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Although the etiology of spontaneous spinal epidural hematoma (SSEH) is unclear, SSEH is known to be associated with anticoagulants, coagulopathy, vascular malformation, hypertension, and pregnancy. However, no report has been issued on the relation between SSEH and venous phlebolith. Here, the authors present an extremely rare case of SSEH associated with phlebolith in the cervical spine and suggest a possible pathogenesis. A 36-year-old man without any relevant medical history presented with neck pain and numbness and severe radiating pain on the left arm. Magnetic resonance imaging showed epidural hematoma at the C5-7 level, and computed tomography revealed a calcified nodule in the left epidural hemorrhage at C6 level. During left partial laminectomy, epidural venous plexus, and thick epidural hematoma were found, and hematoma removal revealed a white, ovoid, smooth, hard mass of diameter 3 mm. Histopathologic examination confirmed the mass as a venous phlebolith. The presence of a calcified solitary nodule in dorsal epidural space indicates the presence of phlebolith and the risk of SSEH. In such cases, the authors recommend spine surgeons should take into consideration the possibility of epidural hemorrhage. [ABSTRACT FROM AUTHOR]

A rare case of delayed large epidural mucin collection causing neurologic deficit after surgery for metastatic pancreatic cancer is reported. A 65-year-old man presented with intractable upper- thoracic back pain radiating to the chest and gait disturbance. He had a history of subtotal pancreatectomy due to intraductal papillary mucinous neoplasm (IPMN) of the pancreas and concurrent chemotherapy. Eight months after pancreatectomy, multiple thoracic spinal metastasis was diagnosed with routine up positron emission tomography-computed tomography. Radiotherapy for spinal metastasis and subsequent chemotherapy was carried out. Sixteen months after pancreatectomy, gait disturbance occurred and follow-up thoracic magnetic resonance imaging (MRI) showed aggravation of metastasis at T2 and T4 compressing the spinal cord. We performed a decompressive laminectomy with subtotal resection of the tumor masses and pedicle screw fixation at C7-T6. Neurologic status improved after the operation. Histopathologic examinations revealed the tumor as metastatic mucin producing adenocarcinoma. Three months after surgery, motor weakness and pain was reappeared. MRI showed large amount of epidural fluid collection. We performed wound revision and there was large amount of gelatinous fluid at the epidural space. We suggest that postoperative mucin collection and wound problems should be considered after surgery for mucin producing metastatic pancreatic tumor. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the incidence, cause, and influence of the adverse drug reactions (ADRs) associated with long-term intravenous antibiotics in patients with pyogenic spondylitis (PS). Methods: We retrospectively reviewed the medical records of 84 patients with PS who underwent intravenous antibiotic therapy in our hospital from January 2001 to December 2012. ADRs were categorized to drug eruption, acute renal failure (ARF), hematologic toxicity, toxic hepatitis, pseudomembranous colitis (PMC), drug fever, and neuronal toxicity. Incidence and onset time of each ADR after antibiotic therapy were analyzed with the incidence of ADRs according to types of antibiotics. Results: ADRs occurred in 38 of the 84 patients (incidence: 45.2%). The use of antibiotics was longer in the patients with ADRs (62.7 days) than in the patients without ADRs (44.3 day). The incidence of drug eruption, ARF, hematologic toxicity, toxic hepatitis, PMC, drug fever, and neuronal toxicity were 22.6, 11.9, 11.9, 10.7, 7.1, 3.6%, and 1.2%, respectively. The duration of antibiotics administration was related to the occurrence of PMC(p=0.001). ADRs were more common in patients treated by glycopeptides including vacomycin and teicoplanin. Conclusion: The incidence of ADRs due to long-term intravenous antibiotics was as high as 45.2% in patients with PS. Therefore, we speculate that the possibility of delayed ADRs should be considered after long-term use of the antibiotics. Furthermore, close observation is mandatory to identify and treat ADRs promptly, even though PS revealed the improvement after antibiotic therapy. [ABSTRACT FROM AUTHOR]

