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Curr Opin Infect Dis 2019 Jun;32(3):233-238

Section of Infectious Diseases, UT Health McGovern Medical School, Houston, Texas, USA.

Purpose Of Review: Community-acquired bacterial meningitis continues to occur and be associated with significant morbidity and mortality despite the availability of effective conjugate vaccines for the three most important meningeal pathogens.

Recent Findings: Indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Cranial imaging is of no clinical utility in those patients without indications and fosters delays in performing a lumbar puncture. Read More

J Emerg Med 2019 Apr 20. Epub 2019 Apr 20.

Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI.

Background: Febrile infants commonly present to emergency departments for evaluation.

Objective: We describe the variation in diagnostic testing and hospitalization of febrile infants ≤60 days of age presenting to the emergency departments in the Pediatric Emergency Care Applied Research Network.

Methods: We enrolled a convenience sample of non-critically ill-appearing febrile infants (temperatures ≥38. Read More

Alzheimers Dement (N Y) 2019 12;5:129-138. Epub 2019 Apr 12.

Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA.

Introduction: Neurodegeneration appears to be the biological mechanism most proximate to cognitive decline in Alzheimer's disease. We test whether t-tau and alternative biomarkers of neurodegeneration-neurogranin and neurofilament light protein (NFL)-add value in predicting subclinical cognitive decline.

Methods: One hundred fifty cognitively unimpaired participants received a lumbar puncture for cerebrospinal fluid and at least two neuropsychological examinations (mean age at first visit = 59. Read More

Cureus 2019 Feb 7;11(2):e4034. Epub 2019 Feb 7.

Internal Medicine, St. Barnabas Hospital, Bronx, USA.

Neurosyphilis (NS) is more frequently seen in patients with human immunodeficiency virus (HIV) infection, especially those not on antiretroviral therapy or with a low CD4 cell count. Ocular syphilis is an unusual and early form of neurosyphilis. Lumbar puncture should be considered in all HIV infected patients who present with neurologic or ocular disease. Read More

Dement Geriatr Cogn Dis Extra 2019 Jan-Apr;9(1):100-113. Epub 2019 Mar 12.

Department of Biomedical Science, Chosun University, Gwangju, Republic of Korea.

Background/aims: Disease-modifying therapy for Alzheimer's disease (AD) has led to a need for biomarkers to identify prodromal AD and very early stage of AD dementia. We aimed to identify the cutoff values of cerebrospinal fluid (CSF) biomarkers for detecting prodromal AD.

Methods: We assessed 56 patients with amnestic mild cognitive impairment (aMCI) who underwent lumbar puncture. Read More

Eur Stroke J 2017 Sep 21;2(3):195-221. Epub 2017 Jul 21.

Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands.

The current proposal for cerebral venous thrombosis guideline followed the Grading of Recommendations, Assessment, Development, and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews of all available evidence and writing recommendations and deciding on their strength on an explicit and transparent manner, based on the quality of available scientific evidence. The guideline addresses both diagnostic and therapeutic topics. We suggest using magnetic resonance or computed tomography angiography for confirming the diagnosis of cerebral venous thrombosis and not screening patients with cerebral venous thrombosis routinely for thrombophilia or cancer. Read More

MedEdPORTAL 2016 Sep 28;12:10468. Epub 2016 Sep 28.

Professor of Pediatrics, University of Vermont College of Medicine.

Introduction: Fever in early infancy is a common problem for which management can be challenging. All residents need to be able to recognize critical illness such as meningitis in febrile infants and manage complications such as seizures. Many new residents are not competent performing bedside procedures as there is little opportunity to perform them while in medical school. Read More

MedEdPORTAL 2016 Jul 21;12:10427. Epub 2016 Jul 21.

Director of Advancing Scholarship, University of Michigan Medical School.

Introduction: From the first day of residency, residents may be required to consent patients for interventions, procedures, or tests. The ability to perform an informed consent is considered one of the Association of American Medical College's Core Entrustable Professional Activities for entering residency. This case provides learners with the opportunity to obtain informed consent for a lumbar puncture procedure and to receive immediate structured feedback on their performance. Read More

Clin J Pain 2019 Apr 18. Epub 2019 Apr 18.

The Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.

Objectives: The risks of epidural analgesia differ depending on the population studied. We describe our experience with postoperative epidural analgesia for oncologic surgery.

