Person:

Motiei-Langroudi, Rouzbeh

Study Design Retrospective study. Purpose To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term. Overview of Literature SCI is a potentially disabling and devastating neurological outcome that can occur because of spinal column fractures. Most studies have not evaluated or have failed to show the influence of different surgical approaches and other parameters on neurological recovery. Methods: A thorough history regarding sensory, motor, and urinary complaints was taken from 103 patients with SCI due to vertebral fracture; patients were followed by a thorough neurological examination. Subsequently, all medical records of patients, including neurological state after trauma, trauma mechanism, treatment protocol, surgical protocol, and imaging findings, were evaluated. Results: Of the 103 patients, 73.8% were survivors of a major earthquake and 26.2% were victims of vehicle accidents; 92.2% patients were surgically treated, while 7.8% underwent conservative management. The mean follow-up duration was 10.3 years. In follow-up visits, 67.0%, 12.6%, 13.6%, and 6.8% patients showed no, partial, substantial, and complete motor improvement, respectively; 68.0%, 26.2%, and 5.8% showed no, mild, and substantial sensory improvement, respectively; and 73.8%, 17.5%, and 8.7% showed no, substantial, and complete urinary improvement, respectively. Logistic regression analysis showed that sex, age at injury time, follow-up duration, trauma mechanism, and stem cell therapy had no effect on motor, sensory, and urinary improvement. Higher initial scores on the American Spinal Injury Association (ASIA) classification, lumbar fracture level, and performance of laminectomy improved motor outcome; higher initial ASIA scores improved urinary and sensory outcomes. Conclusions: The initial ASIA score is the most important factor for prognosticating motor, sensory, and urinary improvement in SCI patients. Lumbar (L3–L5) and thoracic (T1–T10) fractures have the best and worst prognosis, respectively, in terms of motor recovery. Laminectomy during surgery improves motor function.

Introduction: Brain death (BD) is the irreversible termination of the functioning of the brain. The diagnosis should be first made by clinical criteria and confirmed by using paraclinical confirmatory techniques (ancillary tests). While conventional brain angiography remains the standard method of choice, computed tomography angiography (CTA) has emerged as an alternative method. In this study, we tried to evaluate the accuracy of CTA for the diagnosis of BD. Methods: In this study, we included nine patients with a clinical diagnosis of BD, confirmed by electroencephalography (EEG). CTA was then performed to compare the results. Results: The most frequent cause for BD was multiple trauma (7/9) in our patients, followed by aneurysm rupture and brain infarct. CTA examination in all patients showed opacification of extracranial arteries and major branches of external carotid artery (ECA), including superficial temporal arteries (STAs), while no opacification was observed in the internal carotid arteries (ICA) including and beyond the cavernous segment, middle cerebral arteries (MCAs), anterior cerebral arteries (ACAs), distal vertebral arteries (VAs), and basilar artery (BA). Moreover, no opacification was observed in the internal cerebral veins (ICVs) or great cerebral vein (GCV). Conclusion: The accuracy rate of CTA in the detection of intracranial circulatory arrest was 100%. CTA examinations confirmed BD diagnoses in all patients who had clinical and EEG BD diagnoses, and no confliction between CTA findings and clinical diagnoses was observed.

Glioblastoma multiforme (GBM) is a malignant brain tumor with an ominous prognosis. The standard treatment includes maximal safe resection plus adjuvant therapy. Thalamic GBMs, however, are unfavorable for microsurgical removal because of deep location and proximity to critical structures. We present a patient presenting with progressive hemiparesis and decreased consciousness with a large thalamic GBM who underwent subtotal resection through a transsylvian approach. His clinical and neurologic condition improved after surgery and he survived nine months after surgery. This may propose that in selected cases, more aggressive microsurgery for debulking of tumors might have some impact in the final outcome.​​​