Pub Date : 2021-01-01DOI: 10.11648/j.cnn.20210504.18
Shweta Pandey, R. Chakraborty
: Cerebrospinal fluid (CSF) rhinorrhoea is the leakage of CSF from the subarachnoid space into the nasal cavity. A cerebrospinal fluid leak from intracranial cavity to nasal respiratory tract has the potential to produce fulminant meningitis because of the risk of an ascending infection. Recurrent spontaneous CSF rhinorrhoea is definitely a life-threatening entity that can be preventable with timely intervention. This case report describes the clinical course of a 51 year old obese female with recurrent episodes of spontaneous CSF rhinorrhoea presenting with high grade fever, vomiting, headache and new-onset seizure. She was evaluated for meningoencephalitis and CSF culture revealed growth of Staphylococcus arlettae. Patient improved with ceftriaxone, vancomycin and levetiracetam and was advised for early surgical repair. A longer duration of nasal discharge of CSF has greater risk of morbidity/mortality due to ascending CNS infection. The episodes of spontaneous CNS rhinorrhoea can pass by unnoticed and can also be missed for rhinosinusitis. A high suspicion of diagnosis can lead to early detection of this condition and better outcome. Treatment decisions should be dictated by the severity of neurological decline during the emergency period and the presence/absence of associated intracranial lesions. The emphasis for timely surgical repair should be advocated for better outcome.
{"title":"A Case of Recurrent Spontaneous CSF Rhinorrhoea with Meningoencephalitis","authors":"Shweta Pandey, R. Chakraborty","doi":"10.11648/j.cnn.20210504.18","DOIUrl":"https://doi.org/10.11648/j.cnn.20210504.18","url":null,"abstract":": Cerebrospinal fluid (CSF) rhinorrhoea is the leakage of CSF from the subarachnoid space into the nasal cavity. A cerebrospinal fluid leak from intracranial cavity to nasal respiratory tract has the potential to produce fulminant meningitis because of the risk of an ascending infection. Recurrent spontaneous CSF rhinorrhoea is definitely a life-threatening entity that can be preventable with timely intervention. This case report describes the clinical course of a 51 year old obese female with recurrent episodes of spontaneous CSF rhinorrhoea presenting with high grade fever, vomiting, headache and new-onset seizure. She was evaluated for meningoencephalitis and CSF culture revealed growth of Staphylococcus arlettae. Patient improved with ceftriaxone, vancomycin and levetiracetam and was advised for early surgical repair. A longer duration of nasal discharge of CSF has greater risk of morbidity/mortality due to ascending CNS infection. The episodes of spontaneous CNS rhinorrhoea can pass by unnoticed and can also be missed for rhinosinusitis. A high suspicion of diagnosis can lead to early detection of this condition and better outcome. Treatment decisions should be dictated by the severity of neurological decline during the emergency period and the presence/absence of associated intracranial lesions. The emphasis for timely surgical repair should be advocated for better outcome.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89867821","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}
Pub Date : 2021-01-01DOI: 10.11648/j.cnn.20210504.17
Djingri Labodi Lompo, Nagaonlé Éric Some, Pegde-bamba Carine Dakouré, Adja Mariam Ouédraogo, O. Diallo, C. Napon, J. Kaboré, A. Millogo
Introduction: In sub-Saharan Africa, cerebrovascular aetiologies of status epilepticus (SE) are on the rise alongside infectious brain lesions. The aim of our study was to describe the etiologic spectrum of SE in Ouagadougou, Burkina Faso, in a high risk SE setting. Patients and methods: This is a prospective, cross-sectional, descriptive, multicenter and hospital study of patients hospitalized consecutively in the university hospitals of the city of Ouagadougou, in Burkina Faso, from 01/01/2015 to 12/31/2019, for SE. The sociodemographic, clinical, paraclinical (biological, critical and / or intercritical EEG, neuroradiological) characteristics and the aetiological data of the patients were analyzed using the Epi-info 7.2.1.0 software: calculations of numbers, frequencies, averages. The significance rate was set at 0.05. Results: 91 patients hospitalized for SE were collected, with a male predominance (73.62%). The mean age was 36.6 years +/24.5 years (2 days and 86 years); 25 patients (27.5%) already had known epilepsy. Generalized tonic-clonic SE from the start and focal SE with convulsive bilateralization were the most common seizure types with 46 cases (50.5%) and 27 cases (29.7%), respectively. The average duration of an EME episode was 18 hours +/31 (5 minutes 6 days). On admission, a focused motor deficit with 36 cases (46.7%) and fever in 28 patients (30.8%) were the main clinical signs; hyperleukocytosis with 23 cases (25.3) and anemia with 22 cases (24.2%), were the main laboratory abnormalities. On cerebral CT scan, sequelae with 33 cases (51.6%), acute stroke with 14 cases (21.9%) and acute meningoencephalitis with 8 cases (12.5%), were the most frequent. SEs symptomatic of acute brain disease, with 61 cases (67%), were dominated by infectious etiologies with 30 cases (33%) and acute strokes with 16 cases (17.6%). Among the non-acute or sequelae SEs of etiology, the sequelae of traumatic brain injury with 10 cases (11%) and the sequelae of stroke with 8 cases (8.8%) were the most represented. Conclusion: The aetiologies of SE are dominated in the Ouagadougou CHUs by CNS infections, acute or sequelae strokes and cranio-encephalic trauma. The fight against infectious diseases and the prevention of vascular risk factors will help reduce the frequency and severity of EMEs.
