Neurosurgeons and Neurocritical Care
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Challenges and Techniques for Presurgical Brain Mapping with Functional MRI
Challenges and techniques for presurgical brain mapping with functional MRI The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Silva, Michael A., Alfred P. See, Walid I. Essayed, Alexandra J. Golby, and Yanmei Tie. 2017. “Challenges and techniques for presurgical brain mapping with functional MRI.” NeuroImage : Clinical 17 (1): 794-803. doi:10.1016/j.nicl.2017.12.008. http://dx.doi.org/10.1016/ j.nicl.2017.12.008. Published Version doi:10.1016/j.nicl.2017.12.008 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:34651769 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA NeuroImage: Clinical 17 (2018) 794–803 Contents lists available at ScienceDirect NeuroImage: Clinical journal homepage: www.elsevier.com/locate/ynicl Challenges and techniques for presurgical brain mapping with functional T MRI ⁎ Michael A. Silvaa,b, Alfred P. Seea,b, Walid I. Essayeda,b, Alexandra J. Golbya,b,c, Yanmei Tiea,b, a Harvard Medical School, Boston, MA, USA b Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA c Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA ABSTRACT Functional magnetic resonance imaging (fMRI) is increasingly used for preoperative counseling and planning, and intraoperative guidance for tumor resection in the eloquent cortex. Although there have been improvements in image resolution and artifact correction, there are still limitations of this modality. -
Medical Term for Spine
Medical Term For Spine Is Urban encircled or Jacobethan when tosses some deflections Jacobinising alfresco? How Ethiopian is Fonz when undercuttingprobationary and locoedformulated ahorse, Stefan uncompounded recommence andsome laigh. fifers? Si rage his Saiva niche querulously or therewith after Reagan Centers for too extensively or destroy nerve roots exit the term for back pain Information on spinal stenosis for patients and caregivers what fear is signs and symptoms getting diagnosed treatment options and tips for. Medical Terminology Skeletal Root Words dummies. Depending on relieving pressure for medical terms literally means that put too much as well as pain? At birth involving either within this? Transverse sinus stenting is rotation or relax the space narrowing can cause narrowing is made worse in determining if a form for medical term results in alphabetical order for? Below this term for these terms and spine conditions, making a flat on depression can develop? Spine Glossary Dr Joshua Rovner. The term for hypophysectomies among pediatric neurooncological care professional medical terms, or weakness of. Understanding Lumbosacral Strain Fairview. Decompressive surgery often involves a laminectomy or erase process of enlarging your spinal canal to relieve pressure on the spinal cord or nerves by removing. Vertigo is a medical term that refers to the big of motion that help out of. It is prominent only rehabilitation system licensed as a military-term acute day hospital. Spinal Surgery Terminology Gwinnett Medical Center. Lumbago Is a non medical term usually lower lumbar back pain. A Glossary of Neurosurgical Terms Weill Cornell Brain and. Anatomy of the Spine Cedars-Sinai. Glossary of terms used in Neurosurgery brain thoracic spine. -
Electrophysiologic Monitoring in Neurointensive Care
Ovid: Electrophysiologic monitoring in neurointensive care. Main Search Page Ask A LibrarianDisplay Knowledge BaseHelpLogoff Full Text Save Article TextEmail Article TextPrint Preview Electrophysiologic monitoring in neurointensive care Procaccio, Francesco MD*†; Polo, Alberto MD*; Lanteri, Paola MD†; Sala, ISSN: Author(s): Francesco MD† 1070- 5295 Issue: Volume 7(2), April 2001, pp 74-80 Accession: Publication Type: [Neuroscience] 00075198- Publisher: © 2001 Lippincott Williams & Wilkins, Inc. 200104000- University and City Hospital Neuroanesthesia and Intensive Care, Department 00004 of Neurological Sciences and Vision, Divisions of *Neurology and Full †Neurosurgery, Verona, Italy. Institution(s): Text Correspondence to Francesco Procaccio, MD, Neuroanesthesia and Intensive (PDF) Care, University and City Hospital, Pz Stefani, 1, 37124 Verona, Italy; e-mail: 69 K [email protected] Email Jumpstart Table of Contents: Find ≪ Neurologic complications in intensive care. Citing ≫ Pediatric neurologic emergencies. Articles ≪ Abstract Table Links of Cumulative evidence of potential benefits of Contents Abstract electroencephalography (EEG) and evoked potentials in About Complete Reference the management of patients with acute cerebral this ExternalResolverBasic damage has been confirmed. Continuous EEG Journal Outline monitoring is the best method for detecting ≫ nonconvulsive seizures and is strongly recommended for the treatment of status epilepticus. Continuously displayed, ● Abstract validated quantitative EEG may facilitate early detection -
An Introduction to Anaesthesia for Neurosurgery
