ScienceDirect Publication: Clinical Neurology and Neurosurgery

Editorial Board

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Prognosis of phrenic nerve injury following thoracic interventions: Four new cases and a review

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Monika Ostrowska, Mamede de Carvalho

Introduction

Phrenic nerve lesion is a known complication of thoracic surgical intervention, but it is rarely described following thymectomy and lung surgery.

Objective

To review the literature on thoracic intervention and phrenic nerve lesion and to describe four new cases, in which regular neurophysiological studies were performed.

Methods

We reviewed the literature concerning phrenic nerve lesion after cardiac, lung and thymus surgical interventions. We described four cases of phrenic nerve lesion, three associated with thymectomy and one in lung surgery.

Results

The review shows that cryogenic or thermal injuries during cardiac surgeries are associated with good prognosis. The information on the outcome of phrenic nerve lesion in thymectomy or lung surgery is insufficient. Our cases and this review suggest that phrenic lesion in the last two interventions are associated with a poor recovery.

Conclusion

Our data suggests that the prognosis of phrenic nerve lesion following thoracic intervention depends on the nature of the damage. Probably, in thymectomy and lung surgery, nerve stretch or laceration are involved, consequently the outcome is poorer in comparison with cardiac surgery, where cold lesion is more frequent. Neurophysiological tests give a direct, quantified and reliable assessment of nerve regeneration.

Estimating postoperative skull defect volume from CT images using the ABC method

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Furen Xiao, I-Jen Chiang, Thomas Mon-Hsian Hsieh, Ke-Chun Huang, Yi-Hsin Tsai, Jau-Min Wong, Hsien-Wei Ting, Chun-Chih Liao

Objectives

Surgeons often perform decompressive craniectomy to alleviate a medically-refractory increase of intracranial pressure. The frequency of this type of surgery is on the rise. The goal of this study is to develop a simple formula for clinicians to estimate the volume of the skull defect, based on postoperative computed tomography (CT) studies.

Methods

We collected thirty sets of postoperative CT images from patients undergoing craniectomy. We measured the skull defect volume by computer-assisted volumetric analysis (V m) and our own ABC technique (V abc). We then compared the volumes measured by these two methods.

Results

The V m ranged from 3.2 to 76.4mL, with a mean of 38.9mL. The V abc ranged from 3.8 to 71.5mL, with a mean of 38.5mL. The absolute differences between V abc and V m ranged from 0.05 to 17.5mL (mean: 3.8±4.2). There was no statistically significant difference between V abc and V m (p =0.961). The correlation coefficient between V abc and V m was 0.969. In linear regression analysis, the slope was 1.00086 and the intercept was −0.0035mL (r ² =0.939). The residual was 5.7mL.

Conclusion

We confirmed that the ABC technique is a simple and accurate method for estimating skull defect volume, and we recommend routine application of this formula for all decompressive craniectomies.

Treatment of traumatic acute subdural hematoma in adult hydrocephalus patients with cerebrospinal fluid shunt

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Katsumi Hoya, Yoshihiro Tanaka, Takanori Uchida, Issei Takano, Masaya Nagaishi, Kazuma Kowata, Akio Hyodo

Objective

The presence of a cerebrospinal fluid (CSF) shunt is a predisposing factor for the development of subdural hematoma (SDH) in patients with hydrocephalus. However, few reports have addressed how patients with a CSF shunt should be treated in the event of traumatic acute SDH. The purpose of this study was to show how post-traumatic management of CSF shunt affects acute SDH in adult patients with hydrocephalus.

Methods

Twelve patients were studied retrospectively. Pressure settings of shunt valve prior to head injury (HI), severity of HI, treatment on admission, changes in SDH thickness and subsequent hydrocephalus were mainly analyzed.

Results

Ten patients experienced mild HI, with nine showing neurological deterioration until admission. Five patients needed surgical hematoma removal soon after admission. SDH recurred in four cases where shunt pressure levels were kept relatively low. Shunt ligation or raising the pressure level in the programmable valve proved effective for controlling postoperative SDH in such cases. Six of the remaining seven patients underwent only shunt ligation or readjustment of pressure level in the programmable valve on admission. SDH thickness was reduced as ventricles dilated without major neurological complications. Four patients showed delayed development of SDH even though shunts were kept ligated.

Conclusions

Hematoma removal alone may result in hematoma recurrence and require a second treatment comprising shunt management to effectively control hematoma. Using shunt management as the only initial treatment can reduce hematoma volume, but some patients may suffer delayed SDH development and require surgery.

Patients with psychogenic non-epileptic seizures referred to a tertiary epilepsy centre: Patient characteristics in relation to diagnostic delay

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

N.M.G. Bodde, R.H.C. Lazeron, J.M.A. Wirken, S.J. van der Kruijs, A.P. Aldenkamp, P.A.J.M. Boon

Objective

This clinical study examines patient and seizure characteristics of patients with psychogenic non-epileptic seizures (PNES) in a tertiary epilepsy centre. The main focus was whether a new subgroup of PNES patients emerged with a relatively short referral time and possible specific characteristics.

