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    Endolymphatic hydrops in idiopathic intracranial hypertension: prevalence and clinical outcome after lumbar puncture. Preliminary data.
    Neurol Sci 2017 May;38(Suppl 1):193-196
    Department of Neurosciences, Reproductive Sciences and Odontostomatology, Headache Centre, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
    Idiopathic intracranial hypertension is characterized by raised intracranial pressure (ICP) without any underlying pathology, presenting with (IIH) or without papilledema (IIHWOP). Headache, often on daily basis, is the most frequent symptom. Among audiovestibular symptoms, tinnitus and dizziness are commonly reported, while vertigo and hearing impairment are infrequent reports. Read More

    Lumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study.
    J Pediatr 2017 May 16. Epub 2017 May 16.
    Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA.
    Objectives: To determine the incidence of bacterial meningitis (BM) among all febrile infants 29-56 days old undergoing a lumbar puncture (LP) in the emergency department of a tertiary care children's hospital and the number of low-risk febrile infants with BM to reassess the need for routine LP in these infants.

    Study Design: Retrospective cohort study using a quality improvement registry from July 2007-April 2014. Infants included were 29-56 days old with fever and who had an LP in the emergency department. Read More

    [Dural sinus thrombosis following epidural analgesia for delivery: a clinical case].
    Rev Bras Anestesiol 2017 May 12. Epub 2017 May 12.
    Centro Hospitalar do Algarve, Hospital de Faro, Algarve, Portugal.
    Background And Objectives: Neurological complications of spinal anesthesia are rare conditions. Headache caused by low pressure of the cerebrospinal fluid is one of the most frequent, which occurs after post-dural puncture. A comprehensive history and physical exam must be carried out before making the diagnosis of Post-Dural Puncture Headache (PDPH) and additional tests are necessary to exclude the possibility of developing serious neurological complications such as Dural Sinus Thrombosis (DST). Read More

    Epidural hematoma after total hip arthroplasty in ankylosing spondylitis patient: A case report and review of the literature.
    Medicine (Baltimore) 2017 May;96(19):e6859
    Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China.
    Rationale: Ankylosing spondylitis (AS) can affect the hip joint, causing deformity and disability. Total hip arthroplasty can obviously relieve the pain of the hip joint, and reconstruct the function of hip joint. Epidural anesthesia in this patient population has high risk of epidural hematoma, but the reason is unclear. Read More

    Heart-Shaped Bilateral Medullary Pyramidal Infarction as a Pathognomonic Finding of Anterior Spinal Artery Occlusion.
    Neurocrit Care 2017 May 8. Epub 2017 May 8.
    Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
    Background: Unilateral anterior spinal artery (ASA) occlusion resulting in bilateral medullary pyramidal (BMP) infarction is a rare and devastating stroke subtype. We present two cases highlighting the diagnostic and clinical challenges of BMP infarction.

    Methods: Case reports and literature review. Read More

    Relationship between the optic nerve sheath diameter and lumbar cerebrospinal fluid pressure in patients with normal tension glaucoma.
    Eye (Lond) 2017 Apr 28. Epub 2017 Apr 28.
    Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland.
    PurposeTo investigate on the relationship between the optic nerve sheath diameter (ONSD) and the lumbar cerebrospinal fluid pressure (CSF-p) in Caucasian patients with normal tension glaucoma (NTG).Patients and methodsRetrospective analysis of medical records of patients with open-angle glaucoma in the period from 2005 to 2015 from the Ophthalmology Department, Cantonal Hospital Aarau, Switzerland was performed. A total of 38 patients (mean age 68. Read More

    Knowing How and Knowing Why: testing the effect of instruction designed for cognitive integration on procedural skills transfer.
    Adv Health Sci Educ Theory Pract 2017 Apr 22. Epub 2017 Apr 22.
    The Wilson Centre, University Health Network, University of Toronto, Toronto, Canada.
    Transfer is a desired outcome of simulation-based training, yet evidence for how instructional design features promote transfer is lacking. In clinical reasoning, transfer is improved when trainees experience instruction integrating basic science explanations with clinical signs and symptoms. To test whether integrated instruction has similar effects in procedural skills (i. Read More

