Volume 3 Issue 2

Research Article: Dynamic Medical Consultation on Based on Problem Solving and Decision Making in Craniosynostosis Surgery

Mehrdad Rostam Pour*

The purpose of this paper is to make a protocol to help physicians and surgeons to set a treatment plan up according to their diagnosis and patient`s problems and desires.
In fact it's physician duty to use his/her ability to identify current and potential health problems of the patient and to make timely decisions for treating.
Treatment when is going to success which:
- Physician understand patient`s desires and problems
- Patient understand aim (goal) of the treatment
So this success in medicine can be possible with a dynamic consultation.
In Dynamic Medical Consultation (DMC) patients can be more active about their own health and health care [1].
In this kind of dialogue physician understand the patient problems and the patient would has better aspect the goal of the treatment. In this way the care pathway and the monitoring of patient`s progress is going to ease and both parties would have better provision in treating process.
A dynamic Medical consultation become important when patient is faced with major treatment plan. Usually most of the patients are under pain or stress situation, taking decision for them become more difficult or sometimes is impossible.
An expert health provider with help of his/her abilities, skills, experiences and knowledge can make the patient`s mind clear about the treatment and care planning. The base of this strategic and holistic communication is obtaining information. In such a way the physician can have a clear view to all dimensions of causes of the problems, treatment plan and outcomes.

Cite this Article: Rostam pour M. Dynamic Medical Consultation on Based on Problem Solving and Decision Making in Craniosynostosis Surgery. Scientific Journal of Neurology & Neurosurgery. 2017;3(2): 041-047.

Published: 22 August 2017

Case Report: Bilateral Deep Brain Stimulation of the Subthalamic Nuclei in Parkinson's disease Patients with Camptocormic Posture

Fadi Almahariq, Marina Raguz*, Vladimira Vuletic, Darko Oreskovic, Ivica Franciskovic, Petar Marcinkovic and Darko Chudy

Background: Camptocormia is a disabling syndrome characterized by forward flexion that can be an idiopathic or associated with numerous diseases like movement disorders. Posture improvement could be expected after bilateral deep brain stimulation (DBS) of the Globus Pallidus Internus (GPI) or Subthalamic Nucleus (STN) in Parkinson's disease (PD) patients with camptocormia. The aim of this study was to determine the efficacy of bilateral STN DBS in alleviating the degree of camptocormia in PD patients.
Methods: Two patients (67 year old female and 66 year old male) suffering from PD in the last ten years were subjected to bilateral STN DBS procedure. The positions of electrodes were verified with a postoperative magnetic resonance imaging. The results were objectivized by measuring thoracolumbar flexion angle before and after operation and utilizing all recommended scales for the international survey of DBS.
Results: The degree of forward flexion of the spine substantially decreased and the quality of life, motor symptoms and functioning was improved in both patients.
Conclusions: STN DBS should be considered as a potential treatment option for PD patients with camptocormia. Further analysis is needed to conclude which PD patients are suitable candidates for bilateral STN or GPi stimulation in the treatment of camptocormia.
Keywords: Camptocormia; Deep Brain Stimulation (DBS); Parkinson's disease (PD); Subthalamic Nucleus (STN); Globus Pallidus Internus (GPI).

Cite this Article: Almahariq F, Raguz M, Vuletic V, Oreskovic D, Franciskovic I, et al. Bilateral Deep Brain Stimulation of the Subthalamic Nuclei in Parkinson's disease Patients with Camptocormic Posture. Scientific Journal of Neurology & Neurosurgery. 2017;3(2): 037-040.

Published: 19 August 2017

Letter to Editor: Standard Algorithm and Tailor-Made Treatment in Parkinson Disease: How to Find a Balance?

Maria Chiara Malaguti*

Parkinson Disease (PD) is a neurodegenerative disorder that goes toward continuous changes and transformation. It starts with some symptoms but ends with many others that usually become more troublesome than the initial ones. We have a large collection of disposable treatment options to face the disease in its evolution.
Keywords: Treatment Parkinson Disease

Cite this Article: Malaguti MC. Standard Algorithm and Tailor-Made Treatment in Parkinson Disease: How to Find a Balance? Scientific Journal of Neurology & Neurosurgery. 2017;3(2): 035-036

Published: 18 August 2017

Case Report: Continuous Vasopressin Infusion for the Management of Central Diabetes Insipidus

Amber Rollstin*, Mindy Mason, Ashley K. Green, Lauren Coleman, Peter Bui and Jonathan Marinaro

Central Diabetes Insipidus (CDI) is a common complication of Traumatic Brain Injury (TBI). One option for CDI management is a Continuous Vasopressin Infusion (CVI). However, evidence of efficacy for this regimen is lacking. We present a case series evaluating the effect of CVI on urine output and possible adverse effects related to renal function and tissue perfusion.
We retrospectively identified subjects at the University of New Mexico Hospital between January 2008 to November 2013 who had received CVI and had been declared dead by neurological criteria. Our analysis included time to decreased urine output and compared changes in creatinine (paired t-test), lactate, and systolic blood pressure (repeated measures ANOVA) before and after infusion of vasopressin. Thirty-two subjects met inclusion criteria. Urine output declined from a median of 345 ml/hour (IQR 178-500) to 222 ml/hour (IQR 114-273) within an hour of starting CVI. Urine output had declined to 50% goal by a median time of 90 minutes (IQR 60-123) with goal urine output at a median of 120 minutes (IQR 84-210). Our results also indicate that systolic blood pressure (repeated measures ANOVA), creatinine (paired t-test) and lactate after infusion of vasopressin were not statistically different compared with values prior to CVI.CVI appears to be an effective means of decreasing urinary output without adverse effects on renal function and tissue perfusion in patients on the donor service with CDI.

Cite this Article: Rollstin A, Mason M, Green AK, Coleman L, Bui P, et al. Continuous Vasopressin Infusion for the Management of Central Diabetes Insipidus. Scientific Journal of Neurology & Neurosurgery. 2017;3(2): 031-034.

Published: 29 June 2017

Case Report: Surgical Management of Super-Refractory Status Epilepticus with Successful Outcomes- A Presentation of 3 Case Series

Soundarya N. Gowda*, Ammar Hussain, Victor G. Montoya and Kathryn Holloway

Refractory Status Epilepticus (SE) and Super-refractory status epilepticus have significant mortality and morbidity. Urgent neurosurgical intervention is rarely used, but in selected cases where medical therapy has failed, it can successfully help control refractory partial SE and also prevent associated morbidity and mortality. At our institution, urgent resective surgery was performed on three patients with medically refractory convulsive status epilepticus in the past 4 years. The etiology on histopathological analysis was focal cortical dysplasia on two patients and non-specific gliosis on the third patient. In all cases, surgery resulted in termination of status epilepticus, permitting de-escalation of therapy, and led to marked improvement in quality of life. There are recent advances in anatomical and functional neuroimaging techniques, which in combination with improved and relatively easier availability of continuous intracranial EEG recording, have markedly improved the diagnostic localization of epileptogenic cortex. Diagnostic work up and surgical intervention in a multistep algorithmic approach are crucial to achieving improved patient outcome. Our cases demonstrate the importance of timely surgical intervention in the management of selected patients with medically refractory status epilepticus.
Keywords: Super refractory status epilepticus; Surgical resection; Epilepsy surgical outcomes

Cite this Article: Gowda SN, Hussain A, Montoya VG, Holloway K. Surgical Management of Super-Refractory Status Epilepticus with Successful Outcomes- A Presentation of 3 Case Series. Sci J Neuro Neurosur. 2017;3(2): 028-030.

Published: 06 April 2017

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