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Full-Text Articles in Medicine and Health Sciences
Neurological Improvement Of Perineural And Leptomeningeal Spread Of Squamous Cell Carcinoma Treated With Intrathecal Chemotherapy And Systemic Egfr Inhibition., Vincent Alexander Van Vugt, Marlon Garzo Saria, Andres Javier, Navin Kesari, Tiffany Turpin, Santosh Kesari
Neurological Improvement Of Perineural And Leptomeningeal Spread Of Squamous Cell Carcinoma Treated With Intrathecal Chemotherapy And Systemic Egfr Inhibition., Vincent Alexander Van Vugt, Marlon Garzo Saria, Andres Javier, Navin Kesari, Tiffany Turpin, Santosh Kesari
Marlon Garzo Saria, PhD, RN, AOCNS, FAAN
Squamous cell carcinoma (SCC) is a common cancer of the skin. Risk factors include fair skin, excessive sun and ultraviolet light exposure, and history of xeroderma pigmentosa. Perineural invasion (PNI), an uncommon manifestation of SCC, involves microscopic tumor cells invading various layers of the nerve sheath. It is associated with a poorer prognosis. Standard treatment for PNI includes radiation therapy. Here, we describe a case an older gentleman with a history of SCC with PNI successfully treated with erlotinib and intrathecal chemotherapy.
Use Of Telemedicine To Increase Thrombolysis And Advance Care In Acute Ischemic Stroke, Nils Henninger, Nabi Chowdhury, Marc Fisher, Majaz Moonis
Use Of Telemedicine To Increase Thrombolysis And Advance Care In Acute Ischemic Stroke, Nils Henninger, Nabi Chowdhury, Marc Fisher, Majaz Moonis
Nils Henninger
The use of the only proven therapy for acute ischemic stroke, intravenous tissue plasminogen activator (tPA), remains disappointingly low. One potential way to increase the use of tPA is by the implementation of telemedicine stroke care networks. Preliminary data from several studies indicate that the safe and expanded use of tPA for ischemic stroke can be accomplished with the help of telemedicine. Telemedicine stroke care networks can also be used in the future to enhance stroke diagnosis with advanced CT and MRI technology and to potentially increase the number of patients referred to tertiary stroke centers for intra-arterial therapies. It …
Leukoaraiosis And Sex Predict The Hyperacute Ischemic Core Volume, Nils Henninger, Eugene Lin, Diogo Haussen, Laura Lehman, Deepak Takhtani, Magdy Selim, Majaz Moonis
Leukoaraiosis And Sex Predict The Hyperacute Ischemic Core Volume, Nils Henninger, Eugene Lin, Diogo Haussen, Laura Lehman, Deepak Takhtani, Magdy Selim, Majaz Moonis
Nils Henninger
BACKGROUND AND PURPOSE: Leukoaraiosis (LA) and male sex have been associated with decreased cerebrovascular reactivity, which potentially adversely affects tissue viability in acute stroke. Therefore, we aimed to elucidate the contribution of LA-severity and sex to the extent of the hyperacute ischemic core volume after intracranial large artery occlusion. METHODS: We analyzed data from 87 patients with acute intracranial large artery occlusion who had acute multimodal computed tomography-imaging. LA-severity was assessed using the van Swieten scale on noncontrast computed tomography. Computed tomography perfusion data were analyzed using automatic calculation of the mean transit time and hyperacute cerebral blood volume defects. …
Translational Research In Stroke: Taking Advances In The Pathophysiology And Treatment Of Stroke From The Experimental Setting To Clinical Trials, Marc Fisher, Nils Henninger
Translational Research In Stroke: Taking Advances In The Pathophysiology And Treatment Of Stroke From The Experimental Setting To Clinical Trials, Marc Fisher, Nils Henninger
Nils Henninger
Many advances have occurred regarding an increased understanding of the basic pathophysiology of ischemic brain injury that could lead to enhanced therapy for this disorder. Among the more important basic science advances are enhanced knowledge of the components of the ischemic cascade, the phenomenon of ischemic preconditioning, the potential relevance of hibernation, studies on gene expression in ischemic tissue, and imaging identification of the ischemic penumbra. The large number of unsuccessful prior clinical trials with a wide range of purported acute stroke therapies has provided many insights and lessons regarding how to perform better trials in the future. Translating these …
