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         Intracranial Hypotension:     more detail
  1. Spontaneous intracranial hypotension.: An article from: Southern Medical Journal by Megdad Zaatreh, Alan Finkel, 2002-11-01

21. Searchalot Directory For Intracranial Hypotension
Related Web Sites. Spontaneous intracranial hypotension A discussionabout this disorder, its features, causes, diagnosis and treatment.
http://www.searchalot.com/Top/Health/ConditionsandDiseases/NeurologicalDisorders
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22. The World Arnold Chiari Malformation Association
242 Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinalfluid leakage and chronic intracranial hypotension syndrome in seven cases.
http://www.pressenter.com/~wacma/acquired.htm
World Arnold Chiari Malformation Association
Acquired vs. Congenital 1. J Neurosurg 1995 Sep;83(3):556-558 Acquired Chiari I malformation and syringomyelia associated with bilateral chronic subdural hematoma.
Case report.Morioka T, Shono T, Nishio S, Yoshida K, Hasuo K, Fukui M
Department of Neurosurgery, Kyushu University, Fukuoka, Japan. The authors report a case of bilateral chronic subdural hematoma in a 25-year-old woman who had occipital and neck pain. Magnetic resonance imaging revealed progressive caudal descent of the cerebellar tonsils (acquired Chiari I malformation) and a large eccentric syrinx in the spinal cord from the C3-T7 levels. Spontaneous disappearance of the chronic subdural hematomas resulted in radiographic resolution of both lesions, as well as clinical improvement. Theories of syringomyelia formation, the relationship to acquired Chiari I malformation, and the implications of this case are discussed. 2. J Neurosurg 1998 Feb;88(2):237-242
Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal
fluid leakage and chronic intracranial hypotension syndrome in seven cases.

23. SpringerLink: Acta Neurochirurgica - Abstract Volume 140 Issue 1 (1998) Pp 47-50
Spontaneous intracranial hypotension Associated with Subdural Hematoma DiagnosticUsefulness of Percutaneous Subdural Tapping and Magnetic Resonance Imaging.
http://link.springer-ny.com/link/service/journals/00701/bibs/8140001/81400047.ht
Acta Neurochirurgica
ISSN: 0001-6268 (printed version)
ISSN: 0942-0940 (electronic version) Table of Contents Abstract Volume 140 Issue 1 (1998) pp 47-50
Spontaneous Intracranial Hypotension Associated with Subdural Hematoma: Diagnostic Usefulness of Percutaneous Subdural Tapping and Magnetic Resonance Imaging
N. Aoki, T. Sakai, A. Oikawa
Department of Neurosurgery, Tokyo Metropolitan Ohkubo Hospital, Tokyo, Japan
Summary A 55-year-old woman presented with headache which was characterized by aggravation in the upright position and relief in recumbency. Although intracranial hypotension syndrome was condidered to be the most-likely possible entity, computed tomography (CT) scans demonstrated subdural fluid collections associated with findings reminiscent of transtentorial herniation. Because of these CT features, cerebrospinal fluid pressure measurement by a lumbar puncture was not performed. Instead, as an alternative method, she underwent percutaneous subdural tapping, which failed to obtain spontaneous drainage of liquid haematoma, indicating intracranial hypotension. In addition, gadolinium-enhanced magnetic resonance imaging study performed later supported the diagnosis of spontaneous intracranial hypotension. Thus, the usefulness and safety of percutaneous subdural tapping for the diagnosis of spontaneous intracranial hypotension is stressed. Article in PDF-Format (120 KB) Online publication: July 10, 1998

24. SpringerLink: Neuroradiology - Abstract Volume 43 Issue 6 (2001) Pp 453-461
461. diagnostic neuroradiology Spontaneous intracranial hypotensionthe value of brain measurements in diagnosis by MRI. A. Messori
http://link.springer-ny.com/link/service/journals/00234/bibs/1043006/10430453.ht
Neuroradiology
ISSN: 0028-3940 (printed version)
ISSN: 1432-1920 (electronic version) Table of Contents Abstract Volume 43 Issue 6 (2001) pp 453-461
diagnostic neuroradiology : Spontaneous intracranial hypotension: the value of brain measurements in diagnosis by MRI
A. Messori (1), B. F. Simonetti (1), L. Regnicolo (1), P. Di Bella (2), F. Logullo (2), U. Salvolini (1)
Received: 17 July 2000 Accepted: 20 November 2000 Abstract Keywords Article in PDF format (287 KB) Online publication: May 30, 2001
SpringerLink Helpdesk

