Electrodiagnostic and Advanced Neuroimaging Characterization for Successful Treatment of Spinal Extradural Arachnoid Cyst.

BACKGROUND: Spinal extradural arachnoid cysts are relatively uncommon. Rarely, large cysts presented with spinal cord compression requiring surgical intervention. CASE DESCRIPTION: We report a patient with a progressively enlarging spinal extradural arachnoid cyst causing worsening right S1 radiculopathy and gastrocnemius muscle atrophy. Electromyography and nerve conduction studies revealed an S1 motor radiculopathy. Serial magnetic resonance imaging findings confirmed enlargement of the small cyst originating from the sacral thecal sac on the right while 2 smaller cysts on the left remained stable. Dynamic computed tomography myelogram revealed connection to the thecal sac behind the right S1 nerve root. We performed a right hemilaminectomy from L5 to S2, exposed the cyst pedicle ligated it, and marsupialized the cyst. After surgery, the patient showed clinical and electrodiagnostic improvement. CONCLUSION: This case illustrates the principles of timely surgical intervention after advanced diagnostic imaging and electrodiagnostic testing to improve neurologic function and minimize complications.

Acute Ischemic Stroke: Current Status and Future Directions.

The evolving knowledge on stroke in conjunction with advances in the field of imaging, treatment approaches using recombinant tissue plasminogen activator (rtPA) or thrombectomy devices in recanalization, and efficient emergency stroke workflow processes have opened new frontiers in managing patients with an acute ischemic stroke. These frontiers have been reformed and overcome in overcoming the decades-long watch and wait approach towards patients with ischemic stroke. In this article, we focus on the current strategies for managing ischemic stroke and conclude by providing a brief overview of anticipating developments that can transform future stroke treatments.