    Correspondence - Response to Letter to the Editor - Ultrasound Assisted Lumbar Puncture on Infants in the Pediatric Emergency Department.
    Acad Emerg Med 2017 Apr 17. Epub 2017 Apr 17.
    Dell Children's Medical Center of Central Texas, Austin, Texas, United States.
    We would like to thank our reader for his/her interest in our work and continuing support of point-of-care ultrasound in pediatric emergency medicine. Our study was conducted at a large academic emergency department with pediatrics and emergency medicine residents, nurse practitioners who function at or above the level of a senior resident (PGY-3 and 4), and pediatric emergency fellows who function as attending physicians. As a routine, all initial lumbar puncture (LP) attempts are made by learners. Read More

    Paediatric lumbar punctures: How do paediatric and emergency doctors differ?
    Emerg Med Australas 2017 Apr 9. Epub 2017 Apr 9.
    Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.
    Objective: The objective of the study was to identify any differences between emergency physicians and emergency trainees and paediatricians and paediatric trainees in performing paediatric lumbar punctures (LPs).

    Methods: Anonymous cross-sectional electronic survey was distributed to emergency physicians, emergency trainees, paediatricians and paediatric trainees within three hospitals of a single public health network. There were four standardised clinical scenarios (neonate, infant, young child and adolescent), with accompanying questions relating to neurological evaluation and imaging prior to LP, the use of written consent forms and parental presence during the procedure. Read More

    Acute human herpes virus 7 (HHV-7) encephalitis in an immunocompetent adult patient: a case report and review of literature.
    Infection 2017 Apr 6. Epub 2017 Apr 6.
    Department of Infectious Diseases, University of Modena and Reggio Emilia, via largo del Pozzo 71, 41123, Modena, Italy.
    We report a case of an acute HHV-7 encephalitis involving the nucleus of the VI cranial nerve in an immunocompetent host. The patient was an adult male admitted to our Clinic with headache, diplopia, fever, nausea, vertigo, asthenia and general malaise. PCR for viral and bacterial genomes was run on both serum and cerebral spinal fluid (CSF) after performing lumbar puncture, resulting positive only for HHV-7 DNA on CSF. Read More

    Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: A meta-analysis.
    Medicine (Baltimore) 2017 Apr;96(14):e6527
    Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China.
    Background: Postdural puncture headache (PDPH), mainly resulting from the loss of cerebral spinal fluid (CSF), is a well-known iatrogenic complication of spinal anesthesia and diagnostic lumbar puncture. Spinal needles have been modified to minimize complications. Modifiable risk factors of PDPH mainly included needle size and needle shape. Read More

    A case of paradoxical presentation of a postural postdural puncture headache after combined spinal-epidural anesthesia.
    J Clin Anesth 2017 May 22;38:156-157. Epub 2017 Feb 22.
    Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
    We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position. Read More

    Cranial imaging before lumbar puncture in adults with community-acquired meningitis: clinical utility and adherence to the Infectious Diseases Society of America guidelines.
    Clin Infect Dis 2017 Mar 21. Epub 2017 Mar 21.
    Department of Internal Medicine, University of Texas Health Science Center in Houston.
    Background: The Infectious Diseases Society of America (IDSA) guidelines delineate criteria for the use of computed tomography (CT) scan of the head before lumbar puncture (LP) in adults with community-acquired meningitis (CAM). There is limited data documenting adherence to these guidelines and assessing the clinical utility of brain imaging.

    Methods: A retrospective analysis from January, 2005 to January, 2010 in Houston, Texas. Read More

    MRI-detection rate and incidence of lumbar bleeding sources in 190 patients with non-aneurysmal SAH.
    PLoS One 2017 3;12(4):e0174734. Epub 2017 Apr 3.
    Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany.
    Background: Up to 15% of all spontaneous subarachnoid hemorrhages (SAH) have a non-aneurysmal SAH (NASAH). The evaluation of SAH patients with negative digital subtraction angiography (DSA) is sometimes a diagnostic challenge. Our goal in this study was to reassess the yield of standard MR-imaging of the complete spinal axis to rule out spinal bleeding sources in patients with NASAH. Read More

    Low-pressure Hydrocephalus in Children: A Case Series and Review of the Literature.
    Neurosurgery 2017 Mar;80(3):439-447
    Department of Neuro-surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
    Background: Low-pressure hydrocephalus (LPH) is a rare phenomenon characterized by a clinical picture consistent with elevated intracranial pressure (ICP) and ventricular enlargement, but also a well-functioning shunt and low or negative ICP.

