Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Apr 2008
ReviewHistologically benign intraventricular meningioma with concurrent pulmonary metastasis: case report and review of the literature.
Only 1-2% of all meningiomas are intraventricular in location. Metastasis from a histologically "benign" meningioma is a rare, but well-documented event. ⋯ The tumors in these reports had a frankly malignant histology or were associated with surgical manipulation and recurrence of the primary lesion. In this report, the authors present a rare case of the concurrent presentation of a histologically benign intraventricular meningioma and a solitary lung lesion which proved to be metastatic meningioma.
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Clin Neurol Neurosurg · Apr 2008
Measurement of peak CSF flow velocity at cerebral aqueduct, before and after lumbar CSF drainage, by use of phase-contrast MRI: utility in the management of idiopathic normal pressure hydrocephalus.
Since it was first described, normal pressure hydrocephalus (NPH) and its treatment by means of cerebrospinal fluid (CSF) shunting have been the focus of much investigation. Whatever be the cause of NPH, it has been hypothesized that in this disease there occurs decreased arterial expansion and an increased brain expansion leading to increased transmantle pressure. We cannot measure the latter, but fortunately the effect of these changes (increased peak flow velocity through the aqueduct) can be quantified with cine phase-contrast magnetic resonance imaging (MRI). This investigation was thus undertaken to characterize and measure CSF peak flow velocity at the level of the aqueduct, before and after lumbar CSF drainage, by means of a phase-contrast cine MRI and determine its role in selecting cases for shunt surgery. ⋯ The study concluded that the phase-contrast MR imaging, done before and after CSF drainage, is a sensitive method to support the clinical diagnosis of normal pressure hydrocephalus, selecting patients of NPH who are likely to benefit from shunt surgery, and to select patients of NPH who are not likely to benefit from shunt surgery.
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Clin Neurol Neurosurg · Apr 2008
Effect of bilateral subthalamic deep brain stimulation on diphasic dyskinesia.
The goal of this study was to assess the effect of bilateral subthalamic deep brain stimulation (STN DBS) on levodopa-induced diphasic dyskinesia in patients with Parkinson disease (PD). ⋯ Bilateral STN DBS is good at reducing diphasic dyskinesia, and it can be a good therapeutic option for patients with diphasic dyskinesia.
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Clin Neurol Neurosurg · Mar 2008
Case ReportsExtracorporeal membrane oxygenation resuscitation for traumatic brain injury after decompressive craniotomy.
Acute cardiopulmonary failure in patients with increased intracranial pressure is a significant management challenge to physicians. We report on a 21-year-old patient with traumatic brain injury who developed intractable hypoxemia and hypotension after undergoing a decompressive craniotomy. ⋯ Extracorporeal membrane oxygenation is considered contraindicated in patients with intracranial bleeding because systemic heparin is needed during the support of extracorporeal membrane oxygenation. We describe our successful experience in tackling this dilemma.
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Clin Neurol Neurosurg · Feb 2008
ReviewAlzheimer's disease-related changes in diseases characterized by elevation of intracranial or intraocular pressure.
In this review, we focus on the coexistence of Alzheimer's disease-related changes in brain diseases, such as normal pressure hydrocephalus and traumatic brain injury, and in glaucoma at the level of the retinal ganglion cells. This is a group of diseases that affect central nervous system tissue and are characterized by elevation of intracranial or intraocular pressure and/or local shear stress and strain. In considering possible mechanisms underlying Alzheimer-type changes in these diseases, we briefly summarize recent evidence indicating that caspase activation and abnormal processing of beta-amyloid precursor protein, which are important events in Alzheimer's disease, may play a role both in glaucoma and following traumatic brain injury. ⋯ Data presented in this review could be interpreted to suggest that Alzheimer-type changes in these diseases may result at least in part from exposure of central nervous system tissue to increased levels of mechanical stress. Evidence for such a relationship is of major importance because it may support an association between elevated mechanical load and the development of Alzheimer-type lesions. Further studies are warranted, however, especially to elucidate the role of elevated mechanical forces in Alzheimer's disease neuropathogenesis.