Can J Neurol Sci
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Infection rates in standard vs. hydrogel coated ventricular catheters.
Infection related to external ventricular drain (EVD) use is a common neurosurgical complication. Modified catheters with a hydrophilic surface may impede bacterial adherence and thereby reduce catheter related cerebrospinal fluid (CSF) infection. ⋯ Infection remains a common hazard in the use of EVD, and we found no reduction of infection using the hydrogel-coated catheters when presoaked in low concentration bacitracin solution.
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Spontaneous intracranial hypotension (SIH) is a well-recognized neurologic disorder that typically presents with orthostatic headaches, low cerebral spinal fluid pressures and distinct abnormalities on magnetic resonance imaging. ⋯ The mechanism of coma in SIH is presumed to be compression of the diencephalon from downward displacement of the brain. Although it is very unusual for patients with SIH to present with coma, it is important to recognize since the coma may be reversible with epidural blood patches.
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Comparative Study
Controversies in cervical discectomy and fusion: practice patterns among Canadian surgeons.
Optimal fusion technique and peri-operative management of patients undergoing anterior cervical discectomy (ACD) is unclear. We document current practice patterns among Canadian spinal surgeons regarding the surgical management of single level degenerative cervical spondylosis. ⋯ Practice patterns vary among Canadian surgeons, although nearly all employ fusion and many use instrumentation for single-level ACD. Training background, and type and length of practice influence practice habits.
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Case Reports
Intracranial hypotension with severe neurological symptoms resolved by epidural blood patch.
A patient with a constellation of severe neurological symptoms caused by spontaneous intracranial hypotension, which was successfully managed by epidural blood patch, was described. ⋯ The principal presentation of spontaneous intracranial hypotension is orthostatic headache. The patient described presented a combination of various neurological symptoms, ataxia, memory loss and deafness, which all responded well to epidural blood patch.
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Comparative Study Clinical Trial
Comparison of monitoring techniques for intraoperative cerebral ischemia.
To prospectively compare somatosensory evoked potentials, electroencephalography (EEG) and transcranial Doppler ultrasound (TCD) for detection of cerebral ischemia during carotid endarterectomy (CEA). ⋯ A >50% decrease in the cortically generated P25 amplitude of the median somatosensory evoked potentials, which persisted during the entire period of internal carotid artery occlusion, appears to be the most reliable method of monitoring for intraoperative ischemia in our hands because it accurately detected both intraoperative strokes with no false positive or false negative results.