AN INTRODUCTION TO ANAESTHESIA FOR NEUROSURGERY Barbara Stanley, Norfolk and Norwich University Hospital, UK Email: [email protected] Introduction • Intracranial hypertension Anaesthesia for neurosurgical procedures requires • Associated conditions or trauma understanding of the normal anatomy and physiology of the central nervous system and the likely changes The procedure that occur in response to the presence of space • Short procedure time occupying lesions, trauma or infection. • Great surgical stimulation whilst shunt is In addition to balanced anaesthesia with smooth tunnelled induction and emergence, particular attention should The practicalities be paid to the maintenance of an adequate cerebral perfusion pressure (CPP), avoidance of intracranial • Supine position hypertension and the provision of optimal surgical • Invasive monitoring for burr hole conditions to avoid further progression of the pre- existing neurological insult. Postoperative care Aims of neuroanaesthesia • Rapid recovery and neurological assessment • To maintain an adequate cerebral perfusion Physiological Principals pressure (CPP) Cerebral perfusion pressure and the intracranial pressure/volume relationship • To maintain a stable intracranial pressure (ICP) Maintenance of adequate blood flow to the brain is • To create optimal surgical conditions of fundamental importance in neuroanaesthesia. • To ensure an adequately anaesthetised patient Cerebral blood flow (CBF) accounts for approximately who is not coughing or straining 15% of cardiac output, or 700ml/min. -
Critical Care Neurology and Neuro Critical Care
CRITICAL CARE NEUROLOGY AND NEURO CRITICAL CARE 1 of 86 ROADMAP CRITICAL CARE NEUROLOGY • Analgesia, sedation and neuromuscular blockade o Basic principles, goals, general guidelines and assessment o Table of established drugs o Sedation for endotracheal intubation in critical care o Specialist analgesia in critical care • Sleep • Neurological dysfunction in critical care o Acute brain dysfunction o Delirium o Autonomic dysfunction o Critical illness neuromyopathy o Encephalopathy o Disease specific / syndromal encephalopathies ( ° Hypertensive encephalopathies ° Toxic and metabolic encephalopathies o Common infectious and inflammatory diseases of the nervous system ° Meningitis ° Encephalitis - gereralised and limbic • Transverse myelitis ° Acute inflammatory demyelinating polyneuropathy (AIDP) ° Myaesthenic crises ° Therapeutic plasma exchange and IVIg o Epilespy and seizures ° EEG ° Pathophysiology ° Epidemiology and epileptogenesis ° Epilepsy in ICU • Post injury epilepsy • Status epilepticus ° Anti-epileptic drugs (AEDs) • The controversy of prophylactic AEDs • Proconvulsant drugs o Persistent disorders of consciousness o Brain stem death: diagnosis, pathophysiology and management of the potential organ donor. CORE TOPICS IN NEURO CRITICAL CARE • Secondary brain injury o Pathophysiology – oedema, vascular autoregulation, sodium, glucose, temperature (metabolic supply / demand imbalance), oxygen, carbon dioxide o Prevention and neuroprotection – discussed for each topic above plus pharmacological therapies (epo, progesterone, magnesium -
Molecular Mechanisms of Neuroimmune Crosstalk in the Pathogenesis of Stroke
International Journal of Molecular Sciences Review Molecular Mechanisms of Neuroimmune Crosstalk in the Pathogenesis of Stroke Yun Hwa Choi 1, Collin Laaker 2, Martin Hsu 2, Peter Cismaru 3, Matyas Sandor 4 and Zsuzsanna Fabry 2,4,* 1 School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA; [email protected] 2 Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705, USA; [email protected] (C.L.); [email protected] (M.H.) 3 Chemistry, University of Wisconsin-Madison, Madison, WI 53705, USA; [email protected] 4 Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA; [email protected] * Correspondence: [email protected] Abstract: Stroke disrupts the homeostatic balance within the brain and is associated with a significant accumulation of necrotic cellular debris, fluid, and peripheral immune cells in the central nervous system (CNS). Additionally, cells, antigens, and other factors exit the brain into the periphery via damaged blood–brain barrier cells, glymphatic transport mechanisms, and lymphatic vessels, which dramatically influence the systemic immune response and lead to complex neuroimmune communi- cation. As a result, the immunological response after stroke is a highly dynamic event that involves communication between multiple organ systems and cell types, with significant consequences on not only the initial stroke tissue injury but long-term recovery in the CNS. In this review, we discuss the complex immunological and physiological interactions that occur after stroke with a focus on how the peripheral immune system and CNS communicate to regulate post-stroke brain homeostasis. First, Citation: Choi, Y.H.; Laaker, C.; Hsu, we discuss the post-stroke immune cascade across different contexts as well as homeostatic regulation M.; Cismaru, P.; Sandor, M.; Fabry, Z. -
The Range of Neurological Complications in Chikungunya Fever
