ABBREVIATIONS: AOD, atlanto-occipital dislocation BAI-BDI, basion-axial interval-basion dental interval CCI, condyle-C1 interval STS, soft tissue swelling TBI, traumatic brain injury
BACKGROUND:Significant controversy exists regarding when an athlete may return to contact sports after anterior cervical discectomy and fusion (ACDF). Return-to-play (RTP) recommendations are complicated due to a mix of medical factors, social pressures, and limited outcome data. OBJECTIVE:The aim of this study was to characterize our diagnostic and surgical criteria, intervention, postoperative imaging results, and rehabilitation and report RTP decisions and outcomes for professional athletes with cervical spine injuries. METHODS:Fifteen professional athletes who had undergone a 1-level ACDF by a single neurosurgeon were identified after a retrospective chart and radiographic review from 2003 to 2012. Patient records and imaging studies were recorded. RESULTS:Seven of the 15 athletes presented with neurapraxia, 8 with cervical radiculopathy, and 2 with hyperintensity of the spinal cord. Cervical stenosis with effacement of the cerebrospinal fluid signal was noted in 14 subjects. The operative level included C3-4 (4 patients), C4-5 (1 patient), C5-6 (8 patients), and C6-7 (2 patients). All athletes were cleared for RTP after a neurological examination with normal findings, and radiographic criteria for early fusion were confirmed. Thirteen of the 15 players returned to their sport between 2 and 12 months postoperatively (mean, 6 months), with 8 still participating. The RTP duration of the 5 who retired after full participation ranged from 1 to 3 years. All athletes remain asymptomatic for radicular or myelopathic symptoms or signs. CONCLUSION:After a single-level ACDF, an athlete may return to contact sports if there are normal findings on a neurological examination, full range of neck movement, and solid arthrodesis. There may be an increased risk of the development of adjacent segment disease above or below the level of fusion. Cord hyperintensity may not necessarily preclude RTP. ABBREVIATIONS:ACDF, anterior cervical discectomy and fusionCCN, cervical cord neurapraxiaNFL, National Football LeagueRTP, return to play
BACKGROUND:The Centers for Disease Control and Prevention have called for studies detailing the prevalence and burden of mild traumatic brain injury (mTBI) in the outpatient clinical setting. OBJECTIVE:The aim of this study was to describe the prevalence of outpatient visits for minor head injury and compare the number of outpatient visits for minor head injury with the number of emergency department (ED) visits. METHODS:This was a cross-sectional study of outpatient visits for minor head injuries from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). We examined outpatient visits for minor head injury between 2005 and 2009 and compared them with visits in the ED for the same diagnoses using simple survey-weighted descriptive statistics. RESULTS:In the 5-year study period, there were 4 146 777 outpatient visits for minor head injury and 6 077 147 ED visits for minor head injury. In the outpatient setting, 14% of office-based visits and 21% of hospital-based visits referred patients for advanced imaging, whereas 63% of minor head injury patients in the ED underwent imaging. A return visit was arranged for 54% of minor head injury patients in office-based practices and 29% of patients in hospital-based clinics, while 67% of minor head injury patients were given instructions to follow-up after an ED visit. CONCLUSION:More than 800 000 outpatient visits for minor head injury occur each year. The diagnostics and management associated with these visits differ from those seen in the ED setting. ABBREVIATIONS:CDC, Centers for Disease Control and PreventionED, emergency departmentmTBI, mTBI, traumatic brain injuryNAMCS, National Ambulatory Medical Care SurveyNHAMCS, National Hospital Ambulatory Medical Care SurveyPSI, primary sampling unitNeurosurgery Blog just shared an Instagram photo with you:
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The aging of our population means the incidence of cognitive impairment will continue to rise over the next decades, bringing urgency to our obligation to unravel this condition's complex pathophysiology. The prevailing conception from diseases such as Alzheimer dementia, stroke, and frontal temporal dementia is that progressive cognitive dysfunction, once identified, is an irreversible process, leading inexorably to a state of total dependence, and to family and societal burden. Any advance in our knowledge, including the prospect that cognitive decline may have a potentially treatable pathophysiology, creates some light in an otherwise apparently dark tunnel.
Original Article: http://www.neurology.org/cgi/content/short/80/23/2086?rss=1
Guidelines for the diagnosis and treatment of concussion were last published 15 years ago.1 Over the course of those years, much has changed, not only in our knowledge of this clinical syndrome, but also in the neurologist's role in the field of sports.