Acute Ischemic Stroke Therapy, Nils Henninger, Rajat Kumar, Marc Fisher
Acute Ischemic Stroke Therapy, Nils Henninger, Rajat Kumar, Marc Fisher
Nils Henninger
Data from the European Cooperative Acute Stroke Study (ECASS) III trial demonstrated that tissue plasminogen activator given up to 4.5 h after stroke onset improves outcome and treatment guidelines support its use during this time window. Intra-arterial therapy with tissue plasminogen activator or devices is commonly used at large tertiary centers up to 6-8 h after stroke onset, but conclusive evidence of efficacy remains lacking. During the acute phase after stroke onset, blood pressure elevations should be reduced as should substantial elevations in blood glucose. Statins are recommended in essentially all non-cardioembolic stroke patients. The most important future directions for …
Hippocampal Functional Connectivity Patterns During Spatial Working Memory Differ In Right Versus Left Temporal Lobe Epilepsy., Gaelle Eve Doucet, Karol Osipowicz, Ashwini Sharan Md, Michael R Sperling, Joseph I Tracy
Hippocampal Functional Connectivity Patterns During Spatial Working Memory Differ In Right Versus Left Temporal Lobe Epilepsy., Gaelle Eve Doucet, Karol Osipowicz, Ashwini Sharan Md, Michael R Sperling, Joseph I Tracy
Gaelle Eve Doucet
Temporal lobe epilepsy (TLE), affecting the medial temporal lobe, is a disorder that affects not just episodic memory but also working memory (WM). However, the exact nature of hippocampal-related network activity in visuospatial WM remains unclear. To clarify this, we utilized a functional connectivity (FC) methodology to investigate hippocampal network involvement during the encoding phase of a functional magnetic resonance imaging (fMRI) visuospatial WM task in right and left TLE patients. Specifically, we assessed the relation between FC within right and left hippocampus-seeded networks, and patient performance (rate of correct responses) during the encoding phase of a block span WM …
Novel Ubiquitin Neuropathology In Frontotemporal Dementia With Valosin-Containing Protein Gene Mutations, Mark Forman, Ian Mackenzie, Nigel Cairns, Eric Swanson, Philip Boyer, David Drachman, Bharati Jhaveri, Jason Karlawish, Alan Pestronk, Thomas Smith, Pang-Hsien Tu, Giles Watts, William Markesbery, Charles Smith, Virginia Kimonis
Novel Ubiquitin Neuropathology In Frontotemporal Dementia With Valosin-Containing Protein Gene Mutations, Mark Forman, Ian Mackenzie, Nigel Cairns, Eric Swanson, Philip Boyer, David Drachman, Bharati Jhaveri, Jason Karlawish, Alan Pestronk, Thomas Smith, Pang-Hsien Tu, Giles Watts, William Markesbery, Charles Smith, Virginia Kimonis
Jason Karlawish
Frontotemporal dementia (FTD) with inclusion body myopathy and Paget disease of bone (IBMPFD) is a rare, autosomal-dominant disorder caused by mutations in the valosin-containing protein (VCP) gene, a member of the AAA-ATPase gene superfamily. The neuropathology associated with sporadic FTD is heterogeneous and includes tauopathies and frontotemporal lobar degeneration with ubiquitin-positive inclusions (FTLD-U). However, there is limited information on the neuropathology in IBMPFD. We performed a detailed, systematic analysis of the neuropathologic changes in 8 patients with VCP mutations. A novel pattern of ubiquitin pathology was identified in IBMPFD that was distinct from sporadic and familial FTLD-U without VCP gene …
Impact Of Age And Anticoagulation: Need For Neurosurgical Intervention In Trauma Patients With Mild Traumatic Brain Injury, Margaret Moore, Michael Pasquale, Michael Badellino
Impact Of Age And Anticoagulation: Need For Neurosurgical Intervention In Trauma Patients With Mild Traumatic Brain Injury, Margaret Moore, Michael Pasquale, Michael Badellino
