Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Our retrospective study was carried out to demonstrate the value of, indications for, and results of use of the posterolateral approach (PLA) with decompression and instrumental stabilisation in paediatric patients with unstable vertebral body fractures at the thoracic-lumbar junction. ⋯ The PLA makes if possible to define a proper surgical corridor to accomplish all surgical goals in the treatment of spinal fractures in children: decompression, spinal alignment and stabilisation minimising the surgical stress, that are essential in paediatric surgery. It allows early mobilisation and an early start on the rehabilitative treatment, which is very important in children and is difficult to reconcile with bracing and a long period of bed rest as recommended for conservative treatment.
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The authors present a rare case of ossified chronic epidural hematoma. A 13-year-old female patient presented with an ossified chronic epidural hematoma. She had sustained a head injury about 10 weeks previously and had received conservative care for a delayed-onset epidural hematoma at a local hospital. Ossification was identified about 4 weeks after the head injury and then progressed rapidly. A chronic epidural hematoma with a thick collagenous capsule and newly formed bone was removed 73 days after the head injury. ⋯ An epidural hematoma with mild symptoms can be treated conservatively. When, however, the hematoma is observed not to be naturally absorbed during serial follow-up examinations, surgical removal must be considered, even if the patient's condition is good, because this entity carries the risk of bone calcification and ossification.
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There are controversies over the pattern of glial differentiation in spinal open neural tube defect (ONTD) at the prenatal stage. A surgical model of ONTD allows a more precise comparison of glial differentiation between the ONTD and control groups than chemical and genetic models. ⋯ The results reveal that ONTD promotes astrocytic differentiation and prolongs expression of radial glial fibers, which seems to be a reaction to the damage caused by exposure of the spinal cord tissue to amniotic fluid.
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Review Case Reports
Intrathecal baclofen withdrawal: a case report and review of the literature.
Spasticity is an endpoint of a variety of neurologic disorders with upper motor neuron damage. There have been several studies demonstrating improvement in spasticity through administration of intrathecal baclofen. Withdrawal from oral baclofen has been well described. Intrathecal baclofen withdrawal has been less frequently reported. We present a case of withdrawal after intrathecal baclofen pump catheter failure. ⋯ Intrathecal baclofen withdrawal can be life threatening. Prompt recognition and restoration of an adequate intrathecal baclofen dose is essential for recovery.
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THALAMUS: The human thalamus is a nuclear complex located in the diencephalon and comprising of four parts (the hypothalamus, the epythalamus, the ventral thalamus, and the dorsal thalamus). The thalamus is a relay centre subserving both sensory and motor mechanisms. Thalamic nuclei (50-60 nuclei) project to one or a few well-defined cortical areas. ⋯ Involvement of the basal ganglia is related to involuntary and stereotyped movements or paucity of movements without involvement of voluntary motor functions, as in Parkinson's disease, Wilson's disease, progressive supranuclear palsy or Huntington's disease. The symptoms differ with the location of the lesion. The commonest disturbances in basal ganglia lesions are abulia (apathy with loss of initiative and of spontaneous thought and emotional responses) and dystonia, which become manifest as behavioural and motor disturbances, respectively.