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Mult Scler Relat Disord 2019 Feb 11;30:136-140. Epub 2019 Feb 11.

Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Pathology 627, Baltimore, MD 21287, USA.

Background: Leptomeningeal inflammation is associated with increased cortical damage and worse clinical outcomes in MS. It may be detected on contrast-enhanced T2-FLAIR imaging as focal leptomeningeal contrast-enhancement (LME).

Objective: To assess the safety of intrathecal (IT) rituximab in progressive MS (PMS) and to assess its effects on LME and CSF biomarkers. Read More

Mult Scler Relat Disord 2019 Feb 8;30:123-128. Epub 2019 Feb 8.

Navy Clinical College, Anhui Medical University, Hefei, 230032 Anhui, China; Department of Neurology, The Sixth Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, 100048 China. Electronic address:

Background: Central nervous system (CNS) inflammatory demyelinating disease (IDD) is an immune-mediated disease that is pathologically characterized by demyelination and inflammatory infiltration in the CNS and includes clinically isolated syndrome (CIS), multiple sclerosis (MS), and neuromyelitis optica spectrum disorders (NMOSD). IDD is usually characterized by variable symptoms, multivariate imaging, uncertain reactions to treatment, and a variable prognosis, which makes it difficult to diagnose early. In recent years, the role of the neurofilament light chain (NFL), an axonal injury biomarker, in IDD has become increasingly important. Read More

Sleep Med 2018 Dec 18. Epub 2018 Dec 18.

IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.

J Neurosurg Anesthesiol 2019 Jan;31(1):144-150

Department of Anesthesiology, Columbia University, New York, NY.

Background: Simple febrile seizure (SFS) affects 2% to 4% of children under 6 years of age. The purpose of this study is to examine the epidemiologic patterns and resource utilization of SFS-associated hospitalizations in children aged younger than 6 years of age in the United States.

Materials And Methods: This study is a serial, retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Databases for the years 2003, 2006, 2009, and 2012. Read More

BMJ Open 2019 Feb 13;9(2):e025348. Epub 2019 Feb 13.

Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada.

Objective: We set out to test the discriminative power of an age-adjusted upper reference limit for cerebrospinal fluid total protein (CSF-TP) in identifying clinically relevant causes of albuminocytological dissociation (ACD).

Methods: We reviewed the charts of 2627 patients who underwent a lumbar puncture at a tertiary care centre over a 20-year period. Samples with CSF-TP above 45 mg/dL (0. Read More

Clin Nucl Med 2019 Feb 8. Epub 2019 Feb 8.

A 34-year-old woman presented with a 3-month history of right-sided headaches associated with photophobia and pulsatile tinnitus. Investigations including lumbar puncture revealed elevated opening CSF pressure, increased protein, and presence of monocytosis consistent with an inflammatory/infective process. Brain MRI showed an area of thickened enhancing dura around the venous sinus posteriorly. Read More

Turk J Med Sci 2019 Feb 11;49(1):258-264. Epub 2019 Feb 11.

Background/aim: We aimed to compare the effectivity of percutaneous disc coagulation therapy (PDCT) and navigable ablation decompression treatment (L-DISQ) in patients who were diagnosed with cervical disc herniation.

Materials And Methods: Visual analog scale (VAS) and Neck Pain Index (NPI) scores were recorded initially and at the 1st, 3rd, 6th, and 12th months after the procedures. Patient Satisfaction Scale (PSS) scores were recorded 12 months after the procedures

Results: Mean VAS scores were 7. Read More

Clin Teach 2019 Feb 13. Epub 2019 Feb 13.

Department of Internal Medicine, Haut-Leveque Hospital, University Hospital Center of Bordeaux, Pessac cedex, France.

Background: In self-regulated procedural simulation, learners practise on many simulators (e.g. paracentesis), self-regulating their choice of simulators, time and goals. Read More

Front Neurol 2019 29;10:39. Epub 2019 Jan 29.

Division of Neurology and Stroke Unit, Hospital A. Cardarelli, Naples, Italy.

Eur J Case Rep Intern Med 2018 25;5(5):000819. Epub 2018 May 25.

