Neurosurgery
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Case Reports
Paraparesis during myelography associated with a ruptured thoracic intervertebral disc.
Serious or permanent neurological complications following routine lumbar myelography are uncommon in clinical practice. We describe the sudden and dramatic onset of a symmetrical dense paraparesis in a patient after an uneventful lumbar puncture performed during myelography. A herniated thoracic intervertebral disc was subsequently diagnosed and successfully treated.
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A rare neurovascular complication of a antebrachial arteriovenous fistula in a chronic hemodialysis patient is reported. A large brachial venous pseudoaneurysm caused median neuralgia by direct compression of the nerve. Surgical resection of the pseudoaneurysm resulted in complete relief of neuralgia.
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Abnormal coagulation and fibrinolysis is a frequent complication in patients with head injury. This complication can be severe enough to lead to hemorrhage or thrombosis. A study was undertaken to determine if the hemostatic abnormalities are reliable indicators of outcome. ⋯ Other tests did not provide additional predictive value. Abnormal hemostasis frequently complicates the course of patients with head injuries. This study demonstrates that hemostasis tests are predictors of outcome in these patients.
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Multi-level cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) are well-documented causes of myelopathy. The choice of surgical procedures remain controversial. Between January 1983 and December 1987, we have performed anterior cervical vertebrectomy in 45 patients with cervical myelopathy caused by multi-level spondylosis and OPLL. ⋯ Neurological signs did not improve in 5 patients (11%). One patient died because of agranulocytosis secondary to treatment with antibiotics. In conclusion, cervical cord compression caused by lesions located principally in the anterior aspect of the spinal canal may be completely relieved via anterior vertebrectomy, discectomy, removal of the calcified ligament, and fusion.
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Biography Historical Article
The Johns Hopkins medical centennial. 1889-1989: a century of neurosurgery.