Neurocrit Care DOI 10.1007/s12028-017-0413-8 REVIEW ARTICLE The Range of Neurological Complications in Chikungunya Fever 1 2 3 4 5,6 T. Cerny • M. Schwarz • U. Schwarz • J. Lemant • P. Ge´rardin • E. Keller1 Ó Springer Science+Business Media New York 2017 Abstract assigning categories A–C, category A representing the Background Chikungunya fever is a globally spreading highest level of quality. Only A and B cases were con- mosquito-borne disease that shows an unexpected neu- sidered for further analysis. After general analysis, cases rovirulence. Even though the neurological complications were clustered according to geospatial criteria for subgroup have been a major cause of intensive care unit admission analysis. and death, to date, there is no systematic analysis of their Results Thirty-six of 1196 studies were included, yielding spectrum available. 130 cases. Nine were ranked as category A (diagnosis of Objective To review evidence of neurological manifesta- Neuro-Chikungunya probable), 55 as B (plausible), and 51 tions in Chikungunya fever and map their epidemiology, as C (disputable). In 15 cases, alternative diagnoses were clinical spectrum, pathomechanisms, diagnostics, therapies more likely. Patient age distribution was bimodal with a and outcomes. mean of 49 years and a second peak in infants. Fifty per- Methods Case report and systematic review of the litera- cent of the cases occurred in patients <45 years with no ture followed established guidelines. All cases found were reported comorbidity. Frequent diagnoses were encephali- assessed using a 5-step clinical diagnostic algorithm tis, optic neuropathy, neuroretinitis, and Guillain–Barre´ syndrome. Neurologic conditions showing characteristics of a direct viral pathomechanism showed a peak in infants Electronic supplementary material The online version of this and a second one in elder patients, and complications and article (doi:10.1007/s12028-017-0413-8) contains supplementary neurologic sequelae were more freque material, which is available to authorized users. -
Patient-Tailored Connectomics Visualization for the Assessment of White Matter Atrophy in Traumatic Brain Injury
Patient-Tailored Connectomics Visualization for the Assessment of White Matter Atrophy in Traumatic Brain Injury The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Irimia, Andrei, Micah C. Chambers, Carinna M. Torgerson, Maria Filippou, David A. Hovda, Jeffry R. Alger, Guido Gerig, et al. 2012. Patient-tailored connectomics visualization for the assessment of white matter atrophy in traumatic brain injury. Frontiers in Neurology 3:10. Published Version doi://10.3389/fneur.2012.00010 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:8462352 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA METHODS ARTICLE published: 06 February 2012 doi: 10.3389/fneur.2012.00010 Patient-tailored connectomics visualization for the assessment of white matter atrophy in traumatic brain injury Andrei Irimia1, Micah C. Chambers 1, Carinna M.Torgerson1, Maria Filippou 2, David A. Hovda2, Jeffry R. Alger 3, Guido Gerig 4, Arthur W.Toga1, Paul M. Vespa2, Ron Kikinis 5 and John D. Van Horn1* 1 Laboratory of Neuro Imaging, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA 2 Brain Injury Research Center, Departments of Neurology and Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA 3 Department of Radiology, David -
Neuropathology / Neurosurgery
Interinstitutional and interstate teleneuropathology Clayton A. Wiley, MD/PhD [email protected] Disclosures • None – Employee of UPMC and U Pittsburgh – Clinical evaluation board for OMNYX • But I remain receptive if anyone has any great ideas ….. History • 1973: Washington, DC pathologists diagnosed lymphosarcoma/leukemia via satellite in a patient on a ship docked in Brazil • 1986: “telepathology” coined • 1993: first teleneuropathology paper (Becker et al.) – High error rate (27%) – Static imaging system • 2001: Szymas et al. – Robotic dynamic system – 83 paraffin-embedded neurosurgical cases – 95% accuracy Telepathology systems • Static versus dynamic – Static images dependent on proper selection of diagnostic fields • Dynamic: Robotic versus non-robotic – Non-robotic requires two pathologists, one at each end • Whole Slide Imaging 2001 • Dynamic non-robotic for IO consults • Teleconferencing between 2 pathologists at 2 hospitals 18 blocks apart • Problems – Inadequate image quality (NTSC 640 X 480) – No remote control – Required 2 pathologists – Frequent technical glitches, also required presence of IT techs to assist 2002: Nikon DN100 • Static, non-robotic • High-resolution imaging (1280 X 960) • Broadcast every 2 seconds • No remote control • No whole-slide image available 2003: Nikon Coolscope • Dynamic-robotic system • High resolution • Full remote control by consulting neuropathologist • Trained PA to make specimens Our Analysis • Compared error and deferral rates between conventional and telepathology IO cases over 5 years 2002-2006 -
Synaesthesia — a Window Into Perception, Thought and Language
