World Neurosurg
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Case Reports
Cervical spinal brucellosis with epidural abscess causing neurologic deficit with negative serologic tests.
Here we present a case of cervical spinal epidural abscess causing neurologic deficits despite negative serologic tests. ⋯ It is important for clinicians to consider brucellar cervical spondylodiscitis when an epidural abscess is identified in a patient with a history of potential exposure. We recommend both blood and tissue cultures for diagnosis when serologic tests are negative.
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We are in an aging population and many elderly people are prone to falling and suffering an acute traumatic subdural hematoma (aSDH). Yet, the operative treatment of patients older than 65 years of age for aSDH remains controversial, and very limited data exists with regard to expected outcome in this elderly patient group. ⋯ Craniotomy for patients older than 65 years of age remains controversial, and our case series seems to support the notion that surgical treatment is associated with significant postoperative morbidity, mortality, and adverse outcome. However, selected patients benefit from an intervention, with a good outcome in 41% of patients.
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Biography Historical Article
The philosopher's swoon--the concussion of Michel de Montaigne: a historical vignette.
The French philosopher Michel Eyquem de Montaigne (1533-1592) sustained a transient loss of consciousness due to a head injury. Montaigne described his concussion as a "swoon," with astutely illustrative details of the symptoms he experienced, including brief loss of consciousness, with apparent (temporary) confusion, and post-traumatic amnesia. His vivid portrayal of the recovery period lends understanding of the process of conscious awakening after his near-death experience. Thanks to his power of introspection and literary talent we may gain insight into the feelings and perceptions of some patients during their recovery from concussion.
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Comparative Study
Intraarterial colforsin may improve the outcome of patients with aneurysmal subarachnoid hemorrhage: a retrospective study.
Papaverine hydrochloride (PPV) has been widely used for pharmacologic angioplasty to dilate spastic vessels after aneurysmal subarachnoid hemorrhage (SAH). Colforsin daropate hydrochloride (CDH) has also recently been reported to be useful for reversal of cerebral vasospasm (CV). In this study, we compared the impacts of intraarterial PPV and CDH on the outcomes of SAH patients. ⋯ CDH appears to be associated with a better outcome in patients with SAH.
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Arthrodesis is considered to be the reference treatment for degenerative disc disease (DDD), if the symptoms are refractory to conservative management. The drawback of arthrodesis is, besides a percentage of non-union, the reduced mobility that might generate an increased load and risk for degeneration of the adjacent levels. Total disc replacement (TDR) implants may overcome this problem. The long-term clinical effect and radiographic evaluation of motion preservation after implantation, however, have been subject to several nonconclusive studies. This study evaluated the long-term clinical and radiographic results and the safety of TDR with the Maverick prosthesis for surgical treatment of monosegmental DDD. ⋯ In this study, TDR with the Maverick prosthesis at one lumbar segment reduced pain and disability and improved quality of life as well as the general condition. Motion was preserved at the operated level, 48 months after surgery. The long-term effect on adjacent levels needs further follow-up.