World Neurosurg
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We report a case of an 18-year-old patient who presented with late progressive deterioration of neurologic condition 8 weeks after a penetrating injury to the back. Investigations revealed a dorsally located post-traumatic spinal cord herniation. Urgent exploration, decompression, and repair were performed. We reviewed the literature and found only 19 similar cases previously reported. Pathophysiology and presentations were variable and even poorly understood. ⋯ Late-onset post-traumatic spinal cord herniation is a potentially curable cause of neurologic deterioration after spinal trauma and should be considered in all cases with late neurologic deterioration after spinal trauma.
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Case Reports
Ruptured Vertebral Artery Dissecting Aneurysm in a Patient with Recurrent Bacterial Meningitis.
Intracranial mycotic aneurysms are uncommon. They can occur due to extravascular extension or intravascular seeding of the vessel wall. They often result in subarachnoid hemorrhage with poor prognosis. We present a rare case of subarachnoid hemorrhage due to vertebral artery dissection with aproximal anterior inferior cerebellar artery (AICA)-posterior inferior cerebellar artery common trunk mycotic aneurysm after an episode of bacterial meningitis. ⋯ Bacterial meningitis can lead to inflammatory injury of the intracranial vessels with resultant aneurysm formation. New enhancement of the vessel wall indicates that patients are at risk of developing mycotic aneurysms; therefore close observation with repeated vascular imaging is necessary.
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To identify if there are cultural, medical, educational, economic, nutritional and geographic barriers to the prevention and treatment of spina bifida and hydrocephalus. ⋯ Our study highlights some of the cultural, educational, geographic, nutritional, and economic difficulties in the prevention and management of spina bifida and hydrocephalus in Tanzania.
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Neurenteric cysts rarely present in infancy. Compressive myelopathy or meningitis are the usual presenting features of these cysts in infants. ⋯ Although rare, compressive lesions such as neurenteric cysts may present with acute flaccid paralysis in very young children. Differentiating from other causes and timely intervention bears an excellent outcome.
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External ventricular drain (EVD) placement is a life-saving procedure performed frequently by neurosurgical residents. The July effect is a theoretic decline in quality of health care sometimes perceived in teaching hospitals at the start of an academic year. We sought to quantify the learning curve of ventriculostomy drain placement in teaching hospitals and determine its impact on patient outcomes, health care utilization, and cost. ⋯ There was no evidence of a July effect on EVD complication rates in outcomes for patients admitted in the beginning of an academic year versus the end.