Neurosurgery
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Five patients with vertebral fracture and spinal epidural hematoma (SEH) are described. Another 58-year-old man developed a post-traumatic SEH without bony damage. From the literature, 38 patients (31 male, 4 female, and 3 unknown) were collected. ⋯ In the very young patient, there is usually no fracture/dislocation of the spine. A predisposing lesion may be present when spinal fracture is not evident. The prognosis after surgical intervention is better in patients without spinal fracture than in those with vertebral damage, probably because of less contusion to the spinal cord and the presence of very young subjects in the former group of patients.
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Among 140 cases of chronic extracerebral fluid collections treated surgically, 7 cases (5%) of intracerebral hematoma occurring immediately after drainage were encountered. In none of the patients was a preoperative intracerebral clot or contusion identified by either computed tomographic scan or angiography. One patient had pre-existing systemic hypertension. ⋯ The factors that all of the patients had in common were preoperative increased intracranial pressure and shift of the midline structures, as well as rapid surgical decompression of the initial lesion. Possible pathogenic mechanisms include hemorrhage into previously undetected areas of contusion, a sudden increase in cerebral blood flow combined with faulty autoregulation, and damage to parenchymal vessels secondary to rapid intra- or postoperative shift of the intracranial contents. Perhaps this devastating complication can be avoided if closed system drainage is used for the treatment of chronic surface collections.
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Historical Article
Birth of a journal: the origin and early years of Neurosurgery.