{"title":"Etiological Spectrum of Status Epilepticus in Ouagadougou, Burkina Faso: A Prospective Cross-sectional Multicenter Hospital Study","authors":"Djingri Labodi Lompo, Nagaonlé Éric Some, Pegde-bamba Carine Dakouré, Adja Mariam Ouédraogo, O. Diallo, C. Napon, J. Kaboré, A. Millogo","doi":"10.11648/j.cnn.20210504.17","DOIUrl":"https://doi.org/10.11648/j.cnn.20210504.17","url":null,"abstract":"Introduction: In sub-Saharan Africa, cerebrovascular aetiologies of status epilepticus (SE) are on the rise alongside infectious brain lesions. The aim of our study was to describe the etiologic spectrum of SE in Ouagadougou, Burkina Faso, in a high risk SE setting. Patients and methods: This is a prospective, cross-sectional, descriptive, multicenter and hospital study of patients hospitalized consecutively in the university hospitals of the city of Ouagadougou, in Burkina Faso, from 01/01/2015 to 12/31/2019, for SE. The sociodemographic, clinical, paraclinical (biological, critical and / or intercritical EEG, neuroradiological) characteristics and the aetiological data of the patients were analyzed using the Epi-info 7.2.1.0 software: calculations of numbers, frequencies, averages. The significance rate was set at 0.05. Results: 91 patients hospitalized for SE were collected, with a male predominance (73.62%). The mean age was 36.6 years +/24.5 years (2 days and 86 years); 25 patients (27.5%) already had known epilepsy. Generalized tonic-clonic SE from the start and focal SE with convulsive bilateralization were the most common seizure types with 46 cases (50.5%) and 27 cases (29.7%), respectively. The average duration of an EME episode was 18 hours +/31 (5 minutes 6 days). On admission, a focused motor deficit with 36 cases (46.7%) and fever in 28 patients (30.8%) were the main clinical signs; hyperleukocytosis with 23 cases (25.3) and anemia with 22 cases (24.2%), were the main laboratory abnormalities. On cerebral CT scan, sequelae with 33 cases (51.6%), acute stroke with 14 cases (21.9%) and acute meningoencephalitis with 8 cases (12.5%), were the most frequent. SEs symptomatic of acute brain disease, with 61 cases (67%), were dominated by infectious etiologies with 30 cases (33%) and acute strokes with 16 cases (17.6%). Among the non-acute or sequelae SEs of etiology, the sequelae of traumatic brain injury with 10 cases (11%) and the sequelae of stroke with 8 cases (8.8%) were the most represented. Conclusion: The aetiologies of SE are dominated in the Ouagadougou CHUs by CNS infections, acute or sequelae strokes and cranio-encephalic trauma. The fight against infectious diseases and the prevention of vascular risk factors will help reduce the frequency and severity of EMEs.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73794945","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}
Pub Date : 2020-12-16DOI: 10.11648/J.CNN.20200404.15
Johanes Ari Cahyo Prabowo, I. Suwarba, Dewi Sutriani Mahalini
One million people live with epilepsy in Indonesia. The using of antiepileptic drug for the long time can affect the nutritional and growth profile among children with epilepsy. The purpose of this study is to determine the characteristics of nutritional profile among children with epilepsy at Sanglah Hospital Denpasar. This study is an observational retrospective study using a descriptive design that examined the nutritional profile among hospitalized children with epilepsy at the pediatric neurology ward at Sanglah Hospital, Denpasar. This study was done retrospectively based on secondary data since January 1, 2017 until December 31, 2019, with 95 samples population were collected. The mean age of sample population was 5,4 years (SD±4.3) with majority samples were male 60 children (63.1%) and female were 35 children (36,9%). The majority of samples had general epilepsy 59 children (62.1%), followed by focal epilepsy 23 children (24.2%) and general combined focal epilepsy 13 children (13.7%). In this study, the most common etiology of epilepsy were idiopathic 53 children (55.8%), followed by structural 30 children (31.6%), infection 8 children (8.4%), immunology and metabolic 4 children (4.2%). The most of sample population had normal nutritional status based on waterlow method (weight for height) was 55,4% and height for age was 74,7%. However, there were increasing number of overweight/obesity was 14 children (14,7%) with history of prolonged anti epileptic drug more than 12 month that using phenobarbital, phenytoin, and valproic acid for medication. The short stature was noted among 24 children (25,3%) of samples, with history of phenobarbital, phenytoin and carbamazepine medication. Sample population with moderate of protein energy malnutrition was 8 children (8.4%) with dysfunction of oromotor. We conclude that almost children with epilepsy at Sanglah hospital had normal nutritional status and height stature. However regular follow up of antropometric status and diagnostic serum calcium, and folic acid should be done for early detection of overweight and obesity along with short stature.
