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.
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Pain in avulsions lesions of the brachial plexus is related with deafferentation; experimental studies demonstrate that spontaneous discharges can be recorded with micro electrodes in the dorsal horn, after division of the dorsal roots. These discharges ("firing") are related with the loss of control of the inhibitory effects of the large caliber sensory fibers. ⋯ These technical advances and early return to work and to community offer the best prospect of relief of pain. Incidence of intractable pain problem is less than 10% after 10 years.
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The authors present a review of their experience of cranioplasty in cases showing of skull defects. Forty recent case reports were retained out of a total of 125 cases and of these, 15 showed neurological deficiency prior to cranioplasty. In 7 out of these 15 cases cranioplasty appeared to have no effect, but in the 8 remaining cases, an improvement in the neurological condition was observed. ⋯ The rate varying from 15 to 30% and this improvement was even observable in the case of small skull defects of the order of 10 cm2. The mechanism giving rise to such improvements is discussed; it may be related to cerebral hemodynamic normalization after skull restoration. The improvement in cerebral blood flow brought about by cranioplasty in all the cases studied suggests that this technique may be important not only for simple skull repair but also to improve neurological function.