Occurrence Of Neurological Deficits Research Articles

The effect of postoperative immobilization in a plaster of Paris back-slab on the surgical wound-healing following the open reduction and plate and screw fixation of the closed calcaneal fractures: a randomised controlled study

Background: Intraarticular calcaneal fractures often need open reduction and internal fixation with plate osteosynthesis. Wound complication is one of the common problems encountered following this. It affects the outcome adversely. Our study was done to assess if a postoperative back-slab can offer any significant difference in the incidence of wound complications. Methods: Out of 42 patients with unilateral intraarticular calcaneal fractures, 20 were provided postoperative slab and continued for six weeks. The remaining 22 patients were not provided any plaster. All patients were followed-up for two years. Results: The incidence of wound dehiscence was 2 in the plaster group as well as 8 in the non-plaster group and this was statistically significant (p=0.02). Also, significantly lower heel widening was reported in the plaster group (p=0.03). Although there was no significant difference in the patient-reported outcome (Maryland Foot Score) and the incidence of pain between the two groups, the occurrence of neurological deficit following surgery and the postoperative range of movements were comparable in these two groups. Conclusions: Thus, it may be concluded that postoperative plaster application for the initial six weeks could be a low-cost yet effective way to reduce wound complications following plate osteosynthesis in intraarticular calcaneal fractures.

Spinal Fractures during Touristic Motorboat Sea Cruises: An Underestimated and Avoidable Phenomenon

Each summer, many vacationers enjoy the Mediterranean Sea shores. Among the recreational nautical activities, motorboat cruise is a popular choice that leads to a significant number of thoracolumbar spine fractures at our clinic. This phenomenon seems to be underreported, and its injury mechanism remains unclear. Here, we aim to describe the fracture pattern and propose a possible mechanism of injury. We retrospectively reviewed the clinical, radiological, and contextual parameters of all motorboat-related spinal fracture cases during a 14-year period (2006-2020) in three French neurosurgical level I centers bordering the Mediterranean Sea. Fractures were classified according to the AOSpine thoracolumbar classification system. A total of 79 patients presented 90 fractures altogether. Women presented more commonly than men (61/18). Most of the lesions occurred at the thoracolumbar transition region between T10 and L2 (88.9% of the levels fractured). Compression A type fractures were seen in all cases (100%). Only one case of posterior spinal element injury was observed. The occurrence of neurological deficit was rare (7.6%). The most commonly encountered context was a patient sitting at the boat's bow, without anticipating the trauma, when the ship's bow suddenly elevated while crossing another wave, resulting in a "deck-slap" mechanism hitting and propelling the patient in the air. Thoracolumbar compression fractures are a frequent finding in nautical tourism. Passengers seated at the boat's bow are the typical victims. Some specific biomechanical patterns are involved with the boat's deck suddenly elevating across the waves. More data with biomechanical studies are necessary to understand the phenomenon. Prevention and safety recommendations should be given before motorboat use to fight against these avoidable fractures.

