Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Review Case Reports
Thromboembolic stroke associated with thoracic outlet syndrome.
Thoracic outlet syndrome occurs due to compression of the neurovascular structures as they exit the thorax. Subclavian arterial compression is usually due to a cervical rib, and is rarely associated with thromboembolic stroke. The mechanism of cerebral embolisation associated with the thoracic outlet syndrome is poorly understood, but may be due to retrograde propagation of thrombus or transient retrograde flow within the subclavian artery exacerbated by arm abduction. We report an illustrative patient and review the clinical features, imaging findings and management of stroke associated with thoracic outlet syndrome.
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Endoscopic extradural anterior clinoidectomy and optic nerve decompression through a pterional port.
Since the first description of the intradural removal of the anterior clinoid process, numerous refinements and modifications have been proposed to simplify and enhance the safety of the technique. The growing use of endoscopes in endonasal and transcranial approaches has changed the traditional management of many skull base lesions. We describe an endoscopic extradural anterior clinoidectomy and optic nerve decompression through a minimally invasive pterional port. ⋯ An extradural approach helped minimize complications associated with infraction of the subdural space and allowed for the maintenance of visibility while drilling with continuous irrigation. Adequate 270° bone decompression of the optic canal was achieved in all specimens. Endoscopic extradural anterior clinoidectomy and optic nerve decompression is feasible through a single minimally invasive pterional port.
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To our knowledge, the risk factors for intracranial hemorrhage from dural arteriovenous fistula (DAVF) have not been systematically described, due to the complexity of their anatomy and low incidence. We performed this retrospective study to investigate the DAVF factors predicting intracranial hemorrhage. A 10year database of 144 consecutive patients with DAVF was reviewed. ⋯ Secondary multivariate logistic regression analysis with sex, lesion location, and venous drainage pattern showed that only venous drainage pattern was statistically significant in predicting intracranial hemorrhage (p<0.05). Therefore, venous drainage pattern, particularly the cortical venous drainage, significantly predicts intracranial hemorrhage from DAVF. Both sex and lesion location may be confounding factors in predicting intracranial hemorrhage from DAVF, while the other factors may not be associated with hemorrhage.
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Case Reports
Hypoventilation in glycine-receptor antibody related progressive encephalomyelitis, rigidity and myoclonus.
Glycine receptor (GlyR) antibodies have been identified in patients with rigidity and hyperekplexia, but the clinical phenotype associated with these antibodies has not been fully elucidated. The clinical features in two additional patients with GlyR antibodies are described. A 55-year-old man presented with stimulus-induced hyperekplexia and rigidity in the lower limbs and trunk. ⋯ She responded to benzodiazepines and has remained in remission. The clinical picture associated with GlyR antibodies includes autonomic dysfunction, cardiac arrhythmias and hypoventilation. It is important to recognise these serious complications early to limit mortality from this treatable condition.
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Use of an external ventricular drain (EVD) is essential for managing patients with hydrocephalus or intracranial hypertension. While this procedure is safe and efficacious, ventriculostomy-associated infections (VAI) continue to cause significant morbidity. In this study, we evaluated the efficacy of antibiotic-coated EVD (AC-EVD) in reducing the occurrence of VAI. ⋯ The mean duration between catheter insertion and positive cerebrospinal fluid culture was significantly greater in the AC-EVD group versus the uncoated EVD group (15±4days versus 4±2days, respectively; p=0.001). In the uncoated EVD group, 17 of 69 patients (24.6%) were dead at 3years versus 12 of 76 (15.8%) patients in the AC-EVD group (p=0.21). The overall VAI rate was 6.9% with a trend toward lower infection rates in the AC-EVD group compared to the uncoated EVD group (3.9% versus 10.1%, respectively; p>0.05).