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Journal of Trauma-Injury Infection & Critical Care. 62(1):26-35, January 2007
Beta-blocker use in elective noncardiac surgery has been associated with a reduction in mortality and cardiovascular complications. Traumatic brain injury (TBI) is often associated with a hyperadrenergic state. We hypothesized that adrenergic blockade would confer improved survival among TBI patients.
Very few cases of severe penetrating injuries to the skull base with a seemingly innocuous object have been described in the literature. Of the cases reported, only ten involve a penetrating screwdriver. However, the choice of therapeutic management, whether it be emergency surgical or non-surgical removal of the penetrating object as well as the selected surgical approach remain quite controversial.
Clinical Neurology and Neurosurgery Volume 109, Issue 1 , January 2007, Pages 106-110
Fractional anisotropy (FA) is influenced by histological data such as cellularity, vascularity and/or fiber structure in astrocytic tumors. We describe two patients with tumor recurrence and one patient with radiation necrosis who were diagnosed using assessment of FA value.
Topics in Magnetic Resonance Imaging. 17(2):89-106, April 2006
Brain tumors are one of the most common neoplasms in young adults and are associated with a high mortality and disability rate. Magnetic resonance imaging (MRI) is widely accepted to be the most sensitive imaging modality in the assessment of cerebral neoplasms.
Brain and Cognition Volume 63, Issue 1 , February 2007, Pages 13-23
The objective of this study was to suggest a new formulation of the core research diagnostic consensus criterion "loss of insight" in frontotemporal dementia (FTD). Eight patients with FTD (diagnoses made by interviews, medical and neuropsychological examination, CT scan, and regional cerebral glucose metabolism measured by positron emission tomography (PET) participated in the study).
Brain and Cognition Volume 63, Issue 1 , February 2007, Pages 70-78
Emotional well-being depends in part on affect modulation. The present study extends research on emotion regulation by assessing the physiological and cognitive effects of a novel response-focused regulation strategy, termed â€˜expressive dissonance.â€™ Expressive dissonance refers to the incongruence between an emotional state (e.g., sadness) and a behavioral expression (e.g., a smile).
European Journal of Neurology, Volume 14, Number 1, January 2007, pp. 90-94(5)
The aim of this study was to compare the seizure outcome of two different types of epilepsy surgery, selective amydalohippocampectomy (AHE) and anterior temporal lobectomy (ATLE) in patients with temporal lobe epilepsy.
Subcortical stimulation can be used to identify functional language tracts during resection of gliomas located close to or within language areas or pathways. The objective of the present study was to investigate the feasibility of the routine use of subcortical stimulation for identification of language tracts in a large series of patients with gliomas and to determine the influence that subcortical language tract identification exerted on the extent of surgery and on the appearance of immediate and definitive postoperative deficits.
A small percentage of tuberous sclerosis patients will develop a subependymal giant-cell astrocytoma. Given the morbidity and mortality when such a lesion is left undiagnosed, successive follow-up imaging in pediatric patients has been recommended.
Phenytoin (PHT) is widely administered after subarachnoid hemorrhage, often for several weeks or months. In addition to known side effects, PHT use has been correlated with cognitive disability and poor outcome.
Only one-third of patients regain functional independence after aneurysmal subarachnoid hemorrhage (SAH). Despite this recovery, many of these patients experience psychosocial problems. We assessed the long-term effects of SAH on employment, relationships, personality, and mood.
The widespread use of the endoscope in transsphenoidal pituitary surgery has recently contributed to the extension of the approach beyond the tuberculum sellae and planum sphenoidale for the management of lesions located in the suprasellar area, either with an endoscope-assisted or purely endoscopic technique.
Although gemistocytic astrocytomas are graded as World Health Organization II astrocytomas, they behave more aggressively than other astrocytomas. Their proliferative potential is low, and it remains an intriguing question why these tumors are so biologically "successful."
Identifying the genetic alterations in gliomatosis cerebri (GC) may yield clinically useful prognostic markers and provide clues as to whether GC represents a distinct pathological entity or is an extreme form of diffusely infiltrative glioma.
