Neurochirurgie
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Case Reports
[Unilateral traumatic temporal lesions and secondary involvement of the 3d cranial nerve. Role of medical treatment].
Four cases of unilateral traumatic cerebral lesion with secondary third nerve palsy are reported. These four cases were observed over the course of one year and represent 5% of all unilateral traumatic cerebral lesion observed in our department during that period. The clinical situation presumptive of tentorial herniation included: partial (2 patients) or total (2 patients) secondary third nerve palsy, homolateral to the cerebral lesion; noncomatose state with initial Glasgow verbal score of 3 or greater; slight or no contralateral deficit. ⋯ Based on the clinical information (non comatose state) and CT-scans (basal cisterns present or slight compressed in 3 of 4 cases), the authors believe that there was no tentorial herniation; third nerve palsy occurred without axial compression. The authors analysed several of the accepted criteria for severe head injuries (GCS, CT-scan, and ICP) and referred to the literature in order to determine optimal patient management in such reversible situations that posed a danger of tentorial herniation. Repeated clinical examination and CT-scan for visualization of basal cisterns appeared to be the best criteria for therapeutic decision.
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Cerebral transfontanelle ultrasonography has been making many progress for ten years, with the grey scale of new echographs. We report here our experience. ⋯ The flexible cable permits the examination of preterm infants in incubator. After the description of normal echoanatomy, we give examples of the most frequent pathology observed: hydrocephalus, intracranial haemorrhage, periventricular leukomalacia, corpus callosum lipoma, brains dysraphism, Dandy Walker malformation.
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The authors have reviewed 100 cases of trigeminal neuralgia operated upon at the cerebello-pontine angle using microsurgical techniques, i.e. 20% of their total series of 513 patients with tic douloureux, 413 of them having been submitted to percutaneous R. F.--thermocoagulation. In 10 of the above 100 patients, a tumour or an angioma have been found and with its removal a total relief of pain has been obtained. ⋯ A correlation of the above findings with the angiographic ones has been made. A measurable method has been used to make available data which could be informative as to the presence of a conflict, as well as to its anatomical cause. But this still needs a further critical elaboration.