Materials And Methods: After approval from the Institutional Review Board of The University of Texas MD Anderson Cancer Center to conduct this retrospective analysis, we searched our acute pain medicine database for cases in which postoperative epidural analgesia was used between 2003 and 2012. Read More

J Neurosurg Spine 2019 Apr 19:1-5. Epub 2019 Apr 19.

3Neurological Surgery, Oregon Health & Science University, Portland, Oregon.

Nusinersen (Spinraza) is a US Food and Drug Administration-approved intrathecal medication for the treatment of spinal muscular atrophy (SMA). Adult patients with SMA often undergo thoracolumbar fusion to treat neurogenic scoliosis, preventing thecal access. The authors report a laminotomy technique and the ease of intrathecal access in three SMA patients with prior thoracolumbar fusions. Read More

J Neurosci Rural Pract 2019 Apr-Jun;10(2):355-359

Division of Neurocritical Care, Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Reversible cerebral vasoconstriction syndrome (RCVS) is a disorder of dysregulation of cerebrovascular tone resulting in transient segmental vasoconstriction which resolves in 1-3 months. Cerebral edema is an underrecognized complication in RCVS. It is likely multifactorial. Read More

BMC Anesthesiol 2019 Apr 16;19(1):57. Epub 2019 Apr 16.

Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.

Background: Neuraxial procedures are commonly performed for therapeutic and diagnostic indications. Currently, they are typically performed via palpation-guided surface landmark. We devised a novel intelligent image processing system that identifies spinal landmarks using ultrasound images. Read More

Neurosurgery 2019 Apr 15. Epub 2019 Apr 15.

Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.

Background: The incidental discovery of brain lesions in children has increased due to greater utilization of neuroimaging. Standardized surveillance and management guidelines following the discovery of such lesions remain nonexistent.

Objective: To study the natural history and management of incidental brain lesions in children. Read More

BMC Neurol 2019 Apr 13;19(1):64. Epub 2019 Apr 13.

Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Nalishi Road 56#, Xicheng District, Beijing, 100045, China.

Background: To evaluate whether a shorter time of lying supine without a pillow and fasting for solids and liquids (LSFSL) after a lumbar puncture (LP) is associated with a higher risk of post-lumbar puncture headache (PLPH) and post-lumbar puncture lower back pain (PLPBP) in a randomized, assessor-blinded, controlled trial.

Methods: Paediatric patients who underwent their first LP after hospital admission were randomly allocated to either the group with half an hour of LSFSL (0.5 h LSFSL) or 4 h of LSFSL (4 h LSFSL) immediately after LP. Read More

PLoS One 2019 15;14(4):e0215410. Epub 2019 Apr 15.

Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

Background: The presence of ≥3 oligoclonal bands (OCB) in the cerebrospinal fluid (CSF) without corresponding bands in serum represents a definite pathological pattern, whereas the clinical significance of 1-2 CSF bands (borderline pattern) is poorly investigated.

Methods: We screened 1986 consecutive CSF and serum samples which were collected over a four-year time period and had results of isoelectric focusing (IEF) available. Of patients with borderline OCB we reviewed individual medical charts for assessment of clinical diagnoses. Read More

Medicine (Baltimore) 2019 Apr;98(15):e15014

Service de Cardiologie Médicale, CHU de Nancy Hôpitaux de Brabois, Vandœuvre-lès-Nancy, France.

Rationale: Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy presumed to result from an infection-triggered autoimmune reaction.

Patient Concerns: This paper describes a 53-year-old man admitted to hospital for deterioration of his general condition.

Diagnosis: He developed GBS, confirmed by lumbar puncture and electromyogram, which recovered after intravenous immunoglobulins. Read More

Rev Esp Quimioter 2019 Apr 11. Epub 2019 Apr 11.

Lucía López-Amor, Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias. Avenida de Roma s/n 33011 Oviedo. Spain.

Objective: To evaluate the clinical impact of Meningitis/Encephalitis FilmArray® panel for the diagnosis of cerebral nervous system infection and to compare the results (including time for diagnosis) with those obtained by conventional microbiological techniques.

Methods: A prospective observational study in an Intensive Care Unit of adults from a tertiary hospital was carried out. Cerebrospinal fluid from all patients was taken by lumbar puncture and assessed by the meningitis/encephalitis FilmArray® panel ME, cytochemical study, Gram, and conventional microbiological cultures. Read More

Open Access Maced J Med Sci 2019 Mar 30;7(6):996-1000. Epub 2019 Mar 30.