Preliminary experience in Awake Surgery:Functional recovery profile

Background. Until the advent of new exploration techniques: functional magnetic resonance imaging (fMRI) and surgical protocols such as exeresis in awake mode, the functional recovery potential of postoperative deficits was limited by conventional tumor surgery. The use of these methods simultaneously improves the quality of life and survival medians, mainly for removing low-grade gliomas massively infiltrating subcortical networks in eloquent regions where surgery is historically not associated with high functional recovery rates. Accordingly, the results from the awake brain surgery literature motivate us to establish a new baseline on the relationship between electrical stimulation mapping (ESM) threshold, the extent of resection (EOR), neuroplastic typology, and functional recovery after intraoperative crises or postoperative care deficits using induced neuroplasticity. Materials and patients. This is a retrospective analytical study of 35 brain tumor cases of gliomas, operated by common craniotomy in awake conditions from September 2016 to July 2022. Before entering awake resection mode, all patients underwent brain mapping (ESM) by direct electrical stimulation (DES) according to standard conditions and Helsinki ethical guidelines. Analysis according to ESM was done for two groups (group 1 and group 2) of different intensities of DES. Outcomes. The ESM by threshold intensity expressed in mean ± deviation standard was: 2,45 ± 0.125 mA for sensorimotor functions against 1.35 ± 0.175 mA for cognitive mapping. These stimulation currents were optimum thresholds which allowed us during control mapping to overcome all boundary conditions, mostly false negative results. The functional recovery time (FRT) following stimulation-induced seizures was varied from 2 s to 6.26 s, marking the intraoperative neuroplasticity operated mainly by synaptic remodeling during the functional reactivation. The EOR was better for group 1 with 82.35 % gross total resection (GTR) with only 8.75% of the occurrence of transient seizures against 45.7% for group 2 and only 2.86% suffered from neurological permanent deficits in group 1 against 11.42% in group 2. Conclusions. ESM in the range of [2.35 - 2.45 mA] improved DES sensitivity without false negatives. We had a compromise of improved results between these stimulation thresholds, the duration of the craniotomy, the functional recovery time, the EOR and overall the occurrence of neurological deficits, which explain the processes involved in the success of awake surgery.

RADIOLOGICAL EXAMINATION OF FACE-JAW JOINT WOUNDS

The reason for the interest in the problem of facial and maxillofacial injuries (CJS) is the increase in the number of injuries to the tissue structures of the face and brain, which is characterized by uncertainty of consequences and difficulty of treatment outcome. Occurrence of neurological deficits in the post-injury period disrupts patients’ social adjustment. The serious consequences of acute joint facial injuries make it one of the social problems of national and global importance.

Return to play in children with shunted hydrocephalus.

The objective of this study was to assess the relevance of shunted hydrocephalus in regard to participation by young patients in physical education (PE) classes. Students diagnosed with this condition are very often restricted in PE classes owing to the lack of official and well-defined guidelines. However, the medical literature suggests that there is no relationship between the disease and risk of sport-related injuries. In this study, the authors intended to evaluate not only the accuracy of this statement, but also to explore the factors that delay or foreclose return to exercise. The analysis was conducted on patients aged < 18 years with a diagnosis of shunt-treated hydrocephalus who received follow-up for a minimum of 1 year. Collected medical data were examined for factors limiting participation in PE at school. Indicators of both sport-related injuries and conditions acceptable for return to exercise were gathered during follow-up visits. In this study, 72.72% of patients attended sport activities in schools. The group based on return to PE class differed significantly in the occurrence of neurological deficits, as well as presence of comorbidities. In univariate analysis, the authors identified these parameters as risk factors limiting participation in PE. On the contrary, etiology of hydrocephalus, type of shunting device, number of shunt malfunctions, and presence of epilepsy did not significantly influence sport engagement. This study shows that many patients with shunt-treated hydrocephalus can safely participate in PE. Presence of neurological deficits before and after neurosurgical treatment, as well as presence of comorbidities, are factors that negatively impact the possibility of a patient returning to physical activity. Sport-related injuries do occur, but at a low incidence.

Pemenuhan kebutuhan pengetahuan dasar penyakit stroke pada masyarakat awam

Introduction:Cerebrovascular injury or often referred to as a stroke is a sudden occurrence of neurological deficits due to the failure of the blood supply to a part of the brain. Insufficiency or interruption of the blood supply caused by thrombosis, usually secondary to arteriosclerosis, to embolism originating elsewhere in the body, or to bleeding from ruptured arteries.&#x0D; Objective: The activities carried out are to provide fulfillment of basic knowledge needs about this stroke. Stroke, also known as screbrovascular injury (CVA) is the cessation of blood supply to the brain and causes the function of part of the brain to disappear.&#x0D; Method: The method used in this counseling is based on strategy, implementation and action, ending with an evaluation carried out at the end of the extension with the number of questionnaires given to the community for the needs of the required research results.&#x0D; Results: The fulfillment of the need for basic knowledge about stroke to the community and the community can implement the results of counseling in accordance with the directions that have been given.&#x0D; Conclusion: The implementation is divided into several dimensions, namely timeliness and duration, participation, knowledge and problem solving. Work and evaluation carried out by 5 observators.

