Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Comparative Study
Arterial inflow and venous outflow in idiopathic intracranial hypertension associated with venous outflow stenoses.
A reduction in the proportion of the arterial inflow drained by the superior sagittal sinus in idiopathic intracranial hypertension (IIH) patients without stenoses has been noted and this has suggested elevated collateral flow. This study defines the interaction between arterial inflow and venous outflow in patients with outflow stenoses and IIH. Forty patients with clinical IIH underwent standard MRI, MR venography and MR flow quantification studies of the cerebral arteries and veins. ⋯ The arterial inflow was 21% higher than normal (p=0.01); however, the superior sagittal sinus outflow was normal, giving a reduced percentage of venous outflow compared to inflow. Seven patients were followed up after remission of their symptoms and the arterial inflows and percentage outflow returned to normal. There is a spectrum of findings in IIH; patients with stenoses have lower inflows than those with patent sinuses but still have evidence of collateral flow.
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This was a pilot study to compare the cerebral haemodynamics and neurochemical changes in patients with primary basal ganglia haemorrhage (PBGH), who underwent conventional blood glucose level (BGL) control and intensive BGL control with continuous titrated insulin therapy. Patients admitted over an 18-month period with PBGH after evacuation of haematoma were retrospectively divided into two groups according to the method used for BGL control: the 'intensive' group consisted of patients who underwent continuous titrated insulin infusion to maintain a lower normoglycemic level of 4-8 mmol/L, and the 'conventional' group consisted of patients whose BGL was maintained at between 8.1 and 10.0 mmol/L using conventional 'sliding scale' bolus subcutaneous insulin administration. Data on cerebral haemodynamics, interstitial brain oxygenation (PtiO(2)) and neurochemical monitoring were collected via microcatheters inserted in the perihaemorrhagic penumbral region. ⋯ The mean intracranial pressure, mean arterial pressure, BGL, extracellular (EC) lactate, EC glutamate, EC pyruvate and EC glycerol levels and the lactate/pyruvate ratio were found to be significantly lower (p<0.001) in the intensive group compared with the conventional group, but the mean PtiO(2) and amount of insulin administered were higher (p<0.001) in the intensive group. The mean cerebral perfusion pressure and EC glucose did not differ significantly between the two groups of patients. Maintenance of lower normoglycaemia (4-8 mmol/L) with continuous titrated insulin therapy is associated with improved cerebral haemodynamics, oxygenation and neurochemistry in the perihaemorrhagic penumbral region.
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This paper reports the first case in which an intracranial dermoid cyst that underwent traumatic rupture was treated surgically and discusses the importance of the preoperative radiological identification and management of the rupture. For adequate management of a ruptured intracranial dermoid cyst, in addition to early surgery, we emphasize the importance of expeditious identification of the rupture with MRI, including an additional fat-suppression sequence, and prompt management of the accompanying chemical meningitis with intravenous steroid therapy beginning from the pre-operative period.
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We present the case of a 36-year-old man with neck pain and parasthesia of both upper limbs. Magnetic resonance imaging demonstrated a cervical disc protrusion with spinal cord compression, a Chiari I malformation and cervical syringomyelia. On clinical grounds it was suspected that the cervical stenosis was the symptomatic pathology and an anterior cervical decompression was performed, followed by arthroplasty. ⋯ Cervical spondylosis is infrequently associated with syringomyelia. Chiari I malformations are increasingly incidentally detected and asymptomatic. This first report of arthroplasty for cervical spondylosis associated with syringomyelia adds to the growing body of experience with this new technology.