bluuebunny/crossref_metadata_2025 huggingface dataset:
Cannabis Use, Ischemic Stroke, and Multifocal Intracranial Vasoconstriction
Authors: Wolff Valérie , Lauer Valérie , Rouyer Olivier , Sellal François , Meyer Nicolas , Raul Jean Sébastien , Sabourdy Cécile , Boujan Fazel , Jahn Christine , Beaujeux Rémy , Marescaux Christian
Published: April 2011

Background and Purpose—

Our objective was to evaluate the relationship between cannabis use and ischemic stroke in a young adult population.

Methods—

Forty-eight consecutive young patients admitted for acute ischemic stroke participated in the study. First-line screening was performed, including blood tests, cardiovascular investigations, and urine analysis for cannabinoids. If no etiology was found, 3D rotational angiography and cerebrospinal fluid analysis were performed. A control was planned through neurovascular imaging within 3 to 6 months.

Results—

In this series, there was multifocal intracranial stenosis associated with cannabis use in 21% (n=10).

Conclusions—

Multifocal angiopathy associated with cannabis consumption could be an important cause of ischemic stroke in young people.
Group-based Trajectory Modeling Extended to Account for Nonrandom Participant Attrition
Authors: Haviland Amelia M. , Jones Bobby L. , Nagin Daniel S.
Published: April 2011

This article reports on an extension of group-based trajectory modeling to address nonrandom participant attrition or truncation due to death that varies across trajectory groups. The effects of the model extension are explored in both simulated and real data. The analyses of simulated data establish that estimates of trajectory group size as measured by group membership probabilities can be badly biased by differential attrition rates across groups if the groups are initially not well separated. Differential attrition rates also imply that group sizes will change over time, which in turn has important implications for using the model parameter estimates to make population-level projections. Analyses of longitudinal data on disability levels in a sample of very elderly individuals support both of these conclusions.
Estimating Expected Value of Sample Information for Incomplete Data Models Using Bayesian Approximation
Authors: Kharroubi Samer A. , Brennan Alan , Strong Mark
Published: April 2011

Expected value of sample information (EVSI) involves simulating data collection, Bayesian updating, and reexamining decisions. Bayesian updating in incomplete data models typically requires Markov chain Monte Carlo (MCMC). This article describes a revision to a form of Bayesian Laplace approximation for EVSI computation to support decisions in incomplete data models. The authors develop the approximation, setting out the mathematics for the likelihood and log posterior density function, which are necessary for the method. They compare the accuracy of EVSI estimates in a case study cost-effectiveness model using first- and second-order versions of their approximation formula and traditional Monte Carlo. Computational efficiency gains depend on the complexity of the net benefit functions, the number of inner-level Monte Carlo samples used, and the requirement or otherwise for MCMC methods to produce the posterior distributions. This methodology provides a new and valuable approach for EVSI computation in health economic decision models and potential wider benefits in many fields requiring Bayesian approximation.
Using Administrative Claims Data to Estimate Virologic Failure Rates among Human Immunodeficiency Virus–Infected Patients with Antiretroviral Regimen Switches
Authors: Broder Michael S. , Juday Timothy , Chang Eunice Y. , Jing Yonghua , Bentley Tanya G. K.
Published: April 2011

Objective. To develop and validate a claims signature model that estimates proportions of HIV-infected patients in administrative claims databases who switched combination antiretroviral therapy (cART) regimens because of virologic failure. Methods. The authors used an HIV-specific registry (development data set) to develop logistic regression models to estimate odds of virologic failure among patients who switched cART regimens. Models were validated in a sample of administrative claims with laboratory values (validation data set). The final model was applied to an application data set as a worked example. Results. There were 1691, 1073, and 3954 eligible patients with cART switches in the development, validation, and application data sets, respectively. In the development data set, virologic failure before a switch was observed 21.8% of the time. Failure more likely caused the regimen switch among patients who were treatment experienced, had been receiving their baseline regimen for > 180 days, had ≥ 2 or more physician visits within 90 days, had > 1 HIV RNA or CD4 cell count test within 30 days, had any resistance test within 180 days, or had a change in regimen type. The final model had good discriminatory ability (C = 0.885) and fit (Hosmer-Lemeshow P = 0.8692). Failure was estimated to occur in 18.9% (v. 18.6% observed) of switches in the validation data set and 13.8% in the application data set. Conclusions. This claims signature model allows payers to use claims data to estimate virologic failure rates in their patient populations, thereby better understanding plan costs of failure.
Effects of Local Anesthetics on Articular Cartilage
Authors: Piper Samantha L. , Kramer Jonathan D. , Kim Hubert T. , Feeley Brian T.
Published: April 2011

Background: Recent basic science studies have demonstrated local anesthetic chondrotoxicity in vivo and in vitro in both human and animal cartilage. Clinically, chondrolysis associated with the use of intra-articular local anesthetic pain pumps has been described by several groups. This has raised concern regarding the clinical use of intra-articular local anesthetics.

Methods: The authors undertook a review of the current orthopaedic literature on local anesthetic chondrotoxicity and its potential relationship to clinical chondrolysis.

