Clinical neurology and neurosurgery
-
Clin Neurol Neurosurg · Dec 2003
Case ReportsYawning despite trismus in a patient with locked-in syndrome caused by a thrombosed megadolichobasilar artery.
We report a 62-year-old woman with a locked-in syndrome with bilateral masticatory spasms and persistent trismus, who was still able to yawn. A vascular malformation of the basilar artery-megadolichobasilar artery (fusiform aneurysm, vertebrobasilar dolichoectasia) was determined to be the underlying cause of this rare combination of symptoms. A thrombus in the megadolichobasilaris as well as an almost total pontine infarction were demonstrated on CT- and MRI-scans. Thus, trismus may be associated with locked-in syndrome due to megadolichobasilar artery thrombus, although yawning is still possible.
-
Clin Neurol Neurosurg · Jul 2003
Case ReportsDelayed manifestation of spinal metastasis: a special feature of hemangiopericytoma.
Metastatic hemangiopericytoma to the spine is rare, and operative management of these highly vascularized tumors is challenging. Review of the literature identified only seven previously reported cases. Metastases of hemangiopericytomas to the spine are diagnosed often only after a long delay following resection of the primary tumors. ⋯ One year later, however, new metastases were present. Patients with hemangiopericytoma should be controlled regularly for local recurrence and systemic tumor spread. The best available treatment for delayed metastasis to the spinal column is complete tumor removal followed by postoperative radiotherapy.
-
Clin Neurol Neurosurg · Apr 2003
Clinical TrialIs mannitol safe for patients with intracerebral hemorrhages? Renal considerations.
Mannitol, a drug widely used to decrease intracranial pressure, can cause renal failure. The goal of this study is to determine the renal safety of mannitol therapy in patients with intraparenchymal hemorrhages. ⋯ Our study points out safety of mannitol therapy under control of osmolality, although control of urea and creatinine concentrations in special group of patients (persons with history of renal failure or diabetes) should be considered.
-
Clin Neurol Neurosurg · Dec 2002
Case ReportsIntravenous immunoglobulin monotherapy in long-term treatment of myasthenia gravis.
To investigate effectiveness of long-term treatment of myasthenia gravis (MG) with intravenous immunoglobulin (IVIG). ⋯ IVIG therapy is a convenient, effective therapy when used selectively for treatment of MG on a long-term basis without any significant side effects.
-
This anatomic study describes how to optimize the use of the endoscope in the cerebellar pontine angle (CPA) through a retrosigmoid approach. Unlike the microscope, that only permits visualization of structures directly ahead, the endoscope can see 'around the corner', also showing the structures down narrow. Nevertheless, to use the endoscope it is necessary to insert it into the CPA that is full of neurovascular structures which limit its movements. ⋯ The limits of view offered by each trajectory as well as the neurovascular structures together with the obstacles encountered on each route have been described. The systematic adoption of three different endoscope trajectories at the CPA level permits to view from different angulation the same structure as well as its relationships with the surrounding nerves and vessels. Considerable experience on cadavers should have already been obtained with the endoscope prior to any application in the operating room.