS) at 6-month follow-up.

Results

Of the 223 eligible patients, 113 (50.7 %) were male and the mean age was 48.68 ± 13.97 years. In-hospital mortality rate was 48.4 % (n = 108). Of the survivors, 28 (30.4 %) had favorable outcomes (GOS 4–5). The most common post-operative complications were infection with respiratory source (n = 52, 23 %) and external cerebral herniation (n = 61, 27.4 %). Presence of diabetes mellitus (DM) (OR = 6.09; 95 % CI = 2.0–18.51; P = 0.001), subarachnoid hemorrhage (SAH) (OR = 5.61; 95 % CI = 1.47––21.3; P = 0.01), and prolonged duration of ICU-stay (OR = 1.37; 95 % CI: 1.03, 1.24; P = 0.006) were associated with in-hospital mortality. Also, preexisting DM was two times more prevalent among the subjects deceased in the hospital than those who survived.

Conclusions

Concomitant SAH, DM, and prolonged ICU stay were associated with increased in-hospital mortality. In addition, preexisting DM may increase mortality rates, likely irrespective of age factor.

背景压缩性颅骨切除术(DC)用于治疗急性颅内压(ICP)升高的患者。考虑到有关非创伤性 ICP 升高患者预后预测因素的证据不足,我们旨在评估 DC 受试者的短期和长期预后相关因素。方法在这项横断面研究中,我们询问了五年来因非创伤性病因接受 DC 的患者的健康记录,并收集了人口统计学数据、临床特征、手术结果和随访记录。短期和长期的主要结果分别是院内死亡率和功能状态。结果 在 223 名符合条件的患者中,113 名(50.7%)为男性,平均年龄为 48.68±13.97 岁。院内死亡率为 48.4%(108 人)。幸存者中有 28 人(30.4%)的预后良好(GOS 4-5)。最常见的术后并发症是呼吸道感染(52人,23%)和脑外疝(61人,27.4%)。糖尿病(DM)(OR = 6.09;95 % CI = 2.0-18.51;P = 0.001)、蛛网膜下腔出血(SAH)(OR = 5.61;95 % CI = 1.47--21.3;P = 0.01)和ICU住院时间延长(OR = 1.37;95 % CI:1.03-1.24;P = 0.006)与院内死亡率相关。结论合并 SAH、DM 和 ICU 住院时间延长与院内死亡率增加有关。此外,原有的 DM 可能会增加死亡率,这可能与年龄因素无关。
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引用次数: 0
Steroid-responsive acute post-traumatic headache with neuroinflammation 类固醇反应性急性创伤后头痛伴神经炎症
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-02-23 DOI: 10.1016/j.inat.2024.101974
Shigeta Miyake , Makoto Ohtake , Taisuke Akimoto , Masato Tsuchimochi , Yuta Otomo , Kotaro Oshio

Post-traumatic headache is a common secondary headache disorder caused by head or neck trauma. However, the etiology and management have not been established. Here, we present a unique case of steroid-responsive acute post-traumatic headache with neuroinflammation following a mild head injury.

A 19-year-old female soccer player experienced persistent headache, vomiting, and low-grade fever after sustaining a mild sports-related head injury. Subsequent cerebrospinal fluid (CSF) examination and contrast-enhanced magnetic resonance imaging (MRI) revealed leptomeningeal contrast enhancement, elevated intracranial pressure, and an increased CSF cell count. Notably, the patient tested negative for viral, fungal, tumor, and autoimmune markers, thus a diagnosis of acute post-traumatic headache with neuroinflammation was determined. Treatment with dexamethasone (8 mg/day) resulted in rapid symptom relief, enabling the patient to return to sports without symptom recurrence.

This case highlights the importance of considering post-traumatic headache with neuroinflammation in patients with atypical post-head injury symptoms. Although her condition shared clinical similarities with concussions, the presence of fever accompanied with specific MRI and CSF findings offered critical diagnostic differentiators. Additionally, our report highlights the potential underdiagnosis of steroid-responsive neuroinflammation following head injury and the necessity for active differential diagnosis.

创伤后头痛是一种常见的继发性头痛疾病,由头部或颈部创伤引起。然而,其病因和治疗方法尚未确定。这里,我们将介绍一例独特的轻微头部损伤后类固醇反应性急性创伤后头痛伴神经炎症的病例。一名 19 岁的女足球运动员在一次轻微的运动相关头部损伤后出现持续性头痛、呕吐和低烧。随后进行的脑脊液(CSF)检查和造影剂增强磁共振成像(MRI)显示,患者出现了脑膜造影剂强化、颅内压升高和脑脊液细胞计数增加。值得注意的是,患者的病毒、真菌、肿瘤和自身免疫标记物检测结果均为阴性,因此诊断为急性创伤后头痛伴神经炎症。使用地塞米松(8 毫克/天)治疗后,症状迅速缓解,患者得以重返运动场,症状没有复发。虽然她的病情与脑震荡的临床表现相似,但发热以及特殊的磁共振成像和脑脊液检查结果提供了重要的诊断鉴别依据。此外,我们的报告还强调了颅脑损伤后类固醇反应性神经炎的潜在诊断不足以及积极鉴别诊断的必要性。
{"title":"Steroid-responsive acute post-traumatic headache with neuroinflammation","authors":"Shigeta Miyake ,&nbsp;Makoto Ohtake ,&nbsp;Taisuke Akimoto ,&nbsp;Masato Tsuchimochi ,&nbsp;Yuta Otomo ,&nbsp;Kotaro Oshio","doi":"10.1016/j.inat.2024.101974","DOIUrl":"https://doi.org/10.1016/j.inat.2024.101974","url":null,"abstract":"<div><p>Post-traumatic headache is a common secondary headache disorder caused by head or neck trauma. However, the etiology and management have not been established. Here, we present a unique case of steroid-responsive acute post-traumatic headache with neuroinflammation following a mild head injury.</p><p>A 19-year-old female soccer player experienced persistent headache, vomiting, and low-grade fever after sustaining a mild sports-related head injury. Subsequent cerebrospinal fluid (CSF) examination and contrast-enhanced magnetic resonance imaging (MRI) revealed leptomeningeal contrast enhancement, elevated intracranial pressure, and an increased CSF cell count. Notably, the patient tested negative for viral, fungal, tumor, and autoimmune markers, thus a diagnosis of acute post-traumatic headache with neuroinflammation was determined. Treatment with dexamethasone (8 mg/day) resulted in rapid symptom relief, enabling the patient to return to sports without symptom recurrence.</p><p>This case highlights the importance of considering post-traumatic headache with neuroinflammation in patients with atypical post-head injury symptoms. Although her condition shared clinical similarities with concussions, the presence of fever accompanied with specific MRI and CSF findings offered critical diagnostic differentiators. Additionally, our report highlights the potential underdiagnosis of steroid-responsive neuroinflammation following head injury and the necessity for active differential diagnosis.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"36 ","pages":"Article 101974"},"PeriodicalIF":0.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000203/pdfft?md5=304c7ab68c50ac02646d81c335841a96&pid=1-s2.0-S2214751924000203-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139942613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
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