25. Conditions And Diseases: Neurological Disorders: Brain Diseases: Intracranial Hy
Information on Conditions and Diseases, Neurological Disorders, Brain Diseases,intracranial hypotension and much more Treasure Coast Health.
http://treasurecoasthealth.com/treasurecoasthealth.php/Health/Conditions_and_Dis
Find Doctors on the Treasure Coast Select Specialty Ambulatory Care Anesthesiology Cardiology Dermatology Emergency Medicine Endocrinology Family Practice Gastroenterology Hematology/Oncology Infectious Diseases Internal Medicine Maxillofacial Surgery Neonatology Nephroology Neurology Neurosurgery Obstetrics/Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Pathology Pediatics Physical Medicine Plastic Surgery Podiatry Psychiatry Psychology Pulmonary Radiation Oncology Radiology Rheumatology Surgery Thoracic Surgery Urology Vascular Surgery Select City Sebastian Palm Bay Vero Beach Fort Pierce Okeechobee Port St. Lucie Jensen Beach Stuart Palm City Hobe Sound Loxahatchee MENU Home Doctor Directory Health Resources Women Only ... About Us
Conditions and Diseases: Neurological Disorders: Brain Diseases: Intracranial Hypotension

26. 1Up Health > CSF Leak > Treatment Of CSF Leak (Intracranial Hypotension)
Comprehesive information on CSF leak (intracranial hypotension). CSF leakTreatment. Alternative names intracranial hypotension. Definition
http://www.1uphealth.com/health/csf_leak_treatment.html
1Up Health CSF leak Alternative Medicine Clinical Trials ... Health Topics A-Z Search 1Up Health CSF leak Information CSF leak Treatment Alternative names : Intracranial hypotension Definition : Escape of fluid that normally surrounds the brain and spinal cord from between the cavities within the brain or from the central canal in the spinal cord.
Treatment
Depending on the cause of the leak, many cases resolve spontaneously after a few days. Complete bed rest for several days is usually recommended. Headache may be treated with pain relievers and fluids. If the headache persists longer than a week after a lumbar puncture, a blood patch procedure may be done to block the hole that may be leaking fluid. In most cases, this resolves the symptoms. If symptoms of infection occur ( fever , chills, change in mental status), antibiotic therapy is required.
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Causes, Incidence, and Risk Factors

Symptoms

Prevention
...
Diagnosis, Signs, and Tests

Treatment
Prognosis (Expectations)

Complications

Calling your Health Care Provider

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27. 1Up Health > CSF Leak > Symptoms Of CSF Leak (Intracranial Hypotension)
Comprehesive information on CSF leak (intracranial hypotension). CSF leakSymptoms. Alternative names intracranial hypotension. Definition
http://www.1uphealth.com/health/csf_leak_symptoms.html
1Up Health CSF leak Alternative Medicine Clinical Trials ... Health Topics A-Z Search 1Up Health CSF leak Information CSF leak Symptoms Alternative names : Intracranial hypotension Definition : Escape of fluid that normally surrounds the brain and spinal cord from between the cavities within the brain or from the central canal in the spinal cord.
Symptoms
Symptoms usually include a headache that is worse with sitting up and improves when the affected person is lying down. Leakage of CSF from a tear of the dura in the head can also cause a runny nose.
Previous
Next Jump to Another Section of this Guide Definition
Causes, Incidence, and Risk Factors

Symptoms
Prevention

Diagnosis, Signs, and Tests

Treatment

Prognosis (Expectations)
...
Calling your Health Care Provider

Related Tools and Utilities Search Books on Amazon: Read Articles on eLibrary: Health Products on drugstore.com:
Review Date Reviewed By
: Elaine T. Kiriakopoulos, M.D., MSc, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA. Review provided by VeriMed Healthcare Network. Guide Definition Causes, Incidence, and Risk Factors

