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Shock
Published in Rudi Coetzer, The Notebook of a New Clinical Neuropsychologist, 2017
‘Oh yes. Which reminds me, at some point in the future we need to train you up to do the cognitive testing which is part of the Wada test. Also, coming back to epilepsy care, the neuropsychologist helps with serial testing, looking for decline, medication side-effects, you know, all that stuff. And to help them understand the nature of their diagnoses. I could go on forever, but must go now’, he says while starting to walk towards the double doors exiting the neurology ward.
The viva: investigation of the neurosurgical patient including neuroradiology and neuropathology
Published in Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad, Neurosurgery, 2014
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad
A Wada test involves infusion of amytal sodium to create a temporary chemical dysfunction of either hemisphere. It is usually performed as a preoperative investigation for lateralizing speech and memory in temporal lobe resection for epilepsy.
Management of epilepsy
Published in Timothy Betts, Lyn Greenhill, Managing Epilepsy with Women in Mind, 2005
Likewise it is important to be sure that removal of (part of) one temporal lobe (particularly on the left) will not cause devastating psychophysiological damage. For this reason many surgeons, particularly if proposing to operate on the left temporal lobe, carry out a procedure beforehand designed to temporarily immobilize one temporal lobe at a time by injecting sodium amytal into one carotid artery at a time via an indwelling catheter introduced into the femoral artery, to immobilize that side of the brain and determine how much function the other temporal lobe can sustain. This is the Wada test. Likewise left temporal surgery is often carried out initially while the area to be removed is delineated under local anaesthesia (with sedation) so that the patient is awake and can talk. Thus the speech area (whose precise position varies from patient to patient) is not inadvertently removed during the operation.
Contemporary surgical management of drug-resistant focal epilepsy
Published in Expert Review of Neurotherapeutics, 2020
Jasmina R. Milovanović, Slobodan M. Janković, Dragan Milovanović, Dejana Ružić Zečević, Marko Folić, Marina Kostić, Goran Ranković, Srđan Stefanović
Pre-surgical neurophysiological evaluation can provide information about potential influence of surgery on postoperative verbal memory. The concordance between FMRI and Wada test has been estimated on 91%, but only in respect to language lateralization, while in relation to functioning of memory, postoperative seizure control, and degree of verbal memory impairment, the Wada test is more effective. The Wada test is indicated in subset of patients with higher risk for clinically significant memory loss, whereas noninvasive neuropsychological examination should be performed in all patients who are candidates for surgical treatment [19].
Ophthalmic artery occlusion following n-butyl cyanoacrylate embolization of an orbital arteriovenous malformation
Published in Orbit, 2023
Marissa K. Shoji, Ann Q. Tran, Wendy W. Lee, Sander R. Dubovy, Andrea L. Kossler
AVMs are typically supplied by branches of the ophthalmic artery, distal internal maxillary artery, or middle meningeal artery,4 and peri-procedural angiography is required to determine the arterial feeders and location of the central retinal artery. The primary goals of embolization include reducing blood flow before surgery by obliterating feeding vessels, palliation, or intent to cure through complete obliteration of vessels.1 Ophthalmic artery embolization is traditionally performed with N-butyl cyanoacrylate glue4,5 and may be followed by surgical excision to minimize the risk of recurrence.1 Despite the benefits of embolization, it carries a risk of central retinal artery occlusion and resulting blindness,6 and vision loss due to vascular occlusion has been reported following orbital AVM transarterial embolization with Onyx and polyvinyl alcohol (Table 1). Techniques to facilitate safe embolization include advancement of the tip of the catheter at least beyond the second segment of the ophthalmic artery,6,7 with advancement of the catheter tip 1 cm beyond the central retinal artery anecdotally considered a safe distance to accommodate for reflux, simultaneous infusion of 5% dextrose water to reduce the risk of reflux of NBCA glue, and controlled delivery of NBCA through the continuous column method, in which the NBCA is injected slowly but continuously to allow it to form a cast inside the lumen.2,8 The retinal Wada test may also be performed to ensure safe embolization. This test involves injection of lidocaine through selected vessels to replace blood flow for at least 2 seconds to evaluate for vision loss in the form of a scotoma, which indicates that the selected vasculature is associated with ocular blood flow.9 If temporary vision loss is detected during the retinal Wada test, that vessel should be avoided during embolization.