Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Many investigators attribute the postconcussion syndrome following mild closed head injury to permanent brain damage. The evidence supporting this conclusion is reviewed, including the force necessary to cause permanent brain damage; the basis for determining whether the patient was exposed to sufficient force in the accident to permanently damage the brain; the basis for determining whether the patient actually has permanent brain damage (not just brain dysfunction) traceable to the accident; and whether the location and severity of brain damage is sufficient to account for the postconcussion syndrome. ⋯ the evidence for permanent traumatic brain damage as the cause of the postconcussion syndrome following mild closed head injury is weak.
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A prospective study was undertaken to evaluate the efficacy of spinal cord stimulation (SCS) in the management of chronic pain syndrome. The study included all patients who underwent this procedure at the Royal Melbourne Hospital and the Melbourne Private Hospital over a period of two years. A total of 29 patients were managed by the end of June 1996. ⋯ From the group of 29 patients, four patients failed to obtain any relief during the trial phase of the procedure and thus did not have the stimulator implanted permanently. From the 25 patients who proceeded to have the stimulator implanted, 11 patients had a variable beneficial response, three patients found it to be of marginal benefit, six had no benefit, three patients initially had a good response but subsequently gained no benefit whilst two patients were uncertain of its benefit. It thus appears that SCS was of benefit in 50% of our carefully selected patients with chronic pain syndromes.
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Among 462 cases of cerebral arteriovenous malformation (AVM) treated with gamma-radiosurgery, the initial presentations were haemorrhage in 68%, epilepsy in 12.8%, neurological deficits in 3.2%, minor symptoms in 7.6% and asymptomatic in 4.5% respectively. There were 79 cases (17.1%) who had had a convulsive seizure before radiosurgery and they were classified into two groups: 58 cases presented with seizure as an initial symptoms (group A) and the other 21 cases mostly had seizures following intracranial haemorrhage (group B). Before radiosurgery, generalised seizure was the predominant seizure pattern in both groups, followed by pure partial and complex partial seizures. ⋯ Seizures were either decreased or had disappeared in 91.6% of group A and 62.5% of group B patients. The overall results indicate that seizures improved in 85.5%, were changed in 11.6% and deteriorated in 2.9% of patients. Radiosurgery is effective not only for the obliteration of nidus of cerebral AVM, but also for seizure control, even before complete occlusion of the nidus.
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We describe the case of an acute cauda equina syndrome secondary to a confined subarachnoid bleed from a spinal arteriovenous malformation. The patient was elderly and made a complete neurological recovery following surgery.