{"title":"The Nutritional Profile Among Children with Epilepsy at Sanglah Hospital","authors":"Johanes Ari Cahyo Prabowo, I. Suwarba, Dewi Sutriani Mahalini","doi":"10.11648/J.CNN.20200404.15","DOIUrl":"https://doi.org/10.11648/J.CNN.20200404.15","url":null,"abstract":"One million people live with epilepsy in Indonesia. The using of antiepileptic drug for the long time can affect the nutritional and growth profile among children with epilepsy. The purpose of this study is to determine the characteristics of nutritional profile among children with epilepsy at Sanglah Hospital Denpasar. This study is an observational retrospective study using a descriptive design that examined the nutritional profile among hospitalized children with epilepsy at the pediatric neurology ward at Sanglah Hospital, Denpasar. This study was done retrospectively based on secondary data since January 1, 2017 until December 31, 2019, with 95 samples population were collected. The mean age of sample population was 5,4 years (SD±4.3) with majority samples were male 60 children (63.1%) and female were 35 children (36,9%). The majority of samples had general epilepsy 59 children (62.1%), followed by focal epilepsy 23 children (24.2%) and general combined focal epilepsy 13 children (13.7%). In this study, the most common etiology of epilepsy were idiopathic 53 children (55.8%), followed by structural 30 children (31.6%), infection 8 children (8.4%), immunology and metabolic 4 children (4.2%). The most of sample population had normal nutritional status based on waterlow method (weight for height) was 55,4% and height for age was 74,7%. However, there were increasing number of overweight/obesity was 14 children (14,7%) with history of prolonged anti epileptic drug more than 12 month that using phenobarbital, phenytoin, and valproic acid for medication. The short stature was noted among 24 children (25,3%) of samples, with history of phenobarbital, phenytoin and carbamazepine medication. Sample population with moderate of protein energy malnutrition was 8 children (8.4%) with dysfunction of oromotor. We conclude that almost children with epilepsy at Sanglah hospital had normal nutritional status and height stature. However regular follow up of antropometric status and diagnostic serum calcium, and folic acid should be done for early detection of overweight and obesity along with short stature.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87645304","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}
Pub Date : 2020-11-18DOI: 10.52588/clinical-neurology-neuroscience.1.10
A. Catharino, M. A. O. Neves, N. Nunes, Jacqueline Stephanie Fernandes do Nascimento, Janie Kelly Fernandes do Nascimento, R. R. Castro, Marco Antônio Alves Azizi, A. R. Airão, R. Alvarenga
{"title":"COVID-19 Related Optic Neuritis: Case Report","authors":"A. Catharino, M. A. O. Neves, N. Nunes, Jacqueline Stephanie Fernandes do Nascimento, Janie Kelly Fernandes do Nascimento, R. R. Castro, Marco Antônio Alves Azizi, A. R. Airão, R. Alvarenga","doi":"10.52588/clinical-neurology-neuroscience.1.10","DOIUrl":"https://doi.org/10.52588/clinical-neurology-neuroscience.1.10","url":null,"abstract":"","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81262315","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}
Pub Date : 2020-11-05DOI: 10.11648/J.CNN.20200404.12
Putu Tarita Susanti, I. Suwarba, Dewi Sutriani Mahalini
