Conradsendickey3987

Background The premamillary artery (PMA) usually arises from the posterior communicating artery. Thus, an internal carotid artery (ICA) origin for PMA is rare. We report a rare case of a patient who presented with subarachnoid hemorrhage resulting from kissing aneurysms arising from the origin of the anterior choroidal artery and the aberrant origin of PMA and was successfully treated with coil embolization. Case description A conscious and alert 36-year-old woman arrived at our hospital with a severe headache. LY2835219 Computed tomography (CT) of the head showed a thin subarachnoid hemorrhage. CT angiography revealed kissing aneurysms arising from the ICA. Digital subtraction angiography showed that these kissing aneurysms had arisen from the anterior choroidal artery and the aberrant origin of the PMA. Endovascular coil embolization was performed for both aneurysms. Her clinical course was good, and she was discharged from our hospital 20 days after admission. Conclusions To the best of our knowledge, the present study is the first report of a ruptured saccular PMA aneurysm arising from ICA that was successfully treated with coil embolization. Three-dimensional digital subtraction angiography and cone-beam CT were useful for confirming the precise vasculature of the PMA.Background Mexico declared the first case of novel coronavirus disease (COVID-19) in February 2020. At the time we write this article, our country is facing a community spread phase, expecting a rapid increase in the number of cases and fatalities. The Fray Antonio Alcalde Civil Hospital of Guadalajara has been declared a non-COVID-19 hospital with the mission of providing care to patients already registered and also those transferred from neurosurgical departments of neighboring centers, which have been converted into COVID-19 only hospitals. Methods An organized response regarding personnel, surgical case selection, operating room behavior, and facility reorganization were designed to prevent an internal coronavirus outbreak in the neurosurgery department at the Fray Antonio Alcalde Civil Hospital of Guadalajara. Results Distancing actions by the staff and residents, including ward case discussions, neurosurgery rounds, and classes, will be carried out virtually. We classified neurosurgical patients into 4 groups depending on whether their condition demands care in 0-6 hours, 6-48 hours, 48 hours to 14 days, and >14 days. Subsequently, a questionnaire with epidemiologic, radiologic, clinical, and serologic criteria will be applied to determine the risk of COVID-19 infection to define to which area they are going to be transferred according to the different risk zones in our facility. Conclusions Despite not being a COVID-19 center, we consider all patients at the neurosurgical ward and staff members as asymptomatic carriers or infected in the preclinical period. Specific measures must be taken to ensure the safety and care of neurosurgical patients and medical staff during the community spread phase.Background Intracranial arterial dissection (IAD) is known to exhibit various patterns of arterial imaging features such as stenosis and dilation; however, the genetic background of IAD has not been elucidated so far. RNF213 was recently identified as a susceptibility gene for moyamoya disease (MMD) and intracranial artery stenosis (ICAS). More recently, RNF213 p.Arg4810Lys also has been shown to be associated with various systemic vascular diseases. RNF213 p.Arg4810Lys is beginning to attract attention as a genetic factor that causes systemic vascular disease. Case description Herein, we report a rare case of de novo progression of the intracranial vascular lesion with the RNF213 p.Arg4810Lys variant; which firstly presented IAD of middle cerebral artery (MCA) with subarachnoid hemorrhage, secondly progressed into the ICAS, and finally evolved into the MMD-like angiogenesis over six years. Conclusions The present case suggests that IAD of MCA could be associated with RNF213 p.Arg4810Lys variant. This genetic variant could also have a key role in the overlap among the different disease states. A large-scale genetic analysis study of the IADs of the anterior circulation is awaited. To qualify the significance of RNF213 p.Arg4810Lys variant as a stroke risk allele, accumulation of various cases of cerebrovascular lesions would be essential.Background Deep brain stimulation of the ventral intermediate nucleus (VIM) or caudal zona incerta (cZI) is effective for refractory essential tremor (ET). To refine stereotactic planning for lead placement, we developed a unique individualized anatomy-based planning protocol that targets both the VIM and the cZI in patients with ET. Methods 33 patients with ET underwent VIM-cZI lead implantation with targeting based on our protocol. Indirect targeting was adjusted based on anatomic landmarks as reference lines bisecting the red nuclei and ipsilateral subthalamus. Outcomes were evaluated through the follow-up of 31.1 ± 18.4 months. Active contact coordinates were obtained from reconstructed electrodes in the Montreal Neurological Institute space using the MATLAB Lead-DBS toolbox. Results Mean tremor improvement was 79.7% ± 22.4% and remained stable throughout the follow-up period. Active contacts at last postoperative visit had mean Montreal Neurological Institute coordinates of 15.5 ± 1.6 mm lateral to the intercommissural line, 15.3 ± 1.8 mm posterior to the anterior commissure, and 1.4 ± 2.9 mm below the intercommissural plane. No hemorrhagic complications were observed in the analyzed group. Conclusions Individualized anatomy-based VIM-cZI targeting is feasible and safe and is associated with favorable tremor outcomes.Background As a common non-neurologic complication following traumatic brain injury (TBI), acute