Murphey's teat: history and insight into an enigmatic cerebrovascular eponym.

Dr. Francis Murphey of the Semmes-Murphey Clinic in Memphis recognized that a focal sacculation on the dome of an aneurysm may be angiographic evidence of a culpable aneurysm in the setting of subarachnoid hemorrhage with multiple intracranial aneurysms present. This has been referred to as a Murphey's "teat," "tit," or "excrescence.

Idiopathic localizing signs and atypical symptoms of cervical disk pathology: A case report.

Cervical disc herniations most often present with neck and arm pain resulting from direct nerve root compression from a paramedian or foraminal disc herniation. It is unusual to encounter unilateral lower extremity symptoms in the absence of other neurological symptoms due to a centrally herniated cervical disc. Because this clinical presentation is uncommon, there can be misdiagnosis, or delay in treatment of patients who suffer from debilitating pain or weakness.

Vertebral Venous Collaterals with Underlying Agenesis of the Inferior Vena Cava: Implications for Spinal Surgery.

Background: Congenital agenesis of the inferior vena cava (IVC) can lead to the development of a prominent venous collateral system within and around the spine due to the development of venous collaterals. In such patients, surgery can carry a risk of catastrophic bleeding or decompensation of a delicate venous drainage pattern during spinal manipulation or even epidural exploration.

Case Description: A 49-year-old man with a congenital agenesis of the IVC presented with signs and symptoms of an L5 radiculopathy.

A History of the Council of State Neurosurgical Societies.

As neurological surgery evolved into its own subspecialty early in the 20th century, a need arose to create an environment for communication and education among those surgeons working in this burgeoning surgical discipline. As the socioeconomic climate in health care began to change in the United States, an unforeseen need arose that was outside the scope of the American Association of Neurological Surgeons, Congress of Neurological Surgeons, and Society of Neurological Surgeons. The capacity to understand and address the evolving socioeconomic landscape and to offer a platform for advocacy required a new entity.

The National Neurosurgery Quality and Outcomes Database (N2QOD): a collaborative North American outcomes registry to advance value-based spine care.

Study Design: National Prospective Observational Registry.

Objective: Describe our preliminary experience with the National Neurosurgery Quality and Outcomes Database (NQOD), a national collaborative registry of quality and outcomes reporting after low back surgery.

Summary Of Background Data: All major health care stakeholders are now requiring objective data regarding the value of medical services.

Acute carotid stenting for treatment of stuttering transient ischemic attacks after recent carotid endarterectomy.

Carotid endarterectomy (CEA) is the established standard to treat occlusive extracranial atherosclerotic carotid disease. Complications of CEA must be recognized and dealt with efficiently due to the potentially catastrophic neurologic sequelae. A 67-year-old African American man was transferred from an outside hospital for an acute stroke.

Acute carotid stenting for treatment of stuttering transient ischemic attacks after recent carotid endarterectomy.

Carotid endarterectomy (CEA) is the established standard to treat occlusive extracranial atherosclerotic carotid disease. Complications of CEA must be recognized and dealt with efficiently due to the potentially catastrophic neurologic sequelae. A 67-year-old African American man was transferred from an outside hospital for an acute stroke.

The history of neurosurgery in Memphis: the Semmes-Murphey Clinic and the Department of Neurosurgery at the University of Tennessee College of Medicine.

Neurological surgery was defined as a separate surgical specialty by Harvey Cushing and a few other surgeons, most of whom were trained and influenced by Cushing. One of these, Raphael Eustace Semmes, became the first neurosurgeon in Memphis, Tennessee, in 1912. After World War II, Semmes and his first associate, Francis Murphey, incorporated the Semmes-Murphey Clinic, which has been primarily responsible for the growth of the Department of Neurosurgery at the University of Tennessee Health Science Center in Memphis, as well as the development of select neurosurgical subspecialties in Memphis area hospitals.

Metastatic paraganglioma causing spinal cord compression.

Summary Of Background Data: Paragangliomas are neoplasms that arise from the autonomic nervous system-associated paraganglia. Most often they are benign tumors. However, infrequently they have been reported to metastasize.