Results: Local anesthetics such as bupivacaine, lidocaine, and ropivacaine are chondotroxic to human articular cartilage in vitro, although ropivacaine is less so. The evidence suggests that there is a greater risk for chondrolysis with a longer exposure to a higher concentration of local anesthetic, such as with a pain pump, than with a single injection. However, late cellular and metabolic changes are seen after even a single injection of bupivacaine in animal models, and the loss of an intact cartilage matrix also leads to more extensive chondrocyte death. Some studies suggest that additives and the pH of the local anesthetic solution may also play a role in chondrotoxicity.

Conclusion: Intra-articular local anesthetics should be used with caution, especially continuous infusions of bupivacaine and lidocaine at high concentrations in joints with compromised cartilage. The consequences of a single intra-articular injection of local anesthetic remains unclear and requires further investigation.

Clinical Relevance: Intra-articular use of local anesthetics may have lasting detrimental effects on human articular cartilage and chondrocytes, although the clinical relationship between local anesthetic exposure and chondrolysis requires further study.
Holoprosencephaly in Hungary
Authors: Szabó Nóra , Gergev Gyurgyinka , Kóbor Jenő , Szűcs Péter , Túri Sándor , Sztriha László
Published: April 2011

A retrospective population based survey of patients born with holoprosencephaly in South-Eastern Hungary between July 1, 1992 and June 30, 2006 was performed. All live birth cases with craniofacial and non-craniofacial abnormalities were included in the study. A total of 9 patients (5 boys and 4 girls) were found with holoprosencephaly among 185 486 live births, which correspond to a birth prevalence of 0.49 per 10 000 live births (95% confidence interval [CI]: 0.17-0.80). These figures were similar to those ones found in New York State and several European regions. In our series one newborn had trisomy 13. Eight patients did not have chromosomal abnormalities on routine testing, 4 of them had craniofacial abnormalities only and another 4 showed non-craniofacial anomalies as well. Three patients died in the neonatal period and another one in childhood. Patients surviving the neonatal period had intellectual and motor handicap, and epilepsy.
The Clinical Mental Health Counseling Needs of Mothers in the Criminal Justice System
Authors: Laux John M. , Calmes Stephanie , Moe Jeffry L. , Dupuy Paula J. , Cox Jane A. , Ventura Lois A. , Williamson Celia , Benjamin Barbaranne J. , Lambert Eric
Published: April 2011

This study investigated the mental health needs of mothers in the criminal justice system using qualitative methods. Identified needs included counseling to help mothers recover from trauma, to define sense of self, and to link them with external support systems.
GMAT-AWA Score as a Predictor of Success in a Managerial Communication Course
Authors: Hill Kathy L. , Hynes Geraldine E. , Joyce Marguerite P. , Green John S.
Published: April 2011

Because communication skills, especially writing, are such an integral part of managerial work, it may be postulated that these skills are associated with managerial success. Yet evidence of writing competency is not universally considered for admission to MBA programs. The purpose of this study was to investigate the possible correlation between the Analytical Writing Assessment Section (AWA) of the GMAT exam and a “critical thinking” writing assignment that is similar to the AWA. Results indicate that the AWA is significantly correlated with achievement, not only on the writing assignment but also with the final grade in a managerial communication course.
Recovery of Coordinated Gait
Authors: Daly Janis J. , Zimbelman Janice , Roenigk Kristen L. , McCabe Jessica P. , Rogers Jean M. , Butler Kristi , Burdsall Richard , Holcomb John P. , Marsolais E. Byron , Ruff Robert L.
Published: April 2011

Background. No single intervention restores the coordinated components of gait after stroke. Objective. The authors tested the multimodal Gait Training Protocol, with or without functional electrical stimulation (FES), to improve volitional walking (without FES) in patients with persistent (>6 months) dyscoordinated gait. Methods. A total of 53 subjects were stratified and randomly allocated to either FES with intramuscular (IM) electrodes (FES-IM) or No-FES. Both groups received 1.5-hour training sessions 4 times a week for 12 weeks of coordination exercises, body weight–supported treadmill training (BWSTT), and over-ground walking, provided with FES-IM or No-FES. The primary outcome was the Gait Assessment and Intervention Tool (G.A.I.T.) of coordinated movement components, with secondary measures, including manual muscle testing, isolated leg movements (Fugl-Meyer scale), 6-Minute Walk Test, and Locomotion/Mobility subscale of the Functional Independence Measure (FIM). Results. No baseline differences in subject characteristics and measures were found. The G.A.I.T. showed an additive advantage with FES-IM versus No-FES (parameter statistic 1.10; P = .045, 95% CI = 0.023-2.179) at the end of training. For both FES-IM and No-FES, a within-group, pre/posttreatment gain was present for all measures ( P < .05), and a continued benefit from mid- to posttreatment ( P < .05) was present. For FES-IM, recovered coordinated gait persisted at 6-month follow-up but not for No-FES. Conclusion. Improved gait coordination and function were produced by the multimodal Gait Training Protocol. FES-IM added significant gains that were maintained for 6 months after the completion of training.
Intravascular Ultrasound
Authors: Yehya Amin , Mandawat Mahendra K.
Published: April 2011

Coronary angiography is the gold standard for evaluating coronary atherosclerotic heart disease, yet it has well-known limitations. Intravascular ultrasound (IVUS) is an invasive technique that is used to improve the assessment and management of coronary artery disease. IVUS is a readily available imaging modality that is easy to learn and interpret with low complication rates. In this literature review, the authors will review the technique and discuss the various current usages of IVUS and its limitations, safety, and complications.
Acute urinary retention in a 23-year-old woman with mild encephalopathy with a reversible splenial lesion: a case report
Authors: Kitami Makiko , Kubo Shin-ichiro , Nakamura Shinichiro , Shiozawa Shinji , Isobe Hideyuki , Furukawa Yoshiaki
Published: April 2011

Introduction

Patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion present with relatively mild central nervous system disturbances. Although the exact etiology of the condition remains poorly understood, it is thought to be associated with infective agents. We present a case of a patient with mild encephalitis/encephalopathy with a reversible splenial lesion, who had the unusual feature of acute urinary retention.