Role of mTOR and VEGFR Inhibition in Prevention of Metastatic Tumor Growth in the Spine.

Objective: Spinal metastatic disease remains a major problem of oncological diseases. Patients affected may suffer pain, spinal instability, and severe neurological deficits. Today, palliative surgery and radiotherapy are the mainstays of therapy. In contrast, preventive treatment strategies or treatment concepts for an early stage are lacking. Here, we have used a syngeneic, experimental spine metastases model in the mouse to test the efficacy of mTOR inhibition and anti-angiogenesis on the formation and progression of spinal melanoma metastases.Methods: We used our previously established syngeneic spinal metastases mouse model by injecting luciferin-transfected B16 melanoma cells into the common carotid artery. Following injection, mice were treated with everolimus, an inhibitor of the mammalian target of rapamycin (mTOR) complex, axitinib, a tyrosine kinase inhibitor, that blocks vascular endothelial growth factor receptors (VEGFR) 1-3, as well as placebo. Animals were followed-up daily by neurological assessment and by repeat in vivo bioluminescence imaging. With occurrence of neurological deficits, a spinal MRI was performed, and mice were sacrificed. The whole spine was dissected free and analyzed by immunohistochemical techniques.Results: Overall survival was 23 days in the control group, significantly prolonged to 30 days (p = 0.04) in the everolimus group, and to 28 days (p = 0.04) in the axitinib group. While 78% of mice in the placebo group developed symptomatic metastatic epidural spinal cord compression, only 50% did so in the treatment groups. The mean time to manifestation of paralysis was 22 days in the control group, 26 days (p = 0.10) in the everolimus group, and 27 days (p = 0.06) in the axitinib group. Screening for spinal metastases by bioluminescence imaging on two different time points showed a decrease in metastatic tumor formation in the treatment groups compared to the controls. Immunohistochemical analysis confirmed the bioactivity of the two compounds: The Ki67 proliferation labeling index was reduced in the everolimus group and numbers of CD31 positive endothelial cells were reduced in the axitinib group.Conclusion: Both, the mTOR inhibitor everolimus as well as antiangiogenetic effects by the VEGFR inhibitor axitinib showed potential to prevent and retard formation of symptomatic spinal metastases. However, the therapeutic efficacy was only mild in this experimental model.

Relationship between Types of Cervical SpineTrauma and Occurrence of Neurological Deficits

Background: About 3,500 people died each year due to neck injury, according to a study in the USA. Trauma at cervical spine level causes injury in soft tissue, cervical vertebrae, and spinal cord that can cause neurological deficits. The aim of this study was to analyze the relationship between type of cervical trauma and the occurrence of neurological deficits. Methods: An analytic study was carried out to 121 medical records of patients diagnosed with cervical spine trauma at Dr. Hasan Sadikin General Hospital Bandung in the period of January 2010−December 2012. Data were classified according to age, sex, period of initial visit to hospital, mechanism of trauma, cervical trauma type, fracture’s or dislocation’s location (without any other vertebral injury) and neurological status. The collected data were analyzed using Chi-Square test and presented in tables. Results: There were 121 cases of cervical spine trauma. Most patients were male and in the productive age group (30−44 years). Most of the initial visits to the hospital were in 2010 and most of the mechanism was traffic accident (46.28%), while soft tissue injury was the most common type of cervical trauma (54.54%) and lower cervical vertebrae was the most common location of fractures or dislocations (76.36%). Sixty two patients were recorded with neurological deficits. Chi-Square test of relationship between the type of cervical trauma and the occurrence of neurological deficit was statistically significant (p=0.000). Conclusions: There is relationship between the type of cervical trauma and occurrence of neurological deficits. DOI: 10.15850/amj.v4n2.1084