Original Article: http://www.neurology.org/cgi/content/short/80/24/2178?rss=1
The World Congress of Neurology (figure 1) theme "Neurology in a Globalizing World" acknowledges that science and increasingly medicine and neurology are becoming globalized. The best way to manage change is to shape it. It is becoming increasingly clear that brain diseases, particularly stroke and dementia, are projected to rise at a rate that could overwhelm our clinics and hospitals. Hence a new emphasis on prevention and the need to work across disciplines beyond our traditional roles. Neurologists are the guardians of the brain and need to take the lead role in advancing new approaches in stemming the tide of neurologic diseases.
Original Article: http://www.neurology.org/cgi/content/short/80/24/2248?rss=1
Can you train someone to be a nicer person? A recent study using meditation techniques shows that it might be possible. (The research is published in the journal Psychological Science .) [More]
Original Article: http://www.scientificamerican.com/podcast/episode.cfm?id=teaching-people-to-be-nice-13-06-24
Psychological impact of cerebral palsy on families: The African perspective
Olajide A Olawale1, Abraham N Deih2, Raphael KK Yaadar3
1 Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
2 Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
3 Department of Physiotherapy, Korle Bu Teaching Hospital, Accra, Ghana
DOI: 10.4103/0976-3147.112752
Background: Psychological stress associated with cerebral palsy (CP) is known to be one of the most depressing conditions of families. In the traditional African society, some peculiar factors may contribute to the stress. Aims: The aims of this study were to identify and describe, from the African perspective, the psychological impact of CP on families and determine the strategies adopted by families in coping with it. Settings and Design: The study was a cross-sectional descriptive survey conducted in the Physiotherapy Department of a tertiary hospital. Materials and Methods: Participants were 52 parents of children with CP. They completed a questionnaire designed to determine the degree of psychological stress on the families and strategies adopted to cope with the stress. Statistical Analysis: Descriptive statistics were used to show responses in graphical formats. Results: Respondents agreed that having adequate knowledge of CP would help them cope well with the demands of taking care of children with CP. 38.5% of respondents said that people in the society accused them of some wrongdoing that has made their children to have CP. Personal problems experienced include loss of job, lack of concentration at work, loss of family joy, and derangement of financial affairs of the family. 26 (50%) of them resort to religious/spiritual intervention as an alternative or complementary mode of treatment for their children while 28% resort to dependence on the extended family system for support. Conclusion: Families caring for children with CP generally have a positive attitude towards their children. However, there is need to educate the public on the causes of CP and treatment options available to families.
Keywords: Cerebral palsy, coping strategy, family, psychological stress
| How to cite this article: Olawale OA, Deih AN, Yaadar RK. Psychological impact of cerebral palsy on families: The African perspective. J Neurosci Rural Pract 2013;4:159-63 |
How to cite this URL:
Olawale OA, Deih AN, Yaadar RK. Psychological impact of cerebral palsy on families: The African perspective. J Neurosci Rural Pract [serial online] 2013 [cited 2013 Jun 25];4:159-63. Available from: http://www.ruralneuropractice.com/text.asp?2013/4/2/159/112752
The post Psychological impact of cerebral palsy on families appeared first on NEUROSURGERY BLOG.
Original Article: http://neurocirurgiabr.com/psychological-impact-of-cerebral-palsy-on-families/?utm_source=rss&utm_medium=rss&utm_campaign=psychological-impact-of-cerebral-palsy-on-families
The gadget blogs may work themselves into a frenzy over megapixels and processor speed. But if you want to know what really dazzles the masses, consider a feature that's rarely called out by name: machine recognition of real-world sights and sounds. [More]
Original Article: http://www.scientificamerican.com/article.cfm?id=software-recognition-software-technology-amazing-but-not-enough
You are visiting your elderly aunt, and you notice her speech begin to slur. She seems to be having trouble staying upright in her seat, and she looks confused. You recognize the signs of a stroke. You shout for your uncle to call 911 as you help your aunt lie down in a comfortable position. You run your fingers gently over her lips, face and fingertips as you sing into her ear and continue talking to her. The EMTs rush in and outfit her in what looks like a bathing cap encrusted with electronic bling--a kind of defibrillator designed to deliver electrical stimulation to her brain. As they carry her out on a stretcher, your worry is slightly eased, knowing that the sensory stimulation you gave her in those first minutes may have saved her from serious disability. [More]
Original Article: http://www.scientificamerican.com/article.cfm?id=can-caress-protect-brain-from-stroke