Methods

All PNES patients referred to a specialist program in our centre between mid 2007 and mid 2009 were consecutively included. This yielded a study cohort of 90 patients.

Results

The majority of the patients have a patient history with many medical symptoms and they were or had been in treatment by a medical specialist. Furthermore diffuse psychological/psychiatric symptoms and subsequent treatments are also remarkably common, in general without a clear psychological diagnosis. The average time between seizure onset and referral to an epilepsy centre is remarkably low (4.29 years). About 50% of the patients were referred within 2 years of seizure onset. This ‘active high speed referral group’ had significantly more previous psychological complaints, significantly more previous psychological/psychiatric treatments and a trend towards more previous medical investigations.

Conclusion

There seems to be a new subgroup of PNES patients with a short referral time, characterized by a more active attitude towards examination of the symptoms in combination with an active attitude to apply for treatment. However, the PNES cohort as a whole is characterized by having somatoform symptoms based on a process of somatization.

Usefulness of thallium-201 SPECT for prediction of early progression in low-grade astrocytomas diagnosed by stereotactic biopsy

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Kyung-Jae Park, Shin-Hyuk Kang, Dong-Hyuk Park, Tai-Hyoung Cho, Jae Gol Choe, Yong-Gu Chung

Objective

To establish the value of thallium-201 single-photon emission computed tomography (²⁰¹Tl-SPECT) as a predictor of early progression in low-grade astrocytomas (LGAs).

Methods

We studied 57 consecutive patients who underwent 201 Tl-SPECT before stereotactic biopsy (n =33) or surgical resection (n =24). The value of radiologic and histopathological variables (²⁰¹Tl index and MIB-1 index) in predicting progression free survival (PFS) was examined in each group of patients.

Results

During a median follow up of 55 months (range, 11–101), progression of the primary lesion was identified in 46 patients (80.7%). Based on Cox's proportional hazards model, the increased thallium uptake was associated with a short PFS in both biopsy and resection groups, whereas the MIB-1 index was significant only in the resection group. Considering the cut-off value, ²⁰¹Tl index>1.7 was statistically significant for reduced PFS in the biopsy group; however, MIB-1 index was not directly related to the PFS at any level. For the surgical resection group, both a ²⁰¹Tl index>1.9 and a MIB-1 index>6% were associated with short PFS.

Conclusion

²⁰¹Tl SPECT may play a role in prediction of early tumor progression not only in resected LGAs, but also in biopsy-proven LGAs. Therefore, we suggest that patients with LGAs established from biopsy should be considered as high-risk groups for early progression if the tumor shows a high ²⁰¹Tl uptake, even if the tumor demonstrates low proliferative activity on histopathologic examination.

Atypical onset in a series of 122 cases with FacioScapuloHumeral Muscular Dystrophy

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Ebe Pastorello, Michelangelo Cao, Carlo P. Trevisan

Introduction

FacioScapuloHumeral Muscular Dystrophy (FSHD), a disease linked to a heterozygous D4Z4 deletion on chromosome 4q35, typically starts with shoulder-girdle and facial muscle involvement. Atypical presentations have occasionally been reported, but their frequency has still not been defined.

Patients and methods

We studied the occurrence rate of FSHD with atypical onset in 122 symptomatic subjects from 76 unrelated families with genetically confirmed FSHD. These 75 males and 47 females, with a mean age of 49 years (range: 11–85), had a mean EcoRI fragment of 25kb (range: 11–38).

Results

Typical shoulder-girdle or facial weakness at onset was reported by 88 patients (72%). Unusual presentations included: foot drop in 16 (13%) and proximal lower limb weakness in eight patients (7%). Two cases at onset manifested quite atypical, apparently non-FSHD-related syndromes: a 42-year-old woman presented with infantile epilepsy and a 41-year-old man with myoglobinuria. In the latter patient, DNA analysis detected a 4q35 deletion associated to an heterozygous CAPN3 mutation.

Conclusion

FSHD presentation with foot drop or lower limb proximal weakness appeared to be more frequent than expected. This type of weakness at onset has to be considered premature, but still representative of disease-related muscle involvement. Quite atypical onset appears very rare and calls for further investigation on non-FSHD-related etiology.

Cerebral abscesses in hereditary haemorrhagic telangiectasia: A clinical and microbiological evaluation

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Stéphane Mathis, Sophie Dupuis-Girod, Henri Plauchu, Maurice Giroud, Bruno Barroso, Kim Heang Ly, Pierre Ingrand, Brigitte Gilbert, Gaëlle Godenèche, Jean-Philippe Neau

Objectives

Hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder that can lead to neurological manifestations including strokes and cerebral abscesses. Our objectives were to describe clinical, radiological, bacteriological, and outcome characteristics of patients with cerebral abscess and HHT, and to concurrently compare this group with a control group with cerebral abscess, but without HHT.

Patients and methods

Patients with HHT and cerebral abscess in 5 French medical centers were included. Their clinical, radiological, biological data and prognosis were compared to the data of unselected patients with cerebral abscesses but without HHT included during the same period of time.

