Neurosurgery
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Distal anterior choroidal artery aneurysms with intraventricular hemorrhage are rare and difficult to treat. We report the case of a 46-year-old woman with a left distal anterior choroidal artery aneurysm presenting as a typical subarachnoid hemorrhage from which she had no focal neurological signs. ⋯ This is the first report of a successfully treated distal anterior choroidal artery aneurysm. Reports of this unusual aneurysm and methods of approaching deep temporal lesions are reviewed.
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Disruption of local cortical blood flow (CBF) autoregulation and CO2 reactivity, or vasoparalysis, has been documented in humans after aneurysmal subarachnoid hemorrhage (SAH). Generally, the degree of vasoparalysis is related to the patient's clinical grade. Using intraoperative measurement of local CBF, we evaluated pressure autoregulation and CO2 reactivity in patients after SAH. ⋯ After aneurysm clipping, significant CBF changes (P less than 0.001) with PCO2 alteration occurred in control patients and those operated on more than 7 days after SAH. There was no significant change in CBF in patients operated on within 7 days after SAH. Changes in CBF reactivity to alteration of MABP were significantly larger in early operation patients than in other groups (P less than 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Preliminary experiences with brachial plexus exploration in children: birth injury and vehicular trauma.
The application of microsurgical techniques to the peripheral nervous system has made possible the reconstruction of the brachial plexus after vehicular and penetrating injuries. We now report our preliminary experiences utilizing these same techniques in the microsurgical management of brachial plexus birth injury. In contrast to other authors and in distinction from our own experiences with vehicular trauma in children, we did not find lesions requiring reconstruction by grafting or neurotization in any of seven plexus explorations for birth injury. ⋯ All children with birth injuries of the brachial plexus require careful, repeated neurological evaluation during the first few months of life. Although the great majority make a rapid and satisfactory spontaneous recovery, the minority who do not recover are destined to suffer significant, life-long disability. Microsurgical brachial plexus exploration may benefit this select group of patients.
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A sneeze caused acute left arm pain in a 36-year-old woman with a lumboperitoneal (LP) shunt that had been placed 3 years earlier for relief of headaches caused by pseudotumor cerebri. Numbness progressed up the left arm, neck, and back of the head and finally into the left face along with weakness of the hand and arm. Magnetic resonance imaging (MRI) and computed tomography revealed new tonsillar herniation and a large eccentric syrinx extending from C2 to T6. ⋯ Pain lessened and motor function improved slightly. MRI revealed complete resolution of the syrinx and resolution of the tonsillar herniation. Theories of syringomyelia formation, the relationship to Chiari I malformation, and the implications of this case are discussed.
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A series of 13 patients with synovial or ganglion cysts of the spinal facet joints causing nerve root compression is reported. These cysts were found in both the cervical and the lumbar spine, and the anatomical location of each cyst corresponded to the patient's signs and symptoms. In no case was there evidence of intervertebral disc abnormality found at operation. ⋯ The extradural defects defined with positive contrast myelography or postmyelography computed tomographic scanning were usually posterior or posterolateral to the common dural sac and were misinterpreted as extruded discs in the majority of cases. Treatment consisted of laminectomy and surgical excision of cysts. All patients reported improvement or resolution of their presenting symptoms.