    Objective: To report our experience in evaluating this challenging problem.

    Methods: Patients with LPH were identified from several sources, including institutional procedural databases and personal case logs. Read More

    Digital subtraction myelography in the investigation of post-dural puncture headache in 27 patients: technical note.
    J Neurosurg Spine 2017 Mar 31:1-5. Epub 2017 Mar 31.
    Radiology, Cedars-Sinai Medical Center, Los Angeles, California.
    OBJECTIVE Post-dural puncture headaches are common, and the treatment of such headaches can be complex when they become chronic. Among patients with spontaneous spinal CSF leaks, digital subtraction myelography (DSM) can localize the exact site of the leak when an extradural CSF collection is present, and it can also demonstrate CSF-venous fistulas in those without an extradural CSF collection. The authors now report on the use of DSM in the management of patients with chronic post-dural puncture headaches. Read More

    SLIDE: automatic spine level identification system using a deep convolutional neural network.
    Int J Comput Assist Radiol Surg 2017 Mar 30. Epub 2017 Mar 30.
    Department of Electrical and Computer Engineering, The University of British Columbia, 2332 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
    Purpose: Percutaneous spinal needle insertion procedures often require proper identification of the vertebral level to effectively and safely deliver analgesic agents. The current clinical method involves "blind" identification of the vertebral level through manual palpation of the spine, which has only 30% reported accuracy. Therefore, there is a need for better anatomical identification prior to needle insertion. Read More

    Assessment of risk factors for postdural puncture headache in women undergoing cesarean delivery in Jordan: a retrospective analytical study.
    Local Reg Anesth 2017 17;10:9-13. Epub 2017 Mar 17.
    Department of Anesthesia.
    Purpose: Postdural puncture headache (PDPH) is one of the most recognized complications after spinal anesthesia in women undergoing cesarean delivery. This study aimed to investigate the incidence of PDPH and its associated risk factors in women undergoing cesarean delivery in Jordan.

    Patients And Methods: This study included all women who underwent cesarean delivery at King Abdullah University Hospital in Jordan during 2015. Read More

    Effects of multiple-injection of bone marrow mononuclear cells on spinal cord injury of rats.
    J Neurotrauma 2017 Mar 28. Epub 2017 Mar 28.
    Aino University, Central Biomedical Laboratory, Ibaraki City, Osaka, Japan ;
    The effects of multiple-injection of bone marrow mononuclear cells (BMNCs) on spinal cord injury (SCI) were compared with those of single-injection in rats. BMNCs separated by density-gradient centrifugation from a bone marrow perfusate were injected 3 times (once weekly) through the cerebrospinal fluid (CSF) via the 4th ventricle, and the locomotor improvement and tissue recovery, including axonal regeneration, were compared with those of single-injection. While the single-injection group showed a steep elevation of the BBB (Basso-Beattie-Bresnahan) score 1 week after transplantation, the multiple-injection group maintained a similar steep elevation for 2 weeks after transplantation, and the BBB scores of the multiple-injection group remained thereafter at a level around 2-3 points higher than those of the single-injection group until the end of the experiment. Read More

    Jolt accentuation and its value as a sign in diagnosis of meningitis in patients with fever and headache.
    Turk J Emerg Med 2017 Mar 24;17(1):29-31. Epub 2016 Nov 24.
    Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
    Objectives: Meningitis is an important disease among the patients being visited in Emergency Departments (EDs). There are many signs to diagnose it with different sensitivity and specificity reported in previously done studies. Current study tries to evaluate diagnostic accuracy of "Jolt accentuation" in the diagnosis (Dx. Read More

    Significance of preoperative planning software for puncture and channel establishment in percutaneous endoscopic lumbar DISCECTOMY: A study of 40 cases.
    Int J Surg 2017 May 23;41:97-103. Epub 2017 Mar 23.
    Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, PR China. Electronic address:
    Background: Preoperative planning software has been widely used in many other minimally invasive surgeries, but there is a lack of information describing the clinical benefits of existing software applied in percutaneous endoscopic lumbar discectomy (PELD). This study aimed to compare the clinical efficacy of preoperative planning software in puncture and channel establishment of PELD with routine methods in treating lumbar disc herniation (LDH).