Results

Twenty-six patients (13 men and 13 women; 44.7±17.2; range 12–79 years), with HHT and cerebral abscess were included. A pulmonary arteriovenous malformation (AVM) was present in all cases. Cerebral abscesses were solitary, supratentorial, and mostly lobar. In all cases, pathogens were anaerobic or facultative anaerobic germs (particularly streptococcus). No death was observed, but various sequels were present in up to two-thirds of the patients. We observed a recurrence of the cerebral abscess in 4 patients with a mean delay of 81 months. In comparison with the control group, cerebral abscesses were generally of later recurrence and significantly more often unique and less often due to staphylococcus.

Conclusion

HHT cerebral abscesses are particularly linked to pulmonary arteriovenous malformations and anaerobic germs. Their clinical, radiological and bacteriological characteristics are quite different than in a control group with more solitary brain localizations, no staphylococcus infection and a significantly longer interval to recurrence.

Resveratrol inhibited GH3 cell growth and decreased prolactin level via estrogen receptors

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Chao Wang, Zhi-qiang Hu, Ming Chu, Zhi Wang, Wei-guang Zhang, Lai-zang Wang, Chen-guang Li, Jun-sheng Wang

Aims

Pituitary prolactinoma is one of the estrogen-related tumors, some anti-estrogen compounds have suppressive effects on prolactinoma. Previous studies have suggested that resveratrol, a phytoestrogen, displays anti-estrogen and anti-tumor characteristics. Therefore, We determined whether resveratrol could inhibit the cell proliferation and decrease prolactin level in prolactinoma cell line, and identify the signaling pathways that mediate the effects of resveratrol.

Main methods

Prolactinoma cell line, GH3 cells were treated with resveratrol. Changes in proliferation, cell cycle, and apoptosis were assessed. The level of prolactin was assayed by Western blot or EIA. Expression of total Rb (retinoblastoma protein), phosphorylated Rb (pRb) and cyclin D3 were measured by Western blot. The changes of estrogen receptors and their roles in the effects of resveratrol were also determined.

Key findings

We report that resveratrol had a dose-dependent inhibitory effect on GH3 cell proliferation. Inhibitory effects of resveratrol persisted, even on removal of resveratrol. The growth-inhibitory effect of resveratrol was accompanied by decreased expression of cyclin D3 and pRb. In addition, resveratrol induced G0/G1 cell cycle block and apoptosis. Furthermore, resveratrol suppressed intracellular levels and release of prolactin. Finally, we show that two types of estrogen receptor were involved in the different effects of resveratrol.

Significance

Taken together, we demonstrate that resveratrol could inhibit prolactinoma cell proliferation, induce cell cycle block and apoptosis, and decrease prolactin production and release, and estrogen receptors mediate its antitumor effects. And thus, these results lead us to propose developing resveratrol as a novel therapeutic agent for treatment of prolactinoma.

Telovelar approach for choroid plexus papilloma in the foramen of Luschka: A safe way using a neuromonitor

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Cheng-Chia Lee, Chun-Fu Lin, Tsui-Fen Yang, Sanford P.C. Hsu, Hsin-Hung Chen, Shao-Ching Chen, Yang-Hsin Shih

Background

Tumors located in the 4th ventricle are always challenging to neurosurgeons, especially tumors that extend to the cerebellopontine (CP) angle by the foramen of Luschka. Recent advances in microsurgical technique, including the neuromonitor and brainstem mapping, facilitate the surgical resection of tumors located in the foramen of Luschka. Herein, we present the use of the telovelar approach to access a choroid plexus papilloma within the right foramen of Luschka.

Case presentation

A 28-year-old female presented with a history of sudden onset pulsatile headache and syncope twice without prodrome. The brain MRI revealed a 4th ventricular tumor deviated to the right foramen of Luschka and extending to the CP angle, 2.2cm in diameter. There was no secondary hydrocephalus due to the patent foramen of Magendie and left foramen of Luschka. The patient underwent suboccipital craniotomy and C1 laminectomy with a telovelar approach. The right tonsil was elevated and teal chloride was incised from the foramen of Magendie to the telovelar junction. The tumor was centrally decompressed, and the margin was gently dissected from the brainstem and cerebellum peduncles. Functions of the facial, cochlear, glossopharyngeal, vagus, and hypoglossal nerves and nuclei were monitored. Mapping of the facial nucleus, ambiguous nucleus, and hypoglossal nucleus was also done. Total tumor removal was achieved and the histology showed choroid plexus papilloma. No functional neurological disorientation was observed after surgery.

Conclusion

The report demonstrated a safe and effective surgical approach to the foramen of Luschka. The approach yielded a better view of the foramen of Luschka laterally, and up to the middle cerebellar peduncle superiorly. Also, it minimized neural damage, and preserved the function of the cranial nerves and nucleus.

Clinical and radiological observation in a surgical series of 36 cases of fibrous dysplasia of the skull

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

MingJun Cai, LianTing Ma, GuoZheng Xu, Peter Gruen, Jun Li, Ming Yang, Li Pan, HanFeng Guan, Gang Chen, Jie Gong, JunMing Hu, ShangZheng Qin

Objectives

To describe the clinical and radiological findings in a consecutive series of patients diagnosed with fibrous dysplasia of the skull.