Institute of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.

Background: There is a widespread belief that spinal anaesthesia in patients with preeclampsia might cause severe hypotension and decreased uteroplacental perfusion. This study aimed to evaluate the incidence and severity of spinal induced-hypotension in preeclamptics and healthy parturients.

Methods: Total of 78 patients (40 healthy and 38 preeclamptic) undergoing a C-Section with spinal anaesthesia were included. Read More

Can J Ophthalmol 2019 Apr 25;54(2):e57-e59. Epub 2018 Aug 25.

Department of Diagnostic Radiology, Dalhousie University, Halifax, N.S., Canada.

Spine (Phila Pa 1976) 2019 Apr 5. Epub 2019 Apr 5.

Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY.

Study Design: A rat puncture injury intervertebral disc (IVD) degeneration model with structural, biomechanical, and histological analyses.

Objective: To determine if males and females have distinct responses in the IVD after injury.

Summary Of Background Data: Low back pain (LBP) and spinal impairments are more common in women than men. Read More

Pediatr Emerg Care 2019 Apr 9. Epub 2019 Apr 9.

Objective: Our aim is to emphasize the varied presentation of acute disseminated encephalomyelitis (ADEM) to help health care professionals improve recognition of the disease in a timely manner, thereby allowing for the selection of an appropriate treatment regimen. Therefore, this may avoid neurocognitive consequences and the ultimate fatality of the patient.

Patients And Methods: This is a retrospective case series involving 7 cases of children presenting to the Pediatric Emergency Department of Hackensack University Medical Center who were ultimately diagnosed with ADEM. Read More

Front Neurol 2019 26;10:281. Epub 2019 Mar 26.

Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States.

To assess the clinical utilization and performance of the FilmArray® Meningitis/Encephalitis (ME) multiplex polymerase chain reaction (PCR) panel in a hospital setting. Rapid diagnosis and treatment of central nervous system (CNS) infections are critical to reduce morbidity and mortality. The ME panel is a Food and Drug Administration (FDA) approved rapid multiplex PCR assay that targets 14 bacteria, viruses, and fungi. Read More

Dement Geriatr Cogn Disord 2019 Apr 10;47(1-2):114-123. Epub 2019 Apr 10.

Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.

Background: Dementia of Alzheimer's type (AD) is related to decreased survival. It is not clear whether also biological markers of AD are related to mortality. Low levels of amyloid beta-42 (Aβ42) and high levels of total tau (T-tau) protein in cerebrospinal fluid (CSF) are established biomarkers for AD. Read More

BMJ Case Rep 2019 Apr 8;12(4). Epub 2019 Apr 8.

ID, Mayo Clinic, Rochester, Minnesota, USA.

A 51-year-old man with a medical history of coronary artery disease and dyslipidaemia presented with acute myocardial infarction resulting in cardiogenic shock, necessitating intra-aortic balloon pump placement and extracorporeal membrane oxygenation (ECMO). His hospital course was complicated by several infectious complications including ECMO circuit bloodstream infection and presumed infected right atrial thrombus. He subsequently underwent urgent left ventricular assist device placement and had a prolonged hospital stay. Read More

J Alzheimers Dis 2019 Apr 3. Epub 2019 Apr 3.

Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.

Background: Biomarkers may soon be used to predict decline in older individuals. Extended follow-up studies are needed to determine the stability of such biomarker-based predictions.

Objective: To examine the long-term performance of baseline cognitive, neuroimaging, and cerebrospinal fluid (CSF) biomarker-assisted prognosis in patients with mild cognitive impairment. Read More

J Alzheimers Dis 2019 Apr 1. Epub 2019 Apr 1.

Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.

Background: Previous studies indicate that cardiorespiratory fitness (CRF) and sleep are each favorably associated with Alzheimer's disease (AD) pathophysiology, including reduced amyloid-β (Aβ) and tau pathology. However, few studies have examined CRF and sleep in the same analysis.

Objective: To examine the relationship between sleep and core AD cerebrospinal fluid (CSF) biomarkers among at-risk healthy late-middle-aged adults and determine whether CRF modifies this association. Read More

BMJ Paediatr Open 2019 15;3(1):e000412. Epub 2019 Mar 15.

Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences Stellenbosch University, Tygerberg, Cape Town, South Africa.

