Cervical myeloradiculopathy as an initial presentation of pseudogout.

Pseudogout, also known as calcium pyrophosphate deposition disease, is an inflammatory arthropathy that primarily occurs in the peripheral joints, such as the knee or elbow. Spinal pseudogout is uncommon, and neck pain is its most common clinical manifestation. However, cervical myeloradiculopathy as an initial presentation of pseudogout attack of the ligamentum flavum has rarely been reported in the literature. We report a case of a 65-year-old woman who presented with neck pain, bilateral finger numbness, and left-sided upper extremity weakness. Magnetic resonance images showed an epidural mass at the C4-5 level, compressing the spinal cord. Following laminectomy with removal of the calcified mass, the profound neurologic deficits gradually recovered. A pathological examination confirmed the diagnosis of cervical pseudogout.

Validation of ICD-10-CM Diagnosis Codes for Identification of Patients with Acute Hemorrhagic Stroke in a National Health Insurance Claims Database.

PURPOSE: The performance of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for identifying acute hemorrhagic stroke in Taiwan's National Health Insurance claims database has not been assessed. This study aimed to construct and validate the case definitions for acute hemorrhagic stroke based on ICD-10-CM diagnostic codes. PATIENTS AND METHODS: From January 2018 to December 2019, all inpatient records with ICD-10-CM code of I60 or I61 in any field of the discharge diagnoses were retrieved from the hospitalization claims data and all hospitalizations with a final diagnosis of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) were identified from the stroke registry databases. The clinical diagnosis in the stroke registry was treated as the reference standard. For hospitalizations not recorded in the stroke registry, manual review of the medical records and images was done to ascertain the diagnosis. The positive predictive value (PPV) and sensitivity of various case definitions for acute hemorrhagic stroke were estimated. RESULTS: Among the 983 hospitalizations, 860, 111, and 12 were determined to be true-positive, false-positive, and false-negative episodes of acute hemorrhagic stroke, respectively. The PPV and sensitivity of the ICD-10-CM codes of I60 or I61 for identifying acute hemorrhagic stroke were 88.6% and 98.6%, respectively. The PPV increased to 98.2%, whereas the sensitivity decreased to 93.1% when acute hemorrhagic stroke was defined as hospitalizations in which the primary diagnosis field contained I60 or I61. Hemorrhagic transformation of ischemic stroke and concomitant cerebrovascular diseases other than SAH or ICH were the main reasons for a false-positive and false-negative diagnosis of acute hemorrhagic stroke, respectively. CONCLUSION: This study demonstrated the performance of ICD-10-CM codes for identifying acute hemorrhagic stroke and may offer a reference for future claims-based stroke studies.

Acute hemiparesis. A rare presentation of spontaneous spinal epidural hematoma mimicking acute stroke.

Acute hemiparesis is an extremely rare presentation of spontaneous spinal epidural hematoma, which may be misdiagnosed as acute ischemic stroke and improperly treated with an intravenous thrombolytic agent. Here, we report a case of a 54-year-old woman who presented with acute neck pain and right-sided weakness. She was initially suspected of having ischemic stroke and therefore treated with an intravenous thrombolytic agent. However, she developed progressive tetraparesis, and subsequent magnetic resonance images confirmed cervical spontaneous spinal epidural hematoma.

Trajectories and associated factors of quality of life, global outcome, and post-concussion symptoms in the first year following mild traumatic brain injury.

PURPOSE: To investigate the associated factors and change trajectories of quality of life (QoL), global outcome, and post-concussion symptoms (PCS) over the first year following mild traumatic brain injury (mTBI). METHODS: This was a prospective longitudinal study of 100 participants with mTBI from neurosurgical outpatient departments in Chiayi County District Hospitals in Taiwan. The checklist of post-concussion syndromes (CPCS) was used to assess PCS at enrollment and at 1, 3, and 12 months after mTBI; the glasgow outcome scale extended (GOSE), the quality of life after brain injured (QOLIBRI), Chinese version, and the Short Form 36 Health Survey (SF-36), Taiwan version, were used to assess mTBI global outcome and QoL at 1, 3, and 12 months after mTBI. RESULTS: Latent class growth models (LCGMs) indicated the change trajectories of QOLIBRI, PCS SF-36, MCS SF-36, GOSE, and PCS. Classes of trajectory were associated with age ≥40 years, unemployment at 1 month after injury, and educational level ≤12 years. Univariate analysis revealed that employment status at 1 month post-injury was correlated with the trajectories of QOLIBRI, PCS SF-36, MCS SF-36, and GOSE, but not PCS. CONCLUSIONS: Employment status was the most crucial associated factor for QoL in individuals with mTBI at the 1-year follow-up. Future studies should explore the benefits of employment on QoL of individuals with mTBI.

Mock jury trials in Taiwan--paving the ground for introducing lay participation.