Efficiency of the treatment of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) by interfering with the nitric oxide-cyclic guanosine monophospate (cGMP) pathway seems to be inconsistent. So far, it remains unclear whether or not insufficient access to the drugs or impaired reactivity of the vessels is responsible for this inconsistency.
To evaluate clinical usefulness of cerebrospinal fluid stroke volume (SV) assessed in the cerebral aqueduct, via cine phase-contrast magnetic resonance imaging, for predicting outcome after shunt surgery in suspected normal pressure hydrocephalus.
American Journal of Neuroradiology 27:2122-2127, November-December 2006
Transcranial color-coded duplex sonography (TCCD) is a diagnostic technique for evaluation of intracranial arteries in patients with acute stroke. Echo-enhancing contrast agents (EEAs) are necessary to visualize intracranial vessels in up to 30% of patients because of limited acoustic bone windows. In this study, we assessed the diagnostic efficacy of echo-enhanced TCCD (eTCCD) in correlation with the gold standard, digital subtraction angiography (DSA).
Journal of Neurotrauma Dec 2006, Vol. 23, No. 12 : 1726 -1738
Following contusive spinal cord injury (SCI), 50% of oligodendrocytes in the residual white matter are lost within 24 h. NG2-expressing cell proliferation is maximal 3 days after SCI, and may be the source of mature oligodendrocytes and astrocytes that chronically replace those that were lost.
American Journal of Neuroradiology 28:155-158, January 2007
We report a case of 46-year-old man who underwent endovascular coil embolization for left anterior inferior cerebellar and posterior inferior cerebellar aneurysms. During embolization of both aneurysms, thrombotic complications were observed along with a relative lack of response to heparin.
Anaesthesia, Volume 62, Number 2, February 2007, pp. 140-145(6)
Skin surface warming of patients not only improves thermal comfort, but has been shown to reduce anxiety in a pre-hospital setting. We tested the hypothesis that pre-operative warming can reduce pre-operative anxiety as effectively as a conventional dose of intravenous midazolam in patients undergoing neurosurgery.
The authors report a 7-year-old girl who presented with progressive quadriparesis which had started a month before admission. Magnetic resonance imaging of the spine revealed an intramedullary cystic lesion extending from C2 to C4. After performing a C2-5 laminectomy, the cyst was drained and anatomically fenestrated with the subarachnoid space by a 1-cm vertical median myelotomy without using a stent. The histopathological findings revealed arachnoid cyst.
American Journal of Cancer, Volume 5, Number 6, 2006, pp. 427-432(6)
In the UK, the current management of high-grade gliomas consists of maximal surgical debulking, where possible, followed by radiotherapy. A large, randomized, multicenter trial assessing the addition of temozolomide to radiotherapy found a significant increase in median survival of the order of 2.5 months in favor of the combined treatment (14.6 vs 12.1 months; p < 0.001).
The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging.
Clinical Cancer Research 13, 68-75, January 1, 2007
Hypoxia in the tumor microenvironment triggers a variety of genetic and adaptive responses that regulate tumor growth. Tumor hypoxia is often associated with more malignant phenotypes, resistance to therapy, and poor survival. The purpose of this study was to evaluate the prevalence of hypoxia in meningiomas using the endogenous hypoxia marker carbonic anhydrase 9 (CA9) and to relate the expression of CA9 to tumor vascularity, histopathologic grade, and clinical variables, such as recurrent tumor status.
Clinical Neurology and Neurosurgery Volume 109, Issue 1 , January 2007, Pages 50-53
Only a small percentage of patients with acute stroke receive thrombolytic therapy, mainly due to late hospital arrival. Factors excluding those who arrive within 3 h after stroke onset are less well known.
Journal of Trauma-Injury Infection & Critical Care. 62(1):207-211, January 2007
Some publications suggest a strong correlation between the intracranial pressure and the intraocular pressure. Other studies claim no correlation between these two physiologic variables. Our aim was to study whether the tonometry could be a useful method to evaluate intracranial pressure in patients with suspected intracranial abnormality.