    Material And Methods: From June 2016 to October 2016, 40 patients who had single L4/5 or L5/S1 disc herniation were divided into two groups. Read More

    Cranial nerve palsy following central neuraxial block in obstetrics - a review of the literature and analysis of 43 case reports.
    Int J Obstet Anesth 2017 Feb 20. Epub 2017 Feb 20.
    Central Manchester University Hospitals and St Mary's Hospital, Oxford Road, Manchester, UK. Electronic address:
    Background: Cranial nerve palsy is a rarely reported complication of central neuraxial block in obstetrics. The aetiology is diverse and includes both decreased and increased intracranial pressure.

    Methods: Medline, CINAHL, and EMBASE databases were searched to identify cases of cranial nerve palsy following obstetric central neuraxial block. Read More

    Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level.
    Pain Physician 2017 Mar;20(3):E465-E468
    Department of Anesthesiology, Kaohsiung Veterans General Hospital, Pingtung Branch, Taiwan.
    Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. Read More

    Idiopathic intracranial hypertension in a paediatric population: a retrospective observational study on epidemiology, symptoms and treatment.
    J Biol Regul Homeost Agents 2017 Jan-Mar;31(1):195-200
    General Paediatrics O.U., Policlinico-Vittorio Emanuele University Hospital, University of Catania, Italy.
    Idiopathic intracranial hypertension (IIH) is a disorder of unknown origin, which is characterized by elevated intracranial pressure (ICP) without underlying etiological evidence of neurological disease. The purpose of the current study was to evaluate epidemiological features, clinical presentation, diagnostic findings and treatment of sixteen children (7 males and 9 females) with IIH. Medical records of the patients were obtained from the University Paediatric Hospital of Catania, Italy. Read More

    Diffuse White Matter Signal Abnormalities on Magnetic Resonance Imaging Are Associated With Human Immunodeficiency Virus Type 1 Viral Escape in the Central Nervous System Among Patients With Neurological Symptoms.
    Clin Infect Dis 2017 Apr;64(8):1059-1065
    Division of Infection and Immunity, University College London, United Kingdom.
    Background.: Human immunodeficiency virus type 1 (HIV-1) can replicate independently in extravascular compartments such as the central nervous system, resulting in either cerebrospinal fluid (CSF) discordance (viral load [VL] in CSF 0.5 log10 copies HIV-1 RNA greater than plasma VL) or escape (detection of HIV VL >50 copies/mL in CSF in patients with suppressed plasma VL <50 copies/mL). Read More

    European Mitochondrial DNA Haplogroups are Associated with Cerebrospinal Fluid Biomarkers of Inflammation in HIV Infection.
    Pathog Immun 2016 Fall-Winter;1(2):330-351
    Infectious Diseases, Vanderbilt University, Nashville, TN.
    Background: Mitochondrial DNA (mtDNA) haplogroups are ancestry-related patterns of single-nucleotide polymorphisms that are associated with differential mitochondrial function in model systems, neurodegenerative diseases in HIV-negative populations, and chronic complications of HIV infection, including neurocognitive impairment. We hypothesized that mtDNA haplogroups are associated with neuroinflammation in HIV-infected adults.

    Methods: CNS HIV Antiretroviral Therapy Effects Research (CHARTER) is a US-based observational study of HIV-infected adults who underwent standardized neurocognitive assessments. Read More

    Screening for early-onset invasive group B Streptococcal disease in neonates in an Irish hospital (2001-2014): a retrospective audit.
    Infect Dis (Lond) 2017 Jun 6;49(6):466-470. Epub 2017 Feb 6.
    a Department of Microbiology , Rotunda Hospital , Dublin 1 , Ireland.
    Group B Streptococcus (GBS) is the most common cause of early-onset neonatal sepsis and meningitis. In babies with no clinical suspicion of infection, who are at risk of early-onset invasive disease based on maternal risk factors, blood cultures are taken to detect bacteraemia. In our institution, lumbar punctures are performed in infants with clinical signs of sepsis but not in infants who are well at the time of screening. Read More

    Development of artificial tissue-like structures for a hybrid epidural anesthesia simulator.
    Conf Proc IEEE Eng Med Biol Soc 2016 Aug;2016:2099-2102
    Puncturing the epidural space and lumbar puncture are common procedures in anesthesia. They are carried out blind, where a needle is advanced from posterior between two adjacent vertebrae. Two different approaches are common practice for this technique, the midline and the paramedian one. Read More

    Natural history of headache in patients with lymphocytic meningitis following lumbar puncture.
    J Clin Neurosci 2017 Mar 2. Epub 2017 Mar 2.
    Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
    Background: Analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP) is essential for diagnosis of meningitis. What is the impact of the procedure upon the natural history of headache and associated signs in patients with lymphocytic meningitis and what factors can have prognostic value for the future progression of symptomatology? This study was aimed at looking into these questions.

