Publications by authors named "Jason Boulter"

Article Synopsis
  • The study investigated the effectiveness of quantitative pupillometry in predicting how long it takes for injured cadets at West Point to return to full activity after a mild traumatic brain injury (mTBI).
  • Researchers performed various assessments, including pupillometry and balance tests, at different stages (baseline and post-injury) to evaluate recovery.
  • Results showed that specific pupillary measurements right after injury were linked to quicker returns to play, suggesting that pupillometry could help gauge resilience and autonomic function in the early phase of mTBI recovery.
View Article and Find Full Text PDF

Background And Objectives: The objective of this study was to determine the utility of the pupillary light reflex use as a biomarker of mild traumatic brain injury (mTBI).

Methods: This prospective cohort study was conducted at The US Military Academy at West Point. Cadets underwent a standard battery of tests including Balance Error Scoring System, Sports Concussion Assessment Tool Fifth Edition Symptom Survey, Standard Assessment of Concussion, and measure of pupillary responses.

View Article and Find Full Text PDF

Purpose: Moyamoya disease and syndrome represent rare entities characterized by progressive stenosis and/or occlusion of the intracranial blood vessels. We present our series of patients with moyamoya disease and syndrome stratified by underlying disease and analyze differences in presentation and outcome following surgical revascularization.

Methods: This was an Institutional Review Board (IRB) approved, retrospective review of all patients surgically revascularized by the senior author (SNM) while at Children's National Hospital in Washington, DC.

View Article and Find Full Text PDF

Background: Transcarotid artery revascularization (TCAR) is becoming an increasingly popular treatment of carotid stenosis. Despite this rapid adoption, little in the literature describes the associated complications of this procedure.

Case Description: We report a case of a left M1 large-vessel occlusion following treatment of symptomatic, high-grade carotid stenosis with a TCAR procedure approximately three weeks earlier.

View Article and Find Full Text PDF
Article Synopsis
  • The study focuses on military personnel who sustained open and penetrating cranial injuries during conflicts in Iraq and Afghanistan from 2009 to 2014, highlighting the challenges and outcomes associated with these injuries.
  • Out of 106 subjects, 11.3% developed intracranial infections post-injury, with a median diagnosis time of 12 days and several significant factors correlating with infection risk, such as the duration of ventriculostomy and number of neurosurgical procedures.
  • Overall, the findings indicate that patients with CNS infections experienced worse conditions and prolonged hospitalization, underscoring the severity of penetrating brain injuries in military settings.
View Article and Find Full Text PDF

The tenets of neurosurgery worldwide, whether in the civilian or military sector, espouse vigilance, the ability to adapt, extreme ownership, and, of course, an innate drive for developing a unique set of technical skills. At a time in history when the complexity of battlefield neurotrauma climaxed coupled with a chronic shortage of military neurosurgeons, modernized solutions were mandated in order to deliver world-class neurological care to our servicemen and servicewomen. Complex blast injuries, as caused by an increased incidence of improvised explosive devices, yielded widespread systemic inflammatory responses with multiorgan damage.

View Article and Find Full Text PDF

Background: Rheumatoid arthritis (RA) frequently features degeneration and instability of the cervical spine. Rarely, this degeneration manifests as symptoms of bow hunter syndrome (BHS), a dynamic cause of vertebrobasilar insufficiency.

Observations: The authors reviewed the literature for cases of RA associated with BHS and present a case of a man with erosive RA with intermittent syncopal episodes attributable to BHS as a result of severe extrinsic left atlantooccipital vertebral artery compression from RA-associated cranial settling.

View Article and Find Full Text PDF

Background: Consensus is currently lacking in the optimal treatment for blunt traumatic cerebral venous sinus thrombosis (tCVST). Anticoagulation (AC) is used for treating spontaneous CVST, but its role in tCVST remains unclear.

Objective: To investigate the characteristics and outcomes of patients treated with AC compared with patients managed conservatively.

View Article and Find Full Text PDF

Background: Moyamoya syndrome refers to a progressive stenosis of the internal carotid arteries and can be associated with sickle cell disease. These codiagnoses result in severe risk for stroke, even in patients on optimal medical management. Surgical revascularization has been shown to be safe in small case series.

View Article and Find Full Text PDF

Traumatic brain injury is a rapidly increasing source of morbidity and mortality across the world. As such, the evaluation and management of traumatic brain injuries ranging from mild to severe are under active investigation. Over the last two decades, quantitative pupillometry has been increasingly found to be useful in both the immediate evaluation and ongoing management of traumatic brain injured patients.

View Article and Find Full Text PDF

Objective: The authors aimed to describe the natural history and optimal management of persistent syringomyelia after suboccipital craniectomy for Chiari malformation type I (CM-I).

Methods: A cohort of all patients who presented to a tertiary pediatric hospital with newly diagnosed CM-I between 2009 and 2017 was identified. Patients with persistent or worsened syringomyelia were identified on the basis of a retrospective review of medical records and imaging studies.

