Neurosurgery
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Observational Study
Current Practice Trends for Use of Early Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage.
Venous thromboembolism (VTE) is common after intracerebral hemorrhage (ICH). Guidelines recommend early VTE prophylaxis. ⋯ Nationwide, the large majority of ICH patients receive early mechanical VTE prophylaxis only, without CP. Patient comorbidities and hospital characteristics such as geographic location are determinants of higher use of early CP.
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After transsphenoidal surgery, delayed hyponatremia (DH) is the leading cause of 30-d unplanned hospital readmissions. ⋯ Although more DH patients were identified after care pathway implementation, readmission rates were not reduced and clinical outcomes were not changed. Because DH onset timing varies, some patients have highly acute presentation, and most readmitted patients develop symptoms before reaching their sodium nadir, close symptom monitoring may be a reasonable alternative to routine screening.
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Case Reports
Hourglass-Like Constriction of the Brachial Plexus in the Posterior Cord: A Case Report.
Hourglass-like constrictions are fascicular conditions confirmed definitively by interfascicular neurolysis. Certain peripheral nerves have vulnerable areas such as around the elbow in the posterior interosseous nerve. We report the first hourglass-like constriction in the brachial plexus supplying the radial innervated forearm musculature. Preoperative magnetic resonance imaging (MRI) findings of the brachial plexus were consistent with neuralgic amyotrophy (NA). ⋯ Hourglass-like constrictions can occur in the brachial plexus. Although surgical approaches for the constrictions are still controversial, several reports demonstrated their effectiveness. Meanwhile, concerning NA treatment, evidence on the surgical intervention is lacking. Brachial plexus MRI might help in discerning the lesion and planning treatment options including surgical interventions. Hourglass-like constrictions are a possible etiology for certain NA patients with residual symptoms or paresis.
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A critical conceptual step in epilepsy surgery is to locate the causal region of seizures. In practice, the causal region may be inferred from the set of electrodes showing early ictal activity. There would be advantages in deriving information about causal regions from interictal data as well. We applied Granger's statistical approach to baseline interictal data to calculate causal interactions. We hypothesized that maps of the Granger causality network (or GC maps) from interictal data might inform about the seizure network, and set out to see if "causality" in the Granger sense correlated with surgical targets. ⋯ GC analysis has the potential to help localize ictal networks from interictal data.