    Methods: One hundred and one patients with clinical and laboratory diagnosis of aseptic meningitis answered a questionnaire intended at assessing the severity and nature of headache and meningeal irritation signs before and one, and twenty four hours after the LP. Read More

    Effect of spinal needle characteristics on measurement of spinal canal opening pressure.
    Am J Emerg Med 2017 Jan 28. Epub 2017 Jan 28.
    Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States.
    Objective: A wide variety of spinal needles are used in clinical practice. Little is currently known regarding the impact of needle length, gauge, and tip type on the needle's ability to measure spinal canal opening pressure. This study aimed to investigate the relationship between these factors and the opening-pressure measurement or time to obtain an opening pressure. Read More

    Retrospective analysis of translaminar, demographic, and physiologic parameters in relation to papilledema severity.
    Can J Ophthalmol 2017 Feb 17;52(1):26-29. Epub 2016 Nov 17.
    Department of Ophthalmology, University of North Carolina Hospitals, Chapel Hill, North Carolina.
    Objective: Some case reports suggest that the translaminar pressure difference is important in cases of papilledema. The purpose of this study was to determine ocular, physiologic, and demographic factors associated with papilledema severity.

    Design: Retrospective, blinded study. Read More

    The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks.
    J Clin Anesth 2017 Feb 4;37:82-85. Epub 2017 Jan 4.
    Department of Anesthesiology and Reanimation, Kafkas University Medical Faculty, 36100 Merkez, Kars, Turkey. Electronic address:
    Study Objective: The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous spaces were not prominent on physical examination.

    Design: Randomized controlled clinical trial.

    Setting: Operating rooms of university hospital of Erzurum, Turkey. Read More

    Preferred view and transducer in lumbar ultrasound in overweight and obese patients.
    Ultrasound 2017 Feb 7;25(1):45-52. Epub 2017 Feb 7.
    Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
    Background: Ultrasound can be used to facilitate lumbar puncture, especially in obese patients.

    Methods: In this study, midline and paramedian approaches with curved and linear transducers were compared in patients with Body Mass Index (BMI) above 25 kg/m(2) for the identification of spinal landmarks. In each view, six major landmarks, including spinous process, ligamentum flavum, laminae, epidural space, subarachnoid space and posterior longitudinal ligament, were detected by emergency medicine residents and were then reviewed by radiologists. Read More

    Ultrasound as a safe and reliable guidance for subarachnoid puncture in rabbits.
    Acta Cir Bras 2017 Jan;32(1):14-21
    PhD, Full Professor, Department of Anesthesiology, UNESP, Botucatu-SP, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision.
    Purpose:: To evaluate a model for studying the toxicity in nervous tissue and meninges using ultrasound to guide needle insertion into the subarachnoid space of rabbits, with the objective of avoiding injuries triggered by the puncture and by intraneural injection of solutions.

    Methods:: Forty-five adult female rabbits were divided into 3 groups (G): G1 underwent subarachnoid puncture, G2 underwent subarachnoid injection of saline solution and G3 underwent subarachnoid injection of 0.5% hyperbaric bupivacaine. Read More

    Incidence and Outcomes of Central Nervous System Hemophagocytic Lymphohistiocytosis Relapse after Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation.
    Biol Blood Marrow Transplant 2017 May 17;23(5):857-860. Epub 2017 Feb 17.
    Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
    Hemophagocytic lymphohistiocytosis (HLH) is an immune regulatory disorder that commonly presents with central nervous system (CNS) involvement. The only cure for genetic HLH is hematopoietic stem cell transplantation (HSCT), typically treated with reduced-intensity conditioning (RIC) regimens. We sought to estimate the incidence of CNS relapse after RIC HSCT, determine risk factors, and evaluate outcomes. Read More

