Smartphone Use in the Management of Neurological Emergencies: A Simulation-Based Study.

Background: Smartphone use in medicine is nearly universal despite a dearth of research assessing utility in clinical performance. We sought to identify and define smartphone use during simulated neuroemergencies.

Methods: In this retrospective review of a prospective observational single-center simulation-based study, participants ranging from subinterns to attending physicians and stratified by training level (novice, intermediate, and advanced) managed a variety of neurological emergencies.

Split Spinal Cord Malformation Fed by Bilateral, Enlarged Radiculopial Arteries.

Anatomical variations of the spinal cord are seen in many manifestations; one rare variant that does not stem from a neural tube defect is known as a split cord malformation (SCM). In this variation, a deviation from normal development causes the spinal cord to divide into two hemicords, typically in the lumbar region. In the case described here, a SCM was observed with large, bilateral, radiculopial arteries.

Effects of intubation technique on intracranial pressure: a cadaveric study.

Patients are at risk of increased intracranial pressure (ICP) during manipulation for endotracheal intubation. The aim of this cadaveric study was to quantify this relationship. Five fresh frozen adult cadaveric heads were used.

A marginal process of the zygomatic bone predicts a lateral exit of the zygomaticotemporal nerve: An anatomical study with application to surgery around the midface.

Previous studies have not verified the contents of accessory foramina of the zygomatic bone on dry skulls and thus could not conclude whether they carried accessory zygomaticofacial nerve branches or branches or the entire trunk of the zygomaticotemporal nerve (ZTN). Therefore, the aim of the current study is to present findings from cadaveric dissections to clarify this relationship. Fifty, fresh frozen, adult cadaveric sides underwent dissection of the ZTN.

An anatomical model for studying cerebellar tonsillar herniation related to raised intracranial pressure.

Brain herniation is one of the most feared complications of many neurological pathologies. However, current understanding of the mechanisms behind brain herniation syndromes is poor. By investigating the correlations between raised intracranial pressure (ICP) and herniation of the cerebellar tonsils, we hope to develop a model that can be used to study intracranial fluid dynamics and its effects on brain tissue.

An unusual variant of the atlantomastoid muscle.

Knowledge of anatomical variations can be of use to clinicians and surgeons when, for example, viewing images of a patient or performing operations. Such knowledge can minimise the risk of iatrogenic complications. Herein, we present a case of a variant atlantomastoid muscle.

Wrist Extension Does Not Change the Position of the Radial Artery: Cadaveric Study With Application to Arterial Line Placement, and Transradial Neurointerventional Procedures.

Background: The radial artery is gaining popularity as a vascular access site for neurointerventional procedures. However, recent analyses of wrist position and radial artery anatomy has suggested that the extended position of the wrist is not always necessary. Therefore, the following cadaveric study was performed to verify these findings.

"False" foramina and fissures of the skull: a narrative review with clinical implications.

"False" foramina and fissures of the skull are described as openings formed between the adjacent edges of two or more bones and not conduits directly through a single bone. Trauma and metabolic disorders appear to affect these foramina and fissures differently when compared to the "true" foramina and fissures. Therefore, the aim of this paper is to provide a narrative review of the current literature about "false" foramina and fissures of the skull and skull base with a focus on their clinical significance.

A Nerve of McKenzie With a Variant Communicating Branch Between the Vagus Nerve and Cranial Root of the Accessory Nerve: A Cadaveric Case Report.

Anatomical variations of the craniocervical junction including a nerve of McKenzie, a branch between the spinal accessory nerve (XI) and the ventral root of the first cervical nerve (C1), have been identified. During routine dissection, a nerve of McKenzie with an interneural connection between the cranial root of the accessory nerve and the vagus nerve was observed on the left side. To our knowledge, a case with these two anatomical variations in the same cadaver and on the same side has not previously been reported.

Bilateral venous sinuses of Kelch.

Knowledge of the variant anatomy of the intradural venous sinuses is important to anatomists and clinicians alike. Herein, we report a cadaveric case of the rare venous sinus of Kelch, which some have believed is a remnant of the cranio-orbital sinuses. To our knowledge, only one other cadaveric case has been reported in the extant medical literature.

Anatomical Study of the Posterior Spinal Artery Branches to the Medulla Oblongata.

Background: The posterior spinal arteries (PSAs), branches of the intracranial segment of the vertebral artery or posterior inferior cerebellar artery, run bilaterally along the spinal cord and are integral to the blood supply primarily to the posterior one third of this structure. However, a less well-described distribution of the PSAs is their supply to the posterior medulla. The purpose of this study is to examine the medullary branches of the PSA anatomically.

