Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Nov 2018
Meta AnalysisThe clinical significance of redundant nerve roots of the cauda equina in lumbar spinal stenosis patients: A systematic literature review and meta-analysis.
Decompression surgery for lumbar spinal stenosis (LSS) is the most performed spine surgery procedure in patients older than 65 years. Around 40% of LSS patients scheduled for decompression surgery have evidence of redundant nerve roots (RNR) of the cauda equina on their magnetic resonance images (MRI). Little is known about the clinical significance of RNR in LSS patients. The objective was to assess the effects of RNR on clinical scores and recovery in older adults diagnosed with LSS. ⋯ There is limited quality evidence that RNR + patients are older, have a longer symptom history and present higher degrees of lumbar stenosis as given by the narrow CSA in comparison to RNR- patients. After decompression surgery RNR + patients have worse clinical scores and lower recovery rates. In view of these results RNR can be seen as a negative prognostic factor in LSS patients.
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Clin Neurol Neurosurg · Nov 2018
Clinical and magnetic resonance imaging predictors of the surgical outcomes of patients with cervical spondylotic myelopathy.
To determine whether clinical characteristics and signal and morphologic changes on magnetic resonance (MR) images of the spinal cord (SC) are associated with surgical outcomes for cervical spondylotic myelopathy (CSM). ⋯ A longer duration of symptom, multisegmental T2HSCs on sagittal MR images, and fuzzy focal T2HSCs on axial MR images were highly predictive of a poor surgical outcome for CSM. Smaller transverse area of the SC and bright T2HSCs were also associated with the prognosis of CSM.
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Clin Neurol Neurosurg · Nov 2018
Efficacy of platelet transfusion in the management of acute subdural hematoma.
Oral Antithrombotic Therapy has become a well documented predisposing risk factor in the development of traumatic intracranial hemorrhage. Currently, a reversal protocol for antiplatelet therapy remains ill-defined in the management of non-surgical traumatic subdural hematoma and there is no evidence to suggest a clear benefit of platelet transfusion to mitigate the effect of antiplatelet agents. This study aims to establish parameters in which platelet transfusion would be of benefit in patients with non-surgical traumatic subdural hematoma with preinjury antiplatelet therapy. ⋯ The results of this study suggest that patients with non-surgical traumatic subdural hematomas on presentation are less likely to expand, however the risk of expansion is greater when the patient is on antiplatelet therapy. There is no clear benefit in the use of platelet transfusion as a reversal agent to mitigate the effects of antiplatelet therapy in the setting of non-surgical traumatic subdural hematomas.
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Clin Neurol Neurosurg · Nov 2018
Relationship of preoperative intramedullary MRI signal intensity and dynamic factors with surgical outcomes of laminoplasty for cervical ossification of the posterior longitudinal ligament.
We aimed to analyze the relationship of preoperative signal intensity on magnetic resonance imaging (MRI) and dynamic factor with surgical outcomes of laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). ⋯ Given its negative correlation with JOA score recovery rate and positive correlation with high-signal changes on preoperative MRI, higher preoperative segmental ROM may be associated with spinal cord damage due to repeated minor trauma, predicting poor surgical outcome of laminoplasty in cervical OPLL.
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Clin Neurol Neurosurg · Nov 2018
Case ReportsTargeting the hot spot in a patient with essential tremor and Parkinson's disease: Tractography matters.
Thalamic ventralis intermedius deep brain stimulation (VIM-DBS) is generally effective in treating refractory tremor in Parkinson's disease (PD) and in essential tremor (ET), but some patients do not respond well due to side effects or from loss of the effect of stimulation over time. The caudal zona incerta (ZI) has emerged as a promising target in ET, and the effects of ZI-DBS on PD tremor are less studied. Here, we describe a rare situation in which both ET and PD coexist in a 72-year-old male referred for ZI-DBS due to refractory tremor. The aim of this study was to evaluate whether there was a difference in the area stimulated to improve each type of tremor and whether tractography could improve and predict motor outcome. ⋯ Regardless of the type of tremor, DRTT can be the most effective region for stimulation. Tractography should be considered when planning the surgical target since the DRTT is not always symmetrical, and the reconstruction of the VTA together with the tractography can greatly improve the DBS programming, and, probably, the patient's outcome to the stimulation.