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  • ISSN: 2373-9479
    Early Online
    Volume 5, Issue 3
    Case Report
    Sara Duarte*, Daniel Dias, and Ernestina Santos
    Introduction: Prion diseases are a group of neurodegenerative disorders of the nervous system caused by a conformational change of an endogenous protein. The sporadic form of Creutzfeldt-Jakob disease (CJD) is responsible for the majority of cases. Despite advances in diagnosis, the absence of effective treatment makes this disease rapidly progressive and invariably fatal.
    Case presentation: A 56-year-old man presented with subjective cognitive complaints without important impact on daily activities, including professional duties. Significant cognitive deterioration occurred three years after the first symptoms and progressed to dementia in about four months. Magnetic resonance imaging showed hyper intensities in multiple cortical regions. The EEG revealed a slow basal activity, with inscription of bilateral periodic activity. The 14-3-3 protein assay in the CSF was positive. In the final phase the patient was in akineticmutism with myoclonus. The diagnosis of probable CJD was made.
    Discussion: This case presents an atypical evolution of the sporadic form of CJD, known for median survival of less than six months after the appearance of the first symptoms.
    Rob Dickerman*, Ashley S. Reynolds NP, and Karl Winters
    Surgical site infections in neurosurgery patients are increase due to the high rates of trauma cases, increase in patient comorbidities, and the prevalence of multi-resistant drug organisms. Recent reports have demonstrated that topical antibiotic powder used during wound closure significantly decreases rates of wound infections in spine cases.
    The authors present a prospective study of 102 consecutive cranial or spinal neurosurgery cases. A mixture of 1 gram Vancomycin powder mixed with 1 gram of Hydrolyzed collagen powder (CellerateRX Surgical) was then placed within the incision. This was followed by skin closure with either staples or subcuticular sutures. Patients were seen at approximately 2 weeks postoperatively for incision check and subsequent removal of sutures or staples.
    In conclusion, this study demonstrated that the combination of hydrolyzed collagen (CellerateRX Surgical) and Vancomycin powder resulted in no infections or wound dehiscence. The hygroscopic nature of the hydrolyzed collagen bound the aqueous vancomycin to the hydrolyzed collagen retaining and prolonging the antimicrobial environment in the surgical site.
    Arvin Parvathaneni* and Joseph H. Friedman
    Mutations of voltage gated calcium channels are commonly associated with episodic ataxia. There has been no case reports in the literature that describe anon-episodic presentation of ataxia in patients affected with this mutation. This current case report describes a 61-year-old female patient with progressive ataxia and mutations that commonly cause an episodic ataxia.
    Research Article
    Ditte Gry Ellman, Hans Gram Novrup, Louise Helskov Jrgensen, Minna Christiansen Lund, Minna Yli-Karjanmaa, Pernille Marie Madsen, Jonas Heinrich Vienhues, Safinaz Dursun, John R. Bethea, Karin Lykke-Hartmann, Roberta Brambilla, and Kate Lykke Lambertsen*
    Nuclear factor-kappa B (NF-κB) is a key modulator of inflammation and secondary injury responses in neurodegenerative disease, including spinal cord injury (SCI). Inhibition of astroglial NF-κB reduces inflammation, enhances oligodendrogenesis and improves functional recovery after SCI, however the contribution of neuronal NF-κB to secondary inflammatory responses following SCI has yet to be investigated. We demonstrate that conditional ablation of IKK2 in Synapsin 1-expressing neurons in mice (Syn1creIKK2fl/fl) reduces activation of the classical NF-κB signaling pathway, resulting in impaired motor function and altered memory retention under nave conditions. Following induction of a moderate SCI phosphorylated NF-κB levels decreased in the spinal cord of Syn1creIKK2fl/fl mice compared to controls, resulting in improvement in functional recovery. Histologically, Syn1creIKK2fl/fl mice exhibited reduced lesion volume but comparable microglial/leukocyte responses after SCI. In parallel, interleukin (IL)-1 expression was significantly decreased within the lesioned spinal cord, whereas IL-5, IL-6, IL-10, tumor necrosis factor (TNF) and chemokine (C-X-C motif) ligand 1 were unchanged compared to control mice. We conclude that conditional ablation of IKK2 in neurons, resulting in reduced neuronal NF-B signaling, and lead to protective effects after SCI and propose the neuronal classical NF-κB pathway as a potential target for the development of new therapeutic, neuroprotective strategies for SCI.
