Neurosurgery
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Cerebrospinal fluid hypovolemia resulting in postural headaches is a well-known clinical entity, but severe forms of cerebrospinal fluid hypovolemia with altered mental status and signs of transtentorial herniation ("brain sag") have rarely been reported. This article describes the clinical features of brain sag after craniotomy in an attempt to increase recognition of this syndrome. ⋯ Severe cerebrospinal fluid hypovolemia after craniotomy may produce a dramatic herniation syndrome that is completely reversed by the Trendelenburg position. Brain sag should be included in the differential diagnosis for acute postoperative clinical deterioration in this patient population.
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Review Case Reports
Primary extradural epithelioid leiomyosarcoma of the cervical spine: case report and literature review.
No case of primary epithelioid leiomyosarcoma involving the spine has been reported previously. ⋯ This is the first reported case of a primary craniospinal epithelioid leiomyosarcoma.
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Review Case Reports
Intrinsic hematoma of the oculomotor nerve: case report and review of the literature.
Intrinsic oculomotor nerve hematoma is an exceptional cause of third nerve palsy. This case report illustrates the clinical, radiological, and intraoperative relevance of this rare pathological finding. ⋯ We reviewed the literature and found four cases of oculomotor nerve intrinsic hematoma. These cases were all associated with hematological diseases, trauma, or solid tumors, and, as a group, these patients had poor outcomes. In the present report, the possibility of radiotherapy-induced vasculopathy as a predisposing factor is discussed. Surgical removal of an intrinsic nerve hematoma is probably helpful in the functional recovery of these patients.
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Comparative Study
Penetrating civilian craniocerebral gunshot wounds: a protocol of delayed surgery.
Several factors have led to our unique approach of delayed definitive débridement. We wanted to evaluate the effectiveness of our management and compare it with the existing data in the literature. ⋯ Our supportive care of patients is not optimal. We should have saved more of our patients who presented with GCS scores of 14 and 15 who subsequently died. We have been able to report unconventionally late surgical management of two-thirds of survivors, with no surgery in one-third of survivors. Despite a high rate of infectious complications, infection did not lead to death or disability. Our protocol rarely leads to patients surviving in a permanently vegetative state. In the future, we would perform early surgery for patients who present awake and continue our current management for poor-grade patients. In this way, we will improve the number of good outcomes without increasing the population of severely damaged and dependent survivors.
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To identify enduring prolonged neuropsychological effects of cerebral concussion in high school youth athletes. ⋯ There seem to be subtle yet significant prolonged neuropsychological effects in youth athletes with a history of two or more previous concussions.