The International journal of neuroscience
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The aims of this study were to assess the clinical characteristics of patients with postoperative myasthenic crisis (PMC) and to identify the risk factors affecting the occurrence of PMC. ⋯ The important risk factors for developing PMC in generalized MG patients include the presence of bulbar symptoms, history of preoperative MC, and longer operation duration. Optimization of the preoperative evaluation and proper perioperative care of MG patients may decrease the frequency of PMC.
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Intracranial hypotension is a neurologic syndrome characterized by orthostatic headaches and, radiographically, by dural thickening and enhancement as well as subdural collections. Several of etiologies exist, including surgical dural violations, lumbar puncture, or spontaneous cerebrospinal fluid leak. Current management includes conservative management consisting of bed rest, caffeine, and hydration. When conservative management fails, open surgical or percutaneous options are considered. Currently, the gold standard in percutaneous management of intracranial hypotension involves the epidural injection of autologous blood. Recently, some therapies for intracranial hypotension have employed the use of epidural fibrin glue. ⋯ Although consideration must be afforded for the potential risks of viral transmission and aseptic meningitis, the utilization of epidural fibrin glue injection as an alternative or adjunct to the epidural blood patch in the treatment of intracranial hypotension should be further investigated.
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Observational Study
Do fluctuations in endogenous melatonin levels predict the occurrence of postoperative cognitive dysfunction (POCD)?
Delirium is a complex neuropsychiatric disorder that has an adverse impact on CNS function. Abnormal fluctuation of melatonin secretion occurs in the postoperative delirium (POD) in elderly patients. POD is strongly associated with early postoperative cognitive dysfunction (POCD). ⋯ The incidence of POCD in patients with 6-SMT fluctuation was significantly higher (p < 0.01). The results indicate that in the first week after major noncardiac surgery, POCD occurs in a significant proportion of people, and is linked to fluctuations in endogenous melatonin levels. Measurement of urinary 6-SMT during the perioperative period may assist the diagnosis of POCD.
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Cerebral white matter hyperdensities (WMH) are frequently reported on brain magnetic resonance images (MRI) of elderly people; its significance is still under debate. ⋯ From this first ever retrospective Lebanese study, WMH was reported increasingly with aging in accordance with data from the literature; PVWMH was found significantly more correlated with aging and HTN than was DWMH alone.