Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Uncal herniation through the tentorial notch is occasionally associated with false localizing ipsilateral hemiparesis, known as the Kernohan-Woltman notch phenomenon (KWNP). We report an 81-year-old female who presented with a decreased level of consciousness, a right mydriasis and an ipsilateral motor deficit caused by a large right hemispheric subdural hematoma that was immediately evacuated. ⋯ A follow-up MRI showed a residual lesion in the left cerebral peduncle, corresponding to KWNP. The presence of such a structural lesion suggests a poor prognosis for recovery from the initial motor deficit.
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Spontaneous cerebellar haemorrhage following spinal surgery is rare, with fewer than 20 patients reported in the literature. We present a 70-year-old woman who underwent a L5-S1 posterior lumbar interbody fusion for spondylolisthesis. ⋯ The patient became increasingly drowsy 36 hours later. She was subsequently found to have bilateral cerebellar haemorrhages with associated non-communicating hydrocephalus.
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The year 2009 marks the 100th anniversary of the first Nobel Prize to be awarded to a surgeon, Emil Theodor Kocher. Kocher was a surgical pioneer and in 1909 was awarded the Nobel Prize in Physiology or Medicine for his contributions to the understanding and treatment of the thyroid gland. ⋯ He published articles on traumatic epilepsy, brain damage and trepanation. Together with Harvey Cushing, they pioneered and expanded on research of the physiology of intracranial pressure, which led to the advent of the Cushing-Kocher theory.
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Review Meta Analysis
A meta analysis of treating subarachnoid hemorrhage with magnesium sulfate.
Despite the publication of several randomized controlled studies, there is still much debate on whether magnesium sulfate improves outcome in patients with aneurysmal subarachnoid hemorrhage. Here we present data to assess the clinical effectiveness of magnesium sulfate in the prevention of cerebral vasospasm in patients who have suffered from aneurysmal subarachnoid hemorrhage. The EMBASE and PubMed databases were searched using the following terms: "magnesium sulfate" or "MgSO(4)" with "subarachnoid hemorrhage" or "cerebral vasospasm". ⋯ The occurrence of poor outcome (death, vegetative state, or dependency) in patients treated with magnesium sulfate was less likely than control group patients (odds ratio [OR] 0.54 [95% confidence interval, CI 0.36-0.81]). Mortality rates did not differ between magnesium sulfate (14%) and control treated (12%) patients (OR 1.16 [95% CI 0.51-2.65]). Our results indicate that although there was reduced likelihood of a poor outcome for patients treated with magnesium sulfate after SAH, patient mortality was not improved.
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Randomized Controlled Trial Comparative Study
The treatment of first division idiopathic trigeminal neuralgia with radiofrequency thermocoagulation of the peripheral branches compared to conventional radiofrequency.
The aim of this study was to prospectively evaluate and compare the effects of radiofrequency thermocoagulation of the first division branches of the trigeminal nerve (trigeminal peripheral division radiofrequency thermocoagulation, PRT) versus conventional radiofrequency (CRF) in the treatment of first division idiopathic trigeminal neuralgia (ITN). Fifty patients with first division ITN were randomly divided into two groups. The 20 patients in group 1 were treated with CRF, while the remaining 30 patients in group 2 were treated using PRT. ⋯ The recurrence rates of ITN at the 3-year follow-up were 25% and 27% for group 1 and group 2, respectively, and 35% and 40%, respectively, 5 years after treatment. There were no significant differences between groups 1 and 2 at any time. Our study demonstrates that PRT is an effective way to treat first division ITN.