Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2011
Comparative StudyLevetiracetam compared to valproic acid: plasma concentration levels, adverse effects and interactions in aneurysmal subarachnoid hemorrhage.
Both valproic acid and levetiracetam are anti-epileptic drugs, often used either alone or in combination. The present study compares valproate (VPA) with levetiracetam (LEV) as an intravenous (i.v.) anticonvulsant treatment in intensive care patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) with a high risk of seizures. ⋯ Though this finding needs further verification, the enteral liquid application of levetiracetam seems to be associated with lower bioavailability than the common oral application of levetiracetam. The use of the antibiotic drug meropenem together with valproic acid leads to lower pc levels in patients treated with of valproic acid. For clinical practice, this indicates the need to monitor the levels of valproic acid in combination with meropenem.
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Clin Neurol Neurosurg · Oct 2011
Papilloedema as a non-invasive marker for raised intra-cranial pressure following decompressive craniectomy for severe head injury.
Decompressive craniectomy is an extremely useful surgical procedure for decreasing intra cranial pressure following severe head injury. However, there is anecdotal evidence to suggest that some of these patients may continue to have raised intracranial pressure in spite of an apparently adequate Decompressive craniectomy. ⋯ Fundoscopy is an extremely useful non-invasive tool to assess changes in intracranial pressure in severe head injury. Reappearance of papilloedema in the postoperative period even in the absence of ventriculomegaly indicates raised ICP and should be treated aggressively.
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Clin Neurol Neurosurg · Oct 2011
Transsphenoidal surgery assisted by a new guidance device: results of a series of 747 cases.
The objective of this study is to report the efficacy and safety of microsurgical transsphenoidal surgery using a frame for sella guidance in a series of patients with untreated pituitary adenoma. ⋯ The endonasal transsphenoidal technique is a safe, quick, and effective approach to pituitary adenomas. Our guidance frame allows the surgeon to open and close the wound rapidly, which avoids trajectory deviation and shortens the duration of the surgical procedure.
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Clin Neurol Neurosurg · Oct 2011
Cognitive and functional impairments in ischemic stroke patients with concurrent small vessel and large artery disease.
Concurrent small vessel, intracranial and extracranial large artery disease (SLAD) is common in Asian but its impact on cognitive and functional outcomes is unclear. We aimed to evaluate the clinical, cognitive and functional outcomes in ischemic stroke patients with SLAD. ⋯ This was the first MRA-based study to take into consideration the clinical, cognitive and functional outcomes in ischemic stroke patients with SLAD. Patients with SLAD had poorer cognitive and functional outcomes when compared to patients without SLAD.
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Clin Neurol Neurosurg · Oct 2011
Anterior subcutaneous transposition of ulnar nerve with fascial flap and complete excision of medial intermuscular septum in cubital tunnel syndrome: a prospective patient cohort.
Regarding the frequency of cubital tunnel syndrome, varieties of treatment modalities, and ambiguity of anterior subcutaneous transposition of ulnar nerve method, we aimed to evaluate the efficacy of this procedure in patients with cubital tunnel syndrome referred to Taleghani hospital between 2006 and 2009. ⋯ Though considered standard of care, the present study suggests that criteria for surgical techniques of ulnar nerve decompression, e.g. simple decompression vs. more extensive repair as in the present cohort, should be revised by controlled prospective studies.