Case presentation

A 23-year-old Japanese woman developed mild confusion, gait ataxia, and urinary retention seven days after onset of fever and headache. Magnetic resonance imaging demonstrated T2 prolongation in the splenium of the corpus callosum and bilateral cerebral white matter. These magnetic resonance imaging abnormalities disappeared two weeks later, and all of the symptoms resolved completely within four weeks. Except for the presence of acute urinary retention (due to underactive detrusor without hyper-reflexia), the clinical and radiologic features of our patient were consistent with those of previously reported patients with mild encephalitis/encephalopathy with a reversible splenial lesion. To the best of our knowledge, this is the first report of acute urinary retention recognized in a patient with mild encephalitis/encephalopathy with a reversible splenial lesion.

Conclusion

Our findings suggest that mild encephalitis/encephalopathy with a reversible splenial lesion can be associated with impaired bladder function and indicate that acute urinary retention in this benign disorder should be treated immediately to avoid bladder injury.
Management of neurological complications of infective endocarditis in ICU patients
Authors: Sonneville Romain , Mourvillier Bruno , Bouadma Lila , Wolff Michel
Published: April 2011

Patients with infective endocarditis (IE) are generally referred to the intensive care unit (ICU) for one or more organ dysfunctions caused by complications of IE. Neurologic events are frequent causes of ICU admission in patients with IE. They can arise through various mechanisms consisting of stroke or transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most complications occur early during the course of IE and are a hallmark of left-sided abnormalities of native or prosthetic valves. Occlusion of cerebral arteries, with stroke or transient ischemic attack, accounts for 40% to 50% of the central nervous system complications of IE. CT scan is the most easily feasible neuroimaging in critically unstable patients. However, magnetic resonance imaging is more sensitive and when performed should follow a standardized protocol. In patients with ischemic stroke who are already receiving oral anticoagulant therapy, this treatment should be replaced by unfractionated heparin for at least 2 weeks with a close monitoring of coagulation tests. Mounting evidence shows that, for both complicated left-sided native valve endocarditis and Staphylococcus aureus prosthetic valve endocarditis, valve replacement combined with medical therapy is associated with a better outcome than medical treatment alone. In a recent series, approximately 50% of patients underwent valve replacement during the acute phase of IE before completion of antibiotic treatment. After a neurological event, most patients have at least one indication for cardiac surgery. Recent data from literature suggest that after a stroke, surgery indicated for heart failure, uncontrolled infection, abscess, or persisting high emboli risk should not be delayed, provided that the patient is not comatose or has no severe deficit. Neurologic complications of IE contribute to a severe prognosis in ICU patients. However, patients with only silent or transient stroke had a better prognosis than patients with symptomatic events. In addition, more than neurologic event per se, a better predictor of mortality is neurologic dysfunction, which is associated with location and extension of brain damage. Patients with severe neurological impairment and those with brain hemorrhage have the worse outcome.
Complications of Intracranial Pressure Monitoring in Trauma Patients
Authors: Clark Craig W. , Muhlbauer Michael S. , Lowrey Robbie , Hartman Michael , Ray Morris W. , Watridge Clarence B.
Published: April 2011

A retrospective review of 175 intracranial pressure (ICP) monitors placed in 140 trauma patients over a recent 3-year period showed a 10.3% infection rate. Factors that were related to the development of an ICP monitor-related infection included: 1) duration of monitoring; 2) requirement for serial monitors; and 3) concurrent infection at other sites. These findings are discussed in light of the related literature concerning ICP monitoring and recommendations made to decrease the incidence of infection-related complications.
Confirmation by Magnetic Resonance Imaging of Bell's Cruciate Paralysis in a Young Child with Chiari Type I Malformation and Minor Head Trauma
Authors: Erlich Victor , Snow Robert , Heier Linda
Published: April 2011

We report the case of a young girl who suffered bilateral upper extremity paralysis after minor head trauma. Her clinical picture, as well as radiographic evidence of a fracture at C1, led to the diagnosis of Bell's cruciate paralysis, caused by a small lesion in the rostral part of the pyramidal decussation. Magnetic resonance images showed, in addition to a Chiari Type I malformation, an abnormality in the medulla. All previous cases of cruciate paralysis lack both pathological and radiographic supporting evidence.
Stereotactic Biopsy and Resection of Thalamic Astrocytomas
Authors: Kelly Patrick J.
Published: April 2011