The utility of perfusion CT and CT angiography on early diagnosis and the management of vasospasm after subarachnoid hemorrhage

Subarachnoid hemorrhage is one of the most important and dangerous neurologic emergencies worldwide. It is characterized by a sudden and severe headache caused most commonly by the rupture of intracranial aneurysm. Cerebral vasospasm is the most important cause of disability and death in whom survived from the first event. Early diagnosis and management of cerebral vasospasm could prevent and reduce its morbidity and mortality. Thus, an ideal technique must be able to detect the vasospasm before the occurrence of neurological deficits. Perfusion computed tomography could assess vascularity of brain including cerebral blood flow, cerebral blood volume, time to peak and mean transit time. For this application, perfusion computed tomography and computed tomography angiography techniques offer significant advantages and can result in early diagnosis of vasospasm. In this review, we discuss the utility of these two techniques and their safety in the diagnosis and the management of vasospasm following subarachnoid hemorrhage.

Dynamics of interpedicular widening in spinal burst fractures: an in vitro investigation

Background contextSpinal burst fractures are a significant cause of spinal instability and neurologic impairment. Although evidence suggests that the neurologic trauma arises during the dynamic phase of fracture, the biomechanics underpinning the phenomenon has yet to be fully explained. Interpedicular widening (IPW) is a distinctive feature of the fracture but, despite the association with the occurrence of neurologic deficit, little is known about its biomechanics. PurposeTo provide a comprehensive in vitro study on spinal burst fracture, with special attention on the dynamics of IPW. Study designExperimental measurements in combination with computed tomography scanning were used to quantitatively investigate the biomechanics of burst fracture in a cadaveric model. MethodsTwelve human three-adjacent-vertebra segments were tested to induce burst fracture. Impact was delivered through a drop-weight tower, whereas IPW was continuously recorded by two displacement transducers. Computed tomography scanning aided quantifying canal occlusion (CO) and evaluating sample anatomy and fracture appearance. Two levels of energy were delivered to two groups: high energy (HE) and low energy (LE). ResultsNo difference was found between HE and LE in terms of the residual IPW (ie, post-fracture), maximum IPW, or CO (median 20.2%). Whereas IPW was not found to be correlated with CO, a moderate correlation was found between the maximum and the residual IPW. At the fracture onset, IPW reached a maximum median value of 15.8% in approximately 20 to 25 milliseconds. After the transient phase, the pedicles were recoiled to a median residual IPW of 4.9%. ConclusionsOur study provides for the first time insight on how IPW actually evolves during the fracture onset. In addition, our results may help shedding more light on the mechanical initiation of the fracture.

Risks of presurgical embolization of feeding arteries in 137 intracranial meningeal tumors

Embolization of extra-axial tumors has shown its effectiveness in reducing perisurgical blood loss. However, the complication rate of this procedure is poorly reported. We aimed to evaluate the rate of procedure-related complications and their risk factors. From 1998 to 2011, 193 consecutive patients (141 females, 52 males; mean age = 52.9 years) were referred to our institution for presurgical embolization of an extra-axial tumor (meningiomas: n = 178; solitary fibrous tumors: n = 3; other: n = 12). Of 193 patients, 137 (71 %) underwent 141 embolizations (by microparticles: n = 133; by glue: n = 8). The remaining 56 patients (29 %) were not embolized due to unstable catheterization or dangerous anastomosis. Occurrence of neurological deficit was systematically assessed during and after embolization. The risk factors of procedure-related neurological complications were evaluated. Neither intratumoral hemorrhage nor procedure-related death was reported. Two of the 137 patients (1.5 %) had ischemic events with permanent neurological deficit after microparticles embolization. One patient had cortical blindness and one had hemiparesis. Both complications involved the vertebrobasilar system. The first patient had direct intratumoral anastomosis between the middle and the posterior meningeal arteries (PMA); the second one had reflux in the vertebral artery during particles injection in the PMA. Occurrence of ischemic complication was not related to the size of the microparticles. Though embolization of meningeal tumors is considered as a safe technique, serious neurological complications may occur. Opening of dangerous anastomosis or uncontrolled reflux caused two neurological complications (1.5 %). The size of the microparticles was not associated with the occurrence of neurological event.

