Purpose—The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods—A formal literature s...

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000375

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association

Differentiation of embryonic stem cells to clinically relevant populations: lessons from embryonic development.

The protein tyrosine phosphatase (PTP) superfamily of enzymes functions in a coordinated manner with protein tyrosine kinases to control signalling pathways that underlie a broad spectrum of fundamental physiological processes. In this review, I describe recent breakthroughs in our understanding of the role of the PTPs in the regulation of signal transduction and the aetiology of human disease.

Protein tyrosine phosphatases: from genes, to function, to disease

Glioblastoma is the most frequent and most malignant human brain tumor. The prognosis remains very poor, with most patients dying within 1 year after diagnosis. Primary and secondary glioblastoma constitute distinct disease subtypes, affecting patients of different age and developing through different genetic pathways. The majority of cases (>90%) are primary glioblastomas that develop rapidly de novo, without clinical or histological evidence of a less malignant precursor lesion. They affect mainly the elderly and are genetically characterized by loss of heterozygosity 10q (70% of cases), EGFR amplification (36%), p16INK4a deletion (31%), and PTEN mutations (25%). Secondary glioblastomas develop through progression from low-grade diffuse astrocytoma or anaplastic astrocytoma and manifest in younger patients. In the pathway to secondary glioblastoma, TP53 mutations are the most frequent and earliest detectable genetic alteration, already present in 60% of precursor low-grade astrocytomas. The mutation pattern is characterized by frequent G:C→A:T mutations at CpG sites. During progression to glioblastoma, additional mutations accumulate, including loss of heterozygosity 10q25-qter (∼70%), which is the most frequent genetic alteration in both primary and secondary glioblastomas. Primary and secondary glioblastomas also differ significantly in their pattern of promoter methylation and in expression profiles at RNA and protein levels. This has significant implications, particularly for the development of novel, targeted therapies, as discussed in this review.

/pdf/genetic-pathways-to-primary-and-secondary-glioblastoma-54aazofmor.pdf

Genetic Pathways to Primary and Secondary Glioblastoma

Neuroprotective effects of ADAMTS13 against delayed brain ischemia after aneurysmal subarachnoid hemorrhage

Spinal epidural abscess (SEA) is a rare condition with potentially devastating consequences and more aggressive diseases than previously recognized. We report a case with cervical epidural abscess treated successfully by emergent neural decompression. A 49-year-old man presented with fever and cervical pain. An magnetic resonance imaging (MRI) showed an epidural abscess at C5-6. His condition deteriorated with the development of complete sensory loss and tetraparesis. Emergent anterior neural decompression was performed, and pus was aspirated which grew Staphylococcus aureus. Adequate antibiotics were administered, and the patient showed remarkable improvement of neurological signs and symptoms. He underwent reconstruction surgery 3 weeks after the first operation, and returned to his original job 3 months after the operation. Prompt diagnosis and satisfactory surgical decompression are essential to avoid irreversible neurological sequelae in epidural abscess of the cervical spine.

A case of acute cervical epidural abscess

For the spine, anterior column support is more important than posterior column support. Twothirds of the spinal support force is derived from the anterior column. Destruction of the anterior support, which is most frequently due to disc degeneration, can cause a variety of degenerative disorders of the lumbar spine. Mini-ALIF, or minimally invasive anterior lumbar interbody fusion, is a surgical method used to treat the spine. The technique of this surgery is as follows. 1)Under general anesthesia, the patient is placed in the right lateral position. 2)A skin incision is made in the supra-iliac crest area. 3)The psoas major muscle is accessed retroperitoneally. 4)The desired disc is accessed by retracting the psoas major muscle and the disc level is confirmed through fluoroscopy. 5)A discectomy is performed until the posterior ligament can be seen. 6)A distractor is inserted into the disc space and rotated 90°to regain the appropriate disc. height and the correct alignment that have been lost because of scoliosis or spondylolisthesis. 7)Two artificial discs are inserted into the disc level. The patient is allowed to walk the day after surgery. The average hospital stay is 10 days. Approximately 6 months after surgery, bony fusion is confirmed by performing dynamic radiography and computed tomographic scanning. (Received:September 28, 2012;accepted:April 1, 2013)

A Surgical Strategy for Degenerative Lumbar Scoliosis and Spondylolisthesis with the Minimally Invasive Anterior Lumbar Interbody Fusion Technique

Background The pathophysiology of spinal epidural arteriovenous fistulas (SEAVFs) with perimedullary venous drainage remains to be elucidated. This report describes a case of intraosseous SEAVF in a patient with a history of a thoracolumbar vertebral fracture at the same level 10 years before presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. Case description A 71-year-old man presenting with progressive paraparesis was diagnosed with a SEAVF involving a previous Th12 and L1 vertebral compression fracture on which feeders from multiple segmental arteries converged. The interesting feature of this case was that the fistula was located in the fractured vertebral body. The fistula was totally obliterated by transarterial embolization of the segmental arteries followed by symptom improvement. Conclusion We presented a rare case of an intraosseous SEAVF secondary to a thoracolumbar compression fracture with perimedullary venous reflux causing progressive myelopathy. The fistula was located in the fractured vertebral body.

Thoracolumbar intraosseous spinal epidural arteriovenous fistulas after vertebral compression fracture: A case report and literature review.

The Effect of an Amino Acid Administration on the General Metabolism of Patients with an Acute-stage, Ruptured, Intracranial Aneurysm

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