British journal of neurosurgery
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Review Case Reports
Multiple postoperative intracerebral haematomas remote from the site of craniotomy.
A postoperative haemorrhage is a common and serious complication of a neurosurgical procedure. It usually occurs at the site of the surgery, but on occasion a postoperative haematoma is found at a distance from the previous craniotomy. Multiple postoperative haemorrhages are extremely rare. We report the case of a 63-year-old woman, operated on for the removal of a supratentorial astrocytoma, who developed in the early post-operative period multiple bilateral intracerebral haematomas without involvement of the surgical bed.
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We carried out a prospective study on patients admitted to busy neurosurgical units in Karachi and Quetta with penetrating craniocerebral injuries. Of the 100 patients, 52 died and 48 survived in spite of aggressive surgical management. ⋯ A review of current literature on pathophysiology and management is included and the importance of prehospital optimum care, and early transfer to the neurosurgical centre are emphasized. Since only two of the 35 patients with a GCS of less than five survived, with severe disabilities, utilizing resources in third world countries on the management of craniocerebral penetrating injuries in patients with a GCS less than 5 is questioned especially when organ donation is not possible.
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The psychosurgical treatment of psychiatric illnesses, using stereotactic subcaudate tractotomy (SST), has been carried out at the Geoffrey Knight Unit since 1961. Recently, the procedure has had to be modified. This paper describes the manner in which this has been achieved and the clinical implications of this change.
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Five cases of intracranial tuberculosis with atypical response to antitubercular chemotherapy are reported. In these cases tuberculomas either increased in sizes or first developed during course of adequate chemotherapy for tubercular meningitis or postmeningitic hydrocephalus. ⋯ Glucocorticoid therapy was instituted in two cases and surgical excision of tuberculomas performed in the others. Recovery was good in all the five cases excluding visual loss, which remained unchanged in two cases because of prexisting secondary optic atrophy.