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Pract Neurol ; 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532808


Functional neurological disorder is a condition in which a patient has physical findings that are not compatible with anatomical boundaries, have no structural substrate and are not representable of an established disease. General anaesthesia and surgery have been previously reported as precipitating factors for functional disorders and mostly involve dissociative (non-epileptic) seizures. We report a patient with no psychiatric history or prior abnormal examination who developed sudden-onset functional tetraplegia and sensory disturbances immediately after elective surgery, and who was subsequently discharged home several days later after nearly complete resolution of neurologic deficits. We highlight the features of this syndrome, including its unique postoperative presentation, unusual resolution and absence of any identifiable psycho-dynamic mechanism. We also introduce the tripod sign as a useful clinical tool in identifying functional tetraplegia.

World Neurosurg ; 137: e383-e388, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32032791


BACKGROUND: Neurosurgery residency in the United States is highly sought after by many international medical graduates (IMGs), and the geographic distribution of IMG candidates who have successfully matched has not been quantitatively explored to date. The aim of this study was to highlight the countries in which successfully matched IMG residents obtained their medical degrees and the states of their respective residency destinations. METHODS: All available resident lists of approved neurosurgical residency programs within the United States with at least 7 years of history were reviewed for IMGs in the most currently updated rosters. Demographic and geographic characteristics were summarized. RESULTS: A total of 1393 current neurosurgical residents in U.S. residency programs were identified from 99 programs across 39 states. Of 1393 residents, 87 were IMGs (6%). The IMG contingent originated from 39 countries, the most common of which was Lebanon (n = 14/87 [16%]). The Middle East was the most represented geographic region (n = 23/87 [26%]). The states with the highest number of IMGs were Kentucky, New York, and Texas (all n = 7/87 [8%]). CONCLUSIONS: IMGs constitute a small but appreciable portion of current neurosurgical residents in U.S. training programs. Particular countries have contributed more IMGs to neurosurgical programs than others, and particular states have higher counts and proportions of IMG residents than others. These outcomes are not geographically homogeneous, and the mechanisms by which IMG applicants successfully match to U.S. neurosurgery programs require more biographic granularity to elucidate.