Neurosurgery
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The SAMMPRIS (Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) trial, comparing aggressive medical vs stent treatment in patients with symptomatic intracranial stenosis, was halted after a 14% stroke and death rate was observed in the stent-treated group. ⋯ The overall 30-day postprocedure stroke and death rate in our study was lower in both SAMMPRIS-eligible and -ineligible groups than the reported 14% stroke and death rate in the SAMMPRIS trial. We hypothesize that a more judicious use of primary angioplasty may be responsible for better postprocedure outcomes and should be considered an acceptable treatment in future trials.
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Although it is generally agreed upon that surgery for high-grade spondylolisthesis (HGS) is associated with more complications than low-grade spondylolisthesis, its description is primarily based on case reports and relatively small case series. ⋯ This study provides short-term complication rates associated with surgical treatment for HGS in adult and pediatric patients and may prove valuable for patient counseling, surgical planning, and in efforts to improve the safety of patient care.
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Knowledge of the properties of white matter fiber tracts isa crucial and necessary step toward a precise understanding of the functional architecture of the living human brain. Previously, this knowledge was severely limited, as it was difficult to visualize these structures or measure their functions in vivo. The HCP has recently generated considerable interest because of its potential to explore connectivity and its relationship with genetics and behavior. ⋯ From a range of ongoing connectomics related activities, the systematic characterization of brain connectedness and the resulting functional aspects of such connectivity will not only realize the work of Ramón y Cajal and others, but will also greatly expand our understanding of the brain, the mind, and what it is to be truly human. The similarities and differences that mark normal diversity will help us to understand variation among people and set the stage to chart genetic influences on typical brain development and decline during aging. What is more, an understanding of how brains might become disordered will shed light on autism, schizophrenia, Alzheimer’s, and other diseases that exact a tremendous and terrible social and economic toll.
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Review Case Reports
Thoracic myelopathy due to an intramedullary herniated nucleus pulposus: first case report and review of the literature.
Herniation of intervertebral discs is relatively common. Migration usually occurs in the ventral epidural space; very rarely discs migrate in the subdural space. No cases of intradural intramedullary disc have been reported in humans. ⋯ Intradural intramedullary migration of a herniated intervertebral disc is extremely rare but should be considered in the differential. It may present in a variety of clinical scenarios, including thoracic myelopathy, and mimic intramedullary spinal cord tumor.