World Neurosurg
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Case Reports
Diffusion Tensor Imaging (DTI) characteristics in Hirayama's Disease (HD): Case Report and Review of Literature.
Hirayama disease (HD) is a rare focal amyotrophy, commonly reported in adolescent Asian males and characterized by unilateral or asymmetric distal upper extremity weakness. This disease exhibits an indolent course of progression over the initial 3-4 years, followed by a stage of stabilization. The diagnosis is confirmed by demonstration of enhanced posterior epidural space and dynamic spinal cord compression on cervical flexion magnetic resonance imaging. Diffusion tensor imaging (DTI) is a functional imaging modality, which can potentially be utilized in the diagnosis of HD. ⋯ DTI tractography and reduced fractional anisotropy in cervical flexion can serve as potential indicators for the diagnosis of HD. Large-scale studies in the future are necessary to identify the potential role of this modality in surgical decision-making and in the assessment of prognosis in patients with HD.
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The aim of this study was to document the initial experience and challenges of cervical decompression in a resource-poor region. ⋯ Despite the challenges of poverty, late presentation, and lack of basic standard instruments and equipment, patients with cervical myelopathy in the resource-poor setting had outcomes similar to other well-established centers after surgical decompression. We infer that challenges in setting up a spine unit in a resource-poor region can be circumvented safely.
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The premamillary artery (PMA) usually arises from the posterior communicating artery. Thus, an internal carotid artery (ICA) origin for PMA is rare. We report a rare case of a patient who presented with subarachnoid hemorrhage resulting from kissing aneurysms arising from the origin of the anterior choroidal artery and the aberrant origin of PMA and was successfully treated with coil embolization. ⋯ To the best of our knowledge, the present study is the first report of a ruptured saccular PMA aneurysm arising from ICA that was successfully treated with coil embolization. Three-dimensional digital subtraction angiography and cone-beam CT were useful for confirming the precise vasculature of the PMA.
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Review Case Reports
Intramedullary-Extramedullary Breast Metastasis to the Caudal Neuraxis Two Decades after Primary Diagnosis: Case Report and Review of the Literature.
Intramedullary metastases to the caudal neuraxis with exophytic extension to the extramedullary space are rare. We describe the unique case of a patient with locally recurrent breast cancer who developed an intramedullary-extramedullary metastasis to the conus medullaris and cauda equina 22 years after primary diagnosis, the longest interval between primary breast cancer and intramedullary spread to date. We also reviewed the published literature on focal breast metastases to the conus medullaris or cauda equina. ⋯ We provide evidence that patients who present with symptoms of spinal neurologic disease and a history of hormone receptor-positive breast cancer require high suspicion for metastatic pathology, despite significant time lapse from primary diagnosis. The tumor may involve both the intramedullary and extramedullary space, complicating resection. Symptom relief and quality of life should guide resection of metastatic lesions to the caudal neuraxis.
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Meta Analysis
The impact of urgent (<8 h) decompression on neurologic recovery in traumatic spinal cord injury: a meta-analysis.
The relationship between urgent decompression and neurologic recovery for traumatic spinal cord injury (TSCI) remains controversial. This meta-analysis was conducted to determine the beneficial effects of surgery within 8 hours for patients with TSCI. ⋯ This meta-analysis provides evidence of benefits from urgent (<8 hours) decompression for patients with TSCI in terms of neurologic recovery. The improvement effect is more definite in patients with initial complete TSCI.