Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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We describe a unique C1-C2 lateral dislocation complicating a displaced type II odontoid fracture. We report a 63-year-old female pedestrian involved in a motor vehicle accident who required posterior open reduction and segmental C1-C2 instrumentation and fusion. Radiological examination of the cervical spine demonstrated a lateral dislocation of the atlantoaxial joint with a displaced type II fracture of the odontoid, fracture of the right lateral mass of C1 and left superior articular facet of C2. ⋯ The dislocated C1-C2 articulation was successfully reduced surgically with subsequent bony fusion and resolution of all neurological symptoms and signs at final follow-up. To our knowledge, this the first report of this type of injury. We also review the related literature on this unique injury pattern.
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Comparative Study
Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
Tumor necrosis factor-alpha (TNF-alpha) has a crucial role in the onset of hemolysis-induced vascular injury and cerebral vasoconstriction. We hypothesized that TNF-alpha measured from brain interstitial fluid would correlate with the severity of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). From a consecutive series of 10 aSAH patients who underwent cerebral microdialysis (MD) and evaluation of vasospasm by CT angiogram (CTA) or digital subtraction angiography (DSA), TNF-alpha levels from MD were measured at 8-hour intervals from aSAH days 4-6 using enzyme-linked immunosorbent assay. ⋯ The median log TNF-alpha area under the curve (AUC) was 1.64pg/mL *day (interquartile range 1.48-1.71) for the VI<2 group, and 2.11pg/mL *day (interquartile range 1.95-2.47) for the VI>2 group (p<0.01). Thus, in this small series of poor-grade aSAH patients, the AUC of TNF-alpha levels from aSAH days 4-6 correlates with the severity of radiographic vasospasm. Further analysis in a larger population is warranted based on our preliminary findings.
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Symptomatic spontaneous pneumocephalus after a spinal fusion for spondylolisthesis without injury to the dura mater is rare. There are only a few reports of tension pneumocephalus after spinal operations published in English. ⋯ CT cisternography and MRI showed no anatomical defects that could have caused the pneumocephalus. We suggest that spontaneous pneumocephalus without dural injury may occur after a spondylolisthesis operation because of increased intra-abdominal pressure, and thus may be avoided by the careful management of abdominal pressure.