Importance: Lumbar puncture (LP) failure rates vary and can be as high as 65%. Ultrasound guidance could increase the success of performing LP.

Objective: To summarise the evidence on the use of ultrasound guidance versus palpation method for LP. Read More

Acta Neurol Scand 2019 Apr 2. Epub 2019 Apr 2.

Departement of Neurology, University Medicine Greifswald, Greifswald, Germany.

Objectives: Correct identification of inflammatory etiologies of stroke is of outmost importance as they require treatment of the underlying disease. Aim of this study was to determine the prevalence of inflammatory changes in cerebrospinal fluid (CSF) observed in young cryptogenic stroke patients.

Materials And Methods: Of 6476 records of patients diagnosed with ischemic stroke, 278 had confirmed ischemia in brain imaging and received lumbar puncture. Read More

J Gen Intern Med 2019 Apr 1. Epub 2019 Apr 1.

The Wilson Centre, University Health Network and University of Toronto, Toronto, Canada.

Background: Curricular constraints require being selective about the type of content trainees practice in their formal training. Teaching trainees procedural knowledge about "how" to perform steps of a skill along with conceptual knowledge about "why" each step is performed can support skill retention and transfer (i.e. Read More

Asian J Neurosurg 2019 Jan-Mar;14(1):310-313

Department of Neurosurgery, Hospital Militar Central, Universidad Militar Nueva Granada, Bogota, Colombia.

Rhinorrhea secondary to a retrosigmoid approach is rare, but when it manifests, it is due to a paradoxical cerebrospinal fluid (CSF) leak, as a result of the communication between the mastoid cells, middle ear, and eustachian tube, which finally ends on the release of CSF through the nasopharynx. Abnormal communications increases the risk of infections, not only at the surgical site but also through an ascending path. Magnetic resonance cisternography (MRC) with intrathecal gadolinium injection through a lumbar puncture not only allows an adequate diagnosis but also helps to establish management plans. Read More

Asian J Neurosurg 2019 Jan-Mar;14(1):249-252

Department of Neurosurgery and Neurology, IRCCS Galeazzi Hospital, 20161 Milan, Italy.

Serious complications following spinal anesthesia (SA) are rare. However, surgeons and neurologist need to be aware that postsurgery headache refractory to conservative treatment or change in headache's characteristics could be due to serious intracranial complications such as a subdural hematoma. Any delay in diagnosis and treatment can be fatal. Read More

Oncologist 2019 Apr 1. Epub 2019 Apr 1.

Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Background: Immune checkpoint inhibitors such as pembrolizumab and nivolumab have emerged as active treatment options for patients with many cancers, including metastatic melanoma, but can also cause symptomatic or life-threatening immune-related adverse events, including encephalitis. Epididymitis and orchitis are rare complications of these therapies.

Case Presentation: We describe herein a patient with metastatic melanoma who developed epididymo-orchitis followed by encephalitis while receiving pembrolizumab. Read More

Can J Neurol Sci 2019 Apr 1:1-2. Epub 2019 Apr 1.

Department of Neurology, Stroke Center, Neuroscience Center,The First Hospital of Jilin University,Changchun,China.

A 15-year-old teenager presented with a 2-month history of headache. Neurological examination was normal except for papilledema. Further lumbar puncture indicated intracranial hypertension (330 mm H2O). Read More

MedEdPORTAL 2019 Feb 27;15:10806. Epub 2019 Feb 27.

Associate Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine.

Introduction: Laceration repair is a core procedural skill in which pediatric residents are expected to attain proficiency per the Accreditation Council for Graduate Medical Education. Restricted trainee work hours have decreased clinical opportunities for laceration repair, and simulation may be a modality to fill that clinical gap. There is a therefore a need for objective measures of pediatric resident competence in laceration repair. Read More

Anesth Analg 2019 Mar 27. Epub 2019 Mar 27.

Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Background: Closed malpractice claim studies allow a review of rare but often severe complications, yielding useful insight into improving patient safety and decreasing practitioner liability.

Methods: This retrospective observational study of pain medicine malpractice claims utilizes the Controlled Risk Insurance Company Comparative Benchmarking System database, which contains nearly 400,000 malpractice claims drawn from >400 academic and community medical centers. The Controlled Risk Insurance Company Comparative Benchmarking System database was queried for January 1, 2009 through December 31, 2016, for cases with pain medicine as the primary service. Read More

Pain Physician 2019 03;22(2):E91-E96

Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning, China.

