ABSTRACT
Based on past laboratory and anecdotal clinical experience, we hypothesized that prolonged cervical spinal cord stimulation (SCS) in the acute settings of aneurysmal subarachnoid hemorrhage (aSAH) would be both safe and feasible, and that 2-week stimulation will reduce incidence of cerebral arterial vasospasm. The goal of our clinical study was to establish feasibility and safety of cervical SCS in a small group of selected aSAH patients. Single-arm non-randomized prospective study of cSCS in aSAH patients involved percutaneous implantation of 8-contact electrode in 12 consecutive aSAH patients that satisfied strict inclusion criteria. The electrode insertion was performed immediately upon surgical or endovascular securing of the ruptured aneurysm while the patient was still under general anesthesia. Patients were stimulated for 14 consecutive days or until discharge. There were no complications related to the electrode insertion or to SCS during the study and no long-term side effects of SCS during 1-year follow-up. There was 1 unrelated death and two electrode pullouts. This article summarizes technical details of SCS electrode insertion and the stimulation parameters used in the research study. Our study of SCS for prevention of vasospasm after aSAH conclusively shows both safety and feasibility of this promising treatment approach. Despite high level of acuity in aSAH patients, impaired level of consciousness, frequent patient re-positioning, need in multiple tests and variety of monitors, SCS electrodes may be safely implanted and maintained for the two-week period. Long-term follow up shows no adverse effects of cervical SCS in this patient category.
ABSTRACT
Neurocutaneous syndromes represent some of the most common inherited disorders of the nervous system. Neurofibromatosis type-1 (NF-1) and tuberous sclerosis are well described. Yet, the presentation of both syndromes in the same patient is quite rare. We performed a thorough review of the literature of such double phakomatosis including pattern of inheritance. Eleven cases were reported in the literature. In addition we report a young patient who presented with clinical picture suggestive of both NF-1 and tuberous sclerosis, and present a radiographic and histopathological description of the case.
Subject(s)
Neurofibromatosis 1/complications , Tuberous Sclerosis/complications , Adult , Humans , Male , Neurofibromatosis 1/diagnostic imaging , Neurofibromatosis 1/pathology , Radiography , Tuberous Sclerosis/diagnostic imaging , Tuberous Sclerosis/pathologyABSTRACT
BACKGROUND: The optimal treatment of low grade intramedullary spinal cord tumours remains controversial. In many cases the tumours continue to progress even after surgery and radiation. Effective chemotherapy may be an important therapeutic adjunct in this setting. Temozolomide is widely used for brain gliomas, yet its role in the management of spinal cord tumours has not been reported. PROCEDURE: Two paediatric patients with low grade spinal cord astrocytomas were diagnosed to have progression of the tumour in spite of surgery and radiotherapy. They received temozolomide, 200 mg/m2 daily for five days every four weeks for 10 cycles, and were followed serially. RESULTS: Stabilization of the spinal tumour in both patients was observed at 18 months of follow-up. One of the patients developed haematological toxicity requiring platelet transfusion and dose reduction. CONCLUSION: Based on our findings in two paediatric patients, temozolomide may be a useful agent in the management of progressive recurrent low grade spinal cord astrocytomas.
Subject(s)
Antineoplastic Agents, Alkylating/administration & dosage , Astrocytoma/therapy , Dacarbazine/analogs & derivatives , Spinal Cord Neoplasms/therapy , Spinal Cord/pathology , Adolescent , Astrocytoma/diagnosis , Astrocytoma/physiopathology , Child , Dacarbazine/administration & dosage , Disease Progression , Drug Administration Schedule , Female , Humans , Magnetic Resonance Imaging , Male , Meningeal Neoplasms/secondary , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/drug therapy , Neoplasm Metastasis/physiopathology , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/physiopathology , Neoplasm Recurrence, Local/prevention & control , Neurosurgical Procedures , Radiotherapy , Spinal Cord/drug effects , Spinal Cord/physiopathology , Spinal Cord Neoplasms/diagnosis , Spinal Cord Neoplasms/physiopathology , Temozolomide , Treatment OutcomeABSTRACT
Spontaneous subdural haematoma is very rare in young patients. The complications of anabolic steroid intake in weight lifters are numerous, yet subdural haematomas have not been reported. We report on two cases of spontaneous subdural haematomas in young weight lifters. Both patients underwent surgical evacuation and made a full recovery. A review of the literature on the complications associated with valsalva manoeuvres is also presented including hemodynamic and intracranial changes. We propose that patients on chronic anabolic steroids may have vascular changes that predispose them to bleeding during a Valsalva manoeuvre (VM).
