World Neurosurg
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Patients with subarachnoid hemorrhage (SAH) by hemorrhagic arteriovenous fistulas (AVFs) usually presents with meningeal signs, including headache and nausea, and focal neurologic deficit is found in rare cases. In this article, we report a case of acute compressive cervical myelopathy caused by hemorrhagic AVF at the craniocervical junction. ⋯ Spinal SAH alone rarely causes focal neurologic deficit. However, this case suggests spinal SAH can cause acute compressive myelopathy when complicated with preexisting spinal canal stenosis.
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Arteriovenous malformation (AVM) diffuseness has been shown to be prognostic of treatment outcomes. We assessed interobserver agreement of AVM diffuseness among physicians of different specialty and training backgrounds using digital subtraction angiography (DSA). ⋯ Agreement of individual physicians on AVM diffuseness varies from fair to substantial. Objective and three-dimensional measures of AVM diffuseness should be developed for consistent clinical application.
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Multiple sclerosis (MS) is a common autoimmune and neurodegenerative disease of the central nervous system characterized by inflammatory demyelination, axonal degeneration, and neuronal loss. The exact pathogenesis of MS remains uncertain; however, studies have shown that the development of MS is influenced by genetic and environmental factors. Cerebral aneurysms (CAs) are life-threatening lesions of cerebral vessels characterized by a bulge in the intracranial arterial wall that spontaneously ruptures. It has been hypothesized that patients with MS are at increased risk of developing cerebral aneurysms. This hypothesis can be supported by analyzing the pathogenesis and genetics of the development of MS and CA. To our knowledge, no previous studies have shown an association between MS and CA. ⋯ This report suggests a possible genetic association between MS and CAs. The strongest evidence of association was found for the TNFRSF1A gene, a proinflammatory gene that is involved in mitogen-activated protein kinase (MAPK) and NF-Kappa B signaling pathways, and has been identified as a candidate gene in the development of MS. MAPKs were also found to be elevated in CAs.
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Percutaneous vertebral augmentation with cement is used as a salvage procedure for failed instrumentation. Few studies have reported the use of this procedure for failed anterior lumbar fusion in elderly patients with osteoporosis and other complicated diseases who have undergone a previous major operation. ⋯ The injection of cement around the instrument might help to stabilize it by providing strength to the axis and preventing further loosening. This salvage procedure could be an alternative in the management of cases with failed interbody fusion.
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Hemiballismus is a rare presentation of symptomatic carotid stenosis that is underreported in the neurosurgical literature. It is characterized by severe large-amplitude movements that are classically caused by lesions of the subthalamic nucleus. Given the arterial border zone position of the subthalamic nucleus between the anterior and posterior circulation, hemodynamically compromising carotid stenosis can lead to hypoperfusion in this location. ⋯ We suggest that neurovascular imaging should be part of the initial workup of this condition and that prompt diagnosis and treatment of carotid artery stenosis in patients who present with new-onset hemiballismus are essential for reducing risk of imminent stroke.