Surg Neurol
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Biography Historical Article
Franz Josef Gall and his contribution to neuroanatomy with emphasis on the brain stem.
Franz Josef Gall, born in 1758, studied medicine in Strasbourg and Vienna and focused his research in two areas. His most notorious research was in craniofacial morphology that gradually evolved into the pseudoscience of phrenology. His second research area was neuroanatomy. ⋯ In this vignette we explore Gall's neuroanatomic contributions especially as they relate to brain stem anatomy. By means of blunt dissection he was the first to describe the origins of several cranial nerves, including the trigeminal nucleus. It will be apparent that Gall--his dubious introduction of phrenology notwithstanding--was a pioneer in the description of brain stem anatomy.
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During 1980-85, cerebral angiography was performed as soon as possible for early operation of ruptured aneurysms. However, during that period, the incidence of rebleeding during angiography conducted within 6 hours after the initial rupture was approximately two-fold higher than the rate of rebleeding within 6 hours for the total series. Therefore, since 1986, patients with grades I-IV have been managed with complete bed rest, and angiography has been withheld during the first 6 hours after rupture, except in patients in whom emergency operation was anticipated. ⋯ In patients with grades I-IV, the percentage of patients receiving angiography within 6 hours after rupture decreased from 45% during 1980-85 to 13% during 1986-92 (p < 0.01), and the ultra-early rebleeding rate decreased from 15% during 1980-85 to 5% during 1986-92 (p < 0.01). However, with the increase in number of patients referred in the ultra-early stage, the number of rebleeding cases during transfer increased. In conclusion, in order to reduce the rate of ultra-early rebleeding, withholding aggressive management such as angiography in this stage seems to be effective, and if there is no need for emergency operation, it is better to withhold patients' transfer in this stage and commence it soon after 6 hours following subarachnoid hemorrhage.
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Review Case Reports
Spinal extradural arteriovenous malformation presenting with recurrent hemorrhage and intermittent paraplegia: case report and review of the literature.
Symptomatic spinal extradural arteriovenous malformations (AVMs) are uncommon. They usually present with slowly progressive myelopathy and/or radiculopathy and only rarely with spinal extradural hemorrhage (SEH). ⋯ Recurrent hemorrhage resulted in intermittent paraplegia and acute chest/shoulder pain--diagnosed initially as hysteria. Interesting sequential myelographic, computed tomographic, and magnetic resonance imaging studies are presented, and the literature on spinal extradural AVMs presenting with SEH is reviewed.
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Case Reports
Ossified and calcified epidural hematoma incidentally found 40 years after head injury: case report.
The authors report a 57-year-old man with an ossified and calcified epidural hematoma found incidentally 40 years after incurring a severe head injury. Since the introduction of computed tomography (CT) scan, few such cases have been described in the literature. A characteristic intracranial "double-outlined" contour on plain skull x-ray films and CT scans represented bone formation and calcification of the hematoma capsule adjacent to the dura.
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Case Reports
Transient peduncular hallucinations secondary to brain stem compression by a medulloblastoma.
Almost all peduncular hallucinations have been described in patients with intrinsic lesions of the midbrain. An as yet unreported case of peduncular hallucinosis caused by posterior compression of the midbrain by a medulloblastoma in a 16-year-old boy is provided. The hallucinations and associated symptoms only ceased after removal of the tumor.