ObjectiveThe objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area.MethodsBetween 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade.ResultsFurther compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales.ConclusionThe necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.
ObjectiveThe aim of this study was to evaluate the safety and efficacy of stent-assisted coil embolization using only a glycoprotein IIb/IIIa inhibitor (tirofiban).Materials and MethodsWe retrospectively reviewed patients with a subarachnoid hemorrhage due to ruptured wide-necked intracranial aneurysms who were treated by stent-assisted coil embolization. In all patients, the glycoprotein IIb/IIIa inhibitor tirofiban was administered just before stent deployment. Electronic medical records for these patients were reviewed for peri-procedural complications and extra-ventricular drainage catheter related hemorrhage, as well as Glasgow outcome scale (GOS) at discharge, 3 months, and 6 months follow-up were recorded.ResultsFifty-one aneurysms in 50 patients were treated. The mean patient age was 64.9 years. Eighteen patients (36%) received a World Federation of Neurosurgical Societies grade of 4 or 5. The mean aneurysm size was 9.48 mm and mean dome-to-neck ratio was 1.06. No intraoperative aneurysm ruptures occurred, although five (10%) episodes of asymptomatic stent thrombosis did occur. Three patients experienced a delayed thrombo-embolic event and two a delayed hemorrhagic event. Immediate radiologic assessment indicated a complete occlusion in 29 patients, a residual neck in 19, and a residual sac in 3. Four patients (8%) died. Sixteen patients (32%) experienced a poor GOS (< 4). Two aneurysms were recanalized during the follow-up period (mean, 19 months for clinical and 18 months for angiographic follow-up).ConclusionTreatment of ruptured wide-necked intracranial aneurysms via stent-assisted coil embolization with a glycoprotein IIb/IIIa inhibitor alone was found to be relatively safe and efficient.
Involuntary movement of the cervical spine can cause damage to the cervical spinal cord. Cervical myelopathy may occur at an early age in involuntary movement disorders, such as tics. We report the case of a 21-year-old man with Tourette syndrome, who developed progressive quadriparesis, which was more severe in the upper extremities. The patient had abnormal motor tics with hyperflexion and hyperextension of the cervical spine for more than 10 years. High-signal intensity intramedullary lesions were observed at C3-4-5-6 level on T2 weighted magnetic resonance imaging. Examinations were performed for high-signal intensity intramedullary lesions that may occur at a young age, but no other diseases were detected. Botulinum toxin injection to the neck musculature and medication for tic disorders were administered. However, the myelopathy was further aggravated, as the involuntary cervical movement still remained. Therefore, laminoplasty was performed at C3-4-5-6, with posterior fixation at C2-3-4-5-6-7 to alleviate the symptoms. The neurological signs and symptoms improved dramatically. The management of tic disorders should be the first priority during treatment. However, surgical treatment may be necessary, if symptoms worsen after appropriate treatment.
Vertebral artery injuries associated with C1 lateral mass screw insertion rarely occur during C1-2 fusion. The posterior inferior cerebellar artery (PICA) is uncommonly located at the C1 lateral mass insertion position. A 71-year-old woman with atlanto-axial subluxation and cord compression underwent C1-2 fusion. Sixth nerve palsy and diplopia were detected postoperatively, and decreased consciousness occurred on postoperative day 4. Brain magnetic resonance image (MRI) and computed tomography (CT) revealed PICA infarction. In the preoperative CT angiography, the PICA originated between the C1 and C2 level. In the postoperative CT scan, the PICA was not visible. The patient was treated conservatively for two weeks and recovered. PICA originating between the C1 and C2 level comprises 1.1-1.3% of cases. Therefore, vertebral artery anomalies should be evaluated prior to C1-2 fusion to prevent vessel injuries.