Medical Intensive Care Unit, Farhat Hached Hospital, Sousse, Tunisia.

Introduction: Cerebral vasculitis is an uncommon life-threatening complication of community-acquired bacterial meningitis.

Patient And Methods: We report the case of a 64-year-old woman with pneumococcal meningitis who developed parainfectious vasculitis causing ischaemic brain damage. Cerebral magnetic resonance imaging (MRI) confirmed the diagnosis. Read More

Clin Infect Dis 2019 Feb 9. Epub 2019 Feb 9.

Department of Infectious Diseases, University Hospital Monklands, NHS Lanarkshire, Airdrie, Scotland.

J Cytol 2019 Jan-Mar;36(1):44-47

Department of Pediatrics, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.

Context: Pyogenic meningitis is often a devastating condition which is diagnosed by analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP). CSF thus obtained can get contaminated with peripheral blood leucocytes during LP which renders it unusable for cytological analysis. Leucocyte esterase strips are available for identifying leucocyte esterase activity in urine and other body fluids which suggest inflammation. Read More

J Nerv Ment Dis 2019 Feb 6. Epub 2019 Feb 6.

Department of Neurology, Department of Neurology and Neuroscience Center, The First Hospital of JiLin University, Changchun, People's Republic of China.

The diagnosis of autoimmune epilepsy is often challenging, and may be misdiagnosed as epileptic disorders or viral encephalitis. Autoimmune epilepsy has a strong association with other autoimmune diseases, especially systemic lupus erythematosus (SLE). In addition, autoimmune epilepsy was reported to present with complex partial seizure (CPS), simple partial seizure (SPS), and secondarily generalized tonic-clonic seizure (sGTCS). Read More

Parkinsonism Relat Disord 2019 Jan 31. Epub 2019 Jan 31.

Northwestern University Feinberg School of Medicine, USA. Electronic address:

Objective: To determine the feasibility, safety and tolerability of lumbar punctures (LPs) in research participants with early Parkinson disease (PD), subjects without evidence of dopaminergic deficiency (SWEDDs) and healthy volunteers (HC).

Background: Cerebrospinal fluid (CSF) analysis is becoming an essential part of the biomarkers discovery effort in PD with still limited data on safety and feasibility of serial LPs in PD participants.

Design/methods: Parkinson's Progression Marker Initiative (PPMI) is a longitudinal observation study designed to identify PD progression biomarkers. Read More

BMJ Case Rep 2019 Feb 7;12(2). Epub 2019 Feb 7.

Medicine, Jawaharlal Institute of Post Graduate Medical Education & Research (JIPMER), Puducherry, Pondicherry, India.

A 16-years-old girl presented to our institution with history of severe bilateral headache for 5 days associated with vomiting. She also had fever for 2 months without any localising symptoms and skin lesions for 1 month. Examination revealed erythematous rash over bridge of nose and ear lobes, ulcer over hard palate and tenderness of small joints of both hands. Read More

Clin Chim Acta 2019 Feb 5. Epub 2019 Feb 5.

University Medical Center Goettingen (UMG), Georg-August-University, Dept. of Psychiatry and Psychotherapy, Von-Siebold-Str. 5, D-37075 Goettingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Von-Siebold-Str. 3a, D-37075 Goettingen, Germany; iBiMED, Medical Science Department, University of Aveiro, Portugal.

With increasing prevalence of Alzheimer's disease (AD) and advances in research of therapeutic approaches, an early and accurate in-vivo diagnosis is crucial. Different biomarkers that are able to identify AD are currently in focus. However, whether and to which extend results of cerebrospinal fluid (CSF) and imaging biomarkers are comparable, is unclear. Read More

Sci Rep 2019 Feb 7;9(1):1552. Epub 2019 Feb 7.

Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.

Several approaches of locating the epidural space have been proposed. However, loss of Resistance method (LOR) remains the most common method for epidural anesthesia. Different optical signals were received from the ligamentum flavum and the epidural space allows operator to pinpoint position of the needle and determine whether the needle tip has entered the epidural space. Read More

Ned Tijdschr Geneeskd 2019 Feb 7;163. Epub 2019 Feb 7.

Amsterdamse UMC, afd. Neurologie, locatie AMC.

