Managing Complex Wounds in Skilled Nursing Facilities (SNFs).

Wounds, especially chronic wounds, can be clinically challenging to manage. The presence of a chronic wound in a patient can not only cause nociceptive pain but also psychological and emotional pain. In extreme cases, they can be life-threatening if they present with infection and sepsis from poor wound care.

Intraventricular choroid plexus tumors: clinical characteristics and impact of current management on survival.

Introduction: Choroid plexus tumors (CPTs) represent one of the most common intraventricular tumors. Although most are benign, they often reach considerable sizes before clinical manifestation, challenging their surgical management. We aim to describe the clinical characteristics and the impact of current management on the survival of patients harboring intraventricular CPT.

Kyphosis Correction in Patients Undergoing a Four-Level Anterior Cervical Discectomy and Fusion.

Introduction Cervical kyphotic deformity can be quite debilitating. Most patients present with neck pain, but they can also present with radiculopathy, myelopathy, altered vertical gaze, swallowing problems, and even cosmetic issues from the severe kyphotic deformity. After failing conservative management, surgery remains the only option for halting symptom progression.

Bilateral Acute Osteoporotic Lumbar Pedicle Fracture Presenting with Associated Neurological Deficit: A Case Report and Review of Literature.

Osteoporosis is a common cause of vertebral compression fractures. Often times affecting post-menopausal women, these fractures may occur spontaneously or following minor trauma and are typically managed non-surgically. Here we present a case of a 67-year-old patient who presented with acute compression fracture of the lumbar 5 vertebra and bilateral pedicle fractures of the fourth and fifth lumbar vertebrae following an episode of coughing secondary to tracheitis.

Intradural Thoracic Arachnoid Cyst Fenestration for Spinal Cord Compression: A Case Illustration and Video Demonstration.

Spinal intradural arachnoid cysts are rare, benign intradural lesions of the spinal cord that can arise as a primary lesion or secondary due to inflammatory processes. Symptoms can range from an asymptomatic incidental finding to progressive myelopathy, with paresthesia and neuropathic pain. We present the case of an 80-year-old female with a longstanding history of back pain, urinary incontinence, difficulty ambulating and frequent falls, with rapid progression of her symptoms prior to presentation.

Enhancing the Informed Consent Process Using Shared Decision Making and Consent Refusal Data from the CLEAR III Trial.

Background: The process of informed consent in National Institutes of Health randomized, placebo-controlled trials is poorly studied. There are several issues regarding informed consent in emergency neurologic trials, including a shared decision-making process with the patient or a legally authorized representative about overall risks, benefits, and alternative treatments.

Methods: To evaluate the informed consent process, we collected best and worst informed consent practice information from a National Institutes of Health trial and used this in medical simulation videos to educate investigators at multiple sites to improve the consent process.

MRSA Spinal Epidural Abscess as a Neurosurgical and Infectious Disease Emergency with Unresolved Antimicrobial Solution.

Spinal epidural abscess caused by MRSA, a life-threatening organism resistant to methicillin and other antibiotics, is a rare but important infectious pathology due to its potential damage to the spinal cord. We present the case of a 74-year-old man who hematogenously seeded his entire epidural spinal canal from C1 to sacrum with MRSA bacteria and remained infected even after maximal treatment with vancomycin and daptomycin. Ceftaroline, a new 5th generation antibiotic with recently described clearance of widespread MRSA infection in epidural complex spine infections, was added to vancomycin as dual therapy for his MRSA infection.

Tumoral calcinosis of the lumbar and cervical spine.

Background: Tumoral calcinosis has been defined as a pathological condition which presents as calcified masses around juxta-articular structures. The etiology of this pathology is still not well understood but degenerative spine diseases seem to play a role. The diagnosis of tumoral calcinosis preoperatively can prevent intraoperative confusion from unexpected findings, especially in cases where removal of the calcified mass is essential to treating the patient's symptoms, i.

Awake-craniotomy for cavernoma resection.

Cavernomas make up approximately 8%-15% of all intracranial vascular malformations, and the most common presenting symptom is seizures. Complete resection of the cavernoma and removal of the surrounding gliotic core presents a cure but poses a challenge if an eloquent brain is involved or with incomplete resection of the epileptogenic foci. The authors present the case of a 53-year-old man with intractable seizures from a left posterior temporal lobe cavernoma who underwent an awake craniotomy with intraoperative seizure monitoring via electrocorticography.