Abstract:
OBJECTIVE:Establishing the neurological localization doctrine for the contralateral hemispheric control of motor functions in the second half of the 19th century, researchers faced the challenge of recognizing false localizing signs, in particular paradoxical or ipsilateral hemiparesis (IH). Despite tremendous progress in current methods of neuroradiological and electrophysiological exploration, a complete understanding of this phenomenon has yet to be attained. METHODS:The authors researched the well-described cases of hemiparesis/hemiplegia ipsilateral to an intracranial lesion published in the scientific literature in the pre-MRI era (before 1980). A comprehensive review of the physiopathological mechanisms proposed for paradoxical hemiparesis throughout this period, as well as the pathological evidence substantiating them, is provided. RESULTS:A collection of 75 patients with hemiparesis/hemiplegia ipsilateral to the primary intracranial lesion reported between 1858 and 1979 were eligible for analysis. Most cases occurred in adults with supratentorial, slowly developing, extraparenchymatous mass lesions, such as neoplasms (38%) or chronic subdural hematomas (36%). Physiopathological theories proposed by the neurologists who investigated IH can be grouped into 4 major concepts: 1) lack of anatomical decussation of the corticospinal tract; 2) impaired functional activation of the contralateral hemisphere by the lesioned dominant hemisphere through the callosal connections; 3) Kernohan's notch phenomenon, or mechanical injury of the contralateral cerebral peduncle against the free edge of the tentorium; and 4) cerebrovascular dysfunction involving the contralateral hemisphere owing to kinking and mechanical flattening of the carotid artery contralateral to the primary intracranial lesion. CONCLUSIONS:IH represents a still underdiagnosed paradoxical neurological phenomenon. With the aid of modern neuroradiological and neurophysiological methods, Kernohan's peduncle notch mechanism has been confirmed to cause IH in many of the cases reported in recent decades. Nevertheless, alternative functional and/or vascular mechanisms must be investigated further for unexplained IH cases, in particular for transitory IH without evidence of peduncle injury. The historical theories reviewed in this paper represent a conceptual framework that may be helpful for this purpose.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Carrasco-Moro R,Castro-Dufourny I,Martínez-San Millán JS,Cabañes-Martínez L,Pascual JMdoi
10.3171/2019.6.FOCUS19337subject
Has Abstractpub_date
2019-09-01 00:00:00pages
E7issue
3issn
1092-0684pii
2019.6.FOCUS19337journal_volume
47pub_type
历史文章,杂志文章abstract:OBJECT:Lamotrigine is an antiepileptic drug that inhibits presynaptic voltage-gated sodium channels and reduces the presynaptic release of glutamate in pathological states. Neuroprotective effects of this drug have already been demonstrated in cerebral ischemia models. The aim of the present study was to determine the ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/FOC.2008.25.11.E6
更新日期:2008-01-01 00:00:00
abstract::OBJECTIVE Stereoelectroencephalography (sEEG) and MR-guided laser interstitial thermal therapy (MRgLITT) have both emerged as minimally invasive alternatives to open surgery for the localization and treatment of medically refractory lesional epilepsy. Although some data are available about the use of these procedures ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.6.FOCUS18209
更新日期:2018-09-01 00:00:00
abstract::Both the history of headache and the practice of craniotomy can be traced to antiquity. From ancient times through the present day, numerous civilizations and scholars have performed craniotomy in attempts to treat headache. Today, surgical intervention for headache management is becoming increasingly more common due ...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/2014.1.FOCUS13549
更新日期:2014-04-01 00:00:00
abstract::Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balan...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2009.4.FOCUS0965
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:In addition to the rising burden of surgical disease globally, infrastructure and human resources for health remain a great challenge for low- and middle-income countries, especially in Uganda. In this study, the authors aim to explore the trends of neurosurgical care at a regional referral hospital in Uganda...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.7.FOCUS18270
更新日期:2018-10-01 00:00:00
abstract:OBJECT:The goal of this study was to review the management of intra- and extradural ependymomas. Spinal ependymomas most commonly occur as intramedullary tumors throughout the spinal axis. In the lumbosacral region, ependymomas are most commonly associated with the conus medullaris and cauda equina, but can also occur ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2003.15.5.13