Patients and methods

A retrospective analysis of collected data for 36 patients with histopathologically confirmed fibrous dysplasia involving the skull is presented. The demographic data, clinical presentation, radiographic characteristics, and the management of these patients were reviewed.

Results

All 36 patients in this review were diagnosed with fibrous dysplasia involving at least part of the skull. In this study, the most commonly involved area of the skull was the frontal bone (52.78% of patients). The next most common area of skull was the temporal bone (30.56% of patients), followed by the sphenoid bone (25% of patients), the parietal bone (19.44% of patients), and orbital bone (13.89% of patients). The principal clinical presentation included headache, local lump, exophthalmos, visual disorder, cranial nerve paralysis, and facial malformation. These patients were treated by surgical treatment, and several of our patients underwent various degrees of reconstruction to optimize function.

Conclusions

Effective surgical treatment may improve the short-term outcome in these patients, and a “tailored” surgical approach is necessary.

Anti-NMDAR encephalitis in small-cell lung cancer: A case report

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Akinori Uruha, Yu Kitazawa, Masatoshi Kuroda, Keiko Tanaka, Reiji Koide

CNS lymphoma masquerading as hemorrhagic stroke

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Leopold J. Streletz, Dino Terzic, Khalid Salem, Ali Raza, Dirk T. Deleu

An upper limb variant of RLS? Report of 2 cases

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Renato P. Munhoz, Walter Oleschko Arruda, Hélio A.G. Teive

Spindle cell oncocytoma of the adenohypophysis: Report of a rare case and review of literature

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Geetika Singh, Shipra Agarwal, Mehar Chand Sharma, Vaishali Suri, Chitra Sarkar, Ajay Garg, Shashank Sharad Kale

Pseudo-Foster Kennedy syndrome in a young woman with meningioma infiltrating the superior sagittal sinus

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

F. Semeraro, E. Forbice, S. Duse, C. Costagliola

Glioblastoma multiforme of the conus medullaris in a 28-year-old female: A case report and review of the literature

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Rory R. Mayer, Grant M. Warmouth, Marci Troxell, Adekunle M. Adesina, Joseph S. Kass

A grid-like hemi-field defect following a lacunar infarct in the lateral geniculate nucleus

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

T.M. de Vries, M.J.H. Aries, J.C. De Groot, G.J. Bonte, B.M. de Jong

Multifocal lateral and fourth ventricular B-cell primary CNS lymphoma

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Rahat Brar, Abhishek Prasad, Tarun Sharma, Nittin Vermani

Meningococcemia presenting as acute painful mononeuritis multiplex

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Laura Cucurachi, Sarah Anna Sperber

Castleman's disease of the sacral spine

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Ross McMillan, C. Rory Goodwin, Wesley Hsu, James Pendleton, Edward McCarthy, Jean-Paul Wolinsky, Allan J. Belzberg

Necrotizing vasculitis revealed in a case of multiple mononeuropathy after a 14-year course of spontaneous remissions and relapses

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

J. Cassereau, C. Baguenier-Desormeaux, F. Letournel, C. Lavigne, C. Leclech, F. Dubas, G. Nicolas

Transient Kluver–Bucy syndrome caused by cerebral edema following aneurysmal subarachnoid hemorrhage

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Yoshikazu Kusano, Tetsuyoshi Horiuchi, Yuichiro Tanaka, Tsutomu Tsuji, Kazuhiro Hongo

Tocilizumab treatment for neuro-Behcet's disease, the first report

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery, Volume 114, Issue 3

Lee S. Shapiro, Jessica Farrell, Afshin Borhani Haghighi

Radiation-induced cavernous malformation at the site of arteriovenous malformation following gamma knife radiosurgery: Case report

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Xiang Wang, Xu-hui Hui, Jian-Ping Liu, Qing Mao

Epidemiology of subarachnoid hemorrhage in the Yaeyama Islands, an isolated subtropical region of Japan most frequently affected by typhoons: A population-based study

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Akifumi Izumihara

Objective

The present study analyzed epidemiological data for patients with subarachnoid hemorrhage (SAH) in a subtropical region of Japan that is the most frequently affected by typhoons.

Patients and methods

The medical records of hospitalized patients who had been diagnosed as having SAH at Okinawa Prefectural Yaeyama Hospital during a 13-year period were reviewed. Demographic and epidemiological data including date and time of onset and activity at onset and clinical data were collected. Meteorological data for typhoon's approaches to the Yaeyama Islands were obtained from the web-site of the Japan Meteorological Agency. In addition, patients who had developed SAH during a period of 3days before and after the closest approach of a typhoon (CAT) were examined.

Results

A total of 94 patients were identified. A monthly peak in August, a weekly peak on Monday, and two daily peaks in the evening and morning were observed. The incidence of SAH during a period of 3days before and after the CAT was approximately twice as high as that on other days, and a statistically significant difference was found.

