Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Occipital condyle fractures are rare. When present, they produce lower cranial palsies and/or brainstem dysfunction. A 32 year old man sustained multiple injuries. ⋯ They may be associated with lower cranial nerve palsies. As demonstrated by this case, this entity should be included in the differential diagnosis of hypoglossal palsy. Since occipital condyle fractures can exist without neurological deficits, special attention should be paid to imaging of the craniovertebral junction in patients with head injury.
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Clinical Trial
Role of single photon emission computed tomography and transcranial Doppler ultrasonography in clinical vasospasm.
This report presents our experience with Transcranial Doppler (TCD) ultrasonography and Single Photon Emission Computed Tomography (SPECT) in the assessment of patients with aneurysmal subarachnoid haemorrhage (SAH). It was designed to evaluate clinical vasospasm with both TCD and SPECT and determine their diagnostic value. Twenty-eight consecutive patients were examined with both TCD and SPECT, performed within 24 hours of each other. ⋯ TCD and SPECT sensitivity for clinical vasospasm was 100% and 50% respectively, their specificity was only 20% and 60%. TCD sensitivity for symptomatic vasospasm was found to be excellent, whereas SPECT was not found to be as useful. We conclude that TCD is the preferred method in the evaluation of patients with subarachnoid haemorrhage.
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Although previous studies have found automated percutaneous discectomy and epidural percutaneous discectomy to be less efficacious than conventional discectomy, these percutaneous procedures may be effective and cost-effective as a first surgical treatment for herniated lumbar disc. Percutaneous procedures for herniated lumbar disc continue to be performed throughout the world without definitive evidence of efficacy or effectiveness. The objective of this article is to report the design considerations and final design of a study with the following objectives: (1) to estimate the efficacy of automated percutaneous and conventional discectomy in treating single level herniated lumbar discs in comparable patient populations, and (2) to test the hypothesis that the use of percutaneous discectomy as the first surgical procedure in such patients would result in less cost and fewer complications than utilizing conventional discectomy as the first procedure. ⋯ Despite using established eligibility criteria, our patient enrollment was lower than expected. Academic health centers and traditional research settings are seeing fewer patients who would be eligible for discectomy; private clinical centers are treating eligible patients but lack the incentives to participate in clinical research. Automated percutaneous discectomy and epidural percutaneous discectomy are widely performed procedures and, despite the aforementioned obstacles, their efficacy and cost-effectiveness need to be scientifically evaluated if we are committed to delivering appropriate patient care.
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Extracranial to intracranial internal carotid artery bypass surgery with vein is well described for a number of diverse conditions. They provide high blood flow with good initial patency. However, long term patencies for specific graft types remains unknown. ⋯ One patient developed a delayed asymptomatic stenosis within the vein graft requiring stenting. Because of the high initial management risks this technique of common carotid to intracranial internal carotid artery saphenous vein bypass surgery should be reserved for patients at considerable risk by alternate management. However, once the acute postoperative period is past the bypass appears to be robust and capable of supplying the entire distribution of a normal internal carotid artery.
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This study was intended to investigate the pre- and postoperative profile of seizures in the patients with cerebral arteriovenous malformations (AVMs). The patients consisted of 46 consecutive cases with supratentorial AVMs operated on from May 1987 to May 1993. Their postoperative mean follow-up duration was 60 months. ⋯ About 70% of the patients with preoperative seizures showed seizures postoperatively, while those without preoperative seizures developed seizures postoperatively in 35%. Regarding postoperative intractable seizures, 57% of the group with preoperative intractable seizures remained intractable postoperatively. In conclusion, removal of AVMs did not change the overall incidence of seizures, and patients with large sized AVMs and preoperative seizure had a higher possibility of postoperative seizures.