Epilepsy is a manifestation of impaired brain function with various etiologies in the form of recurrent paroxysmal seizure symptoms. Epilepsy occurs mostly in children. Electroencephalography (EEG) is performed to observe epileptogenic foci, certain epilepsy syndromes, evaluate treatment, and determine prognosis. The purpose of this study is to determine the characteristics and features of EEG in pediatric patients with epilepsy at Sanglah General Hospital. This study is a retrospective descriptive observational study. The data was achieved from medical records of patients who had just been diagnosed with epilepsy at the Pediatric Clinic of Sanglah General Hospital during the periode of January 2017 to December 2019. There was a total of 204 new epilepsy cases, with the prevalence of 6.4 per 1000 population. The data consists of the men vs female (57.4% vs 42,6%) and the majority of patients age range between 1-5 years old (49%). The data consists of generalized epilepsy with motor tonic clonic onset (75.5%) and focal epilepsy with motor tonic onset (20.6%). EEG examination was abnormal in 55.4% of the cases and abnormalities was found in head CT scans (42.7%). The etiology of pediatrics with epilepsy which was unknown (52.5%). More than half of anti-epileptic drug therapy used a monotherapy of valproic acid (54.4%), and polytherapy therapy of valproic acid and carbamazepine (17.6%). Most of the children had good nutritional status (76%). The data showed that a history of neonatal seizures in was found in 17 cases (8.3%), while a family history of epilepsy was found ini 34 cases (16.7%). Conclution that pediatric epileptic patients present with a generalized type of epilepsy onset tonic-clonic motor with an unknown etiology. EEG images are mostly abnormal. On CT scans of the head, abnormalities were found in 42.7% of cases. Most of them received monotherapy with valproic acid.
癫痫是脑功能受损的一种表现，有多种病因，以反复发作性发作症状的形式出现。癫痫主要发生在儿童身上。脑电图(EEG)用于观察致痫灶、某些癫痫综合征、评估治疗和确定预后。本研究的目的是确定在Sanglah总医院癫痫患儿脑电图的特点和特征。本研究为回顾性描述性观察性研究。这些数据来自2017年1月至2019年12月期间Sanglah总医院儿科诊所刚刚被诊断患有癫痫的患者的医疗记录。共有204例新的癫痫病例，患病率为每1000人6.4例。数据包括男性vs女性(57.4% vs 42.6%)，大多数患者年龄在1-5岁之间(49%)。数据包括全身性癫痫伴运动强直性阵挛发作(75.5%)和局灶性癫痫伴运动强直性发作(20.6%)。脑电图异常占55.4%，头部CT异常占42.7%。病因不明的小儿癫痫(52.5%)。超过一半的抗癫痫药物治疗采用丙戊酸单药治疗(54.4%)，丙戊酸联合卡马西平多药治疗(17.6%)。大多数儿童营养状况良好(76%)。资料显示，有新生儿癫痫发作史17例(8.3%)，有癫痫家族史34例(16.7%)。结论:小儿癫痫患者表现为全身性癫痫发作，病因不明。脑电图多为异常。在头部CT扫描中，42.7%的病例发现异常。大多数患者接受丙戊酸单药治疗。
{"title":"Characteristics and Features of Electroencephalography (EEG) in Children with Epilepsy","authors":"Putu Tarita Susanti, I. Suwarba, Dewi Sutriani Mahalini","doi":"10.11648/J.CNN.20200404.12","DOIUrl":"https://doi.org/10.11648/J.CNN.20200404.12","url":null,"abstract":"Epilepsy is a manifestation of impaired brain function with various etiologies in the form of recurrent paroxysmal seizure symptoms. Epilepsy occurs mostly in children. Electroencephalography (EEG) is performed to observe epileptogenic foci, certain epilepsy syndromes, evaluate treatment, and determine prognosis. The purpose of this study is to determine the characteristics and features of EEG in pediatric patients with epilepsy at Sanglah General Hospital. This study is a retrospective descriptive observational study. The data was achieved from medical records of patients who had just been diagnosed with epilepsy at the Pediatric Clinic of Sanglah General Hospital during the periode of January 2017 to December 2019. There was a total of 204 new epilepsy cases, with the prevalence of 6.4 per 1000 population. The data consists of the men vs female (57.4% vs 42,6%) and the majority of patients age range between 1-5 years old (49%). The data consists of generalized epilepsy with motor tonic clonic onset (75.5%) and focal epilepsy with motor tonic onset (20.6%). EEG examination was abnormal in 55.4% of the cases and abnormalities was found in head CT scans (42.7%). The etiology of pediatrics with epilepsy which was unknown (52.5%). More than half of anti-epileptic drug therapy used a monotherapy of valproic acid (54.4%), and polytherapy therapy of valproic acid and carbamazepine (17.6%). Most of the children had good nutritional status (76%). The data showed that a history of neonatal seizures in was found in 17 cases (8.3%), while a family history of epilepsy was found ini 34 cases (16.7%). Conclution that pediatric epileptic patients present with a generalized type of epilepsy onset tonic-clonic motor with an unknown etiology. EEG images are mostly abnormal. On CT scans of the head, abnormalities were found in 42.7% of cases. Most of them received monotherapy with valproic acid.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82530052","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}
Pub Date : 2020-10-21DOI: 10.11648/J.CNN.20200404.11
M. Mamytov
