Neurosurgery Blog

http://thejns.org/doi/abs/10.3171/2011.9.PEDS11309?ai=3f6&mi=3ba5z2&af=R

Patient with Chiari malformation Type I presenting with inducible hemifacial weakness

Journal of Neurosurgery: Pediatrics, Volume 8, Issue 6, Page 620-624, December 2011.
In this report, the authors describe the first known case of inducible hemifacial weakness in a patient with Chiari malformation Type I (CM-I). The patient was a 14-year-old girl with a 1-year history of right facial paresis induced by sustained leftward head rotation. These episodes were characterized by weak activation of her right facial muscles with preserved eye opening and closure. Additionally, she had hypernasal speech, persistent headaches, and intermittent left arm twitching. Magnetic resonance imaging demonstrated a CM-I. A suboccipital craniectomy and C-1 laminectomy were performed for decompression of the CM-I, with duraplasty and coagulation of the pial surface of the cerebellar tonsils. At the 9-month follow-up, the patient's inducible hemifacial weakness had completely resolved. Her symptoms were thought to have resulted from the CM-I, perhaps due to traction on the right facial nerve by the ectopic tonsils with head rotation.

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Júlio Leonardo B. Pereira

http://www.medicalnewstoday.com/articles/237976.php

Female Orgasm - Brain Activity Captured In FMRI Imaging Device

Brain activity during a female orgasm has been described as secondary to an epileptic seizure, after researchers from Rutgers University, New Jersey, USA recorded the upsurge of oxygen utilization in a 5-minute period of brain networking activity with a fMRI (functional magnetic resonance imaging) scanner...

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Júlio Leonardo B. Pereira

http://www.springerlink.com/content/kv5211q447hj8376/

Hyperosmolar Therapy for Intracranial Hypertension

Abstract

The use of hyperosmolar agents for intracranial hypertension was introduced in the early 20th century and remains a mainstay of therapy for patients with cerebral edema. Both animal and human studies have demonstrated the efficacy of two hyperosmolar agents, mannitol and hypertonic saline, in reducing intracranial pressure via volume redistribution, plasma expansion, rheologic modifications, and anti-inflammatory effects. However, because of physician and institutional variation in therapeutic practices, lack of standardized protocols for initiation and administration of therapy, patient heterogeneity, and a paucity of randomized controlled trials have yielded little Class I evidence on which clinical decisions can be based, most current evidence regarding the use of hyperosmolar therapy is derived from retrospective analyses (Class III) and case series (Class IV). In this review, we summarize the available evidence regarding the use of hyperosmolar therapy with mannitol or hypertonic saline for the medical management of intracranial hypertension and present a comprehensive discussion of the evidence associated with various theoretical and practical concerns related to initiation, dosage, and monitoring of therapy.

Content Type Journal Article
Category Review
Pages 1-14
DOI 10.1007/s12028-011-9649-x
Authors
- Andrew Torre-Healy, Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
- Nicholas F. Marko, Cancer Research UK Cambridge Cancer Research Institute, Robinson Way, Cambridge, CB2 0RE UK
- Robert J. Weil, Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

Journal Neurocritical Care
Online ISSN 1556-0961
Print ISSN 1541-6933

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Júlio Leonardo B. Pereira

http://thejns.org/doi/abs/10.3171/2011.9.PEDS11192?ai=3f6&mi=3ba5z2&af=R

Sunday, November 20, 2011

The economic impact of ventriculoperitoneal shunt failure

Journal of Neurosurgery: Pediatrics, Volume 8, Issue 6, Page 593-599, December 2011.
Object Detailed costs to individuals with hydrocephalus and their families as well as to third-party payers have not been previously described. The purpose of this study was to determine the primary caregiver out-of-pocket expenses and the third-party payer reimbursement rate associated with a shunt failure episode. Methods A retrospective study of children born between 2000 and 2005 who underwent initial ventriculoperitoneal (VP) shunt placement and who subsequently experienced a shunt failure requiring surgical intervention within 2 years of their initial shunt placement was conducted. Institutional reimbursement and demographic data from Children's Hospital of Alabama (CHA) were augmented with a caregiver survey of any out-of pocket expenses encountered during the shunt failure episode. Institutional reimbursements and caregiver out-of-pocket expenses were then combined to provide the cost for a shunt failure episode at CHA. Results For shunt failures, the median reimbursement total was $5008 (interquartile range [IQR] $2068–$17,984), the median caregiver out-of-pocket expenses was $419 (IQR $251–$1112), and the median total cost was $5411 (IQR $2428–$18,582). Private insurance reimbursed at a median rate of $5074 (IQR $2170–$14,852) compared with public insurance, which reimbursed at a median rate of $4800 (IQR $1876–$19,395). Caregivers with private insurance reported a median $963 (IQR $322–$1741) for out-of-pocket expenses, whereas caregivers with public insurance reported a median $391 (IQR $241–$554) for out-of-pocket expenses (p = 0.017). Conclusions This study confirmed that private insurance reimbursed at a higher rate, and that although patients had a shorter length of stay as compared with those with public insurance, their out-of-pocket expenses associated with a shunt failure episode were greater. However, it could not be determined if the significant difference in out-of-pocket expenses between those with private and those with public insurance was due directly to the cost of shunt failure. This model does not take into consideration community resources and services available to those with public insurance. These resources and services could offset the out-of-pocket burden, and therefore should be considered in future cost models.

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Júlio Leonardo B. Pereira