Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Sep 2013
Carotid pseudo-occlusion on CTA in patients with acute ischemic stroke: a concerning observation.
Differentiation between an occluded and a patent extracranial internal carotid artery (ICA) is crucial in the diagnostic workup of patients with acute ischemic stroke; particularly in patients eligible for endovascular treatment. We report neurological and radiological findings of cases in which CTA in the acute phase incorrectly revealed an occlusion of the ICA. ⋯ CTA in the acute phase of ischemic stroke needs to be interpreted with severe caution, and in endovascular treatment decisions we should be aware that an extracranial ICA occlusion may be a false positive finding.
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Clin Neurol Neurosurg · Sep 2013
Prehospital transfer medicalization increases thrombolysis rate in acute ischemic stroke. A French stroke unit experience.
Narrow therapeutic window is a major cause of thrombolysis exclusion in acute ischemic stroke. Whether prehospital medicalization increases t-PA treatment rate is investigated in the present study. ⋯ Prehospital transfer medicalization promotes emergency room bypass, direct radiology room admission and high thrombolysis rate in acute ischemic stroke.
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Clin Neurol Neurosurg · Sep 2013
Purely subcortical tumors in eloquent areas: awake surgery and cortical and subcortical electrical stimulation (CSES) ensure safe and effective surgery.
To analyze the efficacy and safety of cortical and subcortical electrical stimulation CSES and awake surgery to approach purely subcortical tumors in highly functional locations, particularly in guiding the choice of the best transcortical path. ⋯ Approaching purely subcortical tumors requires microsurgical skills, but in eloquent areas, functional topography monitoring is mandatory to allow safe surgery. CSES in an awake patient is a method that produces very good results in terms of resection and neurological outcome.
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Clin Neurol Neurosurg · Sep 2013
Observational StudyCerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis.
Differential diagnosis between post-neurosurgical bacterial meningitis (PNBM) and aseptic meningitis is difficult. Inflammatory and biochemical cerebrospinal fluid (CSF) changes mimic those classically observed after CNS surgery. CSF lactate assay has therefore been proposed as a useful PNBM marker. ⋯ Increased CSF lactate is a useful PNBM marker, with better predictive value than CSF hypoglycorrhachia or pleocytosis. Lactate levels ≥ 4 mmol/L showed 97% sensitivity and 78% specificity, with a 97% negative predictive value.
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Clin Neurol Neurosurg · Sep 2013
Relaxing incision of nostril sill to expand the transnasal transsphenoidal approach: technical note.
The transsphenoidal approach to the pathology of sellar region is a fundamental procedure in the armamentarium of neurosurgeons. Modern practice tends to prefer various transnasal approaches over the more traditional sublabial route. However, the transnasal approach can be limited by small nares, particularly in the pediatric population. ⋯ In our experience, the relaxing incision significantly expands the transnasal corridor and allows easy placement of the self-retaining nasal speculum or endoscopic instruments, is well tolerated by patients, and heals with no cosmetic concerns.