Clinical neurology and neurosurgery
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"Asymptomatic multiple sclerosis (MS)" or "subclinical MS" describes "a clinically silent disease state of MS" discovered by chance either by imaging or at autopsy, or with incidental findings shown by other diagnostic tools that are consistent or suggestive of MS, and that cannot be explained by any other disease or condition. Since the early 1960s there have been a number of autopsy studies reporting cases, in which histopathological brain changes consistent with MS were found, despite that none had any clinical symptom or sign of the disease during their lifetime. Several reports have also shown that asymptomatic first-degree relatives of MS patients may have oligoclonal bands in their cerebrospinal fluids or may turn out to have abnormal evoked potential studies. ⋯ Currently this issue has gained a wide interest as there are no established protocols regarding how to study and follow these individuals or whether they should be treated or not. However, not all patients with RIS are predestined to develop clinical disease and it was recently shown that the rate of conversion to clinical MS is about one-third of RIS cases at five years. Although that there may be some risk factors suggestive of a higher or earlier conversion to clinical disease, none are definite and the current evidence is not supportive of initiating treatment in patients diagnosed as RIS.
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Clin Neurol Neurosurg · Dec 2013
Retinal nerve fiber thickness and MRI white matter abnormalities in healthy relatives of multiple sclerosis patients.
To compare retinal nerve fiber (RNFL) thickness and conventional and non-conventional MRI characteristics of healthy controls (HCs) from the general population (non-fHC) to healthy relatives of multiple sclerosis (MS) patients (fHC). ⋯ There is an association between decreased RNFL thickness on OCT and increased WM injury in healthy relatives of MS patients. Further studies should explore the pathophysiology of these findings.
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Clin Neurol Neurosurg · Dec 2013
Case ReportsEndovascular treatment of distal intracranial aneurysms with Onyx 18/34.
Surgical clipping and coil embolization of distally located intracranial aneurysms can be challenging. The goal of this study was to assess the feasibility, safety and efficacy of treatment of distal aneurysms with the liquid embolic agent Onyx 18/34. ⋯ Parent vessel trapping with Onyx 18/34 offers a simple, safe, and effective means of achieving obliteration of distal challenging aneurysms.
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Clin Neurol Neurosurg · Dec 2013
Long-term neurological and neuropsychological outcome in patients with severe traumatic brain injury.
Severe traumatic brain injury (TBI) remains a major cause of death and disability worldwide. The aim of the study was to evaluate predictors for neurological and neuropsychological long-term outcome in patients with severe TBI treated according to an intracranial pressure (ICP-) targeted therapy. ⋯ The GOS at rehabilitation discharge should be regarded as a better predictor for neuropsychological impairments at long-term follow-up than the GOS at hospital discharge. Even in patients with favourable GOS after finishing a course of rehabilitation, three quarters of these patients may have at least one severe neuropsychological deficit. Therefore, it remains of paramount importance to provide long-term neuropsychological support to further improve outcome after TBI.
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Clin Neurol Neurosurg · Dec 2013
Preoperative spinal tumor embolization: an institutional experience with Onyx.
Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection. ⋯ In our experience, the use of transarterial tumor embolization as an adjunct for spinal surgery is a safe and feasible option.