The International journal of neuroscience
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Case Reports
Aneurysmal subarachnoid hemorrhage with concomitant posterior communicating artery fenestration.
Fenestrations of the posterior communicating artery (PCoA) are extremely rare. Associated aneurysms have only been documented three times in the literature, and none associated with a subarachnoid hemorrhage. ⋯ Surgical management included surmising the etiology of the subarachnoid hemorrhage with subsequent clipping of both the right PCoA and MCA aneurysm. The potential embryological mechanisms leading to a PCoA fenestration are discussed.
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Studies have demonstrated that the cerebrospinal fluid-contacting nucleus (CSF-CN) is involved in neuropathic pain, but the underlying molecular mechanisms still largely remain obscure. Emerging evidence suggests that spinal Wnt5a plays a crucial role in regulation of chronic pain. However, little is known about the potential role of the supraspinal Wnt5a in the development of chronic pain. ⋯ In the present study, we demonstrated that Wnt5a is distributed in the CSF-CN and the Wnt5a protein was up-regulated by nerve injury-induced nociceptive stimuli. Furthermore, lateral intracerebroventricular injection of Wnt5a antagonist Box5 attenuated the chronic constriction injury (CCI)-induced neuropathic pain and down-regulated the expression of Wnt5a in the CSF-CN. These data extend our understanding of the role of Wnt5a in supraspinal site and demonstrate that the CSF-CN participates in nerve injury-induced neuropathic pain via the regulation of Wnt5a.
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Recent data suggest how adverse events occur more frequently after Implantable Pulse Generator (IPG) replacement than during the deep electrode positioning in patients treated with Deep Brain Stimulation (DBS). For instance, erroneous extension adjustment to change in laterality and inaccurate lead connection represent problems, which strongly affect patients' outcome. We analyzed our data after 13 years of IPG replacement. ⋯ Our surgical and postoperative management demonstrates how to avoid some important adverse events with some easy steps, without any discomfort for the patients in terms of duration of surgery or longer hospitalization. Thus, stability of symptoms after the IPG replacement may be easily guaranteed during the first postoperative period.
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We performed a cross-sectional study of 82 Chinese patients with Parkinson's disease (PD) enrolled during an 18-month period. We used a clinical interview to evaluate a Chinese version of the nonmotor symptoms questionnaire (NMSQuest) as an instrument for measuring the nonmotor symptoms (NMS) in Chinese patients with PD. The patients' cognitive deficit, depression/sleep, disease severity and motor status were assessed based on the mini-mental state examination (MMSE), the Hamilton depression scale (HAMD)/Parkinson's disease sleep scale (PDSS), the modified Hoehn and Yahr staging scale (H&Y) and the unified Parkinson's disease rating scale part III (UPDRS III), respectively. ⋯ Our results indicate that the Chinese version of the NMSQuest, a useful screening tool, can be considered as a comprehensive, practical measure for NMS evaluation in Chinese PD patients. The NMSQuest highlights the prevalence of the wide range of NMS and indicated good responsiveness and interpretability. We strongly recommend routine use of the simplified Chinese version of NMSQuest in this country.
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Neurological complications are common in general medical and surgical intensive care units (ICU); they can prolong ICU and hospital stay and worsen outcome, including mortality. We performed a descriptive analysis of neurological consultations in non-neurological ICUs to determine the frequency of various neurological complications and to assess the diagnostic yield, therapeutic implications and prognostic benefit of these consultations. This is a retrospective single group cohort study of all neurological consultations for patients admitted to non-neurological (medical, respiratory care unit, cardiac, cardiothoracic, surgical and trauma) ICUs at Saint Marys Hospital (Mayo Clinic, Rochester) over a 24-month period (01 January 2010 to 31 December 2011). ⋯ Encephalopathy, stroke, seizure and anoxic brain injury were the most common causes of neurological complications in non-neurological ICUs with sedatives and opiates being the most common cause of encephalopathy. Almost half of the patients had change in treatment following neurological consultation. Neurological consultations in non-neurological ICU's are beneficial for patient's care in terms of diagnosis, treatment and prognosis.