Acta neurologica Belgica最新文献

Background and objective: Intramedullary mature teratomas in adults are rare tumors that pose significant diagnostic and therapeutic challenges due to their diverse tissue composition and intramedullary location. This review, which includes an illustrative case, aims to provide a comprehensive overview of the clinical presentation, diagnosis, treatment, and outcomes of adult intramedullary mature teratomas through a systematic review of 89 cases.

Methods: A systematic review was conducted following PRISMA guidelines, using keyword combinations in PubMed, MEDLINE, and Web of Science databases until June 2024. Inclusion criteria were adult patients (> 18 years) with histopathologically confirmed intramedullary mature teratomas. Statistical analyses examined relationships between the extent of resection (EoR), tumor location, and patient outcomes.

Results: Among the 89 cases, the mean age was 39.94 ± 13.52 years, with a male-to-female ratio of 1.39:1. Tumors were most commonly located in the conus region (51.2%). Surgical resection was the primary treatment, with 43 cases undergoing partial resection and 33 gross total resection. No statistically significant differences in outcomes were found between EoR, sex, associated anomalies, or specific outcomes. However, younger patients showed improved outcomes for lower limb weakness and sphincter dysfunction. Recurrence was noted in three cases, all located in the conus.

Conclusion: Intramedullary mature teratomas require a nuanced approach that balances complete resection and neurological preservation. Early diagnosis and individualized surgical planning are crucial for optimizing outcomes. Despite the challenges, effective management is achievable, and ongoing research is essential to refining treatment strategies for this rare tumor.

Purpose: Contrast enhancement (CE) after mechanical thrombectomy (MT) remains a subject of investigation, with a reported prevalence ranging from 31 to 88%. We examined our patients to identify predictors of CE and its impact on outcomes, an aspect that remains understudied.

Methods: We retrospectively analyzed 106 patients who underwent MT at our hospital between 2018 and 2022. The inclusion criteria involved patients who underwent two head CT scans: one immediately after the procedure and a repeat scan within 24 h. This study compared demographic, clinical, laboratory, neuroimaging, and procedure-related variables between patients with CE and those without hyperdensity. Regression analysis was employed to determine the associations between CEs and significant variables.

Results: Among the analyzed patients, 32.1% had CE. Hyperlipidemia was more prevalent in the CE group. CE correlated with an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 within 24 h, intracerebral hemorrhage (ICH) incidence, elevated NIHSS score, and a decreased rate of modified Rankin scale (mRS) 0-3 upon discharge. The adjusted model demonstrated a significant association between CE and the incidence of hyperlipidemia and ICH, with an increase in NIHSS score ≥ 4 within 24 h of ICH and a lower mRS score of 0-3 upon discharge.

Conclusions: CE is associated with hyperlipidemia, ICH, early neurological deterioration, and poor functional outcomes upon discharge. However, no similar association was shown for long-term outcomes. Further studies are required to clarify the pathophysiology of CE and its implications for optimizing stroke care.

Background: Primary Hemifacial Spasm (pHFS) is a disorder caused by compression of vessels on the root of the facial nerve. There has been conflicting evidence regarding the side of the face that is more frequently affected. Moreover, it has been found in several studies that women are afflicted by approximately twice as many as men.

Objectives: We reviewed the literature to explain HFS tendencies from an anatomical aspect. We wanted to see whether there are anatomical variations that can increase the risk of developing HFS or underlie its tendency to a specific gender and side of the face.

Methods and material: A PubMed search was done for the articles on "Hemifacial Spasm" published in English literature, and we selected the articles regarding the significant anatomical differences in HFS patients.

Results: AICA proximal branching pattern, highly originated PICA, VA dominancy, and VA deviation are among the predisposing anatomical variances. Overall, both sides of the face are equally affected in HFS. However, there are side preferences based on the causative vessels, which may be due to differences in the anatomical features of the left and right side vessels.

Conclusions: Various anatomical variations regarding posterior circulation can increase the risk of HFS. Recent evidence suggests whether there is no side dominance or a tendency exists toward the left side. There is no comprehensive explanation for precise reasons underlying the tendency of HFS to affect women. Evidence regarding anatomical variations of the posterior circulation comparing men and women with HFS is scarce, and further studies are required.

Hypermagnesemia is a rare but potentially fatal electrolyte disorder. High serum magnesium levels have been associated with the development of neurological manifestations such as dysautonomia, muscle weakness, respiratory failure, and altered level of consciousness from drowsiness to coma. Although rare, some subjects, such as those with chronic renal failure and those taking magnesium supplements or medications, are at risk of developing this condition. Recognizing this electrolyte alteration promptly allows for an immediate initiation of a therapeutic strategy that is often resolutive when addressed in time. This paper aims to review the neurological complications associated with hypermagnesemia, their pathophysiology, and management.