Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Case Reports
Twiddler's syndrome in a patient with a deep brain stimulation device for generalized dystonia.
Deep brain stimulation (DBS) is the technique of neurostimulation of deep brain structures for the treatment of conditions such as essential tremor, dystonia, Parkinson's disease and chronic pain syndromes. The procedure uses implanted deep brain stimulation electrodes connected to extension leads and an implantable pulse generator (IPG). Hardware failure related to the DBS procedure is not infrequent, and includes electrode migration and disconnection. ⋯ Patients with mental disability, elderly and obese patients are at increased risk. Twiddler's syndrome should be suspected whenever there is a failure of the DBS device to relieve symptoms previously responsive to stimulation. Surgical correction is usually required.
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We aimed to analyze the clinical, radiological, surgicopathological and clinical outcome data of patients who underwent surgery for central nervous system (CNS) hemangioblastoma (HBL) with or without von Hippel-Lindau (VHL) disease. The clinico pathological and radiological findings, management and clinical outcome of patients with CNS HBL (operated between 2000 and 2009) were analyzed retrospectively. The differences between sporadic and VHL-associated HBL were analyzed. ⋯ Of all patients with VHL disease, three required multiple surgeries for new lesions and one died of renal failure and sepsis. Among the patients with sporadic disease (31/39), two died of surgical complications, one died of postoperative sepsis, three were lost to follow-up and the remainder had resolution of symptoms at 1year following surgery. We concluded that the diagnosis of VHL disease is important as management is more difficult and lifelong follow-up and counseling are required in these patients and for their at-risk relatives.
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Case Reports
Cerebral infarction secondary to vasospasm after perimesencephalic subarachnoid hemorrhage.
Perimesencephalic subarachnoid hemorrhage (pSAH) has been described as a distinct form of subarachnoid hemorrhage (SAH) associated with good outcomes. We report a 48-year-old female who developed cerebral infarction due to severe diffuse vasospasm following pSAH. The patient presented with non-aneurysmal pSAH and was discharged home on day 5. ⋯ A brain MRI showed acute infarctions on diffusion weighted imaging and her cerebral angiogram showed diffuse vasospasm. The patient received intra-arterial diltiazem and hypervolemic-hypertensive-hemodilution therapy with resulting resolution of the vasospasm and hemiparesis. While not as common as in SAH, there is a potential for the occurrence of cerebral infarction due to vasospasm after pSAH.
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The discovery of transient receptor potential (TRP) receptors has advanced understanding of temperature sensation, and pre-clinical studies have identified TRP as major novel analgesic targets in inflammatory and neuropathic pain states. We systematically investigated the sensory effects and interactions of TRP agonists capsaicin (TRPV1), menthol (TRPM8) and cinnamaldehyde (TRPA1) applied topically to the skin in 14 healthy human participants. ⋯ Menthol caused cold hypersensitivity and cinnamaldehyde caused heat hypersensitivity, but neither had an effect on evoked potentials. The CHEP after application of capsaicin show features observed in some patients with painful neuropathy, and could provide a model for development of novel analgesics, particularly TRPV1 antagonists.
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This study was undertaken to determine variables that could predict, in the preoperative period, the likelihood for the need for intraoperative temporary arterial occlusion using clips (temporary clipping) when surgically repairing intracranial aneurysms. Data collected prospectively between October 1989 and March 2010 of 1129 unruptured intracranial aneurysms in 934 patients who were managed surgically was examined retrospectively. Temporary clipping was used in 400 patients (35.4%). ⋯ Basilar caput aneurysms larger than 10mm were always managed with temporary clipping. There was no combination of factors studied that consistently predicted that temporary clipping would not be needed. Therefore, the potential need for temporary clipping must be considered for every patient with an aneurysm.