Journal of neurosurgery
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Journal of neurosurgery · Apr 1982
Randomized Controlled Trial Comparative Study Clinical TrialEffect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury.
During 1977-1978, 127 patients with severe head injury were admitted and underwent intracranial pressure (ICP) monitoring. All patients had Glasgow Coma Scale (GCS) scores of 7 or less. All received identical initial treatment according to a standardized protocol. ⋯ Twenty-six patients (25%) had ICP's of 25 mm Hg or greater, compared to 34% in the previous series (p less than 0.05), and 18 of these 26 patients (69%) died. The overall mortality for this current series was 28% compared to 46% in the previous series (p less than 0.0005). This study reconfirms the high mortality rate if ICP is 25 mm Hg or greater; however, the data also document that early aggressive treatment based on ICP monitoring significantly lessens the incidence of ICP of 25 mm Hg or greater and reduces the overall mortality rate of severe head injury.
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Journal of neurosurgery · Apr 1982
Case ReportsCerebral dissecting aneurysm and intimal fibroelastic thickening of cerebral arteries. Case report.
A 19-year-old white man developed aphasia and right hemiplegia after several falls while waterskiing. Cerebral angiography displayed a ripple appearance and a "string of beads" sign along the left middle cerebral artery, with occlusion or stenosis of most of its branches. The patient died after 6 days, of transtentorial herniation due to massive left cerebral infarction. ⋯ A systematic study of cerebral arteries performed in six control cases revealed that IFT was present in a similar distribution to that seen in the patient described. However, the degree of IFT in this patient was greater than in the controls. Some individuals with excessive IFT may be more susceptible to cerebral dissecting aneurysm under a variety of stresses, especially trauma.
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Journal of neurosurgery · Mar 1982
Case ReportsDissecting hematoma of the cervical vertebral artery. Case report.
A 31-year-old woman developed a sudden onset of vertebrobasilar ischemia while exercising. Cerebral arteriography revealed a dissecting hematoma of the cervical portion of the dominant vertebral artery. Both the neurological deficits and the intramural hematoma of vertebral artery resolved with conservative therapy alone.
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Journal of neurosurgery · Feb 1982
Intrathecal and intraventricular morphine for pain in cancer patients: initial study.
Intractable pain in six cancer patients was treated with lumbar intrathecal morphine (two patients) and intraventricular morphine (four patients). Daily percutaneous injections of morphine through Ommaya reservoirs were made. ⋯ Morphine requirements gradually increased. Side effects were minimal, and there were no complications.
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Journal of neurosurgery · Jan 1982
Case ReportsNontraumatic dissecting aneurysm of the vertebral artery. Case report.
A case is described of a nontraumatic dissecting aneurysm of the vertebral artery, which presented as a subarachnoid hemorrhage (SAH). Differentiation from vasospasm and from atherosclerosis is critical. Dissection between the adventitia and media should be noted in the differential diagnosis of SAH when an aneurysm or vascular malformation is not demonstrated angiographically.