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Decoding the data: a comment on the American Heart Association/American Stroke Association (AHA/ASA) 2023 Guideline for the Management of patients with Aneurysmal Subarachnoid Hemorrhage
Guideline summary The 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage was recently released with endorsements from multiple societies, including the Society of NeuroInterventional Surgery.1 All who worked on this document should be congratulated for their work, as it provides many updates, and addresses new components of aneurysmal subarachnoid hemorrhage (aSAH) care. We encourage providers to thoroughly read the statement. While this Guideline statement is thorough, it is important to highlight opportunities for future research, and gaps in the literature, where rigorous adherence to ...
Source: Journal of NeuroInterventional Surgery - August 17, 2023 Category: Neurosurgery Authors: Fraser, J. F., Heit, J. J., Mascitelli, J. R., Tsai, J. P. Tags: Commentary Source Type: research

022 Preliminary results from a consultant-led acute neurology service based in the emergency department
Conclusions Acute Neurology input in the ED had major impacts on working diagnoses, hospital admis- sions, urgent outpatient referrals, and emergency investigations.
Source: Journal of Neurology, Neurosurgery and Psychiatry - August 12, 2022 Category: Neurosurgery Authors: Alim-Marvasti, A., See, I., Kandasamy, R., Hutchinson, J., Lane, C., Baruah, T., Balaratnam, M., Chandratheva, A., Simister, R., Haider, S. Tags: Poster presentations Source Type: research

A Case of a 4-Year-Old Female with a Primary Spinal Malignancy Presenting with Froin's Syndrome
We report the case of a 4-year-old female with a primary extradural intramedullary atypical teratoid/rhabdoid tumor (AT/RT) leading to a middle cerebral artery (MCA) infarct and Froin's syndrome. She presented with a 6-pound weight loss over the previous week, as well as a decreased urinary output and an altered mental status. She underwent a brain MRI that revealed a left MCA infarct, mild ventriculomegaly, and bilateral internal carotid artery, M1, and A1 stenosis. An external ventricular drain (EVD) was placed due to increased intracranial pressure. Cerebrospinal fluid (CSF) was analyzed via lumbar puncture that reveale...
Source: Pediatric Neurosurgery - November 1, 2017 Category: Neurosurgery Source Type: research

Artery of percheron occlusion: a rare cause of coma
Conclusions AOP occlusion is a rare cause of coma and should be suspected in patients who present with acute loss of consciousness, once other common aetiologies are excluded. This case raises pertinent questions regarding the indications and benefits of thrombolysis and/or clot retrieval in such patients.
Source: Journal of Neurology, Neurosurgery and Psychiatry - May 8, 2017 Category: Neurosurgery Authors: El-Wahsh, S., Weerasinghe, D., McDougall, A. Tags: Abstracts Source Type: research

The zebra sign
A 65 year old female was transferred to the Hyperacute Stroke Unit after a routine L5/S1 laminectomy. She suffered a small dural tear. 3 hours post procedure, her GCS dropped to 3. CT scan showed a bi-cerebellar haemorrhage and MRI brain the next day revealed a convexity subarachoid haemorrhage. Imaging was reviewed with neuroradiologists and neurosurgeons. They recognised this as a typical case of post-dural puncture remote cerebellar haemorrhage. In surgical literature there are many cases reported since 1981 of "the Zebra sign". Patients can become obtunded up to 72 hours after the injury. The mechanism of the haemorrha...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 14, 2015 Category: Neurosurgery Authors: Patel, B., Nagendran, A., Khan, U. Tags: Brain stem / cerebellum, Stroke, Radiology, Radiology (diagnostics) Thur 21, Parallel session 5: Therapeutics Source Type: research

Multiple intracranial arteritis and hypothyroidism secondary to Streptococcus anginosus infection
A 50-year-old Chinese woman reported a sharp paroxysmal headache and abrupt paralysis of the left leg. She then developed ptosis, blurred vision, diplopia and fever. On admission, a neurological examination revealed right III, IV, VI and left V1 cranial nerve palsy, bilateral upper eyelid oedema and left leg monoplegia (Medical Research Council grade 2/5). In addition, a left Babinski sign and nuchal rigidity were observed. Blood tests revealed elevated white cell count (WCC) and a majority of the cells were neutrophils. Lumbar puncture revealed that the WCC (120x106/μL) and protein level (0.79 g/L) of the cerebros...
Source: Journal of Neurology, Neurosurgery and Psychiatry - August 13, 2015 Category: Neurosurgery Authors: Zhang, C., Xie, B., Shi, F.-D., Hao, J. Tags: Open access, Immunology (including allergy), Meningitis, Brain stem / cerebellum, Cranial nerves, Drugs: CNS (not psychiatric), Headache (including migraine), Infection (neurology), Pain (neurology), Stroke, Hypertension, Ophthalmology, Radiology, Musculo Source Type: research

E-075 neurosarcoidosis presenting as aneurysmal subarachnoid hemorrhage: an interesting case and novel treatment
Neurosarcoidosis, the term used for sarcoidosis involving the central nervous system, represents an uncommon form of sarcoidosis, found in a 5% of patients with systemic sarcoidosis. Clinically evident cerebrovascular involvement in neurosarcoidosis has been reported but appears to be an extremely rare manifestation of neurosarcoidosis. The literature describes these cerebral vasculopathic changes as areas of stenosis and/or vascular irregularity, with clinical manifestations including headache, ischemic stroke, and parenchymal hemorrhage. Neurosarcoidosis has even been described as the etiology for a case of moyamoya synd...
Source: Journal of NeuroInterventional Surgery - July 26, 2015 Category: Neurosurgery Authors: Gaughen, J. Tags: SNIS 12th Annual Meeting Electronic Poster Abstracts Source Type: research

Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting.
CONCLUSIONS Lumbar puncture and ventriculoperitoneal shunting carry substantial risk when performed in a patient after decompressive craniectomy and before cranioplasty. When the condition that prompts decompression (such as brain swelling associated with stroke or trauma) requires time to resolve, risk is associated with lumbar puncture performed ≥ 1 month after decompressive craniectomy. PMID: 26067613 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - June 12, 2015 Category: Neurosurgery Authors: Creutzfeldt CJ, Vilela MD, Longstreth WT Tags: J Neurosurg Source Type: research

Reversible leukoencephalopathy as a presentation of cerebral amyloid angiopathy
A 73 year old man with a past medical history of hypertension, osteoathritis and asthma presented to the local district general hospital with recurrent episodes of spontaneously resolving encephalopathy. The initial presentation was characterised by acute confusion and visual hallucinations followed by a generalised tonic–clonic seizure. On examination his blood pressure was 215/115 mmHg. Neurological examination did not reveal any lateralising signs but the patient was found to be encephalopathic with a Montreal Cognitive Assessment (MOCA) score of 9/30. Routine blood tests were unremarkable. A CT brain scan showed ...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Lilleker, J., Vassallo, J., Punter, M. Tags: Genetics, Immunology (including allergy), Epilepsy and seizures, Stroke, Hypertension, Drugs: psychiatry, Radiology, Surgical diagnostic tests Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23 Source Type: research

Spontaneous intracranial hypotension: clinical features in eight cases
Conclusions SIH is an under–recognised but fairly common disorder. Clinical examination is usually normal, and confirmation of the diagnosis requires investigations and treatment not used routinely in the management of headache. Investigations, including contrast–enhanced neuroimaging, are often normal in the acute or chronic phase. Clinical history taking skills are therefore paramount in recognising this disorder. Characteristic features include a new daily persistent headache in a cranio–cervical distribution, with often bizarre sounding additional symptoms. Our results challenge the prevailing notions...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Anderson, J., Corkill, R. Tags: Headache (including migraine), Pain (neurology), Stroke, Ear, nose and throat/otolaryngology Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23-24 October 2013 Source Type: research

Staring you in the face! sturge-weber syndrome is a spectrum disorder and late presentation is possible
A 52 year old man with a four year history of migraine with aura presented to hospital with a severe right sided headache and prolonged episode of left sided sensory and motor disturbance. Examination revealed left homonymous hemianopia, sensory inattention and hemiparesis (3/5). Reflexes were symmetrical and plantars downing. He had a facial port wine stain in a V1 distribution on the right. Unenhanced CT scan was normal. Migrainous infarction was the working diagnosis and he was commenced on aspirin. Two days later he experienced intermittent episodes of left face and arm twitching consistent with focal motor seizures, t...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Cosgrove, J., Hassan, A. Tags: Genetics, Drugs: CNS (not psychiatric), Epilepsy and seizures, Headache (including migraine), Pain (neurology), Stroke, Radiology, Radiology (diagnostics) Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP) Source Type: research

Anti glutamic acid decarboxylase antibody mediated encephalopathy while on etanercept in a patient with multiple autoimmune diseases
A 39 year old lady presented with an altered mental state and unsteadiness of gait. She had a history of juvenile idiopathic arthritis, autoimmune thyroiditis and alopecia, protein S deficiency with vena cava thrombosis, previous excision of ovarian mass and vasculitic rash. There was a previous history of ovarian mass and her immunomodulatory therapy for arthritis over the previous year was Etanercept. She used recreational cannabis but denied any other illicit drug usage. Her affect was variable and at times inappropriate with frequent laughter. She would spit regularly. There was anxiety and a prevailing sensation of do...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: MacDougall, N., Waddell, B., O'Riordan, J. I. Tags: Immunology (including allergy), Brain stem / cerebellum, Drugs: CNS (not psychiatric), Epilepsy and seizures, Infection (neurology), Stroke, Drugs misuse (including addiction), Connective tissue disease, Musculoskeletal syndromes Association of British Source Type: research

Grey matter and csf amyloid in early non-demented parkinson's disease: the incidence of cognitive impairment in cohorts with longitudinal evaluation in parkinson's disease (icicle-pd) study
Conclusion We report a significant correlation between reduced GM volume and lower Aβ1–40 and Aβ1–42 levels in patients with newly diagnosed PDND. These data suggest that even in early PD, CSF markers may be associated with measures of brain atrophy. Although neither GM loss nor Aβ1–40 or Aβ1–42 levels correlated with cognitive performance, we postulate that this reflects the very early nature of the neurodegenerative process in this cohort.
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Duncan, G. W., Yarnall, A. J., Firbank, M. J., Barker, R. A., O'Brien, J. T., Burn, D. J. Tags: Dementia, Drugs: CNS (not psychiatric), Parkinson's disease, Stroke, Memory disorders (psychiatry) Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23-24 October 2013 Source Type: research