Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2005
Review Case ReportsContralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature.
We report a complication of decompressive craniectomy in the treatment of aneurismal subarachnoid hemorrhage (SAH) and accompanying middle cerebral artery (MCA) infarction. A 56-year-old man presented with subarachnoid hemorrhage and right sylvian hematoma. He was diagnosed with high-grade SAH and medical therapy was employed. ⋯ In the light of this current case, we hypothesize that a large craniectomy may facilitate the accumulation of recurrent effusion on contralateral side creating a resistance gradient between two hemispheres. This point may be especially true for subarachnoid hemorrhage cases requiring aneurysm surgery. We conclusively suggest that subdural effusions may be resistant to simple drainage techniques if a large contralateral craniectomy does exist, and early cranioplasty may be required for treatment in addition to drainage procedures.
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A case which had developed neurological complication because of compression due to air trapping in the epidural space after spinal surgery is presented with its clinical and radiological findings. Nitrous oxide can easily diffuse into the air-filled spaces in the body from the bloodstream and also increases the pressure of the air in the closed spaces. After the L4-5 discectomy procedure, weakness in dorsal flexion was occurred on the contra lateral leg. ⋯ The surgical approach was not considered. Following the resolution of the air in the epidural space, neurological deficit was progressively improved. In order to prevent neurologic complication due to air trapping in spinal surgery, avoidance of using nitrous oxide and also irrigation of the surgical field with isotonic fluid is recommended.
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Clin Neurol Neurosurg · Aug 2005
Case ReportsIntraventricular colloid cyst, hydrocephalus and neurogenic stunned myocardium.
To report the occurrence of neurogenic stunned myocardium in the context of a hydrocephalus due to a third ventricle colloid cyst. ⋯ The sudden elevation of intracranial pressure, with the subsequent decreased cerebral perfusion pressure induces a vigorous cerebro-protective neuroendocrine system activation that can lead to the neurogenic stunned myocardium. Sudden death in patients with colloid cysts may be related to acute neurogenic cardiac dysfunction, and not necessarily cerebral herniation(s), as previously thought.
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Clin Neurol Neurosurg · Aug 2005
Case ReportsChurg-Strauss syndrome presenting with subarachnoid hemorrhage from ruptured dissecting aneurysm of the intracranial vertebral artery.
Churg-Strauss syndrome (CSS) represents a rare systemic vasculitis that is almost invariably accompanied by bronchial asthma and eosinophilia. We report a case of a 36-year-old woman with previously diagnosed CSS presented with subarachnoid hemorrhage (SAH) from dissecting aneurysm in a vertebral artery (VA). Two months before onset of SAH, the patient had presented with numbness on her right lower leg due to peripheral neuropathy. ⋯ Then pharmacotherapy with prednisone was initiated for CSS. The patient recovered well and was discharged without any neurological deficit. As far as we know, this is the first reported case of CSS presented with SAH from dissecting aneurysm on posterior circulation.