Neurosurgery Commons^™

Cerebellopontine Angle Meningioma Mimicking Acute Stroke, Milan Terzic, Yash B. Patel

Graduate Medical Education Research Journal

Cerebellopontine angle meningiomas are slow-growing benign tumors of the brain with a largely indolent course until compressive and mass effects occur with adjacent neural structures. Clinical presentations are variable and dependent on the rate of growth and location and tend to progress over a longer period. Acute presentations are less common and require consideration of ubiquitous etiologies. A 62-year-old male with a history of hypertension, benign prostatic hyperplasia, dyslipidemia, and gout presented to the emergency department with a sudden onset of dizziness, loss of balance, and persistently elevated blood pressure. The examination was positive for left dysmetria, dysdiadochokinesia, and tandem …

Anti-Acetylated-Tau Immunotherapy Is Neuroprotective In Tauopathy And Brain Injury, Celeste Parra Bravo, Karen Krukowski, Sarah Barker, Chao Wang, Yaqiao Li, Li Fan, Edwin Vázquez-Rosa, Min-Kyoo Shin, Man Ying Wong, Louise D Mccullough, Ryan S Kitagawa, H Alex Choi, Angela Cacace, Subhash C Sinha, Andrew A Pieper, Susanna Rosi, Xu Chen, Li Gan

Faculty, Staff and Student Publications

BACKGROUND: Tau is aberrantly acetylated in various neurodegenerative conditions, including Alzheimer's disease, frontotemporal lobar degeneration (FTLD), and traumatic brain injury (TBI). Previously, we reported that reducing acetylated tau by pharmacologically inhibiting p300-mediated tau acetylation at lysine 174 reduces tau pathology and improves cognitive function in animal models.

METHODS: We investigated the therapeutic efficacy of two different antibodies that specifically target acetylated lysine 174 on tau (ac-tauK174). We treated PS19 mice, which harbor the P301S tauopathy mutation that causes FTLD, with anti-ac-tauK174 and measured effects on tau pathology, neurodegeneration, and neurobehavioral outcomes. Furthermore, PS19 mice received treatment post-TBI to evaluate the …

Roadside Head Trauma In A Middle-Aged Man, Ian Michael Crimmins, David Isaac Beran

School of Medicine Faculty Publications

No abstract provided.

Endovascular Treatment Of Acute Ischemic Stroke Patients With Tandem Lesions: Antegrade Versus Retrograde Approach, Milagros Galecio-Castillo, Michael Abraham, Mudassir Farooqui, Ameer E Hassan, Afshin A Divani, Mouhammad A Jumaa, Marc Ribo, Nils Petersen, Johanna Fifi, Waldo R Guerrero, Amer M Malik, James E Siegler, Thanh N Nguyen, Sunil A Sheth, Albert J Yoo, Guillermo Linares, Nazli Janjua, Darko Quispe-Orozco, Abid Qureshi, Wondwossen G Tekle, Asad Ikram, Syed F Zaidi, Cynthia B Zevallos, Belen Taborda, Alex Devarajan, Linda Zhang, Mohamad Abdalkader, Sergio Salazar-Marioni, Jazba Soomro, Weston Gordon, Aaron Rodriguez-Calienes, Juan Vivanco-Suarez, Katrina Woolfolk, Maxim Mokin, Dileep R Yavagal, Santiago Ortega-Gutierrez

Faculty, Staff and Student Publications

Objective: The optimal technique for treating tandem lesions (TLs) with endovascular therapy is debatable. The authors evaluated the functional, safety, and procedural outcomes of different approaches in a multicenter study.

Methods: Anterior circulation TL patients treated from January 2015 to December 2020 were divided on the basis of antegrade versus retrograde approach and included. The evaluated outcomes were favorable modified Rankin Scale (mRS) score (mRS score 0-2) at 3 months, ordinal shift in mRS score, successful recanalization, excellent recanalization, first-pass effect (FPE), time from groin puncture to successful recanalization, symptomatic intracranial hemorrhage (sICH), and 90-day mortality.

