Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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A subset of brain arteriovenous malformations (AVM) cannot be treated using today's treatment paradigms. Novel therapies may be developed, however, as the underlying pathophysiology of these lesions becomes better understood. Endothelial cells (EC) are the subject of new biological therapies, such as radiosensitisation and vascular targeting. ⋯ Leucocyte and platelet adherence is increased for several days post-irradiation due to increased E-selectin and P-selectin and intercellular adhesion molecule-1 expression. ET-1 is highly expressed in irradiated AVM EC. Radiosurgery produces local radiation-induced changes in EC, which may allow these changes to be harnessed in conjunction with other techniques such as vascular targeting.
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Vertebral hemangiomas (VHs) are frequently asymptomatic lesions found incidentally during investigations for other spinal problems. Symptomatic VHs are less common, and there are few reports of compressive VHs in the literature. VHs with aggressive behavior present with low signal intensity on T1-weighted and high signal intensity on T2-weighted MRI. ⋯ At follow-up (average 53 months), one patient had a recurrent tumor requiring reoperation and radiotherapy. Although it is rare, aggressive VH can be a devastating condition. Total surgical resection or subtotal resection with radiotherapy may be warranted.
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Hemichorea-hemiballismus is a rare complication of nonketotic hyperglycaemia in type 2 diabetes. It is associated with contralateral striatal radiological abnormality, most typically T1 hyperintensity on MRI. We report a case of a 91 year old woman who presented in a nonketotic hyperglycaemic state with right sided hemichorea. ⋯ The chorea improved after control of blood glucose levels. The pathophysiology of this syndrome remains controversial. It is likely that a combination of hyerglycaemia induced basal ganglia metabolic derangement and failure of cerebral blood flow autoregulation contribute to the syndrome.
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Rasmussen's encephalitis is characterized by seizures, progressive neurological deterioration and chronic inflammation of the brain. It typically presents in childhood and requires anatomic or functional hemispherectomy for seizure control. Here, we report an adult woman who presented with new onset, medically refractory seizures that were not progressive. ⋯ The pathologic samples were consistent with Rasmussen's encephalitis. The patient remained seizure free until her last follow-up at 2 years. This is an example of unique adult onset Rasmussen's encephalitis, suggesting that this encephalitis represents a wide spectrum of presentations rather than a specific disease.
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The trigeminocardiac reflex (TCR) is a common event during skull base surgery that can lead to intraoperative arterial hypotension and bradycardia. Arterial hypotension associated with TCR can be a negative prognostic factor for postoperative auditory function and ipsilateral tinnitus in patients undergoing surgery for vestibular schwannoma (VS). In this study, the contribution of TCR to postoperative auditory function in non-VS cerebellopontine angle (CPA) tumor surgery was investigated. ⋯ Of the 30 patients with preoperative functional hearing, 1/3 (33.3%) patients in the TCR group and 23/27 (85.2%) patients in the non-TCR group had functional hearing postoperatively. When patients with large tumors and functional, hearing were considered, only 33.3% of patients in the TCR group and 77.8% of patients in the non-TCR group remained within the same hearing classes following surgical treatment (p=0.1573). TCR may be a negative prognostic factor for postoperative auditory function in patients with large, non-VS CPA tumors.