Neurological Disorders

Background: The classic transvermian route for excision of fourth ventricular tumors could be associated with postoperative cerebellar mutism. The Telovelar approach leads to the fourth ventricle via the cerebellomedullary fissure, avoiding retraction on the dentate nuclei and vermian incisions, hence lowering the incidence of cerebellar mutism. Objective: The aim of this study is to evaluate the Telovelar approach for excision of fourth ventricular tumors.

Patients and methods: This retrospective study was conducted on 25 cases with midline posterior fossa tumors collected between 2012 and 2014. All cases were operated upon via the telovelar approach succeeded by microscopic tumor excision. Follow up data were collected regarding the degree of excision (total, near total, and subtotal), and postoperative complications. Mean follow up period was 5 months.

Results: Age ranged from 2 to 8 years (mean 5.6 years). The most common was medulloblastoma (13 cases), followed by ependymoma (10 cases), and then choroid plexus papilloma (2 cases). Gross total excision was achieved in 8 cases (32%), near total excision (˃80% of tumor volume) in 14 cases (56%), and subtotal excision (˂80% of tumor volume) in 3 cases (12%). We experienced cerebellar mutism in 2 cases (8%) which improved in one case in the long term postoperative follow up. None of the cases had truncal ataxia. Two cases (8%) had postoperative facial palsy, while 3 cases (12%) had postoperative bulbar affection. There were two mortalities in this study, which were related to bulbar palsy and chest infection.

Conclusion: Telovelar approach to the fourth ventricle is becoming a widespread technique for removing midline posterior fossa tumors. It gives excellent access and visualization to the fourth ventricle, with a low incidence of postoperative cerebellar mutism.

Objectives: There have been attempts to establish biomarkers for motor neuron disease, without success. The study aim to seek possible markers to be used in the clinical routine evaluation, to optimize timing for palliative interventions.

Methods: A cohort study evaluated clinical, respiratory and neurophysiological variables every 3-4 months across 20 months in 101 patients with motor neuron disease using riluzole. Primary endpoint was death or tracheostomy. The most significant parameters in cox regression analysis created a predictive model.

Results: There were 58 men and 43 women with a mean age of 57.2 ± 11.7 years. 77 patients (76.2%) had spinal onset and 24 (23.8%) had bulbar onset. The mean survival time was 43.5 ± 5.7 months (CI 95% 32.3-54.8). The variables related to worse prognosis were: age > 65 years (HR=2.50, CI 95% (1.23–5.08); involvement of a second site in less than six months (HR=2.02, CI 95% (1.04 – 3.94); supine Forced Vital Capacity <63% (HR=2.78, CI 95% 1.03–7.48), neck weakness (HR=2.28, CI 95% (1.03–5.05) and presence of pyramidal syndrome (HR= 2.36, CI 95% (1.05–5.33).

Conclusion: It was created a five-factors set that predicts evolution to death or tracheostomy within one year.

Importance: Cognitive impairment is common among patients with stroke and early recognition can optimize patient care.

Objective: To determine the validity of computerized cognitive testing in an adult population with acute ischemic stroke.

Design: Validation study comparing computerized vs paper-pencil assessments at two time points three months apart in a stroke unit.

Main outcome: Correlation analyses between computerized (using CogState Brief Battery) and paper-pencil testing (using the Montreal Cognitive Assessment) both at study entry and follow-up visits.

Results: We found moderate to strong significant correlations between the two instruments at study entry and follow-up sessions. Executive dysfunctions were the main cognitive changes. Test-retest correlations were strong.

Conclusion and Relevance: The CogState Brief Battery is a valid alternative for clinicians who wish to measure cognitive skills following acute ischemic stroke. Limitations of computerized testing are discussed.

Alexia with agraphia is a rare language disorder, which is mostly caused by a stroke in the territory of the middle cerebral artery, with infarction of the inferior parietal lobule that mostly caused by arterial ischemic infarct and venous infarction associated with cerebral venous thrombosis has not been mentioned as a etiology for this disorder and this is the first case presenting by this etiology yet published in literature.

Objective: The objective is to study the approach of removal of craniopharynginoma.

Methods: We remove eight cases of craniopharynginoma in childhood which intrudes the third ventricle transcallosal septum pellucidum interforniceal approach from August, 2013 to December, 2015.

Results: MRI or Recheck CT of brain post-operation can identify the removal situations of the tumor.

Conclusion: Tanscallosal septum pellucidum interforniceal approach to remove craniopharynginoma is a very important method.

Thoracic outlet syndrome refers to a constellation of neurovascular signs and symptoms caused by compression of neural and vascular structures as they exit through the superior thoracic aperture to enter the upper limb. Arterial type is the rarest and requires early diagnosis and management to prevent severe complications like thromboembolic phenomenon. Hence, in this article, we are describing thoracic outlet syndrome arising due to compression of right subclavian artery that was well diagnosed by imaging.

Objective: To evaluate the local effect of vascular endothelial growth factor (VEGF) loaded on gelatin sponge on transected facial nerve regeneration.

Methods: Twelve male white SD rats were divided into two groups randomly (n=6): VEGF group and PBS (phosphate buffer saline) group. In the VEGF group the left facial nerve was transected and the stump was connected by silicone conduit filled with gelatin sponge loaded with VEGF. In PBS group the defect was connected by silicone conduit filled with gelatin sponge loaded with PBS. Functional assessment and morphological evaluation were studied 8 weeks after operation.

Results: Functional study of facial nerve, Electrophysiological assessment and morphometric indices confirmed a faster recovery of regenerated axons in VEGF group than in PBS group (P<0.01).

Conclusion: Local administration of nerve conduit consisting of VEGF and gelatin sponge will improve functional recovery and morphometric indices of facial nerve.

Surgical treatment of chronic Low Back pain syndrome from an aging spine traditionally focuses on fusion as the ultimate surgical means to eliminate debilitating back pain and sciatica.” A variety of painful degenerative conditions of the lumbar spine is treated surgically by translaminar decompression and fusion. Spine surgeons trained to perform fusions, with no training in endoscopic surgery are battling an economic crisis of escalating cost and affordability when fusion surgery is recommended for chronic back pain. This is considered the ultimate treatment by surgeons favoring fusion as a means to treat perceived or actual instability and/or deformity supported by imaging studies.

In this study we have analyzed 1200 people, 580 ADHD and 620 control groups. The genes DSM-IV, DRD4, SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2 and BDNF analyzed in terms of genetic mutations made. In this study, people who have genetic mutations were targeted, with nervous disorders, ADHD. In fact, of all people with ADHD, 360 children had a genetic mutation in the genes DSM-IV, DRD4, SERT, and HTR1B. And 100 children had a genetic mutations in SNAP25, GRIN2A genes were a genetic mutations in the genes ADRA2A, TPH2 and BDNF and 70 children, respectively. Any genetic mutations in the target genes control group, did not show.

Hypothesis and objectives: In this study, we further understand the genes involved in ADHD children with the genetic mutations discussed. The aim of this study was to evaluate genetic and epigenetic closer to induce hyperactivity disorder in children.

In the present era of increasing road-traffic accidents, facial trauma of variable severity is being frequently encountered involving the orbits and sinuses. Post-traumatic, fronto-ethmoidal and orbital encephaloceles are rare entities requiring early intervention to prevent complications. Cross-sectional imaging by computed tomography and magnetic resonance imaging play a pivotal role in early detection of these entities. Hence in this article, we are describing a rare case of post-traumatic encephalocele with fronto-ethmoidal and orbital components with its clinical presentation which was diagnosed confidently by magnetic resonance imaging affecting the final management.