Well leg compartment syndrome is a rare complication of orthopaedic surgery, especially in paediatric patients. The aim of this study is to present a single case of this disease and to provide recommendations for its management. A 16-year-old male semi-professional footballer sustained a midshaft femoral fracture on the field and subsequently underwent fracture fixation with an intramedullary nail. Following surgery, the patient complained of severe pain in the opposite (well) leg and displayed neurological deficits on examination. He was clinically diagnosed with acute compartment syndrome and underwent emergent two-compartment fasciotomy. The postoperative course was complicated by a persistent foot drop, wound infection, residual compartment swelling preventing direct wound closure, and status epilepticus necessitating intensive care admission. At three-month follow up the patient had a residual foot drop. Well leg compartment syndrome is a rare complication of orthopaedic surgery; however, it can have devastating consequences, particularly in the paediatric population. We recommend intraoperative mobilization of the well leg every two hours for long operations, normotensive blood pressure control to ensure adequate tissue perfusion, and minimal elevation of the well leg. Frequent postoperative examinations may facilitate early diagnosis and management.
Occipital lobe epilepsy is a debilitating condition, and surgical resection has been effective, though challenges arise because of the cortex's function. 1-7 Approximately 57% of patients with normal vision experience new visual field deficits postoperatively. 8 A combined approach of resection and responsive neurostimulation (RNS) could aid in decreasing the visual field area severed and the disability tied to it while obtaining seizure freedom. 9,10 We aimed to present a case of medically refractory occipital lobe epilepsy with involvement of the primary visual cortex treated with a combined approach. The patient consented to the procedure and to the publication of his image. Any identifiable individuals consented to publication of his/her image. A 21-year-old right-handed male experienced refractory epilepsy since age 1 year. His first seizure was a severe refractory status epilepticus which resulted in cardiac arrest. His usual seizure semiology exhibited focal impaired awareness to bilateral tonic-clonic seizures occurring monthly. Noninvasive tests did not provide precise localization, but the intracranial electroencephalogram confirmed seizure onset in the right cuneus with rapid spread to the lingual gyrus and the superior parietal lobe. We performed a corticectomy 11 of the seizure onset zone and used RNS to address spreading areas in the parietal and occipital lobe. A complete lobectomy was avoided to prevent postoperative homonymous hemianopsia in a previously intact patient. The patient was discharged on postoperative day 3 with a nondisabling left inferior quadrantanopia. No clinical seizures were detected after RNS was turned on, rendering so far 8.5 months of seizure freedom. The combined surgical approach appears promising for medically refractory epilepsy involving functional areas.
Functional coactivation between human brain regions is partly explained by white matter connections; however, how the structure-function relationship varies by function remains unclear. Here, we reference large data repositories to compute maps of structure-function correspondence across hundreds of specific functions and brain regions. We use natural language processing to accurately predict structure-function correspondence for specific functions and to identify macroscale gradients across the brain that correlate with structure-function correspondence as well as cortical thickness. Our findings suggest structure-function correspondence unfolds along a sensory-fugal organizational axis, with higher correspondence in primary sensory and motor cortex for perceptual and motor functions, and lower correspondence in association cortex for cognitive functions. Our study bridges neuroscience and natural language to describe how structure-function coupling varies by region and function in the brain, offering insight into the diversity and evolution of neural network properties.
CENTRAL ISLIP, N. Y. Red before the Brooklyn Neurological Society, Oct. 26, 1938. From the Neurological and Ophthalmological Services of the Central Islip State Hospita.
Gerstmann syndrome is a tetrad of finger agnosia, left-right disorientation, acalculia, and agraphia.1 It results from lesions affecting the left parietal lobe, specifically the angular gyrus.1,2 Because it often presents as an incomplete tetrad, it is possible that the 4 features may have separate (but adjacent or overlapping) anatomic localization. Here, we present a case in which functional mapping through electrical cortical stimulation (ECS) revealed spatial dispersion of the Gerstmann tetrad.
