Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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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).
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We report an unusual finding of bilateral facial and corporeal diaphoresis and sensation of heat during deep brain stimulation in two patients. Stimulation of the hypothalamospinal tract located medial to the subthalamic nucleus is likely to be responsible for this side effect.
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Review Case Reports
Valproate induced hyperammonemic encephalopathy successfully treated with levocarnitine.
Valproate-induced hyperammonemic encephalopathy is an unusual but serious adverse effect that is usually characterized by the acute onset of impaired consciousness, focal neurological symptoms and increased seizure frequency. It has been reported to occur at therapeutic valproate levels. We report a patient who developed valproate-induced hyperammonemic encephalopathy after a short treatment with valproate and was successfully treated with levocarnitine. We discuss this patient and review the literature regarding the use of levocarnitine in similar patients.
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Cerebrovascular anastomosis (for example in the management of Moyamoya disease or complex aneurysms) is a rarely performed but essential procedure in neurosurgery. Because of the complexity of this technique and the infrequent clinical opportunities to maintain skills relevant to this surgery, laboratory training is important to develop a consistent and competent performance of cerebrovascular anastomosis. We reviewed the literature pertaining to the training practices surrounding cerebrovascular anastomosis in order to understand the ways in which trainees should best develop these skills. ⋯ After gaining sufficient dexterity, the trainee will be able to practice using biological materials followed by high fidelity models prior to actual surgery. Unfortunately, the effectiveness of each model has generally, to our knowledge, only been judged subjectively. Objective quantification methods are necessary to accelerate the acquisition of competence.