Results: Among 691 patients …

Incidence And Factors In Delayed Neurological Deficits After Subarachnoid Hemorrhage In Mice, William Wroe, Ari Dienel, Sungha Hong, Kanako Matsumura, Jose Guzman, Kiara Torres, Angelica Bernal, Hussein A Zeineddine, Peeyush Thankamani Pandit, Spiros L Blackburn, Devin W Mcbride

Faculty, Staff and Student Publications

Background: Delayed cerebral ischemia (DCI) is one of the most feared complications in aneurysmal subarachnoid hemorrhage (SAH). Animal models are crucial to studying the disease mechanisms and potential treatments. DCI in rodents was thought to not exist; herein we examine literature and our experience with DCI in rodents.

Methods: Daily behavioral performance was assessed every day from day 1 to up to 7 days post-SAH on mice from 5 different studies that used the endovascular perforation model. Performance was graded using an 8-test sensorimotor neuroscore previously described. The daily neuroscore was then used to identify the incidence and timing of …

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Transport Of Non-Classical Light Mediated By Topological Domain Walls In A Ssh Photonic Lattice, Gabriel O'Ryan Pérez, Joaquín Medina Dueñas, Diego Guzmán-Silva, Luis E F Foa Torres, Carla Hermann-Avigliano

Faculty, Staff and Student Publications

Advancements in photonics technologies have significantly enhanced their capability to facilitate experiments involving quantum light, even at room temperature. Nevertheless, fully integrating photonic chips that include quantum light sources, effective manipulation and transport of light minimizing losses, and appropriate detection systems remains an ongoing challenge. Topological photonic systems have emerged as promising platforms to protect quantum light properties during propagation, beyond merely preserving light intensity. In this work, we delve into the dynamics of non-classical light traversing a Su-Schrieffer-Heeger photonic lattice with topological domain walls. Our focus centers on how topology influences the quantum properties of light as it moves …

Speech, Voice, And Language Outcomes Following Deep Brain Stimulation: A Systematic Review, Fatemeh Tabari, Joel I. Berger, Oliver Flouty, Brian Copeland, Jeremy D. Greenlee, Karim Johari

School of Medicine Faculty Publications

Background Deep brain stimulation (DBS) reliably ameliorates cardinal motor symptoms in Parkinson’s disease (PD) and essential tremor (ET). However, the effects of DBS on speech, voice and language have been inconsistent and have not been examined comprehensively in a single study. Objective We conducted a systematic analysis of literature by reviewing studies that examined the effects of DBS on speech, voice and language in PD and ET. Methods A total of 675 publications were retrieved from PubMed, Embase, CINHAL, Web of Science, Cochrane Library and Scopus databases. Based on our selection criteria, 90 papers were included in our analysis. The …

Ras G-Domains Allosterically Contribute To The Recognition Of Lipid Headgroups And Acyl Chains, Neha Arora, Huanwen Mu, Hong Liang, Wenting Zhao, Yong Zhou

Faculty, Staff and Student Publications

Mutant RAS are major contributors to cancer and signal primarily from nanoclusters on the plasma membrane (PM). Their C-terminal membrane anchors are main features of membrane association. However, the same RAS isoform bound to different guanine nucleotides spatially segregate. Different RAS nanoclusters all enrich a phospholipid, phosphatidylserine (PS). These findings suggest more complex membrane interactions. Our electron microscopy-spatial analysis shows that wild-types, G12V mutants, and membrane anchors of isoforms HRAS, KRAS4A, and KRAS4B prefer distinct PS species. Mechanistically, reorientation of KRAS4B G-domain exposes distinct residues, such as Arg 135 in orientation state 1 (OS1) and Arg 73/Arg 102 in OS2, …

Improving Time To Mri In The Emergency Room For Spinal Epidural Abscesses, Karim Hafazalla, Md, Angeleah Carreras, Ms, Sean Mcgann, Md, Scott Faro, Md, Adam Flanders, Md, Richard Schmidt, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Magnetic resonance images (MRI) is integral in assessing pathology. This is especially true in the emergency room (ER), where delays in diagnosing emergent neurologic pathologies, including spinal epidural abscesses (EDAs), where the morbidity can be severe if not addressed in time. This study aims to implement an expedited imaging pathway for this urgent / emergent pathology.