Abstract Purpose Management of vestibular schwannoma (VS) is based on tumour size as observed on T1 MRI scans with contrast agent injection. The current clinical practice is to measure the diameter of the tumour in its largest dimension. It has been shown that volumetric measurement is more accurate and more reliable as a measure of VS size. The reference approach to achieve such volumetry is to manually segment the tumour, which is a time intensive task. We suggest that semi-automated segmentation may be a clinically applicable solution to this problem and that it could replace linear measurements as the clinical standard. Methods Using high-quality software available for academic purposes, we ran a comparative study of manual versus semi-automated segmentation of VS on MRI with 5 clinicians and scientists. We gathered both quantitative and qualitative data to compare the two approaches; including segmentation time, segmentation effort and segmentation accuracy. Results We found that the selected semi-automated segmentation approach is significantly faster (167 s vs 479 s, $$p<0.001$$ p<0.001 ), less temporally and physically demanding and has approximately equal performance when compared with manual segmentation, with some improvements in accuracy. There were some limitations, including algorithmic unpredictability and error, which produced more frustration and increased mental effort in comparison with manual segmentation. Conclusion We suggest that semi-automated segmentation could be applied clinically for volumetric measurement of VS on MRI. In future, the generic software could be refined for use specifically for VS segmentation, thereby improving accuracy.
Abstract Precise cortical brain localization presents an important challenge in the literature. Brain atlases provide data-guided parcellation based on functional and structural brain metrics, and each atlas has its own unique benefits for localization. We offer a parcellation guided by intracranial electroencephalography, a technique which has historically provided pioneering advances in our understanding of brain structure–function relationships. We used a consensus boundary mapping approach combining anatomical designations in Duvernoy’s Atlas of the Human Brain, a widely recognized textbook of human brain anatomy, with the anatomy of the MNI152 template and the magnetic resonance imaging scans of an epilepsy surgery cohort. The Yale Brain Atlas consists of 690 one-square centimeter parcels based around conserved anatomical features and each with a unique identifier to communicate anatomically unambiguous localization. We report on the methodology we used to create the Atlas along with the findings of a neuroimaging study assessing the accuracy and clinical usefulness of cortical localization using the Atlas. We also share our vision for the Atlas as a tool in the clinical and research neurosciences, where it may facilitate precise localization of data on the cortex, accurate description of anatomical locations, and modern data science approaches using standardized brain regions.
ObjectiveProspectively investigate the utility of seizure induction using systematic 1Hz stimulation by exploring its concordance with the spontaneous seizure onset zone (SOZ), relation to surgical outcome, and comparison with seizures induced by 50 Hz.MethodsProspective cohort study from 2018-2021 with ³ 1y post-surgery follow up at Yale New Haven Hospital. With 1 Hz, all or most of the gray matter contacts were stimulated at 1, 5, and 10 mA for 30-60s. With 50 Hz, all or most gray matter contacts outside of the medial temporal regions were stimulated at 1 to 5 mA for 0.5 to 3s. Stimulation was bipolar, biphasic with 0.3 ms pulse width. The Yale Brain Atlas was used for data visualization. Variables were analyzed using Fisher’s exact, c2, or Mann–Whitney test, as appropriate.ResultsForty-one consecutive patients with refractory epilepsy undergoing intracranial EEG for localization of SOZ were included. Fifty-six percent (23/41) of patients undergoing 1 Hz stimulation had seizures induced, 83% (19/23) habitual (clinically and electrographically). Eighty two percent (23/28) of patients undergoing 50 Hz stimulation had seizures, 65% (15/23) habitual. Stimulation of medial temporal or insular regions with 1 Hz was more likely to induce seizures compared to neocortex [15/32 (47%) vs. 2/41 (5%), p<0.001]. Sixteen patients underwent resection; 11/16 were seizure free at one year and all had habitual seizures induced by 1 Hz; 5/16 were not seizure free at one year and none of them had seizures with 1 Hz (11/11 vs 0/5, p<0.0001). No patients had convulsions with 1 Hz stimulation, but four did with 50 Hz (0/41 vs. 4/28, p=0.02).SignificanceInduction of habitual seizures with 1 Hz stimulation can reliably identify the SOZ, correlates with excellent surgical outcome if that area is resected, and may be superior (and safer) than 50 Hz for this purpose.
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