Vertebral Compression Fractures in Osteoporotic and Pathologic Bone: A Clinical Guide to Diagnosis and Management

Vertebral Compression Fractures in Osteoporotic and Pathologic Bone: A Clinical Guide to Diagnosis and Management

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Vertebral compression fractures (VCFs) are the most common type of fracture secondary to osteoporosis. These fractures are associated with significant rates of morbidity and mortality and annual direct medical expenditures of more than $1 billion in the United States. This book presents a concise review of the diagnosis, management and treatment of vertebral compression fractures, discussing best practices for evaluation and radiographic diagnosis of vertebral compression fractures, as well as both non-operative and operative treatment options, including cement augmentation.

Opening chapters discuss both normal bone physiology as well as the pathophysiology of osteoporotic bone, and the evaluation and biomechanics of VCF, both osteoporotic and pathologic. Examination, radiography and long-term sequelae of VCF are then presented. The bulk of the remainder of the book focuses on medical, non-operative and operative management strategies, including vertebroplasty and kyphoplasty cement augmentation, management of spinal deformity, VCF adjacent to previous spinal fusion, and sacral insufficiency fractures. A final chapter on future treatment strategies rounds out the presentation. Spinal Compression Fractures in Osteoporotic and Pathologic Bone is ideal for orthopaedic trauma, spine, and neurosurgeons. The book is also intended for endocrinologists, rheumatologists, interventional radiologists, physiatrists, anesthesiologists, primary care physicians, and other practitioners who manage and treat patients with osteoporosis.

Intracranial arachnoid cyst clinical features

Intracranial arachnoid cyst clinical features

Most of the intracranial arachnoid cysts are asymptomatic and are detected as incidental findings on Computed Tomography or Magnetic Resonance Imaging of the head carried out for other reasons.

Those that become symptomatic usually do so in early childhood 1).

The presentation varies with the location of the cyst, and oftentimes appear mild considering the large size of some.

Typical presentations include:

1. symptoms of intracranial hypertension (elevated ICP): H/A, nausea/vomitinglethargy

2. seizures

3. sudden deterioration:

a) due to hemorrhage (into a cyst or subdural compartment): middle fossa cysts are notorious for hemorrhage due to tearing of bridging veins. Some sports organizations do not allow participation in contact sports for these patients

b) due to rupture of the cyst

4. as a focal protrusion of the skull

5. with focal signs/symptoms of a space-occupying lesion

6. incidental finding discovered during evaluation for an unrelated condition

7. suprasellar arachnoid cysts may additionally present with:

a) hydrocephalus (probably due to compression of the third ventricle)

b) endocrine symptoms: occurs in up to 60%. Includes precocious puberty

c) head bobbing (the so-called “bobble-head doll syndrome”): considered suggestive of suprasellar cysts, but occurs in as few as 10%

d) visual impairment.

Cognitive dysfunction

The patients with arachnoid cysts presented with cognitive dysfunction compared to the normal population which improved after surgical decompression. Arachnoid cysts should not be considered asymptomatic unless thoroughly evaluated with clinical and neuropsychological workup 2).

Epilepsy

Sudden deterioration

Due to hemorrhage into cyst or subdural hematoma.see Subdural hematoma and arachnoid cyst

Due to cyst rupture.

There are multiple case reports of arachnoid cysts becoming symptomatic with hemorrhagic complications following head trauma. In such cases, the bleeding is often confined to the side ipsilateral to the arachnoid cyst. Occurrence of contralateral subdural hematomas in patients with temporal fossa arachnoid cysts has rarely been observed and is reported less frequently in the medical literature 3).


Usually they remain stable in size and are asymptomatic, however, a few cysts contain remnants of the choroid plexus or arachnoid granulations leading to secretion of CSF resulting in an increase in size with time. These cases may present with features of compression of adjacent structures (Kallmann syndrome, precocious puberty, bitemporal hemianopia in suprasellar lesions, cranial nerve palsies etc.) and/or raised intracranial pressure due to their large size or hemorrhage. Spontaneous hemorrhage is supposed to be due to a minor trauma with rupture of intracystic or bridging vessels 4) 5).

References

1)

Harsh GR 4th, Edwards MS, Wilson CB. Intracranial arachnoid cysts in children. J Neurosurg. 1986 Jun;64(6):835-42. PubMed PMID: 3701434.
2)

Agopian-Dahlenmark L, Mathiesen T, Bergendal Å. Cognitive dysfunction and subjective symptoms in patients with arachnoid cyst before and after surgery. Acta Neurochir (Wien). 2020 Jan 20. doi: 10.1007/s00701-020-04225-9. [Epub ahead of print] Erratum in: Acta Neurochir (Wien). 2020 Jan 29;:. PubMed PMID: 31960141.
3)

Pillai P, Menon SK, Manjooran RP, Kariyattil R, Pillai AB, Panikar D. Temporal fossa arachnoid cyst presenting with bilateral subdural hematoma following trauma: two case reports. J Med Case Rep. 2009 Feb 9;3:53. doi: 10.1186/1752-1947-3-53. PubMed PMID: 19203370; PubMed Central PMCID: PMC2646743.
4)

Ide C, Coene BD, Gilliard C, et al. Hemorrhagic arachnoid cyst with third nerve paresis: CT and MR findings. Am J Neuroradiol. 1997;18:1407–10.
5)

Gunduz B, Yassa MIK, Ofluoglu E, et al. Two cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage. Neurology India. 2010;58:312–15.

Neurosurgical Review: For Daily Clinical Use and Oral Board Preparation

Neurosurgical Review: For Daily Clinical Use and Oral Board Preparation

by Vasilios Zerris (Author)

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The American Board of Neurological Surgery oral examination has undergone periodic review and revision over the years, with a new format instituted in spring 2017. This review book is specifically geared to the new format. The ABNS oral examination process is relevant, rigorous, and of value to the neurosurgical specialty and the public, ensuring neurosurgeons meet the highest standards of practice.

Neurosurgical Review: For Daily Clinical Use and Oral Board Preparation by Vasilios A. Zerris and distinguished contributors is a multimodal and a visually rich prep tool for the ABNS exam. The resource provides a unique approach to studying and melding online didactic materials with audio-enhanced charts. Readers can use the material as a completely online exam prep course with audio or use the print version as a quick reference guide.

Key Features

Charts and schematics provide an excellent learning tool and study prep The high yield and easy to memorize format helps readers “visualize” knowledge Audio files enhance the ability to create a mental framework, thereby increasing comprehension and retention of content Cases presented at the end of each chapter focus primarily on core material tested in the general neurosurgery ABNS exam session taken by all candidates irrespective of their declared subspecialty This is an essential textbook for neurosurgical residents, fellows, and practitioners prepping for the ABNS boards. It also serves as a user-friendly refresher of fundamental knowledge all neurosurgeons need to know.

This book includes complimentary access to a digital copy on https://medone.thiem

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