Periprocedural management of ruptured blister aneurysms treated with pipeline flow diversion.

Background: Blister aneurysms are high-risk intracranial vascular lesions. Definitive treatment of these lesions has been challenging. Severe disability or mortality rates are as high as 55% when these lesions are treated with open surgery.

Clinical characteristics and outcomes of 85 intensive care patients with Covid-19 in South London: A single centre observational study.

Background: In March 2020, Covid-19 secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was declared a global pandemic.

Methods: This retrospective observational study included patients with Covid-19, managed in a single intensive care unit (ICU). We collected data on patient characteristics, laboratory and radiological findings and ICU management.

Persistent dyskinesias in patients with fetal tissue transplantation for Parkinson disease.

Cell transplants are being developed for patients with Parkinson disease (PD) who have insufficient benefit with standard medical treatment. We describe the clinical features of five patients who developed persistent dyskinesias after fetal dopaminergic tissue transplantation. All had levodopa-induced dyskinesias preoperatively.

The effects of COVID-19 on sickness of medical staff across departments: A single centre experience.

Introduction: COVID-19 presents a risk to healthcare workers, incurring harm to staff physical and mental wellbeing and difficulties in provision of care and service planning.

Methodology: Doctors' anonymised demographic and staff sickness data were collected between 16 March and 26 April 2020, corresponding with the single centre's greatest COVID-19 caseload.

Findings: 128 (39%) of doctors experienced at least one sickness episode.

Subcutaneous Emphysema, Pneumomediastinum, and Pneumothorax in Critically Ill Patients With Coronavirus Disease 2019: A Retrospective Cohort Study.

Importance: Management of severe coronavirus disease 2019 relies on advanced respiratory support modalities including invasive mechanical ventilation, continuous positive airway pressure, and noninvasive ventilation, all of which are associated with the development of subcutaneous emphysema, pneumomediastinum, and pneumothorax (herein collectively termed barotrauma).

Objectives: To assess the occurrence rate of barotrauma in severe coronavirus disease 2019 and to explore possible associated factors.

Design Setting And Participants: A retrospective, single-center cohort study with nested case series, conducted at University Hospital Lewisham: a 450-bed general hospital in London, United Kingdom.

Cross-sectional survey of the wish to die among palliative patients in Spain: one phenomenon, different experiences.

Objective: Cultural backgrounds and values have a decisive impact on the phenomenon of the wish to die (WTD), and examination of this in Mediterranean countries is in its early stages. The objectives of this study were to establish the prevalence of WTD and to characterise this phenomenon in our cultural context.

Methods: A cross-sectional study with consecutive advanced inpatients was conducted.

Microvascular Decompression for Trigeminal Neuralgia: A Durable, Noncompressive Technique Using Teflon Secured With Mini Clip.

Background: In cases of trigeminal neuralgia, the importance of durable separation of involved vessels from the trigeminal nerve as well as avoiding ongoing or recurrent compression by implanted material has been affirmed in recent literature.

Objective: To demonstrate a novel and straightforward technique for trigeminal nerve decompression using a construct of Teflon felt patty (Bard Peripheral Vascular, Tempe, Arizona) secured with an aneurysm mini clip to achieve lasting results with no residual contact between implant or vessels and the nerve.

Methods: Description of our technique and accompanying surgical video.

Immune checkpoint inhibitors and radiosurgery for newly diagnosed melanoma brain metastases.

Introduction: Brain metastases are common in metastatic melanoma and radiosurgery is often utilized for local control. Immune checkpoint inhibitors (CPIs) play a central role in contemporary melanoma management; however, there is limited data exploring outcomes and potential toxicities for patients treated with CPIs and radiosurgery.

Methods: We retrospectively identified all consecutive cases of newly diagnosed melanoma brain metastases (MBM) treated with Gamma Knife radiosurgery at a single institution between 2012 and 2017, and included only patients that initiated CPIs within 8 weeks before or after radiosurgery.

Four-year Survival (and Counting) after Stereotactic Radiosurgery to Nearly 100 Brain Metastases: A Case Report.

Brain metastases are a relatively common consequence of Stage IV melanoma. Historically, patients with brain metastases fare poorly, with median survival of only weeks to months. Patients with multiple metastases in the brain have often been overlooked in the literature, with the focus being placed more on patients with only a small number of metastases.

Clip ligation for ruptured intracranial aneurysm in a child with Loeys-Dietz syndrome: case report.

The authors present the case of a pediatric patient with Loeys-Dietz syndrome (LDS) who underwent craniotomy for clip ligation of a ruptured intracranial aneurysm. To the authors' knowledge, this is the youngest reported patient with LDS who has been treated for a ruptured intracranial aneurysm. The patient presented with aneurysmal subarachnoid hemorrhage even though the results of surveillance screening were negative, and the aneurysm arose from the wall of the parent artery away from an arterial branch point.

Excellent Outcomes with Radiosurgery for Multiple Brain Metastases in ALK and EGFR Driven Non-Small Cell Lung Cancer.

Introduction: Patients with brain metastases (BMs) arising from EGFR-mutated and anaplastic lymphoma kinase gene (ALK)-rearranged NSCLC have a favorable prognosis compared with patients with non-oncogene-addicted NSCLC, emphasizing the importance of minimizing toxicities such as the cognitive sequelae of whole brain radiation therapy (WBRT). Although radiosurgery without WBRT is the preferred strategy for one to three BMs, this paradigm remains controversial for patients with multiple BMs.

