World Neurosurg
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A 60-year-old female with multiple carotid aneurysms underwent endovascular treatment with a Pipeline Flex embolization device (PED) under local anesthesia via femoral puncture. ⋯ Although it was a rare complication, the phenomenon and its mechanisms were known in the carotid artery stenting procedure. To the best of our knowledge, this is the first report of cardiac arrest induced by a carotid sinus reflex during PED deployment. It is important for an operator of PED deployment to recognize its possibility. Vital signs should be closely checked during PED deployment, particularly while pushing the catheter.
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Peripheral white blood cells are regularly analyzed on admission for patients with traumatic brain injury (TBI). The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in predicting the 6-month outcome of patients with TBI is unclear. ⋯ NLR is an independent prognostic factor of predicting 6-month outcome of patients with TBI. A high NLR in patients with TBI is associated with poor outcome. The prognostic value of the NLR in predicting 6-month outcome of patients with TBI is favorable.
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Low-pressure hydrocephalus (LPH) and negative-pressure hydrocephalus (NegPH), secondary to traumatic brain injury, cerebral hemorrhage, tumor resection, and central nervous system (CNS) infection in adults, are seldom reported. They have not been recognized enough pathophysiologically in previous clinical practice. They used to have poor prognosis, and routine shunt surgery has unsatisfactory outcomes. The current classifications of hydrocephalus do not provide proper guidance for clinical practice, especially for LPH and NegPH. ⋯ Both LPH and NegPH used to have poor prognosis. However, a good prognosis can be achieved by proper management with a further understanding of the pathophysiology. A new classification for hydrocephalus was proposed according to ventricular pressure, which is necessary and reasonable.
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To the best of our knowledge, the present study is the first to assess the safety and feasibility of a modified encephalo-galeo-duro-synangiosis operation in patients with atherosclerotic carotid artery occlusion. ⋯ Encephalo-duro-galeo-synangiosis for symptomatic carotid occlusion seems to be safe and feasible and might be able to induce extracranial-to-intracranial collaterals in patients with carotid artery occlusion. Further studies are needed to define the optimal therapeutic window and yield of burr hole surgery in the treatment of symptomatic carotid occlusive disease as an adjuvant to extracranial-intracranial bypass.
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Vertebral artery injury is known to potentially occur in conjunction with blunt cervical spine trauma. Rarely, these injuries present bilaterally as complete occlusions. Twelve cases of bilateral vertebral artery occlusions after closed cervical spine trauma have been described in the reported data, nearly all of which demonstrated signs and symptoms of vertebrobasilar insufficiency and ischemia. ⋯ We present our patient's case as a rare illustration of a bilateral vertebral artery occlusion after blunt cervical spine trauma without clinical vertebrobasilar ischemic sequelae.