Background: Unilateral and bilateral percutaneous kyphoplasty (PKP) have been widely adopted to treat osteoporotic vertebral compression fractures (OVCFs). Unilateral PKP has a shorter operation time and less radiation exposure time compared with bilateral PKP, but the anatomical distinctions of unilateral PKP are not identical in all cases.

Objective: The aim of this study was to examine the significance of age, gender, level, and side in relation to the anatomical distinctions of unilateral PKP for lumbar OVCFs through the transverse process-pedicle approach (TPPA). Read More

J Orthop Case Rep 2018 Nov-Dec;8(6):96-99

Department of Spine Surgery, Baby Memorial Hospital, Calicut, Kerala, India.

Introduction: Lumbar puncture with unstyletted needle or any other spine trauma can cause implantation of skin fragments inside the dura and can cause acquired intraspinal epidermoid tumors. There is significant delay found between the episode of lumbar puncture and the presentation of the tumor. To the best of our knowledge, there is no reported case of intraspinal epidermoid tumor presenting as acute paraparesis secondary to infection of the tumor in the literature. Read More

Neurohospitalist 2019 Apr 27;9(2):58-64. Epub 2018 Sep 27.

Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Background And Purpose: Patients with posterior reversible encephalopathy syndrome (PRES) sometimes undergo analysis of cerebrospinal fluid (CSF) to exclude alternative diagnoses. This study's objectives were to describe the CSF characteristics in patients with PRES and to identify clinical and radiologic findings associated with distinct CSF abnormalities.

Methods: We identified a retrospective cohort of patients with PRES. Read More

Eur Spine J 2019 Mar 25. Epub 2019 Mar 25.

Department of Orthopedic Surgery, Seoul Red Cross Hospital, Seoul, Republic of Korea.

Purpose: To evaluate the accessibility of the preganglionic epidural space in patients with lumbosacral radiculopathy treated with epidural steroid injection (ESI) through trans-lateral recess (TLR) approach.

Methods: From September 2016 to December 2016, we enrolled 50 consecutive preganglionic ESI through TLR approach for 38 patients with lumbosacral radiculopathy at or below L4 territory. Fifteen of patients were diagnosed with lumbar disc herniation and 23 with lumbar spinal stenosis. Read More

A A Pract 2019 Mar 20. Epub 2019 Mar 20.

From the Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California.

Lumbar drains are commonly placed to monitor spinal cerebrospinal fluid (CSF) pressures and drain CSF to augment spinal cord perfusion. Excessive CSF drainage or persistent leakage through the dural puncture site can lead to cerebral hypotension and creation of an intracranial subdural hematoma. Anesthesia providers need to be aware of the risk of subdural hematoma development after major thoracoabdominal surgery where placement and subsequent removal of a lumbar drain have occurred. Read More

Brain 2019 Apr;142(4):1121-1133

Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

Cortical mean diffusivity has been proposed as a novel biomarker for the study of the cortical microstructure in Alzheimer's disease. In this multicentre study, we aimed to assess the cortical microstructural changes in the behavioural variant of frontotemporal dementia (bvFTD); and to correlate cortical mean diffusivity with clinical measures of disease severity and CSF biomarkers (neurofilament light and the soluble fraction beta of the amyloid precursor protein). We included 148 participants with a 3 T MRI and appropriate structural and diffusion weighted imaging sequences: 70 patients with bvFTD and 78 age-matched cognitively healthy controls. Read More

BMJ Case Rep 2019 Mar 22;12(3). Epub 2019 Mar 22.

Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.

A 45-year-old male patient with Tourette syndrome presented to the emergency department with worsening neck pain and stiffness of 1-week duration. Associated symptoms included headache, hoarse voice, trismus and odynophagia. The patient was haemodynamically stable without fevers or leucocytosis. Read More

Seizure 2019 Mar 15;67:52-56. Epub 2019 Mar 15.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.

Purpose This study investigated clinical practice patterns for admissions due to FS at a national level. Method Discharge records were extracted for patients with FS aged < 6 years for the years 2010-16 using national inpatient database in Japan. We ascertained antiepileptic drug use, diagnostic procedures, healthcare costs, and length of hospital stays (LOS), using mixed effect linear or logistic regression models. Read More

Clin Transplant 2019 Mar 22:e13543. Epub 2019 Mar 22.

VA Portland Healthcare System, Portland, Oregon.