View Article and Find Full Text PDF

The therapeutic significance of timing of decompression in acute traumatic central cord syndrome (ATCCS) caused by spinal stenosis remains unsettled. We retrospectively examined a homogenous cohort of patients with ATCCS and magnetic resonance imaging (MRI) evidence of post-treatment spinal cord decompression to determine whether timing of decompression played a significant role in American Spinal Injury Association (ASIA) motor score (AMS) 6 months following trauma. We used the test, analysis of variance, Pearson correlation coefficient, and multiple regression for statistical analysis.

View Article and Find Full Text PDF
Article Synopsis
  • Medical malpractice lawsuits in the military have been limited for a long time because of a rule called the Feres Doctrine, established in 1950, which says active military members can't sue for malpractice.
  • This rule has been challenged more often recently, as many malpractice cases have been thrown out.
  • In 2020, a new law created a group to review and settle these medical malpractice claims in the military's healthcare system, marking the first big change to the Feres Doctrine in 70 years.
View Article and Find Full Text PDF

Introduction: The advancement of interventional neuroradiology has drastically altered the treatment of stroke and trauma patients. These advancements in first-world hospitals, however, have rarely reached far forward military hospitals due to limitations in expertise and equipment. In an established role III military hospital though, these life-saving procedures can become an important tool in trauma care.

View Article and Find Full Text PDF

Severe traumatic brain injury has historically been a non-survivable injury. Recent advances in neurosurgical care, however, have demonstrated that these patients not only can survive, but they also can recover functionally when they undergo appropriate cerebral decompression within hours of injury. At the present, general surgeons are deployed further forward than neurosurgeons (Role 2 compared to Role 3) and have been provided with guidelines that stipulate conditions where they may have to perform decompressive craniectomies.

View Article and Find Full Text PDF

Background: Moyamoya syndrome, a progressive, idiopathic stenosis of the internal carotid arteries, results in increased risk for both ischemic and hemorrhagic strokes. Revascularization procedures have been shown in small studies to be both safe and efficacious for these patients; however, randomized controlled trials are lacking. The goal of this systematic review is to organize the literature evaluating surgical intervention versus conservative medical management.

View Article and Find Full Text PDF

Background: Vagal nerve stimulation is a generally safe adjunctive treatment for medically refractory epilepsy. Nevertheless, reports of vocal cord dysfunction during stimulation can be found in the literature. When vagal nerve stimulation-induced vocal cord dysfunction is compounded with contralateral dysfunction, such as that which can occur after anterior cervical diskectomy and fusion, serious pulmonary complications can occur.

View Article and Find Full Text PDF
Article Synopsis
  • The opioid epidemic is worsening, prompting the Department of Defense and Veterans Health Agency to recommend the elimination of long-acting opioids and benzodiazepines in pain management, leading to changes in postoperative care.
  • A study was conducted on single-level TLIF patients to compare outcomes between those receiving benzodiazepines and long-acting opioids versus those receiving non-benzodiazepine, opioid-sparing medications.
  • Results showed that removing benzodiazepines and long-acting opioids did not change inpatient pain scores but led to reduced opioid use, fewer trigger medications, and shorter hospital stays for patients.
View Article and Find Full Text PDF

OBJECTIVESymptomatic cervical spondylosis with or without radiculopathy can ground an active-duty military pilot if left untreated. Surgically treated cervical spondylosis may be a waiverable condition and allow return to flying status, but a waiver is based on expert opinion and not on recent published data. Previous studies on rates of return to active duty status following anterior cervical spine surgery have not differentiated these rates among military specialty occupations.

View Article and Find Full Text PDF

OBJECTIVEThere are limited data concerning the long-term functional outcomes of patients with penetrating brain injury. Reports from civilian cohorts are small because of the high reported mortality rates (as high as 90%). Data from military populations suggest a better prognosis for penetrating brain injury, but previous reports are hampered by analyses that exclude the point of injury.

View Article and Find Full Text PDF

Background: Although isolated transverse process fractures (ITPF) do not confer any inherent risk of compromised spinal stability, there is increasing interest in their overall prognostic significance. As a proxy for localized or directional forces in high-energy traumatic mechanisms, ITPF may serve as an indicator for the presence of other coexisting traumatic injuries. Specific injuries may be predicted by the presence of ITPF at specific spinal levels, but few studies have examined this in depth and may not account for confounding variables.

View Article and Find Full Text PDF

Background: Sphenoid wing meningiomas (SWMs) can encase arteries of the circle of Willis, increasing their susceptibility to intraoperative vascular injury and severe ischemic complications.

Objective: To demonstrate the effect of circumferential vascular encasement in SWM on postoperative ischemia.

Methods: A retrospective review of 75 patients surgically treated for SWM from 2009 to 2015 was undertaken to determine the degree of circumferential vascular encasement (0°-360°) as assessed by preoperative magnetic resonance imaging (MRI).

View Article and Find Full Text PDF

Background: Computerized tomography angiography (CTA) is commonly used to diagnose ruptured cerebral aneurysms with sensitivities reported as high as 97% to 100%. Studies validating CTA accuracy in the setting of subarachnoid hemorrhage (SAH) are scarce and limited by small sample sizes.

Objective: To evaluate the diagnostic accuracy of CTA in detecting intracranial aneurysms in the setting of SAH.

View Article and Find Full Text PDF