Journal of neurosurgery
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Journal of neurosurgery · Mar 1987
Case ReportsMultiple intracranial aneurysms due to Coccidioides immitis infection. Case report.
True mycotic (fungal) aneurysms are distinctly uncommon. The case of a young woman with multiple intracranial aneurysms of Coccidioides immitis origin is presented. ⋯ There are no previous reports of a coccidioidal mycotic aneurysm. The management of intracranial coccidioidomycosis and fungal aneurysms is reviewed.
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Journal of neurosurgery · Mar 1987
Effect of a calcium channel blocker on posttraumatic spinal cord blood flow.
The normal rat spinal cord blood flow (SCBF) has been shown to increase after administration of nimodipine, a calcium channel blocker. The present study investigates the capability of nimodipine to improve SCBF, as measured by the hydrogen clearance technique, after a 53.0-gm clip compression injury to the T-1 segment of the rat spinal cord. The profound drop in mean systemic arterial blood pressure (MSAP) after cervical cord injury precluded any improvement in posttraumatic SCBF by nimodipine alone. ⋯ The maintenance of an adequate MSAP by a pressor agent was crucial for nimodipine to improve posttraumatic SCBF by its ability to dilate the spinal vascular bed. Adrenaline was the only pressor agent that could fulfill the above criteria, although other pressor agents need to be investigated. Experiments are underway with the combination of adrenaline and nimodipine to further verify these encouraging results demonstrating an improvement in posttraumatic ischemia of the spinal cord.
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Journal of neurosurgery · Feb 1987
Long-term intrathecal baclofen infusion for treatment of spasticity.
Seven patients with spasticity of spinal cord origin have been maintained for up to 2 years with continuous spinal intrathecal infusion of baclofen. Prior to treatment, all of the patients had severe rigidity in their lower limbs and most had frequent and extensive spontaneous spasms, all of which greatly interfered with their activities of daily living. Oral antispasmodic medications were ineffective or caused central side effects. ⋯ The most serious complications were two drug overdoses which took several days to clear up and were due to malfunctions of an earlier pump model. Baclofen clearance from the cerebrospinal fluid occurs with a half-life of 5 hours. The most serious concern in maintaining patients indefinitely on intrathecal baclofen is whether drug tolerance will eventually occur.
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Journal of neurosurgery · Feb 1987
Monitoring retraction pressure on the brain. An experimental and clinical study.
The problem of minimizing tissue damage during brain retraction was studied both experimentally in dogs and clinically with the aid of newly designed strain-gauge retractor. The pressure required to obtain a specific exposure decreased gradually with time. ⋯ The lower the head position of the dog, the larger was the amplitude of brain retraction pressure. Clinical studies demonstrated that: 1) cerebrospinal fluid drainage was effective in decreasing the retraction pressure required; 2) use of multiple retractors reduced the pressure applied by each retractor; and 3) retraction pressure could be monitored when the strain-gauge retractors were applied to arteries and cranial nerves.
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Journal of neurosurgery · Dec 1986
Randomized Controlled Trial Clinical TrialComparison of mannitol regimens in patients with severe head injury undergoing intracranial monitoring.
Eighty patients sustaining head injuries and presenting with Glasgow Coma Scale scores of 8 or less were entered into a prospective randomized study to assess the benefit of intracranial pressure (ICP) monitoring with two regimens of mannitol administration. Group I was treated with mannitol for ICP elevations greater than 25 mm Hg, while Group II received empirical mannitol therapy irrespective of ICP readings. ⋯ These results are comparable to those of several published series of head-injured patients receiving similar treatment from 1977 to 1982. However, those series must be reassessed in light of recently published studies with treatment initiated at lower levels of ICP.