更新日期:2003-11-15 00:00:00
abstract::Frontal sinus fractures are heterogeneous, and management of these fractures is often modified based on injury pattern and institutional experience. The optimal initial treatment of frontal sinus fractures is controversial. Treatment strategies are aimed at correcting cosmetic deformity, as well as at preventing delay...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2012.3.focus1266
更新日期:2012-06-01 00:00:00
abstract:OBJECT:Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis. METHODS:The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 an...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2002.12.5.3
更新日期:2002-05-15 00:00:00
abstract:OBJECT:The authors present a series of 4 patients with rare facial nerve tumors. The relevant literature is reviewed and is discussed regarding diagnostic features, the role of operative management, and surgical approach. METHODS:A retrospective chart review was conducted for patients with tumors of the facial nerve t...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.1.FOCUS12380
更新日期:2013-03-01 00:00:00
abstract:OBJECT:Indocyanine green (ICG) videoangiography (VA) in cerebral aneurysm surgery allows confirmation of blood flow in parent, branching, and perforating vessels as well as assessment of remnant aneurysm parts after clip application. A retrospective analysis and review of the literature were conducted to determine the ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.11.FOCUS13475
更新日期:2014-02-01 00:00:00
abstract::In Cushing disease, a pituitary corticotroph neoplasm causes secondary adrenal hypercortisolism. This condition has known morbidity and mortality, underscoring the need for an efficient and accurate diagnostic approach. An 11 p.m. salivary cortisol level is a modern, simple initial screening tool for the diagnosis of ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2007.23.3.2
更新日期:2007-01-01 00:00:00
abstract::Pediatric spinal deformity results from multiple conditions including congenital anomalies, neuromuscular disorders, skeletal dysplasia, and developmental disorders (idiopathic). Pediatric spinal deformities can be progressive and cause pulmonary compromise, neurological deficits, and cardiovascular compromise. The cl...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2003.14.1.4
更新日期:2003-01-15 00:00:00
abstract:OBJECTIVE:The authors aimed to compare the efficacy of lumbar vertebral body Hounsfield units (HUs) and pedicle HUs at predicting pedicle screw loosening. METHODS:The authors retrospectively assessed 143 patients with L3-5 instrumentation. The patients were classified into one of two groups based on the status of thei...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.5.FOCUS20249
更新日期:2020-08-01 00:00:00
abstract::Electrodiagnostic testing in patients who have upper-extremity symptoms, which may include carpal tunnel syndrome (CTS), has been the gold standard for diagnosis for many years. Despite their value, these tests are underutilized. The authors examined the use patterns of electrodiagnostic testing at the University of V...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1997.3.1.5
更新日期:1997-07-15 00:00:00
abstract::Moyamoya disease is an uncommon cerebrovascular condition characterized by progressive stenosis of the bilateral internal carotid arteries with compensatory formation of an abnormal network of perforating blood vessels providing collateral circulation. The etiology and pathogenesis of moyamoya disease remain unclear. ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2009.1.FOCUS08302
更新日期:2009-04-01 00:00:00
abstract:OBJECTIVE:Convection-enhanced delivery (CED) and osmotic pump delivery both have been promoted as promising techniques to deliver drugs to pediatric diffuse intrinsic pontine gliomas (DIPGs). Correspondingly, the aim of this study was to understand how infusate molecular weight (MW), duration of delivery, and mechanism...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2019.10.FOCUS19703
更新日期:2020-01-01 00:00:00
abstract::Epidermoid cysts or tumors comprise 1% of intracranial tumors with a predilection for the cerebellopontine angle or parasellar cisterns. These tumors are derived from an ectopic ectodermal implant seeded between fusing ectodermal surfaces. This results in a benign proliferation of stratified squamous epithelium along ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2016.1.FocusVid.15466
更新日期:2016-01-01 00:00:00
abstract::Cerebral vasospasm remains a feared complication from subarachnoid hemorrhage. Vasospasm typically occurs from three to fourteen days post-aneurysm rupture, with peak risk on Day 7. Up to 50% of patients with angiographic vasospasm will subsequently develop delayed cerebral ischemia; 15-20% of this subset will develop...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.V2.FOCUS14172
更新日期:2014-07-01 00:00:00