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of cryptococcosis in the pre- and post-transplant period. The current update now includes a discussion of cryptococcosis, which is the third most common invasive fungal infection in SOT recipients. Infection often occurs a year after transplantation; however, early infections occur and donor-derived infections have been described within 3 months after transplant. Read More

Neurol Sci 2019 Mar 21. Epub 2019 Mar 21.

Center for Headache and Intracranial Pressure Disorders, University Hospital "Mater Domini", Catanzaro, Italy.

Isolated cerebrospinal fluid hypertension (ICH) is a condition of increased cerebrospinal fluid (CSF) pressure in the cranial-spinal compartment without an identifiable cause. Isolated headache is the most common symptom of ICH, while missing may be signs such as papilledema or sixth nerve palsy. This fact makes difficult the clinical diagnosis of headache attributable to ICH in headache sufferers. Read More

Open Access Maced J Med Sci 2019 Feb 19;7(4):549-552. Epub 2019 Feb 19.

Cairo University, Cairo, Egypt.

Introduction: Post-dural puncture headache (PDPH) is a common complication following neuraxial anaesthesia that increases the duration of hospital stay.

Aim: This study aims to evaluate the effectiveness of injection of the dexamethasone-lidocaine mixture in suboccipital muscles treatment of PDPH after cesarean section.

Patient And Methods: A group of 90 females with PDPH following cesarean section under spinal anaesthesia were randomly allocated into two equal groups: study group (Group S) and control group (group C). Read More

A A Pract 2019 Mar 18. Epub 2019 Mar 18.

From the Department of Anesthesiology, University of North Carolina Medical Center, Chapel Hill, North Carolina.

One commonly cited complication of neuraxial techniques is postdural puncture headache. Patients with spontaneous intracranial hypotension may present with a similar constellation of symptoms in the absence of any neuraxial instrumentation. The underlying physiology of spontaneous intracranial hypotension is similar to postdural puncture headache, but cerebrospinal fluid leaks may develop spontaneously at multiple levels of the neuraxis due to a variety of proposed mechanisms. Read More

Hematology 2019 Dec;24(1):369-377

b Princess Noorah Oncology Center , King Saud Bin Abdulaziz University for Health Sceinces and King Abdulaziz Medical City, Ministry of National Guard Health Affairs , Jeddah , Saudi Arabia.

Objectives: Acute lymphoblastic leukemia (ALL) with CNS2 status predicts inferior outcome and a high rate of CNS relapse, similar to overt CNS leukemia (CNS3). The purpose of this study was to determine if intrathecal (IT) dose intensification during induction would improve outcomes and reduce CNS relapse for CNS2 disease.

Methods: From January 2001 to December 2014, children (1-14 years) with newly diagnosed ALL were treated at the Princess Noorah Oncology Centre (PNOC) following modifications of the Children's Oncology Group (COG) protocols. Read More

Degener Neurol Neuromuscul Dis 2019 8;9:3-17. Epub 2019 Mar 8.

Department of Neuroscience, University of Kentucky Medical Center, Lexington, KY, USA,

Therapies targeting mutant huntingtin DNA, mRNA, and protein have a chance at becoming the first disease-modifying treatments for Huntington's disease, a fatal inherited neurodegenerative disorder for which only symptom management treatments are available today. This review focuses on evidence addressing several key questions pertinent to huntingtin-lowering, ranging from the functions of wild-type huntingtin (wtHTT) that may be disrupted by huntingtin-lowering treatments through the various ways huntingtin can be lowered, the tolerability of wtHTT-lowering in mice and primates, what has been found in the Ionis Pharmaceutical safety trial of a huntingtin-lowering therapy, and to the question of how much mutant huntingtin may need to be lowered for a therapy to be clinically effective. We conclude that adverse consequences of lowering wtHTT in animals appear to be brain region-specific, and/or dependent upon the animal's stage of development and the amount by which huntingtin is lowered. Read More

J Int Med Res 2019 Mar 17:300060519835084. Epub 2019 Mar 17.

Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Percutaneous vertebroplasty (PVP) is a minimally invasive treatment that has been widely used for the treatment of osteoporotic vertebral compression fractures and vertebral tumors. However, the maximum number of vertebral segments treated in a single PVP remains controversial. Furthermore, PVP may cause complications, including cement leakage, pulmonary embolism, bone cement toxicity, and spinal nerve-puncture injury. Read More