Surgical treatment of symptomatic pineal cysts without hydrocephalus —meta-analysis of the published literature
ConclusionsAlthough the results support the role of surgery in the management of nhSPCs, they have to be interpreted with a great deal of caution as the current evidence is limited, consisting only of case reports and retrospective surgical series. Inherent to such studies are inhomogeneity and incompleteness of data, selection bias and bias related to assessment of outcome carried out by the treating surgeon in the majority of cases. Prospective studies with patient-reported and objective outcome assessment are needed to provide higher level of evidence.
Carotid stenosis is a major risk factor for stroke and surgical treatment is key in preventing recurrent ischaemic events. Previous randomised trials have demonstrated the net benefit of surgery for significant symptomatic carotid stenosis but, with present day medical treatment, there is limited evidence on the risk of late ipsilateral ischaemic stroke (IS) and its main risk factors.
Patients undergoing carotid endarterectomy (CEA) often experience intraoperative and postoperative blood pressure lability and postoperative headache. Postoperative headache and hypertension after CEA are thought to increase the risk of developing postoperative cerebral hyperperfusion syndrome (CHS). Although fortunately rare, CHS spans a wide spectrum of signs and symptoms, with patients usually presenting with an unrelenting ipsilateral headache. Temporary or permanent neurologic deficit, seizures, intracranial hemorrhage, and, sometimes, death can follow the initial headache 3 to 7 days after discharge.
There is a local ortho group that wants to bring me on, versus going out and hiring someone. We already have a mutual relationship and referral pattern of patients. I like my independence but also like the idea of having strength in numbers. They have one PMR guy that is in the twilight of his career and just wants to do lumbar ESI all day. If I do not join, they will go out and hire someone else. Not a threat, just a fact. They want to address a need in their practice. So my... Read more
Cervical artery dissection is a common cause of stroke in young adults and can lead to significant disability. Clinicians should be able to recognize the clinical presentation and diagnose this condition to prevent cerebral ischemia and its complications. Consider cervical artery dissection in a young adult with new-onset, unilateral head pain with or without neck pain with antecedent neck trauma, with or without neurologic deficits or risk factors for dissection. Early diagnosis can lead to better outcomes but the overall prognosis is good for young adults with cervical artery dissection.
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Normal-pressure hydrocephalus (NPH) is characterized by the clinical triad of dementia, gait instability, and urinary incontinence. The estimated annual incidence is 1.8 cases in 100,000 persons, making NPH a rare diagnosis and uncommon cause of dementia. NPH is a form of communicating hydrocephalus that can easily be missed in older adults with multiple comorbidities, so clinicians must exclude reversible causes of dementia before diagnosing irreversible causes such as Alzheimer disease.
AbstractPurposeEvaluating the current health state in chronic otitis media (COM), audiologic results are complemented by subjective outcomes, such as health-related quality of life (HRQoL). Two disease-specific instruments assessing HRQoL in COM in German-speaking patients exist, i.e., the chronic otitis media outcome test (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). Since the psychometric properties of these questionnaires in a concurrent application are unknown, the aim of this study was to compare the COMOT-15 and the ZCMEI-21.MethodsHRQoL was assessed in adult COM patients using the COMOT-15 and t...
CONCLUSIONS: Although the results support the role of surgery in the management of nhSPCs, they have to be interpreted with a great deal of caution as the current evidence is limited, consisting only of case reports and retrospective surgical series. Inherent to such studies are inhomogeneity and incompleteness of data, selection bias and bias related to assessment of outcome carried out by the treating surgeon in the majority of cases. Prospective studies with patient-reported and objective outcome assessment are needed to provide higher level of evidence.PMID:34854993 | DOI:10.1007/s00701-021-05054-0