Background: The cells of the immune system are actively involved in the tumor development process and can either suppress or stimulate tumor growth. Objective: to determine the role and significance of immunological indications of patients with brain tumors of different histostructure before and after surgical treatment. Methods: The number of lymphocytes, neutrophilic granulocytes, and platelets was analyzed in 246 patients with brain tumors of various histostructures. Results: It was determined that there were significant fluctuations in the content of leukocytes in the blood of patients with brain tumors of various histogenesis. The largest number of leukocytes was observed in neuroectodermal and mesenchymal tumors. However, neuroepithelial tumors (pituitary adenomas) did not show a considerable increase in the number of leukocytes compared with that in healthy individuals. Conclusions: It is revealed that the determination of the immune response is an essential component of clinical examination. These immune response options allow to develop targeted immunotherapy. The determination of immunoreactivity for these options was determined to be clinically feasible. In addition, belonging to a particular group based on the immune status considerably determines the further course of the tumor process and the effectiveness of the surgical treatment of brain tumors.
{"title":"Immunoreactivity of the Body During the Surgical Treatment of Brain Tumors","authors":"M. Mamytov","doi":"10.11648/J.CNN.20200404.11","DOIUrl":"https://doi.org/10.11648/J.CNN.20200404.11","url":null,"abstract":"Background: The cells of the immune system are actively involved in the tumor development process and can either suppress or stimulate tumor growth. Objective: to determine the role and significance of immunological indications of patients with brain tumors of different histostructure before and after surgical treatment. Methods: The number of lymphocytes, neutrophilic granulocytes, and platelets was analyzed in 246 patients with brain tumors of various histostructures. Results: It was determined that there were significant fluctuations in the content of leukocytes in the blood of patients with brain tumors of various histogenesis. The largest number of leukocytes was observed in neuroectodermal and mesenchymal tumors. However, neuroepithelial tumors (pituitary adenomas) did not show a considerable increase in the number of leukocytes compared with that in healthy individuals. Conclusions: It is revealed that the determination of the immune response is an essential component of clinical examination. These immune response options allow to develop targeted immunotherapy. The determination of immunoreactivity for these options was determined to be clinically feasible. In addition, belonging to a particular group based on the immune status considerably determines the further course of the tumor process and the effectiveness of the surgical treatment of brain tumors.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74439436","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}
Pub Date : 2019-10-11DOI: 10.11648/j.cnn.20190304.11
Mehrnoush Gorjian, S. Raymond, M. Koch, A. Patel
Background: Vertebral artery (VA) dissection causing acute stroke is commonly treated with anticoagulation and rarely requires stenting. While stenting for atherosclerotic stenosis of VA is an established and efficient treatment option, the safety of stenting for VA dissection has not been studied. Case information: We report the technical challenges associated with stenting of a proximal VA dissection in a 74 year-old male with NIHSSS > 20 outside of the time window for thrombolytic therapy presenting with acute basilar artery thrombus and a hypoplastic contralateral VA. Methods: A coronary Drug-Eluting Stent (DES) was implemented in right VA following balloon angioplasty and basilar artery thrombolysis to maintain the patency of the dissected area in proximal VA. Results: The procedure was completed without complication. Postoperative Digital Subtraction Angiography (DSA) confirmed the patency of the vertebrobasilar system. There was no evidence of significant residual stenosis in the right vertebral artery on the follow up Computed Tomography Angiography (CTA) 2 months after the stent placement. Conclusion: Endovascular stenting of proximal VA dissection in the setting of acute ischemic stroke is relatively safe and feasible. It could be particularly considered in patients ineligible for IV thrombolysis with a hypoplastic contralateral VA. Further studies are needed to evaluate the long-term safety and efficacy of stenting for VA dissection.
