Clinical neurology and neurosurgery
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Refractory pain syndromes often have far reaching effects and are quite a challenge for primary care providers and specialists alike to treat. With the help of site-specific neuromodulation and appropriate patient selection these difficult to treat pain syndromes may be managed. In this article, we focus on supraspinal stimulation (SSS) for treatment of intractable pain and discuss off-label uses of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in context to emerging indications in neuromodulation. ⋯ Overall, a review of the literature demonstrates that DBS should be considered for refractory conditions including nociceptive/neuropathic pain, phantom limb pain, and chronic cluster headache (CCH). MCS should be considered primarily for trigeminal neuropathic pain (TNP) and central pain. DBS outcome studies for post-stroke pain as well as MCS studies for complex regional pain syndrome (CRPS) show more modest results and are also discussed in detail.
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Clin Neurol Neurosurg · Aug 2014
Therapeutic hypothermia for adult community-acquired bacterial meningitis-historical control study.
Despite advances in antibiotic therapy and critical care, community-acquired bacterial meningitis (CABM) continues to have poor outcome in a significant portion of patients. This study was designed to assess the efficacy of therapeutic hypothermia (TH) in the treatment of CABM. ⋯ The new therapeutic concept based on hypothermia significantly improves the outcome in adult patients with severe CABM.
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Clin Neurol Neurosurg · Aug 2014
Median-evoked somatosensory potentials in severe brain injury: does initial loss of cortical potentials exclude recovery?
In patients with severe brain injury (SBI) median-evoked somatosensory potentials (M-SSEP) serve as a prognostic tool. Bilateral loss of cortical responses (BLCR) is usually thought to be a reliable marker of poor prognosis. Prognostic accuracy to predict a poor outcome depends on the cause of coma and is best in hypoxic-ischemic encephalopathy (HIE) reaching almost 100% which is in contrast to patients with other etiologies of coma, especially traumatic brain injury (TBI). Only little evidence exists on the possibility of electrophysiological recovery of BLCR in repeated or serial SSEP-examinations and detailed functional outcome in these cases. ⋯ Electrophysiological recovery from primarily BLCR seems possible and is accompanied by good functional outcome in a relevant number of patients. Thus caution is warranted in predicting a poor prognosis based predominantly on SSEP, especially in patients with TBI. Focusing SSEP-examination on the early days after severe brain injury and performing only one examination in the case of BLCR may lead to systematic underestimation of the possibility of recovery.
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Clin Neurol Neurosurg · Aug 2014
Overlapping stents for blood blister-like aneurysms of the internal carotid artery.
Blood blister-like aneurysms (BBAs) are unique due to their high risk of recurrent bleeding associated with their fragile neck. The best treatment for BBAs is still controversial. This paper sought to evaluate the safety and efficacy of stent-assisted coiling and subsequent overlapping stents (SAC+OS) in the treatment of BBAs. ⋯ Stent-assisted coiling and subsequent overlapping stents are feasible and safe for BBAs. It can be helpful to further decrease the risk of recanalization with more stents. Early angiographic follow-up within 2 weeks is recommended.
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Clin Neurol Neurosurg · Aug 2014
Clinically relevant complications related to posterior atlanto-axial fixation in atlanto-axial instability and their management.
The Magerl transarticular technique and the Harms-Goel C1 lateral mass-C2 isthmic screw technique are the two most commonly used surgical procedures to achieve fusion at C1-C2 level for atlanto-axial instability. Despite recent technological advances with an increased safety, several complications may still occur, including vascular lesions, neurological injuries, pain at the harvested bone graft site, infections, and metallic device failure. ⋯ Atlanto-axial fixation surgery remains a challenging procedure because of the proximity of important neurovascular structures. Nevertheless, on the basis of our current experience, the C1 lateral mass-C2 isthmic screw technique appears to be safe with a low incidence of clinically relevant complications. Postoperative C2 neuralgia, as the most frequent problem, is due to surgical manipulation during preparation of the C1 screw entry point.