Surg Neurol
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Review Case Reports
Magnetic resonance imaging of C2 segmental type of vertebral artery.
Two cases with C2 segmental type of vertebral artery (VA) were reported. One case was a 64-year-old man, who was referred to our hospital suffering from vertigo, ataxia, and right facial palsy. Computed tomography (CT) scan showed multiple lacunae in the basal ganglia bilaterally. ⋯ In our experience of 1669 sides in 1436 cases, such anomaly of the vertebral artery was found in ten cases including the two abovementioned. Six cases of such anomaly have previously been reported, but demonstration of the VA coursing between Atlas and Axis by MRI has not been published in the literature. During surgical therapy on the upper cervical spine, especially when using a posterior approach, or C1-C2 lateral puncture, the possibility of an anomalous vertebral artery, as in our cases, should be taken into consideration.
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A 42-year-old male with subarachnoid and large intracerebral hemorrhage in coma was operated without preoperative angiography because of impending cerebral herniation. After emergent decompressive craniotomy, intraoperative digital subtraction angiography (DSA) was performed and a middle cerebral artery aneurysm was demonstrated clearly. ⋯ The prognosis of patients with ruptured aneurysm with large intracerebral hematoma is affected by early hematoma evacuation. Since the time spent for preoperative angiography may cause irreversible damage to the brain stem, in such case, early decompressive procedure and subsequent aneurysm diagnosis by intraoperative DSA may be used as alternative method to achieve a good outcome.
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Review Case Reports
Thoracic spinal cord injury without spine fracture in an adult: case report and literature review.
The syndrome of traumatic spinal cord injury without spinal column fracture is well known and predominantly involves the cervical spine of children. One case of a thoracic spinal cord injury without bony abnormalities in an adult is reported, and the pertinent literature is reviewed. Although spinal cord injury without radiographic abnormality may exist, such injuries without neuroimaging pathology may not.
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We outline a model hospital policy that amends existing do-not-resuscitate (DNR) policies to temporarily suspend DNR orders during the perioperative period. The policy amendment is justified because, by accommodating the needs of the DNR patient, the surgeon, and the anesthesiologist, it contributes to the betterment of patient care.
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All patients admitted following a minor head injury (GCS is without neurological deficits) during an 18 month period in an entire area were submitted to the same diagnostic and therapeutic protocol. Adult patients were x rayed and in the cases with skull fracture (even asymptomatic), a computed tomographic (CT) scan was performed. Children (below the age of 14) did not routinely receive skull X-rays but were admitted to one of the five regional hospitals where a CT scanner was available 24 hours per day. ⋯ All patients admitted to such a center had a good outcome, but a survey of deaths related to head injury in the area revealed two fatalities following minor head injury. The only avoidable death was a patient with multiple brain contusions who developed sudden brain swelling on day 12 post-trauma. We conclude that, even if management mortality is not zero, our protocol is sufficiently safe for the treatment of minor head injury.