World Neurosurg
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Review
The Management of Hypertension in the Pre-Aneurysmal Treatment Sub-arachnoid Haemorrhage Patient.
Management of hypertension in subarachnoid hemorrhage patients within the preaneurysmal treatment period remains ambiguous, in part due to the lack of high-level, evidence-based guidelines. Despite this, current recommendations offer guidance regarding certain parameters (e.g., mean arterial pressure, systolic blood pressure). However, managing hypertension within this critical period is difficult because a fine balance must be achieved between lowering blood pressure enough to minimize the risk of rebleeding and preventing reduced cerebral perfusion and subsequent ischemic damage. Furthermore, the different causes of hypertension within the preaneurysmal treatment period are polyfactorial and include pathophysiologic responses, sympathetic nervous system activation, and iatrogenic from hyperdynamic therapy and vasopressors, which requires consideration for these patients to receive optimal management. Other factors including loss of autoregulation and concomitant conditions must also be considered when deciding whether to start antihypertensive therapy. ⋯ It is clear that further, larger studies are warranted in order to clarify the effect of antihypertensive therapy on patient outcome and what the BP thresholds are, along with establishing the best treatment, for commencing antihypertensive therapy.
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Spinal eosinophilic granulomas (EGs) are uncommon tumors, constituting <1% of all bone tumors. They are mostly seen in the pediatric age group, whereas adult onset is rare. The cervical spine is an infrequent location for EG. The literature is sparse regarding the clinical and management aspects of these lesions, especially in adults. ⋯ Cervical spine EG is rare in adults and usually presents as an osteolytic lesion involving the vertebral body; vertebra plana is very rare. Surgery is typically reserved for patients with severe neurologic deficits and bony instability. The outcome seems good in most cases.
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Penetrating brain injury is 1 type of traumatic brain injury. Brain abscess is a common complication after penetrating brain injury, and fragments increase the risk of occurrence of brain abscess. It is uncommon to see the migration of bone fragments in the brain in clinical cases. We report a rare case of brain abscess with migration of bone fragments after traumatic brain injury.
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To retrospectively evaluate long-term efficacy and safety of dorsal root entry zone (DREZ) lesion for treatment of neuropathic pain within the lower extremities and perineal region after thoracolumbar spine fracture. ⋯ For patients with neuropathic pain of the lower extremities and/or the perineal region after thoracolumbar spine fracture, pain within the lower extremities was mostly because of nerve root injury. Pain in the perineal region caused by L1 fracture was attributed to spinal cord injury segmental pain. Nerve root injury pain had a good prognosis after DREZ lesion; the effect of DREZ lesion for spinal cord injury segmental pain may be uncertain.
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The purpose of this study was to identify predictors for postacute care facility discharge for patients undergoing posterior cervical decompression and fusion (PCDF) and to determine if discharge placement impacts postdischarge outcomes. ⋯ Results of this cross-sectional study suggest that patients with PCDF discharged to a postacute care facility have a higher likelihood of having a severe AE after discharge as well as a higher likelihood of being readmitted.