    Subdural hematoma occurred after spinal anesthesia in a human immunodeficiency virus-infected patient.
    Saudi J Anaesth 2017 Jan-Mar;11(1):102-105
    Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Seoul, Korea.
    A 25-year-old male patient who was infected with human immunodeficiency virus (HIV) underwent a condyloma excision under spinal anesthesia. The patient complained of suspicious postdural puncture headache. The patient did not respond to conservative management. Read More

    Automated pressure-controlled cerebrospinal fluid drainage during open thoracoabdominal aortic aneurysm repair.
    J Vasc Surg 2017 Feb 16. Epub 2017 Feb 16.
    Vascular Surgery Unit, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy.
    Objective: Perioperative cerebrospinal fluid (CSF) drainage is a well-established technique for spinal cord protection during thoracoabdominal aortic aneurysm (TAAA) open repair and is usually performed using dripping chamber-based systems. A new automated device for controlled and continuous CSF drainage, designed to maintain CSF pressure around the desired set values, thus avoiding unnecessary drainage, is currently available. The aim of our study was to determine whether the use of the new LiquoGuard automated device (Möller Medical GmbH, Fulda, Germany) during TAAA open repair was safe and effective in maintaining the desired CSF pressure values and whether the incidence of complications was reduced compared with a standard catheter connected to a dripping chamber. Read More

    A Rare Case of Pediatric Lumbar Spinal Ependymoma Mimicking Meningitis.
    World Neurosurg 2017 Apr 13;100:710.e1-710.e5. Epub 2017 Feb 13.
    Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
    Spontaneous acute subarachnoid hemorrhage (SAH) from lumbar ependymoma in children is rare. We report a case of a 14-year-old boy who developed sudden radicular low back pain while playing baseball. He was initially managed conservatively in a local hospital for suspected lumbar disc herniation, but he later developed meningeal symptoms and fever before being referred to our hospital. Read More

    Psychosis in the ED: A case of NMDA receptor antibody encephalitis.
    Am J Emerg Med 2017 Feb 6. Epub 2017 Feb 6.
    University of Arizona, College of Medicine, Department of Emergency Medicine, Tucson, AZ, USA.
    Anti-N-methyl-d-aspartate antibody receptor (NMDAR) encephalitis is a newly recognized disease increasing in diagnostic frequency. A 27-year-old female presented with symptoms of oral dyskinesia, tachycardia, and altered mental status following a three-month history of depression, lethargy, catatonia, and auditory hallucinations. We utilized our facilities neurology and psychiatry consult services, performed a lumbar puncture (LP), and requested NMDAR antibody titers. Read More

    Screening for asymptomatic neurosyphilis in HIV patients after treatment of early syphilis: an observational study.
    Sex Transm Infect 2017 Feb 14. Epub 2017 Feb 14.
    Department of Sexual Health and HIV, North Manchester General Hospital (Pennine Acute Hospitals NHS Trust), Crumpsall, Manchester, UK.
    Objective: To determine the prevalence of asymptomatic neurosyphilis (ANS) in HIV-positive individuals after treatment of early syphilis with single-dose benzathine penicillin G (BPG) or oral antibiotic alternatives.

    Methods: Patients at high risk of neurosyphilis (defined by serum rapid plasma reagin (RPR) titre ≥1:32 and/or peripheral blood CD4 lymphocyte count ≤350/μL) underwent lumbar puncture (LP) at a median time of 8.2 months post treatment. Read More

    In vivo images of the epidural space with two- and three-dimensional optical coherence tomography in a porcine model.
    PLoS One 2017 14;12(2):e0172149. Epub 2017 Feb 14.
    Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
    Background: No reports exist concerning in vivo optical coherence tomography visualization of the epidural space and the blood patch process in the epidural space. In this study, we produced real-time two-dimensional and reconstructed three-dimensional images of the epidural space by using optical coherence tomography in a porcine model. We also aimed to produce three-dimensional optical coherence tomography images of the dura puncture and blood patch process. Read More