American Journal of Neuroradiology 27:2128-2134, November-December 2006
Risks associated with surgery of meningiomas, especially those located in the skull base, are influenced by tumor consistency and vascularity. The purpose of this study was to find out if vascularity, consistency, and histologic characteristics of meningioma can be predicted preoperatively by using low-field MR imaging, including dynamic imaging of contrast enhancement.
In this study, we sought to elucidate whether phenylpropanolamine (PPA) in cold remedies (small and divided doses) increases the risk of hemorrhagic stroke (HS). PPA exposure significantly increased the risk, and the risk was much higher in women.
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e232-e240
An extra X chromosome in males (XXY), known as Klinefelter syndrome, is associated with characteristic physical, cognitive, and behavioral features of variable severity. The objective of this study was to examine possible neuroanatomical substrates of these cognitive and behavioral features during childhood and adolescence.
We present a case of prepontine-suprasellar tuberculoma involving the premamillary region of the third ventricular floor, a site suitable to perform an endoscopic third ventriculostomy (ETV) stoma, managed endoscopically, and discuss our findings.
European Radiology, Volume 16, Number 11, November 2006, pp. 2594-2602(9)
The purpose of this study was to compare the image quality of two-dimensional (2D) digital subtraction angiography (DSA) between a flat panel detector (FPD) of the direct conversion type with low radiation dose and a conventional image intensifier (I.I.)-TV system, and to assess 3D DSA with the FPD system in the depiction of intracranial vessels.
Blast-related neurotrauma is associated with the severest casualties from Operation Iraqi Freedom (OIF). A consequence of this is cerebral vasospasm. This study evaluated all inpatient neurosurgical consults related to battle injury from OIF.
Temporal lobectomy is a well-established neurosurgical procedure for temporal lobe epilepsy. In this study, we conducted a retrospective review of children with drug-resistant temporal lobe epilepsy to evaluate seizure outcome after temporal lobe surgery.
Individuals with spinal cord injury (SCI) are prone to orthostatic hypotension (OH). We aimed to develop a simple bedside test to evaluate autonomic control following chronic SCI, and to identify those most at risk of OH and cardiovascular dysfunction.
Topics in Magnetic Resonance Imaging. 17(2):107-116, April 2006
Much work has been done in the last several decades to improve the understanding of the molecular composition of the blood-brain barrier (BBB). Advances in magnetic resonance imaging have resulted in development of dynamic magnetic resonance imaging techniques to quantify permeability measurements across the brain endothelium.
European Journal of Paediatric Neurology Volume 10, Issues 5-6 , September-November 2006, Pages 227-229
The presence of subependymal nodular heterotopia and cortical dysgenesis has been infrequently reported in patients with encephalocele. The majority of these patients were found to have posterior encephaloceles.
We analyzed a consecutive series of patients operated for a foramen magnum (FM) meningioma located on the ventral aspect of the medulla oblongata via a posterolateral suboccipital retrocondylar approach with regard to long-term surgical outcome.
The clinical relevance of the microembolic signals (MES) detected by transcranial Doppler sonography (TCD) in acute stroke remains unclear. In a prospective study the authors analyzed the relationship between MES and the findings on diffusion-weighted magnetic resonance imaging (DWI) in acute stroke patients.
Cerebral cavernous malformations (CCMs) are focal dysmorphic blood vessel anomalies predisposing individuals to hemorrhagic stroke and epilepsy. CCMs are sporadic or inherited as autosomal dominant disease with three known genes.
Stereotactic radiosurgery (SRS) is well established in the treatment of cranial base meningiomas. Fractionated stereotactic radiotherapy (SRT) offers an additional treatment option. Data for radiological regression differ, ranging from 13 to 61%. Therefore, the aims of this prospective study were to quantitatively analyze tumor volume (TV) shrinkage and to calculate determining factors.
