Neurosurgery Blog: November 2014

Saturday, November 29, 2014

Neurosurgery Internet TV Station, Presents:

A Case Presentation by a Russian Neurosurgeon, and a Discussion by a Panel of Neurosurgeons from around the world

Just clik:

http://youtu.be/W8CB11SOmRQ

https://plus.google.com/events/chlolf4bbvr4tli1d207k8ahfcg

Sex and Suicide: Why Do More Men than Women Kill Themselves?

Scientific American: Mind and Brain

How far is it from being to nothingness? I hope it's a journey you never decide to take, but wherever death by firearm is the most common method of suicide, it's about half an inch.

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/blog/post/sex-and-suicide-why-do-more-men-than-women-kill-themselves/

Internal carotid artery dissection after a roller-coaster ride in a 4-year-old. Case Report and Review of the Literature

Pediatric Neurology

A previously healthy 4 year-old boy developed acute onset of left sided weakness when flying home from a trip to an amusement park. He had frequented two rollercoaster rides the day prior. Upon evaluation, he was found to have an acute right middle cerebral artery (MCA) territory infarction. Cerebral angiogram showed dissection of the right cervical internal carotid artery (ICA) and right MCA occlusion involving the M1 segment. He was treated with aspirin. Evaluation for underlying connective tissue diseases was unremarkable.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00676-6/abstract?rss=yes

Mental Health Crises Online: Is Social Media a Friend or Foe?

Scientific American: Mind and Brain

People are increasingly broadcasting symptoms of mental illness on social media. We should listen

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/mental-health-crises-online-is-social-media-a-friend-or-foe/

[Articles] Thrombolysis and clinical outcome in patients with stroke after implementation of the Tyrol Stroke Pathway: a retrospective observational study

The Lancet Neurology

During the period of implementation of our comprehensive stroke management programme, thrombolysis administration increased and clinical outcome significantly improved, although mortality did not change. We hope that these results will guide health authorities and stroke physicians elsewhere when implementing similar programmes for patients with stroke.

Original Article: http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70286-8/abstract?rss=yes

FDA Panel Warns Against Certain Back Pain Injections

Medscape NeurologyHeadlines

Because of possibly catastrophic neurological risks, an FDA committee has recommended contraindication of particulate corticosteroid injections in the cervical spine, using a transforaminal approach.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/835613?src=rss

Friday, November 28, 2014

People Love Their Smartphones but Hate the Batteries [Survey Results]

Scientific American: Mind and Brain

Scientific American readers say smartphones have not replaced tablets or PCs, and still need better batteries, cameras and biometric security options

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/people-love-their-smartphones-but-hate-the-batteries-survey-results/

Wednesday, November 26, 2014

Brain network found that is vulnerable to Alzheimer's and schizophrenia

Neurology News & Neuroscience News from Medical News Today

A specific brain network within grey matter develops later than the rest of the brain and degenerates first in older age, says new study, shedding light on neurological disorders.

Original Article: http://www.medicalnewstoday.com/articles/285978.php

Brain Insulin Resistance Marker May Diagnose Alzheimer's

Medscape NeurologyHeadlines

A novel biomarker of brain insulin resistance defective in Alzheimer's and detectable in blood shows promise for early preclinical diagnosis.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/835489?src=rss

Excess protein during brain development causes abnormalities and faulty connections in laboratory studies, may trigger schizophrenia

Neurology News & Neuroscience News from Medical News Today

A gene associated with schizophrenia plays a role in brain development and may help to explain the biological process of the disease, according to new Rutgers research.

Original Article: http://www.medicalnewstoday.com/releases/285958.php

New ways to assess brain function in Parkinson disease

Neurology recent issues

Over the past 40 years, our understanding of the brain and its function has dramatically changed. Much of this has been due to new ways of looking at the living brain. It was in the 1970s that computed tomography scans (CT or CAT scans) were first used. By the 1980s CAT scans were commonplace. Magnetic resonance imaging (MRI) was developed in the 1980s. It became widely available thereafter and is now a standard way of looking at the brain and other parts of the nervous system. CAT and MRI have allowed scientists to study the structure of the living brain in detail. In addition, doctors and scientists have been able to study neurologic disease in ways that previously were not possible.