{"title":"Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke","authors":"Mehrnoush Gorjian, S. Raymond, M. Koch, A. Patel","doi":"10.11648/j.cnn.20190304.11","DOIUrl":"https://doi.org/10.11648/j.cnn.20190304.11","url":null,"abstract":"Background: Vertebral artery (VA) dissection causing acute stroke is commonly treated with anticoagulation and rarely requires stenting. While stenting for atherosclerotic stenosis of VA is an established and efficient treatment option, the safety of stenting for VA dissection has not been studied. Case information: We report the technical challenges associated with stenting of a proximal VA dissection in a 74 year-old male with NIHSSS > 20 outside of the time window for thrombolytic therapy presenting with acute basilar artery thrombus and a hypoplastic contralateral VA. Methods: A coronary Drug-Eluting Stent (DES) was implemented in right VA following balloon angioplasty and basilar artery thrombolysis to maintain the patency of the dissected area in proximal VA. Results: The procedure was completed without complication. Postoperative Digital Subtraction Angiography (DSA) confirmed the patency of the vertebrobasilar system. There was no evidence of significant residual stenosis in the right vertebral artery on the follow up Computed Tomography Angiography (CTA) 2 months after the stent placement. Conclusion: Endovascular stenting of proximal VA dissection in the setting of acute ischemic stroke is relatively safe and feasible. It could be particularly considered in patients ineligible for IV thrombolysis with a hypoplastic contralateral VA. Further studies are needed to evaluate the long-term safety and efficacy of stenting for VA dissection.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83726794","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}
Pub Date : 2019-08-12DOI: 10.11648/J.CNN.20190303.13
F. Dantas, Eustáquio Claret dos Santos Júnior, Tiago Silva e Carvalho, Róberti Uili Rodrigues Firmino, Romulo Mourao, M. C. Fonseca, F. R. Dantas, R. Botelho, R. Darwich
Reversible cerebral vasoconstriction syndrome is an unusual entity, characterized by recurrent thunderclap headache and segmental narrowing of the cerebral arteries, typically with remission within three months. It has been described since the 1960s with several names, including Call-Fleming syndrome. More than 500 cases have been described in the literature, yet the pathophysiology remains not well understood. Ischemic or hemorrhagic strokes are the major possible complications of the syndrome, leading to permanent neurological deficits or death in a small percentage of patients. We report a case of a 48-year-old female patient without known risk factors that presented two foci of intracerebral hemorrhages, with hemiparesis ipsilateral to the biggest intracerebral lesion. Magnetic resonance imaging tractography revealed normal pyramidal decussation, and the patient evolved with completely recover of the neurological deficit within a week. The authors believe that in the present case neurological deficit may be related to contralateral narrowing of the cerebral arteries and diffuse impairment of the central nervous system instead of intracerebral hemorrhage itself. RCVS is a rare condition that should be considered in patients with recurrent thunderclap type headache. Further prospective and randomized studies are still necessary to improve the management and treatment of patients with the syndrome.