In this study of 72 patients who had histologically verified thalamic astrocytomas, 44 patients underwent stereotactic serial biopsy, 22 underwent stereotactic resection of the neoplasm, and an additional 6 patients underwent stereotactic biopsy followed by stereotactic resection of the tumor at a later date. Of the 50 patients who underwent stereotactic biopsy, 3 were neurologically worse after the procedure (morbidity, 6%), and 3 additional patients with Grade 4 astrocytomas who preoperatively were rapidly deteriorating neurologically, died within 30 days of the procedure. Of the 28 patients who underwent stereotactic resection, 14 were neurologically improved after the procedure, 10 were unchanged, and 4 were worse. One additional patient died 10 days postoperatively. Thirty-four patients had Grade 4 astrocytomas: 27 underwent stereotactic biopsies. The mean survival after biopsy and irradiation for patients with Grade 4 astrocytomas was 21.4 weeks. The mean survival was 62 weeks in 7 patients with Grade 4 astrocytomas who underwent stereotactic resection and radiation therapy. The mean survival time after biopsy and radiation therapy for patients who had Grade 3 and Grade 2 lesions was 54.4 weeks and 91 weeks, respectively. Twenty-three patients had pilocytic astrocytomas; 8 underwent stereotactic biopsies, and 19 underwent stereotactic resection of the tumor (4 of these underwent biopsy prior to resection). There was no neurological morbidity, but one patient died after resection. Many of those who underwent resection were deteriorating due to an enlarging tumor mass or recurring cyst, and had undergone more conservative therapies such as biopsy and radiation. Even though stereotactic biopsy is appropriate in many patients harboring thalamic astrocytomas, selected patients with significant mass effect from solid tumor or recurring cyst can benefit from stereotactic resection.
Cerebral and Two Spinal Meningiomas Removed from the Same Patient: Case Report
Authors: Kandel Edward , Sungurov Eugeny , Morgunov Vladimir
Published: April 2011

An exceptional combination of an intracranial convexity and two thoracic spinal meningiomas in a 17-year-old girl is reported. The small meningioma in the left central parasagittal region was removed. One year later, paraplegia rapidly developed. Two meningiomas (one of them ossified) about 2 cm in size were removed from the midthoracic level of the spinal cord. The distance between the two spinal tumors was about 2 cm. One and one-half years after surgery the patient is well. The problem of multicentricity of meningiomas is discussed.
Cerebral Revascularization: A Review
Authors: Onesti Stephen T. , Solomon Robert A. , Quest Donald O.
Published: April 2011

A review of the development and current methods of surgical revascularization of the cerebral circulation is presented. In addition to the conventional superficial temporal artery to middle cerebral artery (STA-MCA) bypass, the techniques of interposition vein grafting and vertebrobasilar revascularization are discussed. The results and implications of the International Cooperative Study are reviewed. Extracranial-intracranial (EC-IC) bypass grafting remains an essential procedure in the treatment of many cerebrovascular conditions, including Moya Moya disease and giant intracranial aneurysms. The efficacy of interposition vein grafts, as well as the EC-IC bypass in the treatment of vertebrobasilar insufficiency, acute cerebral ischemia, cerebral vasospasm, and multi-infarct dementia, remains to be determined. Several alternative revascularization procedures, including proximal MCA anastomosis and omental transposition, are in development.
Characteristics of Incidental Pineal Cysts on Magnetic Resonance Imaging
Authors: Sandhu Jagveer S. , McLaughlin James R. , Gomez Camilo R.
Published: April 2011

Three patients with different neurological complaints were studied by magnetic resonance imaging. Coincidentally, all studies showed cystic changes within the pineal bodies. These cysts appeared hypointense on T1-weighted, spin-echo pulse sequences and hyperintense on T2-weighted images. Spin-density sequences displayed them as hypointense areas, with relaxation times similar to those of the CSF, suggesting their cystic nature. The increased use of magnetic resonance imaging may result in coincidental imaging of involutional cystic pineal changes of many individuals; their characteristic appearance will allow the differentiation between them and pineal neoplastic conditions.
Surgical Management of Hemangioblastoma of the Spinal Cord: A Report of 18 Cases
Authors: Murota Takenobu , Symon Lindsay
Published: April 2011

The cases of 18 patients operated on for hemangioblastoma of the spinal cord were reviewed. There were 11 men and 7 women. (M:F = 1.6:1) and in 15 patients, the onset of spinal symptoms was before the age of 40 years. There were 19 intradural and 2 extradural tumors. The tumor was accompanied by a cyst in 9 patients (50%). There were 6 cases of Lindau's disease, including 3 cases of multiple spinal tumors. Symptoms improved postoperatively in 13 patients, were unchanged in 2, and were aggravated in 3. At the present time, magnetic resonance imaging with gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA) enhancement is the most useful tool for precise localization of the tumor and differentiation of any accompanying cyst.
Gamma Knife Surgery for Recurrent Solitary Metastasis of a Cerebral Hypernephroma: Case Report
Authors: Lindquist Christer
Published: April 2011

Gamma knife surgery employing a central dose of 70 Gy and a peripheral dose of 25 Gy caused progressive necrosis and shrinkage of a recurrent solitary metastasis of a cerebral hypernephroma, as verified by computed tomographic scan 2 and 4 months after treatment. Gamma knife surgery was an effective palliative treatment for this cerebral metastasis and was an alternative to craniotomy with microsurgical removal.
Outcome after Operative Treatment of Intramedullary Spinal Cord Tumors in Adults: Intermediate and Long-Term Results in 51 Patients
Authors: Cooper Paul R.
Published: April 2011