Background: Investigate how often cerebral herniation occurs following lumbar puncture (LP) in patients with bacterial meningitis, and whether cranial computed tomography (CT) can be used to identify patients at a higher risk of cerebral herniation.

Study Design: Prospective, nationwide cohort study covering the period March 2006 - November 2014.

Method: We identified patients with community-acquired bacterial meningitis who showed signs of clinical deterioration, possibly caused by LP. Read More

Ned Tijdschr Geneeskd 2019 Feb 7;163. Epub 2019 Feb 7.

Haaglanden Medisch Centrum, afd. Neurologie, Den Haag.

A lumbar puncture (LP) is often essential for the diagnosis of bacterial meningitis. An LP can worsen brain displacement in case of a space-occupying lesion. Therefore, in selected patients a CT scan of the brain is made prior to performing the LP. Read More

Front Neurol 2019 23;10:12. Epub 2019 Jan 23.

Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

To identify and compare the cerebrospinal fluid (CSF) parameters that predict the presence of neonatal bacterial meningitis using optimal cutoff values, and to derive and compare predictive profiles based on a combination of individual parameters for the same purpose. The retrospective component of the Shanghai Neonate Meningitis Cohort included all term neonates who underwent lumbar puncture between 2000 and 2017. Those with severe neurological diseases, histories of ventricular drainage, or traumatic lumbar punctures were excluded. Read More

Pediatrics 2019 Feb 6. Epub 2019 Feb 6.

Connecticut Children's Medical Center, Hartford, Connecticut.

Background And Objectives: Significant variation in management of febrile infants exists both nationally and within our institution. Risk stratification can be used to identify low-risk infants who can be managed as outpatients without lumbar puncture (LP) or antibiotics. Our objective was to reduce invasive interventions for febrile infants aged 29 to 60 days at low risk for serious bacterial infection (SBI) through implementation of a clinical pathway supported by quality improvement (QI). Read More

Emerg Med J 2019 Feb 6. Epub 2019 Feb 6.

Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.

Background: Serious bacterial infections in young infants with bronchiolitis are rare. Febrile infants <1 month old with bronchiolitis often receive a lumbar puncture (LP), despite limited data for this practice and lack of clinical practice guidelines for this population. The primary objective was to investigate practice patterns in performance of LPs in the ED management of febrile infants aged ≤30 days with bronchiolitis. Read More

Rev Chilena Infectol 2018 ;35(5):601-605

Servicio de Medicina Interna, Unidad de Infectología, Chile.

Detection of virus in cerebrospinal fluid (CSF) in HIV-infected patients with HIV viral load (VL) undetectable in plasma has been termed viral escape. These leaks may be asymptomatic from a neurological point of view, similar to plasma blips, or associated with neurological disease, with discordant VL between plasma and CSF, and may be evidence of a compartmentalization of the virus and the possibility of identifying quasispecies with mutations that confer resistance to ART. We present the case of a man with AIDS and disseminated tuberculosis who presented neurological symptomatology evidenced by headache and convulsive syndrome, who presented a discordance between plasma and CSF HIV VL; the genotypic test of the virus, obtained by lumbar puncture, identified new mutations that determined a change in ART with subsequent satisfactory evolution. Read More

Rev Mal Respir 2019 Jan 30. Epub 2019 Jan 30.

Service des maladies respiratoires, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, 33600 Pessac, France.

Introduction: Lyme disease is not uncommon and can sometimes progress to neurological complications. We report here an unusual case of bilateral diaphragmatic paralysis secondary to Lyme neuroborreliosis.

Case Report: A 79-year-old man was admitted to the intensive care unit for acute respiratory distress requiring intubation and the long-term use of nocturnal non-invasive ventilation. Read More

Methods Mol Biol 2019 ;1937:305-312

Department of Pharmaceutics, University of Minnesota, Minneapolis, MN, USA.

Delivery of viral vectors directly into the central nervous system (CNS) has emerged as an important tool for the refinement of gene therapy. Intrathecal delivery by direct lumbar puncture in conscious rodents offers a minimally invasive approach that avoids tissue damage and/or destruction. Here we describe delivery of small quantities of viral vector product to the intrathecal space of rodents via direct lumbar puncture aided by a catheter. Read More

Med Clin North Am 2019 Mar 17;103(2):173-190. Epub 2018 Dec 17.

Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA. Electronic address:

The diagnosis of neurologic disease is relevant to the non-neurologist because neurologic symptoms are a common reason patients present to their health care provider and most of these patients are never referred to a neurologist. The diagnosis of a neurologic disease is a rewarding endeavor because it requires intellectual rigor, skill, and is of paramount importance to patient care. A tailored history and examination lead to localization and differential diagnosis. Read More

Medicine (Baltimore) 2019 Feb;98(5):e14260

Department of Neurological Function Examination.

Rationale: The coexistence of Ramsay Hunt syndrome (RHS) and varicella-zoster virus (VZV) encephalitis is rare. A patient who developed RHS after being infected with VZV, along with a pontine lesion, is reported in the present study.

Patient Concerns: A 41-year-old male patient presented with his mouth askew for 7 days, and dizziness, accompanied by hearing loss for 3 days. Read More

Oxf Med Case Reports 2019 Jan 24;2019(1):omy114. Epub 2019 Jan 24.

Department of Oncology, Imperial College Healthcare NHS Trust, Charring Cross Hospital, Fulham Palace Road, London, UK.

Malignant meningitis is a rare condition with varied clinical presentations, often mimicking other neurological conditions. Here we report a rare case of malignant meningitis from primary bronchogenic melanoma. The patient initially presented with vomiting and headache. Read More

Ann Dermatol Venereol 2019 Jan 25. Epub 2019 Jan 25.

Service de dermatologie-infectiologie, CHI Fréjus Saint-Raphaël, 240, avenue de Saint-Lambert, 83600 Fréjus, France.

Background: Toxic shock syndrome (TSS) was first described by Todd in 1978. The relevant Lancet publication reported 7 cases of children with fever, exanthema, hypotension and diarrhoea associated with multiple organ failure. An association between TSS and use of hyper-absorbent tampons in menstruating women was discovered in the 1980s. Read More

J Vis Exp 2019 Jan 10(143). Epub 2019 Jan 10.

Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital; Wound Healing Center, Peking University Third Hospital.

Chemical lumbar sympathectomy (CLS) is a commonly used, minimally invasive procedure for the treatment of conditions including ischemic diseases of the lower extremities, hyperhidrosis, etc. It is commonly practiced to position the puncture needle tip in front of the anterior fascia of the psoas major muscle and inject the inactivating agent around the sympathetic trunk, which is defined as conventional CLS. Although relatively rare, ureteropelvic damage is the most frequently reported complication of conventional CLS and can cause serious harm to patients. Read More

World Neurosurg 2019 Jan 23. Epub 2019 Jan 23.

Maimonides Medical Center, Division of Neurosurgery, 948 48th St, Brooklyn, NY 11219, Brooklyn, New York, USA. Electronic address:

Background: Although rare, spinal meningiomas may cause motor and sensory deficits or difficulty with bladder or bowel function due to spinal cord compression. While hemorrhage of intracranial meningiomas is well documented, there are very few cases of hemorrhage or hematoma associated with spinal meningiomas in the literature. Spinal meningiomas have been reported to be associated with subdural, epidural, intratumoral, and subarachnoid hemorrhage and usually in the setting of inciting event such as lumbar puncture or anti-coagulation therapy. Read More

Pediatr Hematol Oncol 2019 Jan 25:1-7. Epub 2019 Jan 25.

a Department of Pediatrics, Division of Critical Care Medicine , Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston , Atlanta , GA , USA.

Background: Children with cancer undergo serial invasive, painful procedures as a part of their diagnosis, treatment, and surveillance regimens that require procedural sedation (PS). Some may have a delay in their treatment plan due to same-day cancelation (SDC) of the procedure due to issues related to sedation or other factors. The objective of this report was to evaluate the factors resulting in the SDC of hematology and oncology patients in an outpatient pediatric sedation service. Read More

Int J Tuberc Lung Dis 2019 Jan 24. Epub 2019 Jan 24.

