Spontaneous spinal epidural hematoma (SSEH) is a rare condition requiring urgent diagnosis and treatment. Patients with SSEH typically present with acute onset of severe back pain and rapidly develop signs of compression of the spinal cord. The authors present a case with spontaneous resolution of SSEH which is extremely rare. We discuss a man who presented to our clinic with mild paraparesis at the seventh day of his symptoms. He had a history of poorly controlled hypertension and hypercholestrolemia requiring an antihyperlipidemic agent and anticoagulation. His upper level of hypoesthesia was at the third thoracic segment. Cervicothoracic SSEH was diagnosed by magnetic resonance imaging. Since there was a gradual recovery of the neurological deficits beginning 12 hours after the onset of symptoms, surgery was obviated and strict bed rest, serial neurological examinations, and pain controls with opiates were instituted. The neurological deficits showed complete recovery on the 25th day of the clinical course. SSEH is rare and immediate surgical decompression is suggested. Rapid neurological deterioration followed by early and progressive neurological recovery, confirmed by radiological resolution of the lesion, may indicate nonoperative treatment.
BACKGROUND: Craniocerebral gunshot wounds (CGW) are the most lethal injuries of the cranium. CGW is mostly secondary to military conflicts but may also be seen in civilian life. These injuries also have severe consequences, such as epilepsy, hydrocephalus, infection and late-term cognitive dysfunctions. The present study aims to present our series of CGW and to discuss the prognostic factors and consequences of these injuries. METHODS:The data of patients who were treated in our department for CGW between 2011 and 2019 were retrospectively reviewed in this study. The injury type, wounding site, surgical management and outcomes were analyzed. Radiological evaluation was also performed. RESULTS:Thirty patients were treated with the diagnosis of CGW. All of the patients were male and the mean age was 27.9 years. The frontal lobe was affected in 12 (40%) patients, while temporal lobe in eight, occipital lobe in six, parietal lobe in three, and posterior fossa in one patients. Twenty-three patients underwent surgical treatment, seven patients were treated conservatively. Thirteen (43.3%) patients died despite the treatment. CONCLUSION:Mortality in CGW is high. Ventricular injuries, bihemispheric or midline injuries, perforating injuries, brain stem injuries and low GCS score at admission are prognostic factors for CGW. Appropriate management is mandatory to obtain a better clinical outcome.
CABEZAS, J. J.; SOTO, A. & BINVIGNAT, O. Nervio femoral accesorio: Una variación del plexo lumbar. Int. J. Morphol., 31(4):1479-1481, 2013. RESUMEN: Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un nervio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10%, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica. PALABRAS CLAVE: Anatomía; Nervios periféricos; Plexo lumbar; Nervio femoral; Nervio femoral accesorio. INTRODUCCIÓN Variaciones en el origen de los ramos del plexo lum-bar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, división del nervio genitofemoral dentro del vientre muscular del psoas mayor, origen del nervio cu-táneo femoral del muslo desde las raíces L1 y L2 o sólo de L2, presencia de un nervio obturador accesorio y la bifur-cación del nervio femoral (Webber, 1961; Anloague & Huijbregts, 2009). De estas variaciones, destaca la presencia de un ner-vio paralelo al nervio femoral que fue denominado como "nervio accesorio del nervio femoral". Este ramo del plexo lumbar ha sido descrito con un trayecto cubierto por el mús-culo psoas mayor, cruzando oblicuamente en dirección lateral para unirse al nervio femoral a una corta distancia sobre el ligamento inguinal (Jamieson, 1903). El presente artículo muestra la presencia unilateral de este nervio y del nervio femoral compuesto por dos ra-mos, uno anterior y otro posterior, con la correspondiente descripción de su origen, trayecto y sector de inervación. MATERIAL Y MÉTODO La presencia del nervio mencionado se encontró du-rante una disección de rutina en un cadáver de un individuo adulto fijado en formaldehido al 10%, de sexo masculino y de nacionalidad Chilena. Este individuo es parte del Labo-ratorio de Anatomía Humana, Facultad de Medicina, Uni-versidad Católica del Maule, Talca, Chile. La observación y posterior disección del mismo se realizó siguiendo su trayecto paralelo al nervio femoral. Para visualizar su origen, se separaron las fibras del vientre del músculo psoas mayor. Del nervio en cuestión se obtuvieron fotografías y se registraron variables biométricas que fue-ron efectuadas con una regla y un caliper de precisión. DESCRIPCIÓN En el lado derecho del cadáver de un individuo adul-to se observó un nervio femoral accesorio (Fig. 1), que se encontraba paralelo y lateral a...
In recent years, digital game-based language learning has gained a considerable amount of recognition from researchers and educators alike. Emerging as one of the most popular digital game genres, massively multiplayer online role-playing games (MMORPGs) have been at the forefront of online gaming communities and their popularity has expanded to the pedagogical field of second language learning. While the relationship between online gaming and language acquisition is amply documented in various studies, these have mainly been in controlled and formal contexts (gaming sessions observed by a teacher/researcher in a classroom setting). Therefore, this literature review particularly focuses on the lesser-studied aspect of digital gaming; namely in extramural settings of digital engagement. Journal articles published within the last six years have been perused and five have been chosen as part of this overview, which does not aim at discussing the implementation of digital games into curricula but rather at drawing attention to common threads within the articles and to certain niches for improvement. The review shows that the sociocultural and collaborative nature of the gaming experience is an important factor in extramural L2 learning and that it should be studied exclusively.
BACKGROUND Deep-seated intracranial lesions are challenging to resect completely and safely. Fluorescence-guided surgery (FGS) promotes the resection of malignant brain tumors (MBTs). Classically, FGS is performed using microscope equipped with a special filter. Fluorescence-guided neuroendoscopic resection of deep-seated brain tumors has not been reported yet. OBJECTIVE To evaluate the feasibility, safety, and effectiveness of the fluorescence-guided neuroendoscopic surgery in deep-seated MBTs. METHODS A total of 18 patients with high-grade glioma (HGG) and metastatic tumor (MT) underwent fluorescein sodium (FS)-guided neuroendoscopic surgery. Tumor removal was carried out using bimanual microsurgical techniques under endoscopic view. The degree of fluorescence staining was classified as “helpful” and “unhelpful” based on surgical observation. Extent of resection was determined using magnetic resonance imaging (MRI). Karnofsky Performance Status (KPS) score was used for evaluation of general physical performances of patients. RESULTS A total of 11 patients had HGG, and 7 had MT. No technical difficulty was encountered regarding the use of endoscopic technique. “Helpful” fluorescence staining was observed in 16 patients and fluorescent tissue was completely removed. Postoperative MRI confirmed gross total resection (88.9%). In 2 patients, FS enhancement was not helpful enough for tumor demarcation and postoperative MRI revealed near total resection (11.1%). No complication, adverse events, or side effects were encountered regarding the use of FS. KPS score of patients was improved at 3-mo follow-up. CONCLUSION FS-guided endoscopic resection is a feasible technique for deep-seated MBTs. It is safe, effective, and allows for a high rate of resection. Future prospective randomized studies are needed to confirm these preliminary data.
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