Improving Head Ct Utilization After Traumatic Intracranial Hemorrhage According To The Modified Brain Injury Guidelines (Mbig), Mathews Lan, Md, Michael Baldassari, Md, Caitlin Ritz, Md, Tyler Alexander, Bs, Richard Schmidt, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: There are subsets of patients with traumatic intracranial hemorrhage who are low-risk for clinically significant hemorrhage expansion and/or neurologic deterioration requiring procedural intervention, yet these patients often undergo multiple serial head CT’s requiring an extended length of stay that may not be necessary. The Brain Injury Guidelines^1,2 (BIG) and subsequent modified Brain Injury Guidelines³ (mBIG) sought to categorize these low-risk subsets and provide an algorithm for more efficient care for these patients.

Project AIM: For low-risk patients with traumatic intracranial hemorrhage (specifically mBIG 2), we aim to reduce the number of head CT’s during admission …

Improving Post-Operative Educational Handouts After Spine Surgery, Arbaz A. Momin, James Harrop

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: After spine surgery, patients are given take home instructions which are outdated and provide limited answers to frequently asked questions. This leads to increased office calls and overnight calls to on-call physician.

Project AIM:

• Improving educational handouts given to patients after spine surgery
• Aim is to analyze current handouts given to patients after spine surgery
• Identify frequently asked questions by patients after surgery

Resumption Of Anti-Platelet/Anticoagulation Therapy Following Lumbar Spine Surgery, Stephanie Serva, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• No current guideline or protocol for AC/AP resumption in neurosurgical spine patients at TJUH
• There is difficulty in providing consistent perioperative anticoagulation recommendations to patients, as there remains no widely accepted, definitive literature of evidence or guidelines (Louie et al, 2020)

Project Aims:

• To determine standardized protocol for resuming antiplatelet/anticoagulation therapy following lumbar surgery
• To reduce combined postoperative cardiac/cerebrovascular/thrombotic events, and post-operative hematomas

Streamlined Pre-Authorization Expedites Patient Discharges From Stroke Units To Rehabilitation Centers, Michael Vo, William Nguyen, Matthew Trotter, Jeffrey Zhou, Glenn A. Gonzalez, Eric Mong, Rene Daniel, Ross-Jordan Elliott, James Harrop

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem statement: Patient discharge from neurosurgical stroke units to rehabilitation centers is a complex administrative and clinical endeavor involving a population often with cognitive and motor morbidity that can be intensified with extensive hospital length of stay (LOS).

Project aim: This project aims to analyze the change in LOS due to the introduction of liaisons, who advocate for and expedite pre-authorization, rounds, and plan of care establishment for patients with strokes.

Do Large Language Models Adhere To Clinical Guidelines For Cervical Fusion? A Comparison Of Chatbotgenerated Responses With Nass Coverage Recommendations, Advith Sarikonda, Ba, Bs, Emily Self, Md, Dwight Mitchell Self, Md, Abhijeet Sambangi, Bs, Angeleah Carreras, Md, Jack Jallo, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Introduction:

• Cervical fusion is a widely performed procedure with rapidly increasing usage.
• Despite this surge in utilization, there has been limited exploration into whether cervical fusion procedures align with evidence-based guidelines.
• To address these issues, the North American Spine Society (NASS) has developed EBM coverage recommendations for various diagnostic procedures and therapeutic treatments in the field of spine surgery

Project AIM:

• To assess the efficacy of chatbots in adhering to official guidelines for indications for cervical spine surgery

Pituitary Adenoma Presenting As Cranial Nerve Iii Palsy And Hemifacial Pain, Yoona Choe, Justin George, Matthew Boyle, Peter Maduka

Rowan-Virtua Research Day

Pituitary adenomas are common neoplasms arising from the pituitary adenohypophyseal cell. They can be classified by cell type, size and as nonfunctioning or functioning based on the secretion of pituitary hormones. Of these, approximately 48% are macroadenomas (>10 mm) and approximately 53% are prolactinomas. For how common these adenomas are, only 1 of 1100 persons manifest clinical symptoms¹ rendering detection and clinical management challenging.