Aneurysmal subarachnoid hemorrhage during pregnancy: a comprehensive and systematic review of the literature.

Aneurysmal subarachnoid hemorrhage (aSAH) is an emergent condition requiring rapid intervention and prolonged monitoring. There are few recommendations regarding the management of aSAH in pregnancy. We identified all available literature and compiled management decisions as well as reported outcomes through a systematic literature review without meta-analysis to provide recommendations for management of aSAH during pregnancy.

Neurological Impact of Coronavirus Disease of 2019: Practical Considerations for the Neuroscience Community.

Background: The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million individuals globally as of April 25, 2020, with more than 187,000 deaths. An increasing body of evidence has supported central nervous system involvement.

Continuous Qualitative Electroencephalography as a Noninvasive Neuromonitor.

Intracranial pressure (ICP) monitoring frequently guides key decisions in the management of diseases causing intracranial hypertension. Although typically measured by invasive means, contraindications may leave the clinician with little recourse for dynamic ICP evaluation-particularly when the patient's mental status is compromised. We describe here a healthy 18-year-old woman who subacutely progressed to coma due to diffuse cerebral venous sinus thrombosis.

Thrombolysis in Real Time: Demonstration of Revascularization with Intravenous Thrombolysis Therapy in the CT Scanner.

Background And Purpose: Administration of intravenous tissue plasminogen activator (tPA) in the computed tomography (CT) scanner has been recently implemented at our institution, as a means to decrease door-to-needle time. This change in protocol provided us a unique opportunity to visualize imaging signs of early recanalization.

Methods: We evaluated patients who presented with acute ischemic stroke both before and after a change in protocol for intravenous tPA administration.

Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage.

Objectives: Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH).

Methods: Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08-6/30/12.

Multifocal subdural hematomas as the presenting sign of acquired hemophilia A: a case report.

Background: Acquired hemophilia A (AHA) is a rare coagulopathy linked to a variety of etiologies including autoimmune diseases, neoplasms, diabetes, respiratory diseases, and the post-partum state. While bleeding in AHA is often seen in mucocutaneous or intramuscular locations, intracranial and intraspinal bleeds are exceedingly rare.

Case Presentation: We report an unusual case of spontaneous multifocal subdural hematomas in a 25 year old Asian woman with lupus who presented with headache and backache, and was found to have an elevated partial thromboplastin time (PTT) level and new diagnosis of AHA.

The Impact of Left Ventricular Hypertrophy and Diastolic Dysfunction on Outcome in Intracerebral Hemorrhage Patients.

Background: The objective of this study was to determine the prevalence of LVH and DD in patients presenting with supratentorial deep ICH and to determine if the presence of LVH or DD was an independent predictor of initial ICH volume, hematoma expansion, or poor outcome.

Methods: A cross-sectional study was performed on ICH patients who presented from 7/2008 to 12/2010. Cases were excluded if ICH was traumatic, lobar, infratentorial, secondary to elevated international normalized ratio, suspicious for underlying structural malformation, or where surgical evacuation was performed.

Elevated Plasma Factor VIII in Patients with Ischemic Stroke: Does it have any Association with Hypertensive Heart Disease?

Background: Elevated factor VIII (FVIII) has been linked with higher risk of vascular events. We aimed to determine the relationship between FVIII and hypertension in patients with acute ischemic stroke.

Methods: FVIII levels and transthoracic echocardiogram reports were reviewed in patients with acute ischemic stroke who presented to our stroke center between July 2008 and September 2011.

Nadir hemoglobin is associated with poor outcome from intracerebral hemorrhage.

Objective: Examine the relationship between anemia and outcomes from intracerebral hemorrhage (ICH).

Methods: Patients admitted with spontaneous ICH between July 2008 and December 2010 were identified from our prospective stroke registry. Patients were divided into two groups based on admission hemoglobin (low vs.

Hepatitis C and recurrent treatment-resistant acute ischemic stroke.

Since the introduction of recombinant tissue plasminogen activator and thrombolysis, acute ischemic stroke has become a treatable disorder if the patient presents within the 4.5-hour time window. Typically, sporadic stroke is caused by atherosclerotic disease involving large or small cerebral arteries or secondary to a cardioembolic source often associated with atrial fibrillation.

24-Hour ICH Score Is a Better Predictor of Outcome than Admission ICH Score.

Background: The ICH score is a validated tool for predicting 30-day morbidity and mortality in patients with intracerebral hemorrhage.

Aims And/or Hypothesis: The aim of this study is to determine if the ICH score calculated 24 hours after admission is a better predictor of mortality than the ICH score calculated on admission.

Methods: Patients presenting to our center with ICH from 7/08-12/10 were retrospectively identified from our prospective stroke registry.