Deep neck infections (DNIs) are mainly caused by dental caries, tonsillitis, and pharyngitis; however, DNIs can also occur after head and neck trauma. A 79-year-old male patient underwent a craniectomy due to an acute subdural hematoma. The patient was unconscious and continued to have a fever, but no clear cause was found. On postoperative day 9, he suddenly showed redness and swelling on the anterior neck. Enhanced computed tomography of the pharynx revealed tracheal necrosis and an abscess in the surrounding area. An incision and drainage were performed and Enterobacter aerogenes and E. faecalis were identified. The infection was controlled after antibiotic treatment. High endotracheal tube cuff pressure was suspected as the cause of the tracheal infection. Although DNIs are difficult to predict in patients who cannot report their symptoms due to unconsciousness, prevention and rapid diagnosis are important, as DNIs have serious side effects.
Pneumonia is a very serious medical complication in patients with hemorrhagic stroke such as spontaneous intracerebral hemorrhage and subarachnoid hemorrhage. In the case of hemorrhagic stroke patients, hospital-acquired pneumonia increases morbidity, mortality and medical costs in addition to the already poor prognosis of hemorrhagic stroke. The purpose of this study was to identify risk factors for hospital-acquired pneumonia in hemorrhagic stroke patients treated in the intensive care unit. MethodsOur study was a retrospective review of 112 hemorrhagic stroke patients treated in an intensive care unit who were hospitalized in the neurosurgery department of Gyeonsang National University Hospital from August 2019 to July 2020. The data included basic demographic data, the underlying disease, lifestyle factors, neurological evaluation results, severity of the condition and other characteristics. The radiological data and medical records of the patients were retrospectively analyzed. ResultsA total of 97 patients were included in the study, and 10 of them met the diagnostic criteria for hospital-acquired pneumonia. Diabetes mellitus, a high simplified acute physiology score 3 (SAPS3), a low glasgow coma scale (GCS) score, mechanical ventilation, tracheostomy, dysphagia and nasogastric tube feeding were identified as risk factors for the development of hospital-acquired pneumonia (p<0.05). Six of 10 bacterial pathogens isolated from sputum were identified as multidrug-resistant pathogens. Hospital-acquired pneumonia led to further antibiotic treatment and general deterioration, which in turn increased the intensive care unit length of stay (p<0.001). ConclusionWe found that mechanical ventilation, tracheostomy, dysphagia, tube feeding, a high SAPS3, and a low GCS score were risk factors for hospital-acquired pneumonia (HAP) in hemorrhagic stroke patients. Efforts will be needed to prevent pneumonia by understanding the risk factors for HAP identified in our study.
Objective: In recent years, the number of cases of unruptured intracranial aneurysms in older patients has been increasing, but the best treatment remains a matter of debate. This study aimed to compare the treatment methods for unruptured intracranial aneurysms in patients aged 65 years and older.Methods: A retrospective review was conducted of data from unruptured intracranial aneurysms treated with surgical clipping or endovascular coiling between 2004 and 2019. Clinical and imaging information was collected. The treatment methods, procedure-related complications, and imaging and clinical results were analyzed. Data were assessed through a comparative analysis of underlying diseases (diabetes mellitus, hypertension, and hypercholesterolemia), smoking and alcohol use history, the location and size of the aneurysms for patients who received each treatment, and complications that occurred after each treatment.Results: Of 211 patients over the age of 65, 71 were treated with clipping and 140 with coiling. The complications that occurred immediately after treatment included postoperative hemorrhage (subarachnoid hemorrhage, intracerebral hemorrhage, intraventricular hemorrhage), chronic subdural hemorrhage, infection, and puncture site infection. Postoperative computed tomography images of the clipping sites had four times more opacity than those of coil embolization, but the outcomes (Glasgow outcome scores) showed no significant differences between clipping and coil embolization.Conclusion: Coil embolization and clipping are safe and effective treatment methods for unruptured intracranial aneurysms in elderly patients. Thus, the active treatment of unruptured intracranial aneurysms, which are likely to be retrofitted, should be considered.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.