You are visiting your elderly aunt, and you notice her speech begin to slur. She seems to be having trouble staying upright in her seat, and she looks confused. You recognize the signs of a stroke. You shout for your uncle to call 911 as you help your aunt lie down in a comfortable position. You run your fingers gently over her lips, face and fingertips as you sing into her ear and continue talking to her. The EMTs rush in and outfit her in what looks like a bathing cap encrusted with electronic bling--a kind of defibrillator designed to deliver electrical stimulation to her brain. As they carry her out on a stretcher, your worry is slightly eased, knowing that the sensory stimulation you gave her in those first minutes may have saved her from serious disability. [More]
Original Article: http://www.scientificamerican.com/article.cfm?id=can-caress-protect-brain-from-stroke
Maroon, Joseph C. MD*,‡; Bost, Jeffrey W. PA-C*; Petraglia, Anthony L. MD§; LePere, Darren B. BS*; Norwig, John ATC¶; Amann, Christopher MD‖; Sampson, Michael DO‖; El-Kadi, Matt MD, PhD*
*Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
‡Team Neurosurgeon, Pittsburgh Steelers, Pittsburgh, Pennsylvania;
§Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York;
¶Head Athletic Trainer, Pittsburgh Steelers, Pittsburgh, Pennsylvania;
‖Ringside Physician, World Wrestling Entertainment, Inc, Stamford, Connecticut
Correspondence: Jeff Bost, PA-C, Department of Neurosurgery, UPMC Presbyterian Hospital, 200 Lothrop Street, Suite 5C, Pittsburgh, PA 15213. E-mail: bostj@upmc.edu
Received September 28, 2012
Accepted March 19, 2013
OBJECTIVE: The aim of this study was to characterize our diagnostic and surgical criteria, intervention, postoperative imaging results, and rehabilitation and report RTP decisions and outcomes for professional athletes with cervical spine injuries.
METHODS: Fifteen professional athletes who had undergone a 1-level ACDF by a single neurosurgeon were identified after a retrospective chart and radiographic review from 2003 to 2012. Patient records and imaging studies were recorded.
RESULTS: Seven of the 15 athletes presented with neurapraxia, 8 with cervical radiculopathy, and 2 with hyperintensity of the spinal cord. Cervical stenosis with effacement of the cerebrospinal fluid signal was noted in 14 subjects. The operative level included C3-4 (4 patients), C4-5 (1 patient), C5-6 (8 patients), and C6-7 (2 patients). All athletes were cleared for RTP after a neurological examination with normal findings, and radiographic criteria for early fusion were confirmed. Thirteen of the 15 players returned to their sport between 2 and 12 months postoperatively (mean, 6 months), with 8 still participating. The RTP duration of the 5 who retired after full participation ranged from 1 to 3 years. All athletes remain asymptomatic for radicular or myelopathic symptoms or signs.
CONCLUSION: After a single-level ACDF, an athlete may return to contact sports if there are normal findings on a neurological examination, full range of neck movement, and solid arthrodesis. There may be an increased risk of the development of adjacent segment disease above or below the level of fusion. Cord hyperintensity may not necessarily preclude RTP.
ABBREVIATIONS: ACDF, anterior cervical discectomy and fusionCCN, cervical cord neurapraxiaNFL, National Football LeagueRTP, return to play
The post Outcomes After Anterior Cervical Discectomy and Fusion in Professional Athletes appeared first on NEUROSURGERY BLOG.
Original Article: http://neurocirurgiabr.com/outcomes-after-anterior-cervical-discectomy-and-fusion-in-professional-athletes/?utm_source=rss&utm_medium=rss&utm_campaign=outcomes-after-anterior-cervical-discectomy-and-fusion-in-professional-athletes
A 44-year-old man presented with acute left facial weakness. Left Bell palsy with involvement of all motor divisions was diagnosed through neurologic examination and neurophysiologic studies. However, the clinical course was atypical for Bell palsy, as it worsened despite medical treatment for 2 months, prompting detailed neuroimaging studies. CT angiography revealed facial arteriovenous malformation (AVM) (figure, A), and gadolinium-enhanced T1-weighted axial MRI showed that the AVM compressed the facial nerve distal to the stylomastoid foramen (figure, B). The patient underwent digital subtraction angiography and coil embolization 2 months after neuroimaging studies (figure, C), and his symptoms improved immediately after intervention. Parotid tumor and hemangioma have previously been reported as rare causes of facial palsy.1,2 Our case shows that AVM can also cause facial palsy.
Original Article: http://www.neurology.org/cgi/content/short/80/24/e252?rss=1
Thinking in Numbers: On Life, Love, Meaning, and Math Daniel Tammet Little, Brown, 2013 (?26)
Tammet is famous for his unusual brain: he possesses the extraordinary number skills of an autistic savant with very few of the intellectual limitations associated with autism. Because of his gifts, neuroscientists have spent time with him to gain deeper insight into the autistic mind. He is also a best-selling author, and his new book is a collection of beautifully wrought essays about numbers, which he experiences as shapes, colors and textures. Here Tammet ruminates on the number 9 (he hails from a nine-sibling family outside London), the probability of finding life in outer space and, in one of the book's highlights, describes how it felt to recite by memory the digits of pi to the 22,514th decimal place, a process that took more than five hours. He writes that he memorized the numbers in much the same way a painter takes in a beautiful landscape: by sifting light particles (or digits in Tammet's case) "by intuitive meaning and personal taste."
