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Background: The subthalamic nucleus is the preferred target for deep brain stimulation in patients with advanced Parkinson's disease. The site of permanent stimulation is the subject of ongoing debate, as [...]

Background: It has been suggested that a moving correlation index between mean arterial blood pressure and intracranial pressure, called PRx, can be used to monitor and quantify cerebral vasomotor reactivity [...]

Purpose: The aim of this study was to examine the prevalence of comorbid mental disorders as well as the extent of psychosocial distress in patients with intracranial tumours and their partners during the early treatment phase. Moreover, we aimed to identify which events are experienced as most distressing in the context of the early diagnosis of brain cancer by patients and spouses.Methods: Structured clinical interviews for DSM-IV (SCID-IV) were conducted with 26 patients and their partners after the first neurosurgical treatment within the first 3 months after the detection of a brain tumour. Screening measures (NCCN distress thermometer, HADS, IES-R) were used to assess the extent of psychosocial distress as well as anxiety, depression and traumatic stress responses. Distressing experiences were assessed via a structured questionnaire and interview.Results: Thirty-eight per cent of the patients and 47% of the partners suffered from a psychiatric disorder. Most frequent diagnoses were adjustment disorder and acute stress disorder. The majority of the participants suffered from elevated psychosocial distress. Partners were equally or even more affected than the patients. For the patients, the experience most frequently described as distressing was the first detection of the tumour. The majority of the partners reported to be distressed by the fear of surgery outcomes.Conclusions: This study revealed that during this very first treatment phase, both brain tumour patients and their spouses show a high prevalence of comorbid mental disorders and psychosocial distress. The findings suggest that research and clinical efforts are needed to address the psychosocial concerns of these populations. [ABSTRACT FROM AUTHOR]

Intradural spinal arachnoid cysts with cord compression are rare. When becoming symptomatic they cause variable symptoms involving gait disturbance, paraparesis or tetraparesis and neuropathic pain, decreasing significantly the patients' life quality. The extension of such cysts averages 3.7 vertebral bodies. The diagnosis is clinical and radiological with the use of MRI, CT myelography or a combination of both. The best treatment option is complete removal of the cyst. However, even when paresis is regressing there is no good recovery from neuropathic pain. Laminectomy approach can cause postoperative complications especially when the cyst(s) expand(s) in more than one level. Alternatively, a cyst fenestration can be performed, including the levels of the maximal spinal cord compression. The clinical outcome is as good as after the cyst resection enabling the patient to walk again. The neuropathic pain may persist and require medication. A clinical case is presented, and the literature is reviewed. In the present case we report a patient with intradural arachnoid cysts extending from T6 to L2 and causing severe gait ataxia as well as neuropathic pain and hypaesthesia. The spinal-cord was compressed at T8 and T12. Surgical treatment with partial cyst resection in the compressed levels with an interlaminar approach brought similar results as complete resection. The patient was able to walk without help which was not possible before surgery. The cysts' extension is impressive as well as the minimal operative procedure. [ABSTRACT FROM AUTHOR]

Background: SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing) is a rare syndrome characterized by the sudden onset of excruciating unilateral periorbital pain that is accompanied by conjunctival injection and lacrimation or further autonomic signs. Similar to patients with chronic cluster headache, Leone and Lyons showed a beneficial effect of deep brain stimulation of the posterior hypothalamic region in two patients with a chronic SUNCT. Case: Here, we present the case of a man with a chronic SUNCT responding to deep brain stimulation of the posterior hypothalamic area. Conclusion: This case supports the idea of a central origin of SUNCT and shows that deep brain stimulation of the hypothalamic region can be effective in the treatment of the chronic form of this rare disorder. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) of the posterior hypothalamus was found to be effective in the treatment of drug-resistant chronic cluster headache. We report the results of a multicentre case series of six patients with chronic cluster headache in whom a DBS in the posterior hypothalamus was performed. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to published coordinates 2 mm lateral, 3 mm posterior and 5 mm inferior referenced to the mid-AC-PC line. Microelectrode recordings at the target revealed single unit activity with a mean discharge rate of 17 Hz (range 13–35 Hz, n = 4). Out of six patients, four showed a profound decrease of their attack frequency and pain intensity on the visual analogue scale during the first 6 months. Of these, one patient was attack free for 6 months under neurostimulation before returning to the baseline which led to abortion of the DBS. Two patients had experienced only a marginal, non-significant decrease within the first weeks under neurostimulation before returning to their former attack frequency. After a mean follow-up of 17 months, three patients are almost completely attack free, whereas three patients can be considered as treatment failures. The stimulation was well tolerated and stimulation-related side-effects were not observed on long term. DBS of the posterior inferior hypothalamus is an effective therapeutic option in a subset of patients. Future controlled multicentre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders. [ABSTRACT FROM AUTHOR]