World Neurosurg
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Transient loss of consciousness (LOC) is one of the most common presentations of aneurysmal subarachnoid hemorrhage (SAH) and may be an indicator of early brain injury. In this study, we examined the association of LOC and functional outcomes in patients with good-grade SAH. ⋯ LOC at ictus of SAH is associated with a higher rate of unfavorable functional outcomes but not of mortality, DCI, or rebleed in patients with good-grade SAH. Future studies should further investigate the putative mechanisms through which LOC mediates early brain injury in SAH.
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Fiber dissection studies of the cerebrum have focused on the lateral surface. No comparable detailed studies have been done on the medial and inferior surfaces. The object of this study was to examine the fiber tracts, cortical, and subcortical structures of the medial and inferior aspects of the brain important in planning operative approaches along the interhemispheric fissure, parafalcine area, and basal surfaces of the cerebrum. ⋯ Understanding the fiber network underlying the medial and inferior aspects of the brain is important in surgical planning for approaches along the interhemispheric fissure, parafalcine area, and basal surfaces of the cerebrum.
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Randomized allocation of treatment options is not well accepted within the clinical community. Some methods of implementation may be received more favorably than others. Prerandomization may be an acceptable means to facilitate recruitment in some clinical trials. ⋯ Until the ethical functions of randomized allocation of selected treatment options in the care of patients are recognized by the neurovascular community, Zelen's prerandomization may help recruitment into difficult trials and contribute a means to provide best possible care in the presence of uncertainty.
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Case Reports
Neglected Recurrent Scalp sinus: Calvarial Tuberculosis with Intracrnial and Extracranial Extension.
Calvarial tuberculosis (TB) with intracranial tuberculoma and skin involvement is rare condition even in endemic regions. ⋯ Calvarial TB manifests with various clinical features, and strong clinical suspicion is needed to diagnose and treat it. Only a few cases of calvarial TB with either skin involvement or intracranial extension have been reported in the literature. The present case was challenging to diagnose with a rare presentation involving both intracranial and extracranial extension.
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A subset of surgically treated patients with traumatic brain injury (TBI) cannot be stabilized by initial surgery. Mobile computed tomography (CT) provides real-time information for diagnosis in these TBI surgically high-risk (TBI-SHR) patients. The objective of this study was to analyze a 5-year series of TBI-SHR patients to evaluate the impact of intraoperative mobile CT (imCT) on prognosis. ⋯ The use of imCT is associated with better neurologic outcomes at discharge days compared with the use of fixed-unit CT in TBI-SHR patients.