Journal of neurosurgery
-
Journal of neurosurgery · Jun 2003
Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests.
The aim of this study was to assess the diagnostic yield of imaging tests performed in patients in whom the cause of subarachnoid hemorrhage (SAH) had not been demonstrated on initial angiography. ⋯ Repeated catheter angiography remains the most sensitive test to determine the cause of SAH that is not demonstrated on initial angiography, particularly in the subtype of nonperimesencephalic SAH. Newer, noninvasive imaging techniques provide little diagnostic yield.
-
Journal of neurosurgery · Jun 2003
Preservation of bone flaps in patients with postcraniotomy infections.
Management of postcraniotomy wound infections has traditionally consisted of operative debridement and removal of devitalized bone flaps followed by delayed cranioplasty. The authors report the highly favorable results of a prospective study in which postcraniotomy wound infections were managed with surgical debridement to preserve the bone flaps and avoid cranioplasty. ⋯ In patients with uncomplicated postcraniotomy infections, simple operative debridement is sufficient and it is not necessary to discard the bone flaps and perform cranioplasties. Even patients with risk factors such as prior surgery or radiotherapy can usually be treated using this strategy. Patients who undergo craniofacial surgeries involving the nasal sinuses are at higher risk and may require bone flap removal.
-
Journal of neurosurgery · Jun 2003
Leukocytosis as an independent risk factor for cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
The identification of patients at an increased risk for cerebral vasospasm after subarachnoid hemorrhage (SAH) may allow for more aggressive treatment and improved patient outcomes. Note, however, that blood clot size on admission remains the only factor consistently demonstrated to increase the risk of cerebral vasospasm after SAH. The goal of this study was to assess whether clinical, radiographic, or serological variables could be used to identify patients at an increased risk for cerebral vasospasm. ⋯ During this 7-year period, spontaneous nonaneurysmal SAH and ruptured PCA aneurysms decreased the odds of developing vasospasm sevenfold and 20-fold, respectively. The presence of Fisher Grade 3 SAH on admission or a peak leukocyte count greater than 15 x 10(9)/L increased the odds of vasospasm sevenfold and threefold, respectively. Monitoring of the serum leukocyte count may allow for early diagnosis and treatment of vasospasm.
-
Journal of neurosurgery · Jun 2003
Case ReportsPrimary hypertension-induced cerebellar encephalopathy causing obstructive hydrocephalus. Case report.
Hypertension-induced encephalopathy is a recognized pathological process commonly focused in the parietal and occipital lobes of the cerebral hemispheres. The parenchyma of the posterior fossa is infrequently involved. The authors report on two cases of isolated edema of the cerebellar hemispheres, which occurred in the setting of hypertensive crisis and led to complete obstruction of or significant impingement on the fourth ventricle and potentially lethal hydrocephalus. ⋯ The authors hypothesize that the development of hypertension beyond the limits of cerebral autoregulation led to breakdown of the blood-brain barrier in the cerebellum and development of posterior fossa edema secondary to the focal transudation of protein and fluid. Correction of the elevated blood pressure led to amelioration of cerebellar edema. In the appropriate clinical setting, hypertension as the inciting cause of cerebellar encephalopathy should be considered.