The reported results of treatment of intramedullary spinal cord tumors (IMSCT) are difficult to interpret because of heterogeneous management strategies, small numbers of patients, and short periods of follow-up. In 1985 we published the early results of operative treatment of 29 patients with IMSCT and were cautiously optimistic that aggressive operative management would have a salutary effect on long-term outcome. In this report, the most recent clinical status of these 29 original patients is reviewed, along with that of 22 additional ones, to assess the intermediate and long-term results of treatment of IMSCT in 51 patients who underwent microsurgical resection between 1981 and 1987. Of these 51 patients, 24 had ependymomas, 18 had astrocytomas, and the remainder had a variety of less common lesions. Thirty-seven patients survive and have been followed for periods up to 72 months (mean 38 months). The neurological conditions of 21 patients are improved or have stabilized following operation. The conditions of 16 patients are worse postoperatively: 11 from operation and 5 from progression of disease. Eight patients are neurologically intact, 7 walk independently but abnormally, 9 ambulate with the aid of a cane or walker, and the remaining 13 are not ambulatory. Twelve of 18 patients with astrocytomas and 2 of 24 patients with ependymomas have died after a mean survival of 10 months from operation. Patients with ependymomas who had gross total resection have fared the best, with no deaths or recurrences, but no relationship could be discerned between the extent of resection and outcome in patients with astrocytomas. The author concludes that radical resection of IMSCT may be performed with initial stabilization or improvement of neurological function in the majority of patients. In patients with ependymomas the extent of resection correlated well with long-term outcome. In patients with astrocytomas. however, there was no such relationship. All 7 patients with astrocytomas of Grades III and IV have died, as have 4 of 11 patients with astrocytomas of Grades I and II.
Proliferation Activity in Pituitary Adenomas: Measurement by Monoclonal Antibody Ki-67
Authors: Knosp Engelbert , Kitz Klaus , Perneczky Axel
Published: April 2011

The monoclonal antibody (MAb) Ki-67 detects a nuclear antigen expressed by proliferating cells during the entire cell cycle. In contrast to conventional histological techniques, the use of MAb Ki-67 on frozen sections or cytological smear preparations allows direct determination of the growth rate of tumors routinely. Sixty-two pituitary adenomas were investigated by use of the MAb Ki-67 in a two-step avidin-biotin-peroxidase complex technique. The proliferation activity ranged from 0.1 to 2.8%. There was no significant difference between the proliferation and hormonal state of the adenomas. Adenomas for which there was histological evidence of dural infiltration, however, showed a statistically significant higher proliferation activity (P> 0.05) compared to noninvasive adenomas.
Hyperperfusion Syndrome after Carotid Endarterectomy: A Transcranial Doppler Evaluation
Authors: Powers Alexandros D. , Smith Robert R.
Published: April 2011

Transcranial Doppler ultrasonography was used to evaluate 2 patients who developed hyperperfusion syndromes after carotid endarterectomy. During the initial postoperative period, each patient had symptoms that were associated with elevated flow velocities in the ipsilateral cerebral vasculature. In addition, vascular resistance of these vessels was found to be abnormally low, as reflected by the Gosling pulsatility index. As the patients' symptoms improved, flow velocities decreased to normal levels and pulsatilities were noted to increase proportionately. (Neurosurgery 26:56-60, 1990)
Endoscopic Third Ventriculostomy
Authors: Jones R. F. C. , Stening W. A. , Brydon M.
Published: April 2011

Long-term extracranial shunting for hydrocephalus has numerous drawbacks related to shunt malfunction and infection. In some cases outcome has been very disappointing. We successfully managed 5 patients with acquired aqueductal stenoses with no significant morbidity by the use of an intracranial cerebrospinal fluid diversion, namely a third ventriculostomy. First advocated by Dandy, ventriculostomy was largely passed over in favor of extracranial procedures. With improved surgical techniques, however, ventriculostomy is now considered to be a viable alternative in selected cases. In a further 19 patients, we subsequently broadened our patient selection to include those with Arnold-Chiari malformations, congenital noncommunicating hydrocephalus, and tumors. Two thirds of these children remain without shunts and apart from 1 child developing hemiplegia postoperatively, there has been no significant morbidity. Although the best results have been seen in the late onset groups, even early onset, noncommunicating hydrocephalus has been successfully managed. Even in patients in whom third ventriculostomy has failed and who have subsequently required ventriculoperitoneal shunts, we anticipate that they will remain less dependent on shunts because their hydrocephalus is now communicating, which tends not to have such a rapid onset or extreme levels of raised intracranial pressure. (Neurosurgery 26:86-92, 1990)
Intracerebral Arteriovenous Fistulas Associated with Intraparenchymal Varix in Childhood: Case Reports
Authors: Barnwell Stanley L. , Ciricillo Samuel F. , Halbach Van V. , Edwards Michael S. B. , Cogen Philip H.
Published: April 2011

This report describes three children, each of whom developed an unusual malformation consisting of one or more intracerebral arteriovenous fistulas and a large intraparenchymal venous varix. Their clinical symptoms were similar to those produced by aneurysms of the vein of Galen: increasing head circumference, seizures, hemorrhage, and developmental delay. We treated each child with endovascular embolization and/or surgery and obtained complete closure of all fistulas without mortality. (Neurosurgery 26:122-125, 1990)
Cerebral Aspergillosis after Burr-Hole Surgery for Chronic Subdural Hematoma: Case Report
Authors: Morioka Takato , Tashima Takatoshi , Nagata Shinji , Fukui Masashi , Hasuo Kanehiro
Published: April 2011

