Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Sep 2014
ReviewManagement of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: a review.
This article reviews the literature regarding tandem asymptomatic cervical stenosis in the setting of symptomatic lumbar stenosis. The presenting features of cervical spondylotic myelopathy are insidious and consistent with upper motor neuron loss. Often, asymptomatic cervical stenosis is encountered in the clinical setting during the workup of a symptomatic lumbar stenosis and degenerative disease. ⋯ There is insufficient evidence in the literature to support the need for preemptive decompression for asymptomatic cervical cord compression with or without a correlative T2 hyperintense cord signal. Early diagnosis of radiculopathy or myelopathy in patients with cervical stenosis (i.e., through conversion of asymptomatic to symptomatic state) is important as each patient with in this clinical setting should be followed closely, as the literature shows the tendency for a clinical progression to eventual cervical myelopathy.
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Clin Neurol Neurosurg · Sep 2014
Quality of life in advanced Parkinson's disease after bilateral subthalamic stimulation: 2 years follow-up study.
The aims of this study were to assess the quality of life (QoL) using Parkinson's Disease Questionnaire PDQ-39 after bilateral subthalamic deep brain stimulation (STN DBS), and to identify correlations between changes in UPDRS score and separate PDQ-39 QoL dimensions and PDQ summary index (SI) score at long-term follow-up. ⋯ STN DBS significantly improved important aspects of QoL as measured by PDQ-39. The improvements were maintained at 2 years follow-up except for social support and communication. We demonstrated a positive correlation between changes in the off condition of motor UPDRS scores and dyskinesia UPDRS scores in several PDQ-39 dimensions, whereas fluctuation UPDRS scores were negatively correlated with PDQ-39 mobility scores.
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Clin Neurol Neurosurg · Sep 2014
Clinical features associated with sleep disturbances in Parkinson's disease.
Sleep disturbances, such as REM sleep behavior disorder (RBD) and excessive daytime sleepiness, are more common in patients with Parkinson's disease (PD) than in the general population. Apart from that, their relation to PD seems to diverge considerably. Our aim was to explore the frequency and associated motor- and non-motor features of sleep related symptoms in PD. ⋯ Our results suggest that excessive daytime sleepiness is related to disease duration, and possibly caused by progressive neurodegeneration. pRBD seems to be a distinct feature present in only a proportion of PD patients.
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Clin Neurol Neurosurg · Sep 2014
Comparative StudyCryopreservation versus subcutaneous preservation of autologous bone flaps for cranioplasty: comparison of the surgical site infection and bone resorption rates.
Decompressive craniectomy is performed to treat malignant brain hypertension. Surgical site infection (SSI) and bone resorption are common complications following cranioplasty, and the storage method that minimizes such complication has yet to be identified. ⋯ In this series, the SSI rates were similar in the SP and CP groups. There was no significant difference when the patients were grouped by TBI etiology. The incidence of bone flap resorption in the CP group was higher than that in the SP group. However, identifying of the method that yields superior results might depend on the individual surgeon's preference and the available equipment.
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Clin Neurol Neurosurg · Sep 2014
Visualization of small veins with susceptibility-weighted imaging for stereotactic trajectory planning in deep brain stimulation.
Intracerebral hemorrhage (ICH) is the most significant complication of Deep Brain Stimulation (DBS). To prevent ICH, stereotactic contrast enhanced T1-weighted images are used to visualize vessels as source of hemorrhage. Susceptibility-Weighted Imaging (SWI) is an MRI sequence with improved visualization of susceptibility differences between tissues, particularly sensitive for brain veins. ⋯ SWI facilitates the visualization of small veins superior to T1-weighted images. However, cerebral veins within the trajectory were not found to be a significant source of ICH after DBS. Potential sources of ICH are mesencephal veins at the endpoint of electrodes which can cause fatal hemorrhage and are visualized with SWI reliably.