Methods: We reviewed the cases of patients with EGFR-mutated and ALK-rearranged NSCLC presenting to our cancer center between 2008 and 2017 and included only patients receiving treatment to four or more BMs in a single radiosurgery session.

Arteriovenous Malformation in a Youth with Atypical Autism Symptoms.

Cerebral arteriovenous malformations (AVMs) present a challenge to diagnose in children with developmental disability, because of the overlap in behavioral symptoms and neurologic manifestations. They have been very rarely reported in conjunction with autism spectrum disorder. This case involves a 13 year old male with a history of autism spectrum disorder and significant behavioral issues diagnosed with a thalamic AVM following lateralizing neurologic symptoms.

Histopathologic features of intracranial vascular involvement in fibromuscular dysplasia, ehlers-danlos type IV, and neurofibromatosis I.

Nonatherosclerotic cerebrovascular arteriopathies share epidemiologic and clinical features, but few studies directly compare histologic features of the intracranial vasculature. We studied 3 adult autopsy cases of fibromuscular dysplasia in patients who died of basilar artery aneurysm rupture, vertebral artery dissection, or Moyamoya syndrome. Fibromuscular dysplasia was only identified when multiple sections (optimally of the entire circle of Willis) were examined by microscopy.

The Meniere attack: an ischemia/reperfusion disorder of inner ear sensory tissues.

We believe Meniere attacks arise as a chance association of endolymphatic hydrops and vascular risk factors for intracerebral ischemia. Hydrops acts as a variable Starling resistor upon the inner ear vasculature that is capable of inducing ischemic attacks only in people with reduced perfusion pressure in the ear. The unique characteristics of the attacks (loss of vestibular response and hearing acutely followed by a return to apparent normalcy over hours) are explained by the differential sensitivity of the inner ear tissues to transient ischemia, with the sensory tissues (dendrites, hair cells) vulnerable to hours-long ischemia/reperfusion injury, and the stria vulnerable to ischemia due to its high metabolic rate.

Endolymphatic hydrops in Ménière's disease: cause, consequence, or epiphenomenon?

Objective: To determine the relationship of endolymphatic hydrops to Ménière's disease.

Data Sources: Comprehensive review of articles from 1938 through 2012 via Medline and Index Medicus.

Study Selection: Articles discussing Ménière's disease and/or endolymphatic hydrops that include temporal bone autopsy data.

Dopamine cell transplantation for Parkinson's disease: the importance of controlled clinical trials.

Transplantation of human fetal dopamine neurons into the brain of Parkinson's disease patients started in the late 1980s, less than 10 years after experiments in rats showed that embryonic dopamine neurons from a narrow window of development are suitable for transplantation. For human transplantation, the critical stage of development is 6 to 8 weeks after conception. Because putamen is the basal ganglia structure most depleted of dopamine in Parkinson's disease and because it is the structure most closely mapped to the motor cortex, it has been the primary target for neurotransplantation.

Osteochondroma of the convexity: pathologic-neuroimaging correlates of a lesion that mimics high-grade meningioma.

Intracranial chondromas are uncommon benign lesions usually attached to dura and located over the convexity of the skull. Osteochondromas are even rarer and additionally contain a benign bony component. Both lesions are reportedly difficult to distinguish from meningiomas on pre-operative neuroimaging studies, although few detailed pathologic-neuroimaging correlation studies have appeared in the literature, particularly for intracranial osteochondromas.

Dopamine cell implantation in Parkinson's disease: long-term clinical and (18)F-FDOPA PET outcomes.

Unlabelled: We have previously reported the results of a 1-y double-blind, placebo-controlled study of embryonic dopamine cell implantation for Parkinson's disease. At the end of the blinded phase, we found a significant increase in putamen uptake on (18)F-fluorodopa ((18)F-FDOPA) PET reflecting the viability of the grafts. Nonetheless, clinical improvement was significant only in younger (age < or = 60 y) transplant recipients, as indicated by a reduction in Unified Parkinson's Disease Rating Scale (UPDRS) motor scores.

Cerebral cavernous malformations: somatic mutations in vascular endothelial cells.

Objective: Germline mutations in 3 genes have been found in familial cases of cerebral cavernous malformations (CCMs). We previously discovered somatic and germline truncating mutations in the KRIT1 gene, supporting the "2-hit" mechanism of CCM lesion formation in a single lesion. The purpose of this study was to screen for somatic, nonheritable mutations in 3 more lesions from different patients and identify the cell type(s) in which somatic mutations occur.

An overview of central nervous system transplantation in human disease.

Although its roots date back over a century, the field of neurotransplantation has been shaped mostly by advances over the past 30 years. Animal models of nigrostriatal disconnection in the 1970s allowed investigators to explore the feasibility of neural grafting. By the end of that decade, functional and behavioral effects had been demonstrated using fetal tissue grafts.

Technology, public policy and control of transboundary livestock diseases in our lifetimes.

There are no technological barriers to eliminating major transboundary livestock diseases. 'Elimination' means that diseases no longer threaten livestock in the developed world nor the livelihoods of hundreds of millions of small farmers elsewhere. The problem is not lack of technology but failure of public policy.