Neurosurgery
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The possibility of neural damage during extracranial brain stimulation for motor evoked potentials (MEPs) is discussed from the perspective of animal studies in which the stimulating electrodes were in direct contact with the brain. These data indicate that the charge per phase used in most of the extracranial MEP protocols is sufficient to induce neural damage if the stimulation is applied continuously for several hours. ⋯ The possibility of such focusing may be less with magnetic field than with direct electrical field stimulation. We stress the need for additional animal studies designed to delineate a range of safe stimulus parameters for this particular technique.
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Somatosensory evoked potentials (SSEPs) and corticomotor evoked potentials (CMEPs) were utilized to study acute and chronic blunt spinal cord trauma. Rats, anesthetized with ketamine hydrochloride, were subjected to parasagittal craniectomies and midthoracic laminectomies. SSEPs were cortically recorded and CMEPs were transcortically produced using epidural ball and disc electrodes. ⋯ The results of this study suggest that the CMEP is a reliable indicator of the initial degree of loss of neurological motor function in acute blunt spinal cord injury in the rat, as well as an accurate measure of the degree and extent of recovery. The rat model as outlined here is a simple and inexpensive system for evaluation both clinically and electrophysiologically of the degree of motor recovery from spinal cord injury. This model should prove useful in the evaluation of promising pharmacological agents for potential use in the treatment of acute spinal cord injury.
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The toy BB gun that was commonly available 20 years ago has been modernized into a weapon with lethal potential. We report four children who had intracranial penetration by BBs. ⋯ Two of the children have permanent, severe neurological sequelae. BB rifles should require the same safety precautions and considerations as more traditional firearms.
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Two cases of ventriculitis with Staphylococcus epidermidis that failed on therapy with an antistaphylococcal penicillin are presented. Both infections responded to a combination of intravenous and intraventricular vancomycin and rifampin. Vancomycin and rifampin represent an important antibiotic regimen for the management of resistant infections of the central nervous system, especially with those due to S. epidermidis or methicillin-resistant Staphylococcus aureus.
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Acute mountain sickness (AMS) is usually a benign and self-limited illness that befalls previously healthy individuals who ascend rapidly to high altitude without sufficient acclimatization. In its more severe forms, AMS can progress to a life-threatening condition in which pulmonary or cerebral edema can occur singly or in concert. ⋯ The epidemiology and clinical picture of HACE are reviewed. In addition, the pathology and predominant pathophysiological mechanisms postulated to explain HACE are examined, and the present recommendations for the prevention and treatment of this dangerous and unusual form of brain swelling are discussed.