Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Although there have been improvements in treatment, neuropathic pain often remains unresponsive to all treatment modalities. This pilot study assessed the efficacy of combination therapy with isoniazid for the treatment of intractable neuropathic pain. We conducted this prospective, open-label, add-on study in 45 consecutive patients who suffered from treatment-refractory neuropathic pain. ⋯ There was a significant decrease in the mean VAS score following eight weeks of treatment compared with the baseline. In addition, PGIC and mean sleep score also improved. This study suggests that combination therapy with isoniazid has potent analgesic properties and may therefore be useful in the management of intractable neuropathic pain.
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Ventriculoperitoneal shunt placement is the standard of care for idiopathic normal pressure hydrocephalus (iNPH). Studies have reported shunt complication rates up to 38%, with subdural hemorrhage rates as high as 10%. Lumboperitoneal (LP) shunts with horizontal-vertical valves (HVV) are an alternative for cerebrospinal fluid (CSF) diversion that avoids direct cerebral injury and may reduce the risk of overdrainage. ⋯ There were no neurologic complications, including no hemorrhages. Thus, LP-HVV shunt placement is a safe and effective alternative to ventriculoperitoneal shunting for iNPH, resulting in significant symptomatic improvement with a low risk of overdrainage. It should be considered as an option for the treatment of patients with iNPH who demonstrate clinical improvement following lumbar drainage.
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Randomized Controlled Trial
A randomized, placebo-controlled pilot study of patients with spontaneous intraventricular haemorrhage treated with intraventricular thrombolysis.
Intraventricular hemorrhage (IVH) occurring after spontaneous intracerebral hemorrhage (ICH) is an independent risk factor for mortality. The use of intraventricular urokinase (Uk) to reduce intraventricular blood clot volume and improve outcome was investigated. Patients with IVH requiring external ventricular drainage were recruited and randomized into a double-blind placebo controlled study. ⋯ Our results showed an increase in both the drained CSF Hb concentration in patients treated with Uk compared to placebo and in the rate of resolution clot volume. No differences were found in the other outcome measures but there was a trend towards lowered mortality in the group treated with Uk. Therefore, intraventricular Uk resulted in faster resolution of IVH with no adverse events.
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Hemifacial spasm (HFS) is usually produced by compression of the facial nerve by tortuous blood vessels at the root exit zone, including vertebrobasilar dolichoectasia (VBD). Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with a variety of symptoms, affecting mainly the skin and nervous system. ⋯ We report a 38-year-old female patient with HFS produced by VBD with NF1 presenting with other cerebrovascular abnormalities associated with this disease. We discuss the possible association between these three entities, assuming that a causal relationship may be established and that VBD is part of the spectrum of vascular abnormalities caused by NF1 in this patient.
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Review Case Reports
Cerebral blood flow velocity changes and the value of the pulsatility index post decompressive craniectomy.
Decompressive craniectomy (DC) is used to relieve intractable intracranial hypertension and/or to prevent or reverse cerebral herniation. Significant controversy exists on selection of candidates, timing of the procedure and neurologic outcomes. Furthermore, the cerebral hemodynamic consequences post-DC have been researched only recently. ⋯ To our knowledge, this is the first report on FV/PI monitoring after SOC. TCD is a readily available, non-invasive test. The PI may provide useful information regarding timing and effectiveness of DC.