kidney injury (AKI) is a risk factor of mortality. Some studies confirmed the predictive value of procalcitonin (PCT) on AKI in several clinical settings. We designed this study to explore the predictive value of PCT on AKI following TBI. Methods We retrospectively enrolled patients admitted to our hospital with TBI from February 2015 to June 2019. Multivariate logistic regression analysis was performed to find risk factors of AKI and construct predictive model for AKI. Receiver operating characteristics (ROC) curves were drawn to compare the predictive value of PCT and constructed model. Results A total of 214 patients was included in this study. The incidence of AKI following TBI was 25.70% in this study. Compared with non-AKI group, AKI group had higher age (P =0.031), lower GCS (P less then 0.001), higher incidence of coagulopathy (P less then 0.001) and shock (P less then 0.001). Moreover, patients complicated with AKI had higher in-hospital mortality (P less then 0.001) and worse 90-day outcome (P less then 0.001). Multivariate logistic regression analysis indicated that age (P =0.033), PCT (P =0.002), serum chlorine(P=0.011) and creatinine (P less then 0.001) were independent risk factors of AKI. We constructed predictive model using these four risk factors. The area under ROC curves (AUC) of predictive model was 0.928, which was significantly higher than that of single PCT value (AUC=0.833) (Z=2.395, P less then 0.05). Conclusions PCT is valuable in predicting AKI following TBI. link2 Try to avoid AKI following TBI, physicians can adjust treatment strategies according to the level of PCT.Background Cerebral aneurysm and aneurysm rupture have rarely been reported in the literature during pregnancy. Aneurysm might rupture and may cause intracranial hemorrhage during or after pregnancy. Aneurysmal subarachnoid hemorrhage (aSAH) during pregnancy presents a challenge regarding treatment and management. There is no institution which has a large patient population or experience in managing this condition during pregnancy in the literature. Due to the limited number of cases, there are no available treatment guidelines. Thus, treatment is usually based on a case-by-case approach. Case description The present study reports the case of a 31-year-old pregnant female patient who presented with sudden onset headache and diagnosed as subarachnoid hemorrhage at 27th week of pregnancy. By magnetic resonance imaging (MRI) and digital subtraction angiography (DSA), the diagnosis of subarachnoid hemorrhage and aneurysm located on anterior communicating artery was made. The aneurysm was treated by surgical clipping. The pregnancy continued successfully until the 35th gestational week, delivery was done by planned cesarean section due preeclampsia and fetal growth retardation, planned caesarean section (C/S) was successfully performed. Postoperative follow-up was uneventful. Conclusion Here in we present our experience in the management of aSAH and maternal and fetal outcomes of this rare disease. More cases and multi-center studies are needed to achieve the standardized management of this disease.Background Patients with cervical spinal cord injuries (CSCIs) may be required to undergo tracheostomy. However, in patients undergoing anterior cervical fusion (ACF), percutaneous dilational tracheostomy (PDT) may be delayed given the risk of cross-contamination. We aimed to evaluate the risk of surgical site infection (SSI) in early PDT in patients with traumatic CSCI after ACF. Methods All trauma patients admitted to the intensive care unit from 2008 to 2018 were retrospectively analyzed. Patients with CSCIs who underwent both ACF and PDT were identified, with or without posterior cervical fusion. Cases were classified as having undergone early PDT (≤4 days after ACF) versus late PDT (>4 days after ACF). Propensity scores were matched, and outcomes were compared between matched groups to reduce confounding by indication. Results From a total of 133 enrolled patients, a well-balanced propensity-matched cohort of 68 patients was defined. On the basis of the comparison of outcomes after matching, no significant difference in SSI was observed between both groups. link3 There was no patient with SSI in the early PDT group (0%), whereas there were 2 SSI patients (5.9%) in the late PDT group (P = 0.493) The tracheostomy site was involved in 1, and the posterior approach site was involved in the other. Early PDT was associated with a shorter duration of mechanical ventilation (P = 0.042). There were no significant differences in the length of intensive care unit stay and hospital mortality between groups. Conclusions Early PDT within 4 days after ACF did not increase the risk of SSI compared with late PDT in patients with traumatic CSCIs.We present a rare case of multiple intracranial arteriovenous fistulas (AVFs). A young female presented with headache and a left eyelid pulsatile swelling. Magnetic resonance imaging demonstrated numerous dilated cortical veins, along with a prominent left superior ophthalmic vein. A diagnostic cerebral angiogram revealed 5 distinct AVFs including 4 dural AVFs (dAVFs) and a pial AVF (pAVF). The largest dAVF was at the superior sagittal sinus (SSS). The others included bilateral ethmoidal, torcular, and a pAVF arising of the right pericallosal artery. She was treated by endovascular transarterial Onyx embolization. Only the SSS fistula was treated via middle meningeal artery feeders with complete occlusion. Immediate follow-up angiogram also showed complete spontaneous occlusion of the untreated dAVFs and the pial AVF. This case is exceedingly unique considering the multiplicity of AVFs, concurrent presence of pial and dural AVF, and spontaneous occlusion of all untreated AVFs after embolizing the largest shunting fistula.