TB Centre, London School of Hygiene & Tropical Medicine, London, UK.

OBJECTIVE

METHODS

Acta Neurol Scand 2019 Jan 24. Epub 2019 Jan 24.

Barrow Neurological Institute, St. Joseph Hospital and Medical Center, Dignity Health Organization, 240 W. Thomas Road, Phoenix, AZ, 85013.

Object: We characterize idiopathic normal pressure hydrocephalus (NPH) following treatment with lumbar puncture (LP) and shunt placement through clinical evaluation and quantitative ProtoKinetics Zeno walkway assessments. We evaluate the symptomology by determining gait characteristics altered by treatment.

Methods: Patients at Barrow Neurological Institute (BNI) who underwent a lumbar puncture (LP, removing 30-32 ml cerebrospinal fluid) followed by ventriculoperitoneal shunt placement in February 2015 to February 2017 were analyzed for gait impairments. Read More

Case Rep Nephrol Dial 2018 Sep-Dec;8(3):268-276. Epub 2018 Dec 11.

Department of Medicine, National University Health System, Singapore, Singapore.

Injuries to extrarenal arteries caused by percutaneous biopsy needles are very rare but highly lethal due to delay in recognition. Here we report the case of an inadvertent lumbar artery puncture after native renal biopsy and provide a literature review and a proposed workflow for management of massive bleed after renal biopsy. This case highlights evidence-based management considerations regarding massive bleed after renal biopsy, including the first-line imaging modality and the need to consider extrarenal site bleed. Read More

Nature 2019 01 23;565(7741):654-658. Epub 2019 Jan 23.

Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Diffuse gliomas are the most common malignant brain tumours in adults and include glioblastomas and World Health Organization (WHO) grade II and grade III tumours (sometimes referred to as lower-grade gliomas). Genetic tumour profiling is used to classify disease and guide therapy, but involves brain surgery for tissue collection; repeated tumour biopsies may be necessary for accurate genotyping over the course of the disease. While the detection of circulating tumour DNA (ctDNA) in the blood of patients with primary brain tumours remains challenging, sequencing of ctDNA from the cerebrospinal fluid (CSF) may provide an alternative way to genotype gliomas with lower morbidity and cost. Read More

BMC Infect Dis 2019 Jan 22;19(1):80. Epub 2019 Jan 22.

Department of Infectious Diseases, Oslo University Hospital Ullevaal, P. O. Box 4956, Nydalen, N-0450, Oslo, Norway.

Background: Recognizing patients with encephalitis may be challenging. The cardinal symptom, encephalopathy, has a wide array of differential diagnoses. In this prospective study we aimed to explore the etiology of encephalitis and to assess the diagnostic accuracy of symptoms and clinical findings in patients with encephalitis in an encephalopathic population. Read More

Neurol Sci 2019 Jan 21. Epub 2019 Jan 21.

Neurology Unit, Department of Translational Medicine, AOU Maggiore della Carità and University of Piemonte Orientale, Novara, Italy.

Background: Lumbar puncture (LP) is a safe procedure commonly performed in the diagnostic work-up of multiple sclerosis (MS), and its main adverse event is post-LP headache (PLPH). Predictors for PLPH in MS are not established.

Aims: To describe the occurrence of, and, factors related to PLPH in patients with suspected MS, studied on a daily-basis admission. Read More

Biomed Res Int 2018 19;2018:7692794. Epub 2018 Dec 19.

Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, No. 76 Linjiang Road, District Yuzhong, Chongqing, China.

Objective: To compare the clinical efficacy and complications which obtained foraminoplasty at the tip or base of the superior articular process (SAP) for the patients with lateral recess stenosis treated by percutaneous endoscopic lumbar discectomy (PELD).

Methods: Between January 2015 and January 2016, 156 patients of lumbar disc herniation accompanying with lateral recess stenosis were treated with PELD in five tertiary hospitals and fulfilled the 2-year follow-up. Among them, 78 patients obtained a foraminoplasty at the tip of SAP (group A), and foraminoplasty at the base of SAP was performed in the other 78 cases (group B). Read More

Seizure 2019 Feb 14;65:94-97. Epub 2019 Jan 14.

