Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Feb 2013
Review Case Reports Meta AnalysisPannus regression after posterior decompression and occipito-cervical fixation in occipito-atlanto-axial instability due to rheumatoid arthritis: case report and literature review.
Several techniques have been proposed for treating cervical spine instability due to rheumatoid arthritis. The aim of this study was to screen the different treatment options used in this pathology to evaluate the best form of treatment when the progression of rheumatoid disease affected the cranio-vertebral junction (CVJ) stability. The most important purpose of this study was to achieve both the efficacy of occipito-cervical fusion (OCF) to stabilize the occipitocervical junction and stop pannus progression. The authors describe their case example and stress, in the light of a literature review, the hypothesis that a stable biomechanical system extended to all the spaces involved, has both direct and indirect effects on RA pannus progression and the condition responsible for its formation, such as inflammation and articular hypermobility. Hence, the aim of this study is to advance this thesis, which may be extended to a wider statistical sample, with the same characteristics. ⋯ Thirty-seven different studies were identified that reflected search criteria, five of which were literature reviews. The different surgical treatment options in cervical RA disease are described in relation to neurological outcome according to the Ranawat grading system, functional outcome or quality of life according to the Steinbrocker classification, and progression of cervical instability and radiographic index of cranial settling, focusing on the role of OCF.
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Clin Neurol Neurosurg · Feb 2013
Case ReportsRevision to an adjustable non-siphon control valve in low pressure hydrocephalus: therapeutic siphoning and a new perspective on NPH: series of 3 cases and review of the literature.
High intracranial compliance states requiring negative pressure drainage, otherwise known as low-pressure hydrocephalus syndromes, are rare conditions. The use of siphoning, enabled by revision to an adjustable shunt without an anti-siphon device, has been largely unexplored in low-pressure hydrocephalus. ⋯ Our findings indicate that intermittent intracranial hypotension achieved by siphoning is effective in the treatment of a subset of patients presenting clinically with NPH. Direct conversion to a shunt system without an anti-siphon device allows reduction of ventricular size without the risk associated with external ventricular drainage (EVD). With conversion to the Strata NSC valve, our patients had sustained clinical improvement, even at higher valve settings.
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Clin Neurol Neurosurg · Jan 2013
Leptomeningeal carcinomatosis: prognostic value of clinical, cerebrospinal fluid, and neuroimaging features.
Leptomeningeal carcinomatosis (LC) is a devastating complication occurring in 5% of all patients with cancer. To date there are no well-established prognostic markers in patients with LC, except for the presence of cerebrospinal fluid (CSF) blocks and the Karnofsky performance status scale (KPS). We aimed to identify clinical, neuroradiologic and CSF prognostic factors related to LC survival and to develop an easy-to-use Prognostic Scoring Scale (PSS) to identify patients who are more likely to benefit from receiving treatment. ⋯ Prognosis remains poor in LC. The predictive factors for patients with LC here identified could help to improve the selection of patients who are more likely to benefit from receiving treatment.
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Clin Neurol Neurosurg · Dec 2012
Local intraarterial tirofiban after formation of anterograde flow in patients with acute ischemic stroke: preliminary experience and short term follow-up results.
Despite the risk of intracranial hemorrhage, combination therapy with intravenous recombinant tissue plasminogen activator and intraarterial mechanical thrombolysis can be effective for treatment of acute ischemic stroke. We investigated the feasibility and safety of intraarterial tirofiban following formation of anterograde flow after mechanical thrombolysis in acute ischemic stroke. ⋯ Our results suggest that administration of local intraarterial tirofiban after anterograde flow formation is a viable treatment strategy for patients of acute ischemic stroke for reducing the risk of reocclusion after intraarterial thrombolysis.