Vascular diseases of the spinal cord.

Vascular disease affecting the spinal can cause substantial neurologic morbidity. Several vascular spinal cord ailments present as neurologic emergencies, and should thus be recognizable to the practicing neurologist. We review the epidemiology, presentation, management strategies, and prognosis of various pathologies, including infarction, dural arteriovenous fistula, arteriovenous malformation, cavernous malformation, compressive epidural hematoma, vasculitis, and genetic abnormalities.

Cardiac injury in refractory status epilepticus.

Purpose: We sought to describe the spectrum of cardiac injury in refractory status epilepticus (RSE).

Methods: We reviewed all patients with RSE between 1999 and 2011 at Mayo Clinic. RSE was defined as generalized convulsive or nonconvulsive status epilepticus (SE) that continued despite initial therapies.

Racial and ethnic disparities in the treatment of unruptured intracranial aneurysms: a study of the Nationwide Inpatient Sample 2001-2009.

Background And Purpose: Minorities in the United States have less access to healthcare system resources, especially preventative treatments. We sought to determine whether racial and sex disparities existed in the treatment of unruptured intracranial aneurysms.

Methods: Using the Nationwide Inpatient Sample, hospitalizations for clipping and coiling of intracranial aneurysms from 2001 to 2009 were identified by cross-matching International Classification of Diseases, 9th Revision codes for diagnosis of unruptured aneurysm and subarachnoid hemorrhage (SAH) with procedure codes for clipping or coiling of cerebral aneurysms.

Age-related trends in the treatment and outcomes of ruptured cerebral aneurysms: a study of the nationwide inpatient sample 2001-2009.

Background And Purpose: Patient age substantially influences treatment decisions for ruptured cerebral aneurysms. It would be useful to understand national age-related trends of treatment techniques and outcomes in patients treated for ruptured cerebral aneurysm in the United States.

Materials And Methods: Using the US Nationwide Inpatient Sample, we evaluated trends in treatment technique (clipping versus coiling) and discharge status of patients undergoing clipping or coiling of ruptured cerebral aneurysms between 2001 and 2009.

Intracranial supraclinoid ICA dissection causing cerebral infarction and subsequent subarachnoid hemorrhage.

Background: Intracranial arterial dissection usually leads to cerebral infarction or subarachnoid hemorrhage (SAH). It is rare to see both complications in one clinical scenario.

Methods: Case report and review of the literature.

Stroke from acute cervical internal carotid artery occlusion: treatment results and predictors of outcome.

Background: Previous studies have not distinguished patients with acute cervical internal carotid artery (ICA) occlusions from those with intracranial occlusions and often consider them together in the same cohort.

Objectives: To evaluate the outcomes of patients with stroke from acute cervical ICA occlusion treated with intravenous thrombolysis or primary endovascular procedures and to identify early predictors of functional recovery among these patients.

Design: Retrospective study.

Capsular warning syndrome and crescendo lacunar strokes after atherosclerotic stenosis of the recurrent artery of Heubner.

The stereotype of repetitive transient cerebral ischemia causing unilateral motor, sensory, or sensorimotor deficits that simultaneously affect the face, arm, and leg, clinically localized to the internal capsule, fits with the description of capsular warning syndrome (CWS). A high proportion of individuals with these symptoms develop subsequent capsular stroke, despite various proposed preventative measures. It has been postulated that the mechanism for such strokes is that of small-vessel single-penetrator disease.

Blood transfusion is an important predictor of hospital mortality among patients with aneurysmal subarachnoid hemorrhage.

Background: Red blood cell (RBC) transfusion after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with increased mortality but prior studies have not adequately adjusted for transfusion-indication bias.

Methods: This is a retrospective study of consecutive aSAH patients admitted to the intensive care units of two academic medical centers over a 7-year period. Data collection included demographics, World Federation of Neurosurgical Surgeons score (WFNS), modified Fisher score (mFisher), admission and nadir hemoglobin (Hb) level, vasospasm, cerebral infarction, acute lung injury, and hospital mortality.

Transient amnesia after coiling of a posterior circulation aneurysm.

Background: Acute amnesia can be caused by medication effect, transient global amnesia, ischemia, metabolic abnormalities, and seizures.

Methods: Case report.

Results: A 56-year-old woman developed acute amnesia resembling transient global amnesia (TGA) after aneurysm coiling.

Facebook: can it be a diagnostic tool for neurologists?

A 56-year-old woman presented with acute ischaemic stroke with NIHSS 13. She had right eye ptosis and miosis. She and her husband were not sure if her facial features were different than usual.

Utilization of intravenous thrombolysis is increasing in the United States.

Background: Evaluating recombinant tissue plasminogen activator utilization rates is important, as many studies have demonstrated that administration of recombinant tissue plasminogen activator to qualified patients significantly improves prognosis.

Aims: We investigated recent trends in the utilization and outcomes of administration of intravenous recombinant tissue plasminogen activator in the United States using the National Inpatient Sample between 2001 and 2008.

Methods: We identified patients with a primary diagnosis of acute ischemic stroke who underwent treatment with intravenous recombinant tissue plasminogen activator and studied utilization rates and clinical outcomes: discharge to long-term facility (morbidity), in-hospital death (mortality), and intracranial hemorrhage.

Spinal cord meningioma: a treatable cause of paraplegia.

Chondrocalcinosis associated with Gitelman syndrome (GS) presents in young adults with either no symptoms or joint pain, muscle weakness, muscle cramps, paresthesias, episodes of tetany, or hypokalemic paralysis. Spinal cord meningiomas present with gradual onset of lower extremities weakness, numbness, pain, or balance problem. We report a 76 year old gentleman who presented with gradually progressive leg weakness puzzling the treating physicians.