We report a case of aspergillosis in the subdural space and frontal lobe in an 83-year-old man. The clinical course simulated that of a brain tumor. The source for the infection was considered to be the previous burr-hole surgery for chronic subdural hematoma, which was performed 2.5 years before the onset of symptoms. The patient was treated by removal of the abscess and granuloma. The clinical features and treatment of aspergillosis after neurosurgical procedures are discussed.
Interstitial Brachytherapy for Malignant Brain Tumors: Preliminary Results
Authors: Bernstein Mark , Laperriere Normand , Leung Phil , McKenzie Stephen
Published: April 2011

The authors report their experience with interstitial brachytherapy in 46 patients with malignant brain tumors. Twentythree patients received implants after external radiation for newly diagnosed malignant astrocytoma, as part of a randomized study (Group I). Eighteen patients received implants for recurrent malignant astrocytoma (Group II) and 3 for recurrent solitary cerebral metastasis from adenocarcinoma of the lung (Group III). Two additional patients received implants as part of their initial therapy for a radiation-induced malignant astrocytoma and a malignant fibrous histiocytoma. In all patients high-activity iodine-125 sources were implanted temporarily by a stereotactic technique. To date 50 patients have been entered in the randomized study with a maximum follow-up of 31 months. The small numbers and short follow-up preclude any conclusions regarding the efficacy of brachytherapy used as part of initial therapy. The median survival to date in the 23 patients in this group who received implants is 60 weeks. The median survival to date for the 18 patients who received implants for recurrent malignant astrocytoma is 44 weeks postimplant. Two of the three patients who received implants for recurrent solitary metastasis are alive at 41 and 49 weeks postimplant; a third died at 39 weeks postimplant. Significant complications attributable to interstitial brachytherapy have been observed in 10 of 46 patients (21.7%). A second operation for clinical and radiological deterioration was performed in 12 patients (26.1%) 8 to 105 weeks after brachytherapy. The authors conclude that interstitial brachytherapy is beneficial for selected patients with recurrent malignant astrocytoma and solitary recurrent metastasis. The role for this therapy as part of the initial management of patients with malignant astrocytoma remains to be adequately determined in ongoing randomized studies.
Pericyte Degeneration and Thickening of Basement Membranes of Cerebral Microvessels in Complex Partial Seizures: Electron Microscopic Study of Surgically Removed Tissue
Authors: Liwnicz Boleslaw H. , Leach James L. , Yeh Hwa-Shain , Privitera Michael
Published: April 2011

Complex partial seizures are associated with alterations in regional cerebral blood flow in abnormally spiking foci, as shown by positron emission tomography and single photon emission computed tomography, with an increase in flow ictally and a decrease interictally. Alterations of vasoregulation during ictal periods have also been described in animal seizure models. An electron microscopic study on human brain tissue from seven patients undergoing resections for the treatment of intractable complex partial seizures was performed to examine ultrastructural changes of the microvasculature and their locations within the microvessel wall. Biopsies were obtained intraoperatively from temporal lobe regions with electrocorticographically detected abnormal spiking and from regions without abnormality on electrocorticograms (control samples) removed as part of the therapeutic resection. A total of 539 microvessels from three regions were evaluated: spiking mesial temporal lobe, spiking lateral temporal cortex, and nonspiking (control) cortex. Evidence of pericyte degeneration (aggregates of cellular debris within the basement membrane) was noted in the majority of spiking area microvessels (76.7% in spiking mesial temporal cortex; 69.8% in spiking lateral temporal cortex) as compared with 37.8% of control microvessels (P< 0.0005). Morphometric studies revealed a significant increase in total wall thickness, pericyte-basement membrane unit thickness, pericyte cytoplasmic density, basement membrane density, and basement membrane thickness in microvessels from spiking (mesial and lateral temporal cortex), as compared to control areas (P< 0.01). No statistically significant difference was noted in pericyte coverage or pericyte or endothelial mitochondrial densities between microvessels in spiking and control regions. This study shows degeneration of pericytes, cells thought to play an essential role in microvascular hemodynamics, and thickening of microvessel walls in abnormally spiking brain regions in patients with intractable complex partial seizures. The pericyte degeneration and basement membrane thickening in abnormally spiking areas may explain alterations in vasoregulation, by a decrease in the microvascular compliance and in cross-capillary diffusion.
Early Aneurysm Surgery and Preventive Therapy with Intravenously Administered Nimodipine: A Multicenter, Double-Blind, Dose-Comparison Study
Authors: Gilsbach Joachim M. , Reulen Hans J. , Ljunggren Bengt , Brandt Lennart , Holst Hans v. , Mokry Michael , Essen Claes v. , Conzen Michael A.
Published: April 2011

