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Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
For subarachnoid hemorrhage, the best available treatment is offered at comprehensive stroke centers. Hypertension is only treated if the mean arterial pressure is higher than 130 mm Hg. Intravenous nicardipine is titrated in the same way as for intracerebral hemorrhage. The patient is confined to bed rest, and there is symptomatic treatment of headache and restlessness. Anticoagulants and antiplatelet drugs are avoided. Oral nimodipine is given every 4 hours, for 21 days, to prevent vasospasm. However, the BP must be kept in the desired range, usually 120–185 mm Hg systolic. Also, with an accessible aneurysm, surgery can allow for it to be clipped or stented. This is especially preferred if the patient has an evacuable hematoma or acute hydrocephalus. When the patient can be aroused from unconsciousness, neurosurgeons usually operate within the first 24 hours.
What Diminishes Joy
Published in Eve Shapiro, Joy in Medicine?, 2020
I enjoy it, I like it. Is the cost–benefit worth it to me? I’m far enough along, I’ve made so much money, I would justify a positive answer no matter what because I’ve spent the last three and a half to four years of my life trying to become a neurosurgeon. It’s such a valuable skill to have. The average neurosurgeon in America makes $500,000–600,000 a year, which is an enormous sum of money; it doesn’t make sense for me to do anything besides finish neurosurgery residency and pursue this path at this point. I think that people justify major decisions that they’ve made retrospectively.
Acquired Bleeding Disorders Associated with the Character of the Surgery
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
William A. Rock, Robert F. Baugh
Any assessment of bleeding related to a neurosurgical procedure should reflect two kinds of risk: first, the risk for bleeding before surgery in the patient with intracranial or spinal cord lesions who has diseases, is on medication or suffers trauma that results in bleeding; second, the risk for bleeding that is a consequence of those aspects of surgery that are unique to neurosurgery.
Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study
Published in Brain Injury, 2021
Jean-Nicolas Tourigny, Véronique Paquet, Émile Fortier, Christian Malo, Éric Mercier, Jean-Marc Chauny, Gregory Clark, Pierre-Gilles Blanchard, Valérie Boucher, Pierre-Hugues Carmichael, Jean-Luc Gariépy, Marcel Émond
A total of 329 patients (69%) received a repeat head CT, 83 (25%) of which had a documented radiological deterioration. Clinical deterioration was found in 49 patients (10%). A total of 40 patients (9%) underwent neurosurgical intervention and of those, 22 underwent repeat head CT prior to surgery. Figure 1 shows overlapping of the primary outcome with clinical and radiological deterioration. In patients who underwent neurosurgery, 6 (15%) had prior clinical deterioration while patients who did not have neurosurgery had a 10% rate of clinical deterioration (43 out of 438 patients) (p = .30). Three (7.5%) patients who underwent neurosurgery had prior radiological deterioration while 80 patients (18%) who did not undergo neurosurgery had radiological deterioration (p = .19). It is important to note that only one patient had radiological deterioration without clinical deterioration before undergoing neurosurgery.
Successful return to professional work after neglect, extinction, and spatial misperception – Three long-term case studies
Published in Neuropsychological Rehabilitation, 2021
This was a male, right-handed police commissioner who suffered suddenly at the age of 51 years from a haemorrhagic right-hemisphere stroke in the right internal carotid and right middle cerebral artery. He was immediately referred to Neurosurgery where CT-scanning revealed a large right temporal, parietal, and basal ganglia lesion with midline shift and distorted lateral ventricle to the ipsilesional left hemisphere. The bleeding was clipped (see lesions in Figure 1). He stayed for five days in Neurosurgery, was then referred to early inpatient rehabilitation for 35 days, after which he received post-primary rehabilitation for another 155 days (see Tables 1 and 2 for details). He suffered from severe left multimodal neglect with a marked gaze-deviation to the right side, incomplete left-sided homonymous hemianopia, left hemiparesis and left hypoaesthesia, initially from a pusher syndrome which changed later into postural imbalance, marked spatial-perceptual and visuoconstructive disorders. Moreover, he had an oculomotor palsy of the right eye with horizontal diplopia and loss of convergent fusion, astereopsis, and impaired depth perception. In addition, numerous other medical complications were present which delayed recovery (see Table 1 for details). The present treatment started after his discharge from inpatient rehabilitation 155 days after his stroke.
Device profile of exAblate Neuro 4000, the leading system for brain magnetic resonance guided focused ultrasound technology: an overview of its safety and efficacy in the treatment of medically refractory essential tremor
Published in Expert Review of Medical Devices, 2021
Ayesha Jameel, Peter Bain, Dipankar Nandi, Brynmor Jones, Wladyslaw Gedroyc
The ability of MRgFUS to target tissues with millimeter precision makes it particularly suited for neurological disorders. The human brain is extremely complex with multiple overlapping connections, many still poorly understood. All traditional invasive neurosurgery is associated with significant risks, including those involved with general anesthesia even before an incision is made. This is compounded by the trauma of an incision involving penetration of the scalp, skull and meninges and insertion of hardware or instruments through the brain structures that lie in the pathway to reach the target tissue. Thus, all invasive neurosurgery risks considerable negative impacts outside of the desired therapeutic effect. MRgFUS significantly reduces these risks; notably there is no general anesthesia with only local anesthetic used when attaching the stereotactic frame. Relatively low risk pharmacological agents are used to support the patient during treatment but are not required for the procedure to be successful. Paracetamol and ondansetron are given routinely to manage any pain, anxiety and nausea and dexamethasone to reduce any post-procedure edema.