    Brief Report: Flow Rate of Cerebrospinal Fluid Through a Spinal Needle Can Accurately Predict Intracranial Pressure in Cryptococcal Meningitis.
    J Acquir Immune Defic Syndr 2017 Mar;74(3):e64-e66
    *Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; †Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and ‡Department of Medicine, Khayelitsha District Hospital, Cape Town, South Africa.
    Background: Patients with HIV-associated cryptococcal meningitis (CM) commonly present with raised intracranial pressure (ICP). Aggressive management of raised ICP reduces mortality but requires manometers, which are unavailable in most resource-limited settings. The law of Poiseuille states that the rate of flow of liquid through a tube is directly proportional to the difference in pressure between each end, and it may be possible to indirectly determine ICP by measuring flow of CSF through a spinal needle rather than using a manometer. Read More

    General anesthesia with a native airway for patients with mucopolysaccharidosis type III.
    Paediatr Anaesth 2017 Apr 8;27(4):370-376. Epub 2017 Feb 8.
    Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
    Background: Mucopolysaccharidosis type III is a progressive disease with worsening airway, pulmonary, and cardiac involvement that may complicate anesthetic care.

    Aim: To prospectively evaluate the incidence of airway issues and complications during magnetic resonance imaging (MRI) and lumbar puncture (LP) during general anesthesia with a native airway for patients with mucopolysaccharidosis type III.

    Method: The study was a part of the natural history study. Read More

    Management of a Ventral Cerebrospinal Fluid Leak With a Lumbar Transforaminal Epidural Blood Patch in a Child With Persistent Postdural Puncture Headache: A Case Report.
    Reg Anesth Pain Med 2017 Mar/Apr;42(2):263-266
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, †Department of Pediatric Radiology, and ‡Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
    Objective: Postdural puncture headache (PDPH) is an uncommon sequel of lumbar puncture in children. When conservative treatment with bed rest, hydration, and caffeine are ineffective, epidural blood patches are recommended and are generally effective. The purpose of this report was to highlight that when lumbar epidural blood patches fail to eliminate PDPH, diagnostic evaluation should be performed and alternative treatment sought. Read More

    Multiple myeloma presenting with bilateral ankle pain (microangiopathy) and complicated by streptococcal meningitis and Pneumocystis carinii pneumonia.
    BMJ Case Rep 2017 Feb 7;2017. Epub 2017 Feb 7.
    Department of Emergency and Intensive Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK.
    Multiple myeloma is characterised by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. This clone of plasma cells proliferates in the bone marrow, resulting in extensive skeletal destruction with osteolytic lesions, osteopenia and pathological fractures. Additional disease-related complications include hypercalcaemia, renal insufficiency, anaemia and infection. Read More

    Rosai-Dorfman disease of the subdural spine with a long segment lesion: A case report and literature review.
    J Int Med Res 2017 Apr 8;45(2):875-881. Epub 2017 Feb 8.
    1 Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
    Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is a rare benign disorder usually characterized by massive painless cervical lymphadenopathy and systemic manifestations. Extranodal involvement, especially spinal involvement, is extremely rare. We report a 41-year-old man who presented with only intermittent dorsodynia. Read More

    An algorithmic approach to the management of unrecognized hydrocephalus in pediatric candidates for intrathecal baclofen pump implantation.
    Surg Neurol Int 2016 20;7:105. Epub 2016 Dec 20.
    Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.
    Background: Complications of intrathecal baclofen (ITB) pump implantation for treatment of pediatric patients with spasticity and dystonia associated with cerebral palsy remain unacceptably high. To address the concern that some patients may have underlying arrested hydrocephalus, which is difficult to detect clinically because of a low baseline level of neurological function, and may contribute to the high rates of postoperative cerebrospinal fluid leak, wound breakdown, and infection associated with ITB pump implantation, the authors implemented a standardized protocol including mandatory cranial imaging and assessment of intracranial pressure (ICP) by lumbar puncture prior to ITB pump implantation.

    Methods: A retrospective case series of patients considered for ITB pump implantation between September 2012 and October 2014 at Seattle Children's Hospital is presented. Read More

    Analysis of serum interleukin-27 and interleukin-35 concentrations in patients with Guillain-Barré syndrome.
    Clin Chim Acta 2017 Feb 4;468:5-9. Epub 2017 Feb 4.
    Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China. Electronic address:
    Backgrounds: Guillain-Barré syndrome (GBS) is a postinfectious immune-mediated peripheral neuropathy. Interleukin (IL)-27 and IL-35 have been recognized as novel members of IL-12 family. We evaluated the serum and cerebral spinal fluid (CFS) concentrations of IL-27 and IL-35 in GBS and analyze their correlations with clinical characteristics. Read More

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