Language Impairment Associated With Arachnoid Cysts: Recovery After Surgical Treatment

Supporting data from the literature, we observe that large arachnoid cysts may affect cognitive function. Neuropsychologic assessment plus magnetic resonance imaging allowed for documentation of associations between left temporal arachnoid cysts, language impairment, and other cognitive dysfunctions. Significant cognitive improvements were evident soon after cysto-peritoneal shunting. These observations reinforce the rationale for neuropsychologic assessments of patients with developmental delay and arachnoid cysts, and support the potential benefit of surgical decompression for arachnoid cysts associated with neurologic deficits, even if surgery is performed well after the occurrence of neurologic deficits.

Endoscopic versus open radial artery harvesting for coronary artery bypass grafting

Background and aim of the study. The radial artery has become the artery of choice after both internal thoracic arteries for coronary artery bypass grafting (CABG). This study compares wound healing and arm complications after endoscopic versus open radial artery harvesting. Methods. From January 2002 to July 2004, 509 patients underwent CABG including a radial artery conduit. Thirty-nine had endoscopic and 470 conventional open radial artery harvesting. A propensity score was used to obtain 1:3 matching of all endoscopic to 117 open-harvesting patients. Postoperative wound healing, local neurologic deficits, wound infection, and pain scores were compared. Results. Wound healing: 34 of 39 endoscopic wounds exhibited a perfect Hollander score versus 339 of 470 open-harvest wounds (p = 0.01). Wound appearance was better for endoscopic harvesting (p = 0.004). Three incomplete neurologic deficits were observed after open harvesting versus one complete neurologic deficit after endoscopic harvesting that recovered prior to hospital discharge. Incidence of wound infection was similar in both groups (p = 0.7), although infection was more severe with open harvesting. Pain score was lower (p = 0.006) with endoscopic harvesting. Conclusions. Endoscopic radial artery harvesting was associated with better wound appearance and less pain. Occurrence of neurologic deficits and wound infection was infrequent in both groups.

A 10-year experience of radiosurgical treatment for cerebral arteriovenous malformations: a perspective from a series with large malformations

The purpose of this study was to describe a 10-year experience in the use of radiosurgery (RS) for patients with arteriovenous malformations (AVMs) in Puerto Rico. This retrospective analysis was performed for all patients with AVMs treated with RS by the senior author (R.H.B.) in Puerto Rico. Between February 1999 and December 2009, a total of 83 patients underwent the procedure. All charts were reviewed for recollection of demographic data, and AVM and treatment characteristics. Clinical and radiographic follow-up information was collected retrospectively. Eighty-three patients were treated and 86 RS procedures for AVMs were performed during a 10-year period. Eight patients were lost to follow-up. The remaining 75 patients included 36 males and 39 females, whose median age was 34.5 years. Hemorrhage was the initial presentation in 40% of patients. Fifty-seven AVMs (73%) were treated previously with endovascular neurosurgery, without success. The median volume of the malformation was 17.7 ml. Nearly 65% of the malformations were considered large (≥ 10 ml) in volume. Forty patients had AVMs with largest diameter ≥ 3.5 cm. The overall obliteration rate was 56.4%, and the median time for obliteration was 29 months. The AVMs ≥ 3.5 cm in diameter had a greater latency period than those < 3.5 cm (31 months vs 46 months, respectively; p = 0.01). In addition, AVM obliteration was inversely associated with its volume, especially in large lesions (p = 0.037). In bivariate analysis, patients achieving obliteration had lower Spetzler-Martin scores compared with patients in whom obliteration was not achieved (p = 0.009). Postradiosurgery hemorrhages were seen in 9 cases. Eleven patients underwent surgery after RS. Major neurological deficits developed in 9 patients, whereas 17 had only minor deficits. The occurrence of neurological deficits was significantly associated with lesions with volume ≥ 10 ml. Radiosurgery is a reasonable treatment option for AVMs in the majority of cases, in spite of the large, difficult-to-treat malformations.