Clinical Neurology and Neurosurgery Volume 109, Issue 1 , January 2007, Pages 45-49
In patients with large middle cerebral artery (MCA) infarction space occupying brain edema may lead to a malignant course with up to 80% mortality under conservative treatment. As interventional treatment strategies must be started before the deterioration occurs predictors of a malignant course are necessary
Coagulation disorders are seen in cancer patients, but it is not clear whether cancer predisposes stroke patients to unique characteristics. The aim of the study was to investigate risk factors, pattern,etiology and outcome in stroke patients with cancer.
Journal of Pediatric Hematology/Oncology. 28(12):837-839, December 2006
High dose of cytosine arabinoside is usually used in treatment of acute myelogenous leukemia. Here we report 1 case of a child who developed neurologic toxicity and rapidly improved after flushing out of cerebral spinal fluid, suggesting it could be treatment in the acute phase of toxicity. Efficacy of this treatment could be explained by reducing cytosine arabinoside metabolites in central nervous system.
Neurosurgery. 59(5) SUPPLEMENT:S3-77-S3-92, November 2006
The purposes of this article are to summarize recent developments and concerns in endovascular aneurysm therapy leading to the adjunctive use of endoluminal devices, to review the published literature on stent-supported coil embolization of cerebral aneurysms, and to describe our experience with this technique in a limited subgroup of problematic complex aneurysms over a medium-term follow-up period.
Neurosurgery. 59(5) SUPPLEMENT:S3-39-S3-47, November 2006
THE HISTORY OF aneurysm therapy is rich in parallelisms that exist between the once-fledgling field of aneurysm surgery and the now-growing field of endovascular aneurysm treatment. The treatment of aneurysms has had a cyclic progression.
ENDOVASCULAR THERAPY HAS continuously evolved since it was first described in 1904. It was first used as a technique to inject particles to follow the flow into vascular lesions, and from the mid-seventies on, microballoons were developed to reach targets in the arterial vascular tree.
American Journal of Neuroradiology 27:2118-2121, November-December 2006
The combination of 3T and parallel-acquisition techniques holds promise for improved performance of contrast-enhanced MR angiography (MRA), in terms of speed, spatial resolution, and coverage. We present a comparison of 2 MRA techniques, including time-of-flight (TOF) and contrast-enhanced MRA, for detection and evaluation of intracranial aneurysms. Our results show that contrast-enhanced MRA with highly accelerated parallel acquisition at 3T does not have the known drawbacks of TOF-MRA techniques, including prolonged acquisition time, spin saturation, and flow-related artifacts, with comparable aneurysm characterization.
Topics in Magnetic Resonance Imaging. 17(2):63-68, April 2006
Brain tumors are a heterogeneous group of neoplasm with a diverse histological, molecular, and genetic spectrum and a widely variable clinical course and prognosis. Although most brain tumors, especially the malignant variety, remain difficult to cure, there are promising novel therapies and drug delivery systems that are under active investigation. One of the greatest challenges in developing effective therapy for brain tumors is the lack of specific markers to directly and accurately assess antitumor effect early and noninvasively.
Intracranial haemorrhage accounts for 30-60% of all stroke admissions into a hospital, with hypertension being the main risk factor. Presence of intraventricular haematoma is considered a poor prognostic factor due to the resultant obstruction to CSF and the mass effect following the presence of blood resulting in raised intracranial pressure and hydrocephalus.
Estrogen loss has been related to higher incidence of stroke in postmenopausal women, but randomized trials have demonstrated an increased risk of stroke in women receiving hormone replacement therapy (HRT).
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2548-2551
A 4-year-old black boy was admitted to the hospital with vomiting, low-grade fever, and dehydration that were thought to be caused by viral gastroenteritis. He proceeded over the next 12 hours to rapidly deteriorate with brain herniation leading to brain death. The ultimate cause of death was found to be acute lead intoxication from a swallowed foreign body.
Coping strategies employed to manage the consequences of a spinal cord lesion (SCL) have been found to be distinctly related to emotional well-being. However, research and clinical implications have been hampered by the lack of cross-validated measures that are directly related to the lesion and its consequences.