Original Article: http://www.neurology.org/cgi/content/short/83/22/e199?rss=1

Art and Science Team Up To Steal Your Attention With Magic

Scientific American: Mind and Brain

Artist Ellen Levy teamed up with neuroscientist Michael E. Goldberg, Director of the Mahoney Center for Brain and Behavior at Columbia University in New York, to apply the concept of change blindness...

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/blog/post/artist-ellen-levy-steals-your-attention/

Cost to Develop New Pharmaceutical Drug Now Exceeds $2.5B

Scientific American: Mind and Brain

A benchmark report estimates that the cost of bringing a drug to market has more than doubled in the past 10 years

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/cost-to-develop-new-pharmaceutical-drug-now-exceeds-2-5b/

Multimodality Monitoring, Inflammation, and Neuroregeneration in Subarachnoid Hemorrhage

Neurosurgery - Most Popular Articles

BACKGROUND: Stroke, including subarachnoid hemorrhage (SAH), is one of the leading causes of morbidity and mortality worldwide. The mortality rate of poor-grade SAH ranges from 34% to 52%. In an attempt to improve SAH outcomes, clinical research on multimodality monitoring has been performed, as has basic science research on inflammation and neuroregeneration (which can occur due to injury-induced neurogenesis). Nevertheless, the current literature does not focus on the integrated study of these fields. Multimodality monitoring corresponds to physiological data obtained during clinical management by both noninvasive and invasive methods. Regarding inflammation and neuroregeneration, evidence suggests that, in all types of stroke, a proinflammatory phase and an anti-inflammatory phase occur consecutively; these phases affect neurogenesis, which is also influenced by other pathophysiological features of stroke, such as ischemia, seizures, and spreading depression. OBJECTIVE: To assess whether injury-induced neurogenesis is a prognostic factor in poor-grade SAH that can be monitored and modulated. METHODS: We propose a protocol for multimodality monitoring-guided hypothermia in poor-grade SAH in which cellular and molecular markers of inflammation and neuroregeneration can be monitored in parallel with clinical and multimodal data. EXPECTED OUTCOMES: This study may reveal correlations between markers of inflammation and neurogenesis in blood and cerebrospinal fluid, based on clinical and multimodality monitoring parameters. DISCUSSION: This protocol has the potential to lead to new therapies for acute, diffuse, and severe brain diseases. ABBREVIATIONS: BBB, blood-brain barrier CPP, cerebral perfusion pressure EEG, electroencephalography ICP, intracranial pressure IL, interleukin MCA, middle cerebral artery SAH, subarachnoid hemorrhage SD, spreading depression SGZ, subgranular zone SVZ, subventricular zone TCD, transcranial Doppler

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/12000/Multimodality_Monitoring,_Inflammation,_and.18.aspx

Research team treats brain injuries in mice using bone marrow stem cells and antioxidants

Neurology News & Neuroscience News from Medical News Today

Researchers of CEU Cardenal Herrera University (CEU-UCH) for the first time transplanted bone marrow stem cells into damaged brain tissue while applying lipoic acid (a potent antioxidant), with the...

Original Article: http://www.medicalnewstoday.com/releases/285932.php

CNS siderosis and orthostatic headache as a delayed complication of spinal surgery

Neurology current issue

A 61-year-old man presented with orthostatic headaches and asymmetric sensorineural hearing loss (ASNHL) 8 years after cervical laminoplasty. Percussion of his cervical spine elicited Lhermitte sign. Brain MRI demonstrated trace intraventricular blood and mild superficial siderosis (figure 1); digital subtraction angiogram had normal results. CT myelogram revealed fractured hardware puncturing adjacent dura with resultant CSF leak (figure 2).