Pharmacokinetics and safety of a phenytoin prodrug given i.v. or i.m. in patients.

ACC-9653, a prodrug of phenytoin synthesized to be water soluble, is converted to phenytoin by phosphatases. In this study, 43 patients received ACC-9653 IV or IM. Side effects were transient and minor.

Traumatic carotid artery dissection: diagnosis and treatment.

Early diagnosis and successful management of traumatic carotid artery dissections require a high index of clinical suspicion. The diagnostic study of choice is cerebral arteriography. In this paper, 24 cases of traumatic carotid artery dissection are described.

Phenytoin prodrug 3-phosphoryloxymethyl phenytoin (ACC-9653): pharmacokinetics in patients following intravenous and intramuscular administration.

A phenytoin prodrug, 3-phosphoryloxymethyl phenytoin (ACC-9653; 1), has been developed with more favorable physicochemical properties than phenytoin for parenteral administration. The purpose of this study was to evaluate the pharmacokinetic profile of 1 following iv and im administration in adult patients receiving chronic oral phenytoin monotherapy. Each patient (9 males, 1 female) received a single iv dose of undiluted 1 equivalent to their twice daily phenytoin dose (100-200 mg).

Anatomic evaluation of cisternal puncture.

Cisternal puncture, although less frequently used since the advent of computed tomography and magnetic resonance imaging, is an important tool in the neurodiagnostic armamentarium. An anatomic study of cisternal puncture was conducted on fresh cadavers by direct visualization and fluoroscopic guidance of cisternal puncture. Anatomic and radiographic analyses demonstrated a dramatic dynamic anatomy of the cisternal space during cisternal puncture and indicated that "tenting" of the dura mater over the needle occurs reliably during cisternal puncture.

Complications of intracranial pressure monitoring in trauma patients.

A retrospective review of 175 intracranial pressure (ICP) monitors placed in 140 trauma patients over a recent 3-year period showed a 10.3% infection rate. Factors that were related to the development of an ICP monitor-related infection included: 1) duration of monitoring; 2) requirement for serial monitors; and 3) concurrent infection at other sites.

Phenytoin prodrug: preclinical and clinical studies.

The currently available phenytoin (PHT) solution has many disadvantages stemming from poor aqueous solubility of PHT. A novel approach to solve the problem has been the synthesis of a phosphate ester of PHT (PHT prodrug ACC-9653). This water-soluble compound is metabolized rapidly into PO4 and PHT.

Phenytoin pharmacokinetics in critically ill trauma patients.

Preliminary data have suggested that phenytoin systemic clearance may increase during initial therapy in critically ill patients. The objectives for this study were to model the time-variant phenytoin clearance and evaluate concomitant changes in protein binding and urinary metabolite elimination. Phenytoin was given as an intravenous loading dose of 15 mg/kg followed by an initial maintenance dose of 6 mg/kg/day in 10 adult critically ill trauma patients.

Analysis of 76 civilian craniocerebral gunshot wounds.

A retrospective analysis of 76 civilian craniocerebral gunshot wounds treated over a 20-month period is presented. The authors report a 62% mortality rate and conclude that the admission Glasgow Coma Scale (GCS) score is a valuable prognosticator of outcome. Other important findings were: patients with a GCS score of 3 invariably died, with or without surgical intervention; and the presence of intracranial hematomas, ventricular injury, or bihemispheric wounding was associated with a poor outcome.

Lateral atlantooccipital dislocation: case report.

A case of lateral atlantooccipital dislocation is presented, and its successful management is outlined, demonstrating the importance of the physical examination and the utilization of computed tomography. Open reduction and stabilization with direct visualization of the spinal axis is the preferred method of treatment.

Intracranial internal carotid artery stenosis.

The advent of EC/IC Bypass surgery has focused attention on selected patients who might benefit from this innovative procedure. There is a poverty of natural history data pertaining to all such lesions. Two centres (Memphis, Tennessee and London, Ontario) pooled their resources to carry out a retrospective review of 58 patients with angiographically-proven intracranial internal carotid artery stenosis.