Conclusion

Periodic patterns of SAH onset revealed unusual monthly and circaseptan variations and the usual circadian variation. SAH onset was associated with typhoon's approaches.

Stimulus-induced rhythmic, periodic, or ictal discharges – A case report

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Ji-Ho Lin, Chien Chen, Hann-Yeh Shyu, Shang-Yeong Kwan, Chun-Hing Yiu

Experience of 123I-iomazenil SPECT study for crossed cerebellocerebral diaschisis: Report of two cases

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Kota Kurisu, Masahito Kawabori, Yoshimasa Niiya, Yuzuru Ohta, Naoki Nakayama, Satoshi Kuroda, Shoji Mabuchi, Kiyohiro Houkin

Associations of cigarette smoking with intracranial atherosclerosis in the patients with acute ischemic stroke

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Doh-Eui Kim, Kyung-Bok Lee, Il-Mi Jang, Hakjae Roh, Moo-Young Ahn, Jisung Lee

Background

Although cigarette smoking has been established as an important risk factor for stroke, the effect on the atherosclerotic stenosis, which are based on observational studies, have been controversial. We set out to examine the differences in the risk factors between smokers and nonsmokers and to investigate the association of cigarette smoking with cerebral arterial stenosis.

Methods

A total of 989 consecutive patients with acute noncardioembolic ischemic stroke were prospectively enrolled from June 2004 to January 2010. The risk factor profiles were compared between smokers and nonsmokers. We analyzed the degree of stenosis in all MRA, and evaluated influencing factors in the patients with intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) who were randomly matched by age and sex.

Results

There were differences in the distribution of risk factors between the 467 (70.0%) nonsmokers and the 215 (30.0%) smokers. Nonsmokers were older (71.7±11.0 versus 61.7±12.0, p <0.001) and had a higher frequency of hypertension than smokers had (75.4% versus 64.0%, p =0.002). When smokers and nonsmokers were age- and sex-matched, smoking was more prevalent in patients with ICAS than with ECAS (32.9% versus 28.2%). Conditional regression analysis revealed that smoking and hypertension increased the odds of ICAS [smoking, odds ratio (OR): 1.83, p =0.026; hypertension, OR: 1.84, p =0.01], whereas hyperlipidemia increased the odds of ECAS (OR: 1.87, p =0.034).

Conclusion

The distributions of the major risk factors for ischemic stroke were different between smokers and nonsmokers. Cigarette smoking may be more associated with ICAS than with ECAS after adjusting for potential risk factors.

Non-Hodgkin lymphoma presenting with foot drop

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Sophie Anna da Cunha-Bang, Clarissa Crone, Thomas Christensen

Restorative neurology: Past, present, and future

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Justin M. Brown, Byron A. Kakulas

Long-term follow-up of vanishing tumors in the brain: How should a lesion mimicking primary CNS lymphoma be managed?

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Yoshiko Okita, Yoshitaka Narita, Yasuji Miyakita, Makoto Ohno, Shintaro Fukushima, Akiko Maeshima, Takamasa Kayama, Soichiro Shibui

Objectives

The spontaneous disappearance of a tumor is referred to as a vanishing tumor. Most vanishing tumors in the brain are eventually diagnosed as malignant tumors or multiple sclerosis. However, their long-term clinical course remains unclear. This study aims to elucidate the management of vanishing tumors in the brain.

Patients and methods

We defined a vanishing tumor as a case in which the tumor spontaneously disappeared or decreased to less than 70% of the initial tumor volume before definitive diagnosis and treatment (other than steroid treatment). Ten cases of vanishing tumors are reviewed.

Results

Nine patients underwent biopsy at least once. Five patients, all of whom had malignant tumors (primary central nervous system lymphoma: 4, germinoma: 1) that recurred in 4–45 months (median: 7 months), underwent a second biopsy after the reappearance of the tumors. Five patients (tumefactive demyelinating lesion: 1, undiagnosed: 4) who had no relapse are alive, and their median follow-up time is 44 months. No cases have yet been reported of malignant brain tumors that recurred more than 5 years after spontaneous regression.

Conclusions

Patients with vanishing tumors should be followed up carefully by magnetic resonance imaging for at least 5 years, even after the disappearance of an enhancing lesion.

MR imaging in the early stage of 5-fluorouracil-induced leukoencephalopathy: DWI, MR perfusion, and MR spectroscopy

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Minseo Bang, Young Cheol Weon, Hang Jo Yoo, Jee-Hyun Kwon

Bilateral intracranial vertebral artery dissection presenting as sudden bilateral hearing loss

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Koichi Shibata, Kazuhiro Matsui, Hiroyuki Ito, Eiichi Ito, Yoshiko Nishimura, Hiromi Kondo, Hiroshi Sunose, Kuniaki Otuka

Crossed synkinesia associated with long-term, intensive tennis playing

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Marcie L. Rabin, Arash Salardini, Narges Moghimi, Bahman Jabbari

The assessment of prognostic factors in surgical treatment of low-grade gliomas: A prospective study

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Krzysztof Majchrzak, Wojciech Kaspera, Barbara Bobek-Billewicz, Anna Hebda, Gabriela Stasik-Pres, Henryk Majchrzak, Piotr Ładziński

Objective

A prospective volumetric analysis of extent of resection (EOR) was carried out to assess surgical outcomes in adults diagnosed with hemispheric low grade gliomas (LGGs).