Original Article: http://www.scientificamerican.com/article.cfm?id=recommended-thinking-in-numbers
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Neurosurgical practice to take referrals, new patients next week WatertownDailyTimes.com Neurosurgery will return to the north country next week, when Neurological Associates of Northern New York begins accepting referrals and new patients. Associated with a Syracuse neurosurgical practice, the Watertown office will have one full-time ... |
 University at Buffalo Reporter | Bennett students receive intro to neurosurgery through ISEP University at Buffalo Reporter Adnan Siddiqui, associate professor in the UB Department of Neurosurgery in the School of Medicine and Biomedical Sciences, led the tour, illustrating the effective and complex surgery performed to treat intracranial aneurysms. He explained how blood ... |
Medina LS, Sanelli PC, Jarvik JG, eds. Evidence-Based Neuroimaging Diagnosis and Treatment: Improving the Quality of Neuroimaging in Patient Care. Springer; 2013; $239.
Evidence-Based Neuroimaging Diagnosis and Treatment: Improving the Quality of Neuroimaging in Patient Care, edited by Drs. Medina, Sanelli, and Jarvik, is an important new publication that deals with issues we do not consider often enough in our daily work: that is, is there evidence that the imaging we are performing is meaningful and has a positive effect on patient care and outcomes?
In a logical and easy-to-read manner, topics are presented succinctly with important accompanying tables/charts/images without burdening the reader with overwhelming statistics and data. I particularly like the fact that each chapter begins with key points (a reminder of the effective communication dictum of "tell 'em what you are going to tell 'em, then tell 'em"), followed by the information each author wishes to convey. Admixed are what a few authors have called Take-Home Tables (I have already copied them, but I won't take them home), which boils down the essentials of some easily forgotten but important metrics and statistics.
There are 100 authors/co-authors; the editors have called on experts in many areas of neuroradiology and associated specialties. There are 5 sections to the book: (1) An Overview of Evidence-Based Imaging (2 chapters); (2) Special Topics in Evidence-Based Imaging (6 chapters); (3) Brain (18 chapters); (4) Spine (6 chapters); (5) Head and Neck (7 chapters). For those who feel a bit shaky in medical statistics and related topics, the first 2 chapters contain excellent material in a digestible form. The second part of the book contains topics/issues which arise frequently but are not to be easily found in our journals—for example, what to do about incidental findings, the value of decision support systems, radiation exposure in imaging, contrast risks, medicolegal issues in neuroimaging, and regulatory concerns. While these topics would seem to require many pages, the authors cover the material nicely in less than 100 pages.
The remainder of the book takes us to specific diagnoses, drawing us to look at what evidence there is for what we do in these diseases. So, as just one example, let's look at seizure disorders. The chapter starts with an outline of what is contained in the 20 following pages, then the key points (11) and background information such as pathophysiology, epidemiology, and societal costs. What follows is the meat of the chapter; that is, an enumeration of the main issues involved in seizures, each of which has a separate section in which a brief (1-3 sentences) summary is given, followed by paragraphs of supporting evidence under the heading. We read here of evidence related to what types of seizures should be imaged, what specific studies are utilized in temporal lobe epilepsy (and which are more sensitive/specific), whether high-field (3T) imaging improves detection of causative lesions, and what functional imaging is most beneficial (PET, fMRI, DTI). Each chapter in this book goes through the same format; some have images, some don't. But, of course, the inclusion of imaging studies per se is not the object of the book.
The reader of this review can imagine the plethora of diagnoses and conditions. Looking over the topics, one could always think of one or two more subjects, but the common issues are deftly covered. The book also goes into treatment (as the book title indicates), so we encounter an analysis, for example, of treatment options for aneurysms (coiling vs. clipping), where 2 of the 3 authors are neurosurgeons, or the embolic material to be used in AVM treatment, or the value of various procedures related to spine intervention. Of course, each of these topics cover a number of other issues related to aneurysms, AVMs, or spine injections.
The authors have blazed a new trail in radiology publications and are to be congratulated for that. The book should be read by every neuroradiologist. It puts into perspective and educates the reader on those problems we will certainly encounter in justifying what we do as scrutiny by governmental agencies increases.
Original Article: http://www.ajnrblog.org/2013/06/21/evidence-based-neuroimaging-diagnosis-and-treatment-improving-the-quality-of-neuroimaging-in-patient-care/