Original Article: http://www.neurology.org/cgi/content/short/83/22/2097?rss=1

Resting-state fMRI sheds light on neural substrates of cognitive decline in Parkinson disease

Neurology current issue

Connectivity is a distinctive feature of the brain, and the integrity of functional network dynamics is crucial for normal functioning. Resting-state functional MRI (RS-fMRI) is a measure of spontaneous low-frequency (<0.08–0.1 Hz) fluctuations in the blood oxygen level–dependent (BOLD) signal while the patient lies quietly in the scanner without doing any specific task.¹ Functional connectivity is defined by temporal correlations of the BOLD signal between spatially distinct brain regions. RS-fMRI can be obtained in about 8 minutes and added to the structural MRI most patients receive as part of a routine acquisition, although the data analysis is time-consuming and needs expertise.

Original Article: http://www.neurology.org/cgi/content/short/83/22/2000?rss=1

Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association [AHA/ASA Guideline]

Stroke current issue

The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Original Article: http://stroke.ahajournals.org/cgi/content/short/45/12/3754?rss=1

Three-Dimensional Microsurgical Anatomy and the Safe Entry Zones of the Brainstem

Neurosurgery - Most Popular Articles

BACKGROUND: There have been no studies of the structure and safe surgical entry zones of the brainstem based on fiber dissection studies combined with 3-dimensional (3-D) photography. OBJECTIVE: To examine the 3-D internal architecture and relationships of the proposed safe entry zones into the midbrain, pons, and medulla. METHODS: Fifteen formalin and alcohol-fixed human brainstems were dissected by using fiber dissection techniques, ×6 to ×40 magnification, and 3-D photography to define the anatomy and the safe entry zones. The entry zones evaluated were the perioculomotor, lateral mesencephalic sulcus, and supra- and infracollicular areas in the midbrain; the peritrigeminal zone, supra- and infrafacial approaches, acoustic area, and median sulcus above the facial colliculus in the pons; and the anterolateral, postolivary, and dorsal medullary sulci in the medulla. RESULTS: The safest approach for lesions located below the surface is usually the shortest and most direct route. Previous studies have often focused on surface structures. In this study, the deeper structures that may be at risk in each of the proposed safe entry zones plus the borders of each entry zone were defined. This study includes an examination of the relationships of the cerebellar peduncles, long tracts, intra-axial segments of the cranial nerves, and important nuclei of the brainstem to the proposed safe entry zones. CONCLUSION: Fiber dissection technique in combination with the 3-D photography is a useful addition to the goal of making entry into the brainstem more accurate and safe. ABBREVIATION: DTI, diffusion tensor imaging

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/12001/Three_Dimensional_Microsurgical_Anatomy_and_the.12.aspx

Exploring the Scope of Post–Intensive Care Syndrome Therapy and Care: Engagement of Non–Critical Care Providers and Survivors in a Second Stakeholders Meeting

Critical Care Medicine - Most Popular Articles

Background: Increasing numbers of survivors of critical illness are at risk for physical, cognitive, and/or mental health impairments that may persist for months or years after hospital discharge. The post–intensive care syndrome framework encompassing these multidimensional morbidities was developed at the 2010 Society of Critical Care Medicine conference on improving long-term outcomes after critical illness for survivors and their families. Objectives: To report on engagement with non–critical care providers and survivors during the 2012 Society of Critical Care Medicine post–intensive care syndrome stakeholder conference. Task groups developed strategies and resources required for raising awareness and education, understanding and addressing barriers to clinical practice, and identifying research gaps and resources, aimed at improving patient and family outcomes. Participants: Representatives from 21 professional associations or health systems involved in the provision of both critical care and rehabilitation of ICU survivors in the United States and ICU survivors and family members. Design: Stakeholder consensus meeting. Researchers presented summaries on morbidities for survivors and their families, whereas survivors presented their own experiences. Meeting Outcomes: Future steps were planned regarding 1) recognizing, preventing, and treating post–intensive care syndrome, 2) building strategies for institutional capacity to support and partner with survivors and families, and 3) understanding and addressing barriers to practice. There was recognition of the need for systematic and frequent assessment for post–intensive care syndrome across the continuum of care, including explicit "functional reconciliation" (assessing gaps between a patient's pre-ICU and current functional ability at all intra- and interinstitutional transitions of care). Future post–intensive care syndrome research topic areas were identified across the continuum of recovery: characterization of at-risk patients (including recognizing risk factors, mechanisms of injury, and optimal screening instruments), prevention and treatment interventions, and outcomes research for patients and families. Conclusions: Raising awareness of post–intensive care syndrome for the public and both critical care and non–critical care clinicians will inform a more coordinated approach to treatment and support during recovery after critical illness. Continued conceptual development and engagement with additional stakeholders is required.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/12000/Exploring_the_Scope_of_Post_Intensive_Care.7.aspx

