Surg Neurol
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Hyponatremia following subarachnoid hemorrhage (SAH) occurs due to the inappropriate secretion of antidiuretic hormone (SIADH). However, this condition is also sometimes associated with certain dehydration states. ⋯ Hyponatremia following SAH therefore appears to be the result of increased natriuresis, due to the inappropriate elevation of ANP rather than SIADH. In this situation, water restriction should not be recommended, since the circulatory volume is decreased.
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Intramedullary tumors of the cervical spinal cord are common and many believe they are amenable to an aggressive approach. However, surgical removal of intramedullary tumors of the cervical spinal cord is still controversial because of the great risk of respiratory dysfunction or quadriplegia or both upon resection of the tumor. ⋯ We conclude that intramedullary tumors of the cervical spinal cord are amenable to total surgical removal. Surgery is suitable when a patient presents with a moderate neurologic deficit. Proficient surgical technique for total tumor resection is necessary for good results. Preoperative radiotherapy contributes to difficult surgery and poor prognosis, and is not recommended.
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Comparative Study
Spinal cord stimulation for chronic pain in peripheral neuropathy.
Spinal cord stimulation (SCS) has been used for the relief of chronic, intractable pain for over 2 decades. Recent technologic improvements in hardware have resulted in improved clinical outcome. We report our experience with epidural spinal cord stimulation for pain control of peripheral neuropathy for the past 15 years. ⋯ SCS is an effective therapy for pain syndromes associated with peripheral neuropathy. Causalgic and diabetic neuropathic pain seem to respond relatively well. whereas postherpetic pain and intercostal neuralgia syndromes seem to respond less favorably to the long-term beneficial effects of SCS. This information will be useful in the selection of patients with peripheral neuropathic pain who could be helped by SCS.
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Microvascular decompression (MVD) of the trigeminal nerve is a well-established procedure for the treatment of idiopathic trigeminal neuralgia. Multiple sclerosis (MS) has long been considered a contraindication for this procedure, due to the known polycentric nature of the disease. Medical treatment followed by percutaneous procedures provide relief for the great majority of these patients. There exists a small subgroup of patients with trigeminal neuralgia who are diagnosed with MS only after a microvascular decompression procedure has been performed. Furthermore, management of the patient with known MS whose pain continues to recur, despite maximal medical therapy and multiple percutaneous procedures, can be exceedingly difficult. ⋯ Patients with MS and symptoms of typical trigeminal neuralgia may benefit from exploration of the cerebellopontine angle and partial sectioning of the nerve. MVD alone fails to provide adequate or reliable relief of pain.