    Review Article
    Onyekwelu I, Rhea E, Carreon LY*, and Crawford C
    The Ovid Medline database was searched for English language articles published between 2005 and 2015 on PEEK Cages and ACDF. Eleven studies were included: eight Level 1 and three Level 2 studies. Using pooled averages weighted by sample size, the PEEK and non-PEEK cohorts were similar in age (50.0 years vs 51.4 years) and percentage of smokers (58.5% vs 56.4%). The PEEK cohorts had a lower fusion rate (81.3%) at final follow-up compared to the non-PEEK cohorts (93.3%). Inconsistencies in fusion assessment method and data reporting restricted further meta-analysis. Although systematic review of level 1 and 2 studies on PEEK interbody in ACDF showed lower fusion rates compared to non-PEEK interbody, this was based on a very limited number of studies as well as a wide variability in study design, especially with regard to fusion assessment methods, and the reporting styles of authors. As such, results on PEEK fusion rates in ACDF surgery remain inconclusive. Our results suggest a need for a consensus regarding study design and reporting to enable accurate interpretation of studies regarding ACDF fusion rates.
    Short Communication
    Cosamalon-Gan I, Villar Vega V, Cosamalon-Gan T, Cobo R, Mattos-Piaggio G, Garcia-Cosamalon J, and Vega JA*
    The German pathologist C.G. Schmorl was the first to systematically describe the normal structure and the degenerative changes of the human intervertebral disc, considering the age-related changes as primary degeneration. He established the terms of chondrosis, osteochondrosis, disc prolapse or herniation and intraosseus node. This paper briefly summarized the contribution of Schmorl to the knowledge of the intervertebral disc.
    Angel Horcajadas*, Isabel Ortiz*, Majed Katati, Ana Jorques, and Gonzalo Olivares
    Object: To evaluate the clinical and angiographic results as well as the costs of surgical treatment against endo-vascular treatment in a SAH in a paired series of patients.
    Methods: A retrospective study of a series of 78 SAH patients treated endovascularly (EV) or surgically (SC) and paired according to age, Hunt-Hess scale at admission, Fischer grade, aneurysm localization and follow-up time. A descriptive study was performed, as well as clinical results (Glasgow Outcome Scale, GOS, at 6 months), angiographic data (occlusion classification) and economic costs in each of the groups.
    Results: The mean age was 51.4 years (25-82) with a female predominance (7:10). The mean follow-up time was 37.3 months. Glasgow Outcome Scale (GOS) at 6 months was favorable (4-5) in 69.7% of the cases (bet-ter in the SC group). The average length of stay (ALOS) was 36.3 days (slightly higher in the EV group). Complete occlusion of the aneurysm was obtained in 80.0% of the patients in SC series and 47.3% in the EV series. 18.4% of the EV patients required retreatment. Costs of the SC treatment were slightly higher than the EV costs for the first admission (0.2% higher) but EV costs are considerably higher when the costs of follow-up and retreatment were added (13.4% more). The factors that made EV treatment more expensive were the costs of embolization material and retreatment.
    Conclusions: SC and EV treatment have similar clinical results; however SC treatment has greater stability and lower costs. Adequate selection of patients for treatment modality could save costs.
    Nonato MB*, Prandini MN, and De Muzio SDC
    Subarachnoid hemorrhage secondary to ruptured aneurysms is one of the major concerns of neurosurgeons when performing the currently available invasive rupture prevention treatments. Assuming that antiplatelet therapy not only reduces the formation of thrombi but also acts on the physiology of inflammation and decreases its progression, several studies have recently trying to establish a beneficial relationship of the aneurysms rupture prevention with antiplatelet therapy against the hypothesis of causing rates increase in aneurysms bleeding. The aim of the present study was to analyze the published literature on the relationship between antiplatelet therapy and its effect on the rupture of intracranial aneurysms.
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