Mortality Threefold Higher in Epilepsy

Medscape NeurologyHeadlines

A new meta-analysis has found mortality rates to be three times higher in epilepsy than in the general population. Future research must look beyond mortality to risk factors and mechanisms.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/835488?src=rss

Child neuroanatomical, neurocognitive and visual acuity outcomes with maternal opioid- and polysubstance detoxification

Pediatric Neurology

Maternal opioid- and polysubstance use during pregnancy is associated with increased risk of child neurocognitive and visual problems and neuroanatomical differences. We hypothesized that in contrast to findings from a previous study of children born to mothers not detoxified, children born to detoxified mothers would not show gross neuroanatomical and neurocognitive differences.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00677-8/abstract?rss=yes

Psychiatric Symptoms and Acute Care Service Utilization Over the Course of the Year Following Medical-Surgical ICU Admission: A Longitudinal Investigation*

Critical Care Medicine - Most Popular Articles

Objective: To determine if the presence of in-hospital substantial acute stress symptoms, as well as substantial depressive or posttraumatic stress disorder symptoms at 3 months post-ICU, are associated with increased acute care service utilization over the course of the year following medical-surgical ICU admission. Design: Longitudinal cohort study. Setting: Academic medical center. Patients: One hundred fifty patients who are 18 years old or older admitted to medical-surgical ICUs for over 24 hours. Interventions: None. Measurements and Main Results: Participants were interviewed in-hospital to ascertain substantial acute stress symptoms using the Posttraumatic Stress Disorder Checklist-Civilian version. Substantial depressive and posttraumatic stress disorder symptoms were assessed using the Patient Health Questionnaire-9 and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively, at 3 months post-ICU. The number of rehospitalizations and emergency department visits were ascertained at 3 and 12 months post-ICU using the Cornell Services Index. After adjusting for participant and clinical characteristics, in-hospital substantial acute stress symptoms were independently associated with greater risk of an additional hospitalization (relative risk, 3.00; 95% CI, 1.80–4.99) over the year post-ICU. Substantial posttraumatic stress disorder symptoms at 3 months post-ICU were independently associated with greater risk of an additional emergency department visit during the subsequent 9 months (relative risk, 2.29; 95% CI, 1.09–4.84) even after adjusting for both rehospitalizations and emergency department visits between the index hospitalization and 3 months post-ICU. Conclusions: Post-ICU psychiatric morbidity is associated with increased acute care service utilization during the year after a medical-surgical ICU admission. Early interventions for at-risk ICU survivors may improve long-term outcomes and reduce subsequent acute care utilization.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/12000/Psychiatric_Symptoms_and_Acute_Care_Service.2.aspx

Saturday, November 22, 2014

The molecular bases of the suicidal brain

Nature Reviews Neuroscience - Issue - nature.com science feeds

Nature Reviews Neuroscience 15, 802 (2014). doi:10.1038/nrn3839

Author: Gustavo Turecki

Suicide ranks among the leading causes of death around the world and takes a heavy emotional and public health toll on most societies. Both distal and proximal factors contribute to suicidal behaviour. Distal factors — such as familial and genetic predisposition, as well as early-life

Original Article: http://feeds.nature.com/~r/nrn/rss/current/~3/5b_ME1oHNIU/nrn3839

Role of Hemoglobin and Iron in Hydrocephalus After Neonatal Intraventricular Hemorrhage