28. Slit Ventricle Syndrome
overdrainage of CSF, periventricular fibrosis, intermittent proximal shunt malfunction,decreased intracranial compliance, and intracranial hypotension.
http://www.ucch.org/sections/neurosurg/NeuroReview/11-Pediatrics/SlitVentricleSy
Slit Ventricle Syndrome Definition slit ventricle syndrome has been applied to a small subset of these shunt-dependent children who develop disabling chronic or recurring headaches associated with signs and symptoms of increased ICP and persistant small or slit-like ventricles by CT. Pathology Pathogenesis 1. One hypothesis is that chronic overdrainage in the upright position creates a suction-induced collapse of the ventricular wall around the ventricular catheter, causing recurrent elevations of ICP, and ultimately complete shunt obstruction. The CT scan shows increases in ventricular volume during the episodes of severe headache.
2. Failure of the ventricles to enlarge may be due to an increase in CSF outflow resistance and altered intracranial compliance secondary to brain stiffness from periventricular gliosis.
3. A partially obstructed ventricular catheter may limit the ability to increase CSF drainage rate in response to increases in intracranial volume, and thus precipitate the pressure wave; this would explain the observation that in some situations a shunt revision is curative even with a normal preoperative shunt study. Clinical Features headaches that are chronic intermittent , and recurring . Headaches exacerbated by activity and upright position may be suffering from chronic intracranial hypotension. Imaging Treatment and Results Medical steroids and acetazolamide may significantly relieve the headache.

29. A Case Of Spontaneous Intracranial Hypotension Typical Findings
A case of spontaneous intracranial hypotension typical findings of myelogram, CTMand MRI. ?A case of spontaneous intracranial hypotension is presented.
http://www.m.chiba-u.ac.jp/med-journal/76/76-4/764e2.html
A case of spontaneous intracranial hypotension: typical findings of myelogram, CTM and MRI
Hideo Douya, Osamu Saegusa, Masahito Saito, Tsuneji Kita, Wataru Koizumi, Teruhisa Kobayashi and Hideo Kobayashi Division of Orthopaedic Surgery, Narita Red Cross Hospital, Narita 286-0041 Kobayashi Orthopaedic Clinic, Sakura 285-0846
¡¡A case of spontaneous intracranial hypotension is presented. The patient was a 28 year-old female and was admitted to our hospital with orthostatic headache and back pain. Spinal puncture revealed low liquor pressure. Myelogram disclosed narrowed dural tube and emphasized outline of cauda equina and spinal cord. CTM showed an enhanced area in the posterior site of dural tube. Her complaints were gradually relieved without specific treatment. We also performed gadolinium enhanced MRI which revealed meningeal enhancement and dilatation of internal vertebral venous plexus. These typical radiological findings enabled us to diagnose this case as spontaneous intracranial hypotension.

30. Intracranial Hypotension
intracranial hypotension. A Hospital. A resource with informationon over 4000 medical topics including intracranial hypotension.
http://www.bloodandmarrowtransplant.com/medical-terms/02833.htm
Intracranial hypotension
A Medical Encyclopedia Article provided by Maryland General Hospital A resource with information on over 4000 medical topics including: Intracranial hypotension
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31. Science News
Enlarged pituitary glands were identified in the brains of eleven patients sufferingwith headaches characterized as intracranial hypotension syndrome.
http://www.cosmiverse.com/science122704.html
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32. CSF Leaks
spontaneous intracranial hypotension causing reversible frontotemporaldementia. Neurology Spontaneous intracranial hypotension. The
http://www.tchain.com/otoneurology/disorders/central/csf-leak.html
CSF Leaks
Cerebrospinal fluid depetion may be caused by a leak or a shunt. Symptoms commonly include headaches, which are more severe in the upright position and are alleviated by supine positioning. There may also be nausea and tinnitus. Horizontal diplopia, change in hearing, tinnitus, blurring of vision, facial numbness and upper limb radicular symptoms may occur. These symptoms are rather nonspecific as they are commonly encountered in migraine and post-traumatic headache. Cognitive decline has also been reported (Hong et al, 2002; Pleasure et al, 1998). The leaks are typically at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Sometimes they are unintentional consequences of an overdraining CSF shunt, placed for CSF hypertension. CSF leaks can also occur in the nose after trauma or surgery, and following diagnostic or therapeutic lumbar puncture. Spontaneous leaks from the nose are uncommon (1/26 in Mokri, 1997). Speculatively, it would seem possible that CSF leaks might occur after whiplash injury , as frequently there are persistent similar symptoms without findings on other studies. At this writing however (2002), almost nothing has been published regarding this possibility.