Materials and methods

68 consecutive patients diagnosed with LGGs were enrolled in the study. Pre- and post-operative tumor volumes and EOR were measured based on FLAIR MRI. Dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC MRI) was used for the assessment of relative cerebral blood volume (rCBV). Three outcome measures were assessed: overall survival (OS), progression-free survival (PFS), and malignant degeneration-free survival (MFS).

Results

In 6 (9%) patients permanent neurologic deficits were observed. No statistically significant dependence between the EOR and the occurrence of permanent deficits was found. The eloquent or close to the eloquent location was statistically connected with lower EOR (p =0.023). The preoperative volume of tumors treated with gross total resection was significantly smaller than the volume of tumors in subtotal or partial resection groups (p =0.020, p <0.001, respectively). OS was predicted by age at diagnosis (p =0.032), and rCBV (p =0.002). Progression and malignant transformation occurred in 22 (32%) and 11 (16%) out of 68 patients. PFS was predicted by preoperative tumor volume (p =0.005), postoperative tumor volume (p =0.008), the EOR (p =0.001), and by the rCBV (p =0.033). MFS was predicted by preoperative tumor volume (p =0.034), the EOR (p p =0.020), and by rCBV (p =0.022). Postoperative tumor volume was associated with a trend of improved MFS (p =0.072). The univariate analysis shows the statistical trend for the relationship between histological subtype and PFS and MFS (p =0.079, p =0.078, respectively). Multivariate analysis selected preoperative tumor volume and rCBV as independently associated with PFS (p =0.009, p =0.019, respectively) and MFS (p =0.023, p =0.035, respectively). EOR was associated with a trend of improved PFS, and MFS (p =0.069, p =0.094, respectively).

Conclusions

Tumor resection of LGG with the use of intraoperative monitoring and neuronavigation is associated with a low risk of new permanent deficits, but EOR significantly decreases with the size of the tumor and/or its location in/close to the eloquent areas. Smaller preoperative tumor volume and greater EOR are significantly associated with longer OS, PFS and MFS. Preoperative rCBV is one of the important prognostic factors significantly connected with survival. Prognosis in LGGs is still under discussion. Other factors such as age, histopathological subtype and KPS should not be underestimated.

Isolated intracranial Rosai–Dorfman disease presenting as mental deterioration

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Yaxiong Li, Hong Sun, Yuekang Zhang, Weiping Liu

Comparing efficacy and side effects of a weekly intramuscular biogeneric/biosimilar interferon beta-1a with Avonex in relapsing remitting multiple sclerosis: A double blind randomized clinical trial

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Shahriar Nafissi, Amirreza Azimi, Ali Amini-Harandi, Shiva Salami, Mohammad Amir shahkarami, Ramin Heshmat

Objective

We compared the efficacy and safety of two biosimilar forms of interferon beta-1a in the treatment of multiple sclerosis: Avonex (Biogen Idec, USA) and CinnoVex (CinnaGen, Iran).

Methods

In a double blind randomized clinical trial study 84 patients with relapsing remitting multiple sclerosis (RRMS) with Expanded Disability Status Scale (EDSS) score of 0–5.5 were randomly allocated to two groups of 42 subjects.

Results

Twenty-four patients lost to follow-up. Finally, 31 patients (mean±SD of age=33.7±7.0; 7 males and 24 females) in the Avonex and 29 patients (mean±SD of age=32.2±9.2; 8 males and 21 females) in the CinnoVex group completed full 24months of study period. Decrease in EDSS was 1.05±0.24, p =0.62 in the Avonex and 0.16±0.88, p =1.0 in the CinnoVex group after 12months and 0.27±1.05, p =0.46 in the Avonex and 0.16±1.06, p =1.0 in the CinnoVex group after 24months. There was no statistically significant difference in attack number between two groups (1.0±1.2 in Avonex and 1.2±1.3 in CinnoVex; p =0.46). Volume of T2-weighted lesions on MRI showed a progressive significant increase in the 12th month (28056±23693) in Avonex treated patients compared with first image (16353±11172) (p =0.01). But number of gadolinium-enhancing lesions in CinnoVex showed statistically significant decrease after 12months (0.08±0.28 vs. 1.00±1.22; p =0.03). However, there were no significant differences between groups after 24months. There were no significant differences between 2 groups regarding frequency and duration of most considerable side effects, as well. Neutralizing antibodies were not positive in any patients.

Conclusion

CinnoVex can be used as a safe and effective alternative to Avonex in treatment of RRMS.

