JHN Journal最新文献

{"title":"The Use of Prasugrel and Ticagrelor in Pipeline Flow Diversion","authors":"E. Atallah, H. Saad, K. Bekelis, N. Chalouhi, S. Tjoumakaris, D. Hasan, Gorge Eller, D. Stidd, Md Mba Facs Faha Robert H. Rosenwasswer, P. Jabbour","doi":"10.29046/JHNJ.013.2.005","DOIUrl":"https://doi.org/10.29046/JHNJ.013.2.005","url":null,"abstract":"Background: Despite the routine clopidogrel/aspirin anti-platelet therapy, complications like thromboembolism, continue to be encountered with PED. We studied the safety and the efficacy of prasugrel in the management of clopidogrel non-responders treated for intracranial aneurysms. Methods: 437 consecutive neurosurgery patients were identified between January 2011 and May 2016. Patients allergic or having <30% platelet-inhibition with a daily 75mg of clopidogrel were dispensed 10mg of prasugrel daily (n=20) or 90mg of ticagrelor twice daily (n=2). The average follow-up was 15.8 months (SD=12.4 months). Patient clinical well being was evaluated with the modified Rankin Scale (mRS) registered before the discharge and at each follow-up visit. To control confounding we used multivariable mixed-effects logistic regression and propensity score conditioning. Results: 26 of 437(5.9%) patients (mean of age 56.3 years; 62 women [14,2%]) presented with a sub-arachnoid hemorrhage. 1 patient was allergic to clopidogrel and prasugrel simultaneously. All the patients receiving prasugrel (n=22) had a mRS<2 on their latest follow-up visit (mean=0.67; SD=1.15). In a multivariate analysis, clopidogrel did not affect the mRS on last follow-up, p=0.14. Multivariable logistic regression showed that clopidogrel was not associated with an increased long-term recurrence rate (odds ratio[OR], 0.17; 95%Confidence Interval [CI95%], 0.01-2.70; p=0.21) neither with an increased thromboembolic accident rate (OR, 0.46; CI95%, 0.12-1.67; p=0.36) nor with an increased hemorrhagic event rate (OR, 0.39; CI95%,0.91-1.64; p=0.20). None of the patients receiving prasugrel deceased or had a long-term recurrence nor a hemorrhagic event, only 1 patient suffered from mild aphasia subsequent to a thromboembolic event. 3 patients on clopidogrel passed during the study: (2) from acute SAH and (1) from intra-parenchymal hemorrhage. Clopidogrel was not associated with an increased mortality rate (OR, 2.18; CI95%,0.11-43.27; p=0.61). The same associations were present in propensity score adjusted models. Conclusion","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132096837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catastrophic Failure of Conservatively Treated Odontoid Fracture in the Elderly","authors":"J. Harrop, J. Ratliff, Sonia Teufack, Jeffrey A Rihn, T. Albert, A. Vaccaro","doi":"10.29046/jhnj.007.2.004","DOIUrl":"https://doi.org/10.29046/jhnj.007.2.004","url":null,"abstract":"Spine ABSTRACT Background: Odontoid fractures are the most common type of axis injury. Elderly patients can develop odontoid fractures after minor trauma with hyperextension injuries. The optimal treatment of type II fractures is controversial.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121404549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Management of Acute Proximal Internal Carotid Artery Occlusion: the JHN Experience","authors":"R. Dalyai, Vismay Thakkar, Thana Theofanis, P. Jabbour, L. Gonzalez, R. Rosenwasser, S. Tjoumakaris","doi":"10.29046/JHNJ.006.1.001","DOIUrl":"https://doi.org/10.29046/JHNJ.006.1.001","url":null,"abstract":"Introduction Stroke is a major cause of serious, long-term disability and the third leading cause of death, accounting for one in every 18 deaths in the United States. Approximately 800,000 strokes occur in the United States each year, leading to an estimated cost of 74 billion dollars in 2010. The severity and prognosis of patients with an acute internal carotid artery (ICA) occlusion is extremely poor. Studies have shown that 16-55% of patients will die from complications related to the infarction, 40-69% will be left with a profound deficit, and only 2-12% will make a reasonable recovery2. In young patients, internal carotid artery dissections presenting as an acute occlusion or thrombotic clot are responsible for approximately 14-20% of ischemic strokes.1 Results from trials utilizing emergent open surgical carotid recanalization or IVtPA have not been encouraging2,3. Recently, there have been small case reports of endovascular stent-assisted thrombolysis as a treatment option for patients with carotid occlusions and near occlusions.4-8","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132110785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Intramedullary Ganglioma","authors":"Harminder Singh, A. Sharan, John K. Ratliff","doi":"10.29046/JHNJ.004.2.006","DOIUrl":"https://doi.org/10.29046/JHNJ.004.2.006","url":null,"abstract":"A 48 year male presented to the ER with severe headaches which were episodic in nature and which had been present for several weeks. Patient had a history of traumatic head injury (TBI) several years prior. Otherwise, he was in good health with no significant past medical or surgical history. On physical exam, patient was oriented x 3 with an intact cranial nerve exam. He had significant upper and lower extremity spasticity with mild hand intrinsic weakness. His motor exam was otherwise unremarkable. His gait was very spastic. He had sustained lower extremity clonus, upgoing toes, and increased tone in the upper and lower extremities. His sensation was intact to light touch, pinprick, proprioception and temperature.