The first mock jury study in Taiwan, in which 279 community members watched a videotaped trial, investigated how jurors' estimates of the relative undesirability of wrongful conviction versus wrongful acquittal predicted individual decisions and how decision rules affected outcomes. The percentage of jurors who viewed wrongful conviction as more undesirable increased from 50.9% to 60.9% after deliberation and jurors' postdeliberation acquittal rate (71.7%) was higher than predeliberation acquittal rate (58.8%). Jurors' estimates of the undesirability of wrongful conviction were not correlated with their predeliberation votes but became positively correlated with their postdeliberation decisions. The unanimous rule facilitated jurors' change of vote, predominantly from conviction to acquittal, than the simple majority rule. Jurors reaching a verdict under the unanimous rule viewed deliberation and the verdict more positively. This study indicates that deliberation can ameliorate the problem of most Taiwanese citizens not viewing wrongful conviction as more undesirable than wrongful acquittal. It also suggests that Taiwan should adopt a unanimous rule for its proposed lay participation system.

Neuronavigation-guided intubated wake-up craniotomy for a patient with a brain astrocytoma.

Computer-assisted neuronavigation (an image-guided technique that facilitates brain tumor surgery) reduces the risk of neurological morbidity. Postoperative neurological dysfunction is also minimized by performing intraoperative neurological testing during awake craniotomy with proper surgical resection of a brain tumor. However, when the patient's airway is not secured, an awake craniotomy can be hazardous if emergent intubation is necessary. The present report describes a young man with a brain tumor who underwent neuronavigation-guided wake-up craniotomy and surgical resection of an astrocytoma. The patient was intubated throughout the course of the procedure, during which modified intraoperative neurological tests were performed for cortical mapping. The patient recovered well after the operation and without any neurological deficits.

Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma.

BACKGROUND: Decompressive craniectomy (DC) is helpful in lowering the intracranial pressure in patients with severe head injuries. However, it is still unclear which surgical approach (DC or craniotomy) is the optimal treatment strategy for severely head-injured patients with acute subdural hematoma (SDH). To clarify this point, we compared the outcomes and complications of the patients with acute SDH and low Glasgow Coma Scale (GCS) score treated with craniotomy or DC. METHODS: We analyzed 102 patients with acute SDH and GCS scores of 4 to 8. Of them, 42 patients (41.2%) were treated with craniotomy and 60 (58.8%) treated with DC for evacuation of hematoma. The demographic and clinical data were analyzed including patient age, sex, injury mechanism, GCS score, pupil size and light reflex, time interval from injury to operation, types of surgical procedures, intracranial findings in pre- and postoperative computed tomography scan, intracranial pressure, complications, requirement of permanent cerebrospinal fluid diversion, and Glasgow Outcome Scale score after at least 1 year of follow-up. RESULTS: The craniotomy and DC groups showed no difference in the demographic and clinical data. There was no difference in the outcomes and complication rates between these two groups except that the DC group had higher mortality than the craniotomy group (23.3% vs. 7.1%, p = 0.04). CONCLUSION: Both craniotomy and DC were feasible treatment strategies for acute SDH. The patients with acute SDH and low GCS score treated with craniotomy or DC showed no difference in the outcomes and complications.

Lumbar intraspinal arachnoid cyst superimposed by hyperacute spinal subdural hematoma: an unusual case.

BACKGROUND CONTEXT: Lumbar intradural arachnoid cyst (AC) concomitant with hyperacute spinal subdural hematoma (SSDH) has never been reported in the literature. PURPOSE: To report a case of lumbar AC superimposed by hyperacute SSDH, which was difficult to diagnose preoperatively using magnetic resonance imaging. Herein, we describe diagrams showing the proposed mechanisms underlying the formation of a symptomatic AC. STUDY DESIGN/SETTING: The study was designed to be a case report and literature review. METHODS: A 65-year-old man presented with acute onset of low back pain, followed by 5-day history of numbness and weakness in both legs before admission. Magnetic resonance imaging of the lumbosacral spine revealed an intradural extramedullary biconvex lesion at the L3-L4 level; the lesion compressed the cauda equina posteriorly. The lesion mainly appeared as hyperintense on T2-weighted images and hypointense on T1-weighted images. On the basis of these findings, the lesion was preoperatively diagnosed as a symptomatic lumbar subdural AC that compressed the cauda equina. RESULTS: The patient underwent laminectomy from L2 to L4. After a dura incision, a partially organized subdural hematoma was noted. Beneath the subdural hematoma was an AC compressing the underlying nerve roots. The patient's back pain and muscle strength markedly improved after the operation. CONCLUSIONS: Preoperative diagnosis of concomitant hyperacute SSDH and AC is difficult. In cases of patients who present with intraspinal AC accompanied by an acute onset of clinical presentation, an associated etiology should be considered until proven otherwise.

Post-traumatic osteomyelitis with spinal epidural abscess of cervical spine in a young man with no predisposing factor.

Spinal osteomyelitis with epidural abscess is a rare disease. Most patients have 1 or more predisposing factors, such as impaired immune system secondary to diabetes mellitus, chemotherapy for cancer, immunological compromised disease, and chronic renal or hepatic impairment. We present a case of a physically steady young man without any predisposing risk factor who suffered from cervical osteomyelitis with epidural abscess after neck blunt injury. This patient recovered well after one-stage anterior surgical debridement with implant instrumentation and proper antibiotics treatment. The initial accurate diagnosis rate of spinal epidural abscess is low, even in patients with predisposing factor(s). We present this case to raise the attention of medical staff to this disease in patients with or without any predisposing factor(s) in order to establish early diagnosis and treatment. Our case report also indicates that with adequate debridement and antibiotic coverage, one-stage surgery is a safe and efficacious method to treat patients with cervical spinal epidural abscess.