J Neurosurg Sci
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Intradural dermoids are rare congenital tumors representing approximately 0.05% of all intracranial lesions. These benign tumors have a typical appearance on CT and MR due to their lipid components. The complication caused by rupture are the spillage of the fatty material into the cerebrospinal fluid. We report a case of a ruptured dermoid cyst showing fat/fluid levels in both side ventricles and fatty material in the subarachnoid space on CT and MR-imaging and the follow-up over four years after incomplete resection of the tumor.
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Penetrating orbital injuries are not frequent but neither are they rare. The various diagnostic and therapeutic problems are related to the nature of the penetrating object, its velocity, shape and size as well as the possibility that it may be partially or wholly retained within the orbit. The authors present another case with unusual characteristics and discuss the strategies available for the best possible treatment of this traumatic pathology in the light of the published data. ⋯ When penetration is suspected and/or the object responsible is inadequately identified, a CT scan is indicated. The type of procedure to adopt for extraction, depends on the size and nature of the retained object. Although the possibility of non-surgical extraction has been described, surgical removal is the safest form of treatment in cases with extensive laceration and brain contusion.
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Clinical Trial
Infections and re-infections in long-term external ventricular drainage. A variation upon a theme.
The infection of the external ventricular drainage (EDV) remains the main morbidity and mortality associated with this procedure, in the setting of the treatment of hydrocephalus and its complications, leading to excess of hospitalization with annual economic burden. METHODS. In this 3-year retrospective study we selected and reviewed the records of 15 of 143 patients (mean age 34 years with range from 1 months to 70 years; 12 males and 3 females) undergone to prolonged EVD in the setting of management of hydrocephalus (5 patients because of acute ventricular dilation post-intraventricular hemorrhage or post-hemorrhagic HCP, 8 because of V-P shunt infection, 1 because of post-traumatic HCP and 1 because of shunt malfunction by elevated CSF protein) and developing a shunt infection or one or more superinfection. ⋯ Based on our experience the management of infection in long-term EVD includes: the standardization of the environment of the surgery achieved with a) use of prophylactic antibiotics; b) preparation of the patient and sterile field; c) no touch technique. After implantation of EVD the risk of infection must be minimized by carefully nursing care of EVD, and administration of above prophylactic antibiotics. CSF must be collected for culture and cell count, glucose and protein when clinically indicated. When infection o reinfection is demonstrated by CSF culture then it is advisable to remove the entire hardware and start the antibiotic therapy intravenously and intraventricularly basing on susceptibility tests, CSF penetration of antibiotics, their bactericidal action, toxicity, specificity and cost. Regard to the duration of the therapy, a practical guide is treating for 10-14 days after three consecutive CSF sterile cultures. Thus, convention of EVD to a shunt can be performed within 3 weeks from admission, in the best favourable cases, decreasing the duration of hospital stay and the overall cost of neurosurgical management of the cerebral pathology requiring as therapeutic adjunct and EVD.
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The aim of the present study was to compare cranial arteries blood flow velocity as measured by means of transcranial Doppler sonography (TCD) with mean regional cerebral blood flow (rCBF) as measured by means of single photon emission computed tomography (SPECT) in migraine with and without aura during headache-free periods and spontaneous and/or induced attacks. ⋯ Our findings do not support the paradigm that migraine with and without aura are two different entities.
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The authors present a case of a patient wounded to the head and back by civilian firearm projectiles. The case peculiarity is that only one bullet reached the brain stem level causing significant neurological deficits. The final clinical picture is comparable to the "caudal pontine tegmentum syndrome". ⋯ The problems associated with prognosis, diagnosis, and treatment for gunshot wounds are discussed. In addition, the authors explain the main intracranial lesions and their mechanisms, the role of investigation, and the protocol of medical and surgical treatment. Lastly, a systematic approach for treating these types of gunshot wounds is outlined.