Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jul 2012
Distribution of delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage and implications for regional neuromonitoring.
Many neuromonitoring devices provide data applicable to a limited region of the brain. Risk of DIND is common after aSAH and may occur near or remote from the ruptured aneurysm. The aim of this study is to determine the distribution of DIND after aneurysms rupture as it relates to the potential value of regional monitoring in detection of vasospasm. ⋯ Vasospasm related infarction occurs most commonly ipsilateral to or in the same distribution of the ruptured aneurysm. Less anatomical correlation is seen with midline aneurysms. Rupture of posterior circulation aneurysms infrequently results in supratentorial infarction. Decisions regarding placement of regional monitors for the purpose of vasospasm detection should consider this distribution of ischemic risk.
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Clin Neurol Neurosurg · Jun 2012
ReviewNeuromodulation of lower limb motor control in restorative neurology.
One consequence of central nervous system injury or disease is the impairment of neural control of movement, resulting in spasticity and paralysis. To enhance recovery, restorative neurology procedures modify altered, yet preserved nervous system function. This review focuses on functional electrical stimulation (FES) and spinal cord stimulation (SCS) that utilize remaining capabilities of the distal apparatus of spinal cord, peripheral nerves and muscles in upper motor neuron dysfunctions. ⋯ This will lead to our human work of epidural and transcutaneous stimulation targeting the lumbar spinal cord for enhancing motor functions in spinal cord injured people, supplemented by pertinent human research of other investigators. We conclude that the concept of restorative neurology recently received new appreciation by accumulated evidence for locomotor circuits residing in the human spinal cord. Technological and clinical advancements need to follow for a major impact on the functional recovery in individuals with severe damage to their motor system.
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Clin Neurol Neurosurg · Jun 2012
Case ReportsDiaphragm paralysis caused by transverse cervical artery compression of the phrenic nerve: the Red Cross syndrome.
The etiology of diaphragm paralysis is often elusive unless an iatrogenic or traumatic injury to the phrenic nerve can be clearly implicated. Until recently, there has been little interest in the pathophysiology of diaphragm paralysis since few treatment options existed. ⋯ We suggest that vascular compression of the phrenic nerve in the neck may occur following traumatic or iatrogenic injuries, and result in symptomatic diaphragm paralysis.