Pediatric Emergency Unit, Department of Pediatrics, Okmeydani Training and Research Hospital, Istanbul, Turkey.

Purpose: The exact etiology of febrile seizures (FS) is still unclear. However, it is thought that cytokine network activation may have a causative role. Therefore, this study aimed to evaluate the levels of interleukin-12 (IL-12) as a proinflammatory cytokine, interleukin-10 (IL-10) as an anti-inflammatory cytokine, and interferon-β (IFN-β), a marker of toll-like receptor-3 activation as a host response to viruses. Read More

Acta Anaesthesiol Scand 2019 Jan 17. Epub 2019 Jan 17.

Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.

The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the BMJ Rapid Recommendation clinical practice guideline on atraumatic (pencil-point) vs conventional needles for lumbar puncture. This includes the strong recommendation for the use of atraumatic needles for lumbar puncture in all patients regardless of age or indication. Read More

Neuropsychiatr 2019 Jan 17. Epub 2019 Jan 17.

Psychiatrische Abteilung mit Zentrum für Psychotherapie und Psychosomatik, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto Wagner Spital, Baumgartner Höhe 1, 1140, Wien, Österreich.

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR encephalitis) is a rare and recently discovered disease. Affected patients are initially often referred to psychiatric departments due to prominent neuropsychiatric symptoms.We present the course of the illness of an 18-year-old female patient, who was primarily and for the first time admitted to the 1. Read More

Br J Neurosurg 2019 Jan 17:1-9. Epub 2019 Jan 17.

a Department of Neurosurgery , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK.

Purpose: To determine the outcome of ventriculo-peritoneal shunts as a treatment for idiopathic intracranial hypertension (IIH) Materials and Methods: Retrospective case series of 28 patients with IIH and evidence of raised intracranial pressure (ICP) who underwent shunt insertion. Patients were identified from a prospectively updated operative database. A case-notes review was performed and data on type of shunt, pre- and post-operative symptoms, ophthalmological findings and post-operative complications were recorded. Read More

Case Rep Med 2018 11;2018:3162403. Epub 2018 Dec 11.

Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.

Introduction: Neurosarcoidosis, either isolated or as part of systemic sarcoidosis, is an uncommon entity and has diagnostic uncertainty. Treatment for neurosarcoidosis can increase the risk of infections, including fungal infections such as disseminated histoplasmosis. Neurosarcoidosis may further predispose patients to infections of the central nervous system. Read More

Turk Neurosurg 2018 Oct 2. Epub 2018 Oct 2.

Antalya Education and Research Hospital.

Aim: There is no consensus in the literature regarding the optimal method of obtaining cerebrospinal fluid sample in patients with suspected shunt infections. The most frequently used method is tapping shunt reservoir. Lumbar puncture is an alternative method yet it used far less frequently. Read More

BMJ Case Rep 2019 Jan 14;12(1). Epub 2019 Jan 14.

Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Llantrisant, UK.

A 46-year-old woman was admitted with tonic-clonic seizures. She was noticed to be withdrawn and low in mood for few months. She had reduced level of consciousness with hyper-reflexia and myoclonus. Read More

Ann Intern Med 2019 Jan;170(2):JC9

J Am Med Dir Assoc 2019 Jan 9. Epub 2019 Jan 9.

Department of Neurosurgery, Moriggia-Pelascini Hospital, Gravedona, Como, Italy.

Objectives: To evaluate the effects of repeated cerebrospinal fluid (CSF) tap procedures in idiopathic normal pressure hydrocephalus (iNPH) patients ineligible for surgical treatment.

Design: Prospective, monocentric, pilot study.

Setting: University hospital. Read More

Indian J Anaesth 2018 Dec;62(12):972-977

Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

Background And Aims: Post-dural puncture headache (PDPH) is a consequence of spinal and epidural anaesthesia in approximately 1% of obstetric patients. The gold standard for its treatment is epidural blood patch. Sphenopalatine ganglion block (SPGB) has been proposed as a non-invasive intervention with minimal adverse effect. Read More

BMC Anesthesiol 2019 Jan 12;19(1):11. Epub 2019 Jan 12.

Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China.

Background: Anticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section. Read More