Acta neurochirurgica
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Acta neurochirurgica · Jan 1992
Case ReportsMultiple intracranial aneurysms: a high risk condition.
There is still a relative silence in the literature on what policy should be followed in treating multiple aneurysms. The main risks are: bleeding of a formerly asymptomatic aneurysm during the haemodynamic tides of the peri-operative period; aneurysm(s) can be hidden on angiograms and tend to be overlooked easier in case of an already revealed aneurysm; misjudgement of the ruptured one as a silent additional aneurysm, therefore left for second stage surgery. ⋯ But it also describes those silent aneurysms which safely could be clipped later. Hazards and disadvantages concerning the more aggressive surgery proved to be less significant than the natural history of multiple aneurysms represents.
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Acta neurochirurgica · Jan 1992
Effects of dorsal root entry zone lesions on CSF and plasma neuropeptides and catecholamines.
Effects of dorsal root entry zone lesions (DREZLs) on cerebrospinal fluid (CSF) and plasma concentrations of neuropeptides, catecholamines, and cyclic nucleotides were studied in 9 patients with intractable chronic pain. Contents of beta-endorphin-like-material in CSF decreased in all patients 12-17 days following DREZLs during which complete to good pain relief was achieved. Contents of beta-endorphin-like-material in CSF increased again about one month after DREZLs in two and remained unchanged in one of three patients tested, who complained of partial reappearance of pain. ⋯ Substance P, noradrenaline, adrenaline, and cyclic nucleotide levels in both CSF and plasma were variable among the subjects and did not change significantly following the operations. Thus, the results suggest that production of beta-endorphin-like-material in the central nervous system is decreased by DREZL, though the increase in its turn-over might not be neglected. The mechanisms of the decrease in contents of beta-endorphin-like-material in CSF after DREZLs were discussed in terms of our current knowledge of pain and pain inhibitory systems.
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Acta neurochirurgica · Jan 1992
Clinical outcome and cognitive impairment in patients with severe head injuries treated with barbiturate coma.
This study reports on clinical outcome in 38 patients with severe head injuries (posttraumatic coma for 6 hours or more) treated with barbiturate coma because of intracranial hypertension. Eighteen patients died, 4 patients remained in a severely disabled or a chronic vegetative state, and 16 patients reached the levels good recovery/moderate disability. ⋯ All patients except one exhibited varying degrees of cognitive dysfunction and 6 patients had signs of personality change. The quality of life for the majority of surviving patients was relatively good but the positive effects of barbiturate coma therapy in the age groups over 40 years appeared to be limited.
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A survey is given of the development and actual state of the prediction of outcome in severe head injury. Thanks to the data collection in some large databanks it has become possible, in a relatively large number of cases, to estimate reliably the chances of survival and the chance of developing an intracranial haematoma base on clinical data and CT obtained during the first 24 hours. Later during the posttraumatic course prediction is possible of the degree of remaining disability in survivors, and the chances of developing epilepsy and neuro-behavioural sequelae. Due to changing management-regimens further data collection in international databanks is necessary.
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Acta neurochirurgica · Jan 1992
Haemodynamic, intracranial pressure and electrocardiographic changes following subarachnoid haemorrhage in rats.
Experimental induction of subarachnoid haemorrhage in rats resulted in acute haemodynamic changes. Heart rate decreased concomitantly with a rise in arterial blood pressure. Intracranial pressure increased and consequently cerebral perfusion pressure dropped. ⋯ The haemodynamic and electrocardiographic changes, which result from subarachnoid haemorrhage, may even become aggravated, when repetitive injections of blood or saline are given into the cisterna magna and when cerebral angiography is performed prior to induction of the subarachnoid haemorrhage. Chronic intracranial pressure monitoring during the 48 hours following subarachnoid haemorrhage revealed no significant rise in pressure. A thorough control of the experimental conditions is thus of utmost importance in order to give a valid interpretation of the observed anomalies.