Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Clinical Trial
Neurological improvement after cranioplasty - analysis by transcranial doppler ultrasonography.
Cranioplasty can improve neurological status in patients with skull bone defects. The mechanism of postoperative improvement in neurologic status might be increased cerebral blood flow (CBF) velocity due to elimination of the effects of atmospheric pressure. Between May 2001 and June 2002, 13 patients (8 men and 5 women; average age, 46 years; range, 21-65 years) were studied. ⋯ While the CBF velocities tended to increase after cranioplasty, only the increase in the non-lesion side middle cerebral artery (MCA) was statistically significant. The interval from decompressive craniectomy to cranioplasty and neurological status change before and after cranioplasty was significantly negatively correlated. We conclude that cranioplasty can improve neurological status, and it should be performed as earlier as edema has resolved.
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This case report describes a 46-year-old man whose first symptom was an attack of acute flank pain, followed by the gradual onset neurological symptoms. We demonstrated a small nidus and serpentine signal-void area in the spinal cord by MRI and diagnosed a glomus type of spinal arteriovenous malformation (AVM). Flank pain is a rare initial finding in an adult with spinal AVM. In cases with acute flank pain, neurologists should consider spinal AVM as a differential diagnosis.
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Pituitary apoplexy is an uncommon syndrome characterised by sudden onset of headache, meningeal signs, visual disturbances, ophthalmoplegia and confusion. Documented recurrent apoplexy or treated apoplexy is even rarer with only few reports in the literature. Between 1994 and 2001, 18 patients were treated for pituitary apoplexy at Bayindir Medical Centre through transsphenoidal route. ⋯ Additional treatment in the form of radiosurgery was found necessary for the first patient. Surgical excision of the pituitary tumours with apoplexy reduces the risk of recurrent bleedings but eradication is not a rule. These patients need to be followed closely in the postoperative period for possible recurrence of bleeding.