Background: The dilemma of neuro-oncological surgery involving suspected eloquent cortex is to maximize the extent of resection while minimizing neurological morbidity, referred to as the "onco-functional balance." Diffuse lower-grade gliomas are capable of infiltrating or displacing neural function within cortical regions and subcortical white matter tracts, which can render classical anatomic associations of eloquent function misleading.
Observations: This study employed presurgical navigated transcranial magnetic stimulation (nTMS) to determine the motor eloquence of a diffuse lower-grade glioma at the superior frontal gyrus extending and intrinsic to the primary motor cortex in a 45-year-old female.
Introduction: Inducting buprenorphine from methadone has traditionally involved initial opioid withdrawal, with risk of mental state deterioration in patients with serious mental illness (SMI). Micro-dosing of buprenorphine, with small incremental doses, is a novel off-label approach to transitioning from methadone and does not require a period of methadone abstinence. Given the limited literature about buprenorphine microdosing, we aimed to evaluate the feasibility and safety of inducting buprenorphine in a series of patients on methadone with SMI.
View Article and Find Full Text PDFBackground: Contrast-induced neurotoxicity (CIN) is an increasingly observed event following the administration of iodinated contrast. It presents as a spectrum of neurological symptoms that closely mimic ischaemic stroke, however, CIN remains a poorly understood clinical phenomenon. An appreciation of the underlying pathophysiological mechanisms is essential to improve clinical understanding and enhance decision-making.
View Article and Find Full Text PDFBackground: Recent reports raise the possibility of cerebral amyloid angiopathy (CAA) leading to intracerebral hemorrhage in young adults following childhood neurosurgery, suggesting transmission of amyloid-β (Aβ) through neurosurgical procedures including dura mater grafting. Parenchymal Aβ deposition, and to a lesser extent tau aggregation, similar to that seen in Alzheimer disease, have also been described.
Methods: We conducted a database review of 634 consecutive intracerebral hemorrhage patients aged <65 years at a tertiary stroke center over 20 years to identify such patients.
This study aimed to assess the correlation of sagittal balance parameters measured intraoperatively, against the gold standard post-operative standing full spine X-ray. A secondary aim was to create a predictive algorithm, that could be used intraoperatively to predict the post-operative balance. 49 patients, who underwent thoracolumbar spinal fusion over a 12-month period were included in this study.
View Article and Find Full Text PDFA ductus arteriosus aneurysm (DAA) is a rare but potentially fatal condition in adults. In the past, open surgery was the only available option for treatment. Nowadays, endovascular repair has emerged as a safe and less invasive treatment option for aortic aneurysms.
View Article and Find Full Text PDFBackground: Intensive care patients with traumatic brain injury (TBI) are at high risk of developing deep vein thrombosis (DVT). A high rate of DVT was reported before routine thromboprophylaxis, but the current DVT rate in TBI patients receiving best-practice mechanical and pharmacological prophylaxis is unknown.
Objectives: To determine the prevalence of DVT among TBI patients.