Surgical strategies for older patients with glioblastoma.

Objective: While adjuvant treatment regimens have been modified for older patients with glioblastoma (GBM), surgical strategies have not been tailored.

Methods: Clinical data of 48 consecutive patients aged 70 years or older, who underwent surgical resection for GBM with intraoperative ultrasonography (IoUS) alone or combination with intraoperative MRI (IoMRI) at Yale New Haven Hospital were retrospectively reviewed. Variables were analyzed, and comparative analyses were performed.

Type of bony involvement predicts genomic subgroup in sphenoid wing meningiomas.

Purpose: As sphenoid wing meningiomas (SWMs) are associated with varying degrees of bony involvement, we sought to understand potential relationships between genomic subgroup and this feature.

Methods: Patients treated at Yale-New Haven Hospital for SWM were reviewed. Genomic subgroup was determined via whole exome sequencing, while the extent of bony involvement was radiographically classified as no bone invasion (Type I), hyperostosis only (Type II), tumor invasion only (Type III), or both hyperostosis and tumor invasion (Type IV).

Hypermutated phenotype in gliosarcoma of the spinal cord.

Gliosarcoma is a variant of glioblastoma with equally poor prognosis and characterized by mixed glial and mesenchymal pathology. Metastasis is not uncommon but the involvement of the spinal cord is rare, and comprehensive genetic characterization of spinal gliosarcoma is lacking. We describe a patient initially diagnosed with a low-grade brain glioma via biopsy, followed by adjuvant radiation and temozolomide treatment.

Clinical and genomic factors associated with seizures in meningiomas.

Objective: The association of seizures with meningiomas is poorly understood. Moreover, any relationship between seizures and the underlying meningioma genomic subgroup has not been studied. Herein, the authors report on their experience with identifying clinical and genomic factors associated with preoperative and postoperative seizure presentation in meningioma patients.

Diagnosis and management of periodic hypothermia.

Hypothermia, defined as a core temperature below 35°C, can occur in a variety of clinical settings, including environmental exposure, shock, infection, metabolic disorders (such as hypothyroidism, adrenal insufficiency, and Wernicke encephalopathy), malnutrition, and alcohol or drug toxicity. Typically, hypothermia should resolve with treatment of the underlying disorder. However, in rare cases patients experience recurrent episodes of hypothermia in the context of a stereotyped syndrome due to a hypothalamic lesion, which can be either congenital or acquired.

Anaplastic gliomas: radiation, chemotherapy, or both?

The optimal treatment of anaplastic gliomas is controversial. Options for treatment include radiation, chemotherapy or a combination of modalities. This article describes how treatment algorithms for anaplastic gliomas have evolved and interprets the results of recent studies.

Plantar flexion with noxious dorsal foot stimulation in brain death.

Background: Plantar flexion with plantar stimulation has been well described in brain death, and is compatible with brain death. However, plantar flexion with stimulation to the dorsal surface of the foot has not been reported previously in brain dead patients.

Methods: Case report with Technetium-99 m hexamethylpropyleneamine oxime brain scan and video.

Paraneoplastic syndrome of inappropriate antidiuretic hormone mimicking limbic encephalitis.

Objective: To compare the features of paraneoplastic syndrome of inappropriate antidiuretic hormone with those of limbic encephalitis.

Design: Case study.

Setting: Academic medical center.

Neurologic prognosis in cardiac arrest patients treated with therapeutic hypothermia.

Background: Therapeutic hypothermia is now commonly used to improve neurologic outcomes in eligible patients after cardiac arrest. The physiologic effects of cooling and pharmacologic effects of sedatives and neuromuscular blocking agents can affect the clinical exam and neurophysiologic findings. This can lead to uncertainty in neurologic prognostication.

Thrombolysis in right versus left hemispheric stroke.

Background: Recent evidence has suggested that patients with right hemispheric stroke (RHS) present later to an emergency department, have a lower chance to receive intravenous (IV) recombinant tissue plasminogen activator (t-PA), and have poorer clinical outcomes than do patients with left hemispheric stroke (LHS).

Methods: We analyzed the rate of IV t-PA administration with respect to the side of the affected hemisphere in a large community population, to determine whether a difference exists. The study population was a large prospective cohort of patients with acute stroke treated with IV t-PA at our hospital's stroke center (October 2000 to October 2006).