Evaluation of factors associated with interhospital transfers to pediatric and adult tertiary level of care: A study of acute neurological disease cases.

Introduction: Patient referrals to tertiary level of care neurological services are often potentially avoidable and result in inferior clinical outcomes. To decrease transfer burden, stakeholders should acquire a comprehensive perception of specialty referral process dynamics. We identified associations between patient sociodemographic data, disease category and hospital characteristics and avoidable transfers, and differentiated factors underscoring informed decision making as essential care management aspects.

Constraining Solar Wind Heating Processes by Kinetic Properties of Heavy Ions.

We analyze the heavy ion components (A>4  amu) in collisionally young solar wind plasma and show that there is a clear, stable dependence of temperature on mass, probably reflecting the conditions in the solar corona. We consider both linear and power law forms for the dependence and find that a simple linear fit of the form T_{i}/T_{p}=(1.35±.

Proton MR Spectroscopy in Patients with Structural MRI-Negative Temporal Lobe Epilepsy.

Background And Purpose: With conventional magnetic resonance imaging (MRI), 20-30% of patients with temporal lobe epilepsy (TLE) have negative pathological MRI findings. Further investigations of the role of magnetic resonance spectroscopy (MRS) in the pre-surgical evaluation of patients with MRI-negative TLE are important to avoid intracranial EEG recording and to better understand the mechanism of the epileptogenic process. This study aimed to compare the measurements of N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) in the hippocampi of MRI-negative TLE patients and normal subjects.

Recurrence-free chronic subdural hematomas: a retrospective analysis of the instillation of tissue plasminogen activator in addition to twist drill or burr hole drainage in the treatment of chronic subdural hematomas.

Objective: To evaluate whether increasing the volume drained from chronic subdural hematomas (SDHs) via either twist drill drainage (TDD) or burr hole drainage (BHD) followed by instillation of tissue plasminogen activator (tPA) is more efficacious than simple drainage alone.

Methods: Patients admitted over the course of 42 months (2007-2010) to a single institution for treatment of chronic SDH were retrospectively evaluated.

Results: There were 139 patients treated for chronic SDH; 54 patients were treated with BHD alone, 3 were treated with tPA after BHD, 85 were treated with TDD alone, and 12 were treated with tPA after TDD.

Cauda equina syndrome (CES) from lumbar disc herniations.

Study Design: A retrospective review was performed to determine the outcomes of patients with cauda equina syndrome (CES) from a herniated lumbar disc at our institutions.

Objective: CES from lumbar herniated discs is considered the only absolute indication for surgery. It is considered a neurosurgical emergency with the outcome related to how quickly it is diagnosed and treated.

Urgent endovascular treatment of acute symptomatic occlusion of the cervical internal carotid artery.

Object: The prognosis of patients with acute symptomatic cervical internal carotid artery (ICA) occlusion is generally considered to be poor. Traditionally, such patients are not considered eligible for urgent thrombolytic/endovascular treatment. Since 1998, an aggressive therapeutic approach with endovascular treatment has been adopted at the authors' institution.

Intracranial hemorrhage following blunt injury to a shunt valve.

Case Report: The authors report a case of a child who sustained blunt injury to a shunt valve during a basketball game, which resulted in an intracranial hemorrhage.

Conclusion: This occurrence, although rare, reinforces the recommendation for protective headgear when patients with shunts engage in activities that may result in direct impact to the head.