Symptomatic intracranial hemorrhage following intravenous thrombolysis for acute ischemic stroke: a critical review of case definitions.

Background: Symptomatic intracranial hemorrhage (SICH) is a devastating complication of intravenous thrombolysis treatment that is associated with high mortality. Clinical trials, stroke registries and cohort studies employ different case definitions to identify stroke patients with SICH following intravenous thrombolysis. We systematically reviewed the reported rates of SICH following intravenous thrombolysis and compared their consistency with mortality outcomes.

Cerebrovascular consequences of pseudohyperaldosteronism.

The study of mechanistically defined forms of hypertension may provide insight into the relationship between hypertension and stroke. The author retrospectively studied a cohort of 23 individuals with pseudohyperaldosteronism (PHA), a condition associated with pathologic activation of the distal nephron epithelial sodium channel but low renin and aldosterone levels. During a median follow-up of 11 years (range: 1-30), 4 of 23 (17.

Coordination tests in persons with acute central nervous system pathology: assessment of interrater reliability and known-group validity.

Background And Purpose: Coordination testing is a standard part of the neurologic examination, yet the psychometric properties of many tests used by practitioners are unknown. This study investigated the interrater reliability and known-group validity of limb coordination tests in participants with acute central nervous system (CNS) pathology.

Methods: Twenty-five participants with CNS pathology completed 20 different limb coordination tests administered at bedside by a physical therapist.

Cognitive decline and hypersomnolence: thalamic manifestations of a tentorial dural arteriovenous fistula (dAVF).

Background: Intracranial dural arteriovenous fistulas (dAVFs) often present with pulsatile tinnitus, orbital congestion, and headache. Occasionally, they present with focal neurologic deficits, a dementia-like syndrome, hemorrhage, or ischemic infarction.

Methods: This study is based on the case of a 71-year-old gentleman who presented with 6 months of progressive forgetfulness, inattention, and hypersomnolence.

Post-cardiac arrest mortality is declining: a study of the US National Inpatient Sample 2001 to 2009.

Background: Despite several advances in postresuscitation care over the past decade, population-based mortality rates for patients hospitalized with cardiac arrest in the United States have not been studied over this time period. The aim of this study was to determine the annual in-hospital mortality rates of patients with cardiac arrest from 2001 to 2009.

Methods And Results: The US mortality rates for hospitalized patients with cardiac arrest were determined using the 2001 to 2009 US National Inpatient Sample, a national hospital discharge database.

Extramedullary tumors and leukemia: a diagnostic pitfall for the neurologist.

Objective: To describe neurologic presentations and radiologic findings of extramedullary myeloid tumor (EMT).

Methods: This is a retrospective case series of patients with neurologic presentations of EMT from January 1, 1981, until May 30, 2011. Clinical data abstracted included demographics, presentation, bone marrow involvement, history of hematologic malignancy, complete blood count at presentation, EMT location, imaging findings, treatments, and outcomes.

Dabigatran: a primer for neurosurgeons.

Objective: This study sought to present an overview of dabigatran, a new anticoagulant, and to discuss the implications for the perioperative management of patients taking dabigatran.

Methods: We reviewed the English literature pertaining to the new oral anticoagulant, dabigatran (Pradaxa).

Results: Dabigatran has the advantage of providing rapid and steady anticoagulation without requiring laboratory monitoring.

Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a case report.

Background: External ventricular drain (EVD) placement temporarily provides cerebrospinal fluid (CSF) diversion and is indicated in patients with aneurysmal subarachnoid hemorrhage (aSAH) to relieve hydrocephalus.

Methods: Case report.

Results: A 56-year-old woman was admitted to our hospital with aSAH complicated by acute hydrocephalus.

Anticoagulation-related intracranial hemorrhages.

Unfractionated heparin, low molecular weight heparin, and warfarin are often used for patients at high risk of thromboembolism and are associated with increased risk of major and even life threatening hemorrhages. They are in use for a long time and have treatment strategies in place in an event of life threatening intracranial hemorrhage. The advent of newer anticoagulants, direct thrombin inhibitors (dabigatran) and two factor Xa inhibitors (rivaroxaban and apixaban), has increased the options of anticoagulation for patients with atrial fibrillation and venous thrombosis, but at the same time, in the absence of an antidote, they have created a great challenge for treating physicians to manage intracranial bleeding related to these agents.

Pharmacological prophylaxis of venous thromboembolism during acute phase of spontaneous intracerebral hemorrhage: what do we know about risks and benefits?

Spontaneous intracerebral hemorrhage (sICH) represents a devastating clinical event with high mortality and morbidity rates. Only few patients with sICH are treated with neurosurgical evacuation of the hematoma, and the majority of them need only a good conservative medical approach. The goal of medical treatment is to avoid secondary neurological and systemic complications.

Thrombolysis outcomes among obese and overweight stroke patients: an age- and National Institutes of Health Stroke Scale-matched comparison.

Background: Whether obese and overweight stroke patients respond differently to intravenous thrombolysis is unclear. The purpose of this study is to determine the influence of obesity and risk components of metabolic syndrome to stroke recovery in patients undergoing intravenous thrombolysis.

Methods: Outcomes after recombinant tissue plasminogen activator treatment were compared between obese (body mass index [BMI] >30 kg/m(2)), overweight (BMI 25-30 kg/m(2)), and normal weight (BMI <25 kg/m(2)) patients.