33. ’ᐑ‰tˆ³ÇŒóŒQ‚©‚ç‚­‚é•Ú‘Å‚¿Low Intracranial Pressure
intracranial hypotension Low intracranial pressure syndrome (?CFS?) (Chronic Fatigue Syndrome
http://www.naxnet.or.jp/~sginakai/shinonaga2.html
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34. Untitled
Case Report Postcontrast Meningeal MR Enhancement Secondary to intracranial hypotensionCaused by Lumbar Puncture. J Comput Assist Tomogr 1995;19(2)299301.
http://rad.usuhs.mil/rad/handouts/jsmirnio/contrast99/outlinec.htm
PATTERNS OF ENHANCEMENT
CONTRAST ENHANCEMENT

CONTRAST ENHANCEMENT

CONTRAST ENHANCEMENT
PATTERNS OF ENHANCEMENT
CONTRAST ENHANCEMENT

CONTRAST ENHANCEMENT

CONTRAST ENHANCEMENT
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References 1. Aoki S, Sasaki Y, Machida T, and Tanioka H. Contrast-Enhanced MR Images in Patients with Meningioma: Importance of Enhancement of the Dura Adjacent to the Tumor. AJNR 1990;11935-938. 2. Bourekas EC, Lewin JS, and Lanzieri CF. Case Report: Postcontrast Meningeal MR Enhancement Secondary to Intracranial Hypotension Caused by Lumbar Puncture. J Comput Assist Tomogr 1995;19(2):299-301. 3. Cairncross JG, Pexman JHW, Rathbone MP, and DelMaestro RF. Postoperative Contrast Enhancement in Patients with Brain Tumor. Ann Neurol 1985;17570-572. 4. Cañellas AR, López MC, Isern EG, and Gaerín XM. Postcontrast Dural MR Enhancement and Acute CSF Intracranial Hypotension. J Comput Assist Tomogr 1995;19(6):1008-1009. 5. Chamberlain MC, Sandy AD, Press GA. Leptomeningeal metastasis: a comparison of gadolinium-enhanced MR and contrast-enhanced CT of the brain. Neurology 1990;40:435-8. 6. DeLaPaz RL. Advances in brain tumor diagnostic imaging. Curr Opin Neurol 1995;8:430-6. 7. Gado M, Phelps M, Coleman R. An extravascular component of contrast enhancement in cranial computed tomography. Radiology 1975;177:589-3. 8. Gupta S, Gupta RK, Banerjee D, Gujral RB. Problems with the dural tail sign. Neuroradiology 1993;35:541-2. 9. Kramer R, Janetos G, Perlstein G. An approach to contrast enhancement in computed tomography of the brain. Radiol 1975;16:641-7. 10. Laohaprasit V, Silbergeld DL, Ojemann GA, Eskridge JM, and Winn HR. Postoperative CT Contrast Enhancement Following Lobectomy for Epilepsy. J Neurosurg 1990;73392-395. 11. Latchaw RE, Gold LHA, and Torrije EJ. A protocol for the use of contrast enhancement in cranial computed tomography. Radiology 1978;126681-687. 12. Messina AV. Computed Tomography: Contrast Enhancement in Resolving Intracerebral Hemorrhage. Am J Roentgenol 1976;1271050-1052. 13. Mittl Jr. RL and Yousem DM. Frequency of Unexplained Meningeal Enhancement in the Brain after Lumbar Puncture. AJNR Am J Neuroradiol 1994;15633-638. 14. Nagele T, Petersen D, Klose U, Grodd W, Opitz H, Voigt K. The dural tail adjacent to meningiomas studied by dynamic contrast-enhanced MRI: a comparison with histopathology. Neuroradiology 1994;36:303-7. 15. Paakko E, Patronal N, Schellinger D. Meningeal Gd-DTPA enhancement in patients with malignances. J of computer assisted tomography 1990;14:542-6. 16. Phillips M, Ryals T, Kambhu S, Yuh W. Neoplastic vs inflammatory meningeal enhancement with Gd-DTPA. J of computer assisted tomography 1990;24:536-41. 17. Pullicino P and Kendall BE. Contrast Enhancement in Ischaemic Lesions. Neuroradiol 1980;19235-239. 18. Senegor M. Prominent meningeal tail sign in a patient with a metastatic tumor. Neurosurg 1991;29:294-6. 19. Steinhoff H, Aviles C. Contrast enhancement response of intracranial neoplasms: its validity for the differential diagnosis of tumors in CT, in Lanksch, W, Kazner E. (eds): Cranial conputerized tomography. New york, springre-Verlag 1976;151-61. 20. Tien RD, Yang PJ, Chu PK. Dural tail sign: a specific MR sign for meningioma? J Comput Assist Tomogr 1991;15:64-6. 21. Tokumaru A, O'uchi T, Eguchi T, Kawamoto S, Kokubo T, Suzuki M, and Kameda T. Prominent Meningeal Enhancement Adjacent to Meingioma on Gd-DTPA-enhanced MR Images: Histopathologic Correlation. Radiology 1990;175431-433. 22. Tokumaru A, O'uchi T, Eguchi T, Kawmoto S, Kokubo T, Suzuki M, Kameda T. Prominent meningeal enhancement adjacent to meningioma on go-DTPA-enhanced MR Images. Histopathologic Correlation. Radiology 1990;175:431-3. 23. Wilms G, Lammens M, Marchal G, Demaerel P, Verplancke J, Van Calenbergh J, Goffin J, Plets C, and Baert AL. Prominent Dural Enhancement Adjacent to Nonmeningiomatous Malignant Lesions on Contrast Enhanced MR Images. AJNR Am J Neuroradiol 1991;12761-764.