Michael D Pasquale MD, FACS, FCCM
BACKGROUND: Of the 500,000 brain injuries in the United States annually, 80% are considered mild (mild traumatic brain injury). Unfortunately, 2% to 3% of them will subsequently deteriorate and result in severe neurologic dysfunction. Intracerebral changes in the elderly, chronic oral anticoagulation, and platelet inhibition may contribute to the development of intracranial bleeding after minor head injury. We sought to investigate the association of age and the use of anticoagulation and antiplatelet therapy with neurologic deterioration and the need for neurosurgical intervention in patients presenting with mild traumatic brain injury. METHODS: A retrospective review of all adult (>14 years) …
Surgical Outcome In Pet-Positive, Mri-Negative Patients With Temporal Lobe Epilepsy, Carla Lopinto-Khoury, Michael R. Sperling, Christopher Skidmore, Maromi Nei, James Evans, Ashwini Sharan, Scott Mintzer
Surgical Outcome In Pet-Positive, Mri-Negative Patients With Temporal Lobe Epilepsy, Carla Lopinto-Khoury, Michael R. Sperling, Christopher Skidmore, Maromi Nei, James Evans, Ashwini Sharan, Scott Mintzer
maromi nei
PURPOSE: Fluorodeoxyglucose positron emission computed tomography (FDG-PET) hypometabolism is important for surgical planning in patients with temporal lobe epilepsy (TLE), but its significance remains unclear in patients who do not have evidence of mesial temporal sclerosis (MTS) on magnetic resonance imaging (MRI). We examined surgical outcomes in a group of PET-positive, MRI-negative patients and compared them with those of patients with MTS. METHODS: We queried the Thomas Jefferson University Surgical Epilepsy Database for patients who underwent anterior temporal lobectomy (ATL) from 1991 to 2009 and who had unilateral temporal PET hypometabolism without an epileptogenic lesion on MRI (PET+/MRI-). We compared …
Erroneous Measurement Of Intracranial Pressure Caused By Simultaneous Ventricular Drainage: A Hydrodynamic Model Study, H. Wilkinson, Jorge Yarzebski, E. Wilkinson, Frederick Anderson
Erroneous Measurement Of Intracranial Pressure Caused By Simultaneous Ventricular Drainage: A Hydrodynamic Model Study, H. Wilkinson, Jorge Yarzebski, E. Wilkinson, Frederick Anderson
Jorge L. Yarzebski
Intracranial pressure (ICP) is often measured from intraventricular catheters, a technique that allows therapeutic drainage of ventricular cerebrospinal fluid (CSF) as an aid in controlling ICP and circumventing obstruction. Drainage of CSF simultaneously with ongoing ICP measurement has been advocated as safe and efficient, and devices are commercially available to permit this practice; however, this concept has been seriously challenged, based on clinical observations. The inaccuracy induced by simultaneous CSF drainage and ICP monitoring is quantitated in this report in a mechanical brain model using a standard ventricular catheter. The following conclusions have been confirmed: 1) rapid CSF drainage induces …
T2 And T3 Sympathetic Ganglia In The Adult Human: A Cadaver And Clinical-Radiographic Study And Its Clinical Application, Jorge Yarzebski, H. Wilkinson
T2 And T3 Sympathetic Ganglia In The Adult Human: A Cadaver And Clinical-Radiographic Study And Its Clinical Application, Jorge Yarzebski, H. Wilkinson
Jorge L. Yarzebski
The technique of percutaneous radiofrequency (RF) upper thoracic sympathectomy mandates an exact knowledge of the anatomical location of the sympathetic ganglia. Because conflicting descriptions are given in anatomy texts, we examined the T2 and T3 sympathetic ganglia in 48 sympathetic chains in adult cadavers to measure the exact location of the ganglia. Measurements were made relative to their distances (a) dorsal to the ventral surface of the vertebral body and (b) rostral or caudal to the midpoint of the vertebral body. Median locations of T2 and T3 ganglia were 17 to 20 mm dorsal to the ventral surface of the …