{"title":"Intracerebral Hemorrhages Secondary to Reversible Cerebral Vasoconstriction Syndrome: Case Report and Literature Review","authors":"F. Dantas, Eustáquio Claret dos Santos Júnior, Tiago Silva e Carvalho, Róberti Uili Rodrigues Firmino, Romulo Mourao, M. C. Fonseca, F. R. Dantas, R. Botelho, R. Darwich","doi":"10.11648/J.CNN.20190303.13","DOIUrl":"https://doi.org/10.11648/J.CNN.20190303.13","url":null,"abstract":"Reversible cerebral vasoconstriction syndrome is an unusual entity, characterized by recurrent thunderclap headache and segmental narrowing of the cerebral arteries, typically with remission within three months. It has been described since the 1960s with several names, including Call-Fleming syndrome. More than 500 cases have been described in the literature, yet the pathophysiology remains not well understood. Ischemic or hemorrhagic strokes are the major possible complications of the syndrome, leading to permanent neurological deficits or death in a small percentage of patients. We report a case of a 48-year-old female patient without known risk factors that presented two foci of intracerebral hemorrhages, with hemiparesis ipsilateral to the biggest intracerebral lesion. Magnetic resonance imaging tractography revealed normal pyramidal decussation, and the patient evolved with completely recover of the neurological deficit within a week. The authors believe that in the present case neurological deficit may be related to contralateral narrowing of the cerebral arteries and diffuse impairment of the central nervous system instead of intracerebral hemorrhage itself. RCVS is a rare condition that should be considered in patients with recurrent thunderclap type headache. Further prospective and randomized studies are still necessary to improve the management and treatment of patients with the syndrome.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72879462","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}
Pub Date : 2019-07-31DOI: 10.11648/J.CNN.20190303.12
Jianxian Luo, Yan Yuhao, Hongsheng Lin
Arachnoiditis ossificans is a rare, chronic and progressive disease, especially cauda equina. Most of its causes are due to severe trauma or sequelae after spinal surgery, generally gradual calcification from the initial adhesive arachnoiditis to the end stage of ossified arachnoiditis. At present, the treatment of this rare disease standard is difficult to determine, and the clinical outcomes of conservative and surgical treatment options remain controversial. We present a 26-year-old female patient who was postoperative lumbar surgery for trauma, plain and reconstructive X-ray, CT and MRI images showed an ossified lesion within the master at the L5-S1 levels and compression of the left spinal canal at L4/5 level. We explored and decompressed spinal canal and released root nerves, while the calcified cauda equina nerve was not treated. Postoperative supportive treatment including detumescence, anti-inflammation, nutritional nerve and analgesia, the postoperative clinical course of the patient was good and the patient was very satisfied with the curative effect. This case, along with a review of literature is reported.
{"title":"A Case of Cauda Equina Arachnoiditis Ossificans and Review the Literature","authors":"Jianxian Luo, Yan Yuhao, Hongsheng Lin","doi":"10.11648/J.CNN.20190303.12","DOIUrl":"https://doi.org/10.11648/J.CNN.20190303.12","url":null,"abstract":"Arachnoiditis ossificans is a rare, chronic and progressive disease, especially cauda equina. Most of its causes are due to severe trauma or sequelae after spinal surgery, generally gradual calcification from the initial adhesive arachnoiditis to the end stage of ossified arachnoiditis. At present, the treatment of this rare disease standard is difficult to determine, and the clinical outcomes of conservative and surgical treatment options remain controversial. We present a 26-year-old female patient who was postoperative lumbar surgery for trauma, plain and reconstructive X-ray, CT and MRI images showed an ossified lesion within the master at the L5-S1 levels and compression of the left spinal canal at L4/5 level. We explored and decompressed spinal canal and released root nerves, while the calcified cauda equina nerve was not treated. Postoperative supportive treatment including detumescence, anti-inflammation, nutritional nerve and analgesia, the postoperative clinical course of the patient was good and the patient was very satisfied with the curative effect. This case, along with a review of literature is reported.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84444600","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}
Pub Date : 2019-07-23DOI: 10.11648/J.CNN.20190303.11
C. Smit, K. Butow, S. Naidoo, S. Olorunju
Context: The concept “epigenetics” highlights that environmental factors are able to trigger changes in gene activity. This confounds the search for aetiological factors of syndromic oro-facial clefts as it interplays between genetics and environmental stimulation. Subjects and Methods: The study makes use of a database of syndromic cleft patients over 33 years at the Department of Maxillo-Facial and Oral Surgery at the University of Pretoria. The ten most common clefting syndromes (Fairbairn-Robin triad, Demarque van der Woude syndrome, Holoprosencephaly, Naso-maxillo-acro dysostosis (Binder’s syndrome), Goldenhar syndrome, Treacher-Collins syndrome, Trisomy 13 (Patau’s syndrome), P63 Mutation associated clefting disorders, Trisomy 21 (Down’s syndrome), Oro-Facial Digital syndromes) were included amounting to 517 patients. The nine most common maternal risk factors (Unknown Infection, Viral Infection, HIV, Medication, Smoking, Alcohol, Oligohydramnios, Vitamins, Hormones) were included totaling 398. Results: Fairbairn-Robin triad had a significant correlation with oligohydramnios, infection and medication. Demarque-van der Woude syndrome presented with a significant contribution from medication and Holoprosencephaly showed a significant correlation with vitamin supplementation. Conclusion: based on the results of this study Fairbairn-Robin triad appears to have a strong environmental component to the presentation thereof. Demarque-van der Woude was indicated to having a genetic-environmental interplay contributing to the presentation of the syndrome.
