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Giuseppe Lanzino, Neal F. Kassell, Teresa Germanson, Laura Truskowski and Wayne Alves

prognostic indicator. All 13 patients with a blood glucose level above 200 mg/dl died; of 10 with a level between 150 and 200 mg/dl, four died and three survivors had severe neurological deficits such as a chronic vegetative state or hemiparesis. Forty-one (89%) of the 46 patients with normal blood glucose levels recovered completely; five of them died later, three after a rebleed. In this study, the initial blood glucose level seemed to be a significant predictor of outcome in SAH patients and comparable with the neurological grading scale of Hunt and Hess. Berek and

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Giuseppe Lanzino, Neal F. Kassell, Teresa P. Germanson, Gail L. Kongable, Laura L. Truskowski, James C. Torner, John A. Jane and Participants

reported by other investigators. 19 Age and Cerebral Vasospasm After aneurysmal SAH, the amount of blood visualized on the admission CT scan is closely related to the subsequent development of vasospasm. 9 In elderly patients, despite a thicker clot on CT, 19, 43 the incidence of angiographic vasospasm is lower than expected; 2, 16, 17 this is especially true in older hypertensive patients. 2 These observations suggest that the cerebral vessels become more rigid with advancing age, especially in the presence of chronic elevated blood pressure, and are less

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Robert A. Mericle, Stanley H. Kim, Giuseppe Lanzino, Demetrius K. Lopes, Ajay K. Wakhloo, Lee R. Guterman and L. Nelson Hopkins

mos  CRI, sm, HH, AAA  stroke 25 22 76, M lt stent Wall no 0 0 0 0 20 20 60 18 HTN, sm, CHOL, CAD, UA UA, urgent CABG excellent, 3 mos 26 23 86, F lt stent Wall no 0 0 0 0 20 20 74 27 HTN, CAD, syncopal episode age >79 yrs excellent postop, no follow up * AAA = abdominal aortic aneurysm; AFIB = atrial fibrillation; asymp = asymptomatic; AVB = atrial-ventricular block; ca = carcinoma; CAD = coronary artery disease; CHF = congestive heart failure; CHOL = hypercholesterolemia; COPD = chronic obstructive pulmonary disease; CRI = chronic renal insufficiency; DM

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Giuseppe Lanzino, Neal F. Kassell, Nicholas W. C. Dorsch, Alberto Pasqualin, Lennart Brandt, Peter Schmiedek, Laura L. Truskowski, Wayne M. Alves and the Participants

: Prognosis of patients with severe head injury. Neurosurgery 4: 283–289, 1979 15. Kanamaru K , Weir BKA , Findlay JM , et al : A dosage study of the effect of the 21-aminosteroid U74006F on chronic cerebral vasospasm in a primate model. Neurosurgery 27 : 29 – 38 , 1990 Kanamaru K, Weir BKA, Findlay JM, et al: A dosage study of the effect of the 21-aminosteroid U74006F on chronic cerebral vasospasm in a primate model. Neurosurgery 27: 29–38, 1990 16. Kanamaru K , Weir BKA , Simpson I , et al : Effect of 21-aminosteroid U-74006F on lipid

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Demetrius K. Lopes, Robert A. Mericle, Giuseppe Lanzino, Ajay K. Wakhloo, Lee R. Guterman and L. Nelson Hopkins

48 65, M unstable angina syncope, PVD rt ICA 75 50 90 IV 3 49 67, M unstable angina MI, rt ICA occlusion, COPD, HTN lt ICA 80 30 95 IV 3 * Italicized items indicate events (stroke or TIA) that occurred within 6 months of the procedure. Abbreviations: AAA = abdominal aortic aneurysm; AFIB = atrial fibrillation; AVB = atrial—ventricular block; CHF = congestive heart failure; CLL = chronic lymphocytic leukemia; COPD = chronic obstructive pulmonary disease; CorAD = CorA disease; DM = diabetes mellitus; HTN

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Huan Wang, Giuseppe Lanzino, Kenneth Fraser, Patrick Tracy and David Wang

relate to the direct extension of the thrombus to involve the bifurcation (“T occlusion” of the ICA). Reestablishment of collateral flow only in the MCA/anterior cerebral artery territory can often result in improvement of the symptoms. Nevertheless, there are several considerations in favor of preservation of the proximal ICA. Overall, a carotid artery is a “bad thing” to lose. This is particularly true in patients with diffuse, coexisting vascular disease. There is also increasing evidence that cognitive dysfunction is associated with chronic reduction in cerebral

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Huan Wang, William Olivero, Giuseppe Lanzino, William Elkins, Jean Rose, Debra Honings, Mary Rodde, Jan Burnham and David Wang

techniques. J Neurosurg 20: 112–117, 1963 16. Dietrich WD , Busto R , Alonso O , et al : Intraischemic but not postischemic brain hypothermia protects chronically following global forebrain ischemia in rats. J Cereb Blood Flow Metab 13 : 541 – 549 , 1993 Dietrich WD, Busto R, Alonso O, et al: Intraischemic but not postischemic brain hypothermia protects chronically following global forebrain ischemia in rats. J Cereb Blood Flow Metab 13: 541–549, 1993 17. Dietrich WD , Busto R , Globus MYT

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Carlo Bortolotti, Huan Wang, Kenneth Fraser and Giuseppe Lanzino

dramatic resolution of the acute intracranial SDH with redistribution of blood, and the intraoperative findings (subacute subdural blood, easily drained through a small dural incision), we hypothesize that the spinal SDH might have been related to progressive migration of the subdural blood to the most dependent areas of the lumbosacral region. As the subdural blood volumetrically expanded secondary to chronic changes, the patient began experiencing progressive low-back pain. This theory is supported by the electron microscopic observation of an anatomical continuity

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Giuseppe Lanzino, Kenneth Fraser, Yassine Kanaan and Anne Wagenbach

classification; we also used this method of assessment. When outcome is assessed with such sensitive and rigorous tools, it is not uncommon to encounter findings that can be quite distressing and frustrating to the treating physician. This situation is well exemplified by two patients in our series. A 40-year-old woman with a history of chronic migraines underwent successful clip ligation of a ruptured small superior hypophysial aneurysm. She was discharged home 1 week after surgery. Six months later, she experienced persistent disabling headaches and assigned herself an mRS

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Eugenio Pozzati, Anna Federica Marliani, Mino Zucchelli, Maria Pia Foschini, Massimo Dall'Olio and Giuseppe Lanzino

the obstructed venous outflow. 15 , 18 , 24 Telangiectasia is generally diagnosed in adults, and reports in pediatric patients, as in Case 1, are unusual. 5 , 15 , 18 Telangiectasia usually exhibits a benign clinical course; however, some reports indicate a more aggressive evolution due to chronic ischemic injury, hemorrhage, or other local damage. 28 In spite of considerable variability, diagnosis is possible with MR imaging, which demonstrates slight, varying hyperintensity on T2-weighted images, contrast enhancement, and gradient recalled echo signal loss