Progressive loss of hearing and balance in superficial siderosis due to occult spinal dural defects.

Purpose: Superficial siderosis, a progressive, debilitating, neurological disease, often presents with bilateral impairment of auditory and vestibular function. We highlight that superficial siderosis is often due to a repairable spinal dural defect of the type that can also cause spontaneous intracranial hypotension.

Methods: Retrospective chart review of five patients presenting with moderate to severe, progressive bilateral sensorineural hearing loss as well as vestibular loss.

Association of Sex and Age With Mild Traumatic Brain Injury-Related Symptoms: A TRACK-TBI Study.

Importance: Knowledge of differences in mild traumatic brain injury (mTBI) recovery by sex and age may inform individualized treatment of these patients.

Objective: To identify sex-related differences in symptom recovery from mTBI; secondarily, to explore age differences within women, who demonstrate poorer outcomes after TBI.

Design, Setting, And Participants: The prospective cohort study Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) recruited 2000 patients with mTBI from February 26, 2014, to July 3, 2018, and 299 patients with orthopedic trauma (who served as controls) from January 26, 2016, to July 27, 2018.

Early versus Late Profiles of Inflammatory Cytokines after Mild Traumatic Brain Injury and Their Association with Neuropsychological Outcomes.

Despite pre-clinical evidence for the role of inflammation in traumatic brain injury (TBI), there is limited data on inflammatory biomarkers in mild TBI (mTBI). In this study, we describe the profile of plasma inflammatory cytokines and explore associations between these cytokines and neuropsychological outcomes after mTBI. Patients with mTBI with negative computed tomography and orthopedic injury (OI) controls without mTBI were prospectively recruited from emergency rooms at three trauma centers.

Radical Cystectomy Perioperative Care Redesign.

Objective: To present an evidence-based review of the perioperative management of the radical cystectomy (RC) patient in the context of a care redesign initiative.

Methods: A comprehensive review of the key factors associated with perioperative management of the RC patient was completed. PubMed, Medline, and the Cochrane databases were queried via a computerized search.

Progressive neuropsychiatric symptoms and motor impairment.

A 42-year-old white man presented with cognitive impairment and behavioral changes followed by rapidly progressive motor and gait impairment. Magnetic resonance imaging revealed striking multifocal white matter signal change, areas of restricted diffusion, diffuse callosal signal change, and atrophy and hyperintensity of the corticospinal tracts. A broad range of etiologies warrant consideration in this case, including degenerative, vascular, inflammatory, metabolic, and neoplastic diseases.

Revisiting cerebral thromboangiitis obliterans.

We describe a 56-year-old patient with progressive cognitive decline in the context of heavy tobacco use and migraine, and imaging evidence of an occlusive terminal cerebral vasculopathy. The results of brain biopsy recapitulated the pathological features described by Lindenberg and Spatz in their classic 1939 treatise on cerebral thromboangiitis obliterans, or cerebral Buerger's disease. Although the condition is associated with heavy smoking, the identification of a hypercoagulable state in our patient suggests a multifactorial pathogenesis.

Redefining the golden hour for severe head injury in an urban setting: the effect of prehospital arrival times on patient outcomes.

Background: In patients with severe head injuries, transportation to a trauma centre within the "golden hour" are important markers of trauma system effectiveness but evidence regarding impacts on patient outcomes is limited.

Objective: To determine the effect of patient arrival within the golden hour on patient outcomes.

Methods: A retrospective cohort of adult patients with severe head injuries (head AIS ≥ 3) arriving within 24h of injury was identified using the trauma registry from 2000 to 2011.

Bronchogenic carcinoid metastasis to the intramedullary spinal cord.

Carcinoid tumours are malignant tumours of neuroendocrine origin. Spinal-cord compression from carcinoid metastasis is uncommon, and intradural spinal carcinoid is rare. We report an instance of intramedullary carcinoid metastasis of the conus medullaris in the context of stable, asymptomatic systemic disease.

Late quadriplegia after adult coarctation repair.

Quadriplegia developed suddenly 1 month after coarctation repair in a 53-year-old human. Cervical cord ischemia caused by thrombosis in an enlarged anterior spinal artery collateral was diagnosed on magnetic resonance scan and spinal angiography. After urgent cord decompression and anticoagulation there was neurologic improvement over a period of several months.