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Allen L. Ho, Anne-Mary N. Salib, Arjun V. Pendharkar, Eric S. Sussman, William J. Giardino and Casey H. Halpern

% ethanol with water until intake stabilized. Bilateral DBS leads were then implanted in either the shell or the core of the NAc, and DBS was delivered for 5 minutes prior to ethanol access and then continued for 30 minutes, during which the volume of consumption was measured. Ethanol consumption was significantly reduced with increasing intensities of DBS, but there was no significant difference in consumption between those rats receiving NAc core or shell DBS. 35 TABLE 1. Summary of animal studies of DBS for alcoholism Authors & Year Animal EtOH Procedure DBS

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Jessica A. Wilden, Kurt Y. Qing, Sheketha R. Hauser, William J. McBride, Pedro P. Irazoqui and Zachary A. Rodd

with health care expenses, law enforcement costs, property loss, and reduced productivity, contribute to the considerable economic burden of alcoholism, 58 which is estimated to be approximately 2% of the United States gross domestic product. 52 Traditional treatments for alcoholism suffer from high rates of noncompliance, variable effectiveness, and serious side effects. An estimated 45%–75% of treated alcoholics will relapse within 3 years, 1 , 3 , 10 indicating that alcoholism can be a chronic and recurring illness, and there is a need for better therapies

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Rabih Aboukais, Caroline Loiez, Xavier Leclerc, Philippe Bourgeois, Frederic Wallet, Tomas Menovsky and Jean-Paul Lejeune

treatment was 54 years (range 31–70 years). Ten patients had a ruptured aneurysm and 20 had an unruptured aneurysm. The mean diameter of all aneurysms was 8.5 mm (range 2.5–50 mm). Patients With a Ruptured Aneurysm In patients with a ruptured aneurysm (n = 10), hypertension was present in 7 patients and hyperlipidemia in 1. Seven patients were smokers. Chronic alcoholism was found in 2 patients. Multiple intracranial aneurysms were present in 5 patients. Polycystic kidney disease was present in 1 patient. The WFNS score was I in 3 patients, II in 3 patients, III in 1

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John S. Meyer, Yasuhisa Kitagawa, Norio Tanahashi, Hisao Tachibana, Prasab Kandula, David A. Cech, Guy L. Clifton and James E. Rose

other risk factors for dementia were present (such as hypertension, chronic alcoholism, or early senile dementia of the Alzheimer type), the type of shunt placed, and any complications of shunting. In six cases the etiology of NPH was not apparent and these cases were classified as idiopathic, two cases were secondary to subarachnoid hemorrhage (SAH), one occurred subsequent to removal of a tentorial meningioma with treated ependymal and meningeal infection, and one was secondary to congenital aqueductal stenosis without increased intracranial pressure but with long

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William C. Newman, Dan W. Neal and Brian L. Hoh

, alcoholism, perivascular disease, tobacco use, hypothyroidism, depression, and hypercholesterolemia (p < 0.05 for all). Predictive Model The statistically significant comorbidities were weighted based on their relative impact on patient outcomes to create a comorbidity index (see Table 3 for results). Individual scores ranged from −2 to 7, with positive scores denoting increased odds of poor outcome and negative scores denoting an inverse relationship with poor outcome. TABLE 3. Comorbidity scoring index Comorbidity Point Score p Value

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Sascha Mann, Michael Schütze, Steffen Sola and Jürgen Piek

Object

Pyogenic vertebral osteomyelitis is of special interest to neurosurgeons because it often results in acute neurological deterioration and requires a combination of adequate surgical and conservative treatment. The aim of the current study was to evaluate the strategy of a primary surgical approach to this disease.

Methods

A group of 24 patients with the clinical and radiological signs of acute pyogenic spondylodiscitis was prospectively followed from 1998 to 2004. Of these, 20 had underlying diseases such as diabetes mellitus, chronic alcoholism, and liver cirrhosis. The main causative organism was Staphylococcus aureus. Most infections were localized in the thoracic or lumbar spine (10 cases each); 15 infections were associated with epidural abscesses. Because of a delay in diagnosis, 13 patients presented with neurological deficits on admission.

Patients with a complete or rapidly progressing neurological deficit underwent immediate surgery. In patients with minor or no deficits or in a stable neurological condition, surgery was delayed for 3 to 5 days. This group was treated with immobilization and intravenous antibiotic drugs before surgery. Surgical procedures included ventral, dorsal, and combined approaches in one- or two-stage operations. Antibiotic treatment included the use of broad-spectrum antibiotic drugs delivered intravenously for at least 10 days, followed by orally administered antibiotics for 3 months.

Twenty patients were independent on follow-up review, 15 with no or minor handicaps. Severe septicemia and multiorgan failure developed in two patients, and these two died of their disease. Major complications were mainly due to long-term antibiotic therapy.

Conclusions

Surgical treatment is the modality of choice in patients with acute spinal osteomyelitis. It is especially indicated in patients with progressive or severe neurological deficits and spinal deformity. In experienced hands, surgery is safe and offers the advantages of spinal cord decompression, immediate mobilization, and correction of spinal deformity. The decision whether an anterior or posterior approach should be used must be made on an individual basis.

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Po-Chou Liliang, Kuo-Sheng Hung, Ching-Hsiao Cheng, Han-Jung Chen, Ikuho Ohta and Chun-Chung Lui

This 66-year-old man with uncontrolled diabetes mellitus and alcoholism was transferred to our hospital because he was experiencing dizziness and right hemiplegia that had developed suddenly over a 3-day period. A computerized tomography (CT) scan of the brain obtained at another hospital revealed a multiloculated rim-enhancing space-occupying lesion, approximately 6 cm in diameter, in the left parietal region ( Fig. 1 left ). On the day of admission the patient's Glasgow Coma Scale (GCS) score deteriorated from 14 to 6. A repeated CT scan revealed a 6-cm

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Junichi Mizuno, Praveen V. Mummaneni, Gerald E. Rodts and Daniel L. Barrow

N ontraumatic SDH is often found in the elderly population. Risk factors for developing spontaneous SDH include hypertension, vascular abnormality, neoplasm, infection, alcoholism, or coagulopathy. Subdural hematomas may also form after CSF overdrainage following a shunt placement procedure, lumbar puncture, external ventricular drainage, and administration of epidural anesthesia. 4 , 5 , 7 , 10 We report a rare case of recurrent SDH caused by a spontaneous CSF fistula located at L-1 to L-2. Case Report Presentation and Examination. This 34

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reported. This 58-year-old man presented with a 1-year history of increasing weakness and numbness of the legs and gait impairment. On clinical examination, he showed marked weakness, mild spasticity, and decreasing superficial and deep sensation of the legs, with ataxospastic gait. He suffered from hepatic cirrhosis caused by alcoholism. At the time of his hospitalization in October, 1980, we could not carry out computerized tomography (CT) scanning of the spine. However, traditional neuroradiological investigations were able to clear up the diagnosis. Plain spine

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Michael B. Henderson, Alan I. Green, Perry S. Bradford, David T. Chau, David W. Roberts and James C. Leiter

thought to approximate many features of alcoholism found in patients with a genetic predisposition toward alcoholism. 25 For this reason, DBS, which is already effective and approved for use in humans in other settings, may be a beneficial therapy in patients with severe alcoholism resistant to other forms of therapy. If DBS proves to be effective at reducing the salient effect of alcohol in abstinent drinkers, it may also decrease the risk of relapse. 28 Thus, DBS may serve as a solitary or an adjunctive therapy in patients resistant to current treatments for