Background: This study was performed to analyze the risk factors for ventriculostomy-related infections (VRIs) in the neurosurgical intensive care unit (NSICU) and the relationship between these risk factors and the patients' outcomes. Methods: We collected demographic, clinical, laboratory and microbiological data from all 146 consecutive adult patients who underwent ventriculostomy in the NSICU from January 2007 to December 2008. We excluded patients with ventriculostomy performed for the draining of intraventricular abscess, infection of ventriculoperitoneal shunt (V-P shunt) or previous ventriculitis. VRI was defined by positive culture from cerebrospinal fluid (CSF) obtained via the ventricular catheter. Results: VRIs were diagnosed in 26 (17.8%) of 146 patients. On average, the patients with VRIs stayed longer in the NSICU than patients without VRIs (mean duration 20 days vs. 11.9 days). All VRIs occurred in patients who had a low Acute Physiology and Chronic Health Evaluation (APACHE) IV score. In addition, the duration required to maintain ventriculostomy was longer in patients with VRIs. However, sex, mortality, the cause of ventriculosotmy, the level of consciousness, combined systemic infections, number of catheters, and performing urokinase irrigation or antibiotics irrigation via the ventriculostomy catheter were not associated with VRIs. Conclusions: VRIs were associated with longer ICU stay. However, VRIs did not influence the overall mortality rate of patients undergoing ventriculostomy in the NSICU. Because the long duration required for maintaining ventriculostomy was the risk factor of VRI, early removal of ventriculostomy catheter must be considered. [ABSTRACT FROM AUTHOR]

Ischemia-induced cerebral injury evolves over a longer period than previously believed through post-ischemic inflammation. Retinoic acid (RA) has been shown to exert cytoprotective effects on several cells, but its effects on ischemia-induced cerebral injury have been poorly characterized. The aim of the present study was to examine the effects of all- trans-RA on ischemia-induced cerebral injury and elucidate the underlying mechanism. All- trans-RA treatment reduced the size of the ischemia-induced cerebral infarct. To elucidate the underlying mechanism, ischemia-induced cerebral inflammation was studied by examination of expressions of interleukin 1β (IL-1β) and ED-1. RA treatment significantly reduced the cerebral inflammation. Moreover, cerebral ischemic induction of cyclooxygenase-2 (COX-2) and CCAAT/enhancer binding protein β (C/EBPβ), which binds to the COX-2 promoter, was also inhibited by RA. These results suggest that RA can reduce ischemia-induced cerebral injury by an anti-inflammatory action, which may be effected via inhibition of C/EBPβ-mediated COX-2 induction. [ABSTRACT FROM AUTHOR]

A 47-year-old woman visited with lumbago and severe left leg pain that had been presented for 1 week. The patient complained of severe radiating pain on left L3 sensory dermatome area and reported aggravation of leg pain at 20 degrees of hip flexion by straight leg raising test (SLRT). However, there was no motor weakness on neurological examination. Magnetic resonance imaging (MRI) demonstrated contrast enhancing spinal extradural mass at L2-3 level that was iso-signal intensity (SI) on T1-weighted images (WI), hypo-SI on T2WI. She was not able to walk and sleep due to incapacitating pain. Thus, surgical removal was performed via left partial laminectomy. Postoperatively, the radiating pain was relieved completely. Histopathologic examination revealed that the tumor consisted of chondroma, which had mature hyaline cartilage with nests of benign-appearing cells and calcium deposits in lacunae. [ABSTRACT FROM AUTHOR]

Objective: Double stenting in a Y-configuration is a promising therapeutic option for wide-necked cerebral aneurysms not amenable to reconstruction with a single stent. We retrospectively evaluated the efficacy and safety of the crossing Y-stent technique for coiling of wide-necked bifurcation aneurysms. Methods: By collecting clinical and radiological data we evaluated from January 2007 through December 2013, 20 wide-necked bifurcation aneurysms. Results: Twelve unruptured and eight ruptured aneurysms in 20 patients were treated with crossing Y-stent-assisted coiling. Aneurysm size and neck size ranged from 3.2 to 28.2 mm (mean 7.5 mm) and from 1.9 to 9.1 mm (mean 4.5 mm). A Y-configuration was established successfully in all 20 patients. All aneurysms were treated with a pair of Neuroform stents. The immediate angiographic results were total occlusion in 17 aneurysms, residual neck in two, and residual sac in one. Peri-operative morbidity was only 5%. Fifteen of 18 surviving patients underwent follow-up conventional angiography (mean, 10.9 months). The result showed stable occlusion in all 15 aneurysms and asymptomatic in-stent occlusion in one branch artery. At the end of the observation period (mean, 33.5 months), all 12 patients without subarachnoid hemorrhage had excellent clinical outcomes (mRS 0), except one (mRS 2). Of eight patients with subarachnoid hemorrhage, four remained symptom free (mRS 0), while the other four had were dependent or dead (mRS score, 3-6). Conclusion: In this report on 20 patients, crossing Y-stent technique for coiling of wide-necked bifurcation aneurysms showed a good technical safety and favorable clinical and angiographic outcome. [ABSTRACT FROM AUTHOR]