Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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The objective of the research was to compare the efficacy of lateral and bilateral PKP approaches for OVCFs. A comprehensive literature search was performed from the PubMed, Cochrane Library and Embase between January 2008 and May 2017. The clinical efficacy of the two approaches was evaluated by comparing perioperative outcomes (operation time, the volume of injected cement, X-ray exposure times and mean radiation dose), clinical outcomes (kyphotic angle reduction, restoration rate, visual analogue scale [VAS], Oswestry Disability Index [ODI] and SF-36), and operation-related complications (cement leakage and adjacent vertebral fracture). ⋯ However, the pooled results revealed no significant difference in X-ray exposure times, kyphotic angle reduction, restoration rate, VAS, ODI, SF-36 and adjacent vertebral fracture. Our study presented that patients with OVCFs could obtain similar satisfactory clinical results via both unilateral and bilateral PKP approaches. Considering less operation time, less cement volume, lower mean radiation dose of patients, a lower rate of cement leakage and less surgery-related costs, we suggest that a unilateral PKP approach is advantageous.
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Case Reports
Pseudomeningocele and percutaneous intrathecal lead placement complication for spinal cord stimulator.
The incidence of symptomatic percutaneous intrathecal subarachnoid lead placement for spinal cord stimulator is almost an unheard of complication in the literature. We present the first case of a spinal cord stimulator implant with a complication of symptomatic intrathecal subarachnoid lead placement with a pseudomeningocele. ⋯ This case illustrates a spinal cord stimulator implant complication of intrathecal percutaneous lead placement with pseudomeningocele and its recognition and treatment involving replacement of the system while minimizing risk of postoperative cerebrospinal fluid leakage. Intraoperative neuromonitoring and interrogation of the spinal cord stimulator system during implantation are effective tools for accurate epidural lead placement.
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Pantothenate kinase-associated neurodegeneration (PKAN) is extremely rare. In this study, we aimed to evaluate the magnetic resonance imaging (MRI) findings of PKAN patients. Conventional MRI and susceptibility weighted imaging (SWI) sequences and quantitative susceptibility mapping (QSM) maps of six patients from three PKAN families and eight healthy male volunteers were retrospectively analyzed. ⋯ No significant differences were observed in the right RN, bilateral thalamus and bilateral occipital regions. Low signals on SWI sequences and high QSM values with a reversed eye-of-the-tiger sign on QSM maps are important for the diagnosis of PKAN, especially in patients who do not show the eye-of-the-tiger sign in early stages. The eye-of-the-tiger sign observed on T2WI is helpful in diagnosing PKAN when the disease has already progressed to an advanced stage.
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Case Reports
Acute reversal of dabigatran with Idarucizumab for intravenous thrombolysis as acute stroke treatment.
Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke (AIS) is contraindicated in patient taking either Factor Xa inhibitors or direct thrombin inhibitors. Idarucizumab completely reverses the biologic effect of dabigatran within minutes. Intravenous rt-PA treatment results in a significant benefit in functional outcome when administered 3-4.5 h after stroke onset or last seen normal time. ⋯ The patient did not experience any symptomatic or asymptomatic intracranial hemorrhage after treatment or through day 90. Though no randomized evidence exists for the risk of IV rt-PA after dabigatran reversal with Idarucizumab, the case experiences are mounting. This case of successful stroke treatment after reversal adds to the anecdotal literature and supports the study of dabigatran reversal with Idarucizumab for thrombolysis in AIS.