Neurosurgery - Current Issue

BACKGROUND: Neonatal germinal matrix hemorrhage/intraventricular hemorrhage is common and often results in hydrocephalus. The pathogenesis of posthemorrhagic hydrocephalus is not fully understood. OBJECTIVE: To explore the potential role of hemoglobin and iron released after hemorrhage. METHODS: Artificial cerebrospinal fluid (aCSF), hemoglobin, or iron was injected into the right lateral ventricle of postnatal day-7 Sprague Dawley rats. Ventricle size, heme oxygenase-1 (HO-1) expression, and the presence of iron were evaluated 24 and 72 hours after injection. A subset of animals was treated with an iron chelator (deferoxamine) or vehicle for 24 hours after hemoglobin injection, and ventricle size and cell death were evaluated. RESULTS: Intraventricular injection of hemoglobin and iron resulted in ventricular enlargement at 24 hours compared with the injection of aCSF. Protoporphyrin IX, the iron-deficient immediate heme precursor, did not result in ventricular enlargement after injection into the ventricle. HO-1, the enzyme that releases iron from heme, was increased in the hippocampus and cortex of hemoglobin-injected animals at 24 hours compared with aCSF-injected controls. Treatment with an iron chelator, deferoxamine, decreased hemoglobin-induced ventricular enlargement and cell death. CONCLUSION: Intraventricular injection of hemoglobin and iron can induce hydrocephalus. Treatment with an iron chelator reduced hemoglobin-induced ventricular enlargement. This has implications for the pathogenesis and treatment of posthemorrhagic hydrocephalus. ABBREVIATIONS: aCSF, artificial cerebrospinal fluid DAB, 3,3′-diaminobenzidine-4HCl GMH-IVH, germinal matrix hemorrhage/intraventricular hemorrhage HO-1, heme oxygenase-1 ICH, intracerebral hemorrhage PBS, phosphate-buffered saline SVZ, subventricular zone TBST, tris-buffered saline with Tween 20

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/12000/Role_of_Hemoglobin_and_Iron_in_Hydrocephalus_After.20.aspx

Factors Associated With Failed Focal Neocortical Epilepsy Surgery

Neurosurgery - Current Issue

BACKGROUND: Seizure outcomes after focal neocortical epilepsy (FNE) surgery are less favorable than after temporal lobectomy, and the reasons for surgical failure are incompletely understood. Few groups have performed an in-depth examination of seizure recurrences to identify possible reasons for failure. OBJECTIVE: To elucidate factors contributing to FNE surgery failures. METHODS: We reviewed resections for drug-resistant FNE performed at our institution between 1998 and 2011. We performed a quantitative analysis of seizure outcome predictors and a detailed qualitative review of failed surgical cases. RESULTS: Of 138 resections in 125 FNE patients, 91 (66%) resulted in freedom from disabling seizures (Engel I outcome). Mean ± SEM patient age was 20.0 ± 1.2 years; mean follow-up was 3.8 years (range, 1-17 years); and 57% of patients were male. Less favorable (Engel II-IV) seizure outcome was predicted by higher preoperative seizure frequency (odds ratio = 0.85; 95% confidence interval, 0.78-0.93), a history of generalized tonic-clonic seizures (odds ratio = 0.42; 95% confidence interval, 0.18-0.97), and normal magnetic resonance imaging (odds ratio = 0.30; 95% confidence interval, 0.09-1.02). Among 36 surgical failures examined, 26 (72%) were related to extent of resection, with residual epileptic focus at the resection margins, whereas 10 (28%) involved location of resection, with an additional epileptogenic zone distant from the resection. Of 16 patients who received reoperation after seizure recurrence, 10 (63%) achieved seizure freedom. CONCLUSION: Insufficient extent of resection is the most common reason for recurrent seizures after FNE surgery, although some patients harbor a remote epileptic focus. Many patients with incomplete seizure control are candidates for reoperation. ABBREVIATIONS: ECoG, electrocorticography EEG, electroencephalography FNE, focal neocortical epilepsy MEG, magnetoencephalography MTLE, mesial temporal lobe epilepsy TSC, tuberous sclerosis complex

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/12000/Factors_Associated_With_Failed_Focal_Neocortical.15.aspx