V.S.Ramachandran and E.M. Hubbard Synaesthesia—AWindow Into Perception, Thought and Language Abstract: We investigated grapheme–colour synaesthesia and found that: (1) The induced colours led to perceptual grouping and pop-out, (2) a grapheme rendered invisible through ‘crowding’ or lateral masking induced synaesthetic colours — a form of blindsight — and (3) peripherally presented graphemes did not induce colours even when they were clearly visible. Taken collectively, these and other experiments prove conclusively that synaesthesia is a genuine percep- tual phenomenon, not an effect based on memory associations from childhood or on vague metaphorical speech. We identify different subtypes of number–colour synaesthesia and propose that they are caused by hyperconnectivity between col- our and number areas at different stages in processing; lower synaesthetes may have cross-wiring (or cross-activation) within the fusiform gyrus, whereas higher synaesthetes may have cross-activation in the angular gyrus. This hyperconnec- tivity might be caused by a genetic mutation that causes defective pruning of con- nections between brain maps. The mutation may further be expressed selectively (due to transcription factors) in the fusiform or angular gyri, and this may explain the existence of different forms of synaesthesia. If expressed very diffusely, there may be extensive cross-wiring between brain regions that represent abstract concepts, which would explain the link between creativity, metaphor and synaesthesia (and the higher incidence of synaesthesia among artists and poets). Also, hyperconnectivity between the sensory cortex and amygdala would explain the heightened aversion synaesthetes experience when seeing numbers printed in the ‘wrong’ colour. Lastly, kindling (induced hyperconnectivity in the temporal lobes of temporal lobe epilepsy [TLE] patients) may explain the purported higher incidence of synaesthesia in these patients. -
Internet Resources for Neurosurgeons and Neuropathologists S Thomson, N Phillips
154 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.74.2.154 on 1 February 2003. Downloaded from REVIEW Internet resources for neurosurgeons and neuropathologists S Thomson, N Phillips ............................................................................................................................. J Neurol Neurosurg Psychiatry 2003;74:154–157 Neurosurgical and neuropathological resources on the Neurosurgery://On-call has an “image bank” internet are rapidly developing. Some excellent clinical, section, which has an excellent downloadable collection of radiographs. There are also some patient information, professional, academic, and photographic images. This is a rapidly developing teaching web sites are available. This review database, easy to search, and likely to have images summarises the most useful online sites for relevant to most neurosurgical and neuropatho- logical conditions. neurosurgeons and neuropathologists in the United Neuroanatomy and Neuropathology on the Kingdom and beyond. More general internet resources Internet provides a very comprehensive collection of pathological images within the online neu- have been covered in the first article in this series. ropathology atlas. The neuroanatomy structures .......................................................................... subsection shows the locations of anatomical structures within normal pathological specimens. ver the past 10 years the internet has The functional neuroanatomy tables are also expanded rapidly. While potential ben- highly -
Neurosurgical Anesthesia Does the Choice of Anesthetic Agents Matter?
medigraphic Artemisaen línea E A NO D NEST A ES Mexicana de IC IO EX L M O G O I ÍA G A E L . C C O . C Revista A N A T Í E Anestesiología S G S O O L C IO I S ED TE A ES D M AN EXICANA DE CONFERENCIAS MAGISTRALES Vol. 30. Supl. 1, Abril-Junio 2007 pp S126-S132 Neurosurgical anesthesia Does the choice of anesthetic agents matter? Piyush Patel, MD, FRCPC* * Professor of Anesthesiology. Department of Anesthesiology University of California, San Diego. Staff Anesthesiologist VA Medical Center San Diego INTRODUCTION 1) Moderate to severe intracranial hypertension 2) Inadequate brain relaxation during surgery The anesthetic management of neurosurgical patients is, by 3) Evoked potential monitoring necessity, based upon our understanding of the physiology 4) Intraoperative electrocorticography and pathophysiology of the central nervous system (CNS) 5) Cerebral protection and the effect of anesthetic agents on the CNS. Consequent- ly, a great deal of investigative effort has been expended to CNS EFFECTS OF ANESTHETIC AGENTS elucidate the influence of anesthetics on CNS physiology and pathophysiology. The current practice of neuroanes- It is now generally accepted that N2O is a cerebral vasodila- thesia is based upon findings of these investigations. How- tor and can increase CBF when administered alone. This ever, it should be noted that most studies in this field have vasodilation can result in an increase in ICP. In addition, been conducted in laboratory animals and the applicability N2O can also increase CMR to a small extent. The simulta- of the findings to the human patient is debatable at best.