Clinical neurology and neurosurgery
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The natural history of giant intracranial aneurysms is generally morbid. Mortality and morbidity associated with giant aneurysms is also higher than for smaller aneurysms. This study was carried out to assess the demographic profile, presenting features, complications, and outcome after surgical treatment of giant intracranial aneurysms. ⋯ It is concluded that 14% of all intracranial aneurysms are giant. The most common clinical presentation is SAH followed by features of an intracranial mass lesion. The cavernous ICA is the most common portion of the ICA affected. Direct surgical clipping is a safe and effective method of treatment and should be considered the first line of treatment whenever possible. With proper case selection, optimal radiological evaluation, and appropriate surgical strategy, it is possible to achieve a favorable outcome in almost 90% of the cases.
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Clin Neurol Neurosurg · Jul 2008
Trigemino-cardiac reflex: the trigeminal depressor responses during skull base surgery.
To observe and analyze the occurrence and management of the trigemino-cardiac reflex (TCR) defined as the phenomenon of abrupt drops in heart rate (HR) and blood pressure during skull base surgery. ⋯ (1) Manipulation at or near the trigeminal nerve during the skull base surgery may cause TCR, even if premedication with anticholinergic drug is used; (2) cessation of irritation from surgical manipulation to disrupt the reflex is the most important step to offset TCR; (3) continuous, especially repeated TCR in some rare cases occasionally necessitates the administration of high dose atropine.
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Clin Neurol Neurosurg · Jun 2008
The impact of neuroendoscopy in the emergency setting--a retrospective study of imaging, intraoperative findings, and surgical outcome in 55 patients.
To assess whether neuroendoscopy is an improved and effective diagnostic as well as therapeutic tool in the emergency setting compared with neuroimaging studies. ⋯ Usefulness of neuroendoscopy to increase the accuracy of intraoperative diagnosis, and therefore modify the surgical procedure in an emergency setting, is stressed.
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Clin Neurol Neurosurg · May 2008
Review Case ReportsHereditary hemorrhagic telangectasia and spinal cord infarct: case report with a review of the neurological complications of HHT.
Hereditary hemorrhagic telangectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant vascular dysplasia with high penetrance and variable expressivity. A wide variety of neurological complications have been reported in association with this condition. We report the first case of spinal cord infarction likely due to paradoxical embolization with HHT and review the literature on the neurological complications of this disorder. ⋯ HHT should be considered in the differential diagnosis of any patient with cutaneous or mucosal telangiectasia or a history of unexplained epistaxis. HHT is associated with a diverse array of neurological disorders; most commonly ischemic and hemorrhagic stroke, transient ischemic attack, and brain abscess. While myelopathy secondary to arteriovenous malformation with HHT has been previously reported, this is the first instance of spinal cord infarction due to paradoxical embolization in this disorder.
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Clin Neurol Neurosurg · May 2008
Comparative StudyHemodynamic blood flow disturbances in the middle cerebral arteries in patients with atrial fibrillation during acute ischemic stroke.
The purpose of the present study was to evaluate whether blood flow in the middle cerebral arteries (MCAs) in patients with atrial fibrillation (AF) during acute ischemic stroke is disturbed, as well as to assess if potential disturbances result from arrhythmia rather than a consequence of an embolus within the cerebral circulation. ⋯ In patients with AF, hemodynamic disturbances occur within the cerebral circulation during acute ischemic stroke which can cause a more severe course and worse stroke outcome. AF patients need more appropriate prevention of stroke, as well as more efficient treatment during acute ischemic stroke.