Giant intracranial capillary hemangioma in a 3-year-old child: Case report and literature review

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Song-Ping Zheng, Yan Ju, Chao You

Postsurgical infection after myelomeningocele repair: A multivariate analysis of 60 consecutive cases

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Humberto Kluge Schroeder, Jean Costa Nunes, Luciano Madeira, Jorge Luis Wollstein Moritz, Roger Walz, Marcelo Neves Linhares

Objective

We investigate the demographic, clinical and surgical variables associated with wound and ventriculoperitoneal (VP) shunt infections in a well-defined group of patients submitted to neurosurgical myelomeningocele repair.

Methods

We analyzed the data of sixty consecutive patients with a myelomeningocele diagnosis submitted to neurosurgical repair between January 2002 and December 2005. Multiple logistic regression analysis identified clinical, demographic and neurosurgical variables that were independently associated with the occurrence of wound and VP shunt infections.

Results

Seven patients (11.7%) developed wound infections after myelomeningocele repair and two (3.3%) presented with sepsis unrelated to the neurosurgical procedures. Forty-six patients (76.7%) received a VP shunt and nine of them (19.6%) had VP shunt infection. There was a non-significant trend (p =0.09) for a higher association between thoracic than lumbar or sacral topography and the occurrence of any type of infection. Among patients who underwent VP shunt placement, there was a non-significant trend for a higher association between VP shunt infection and thoracic topography compared to lumbar or sacral regions (adjusted OR 4.3; CI 95% 0.7–24.7; p =0.10). Evans’ index scores higher than 70 were ten times more associated with VP shunt infection (adjusted OR 10.5; CI 95% 1.6–67.4; p =0.01) than lower scores.

Conclusion

The thoracic topography of myelomeningocele has a trend for a higher association with infection in general and VP shunt infection. Evans’ index scores higher than 70 were independently associated with VP shunt infection.

Neurosurgical considerations on highly eloquent brainstem cavernomas during pregnancy

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Jan-Karl Burkhardt, Oliver Bozinov, Johannes Nürnberg, Benjamin Shin, Christoph M. Woernle, Nils H. Ulrich, Helmut Bertalanffy

Objective

Cerebral cavernous malformations (CCMs) and especially cavernous malformations (CMs) in highly eloquent brain areas such as brainstem CMs are rare but possible events during pregnancy. Due to the few published cases in literature clear recommendations regarding the management are rare. In this study we evaluate the proceeding decision in pregnant patients with highly eloquent brainstem CMs.

Methods

In our series 43 patients with CMs in highly eloquent brain areas, including 39 patients with brainstem CMs, were surgically treated by the senior author between July 2007 and July 2010. Out of these, 29 patients were female and three of them presented with a symptomatic brainstem CMs during pregnancy and were included in this study. According to our experiences and to the available literature we analyzed demographic and clinical variables to provide recommendations for the management of pregnant patients with highly eloquent brainstem CMs.

Results

Only one patient was operated during pregnancy the other two patients were surgically treated after delivery, respectively. A thorough review of the literature revealed 12 patients with brainstem cavernomas during pregnancy there of only two patients were operated during pregnancy.

Conclusion

Surgical treatment during pregnancy is rarely required, but needs to be performed right away in life-threatening and rapidly progressive clinical situations. Pregnant women with CMs in highly eloquent brain areas such as brainstem CMs need to be treated in specialized centers to assess the best point of time for surgery. Our study offers a useful tool to support the proceeding decision in this rare but important situation.

Severe neurobrucellosis in a young infant

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Mustafa Calik, Akin Iscan, Mustafa Gul, Turan Derme, Hasan Cece, M. Fuat Torun

Inspiratory- and finger-flexion-related cortical potentials in patients with amyotrophic lateral sclerosis – An exploratory study

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Nataša Bizovičar, Ignac Zidar, Blaž Koritnik, Janez Zidar

Objective

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by degeneration of the upper and lower motor neurons. Each voluntary movement, including inspiration, is preceded by movement-related cortical potential (MRCP) that can be recorded from the scalp. MRCPs of ALS patients with severe upper motor neuron involvement are smaller. Our aim was to explore whether the inspiratory-(sniffing)-related cortical potentials (SRCPs) and index-finger-flexion MRCPs (FFRCPs) can be used as markers of cortical involvement in ALS.

Methods

Thirteen ALS patients and 15 healthy volunteers were assessed for their hand dexterity and strength, respiratory function, speech capacity, spasticity, electromyographic parameters and functional rating scales. EEG was recorded during self-paced sniffing and the right index finger flexion. The MRCP amplitudes were assessed at the relevant electrode positions.

Results

No statistically significant difference was found between the MRCP amplitudes of the ALS patients and the control subjects. However, patients with more severely affected upper limb functions generated smaller FFRCPs and those with more affected respiratory functions generated smaller SRCPs. Excessively high FFRCPs were associated with better while excessively low FFRCPs with worse scores on some of the clinical measures of the upper limb function.

Conclusion

Our preliminary results demonstrate that it is feasible to record SRCP in ALS patients, which combined with FFRCP, may be useful to determine the spectrum of motor control changes in this population.

