The influence of primary language on postoperative stroke outcomes.

Background: Language barriers have the potential to influence acute stroke outcomes. Thus, we examined postoperative stroke outcomes among non-English primary language speakers.

Methods: Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2016-2019), we conducted a retrospective cohort study of adults diagnosed with a postoperative stroke in Michigan, Maryland, and New Jersey.

Derivation and Validation of an Algorithm to Detect Stroke Using Arm Accelerometry Data.

Background Early diagnosis is essential for effective stroke therapy. Strokes in hospitalized patients are associated with worse outcomes compared with strokes in the community. We derived and validated an algorithm to identify strokes by monitoring upper limb movements in hospitalized patients.

Enhanced Fiber Tractography Using Edema Correction: Application and Evaluation in High-Grade Gliomas.

Background: A limitation of diffusion tensor imaging (DTI)-based tractography is peritumoral edema that confounds traditional diffusion-based magnetic resonance metrics.

Objective: To augment fiber-tracking through peritumoral regions by performing novel edema correction on clinically feasible DTI acquisitions and assess the accuracy of the fiber-tracks using intraoperative stimulation mapping (ISM), task-based functional magnetic resonance imaging (fMRI) activation maps, and postoperative follow-up as reference standards.

Methods: Edema correction, using our bi-compartment free water modeling algorithm (FERNET), was performed on clinically acquired DTI data from a cohort of 10 patients presenting with suspected high-grade glioma and peritumoral edema in proximity to and/or infiltrating language or motor pathways.

Treatable childhood neuronopathy caused by mutations in riboflavin transporter RFVT2.

Childhood onset motor neuron diseases or neuronopathies are a clinically heterogeneous group of disorders. A particularly severe subgroup first described in 1894, and subsequently called Brown-Vialetto-Van Laere syndrome, is characterized by progressive pontobulbar palsy, sensorineural hearing loss and respiratory insufficiency. There has been no treatment for this progressive neurodegenerative disorder, which leads to respiratory failure and usually death during childhood.

No increased risk of spinal cord ischemia in delayed AAA repair following thoracic aortic surgery.

Objective: To examine the results of open or endovascular abdominal aortic aneurysm (AAA) repair following prior open or endovascular thoracic aortic surgery.

Methods: A retrospective review of all patients who underwent AAA repair in a delayed fashion following prior thoracic aortic surgery at a single university hospital between 1999 and 2011 was performed.

Results: Thirteen patients underwent AAA repair following prior thoracic aortic repair.

Predictors of outcome in patients with spinal cord ischemia after open aortic repair.

Introduction: Spinal cord ischemia is a potentially devastating complication of thoracic aortic surgery. However, predictors of outcome have not been well characterized. The study objective was to generate a prognostic score that accurately stratifies patient outcomes, aiding in future management and planning.

A pilot study of darbepoetin alfa for prophylactic neuroprotection in aortic surgery.

Background: Descending aortic (DA) surgery poses a high risk for spinal and cerebral infarction and routine use of lumbar drains allows for measurement of CSF markers of neurologic injury. Erythropoiesis medications have extensive preclinical data demonstrating neuroprotection. We hypothesized that prophylactic darbepoetin alfa (DARB) given before surgery reduces neurologic injury in patients undergoing DA repair.

Effective tool or necessary evil: intraoperative monitoring during thoracic aneurysm repairs.

Background: The aim of our study was to analyze the neurophysiologic monitoring method with regard to its potential problems during thoracic and thoracoabdominal aortic open or endovascular repair. Furthermore, preventive strategies to the main pitfalls with this method were developed.

Methods: Between November 2000 and May 2007, in 97 cases, open surgery or endovascular stent graft implantation was performed on the thoracic or thoracoabdominal aorta.

Cerebral embolic exposure during transfemoral and transapical transcatheter aortic valve replacement.

Aim Of Study: To characterize the cerebral embolic exposure during transfemoral (TF) and transapical (TA) TAVR.

Methods: To detect cerebral embolic events during TAVR, intraoperative neuromonitoring using transcranial Doppler (TCD) was utilized in 28 patients (Edwards SAPIEN valve TF n = 18, TA n = 10). High intensity transient signals (HITS) reflective of embolic events were recorded.

Reversal of delayed-onset paraparesis after revision thoracic endovascular aortic repair for ruptured thoracic aortic aneurysm.

Thoracic endovascular aortic repair (TEVAR) is an important surgical option for the emergency treatment of ruptured thoracic aortic aneurysms, but is associated with a risk of spinal cord ischemia (SCI). Although risk factors for the development of SCI have been well described, the effectiveness of treatment to increase spinal cord perfusion pressure remains incompletely understood. We report the successful treatment of delayed-onset paraparesis after revision TEVAR for acute descending thoracic aortic rupture with the combined use of blood pressure augmentation and cerebrospinal fluid drainage.

Clinical problem-solving: brachial plexus closed injury and reconstruction.

Objective: Current management of severe brachial plexus injury has undergone recent modifications, and surgical options have expanded.

Methods: The case of a man with a severe closed brachial plexus injury resulting from a motorcycle accident is presented. The patient is found to have upper root avulsions that deprive him of function in the proximal arm.

Management of neurologic complications of thoracic aortic surgery.

Neurologic complications of thoracic aortic surgery are strongly associated with increased morbidity and mortality. Identifying preoperative risk factors for neurologic injury may enable us to refine our perioperative approach, and to lessen or avoid these complications. Methods to identify stroke and spinal ischemia intraoperatively such as neurophysiologic monitoring may enable us to improve outcomes in these patients by immediately instituting measures to improve brain and spine perfusion.

