Abstract: Large format (ie, >25 cm2) cranioplasty is a challenging procedure not only from a cosmesis standpoint, but also in terms of ensuring that the patient´s brain will be well-protected from direct trauma. Until recently, when a patient´s own cranial flap was unavailable, these goals were unattainable.
The American Heart Association has played a leadership role in the periodic assimilation and publication of high-quality multidisciplinary stroke-related guidelines. The spontaneous intracranial hemorrhage (ICH) guidelines were last published in 2010.1 Recent advances in our understanding of the pathophysiology of this disease and the recent publication of important clinical trials have prompted the need for an update to these guidelines. Spontaneous ICH is associated with significant morbidity and mortality, with an incidence of 16 to 33 cases per 100 000.2 The newly published guidelines in the July 2015 issue of Stroke have added a number of new recommendations, including 3 new Class I recommendations, compared with the 2010 guidelines.3 In classifying the level of certainty regarding recommendations, the guidelines follow the American Heart Association/American Stroke Association classification system. The writing team conducted a thorough PubMed search on all pertinent studies conducted between 2009 and August 2013; the outcomes from 2 essential phase 3 ICH trials were also integrated.
Abstract Degenerative spinal deformity afflicts a significant portion of the elderly and is increasing in prevalence. Recent evidence has revealed sagittal plane malalignment to be a key driver of pain and disability in this population and has led to a significant shift toward a more evidence-based management paradigm. In this narrative review, we review the recent literature on the epidemiology, evaluation, management, and outcomes of degenerative adult spinal deformity (ASD).
BACKGROUND: Lumbar spinal stenosis can cause symptomatic neurogenic claudication alongside radicular pain and weakness. In appropriately selected patients, surgical intervention has been demonstrated to provide for improvement in pain, disability, and quality of life. This systematic review sought to define the utility and safety of such decompression with or without arthrodesis in the management of symptomatic lumbar spinal stenosis for elderly patients older than 65 years of age.
BACKGROUND: Traumatic central cord syndrome (TCCS) is an incomplete spinal cord injury defined by greater weakness in upper versus lower extremities, variable sensory loss, and variable bladder, bowel, and sexual dysfunction. The optimal timing of surgery for TCCS remains controversial.
Abstract: Vertebral compression fractures (VCFs) are the most common type of fracture secondary to osteoporosis. These fractures are associated with significant rates of morbidity and mortality and annual direct medical expenditures of more than $1 billion in the United States.
Introduction: Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers.
Introduction: CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke.
Introduction: Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) can be reversible or progress to cerebral infarction. In patients with a deterioration clinically diagnosed as DCI, we investigated whether CT perfusion (CTP) can distinguish between reversible ischemia and ischemia progressing to cerebral infarction.
Introduction: Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood–brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT.
Introduction: We investigated circle of Willis (CoW) completeness in relation to the risk of future ischemic stroke in patients without prior cerebrovascular disease.
Introduction: Diagnostic tools to show emboli reliably and protection techniques against embolization when employing stent retrievers are necessary to improve endovascular stroke therapy. The aim of the present study was to investigate iatrogenic emboli using susceptibility-weighted imaging (SWI) in an open series of patients who had been treated with stent retriever thrombectomy using emboli protection techniques.
BACKGROUND AND PURPOSE: The prevalence and clinical importance of primarily fragmented thrombi in patients with acute ischemic stroke remains elusive. Whole-brain SWI was used to detect multiple thrombus fragments, and their clinical significance was analyzed.
SUMMARY: Recanalization of intracranial aneurysms following endovascular coiling remains a frustratingly common occurrence. An understanding of the molecular and histopathologic mechanisms of aneurysm healing following coil embolization is essential to improving aneurysm occlusion rates. Histopathologic studies in coiled human and experimental aneurysms suggest that during the first month postcoiling, thrombus formation and active inflammation occur within the aneurysm dome. Several months following embolization, the aneurysm is excluded from the parent vessel by formation of a neointimal layer, which is often thin and discontinuous, across the aneurysm neck. Numerous coil modifications and systemic therapies have been tested in animals and humans in an attempt to improve the aneurysm-healing process; these modifications have met with variable levels of success. In this review, we summarize the histopathologic and molecular biology of aneurysm healing and discuss how these findings have been applied in an attempt to improve angiographic outcomes in patients with intracranial aneurysms.
BACKGROUND AND PURPOSE: Arterial spin-labeling is a noninvasive method to map cerebral blood flow, which might be useful for early diagnosis of neurodegenerative diseases. We directly compared 2 arterial spin-labeling techniques in healthy elderly controls and individuals with mild cognitive impairment.
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