A European, multicenter. prospective, randomized. double-blind, dose-comparison study on preventive therapy with intravenously administered nimodipine was performed to evaluate the efficacy and tolerability of two different doses: 2 and 3 mg/h. Two hundred four patients fulfilled the criteria for enrollment in the study; surgery within 72 hours after the last subarachnoid hemorrhage, and age between 16 and 72 years. All patients who had Hunt and Hess grades of I to III were operated upon: patients who had poor Hunt and Hess grades (IV-V) were operated on according to the surgeon's choice. This treatment regimen was associated with a low incidence of delayed neurological dysfunction with no significant difference between the two dosage groups: three patients (1.5%) remained severely disabled and two (1%) moderately disabled due to vasospasm with or without additional complications. Among the patients with Hunt and Hess grades of IV or V. the long-term outcome was favorable (good-fair) for 40% and unfavorable for 60%. Among the patients with grades of I to III, the long-term outcome was favorable for 89% and unfavorable for 11%.
Patterns of Failure of Aspirin Treatment in Symptomatic Atherosclerotic Carotid Artery Disease
Authors: Chyatte Douglas , Chen Terence L.
Published: April 2011

Over a 24-month period, 291 patients were consecutively admitted to the West Haven Veterans Administration Medical Center with new ischemic neurological symptoms. Of these, 90 patients (31%) developed ischemic neurological symptoms while taking aspirin (aspirin treatment failure). Of those in whom aspirin treatment failed. 66 patients had ischemic symptoms in the distribution of the carotid artery. Aspirin treatment failed in 21 patients with severe carotid stenosis (>75% stenosis). Eleven of these 21 patients had cerebral infarctions while taking aspirin, and 7 of these 11 infarcts occurred without the prior warning of transient ischemic attacks. Aspirin treatment failed in 45 patients with lesser degrees of carotid stenosis. Transient ischemic attack without permanent ischemia was the most common manifestation of failure in these patients. Infarction occurred in only 12 of these 45 patients and in only 4 patients did infarction occur without warning. We conclude that patients with symptomatic high-grade carotid stenosis (>75%) in whom aspirin treatment failed are likely to suffer an infarct without warning as the first sign of treatment failure (P< 0.033). We suggest that this subgroup of patients should be considered for alternative forms of therapy.
Social Outcome Related to Cognitive Performance and Computed Tomographic Findings after Surgery for a Ruptured Intracranial Aneurysm
Authors: Vilkki J. , Holst P. , öhman J. , Servo A. , Heiskanen O.
Published: April 2011

A series of 83 patients was examined with a battery of cognitive tests, a clinical interview, and computed tomography 1 year after surgery for a ruptured intracranial aneurysm. Disability on the Glasgow Outcome Scale (33%), failure to return to work (25%), impaired social relations (25%), and subjective or clinical mental impairment (56%) were found to be related to each other and to poor performance on cognitive tests, especially to verbal impairments in patients with left lateral infarctions and to memory deficits and cognitive inflexibility in patients with frontal medial infarctions. Furthermore, cognitive deficits and poor outcome were associated with diffuse brain damage. Depression and anxiety were unrelated to test performances, but were frequently reported by patients with right lateral infarctions.
Recurrent Intracerebral Hemorrhage Due to Hypertension
Authors: Lee Kyeong Seok , Bae Hack Gun , Yun H Gyu
Published: April 2011

We report a series of 14 patients who had recurrent intracerebral hemorrhage due to hypertension. These patients comprise 2.7% of all those admitted to the Soonchunhyang University Chonan Hospital for hypertensive intracerebral hemorrhage from 1985 to 1988. Women outnumbered men by 13 to 1. The mean age of the patients was 54.5 years at the time of the first hemorrhage and 55.4 years at the time of the second hemorrhage. The mean interval between attacks was 13.1 months. All patients were hypertensive on admission, and in 10 patients hypertension had been diagnosed previously. None of the patients had received regular antihypertensive therapy, even after the first hemorrhage. Hemiplegia was the most common deficit seen after both the first and second attacks. The site of the first hemorrhage was ganglionic in 9 patients, cerebellar in 3 patients, and lobar in 2 patients. The site of the second hemorrhage was ganglionic in 9 patients and lobar in 5. The site of recurrent hemorrhage was different from the initial site in all patients except one. The most common pattern of recurrence was “ganglionic-ganglionic.” The “lobar-lobar” pattern was noted in only 1 patient. The hypertensive changes of the cerebral arteries are considered to be the major cause of these recurrent hemorrhages. We believe that recurrent intracerebral hemorrhages in hypertensive patients are not rare as previously thought. Possible reasons for the increased frequency of recurrent intracerebral hemorrhage are discussed.
Relationship of Invasiveness to Proliferating Activity and to Cytoskeletal Protein Production in Human Neuroepithelial Tumors Maintained in an Organ Culture System: Use of Human Cortex and Dura as Supporting Matrices
Authors: Ibayashi Norihiro , Herman Mary M. , Boyd James C. , Rubinstein Lucien J.
Published: April 2011

