Middle meningeal artery embolization for chronic subdural hematoma in a young patient with refractory thrombocytopenia secondary to leukemia: more evidence for a paradigm shift? Illustrative case.

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical presentations, with an increasing number now also presenting with concurrent thrombocytopenia. Although middle meningeal artery (MMA) embolization has been considered in elderly patients with high comorbidities, it may permit treatment of CSDH in patients who are at high risk for recurrence or deemed unsuitable for surgical management due to thrombocytopenia.

Observations: A 35-year-old man who had severe thrombocytopenia due to blast cell crisis with chronic myeloid leukemia developed an atraumatic CSDH.

Deep Brain Stimulation and Swimming Performance: A Randomized Within-Person Crossover Study.

Objective: To determine whether deep brain stimulation (DBS) causes swimming impairment, we systematically compared swimming ability between DBS on vs off in 18 patients.

Methods: We conducted a randomized blinded crossover study, comparing swimming ability between DBS on vs off, within participants. Participants swam 3 laps of front crawl and 3 laps of breaststroke.

The Magnetic Resonance Imaging (MRI)-Directed Implantable Guide Tube Technique: Accuracy and Applications in Deep Brain Stimulation.

Objective: The magnetic resonance imaging (MRI)-directed implantable guide tube technique allows for direct targeting of deep brain structures without microelectrode recording or intraoperative clinical assessment. This study describes a 10-year institutional experience of this technique including nuances that enable performance of surgery using readily available equipment.

Methods: Eighty-seven patients underwent deep brain stimulation surgery using the guide tube technique for Parkinson disease (n = 59), essential tremor (n = 16), and dystonia (n = 12).

Modulation of saccades in humans by electrical stimulation of the posterior subthalamic area.

Objective: Posterior subthalamic area (PSA) deep brain stimulation (DBS) targeting the zona incerta (ZI) is an emerging treatment for tremor syndromes, including Parkinson's disease (PD) and essential tremor (ET). Evidence from animal studies has indicated that the ZI may play a role in saccadic eye movements via pathways between the ZI and superior colliculus (incerto-collicular pathways). PSA DBS permitted testing this hypothesis in humans.

Neobladder Obstruction: A Non-ischemic Cause for Hepatic Portal Venous Gas: Case Report.

Hepatic portal venous gas (HPVG) is a rare ominous radiological sign usually indicative of mesenteric ischemia. Increased detection of HPVG has been associated with a growing number of non-ischemic causes. A 64-year-old gentleman following radical cystectomy and neobladder formation developed clinical signs suggestive of bowel obstruction.

Drowning hazard with deep brain stimulation: case report.

The caudal zona incerta target within the posterior subthalamic area is an investigational site for deep brain stimulation (DBS) in Parkinson disease (PD) and tremor. The authors report on a patient with tremor-predominant PD who, despite excellent tremor control and an otherwise normal neurological examination, exhibited profound difficulty swimming during stimulation. Over the last 20 years, anecdotal reports have been received of 3 other patients with PD who underwent thalamic or pallidal lesioning or DBS surgery performed at the authors' center and subsequently drowned.