Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Feb 2008
ReviewAlzheimer's disease-related changes in diseases characterized by elevation of intracranial or intraocular pressure.
In this review, we focus on the coexistence of Alzheimer's disease-related changes in brain diseases, such as normal pressure hydrocephalus and traumatic brain injury, and in glaucoma at the level of the retinal ganglion cells. This is a group of diseases that affect central nervous system tissue and are characterized by elevation of intracranial or intraocular pressure and/or local shear stress and strain. In considering possible mechanisms underlying Alzheimer-type changes in these diseases, we briefly summarize recent evidence indicating that caspase activation and abnormal processing of beta-amyloid precursor protein, which are important events in Alzheimer's disease, may play a role both in glaucoma and following traumatic brain injury. ⋯ Data presented in this review could be interpreted to suggest that Alzheimer-type changes in these diseases may result at least in part from exposure of central nervous system tissue to increased levels of mechanical stress. Evidence for such a relationship is of major importance because it may support an association between elevated mechanical load and the development of Alzheimer-type lesions. Further studies are warranted, however, especially to elucidate the role of elevated mechanical forces in Alzheimer's disease neuropathogenesis.
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Non-missile low velocity penetrating brain injuries are unusual among civilian population. They show specific characteristics different from missile wounds. In this paper we describe a rare case of self-inflicted penetrating head trauma by electric drill. ⋯ It is essential to exclude penetrating brain trauma whenever a scalp wound is noticed in order to provide proper treatment and prevention care. The permanent neurological deficit in low velocity injuries is related to the degree and location of the primary injury. It also depends on an early diagnosis and treatment and the absence of delayed complications.
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The objective of the present study was to retrospectively review the surgical outcome of 309 craniopharyngioma cases treated by a single neurosurgeon in China. ⋯ Pre-surgery neuroimaging evaluations have improved our knowledge of intricate anatomical relationship between craniopharyngioma and the structures of the hypothalamus, pituitary stalk, and optic apparatus, which make total tumor resection feasible with the preservation of these vital structures to ensure a lower recurrence rate with acceptable mortality. However, excessive long-term morbidity, mostly related to hypopituitarism, which leads to the poor quality of life for the craniopharyngioma patients, is still remained. Further effort should be invested to monitor and maintain the normal hormone levels, hence improve the quality of life for craniopharyngioma patients.
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Clin Neurol Neurosurg · Feb 2008
Pallidal surgery for the treatment of primary generalized dystonia: long-term follow-up.
To describe the results and long-term follow-up after functional surgery of the internal segment of the globus pallidus (GPi) in 10 patients with primary generalized dystonia. ⋯ This long-term follow up study confirms the beneficial effect of pallidal DBS or pallidotomy in primary generalized dystonia. In addition, our results extent previous observations by showing that, in these patients, (1) the microlesion effect of DBS is not predictive of long-term benefit; (2) combined DBS with contralateral pallidotomy appears to be more effective than bilateral pallidal DBS; and (3) dystonia can reappear after an initial good response during long term follow up.