Clinical Neurology and Neurosurgery Volume 109, Issue 1 , January 2007, Pages 7-22
The goal of this study is to analyze the suppressive interaction of symmetric temporal lobe epileptic foci, assess some failures of epilepsy surgery, and evaluate the possibility of terminating focal seizures with stimulation of symmetric epileptic foci.
Sleep disturbances are core symptoms of posttraumatic stress disorder (PTSD) and are often resistant to treatment. One reason for the recent use of atypical antipsychotics in PTSD appears to be their effects on sleep.
Oxidative stress has been related in a wide variety of ways with nervous tissue. We studied the effect of antiepileptic monotherapy on serum level of total antioxidant capacity, lipid hydroperoxide, total peroxide, oxidative stress index, and individual serum antioxidants such as albumin, bilirubin and uric acid.
Neurosurgery. 59(5) SUPPLEMENT:S3-113-S3-124, November 2006
Giant intracranial aneurysms present unique therapeutic intricacies. The purpose of this study was to evaluate the anatomic and hemodynamic characteristics of these lesions and the current endovascular and combined surgical and endovascular techniques available for their treatment.
To evaluate the recovery of motor function and the early complications in patients with acute cervical spinal cord injury after receiving a high dose of methylprednisolone sodium succinate (MPSS) within 8 hours of injury.
Though the proportion of elderly stroke patients is increasing, patients 80 years are often excluded from clinical stroke trials. We reviewed the management of older patients presenting with acute ischemic stroke (AIS) and assessed the safety and efficacy of recombinant tissue plasminogen activator (rtPA) administration in a community-based setting.
BMC Complementary and Alternative Medicine 2006, 6:27
Flavonoid-rich extracts from the mature roots of Scutellaria baicalensis have been shown to exhibit antiproliferative effects on various cancer cell lines. We assessed the ability of an ethanolic extract of S. baicalensis root to inhibit the proliferation of malignant glioma cells.
European Journal of Paediatric Neurology Volume 10, Issues 5-6 , September-November 2006, Pages 237-240
Hyperuricemia has been shown to be related to cardiovascular morbidity and mortality. There is controversial data about the effect of sodium valproate (VPA) monotherapy on serum uric acid concentrations.
European Journal of Neurology, Volume 13, Number 12, December 2006, pp. 1340-1345(6)
Neurotrophic effects of the growth hormone (GH), insulin-like growth factor-1 (IGF-1) and insulin on the central nervous system have become more apparent in the past decade. In this study, we measured serum and cerebrospinal fluid (CSF) concentrations of GH, IGF-1 and insulin in 35 patients with motor neuron disease (MND) [24 patients with definite amyotrophic lateral sclerosis (ALS) and 11 patients with progressive bulbar palsy] and in 40 healthy controls.
J Neuropsychiatry Clin Neurosci 18:460-500, November 2006
The authors evaluate quantitative electroencephalography (qEEG) as a laboratory test in clinical psychiatry and describe specific techniques, including visual analysis, spectral analysis, univariate comparisons to normative healthy databases, multivariate comparisons to normative healthy and clinical databases, and advanced techniques that hold clinical promise. Controversial aspects of each technique are discussed, as are broader areas of criticism, such as commercial interests and standards of evidence.
Meningiomas are the commonest primary, non-glial intracranial tumours. The diagnosis is often correctly predicted from characteristic imaging appearances. This paper presents some examples of atypical imaging appearances that may cause diagnostic confusion.
Neurosurgery. 59(5) SUPPLEMENT:S3-48-S3-55, November 2006
FEW COULD HAVE imagined the tremendous growth of endovascular surgery over the past 40 years. Endovascular therapy has greatly enhanced the care of the patient in neurosurgery, spine surgery, and head and neck surgery. Progress in technology and techniques continue to push forward the boundaries of what is deemed "treatable," assuming acceptable risk.
Neurosurgery. 59(5) SUPPLEMENT:S3-139-S3-147, November 2006
CEREBRAL VASOSPASM REMAINS a leading cause of death and disability in patients with ruptured cerebral aneurysms. The development of endovascular intervention in the past two decades has shown promising results in the treatment of vasospasm.