背景:“表观遗传学”的概念强调环境因素能够触发基因活性的变化。这混淆了对综合征性唇腭裂的病因因素的研究，因为它在遗传和环境刺激之间相互作用。研究对象和方法:该研究使用了比勒陀利亚大学颌面口腔外科33年以上的综合征性唇裂患者数据库。10种最常见的裂裂综合征(Fairbairn-Robin三联征、Demarque van der Woude综合征、前脑畸形、鼻-上颌-跨骨发育障碍(Binder综合征)、Goldenhar综合征、ter - collins综合征、13三体(Patau综合征)、P63突变相关裂裂疾病、21三体(唐氏综合征)、Oro-Facial Digital综合征)共517例患者。9个最常见的产妇危险因素(未知感染、病毒感染、艾滋病毒、药物、吸烟、酒精、羊水过少、维生素、激素)共398项。结果:Fairbairn-Robin三联征与羊水过少、感染及用药有显著相关性。Demarque-van der Woude综合征与药物有显著关系，前脑畸形与补充维生素有显著关系。结论:基于本研究的结果，费尔贝恩-罗宾三联症的表现似乎有很强的环境因素。Demarque-van der Woude被认为是遗传-环境相互作用导致了该综合征的出现。
{"title":"Identification of Possible Maternal Risk Factors for Development of Syndromic Oro-Facial Clefts","authors":"C. Smit, K. Butow, S. Naidoo, S. Olorunju","doi":"10.11648/J.CNN.20190303.11","DOIUrl":"https://doi.org/10.11648/J.CNN.20190303.11","url":null,"abstract":"Context: The concept “epigenetics” highlights that environmental factors are able to trigger changes in gene activity. This confounds the search for aetiological factors of syndromic oro-facial clefts as it interplays between genetics and environmental stimulation. Subjects and Methods: The study makes use of a database of syndromic cleft patients over 33 years at the Department of Maxillo-Facial and Oral Surgery at the University of Pretoria. The ten most common clefting syndromes (Fairbairn-Robin triad, Demarque van der Woude syndrome, Holoprosencephaly, Naso-maxillo-acro dysostosis (Binder’s syndrome), Goldenhar syndrome, Treacher-Collins syndrome, Trisomy 13 (Patau’s syndrome), P63 Mutation associated clefting disorders, Trisomy 21 (Down’s syndrome), Oro-Facial Digital syndromes) were included amounting to 517 patients. The nine most common maternal risk factors (Unknown Infection, Viral Infection, HIV, Medication, Smoking, Alcohol, Oligohydramnios, Vitamins, Hormones) were included totaling 398. Results: Fairbairn-Robin triad had a significant correlation with oligohydramnios, infection and medication. Demarque-van der Woude syndrome presented with a significant contribution from medication and Holoprosencephaly showed a significant correlation with vitamin supplementation. Conclusion: based on the results of this study Fairbairn-Robin triad appears to have a strong environmental component to the presentation thereof. Demarque-van der Woude was indicated to having a genetic-environmental interplay contributing to the presentation of the syndrome.","PeriodicalId":93199,"journal":{"name":"Journal of clinical neurology and neuroscience","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78550961","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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