abstract::OBJECTIVE Isolated acute subdural hematoma (aSDH) is increasing in older populations and so is the use of oral anticoagulant therapy (OAT). The dramatic increase of OAT-with direct oral anticoagulants (DOACs) as well as with conventional anticoagulants-is leading to changes in the care of patients who present with aSD...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.8.FOCUS17421
更新日期:2017-11-01 00:00:00
abstract::OBJECTIVE Traumatic brain injury (TBI) in children is a significant public health concern estimated to result in over 500,000 emergency department (ED) visits and more than 60,000 hospitalizations in the United States annually. Sports activities are one important mechanism leading to pediatric TBI. In this study, the ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2016.1.FOCUS15612
更新日期:2016-04-01 00:00:00
abstract:OBJECT:Tumors involving the cervicothoracic junction can have a high propensity for causing instability, with kyphosis and spinal cord compression resulting. Treatment with decompression only can lead to further instability and worsening neurological status. In this article, the authors review their surgical experience...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2003.15.5.3
更新日期:2003-11-15 00:00:00
abstract::The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality Outcomes Database (N2QOD), was established by the NeuroPoint Alliance (NPA) in collaboration with relevant national stakeholders and experts. The overarching goal of this project was to develop a centralized, nationally coordinate...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.2.FOCUS207
更新日期:2020-05-01 00:00:00
abstract:OBJECT:Although a rarely reported occurrence, late failure of endoscopic third ventriculostomy (ETV) may occur in children as a result of a variety of factors. Delay in recognition of symptoms can lead to harmful deterioration in the patient's condition. The authors undertook this study to assess the capacity of cine p...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2011.1.FOCUS10303
更新日期:2011-04-01 00:00:00
abstract::Anterior screw fixation of Type II odontoid fractures provides immediate stabilization of the cervical spine while preserving C1-2 motion. This technique has a high fusion rate, but can be technically challenging. The authors identify key points that should be taken into account to maximize the chance for a favorable ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2011.7.FOCUS11135
更新日期:2011-10-01 00:00:00
abstract::OBJECT Neurosurgery studies traditionally have evaluated the effects of interventions on health care outcomes by studying overall changes in measured outcomes over time. Yet, this type of linear analysis is limited due to lack of consideration of the trend's effects both pre- and postintervention and the potential for...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.9.FOCUS15374
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:The COVID-19 pandemic has forced medical professionals throughout the world to adapt to the changing medical scenario. The objective of this survey was to assess the change in neurosurgical training in India following the COVID-19 pandemic. METHODS:Between May 7, 2020, and May 16, 2020, a validated questionn...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.9.FOCUS20537
更新日期:2020-12-01 00:00:00
abstract::Intracranial or brain arteriovenous malformations (BAVMs) are some of the most interesting and challenging lesions treated by the cerebrovascular neurosurgeon. It is generally believed that the combination of BAVMs and intracranial aneurysms (IAs) is associated with higher hemorrhage rates at presentation and higher r...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.6.FOCUS14165
更新日期:2014-09-01 00:00:00
abstract::Arteriovenous malformation (AVM) presenting with epilepsy significantly impacts patient quality of life, and it should be considered very much a seizure disorder. Although hemorrhage prevention is the primary treatment aim of AVM surgery, seizure control should also be at the forefront of therapeutic management. Sever...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.1.FOCUS19899
更新日期:2020-04-01 00:00:00
abstract:OBJECT:The safety and effectiveness of osteogenic protein (OP)-1 putty (recombinant human bone morphogenetic protein-7) in promoting fusion in complex spinal cases was studied in nine cases. METHODS:The authors prospectively evaluated nine patients requiring spinal fusion in whom there were medical risk factors that w...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.13.6.5
更新日期:2002-12-15 00:00:00
abstract::The authors present a brief and selective history of surgery for peripheral nerve tumors to illustrate how the current understanding of the nature of disease influences the choice of surgical intervention. There was very little understanding of the anatomy and function of peripheral nerves in ancient times; consequent...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章
doi:10.3171/foc.2007.22.6.2
更新日期:2007-06-15 00:00:00