Risk factors for perioperative stroke after thoracic endovascular aortic repair.

Background: Stroke has emerged as an important complication of thoracic endovascular aortic repair (TEVAR). Identifying risk factors for stroke is important to define the risks of this procedure.

Methods: All neurologic complications were analyzed in a prospective database of patients in thoracic aortic stent graft trials from 1999 to 2006.

Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations.

Objective: The aim of this study was to assess the significance of malperfusion syndromes in patients with acute type A aortic dissection following a contemporary surgical management algorithm and the effects on morbidity, hospital mortality, and long-term survival. We believe that obliteration of the primary tear site with restoration of flow in the true aortic lumen results in decreased need for revascularization of malperfused organ systems.

Methods: Our operative approach aims at replacing the entire ascending aorta, resuspension of the aortic valve with repair or replacement of the sinus segment, and routine open replacement of the arch under hypothermic circulatory arrest with retrograde cerebral perfusion with obliteration of false lumen at the distal arch/proximal descending thoracic aorta, thus reestablishing normal flow in the descending thoracic true lumen.

The treatment of spinal cord ischemia following thoracic endovascular aortic repair.

Introduction: Thoracic endovascular aortic repair (TEVAR) is a promising alternative to the traditional open surgical approach, though spinal cord ischemia remains a challenging complication. Spinal cord ischemia has been treated using lumbar cerebral spinal fluid (CSF) drainage.

Methods: We report a case of delayed spinal cord ischemia that was successfully treated with vasopressor therapy alone, supporting aggressive blood pressure augmentation as a primary intervention to increase spinal cord perfusion.

Safety and efficacy of thrombolytic therapy in postoperative cerebral infarctions.

Acute ischemic stroke is a common and devastating complication of many surgical procedures. If diagnosed early, however, there are reasonably safe and effective treatment options. Although IV rtPA is the most well studied means of recanalization after ischemic stroke, it should be avoided within 14 days of a surgical procedure in favor of other locally directed techniques that carry a significantly lower risk of bleeding at the surgical site.

Clinically silent cerebral ischemic events after cardiac surgery: their incidence, regional vascular occurrence, and procedural dependence.

Background: The reported frequency of stroke after coronary artery bypass grafting varies between 1.5% and 6%, approaches 10% after aortic valve replacement, and may occur in between 40 to 70% in high-risk groups. Clinically silent infarction may be far more frequent and could contribute to long-term cognitive dysfunction in patients after cardiac procedures.

Clinical predictors for prolonged intensive care unit stay in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest.

Objective: The purpose of this study was to describe clinical predictors for prolonged length of stay in the intensive care unit (PLOS-ICU) after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA); and to determine the incidence of PLOS-ICU after DHCA, univariate predictors for PLOS-ICU, and multivariate predictors for PLOS-ICU.

Study Design: A retrospective and observational study. PLOS-ICU was defined as longer than 5 days in the ICU.

Perioperative outcome in adults undergoing elective deep hypothermic circulatory arrest with retrograde cerebral perfusion in proximal aortic arch repair: evaluation of protocol-based care.

Objective: The purpose of this study was to describe perioperative outcome in adults undergoing elective proximal aortic arch repair with protocol-based deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP).

Design: Retrospective and observational.

Setting: Cardiothoracic operating rooms and intensive care unit.

Neurological monitoring and off-pump surgery in a very high-risk stroke patient.

Stroke remains a high risk of coronary artery bypass grafting. We present a patient with progressively symptomatic coronary disease and severe four-vessel cerebrovascular disease not amenable to revascularization. This patient underwent coronary revascularization without neurologic complication using off-pump coronary surgery to avoid aortic manipulation and intraoperative electroencephalographic monitoring of cerebral perfusion.

Anesthesia and neurocerebral monitoring for aortic dissection.

Patients presenting to the operating room for repair of aortic dissection are challenging in all aspects of their care. Without exception, they require a multidisciplinary team approach. This article will review some of the specific challenges faced by anesthesiologists and neurologists when confronted with such a diagnosis.

Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms.

Background: Paraplegia is a recognized complication after endovascular stent repair of descending thoracic aortic aneurysms. A management algorithm employing neurologic assessment, somatosensory evoked potential monitoring, arterial pressure augmentation, and cerebrospinal fluid drainage evolved to decrease the risk of postoperative paraplegia.

Methods: Patients in thoracic aortic aneurysm stent trials from 1999 to 2004 were analyzed for paraplegic complications.

Major clinical outcomes in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest: quantification of organ-based perioperative outcome and detection of opportunities for perioperative intervention.

Objective: The purpose of this study was to describe clinical outcome after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA), to determine mortality and length of stay, neurologic outcome, cardiorespiratory outcome, and hemostatic and renal outcome after DHCA.

Design: Retrospective and observational.

Setting: Cardiothoracic operating rooms and intensive care unit (ICU).

Involvement of skeletal muscle in dialysis-associated systemic fibrosis (nephrogenic fibrosing dermopathy).

Nephrogenic fibrosing dermopathy (NFD), a newly recognized scleroderma-like disease, was originally described as a purely cutaneous disorder. More widespread involvement, including fibrosis of pulmonary and cardiac tissues, has been documented only recently, and it has been suggested that a more appropriate designation is dialysis-associated systemic fibrosis. We report five cases of this novel disorder, spanning a spectrum of primarily skin to primarily muscle involvement.