Fourth ventricle glioblastoma

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Ji Zhang, Rajendra Shrestha, Jin Li, Shu Jiang

Morbidity following sural nerve harvesting: A prospective study

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Roberto S. Martins, Rafael A. Barbosa, Mario G. Siqueira, Matheus S. Soares, Carlos Otto Heise, Luciano Foroni, Manoel J. Teixeira

Objective

To evaluate donor site morbidity following sural nerve harvesting, with special attention to the recovery of sensory loss.

Methods

We prospectively followed 38 subjects who underwent sural nerve harvest, including two with bilateral nerve excision. Symptoms related to sural nerve excision were evaluated and demarcation of the area with reduced touch sensation was quantified. Assessments were performed periodically up to 1 year after surgery and the results of different sensory evaluations were compared.

Results

A significant reduction of sensory deficit was identified between consecutive evaluations (p <0.05). Decreases of 26.85%, 20.69% and 24.29% were observed 3, 6 and 12 months after surgery, respectively. Shock-like pain (7.5%), stabbing pain (7.5%), and numbness (5%) were the most frequently reported symptoms. All symptoms were brief and resolved spontaneously 3–6 months after surgery.

Conclusion

Sural nerve harvest can be performed with acceptable morbidity. When present, symptoms resolve between the third and sixth month after surgery and a significant reduction of sensory loss in the area innervated by the sural nerve was observed during the first year of follow-up.

Headaches related to psychoactive substance use

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Yeşim Yetimalar Beckmann, Mustafa Seçkin, Ali İlhan Manavgat, Nabi Zorlu

Aim

To investigate a possible association between headache and psychoactive substance use.

Methods

1055 psychoactive substance abusers were consecutively admitted. All patients filled out a detailed headache questionnaire and 1015 patients were included.

Results

Twenty seven percent of patients reported having headache. Eighteen percent of patients reported having headache attributed to a substance or its withdrawal and 1.4% had unclassified headache. The most commonly used substances were cannabis (80.5%), alcohol (74.6%), methylamphetamine (18.7%), benzodiazepine (10.4%), volatile solvent (5.8%), cocaine (4.4%), heroin (2.1%), opioids (0.5%), and other substances (1.7%). Fifteen patients reported that onset of headache occurred prior to onset of substance use, while 94.5% had headaches occurred after substance abuse. A higher incidence of headache was found in the benzodiazepine, methylamphetamine, cocaine, heroin, volatile solvent abusers. Seventy-eight percent of headache patients have never sought help from a physician despite the severity and frequency of headache.

Conclusions

In our study, the prevalence of headache among all psychoactive substance abusers was 26.9%. Although this is one-group study without any comparison with non-addict population and associational data must be interpreted with caution, the results of this study indicate a possible relationship may exist between headache and substance use since 94.5% of substance users described headaches after the onset of substance use. The younger start and the longer duration of cannabis use caused the higher incidence of headache, but this correlation was not observed in other substance use. Migraine was far more prevalent in the abusers than in previously reported community populations.

Long-term adherence to interferon-beta treatment in a cohort of RRMS patients in Belgrade, Serbia

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Š. Mesaroš, N. Stojsavljević, I. Dujmović-Bašuroski, I. Dejanović, T. Pekmezović, J. Drulović

Objective

Long-term adherence to interferon-beta (IFNβ) treatment in patients with multiple sclerosis (MS) varies considerably in daily clinical practice. The aim of the present study was to assess the frequency and reasons for stopping the INFβ treatment in our relapsing-remitting (RR) MS patients’ cohort.

Patients and method

All patients with RRMS initiating treatment with IFNβ at the Clinic of neurology, CCS, in Belgrade, from January 2004 to June 2009, were included in the study. Treatment was initiated in RRMS patients with at least two relapses in the previous two years, and EDSS score at entry ≤3.5. During the follow-up, patients underwent regular detailed clinical evaluation performed by MS specialists.

Results

The study comprised a total of 290 RRMS patients. During the 6-year follow up period (mean 3.5±2.1years), 18% of patients stopped the treatment. The main reason for treatment discontinuation was lack of efficacy (54%); 21% of patients stopped therapy because of pregnancy and only 17% because of AE.

Conclusion

The frequency of treatment discontinuation in our study pointed to the low permanent termination rate reflecting good adherence to IFNβ in our RRMS patients. Our results support the notion that long-term adherence to IFNβ treatment might be significantly influenced by optimizing the benefits to be achieved from therapy, adequate patient selection and easy accessibility of MS health professionals.

Isolated meningomyeloradiculitis following infection with tick borne encephalitis virus

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Attila Rácz, Gerd Schaller, Jens Lunkenheimer, Tobias Engelhorn, Arnd Dörfler, Wolfgang Sperling, Stefan Schwab, Christian Maihöfner

Primary leptomeningeal medulloblastoma: A rare case

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Xu Guo, Dingrong Zhong, Wenbin Ma

A case of primary central nervous system histiocytic sarcoma

Wed, 28 Mar 2012 19:10:44 GMT

Publication year: 2012
Source:Clinical Neurology and Neurosurgery

Jing Wang, Tianlang Li, Huaihong Chen, Qiang Liu