Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Review Case Reports
Giant PICA aneurysm presenting as intractable hiccups.
We report a 23-year-old female with rare intractable hiccups caused by a giant posterior inferior cerebellar artery (PICA) aneurysm compressing the medulla oblongata, which resolved after surgical resection of the aneurysm and decompression of the medulla oblongata. We review the literature on lesions in the posterior fossa presenting as intractable hiccups.
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We compared the clinical and radiological results of posterior atlantoaxial fixation surgery using transarticular screws to those using a polyaxial screw-rod system in 55 patients with symptomatic atlantoaxial instability. Patients underwent posterior C1-C2 fixation: 28 patients (group 1) underwent C1-C2 transarticular screw fixation and 27 patients (group 2) underwent C1 lateral mass-C2 pedicle screw fixation. Patients were followed-up for at least 24 months. ⋯ One patient in group 2 had occipital neuralgia. One vertebral artery injury occurred during the screw placement in group 1 and another in group 2 during the muscle dissection. C1-C2 transarticular screw fixation and C1 lateral mass-C2 pedicle screw fixation both produced excellent results for stabilization of the atlantoaxial complex, but the radiological outcome tended to be superior in C1 lateral mass-C2 pedicle screw fixation.
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Two patients are presented with cerebral air embolism. Neurological examination and neuroradiologic studies suggested predominant right hemispheric ischemia. Intestinal mucosal trauma allowed air introduction into the systemic vascular system and left-decubitus positioning of the patients resulted in predominant right-sided brain lesions.
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We aimed to identify the incidence, duration and causes of delayed emergence from anesthesia in patients with dystonia undergoing surgery for deep brain stimulation (DBS) placement. A retrospective review of patients with dystonia who underwent DBS placement was conducted and the following characteristics were noted: age, gender, comorbid conditions, American Society of Anesthesiologists classification, anesthetic agents used, amount of initial dose, amount of infusion dose, duration of the infusion and the time needed for emergence. Twenty-four patients underwent 33 DBS procedures for dystonia. ⋯ A possible cause of delayed emergence is excessive anesthetic potentiation of the low output pallidal state in dystonia which may depress the pallido-thalamo-cortical circuitry. Delayed emergence could also result from depression of the previously affected ventral pallidal inputs to the septo-hippocampal system that mediates general anesthesia and awareness. Complex neurotransmitter disturbances may also be involved.
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Comparative Study
Correlation between muscle atrophy on MRI and manual strength testing in hereditary neuropathies.
MRI shows areas where muscle has been replaced by fat, a process which occurs in neuropathies. The purpose of this study was to investigate the usefulness of MRI in assessing disease severity in Charcot-Marie-Tooth (CMT) and hereditary motor neuropathy (HMN) compared to manual muscle testing (MMT). ⋯ In addition, nerve length dependent denervation was confirmed in both CMT and HMN. MRI will be useful to confirm MMT findings and may be helpful for diagnosis of early or subclinical disease, as well as to further investigate the mechanisms of hereditary neuropathies.