Research Highlights

Research Highlights

External carotid artery shunting during carotid endarterectomy: an alternative for cerebral protection?

to assess the application of external carotid artery (ECA) shunting in cerebral protection during carotid endarterectomy (CEA). prospective study. the study comprised 137 consecutive patients who underwent CEA under locoregional anaesthesia. Transcranial Doppler was used to monitor the mean velocity of the middle cerebral artery (mv-MCA): (1) before carotid clamping; (2) after clamping both the common and external carotid arteries; (3) after clamping the internal carotid artery alone ("ECA test"). The decision to shunt was based on the occurrence of neurological deficit during carotid clamping. If the ECA test revealed mv-MCA approaching the pre-clamping values ECA shunting was used, whereas the remaining patients in need of a shunt had a standard internal carotid artery (ICA) shunt. shunting was necessary in 12/137 cases (9%). The ECA test indicated that in four cases - 3% of the whole series or 33% of the shunted cases. In these four patients ECA shunting reversed the neurological deficit, and CEA was successfully performed without any complications. ECA shunting could be considered as an alternative to standard ICA shunting. Suitable cases can be identified on the basis of the ECA test.

Traumatic pseudarthrosis of the dens axis. Aetiology, course and therapy

In a retrospective analysis the significance of internal fixation of unstable and symptomatic non-union of the odontoid was evaluated. In all but one cases a type II fracture of the odontoid was the underlying cause for the pseudarthrosis. The time interval between trauma and definitive diagnosis varied between 6 months and 30 years. All patients asked for medical advice because of acute neck pain; in three cases additional neurological deficits were notified. In all but one case the pseudarthrosis was classified as unstable on flexion-/extension views. The occurrence of neurological deficits showed a positive correlation with the amount of dislocation of the pseudarthrotic odontoid. Nine out of 10 patients underwent internal stabilisation of the non-union. Reoperation because of persistent instability/failure of stabilisation had to be performed in two cases (22.2%). At follow-up all 9 patients were pain-free. The neurological deficits in two patients had improved significantly. According to our experience internal stabilisation in unstable non-union of the odontoid is recommended to achieve significant reduction of the pain level. Also improvement of the neurological deficits can be expected depending on the duration of the symptoms.

Complications of carotid endarterectomy and their prevention.

AbstractMortality and morbidity associated with carotid endarterectomy may be minimized by proper selection of patients and proper operative and postoperative management. Complications include cardiac and airway problems related to anesthesia, infection, hematoma, nerve pareses, parotitis, arterial disruption, false aneurysms, and carotid‐cavernous fistula. The most serious complication is the occurrence of neurologic deficits as a result of cerebral emboli or ischemia. Emboli are due to excessive manipulation of the artery, while ischemia results from hypotension, intracerebral thrombosis, or inadequate cerebral protection. Adequacy of collateral blood flow during carotid clamping is determined by temporary occlusion under local anesthesia, measurement of internal carotid artery stump pressure, or EEG monitoring. The most reliable method of cerebral protection is a temporary inlying shunt. Selective shunting is used if the patient is intolerant of temporary clamping, if stump pressure is below 55 mm Hg, or if EEG changes occur. For maximum safety, the author suggests routine shunting and general anesthesia. Operative mortality for patients experiencing transient ischemic attacks should be less than 1% and operation‐related neurologic deficits no more than 2%. Meticulous attention to technical details is obligatory. Hypotension should be avoided during and after operation to avert thrombosis, and excessive hypertension postoperatively must be treated promptly to avoid cerebral hemorrhage and edema. Operation is contraindicated on patients with acute profound and progressing strokes.