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131242513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Tele-ICU Development and Application","authors":"Annalise DeJesus, M. Athar","doi":"10.29046/jhnj.012.1.005","DOIUrl":"https://doi.org/10.29046/jhnj.012.1.005","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132638401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Prevalence of Deep Vein Thrombosis Among Neurocritical Intensive Care Unit Patients","authors":"A. Dolla, M. Vibbert","doi":"10.29046/jhnj.012.1.009","DOIUrl":"https://doi.org/10.29046/jhnj.012.1.009","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121679070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Neurosurgery Through Experimental and Computer Models","authors":"C. Randazzo, A. Pandey, E. Veznedaroglu","doi":"10.29046/JHNJ.004.1.003","DOIUrl":"https://doi.org/10.29046/JHNJ.004.1.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125467092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Farber Hospitalist Service – Last 5 Years of a Service Dedicated to the Medical Management of Neurosurgical Patients","authors":"René Daniel, C. Harrop","doi":"10.29046/jhnj.015.1.001","DOIUrl":"https://doi.org/10.29046/jhnj.015.1.001","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133236205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report on Intracranial Hemorrhage Related to Type I Cryoglobulinemia","authors":"R. Dalyai, L. Gonzalez","doi":"10.29046/JHNJ.006.2.005","DOIUrl":"https://doi.org/10.29046/JHNJ.006.2.005","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121953832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air in the L4-5 Epidural Space Appearing as Disc Herniation","authors":"Angud Mehdi, P. Amenta, J. Harrop","doi":"10.29046/JHNJ.007.2.005","DOIUrl":"https://doi.org/10.29046/JHNJ.007.2.005","url":null,"abstract":"Disc degeneration or spondylosis, when severe, may lead to the development of a vacuum phenomenon in the spine caused by gas production. This gas is visible on plain X-ray films, and is even more clearly apparent on computed tomography (CT) imaging, but may not be apparent on MRI. We present the case of a 69 year-old female with MRI appearing to exhibit a significant L4-5 disc herniation that, on further imaging with CT, was determined to be air in the epidural space without disc herniation. The importance of correlating clinical presentation, neurologic examination, and multimodal imaging is stressed. CASE REPORT History and Presentation: A 69-year old female presented with musculoskeletal low back pain extending into her hips and thighs, in a non-radicular manner. She was neurologically intact and had received physical therapy and epidural steroid injections without symptomatic relief. Imaging: Anterior-posterior and lateral plain films of the thoracic and lumbar spine were unremarkable. T2-weighted MRI images showed marked loss of disc height at L4-L5, with a large central disc herniation and an “extruded disc fragment” resulting in left greater than right foraminal stenosis (Figures 1). A subsequent spine CT, however, revealed air in the L4-L5 disc space consistent with vacuum disc phenomenon which was chronic and appeared on abdominal ct scans done several years prior (Figure 2). DISCUSSION Gas production or “vacuum phenomenon” in the intervertebral space may be a byproduct of disc degeneration. Accumulated gas is composed of nitrogen and carbon dioxide and remains within the disc space.1,2 Gas may escape into the epidural space through a fissure in the annulus fibrosus. The vast majority of individuals with epidural gas are asymptomatic. Gas in the intervertebral disc space is a relatively common radiologic finding and is found in approxi- mately 46% of CT examinations.3 Air in the disc can be seen as a signal void on T1and T2-weighted MRI, however, CT is more sensitive for identifying air in the disc or epidural space. On T2-weighted MRI, disc herniations appear as isoto hypointense material extending beyond the confines of the disc space. These findings are often associated with the loss of disc height at the level of the herniated disc.4,5 These very findings were observed in the T2-weighted imaging of our patient (Figures 1 and 2). Our patient presented with low back pain and no symptoms consistent with radiculopathy referable to L4-L5. Despite the findings seen on MRI, the CT clearly illustrated air in the L4-L5 disc space and left anterolateral portion of the epidural space (Figure 2). In light of the clinical presentation and CT findings, the MRI findings were deemed to be the result of epidural air and the patient was treated with conservative management. We present a case of contrasting imaging findings as an example of the importance of correlating clinical presentation, neurologic examination, and multimodal imaging in the treatm","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127440186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}