Non-functioning adenomas are slow growing like most pituitary adenomas and are usually detected due to their mass effect on neighboring structures.² The majority of the reported symptoms as a results of these mass …

Spontaneous Intracranial Hemorrhage In A 29-Year-Old Male: A Case Report, Md Fateha, Caroline Nguyen, Michael A. Morris

Rowan-Virtua Research Day

Spontaneous intracranial hemorrhage is rare, especially in a young patient population. Signs and symptoms of intracranial hemorrhage include facial droop, vision loss, motor deficits with extraocular movements, deficits with tongue movement, weakness in the arms or legs, sensation loss, and mental status change. This is a case report of a 29-year-old male with no past medical history who presented for a spontaneous intracranial hemorrhage. This patient's only neurologic deficit was the loss of visual field on the left inferior quadrant of his field of vision. The patient obtained a CT head non-contrast which showed 21 mm acute right occipital hemorrhage …

Quantitative And Comparative Analysis Of Dream Content In Parkinson’S Disease Patients Pre- And Postdeep Brain Stimulation, Sarvar Oreizi-Esfahani, Michael Staud

Posters

Parkinson’s Disease (PD) is a neurodegenerative disorder stemming from the loss of dopaminergic neurons in the substantia nigra, resulting in impaired neuronal activation which primarily affects the body’s motor function1. Common symptoms include tremor, rigidity, akinesia and loss of balance.

PD also exerts significant effects on sleep patterns. The Default Mode Network (DMN), a series of hubs in the brain with increased metabolic rate during rest, are implicated in the process of dreaming2. Differential activation of these regions may alter the content and quality of one’s dreams2. PD has been shown to impact the function of the DMN and as …

Corticospinal Inhibition Investigated In Relation To Upper Extremity Motor Function In Cervical Spinal Cord Injury, Tarun Arora, Jia Liu, Akhil Mohan, Xin Li, Kyle O'Laughlin, Teale Bennett, Gregory Nemunaitis, Francois Bethoux, Svetlana Pundik, Kelsey Baker

School of Medicine Publications

Objective: Corticospinal inhibitory mechanisms are relevant to functional recovery but remain poorly understood after spinal cord injury (SCI). Post-injury characteristics of contralateral silent period (CSP), a measure of corticospinal inhibition evaluated using transcranial magnetic stimulation (TMS), is inconsistent in literature. We envisioned that investigating CSP across muscles with varying degrees of weakness may be a reasonable approach to resolve inconsistencies and elucidate the relevance of corticospinal inhibition for upper extremity function following SCI.

Methods: We studied 27 adults with chronic C1-C8 SCI (age 48.8 ± 16.1 years, 3 females) and 16 able-bodied participants (age 33.2 ± 11.8 years, 9 females). …

Chelation Enables Selectivity Control In Enantioconvergent Suzuki-Miyaura Cross-Couplings On Acyclic Allylic Systems, Violeta Stojalnikova, Stephen J Webster, Ke Liu, Stephen P Fletcher

Faculty, Staff and Student Publications

Asymmetric Suzuki-Miyaura cross-couplings with aryl boronic acids and allylic electrophiles are a powerful method to convert racemic mixtures into enantioenriched products. Currently, enantioconvergent allylic arylations are limited to substrates that are symmetrical about the allylic unit, and the absence of strategies to control regio-, E/Z- and enantioselectivity in acyclic allylic systems is a major restriction. Here, using a system capable of either conjugate addition or allylic arylation, we have discovered the structural features and experimental conditions that allow an acyclic system to undergo chemo- and regioselective, enantioconvergent allylic Suzuki-Miyaura-type arylation. A wide variety of boronic acid coupling partners can be …