Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
-
Data regarding the effect of deep brain stimulation (DBS) surgery on the dopamine dysregulation syndrome (DDS), impulse control disorders (ICDs) and punding in Parkinson's disease (PD) are limited. We present a case series of 21 operated PD patients who had exhibited DDS, ICDs or punding at some stage during the disease. DDS remained unimproved or worsened post-operatively in 12/17 patients with pre-operative DDS (71%) (nine bilateral subthalamic nucleus [STN], one right-sided STN, two bilateral globus pallidus internus [GPi] DBS). ⋯ One patient had pathological gambling which resolved pre-operatively, and did not recur post-DBS. Thus, DDS, ICDs and punding may persist, worsen or develop for the first time after DBS surgery, although a minority of patients improved dramatically. Predictive factors may include physician vigilance, motor outcome and patient compliance.
-
The iatrogenic malnutrition of neurosurgical patients in intensive care units (ICU) is an underestimated problem. It may cause a decrease in plasma albumin and oncotic pressure, leading to an increase in the amount of water entering the brain and increased intracranial pressure (ICP). This study was conducted to test the hypothesis that combined high-protein parenteral and enteral nutrition is beneficial for neurosurgical patients in ICU. ⋯ During Y2, the total hours of ICP > 20 mmHg were fewer. With the Y2 nutrition, maintenance of adequate cerebral perfusion required less catecholamine medication and colloidal fluid replacement. Therefore, adequate nutrition is an important parameter in the management of neurosurgical patients in ICU.
-
Iliac crest bone graft (ICBG) remains the gold standard for promoting bony fusion of the spine. However, harvest-site infection and pain are two of the most significant drawbacks of using iliac crest autograft in spinal fusion procedures. The rationale for its continued use, despite these drawbacks, has been based on the relatively higher rate of fusion reported in the literature. ⋯ In conclusion, there is no significant difference in rates of spinal fusion using laminectomy bone autograft combined with rhBMP-2 with or without allograft, compared to historical controls using ICBG. Fusion rates may be further improved with the use of circumferential fixation. Patient satisfaction remained high and might be because the morbidity associated with harvesting ICBG was avoided, as was the additional muscle dissection required for the fusion of lateral transverse processes.
-
We report a 54-year-old man who suffered a stroke from a complete right internal carotid artery (ICA) occlusion. Two months later, he presented with right eye blindness. ⋯ He underwent a right carotid endarterectomy to prevent contralateral stroke from emboli through a patent anterior communicating artery. Recanalization of a completely occluded proximal ICA due to atherosclerotic disease has been reported but is rare, but such patients emphasize the importance of follow-up vascular studies.