35. Kaj-e
enhancement at MR in patients with post lumbar puncture headache is caused bymeningeal vein widening which in turn is caused by intracranial hypotension.
http://www.ki.se/cns/news/kaj-e.html
News from
Editor: Previous articles
Meningeal enhancement at MR in patients with post lumbar puncture headache is caused by meningeal vein widening which in turn is caused by intracranial hypotension
After lumbar puncture many patients suffer from a more or less severe headache lasting from weeks to months. The reason for post lumbar puncture headache (PLPH) is believed to be leakage of cerebrospinal fluid (CSF).
Ass. Prof. Jan Hannerz, Section of Neurology, Prof. Kaj Ericson
Lumbar puncture may cause a rift in the dural and arachnoidal membranes. This results in CSF leakage which then causes a reduced intracranial pressure. PLPH is a consequence of the reduced pressure. The intracranial meningeal veins are dilated as a result of the reduced intracranial pressure, and this results in increased enhancement. The enhancement may be subtle and noticed only when compared with MR studies after the PLPH has subsided. Patients with more marked enhancement after lumbar puncture may be suspected to have a longer lasting headache.
Awareness of these facts are important since meningeal enhancement may suggest a serious disease such as meningitis or meningeal carcinomatosis. Thus, if conspicuous meningeal enhancement is found at MR it should be explored if the patient has had a recent lumbar puncture and is suffering from PLPH. If not, other causes for the enhancement should be investigated. One such cause may be spontaneous intermittent or continuous leakage of CSF; such leakage may be shown by MR measurements of the CSF flow. These patients may be candidates for treatment with blood patch.

36. Alphabetical Topic Index (AZ) Jump To A B C D E F G H I J K L M
Intracranial Embolism Intracranial Embolism Intracranial Hemorrhage IntracranialHemorrhage, Hypertensive intracranial hypotension intracranial hypotension
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Alphabetical Topic Index (A-Z):
Jump To: A B C D ... Is
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37. MED-LAVRENCIC.SI / Article / Correspondence
to read your article Intrathecal saline infusion in the treatment of obtundationassociated with spontaneous intracranial hypotension technical case report.
http://www.med-lavrencic.si/correspondence.htm
Correspondence:
Prof. Jeffrey S. Kroin, Rush-Presbyterian-Luke's Medical Center, Chicago
January 2003
Dear Professor Jeffrey S.Kroin and Colleagues,
I have read your article [1] with great attention. Your valuable experimental evidence on a rat model is supporting my hypothesis presented on web page http://www.med-lavrencic.si/raziskava.htm and my opinions expressed on web page http://www.med-lavrencic.si/correspondence.htm.
I believe that the intracraniovertebral volumes' homeostatic equilibrium i.e. volumes' balance is relatively stable regardless to different body postures i.e. standing up, lying or hanging with head upside down. The relative hydrostatic pressure difference among CSF pressures and opposite hydrostatic pressures at CSF drainage paths remains relatively constant during different body postures while passively floating CSF formation/removal homeostatic equilibrium along the CSF formation curve supports this stable volumes' balance at the expense of CSF flow: when standing up it is increased and when hanging down it is decreased.
What is your opinion about this?