The proliferation and invasiveness of cultured human neuroepithelial tumors were studied. A human malignant astrocytic glioma cell line (U-251 MG) and a medulloblastoma cell line (D283 Med) were maintained for 3 weeks in an organ culture system using adult human brain cortex, dura mater, or Gelfoam sponge as growth matrices. The cells were labeled with bromodeoxyuridine (BrdU) at different time points, and immunohistochemistry was performed for BrdU, glial fibrillary acidic (GFA) protein (in U-251 MG), and neurofilament (NF) protein (in D283 Med). In the U251 MG line, the cells grew successfully in each matrix, forming a fibrillated solid area and a peripheral zone of invasion. The labeling index (LI) expressed as the percentage of BrdU-labeled cells and the percentage of GFA protein-positive cells in the two zones of the explants were analyzed. The LIs in all cultures were significantly higher in the peripheral than in the central zones. On the other hand, the percentage of GFA protein-positive cells in each matrix was greater in the central zone than in the periphery. The LI was inversely correlated with the percentage of GFA protein-positive cells over the areas counted in each growth matrix. GFA protein production in cells grown on cortex and on dura mater was significantly higher than that in cells grown on Gelfoam. In the D283 Med line, the cells formed an aggregated zone, with peripheral cells infiltrating the Gelfoam. This line showed poor growth on human cortex. Cells grown on the dura demonstrated an LI similar to that on Gelfoam, and cells often infiltrated the dura. The LI of these cells was higher in the peripheral than in the central zone of the explants, both on dura and on Gelfoam. The cells showed variable immunopositivity for each NF protein subunit. No apparent difference in the percentage of immunopositive cells for each NF protein subunit was detected between cells grown on dura and on Gelfoam; however, cells grown on dura often demonstrated neurite-like processes. The results indicate that an organ culture system using human brain cortex or dura mater as matrices for in vitro growth is a promising tool for the study of neuroglial differentiation and of the invasiveness of cultured human neuroepithelial tumors.
Use of Vicryl (Polyglactin 910) Mesh to Limit Epidural Scar Formation after Laminectomy
Authors: Nussbaum Charles E. , McDonald Joseph V. , Baggs Raymond B.
Published: April 2011

A variety of substances have been used at laminectomy sites to prevent postoperative epidural scarring. Free grafts of autologous subcutaneous fat are commonly used both clinically and experimentally. The free fat grafts usually survive, but decrease in size by about 50%. Postoperatively, subcutaneous seroma has been observed with the use of fat grafts, as well as recurrent symptoms of neural compression by the graft that required additional operations. When compared to the use of free fat grafts after laminectomy in dogs, Vicryl mesh produced slightly more scarring, but consistently less than that observed in control animals. The Vicryl mesh was resorbed by a minimal chronic inflammatory response over about 45 days. Seven of 11 fat-grafted zones showed signs of necrosis, at times with a greater collection of inflammatory cells than that associated with the Vicryl mesh. Of the 4 fat-grafted zones that showed good survival. 2 had gross evidence of neural compression. No surgical zone treated with Vicryl mesh exhibited evidence of neural compression. In view of these results, the use of Vicryl mesh at laminectomy sites may be a safer method of limiting postoperative epidural scar formation.
Deep Brain Stimulation for Control of Intractable Pain in Humans, Present and Future: A Ten-Year Follow-up
Authors: Kumar Krishna , Wyant Gordon M. , Nath Rahul
Published: April 2011

Deep brain stimulation with chronically implanted electrodes has provided satisfactory control of pain in patients with intractable chronic pain syndromes, which have been refractory to medication and other conventional modalities of management. In this series the authors present their experience with 48 patients who have been followed for periods ranging from 6 months to 10 years. Long-term pain control was achieved in 30 patients (63%). Both the periventricular gray and specific sensory thalamic nuclei have been used as targets. Our results indicate that there is an initial 2-year fall-off of pain control caused by idiopathic tolerance, with stable results thereafter, regardless of site of the implant. This is suggestive of some biochemical modification of tissues around the electrode. Patients with failed-back syndrome secondary to multiple disc operations fared well; those with pain secondary to progressive neurological disorders or cancer had only short-term pain relief, and those with thalamic pain, cauda equina injury, or phantom limb pain usually had a poor result. Deep brain stimulation, in selected patients, appears to provide long-term pain control safely with few side effects or complications.
Disturbed Cerebrospinal Fluid Circulation after Subarachnoid Hemorrhage and Acute Aneurysm Surgery
Authors: Auer Ludwig M. , Mokry Michael
Published: April 2011

In 138 patients with ruptured cerebral aneurysms operated on within 48 to 72 hours after subarachnoid hemorrhage, an external ventricular drainage catheter was inserted before craniotomy and was used intermittently during the first week after surgery. In 51 patients, intracranial pressure (ICP) was measured intraoperatively. The majority of patients showed increased ICP intraoperatively irrespective of the preoperative Hunt and Hess grade and the amount of subarachnoid blood accumulation or intraventricular blood clot. Intraoperative drainage of cerebrospinal fluid allowed easy access for aneurysm dissection by making the brain slack in more than 90% of patients. Postoperative ICP measurements revealed that significant brain swelling did not occur in the majority of patients, In 7 patients, persistently elevated ICP (>20 mm Hg) was recorded. Nine patients (8%) developed shunt-dependent hydrocephalus; all of these patients had suffered an intraventricular hemorrhage. Measurements of the volumes of cerebrospinal fluid drained did not allow prediction of shunt-dependent hydrocephalus.
Acute Management of Intracranial Hemorrhage in Patients Receiving Thrombolytic Therapy: Case Reports
Authors: Eleff Scott M. , Borel Cecil , Bell William R. , Long Donlin M.
Published: April 2011

Intracranial hemorrhage is an uncommon complication of antithrombotic therapy. We present two patients who suffered life-threatening intracranial bleeding as a complication of thrombolytic/anticoagulant treatment. Early diagnosis and treatment appear to be crucial factors for survival. We suggest an approach to perioperative management for intracranial hemorrhage resulting from antithrombotic therapy.