38. MED-LAVRENCIC.SI / Lavrencic D.: Article From Medicine / Neurology / Science / R
Lavrencic D. The Intracraniovertebral Volumes, the Cerebrospinal Fluid Flow and the Cerebrospinal Category Science Biology Neurobiology Publications...... between CSF formation and CSF removal in physiological phase as presented with illustrativecurves, (3) hypovolemia during intracranial hypotension syndrome, (4
http://www.med-lavrencic.si/raziskava.html
The Intracraniovertebral Volumes, the Cerebrospinal Fluid Flow and the Cerebrospinal Fluid Pressure, Their Homeostasis and Its Physical Regulation
Darko D. Lavrencic, MD
darko.lavrencic@siol.net
Slovenia
Preface.
Summary.
Physiological and pathophysiological processes in the intracraniovertebral space are specific because of its rigid and constant volume (Monro-Kellie doctrine). The hypothesis presents how the homeostasis of the intracraniovertebral compartments' volumes, cerebrospinal fluid (CSF) flow and CSF pressure is physically regulated. The hypothesis takes into account the quantitative and qualitative relations regulating CSF formation and CSF removal on which the homeostasis is based.
top
Introduction
Monro found in 1783, during studying brain blood circulation, that the processes in intracranial space are specific due to the constant volume of the skull. None of the contained masses can be compressed and one of them can be increased, only if another one is decreased. This occurs when the ossification of the cranial sutures is so strong that it resists any increase of intracranial pressure. Monro-Kellie doctrine includes 3 compartments' volumes: (1) brain and medulla spinalis with meninges, (2) cerebrospinal blood vessels with blood, (3) CSF space.
Dural sac is elastic. It can be distended or collapsed. The spinal extradural space, which contains soft tissues and veins plexuses adapts to the changes of dural sac. The author of this text regards this spinal extradural space and intracranial venous sinuses as compartment IV. By the addition of compartment IV, Monro-Kellie doctrine becomes re-established in wider sense.

39. Directory :: Look.com
intracranial hypotension (2) Sites. Spontaneous intracranial hypotension A discussionabout this disorder, its features, causes, diagnosis and treatment.
http://www.look.com/searchroute/directorysearch.asp?p=594558

40. William P. Dillon, MD, Biosketch
18391. Fishman, RA; Dillon, WP. intracranial hypotension letterJournal of Neurosurgery, 1997 Jan, 86(1)165. Dillon WP Cryptic
http://cc.ucsf.edu/people/dillon_william.html
William P. Dillon, MD
Professor, Radiology, Neurology, Neurosurgery, UCSF; Chief, Neuroradiology Section, and Vice-Chairman, Department of Radiology, UCSF Program Member, UCSF Comprehensive Cancer Center mail: Box 0628, UCSF
San Francisco, CA 94143-0628 phone: fax: e-mail: bill.dillon@radiology.ucsf.edu
University of Santa Clara, CA, B.S., 1970-74, Biology University of CA at Los Angeles, CA, M.D., 1974-78, Medicine Virginia Mason Hospital, Seattle, WA, Intern, 1978-79, Internal Medicine University of Utah, Salt Lake City, UT, Resident, 1979-82, Diagnostic Radiology University of California, San Francisco, Fellow, 1/82-6/82, Neuroradiology
University of California, San Francisco Clinical Instructor in Neuroradiology
San Francisco Veterans Administration Medical Center Chief, Neuroradiology Service
University of California, San Francisco Assistant Professor of Radiology in Residence
University of California, San Francisco Associate Professor of Radiology, Neurology and Neurological Surgery in Residence

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