Surg Neurol
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The perimesencephalic type of nonaneurysmal subarachnoid hemorrhage (SAH) is a recently described clinical and radiological entity, with a good outcome. We carried out a retrospective analysis of 294 patients with subarachnoid hemorrhage, of whom 62 had a negative four-vessel angiography. ⋯ However, five cases of aneurysmal subarachnoid hemorrhage had a more or less similar CT appearance: the diagnosis cannot be made on the CT image only and angiography remains mandatory. The use of bed rest, antifibrinolytics, and calcium antagonists is discussed.
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Changes occurring in the extracellular fluid (ECF) concentration of energy-related metabolites were investigated in a well-characterized model of compression trauma to the spinal cord. Microdialysis probes were inserted into exposed grey matter of the dorsal horn at the level of Th 7-8, and perfused with mock cerebrospinal fluid. The trauma was produced 2 hours later by compression of the cord with a 9-, 35-, or 50-g load for 5 min. ⋯ Following decompression, all ECF metabolites normalized within 20-40 min after mild (9 g) to moderate (35 g) trauma. After severe trauma (50 g), resulting in complete ischemia during compression, followed by irreversible paraplegia, there was a partial recovery of ECF inosine and hypoxanthine, whereas the increase in lactate and the lactate/pyruvate ratio persisted. The results suggest that penumbra conditions prevail during the early posttraumatic period when the degree of trauma results in severe neurological deterioration and that ECF lactate levels in the spinal cord is a sensitive indicator of secondary ischemia after compression injury.
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Between 1976 and 1991, we determined that 19 patients harboring bilateral supratentorial aneurysms should be approached in a single sitting through a unilateral pterional craniotomy. Using microsurgical techniques, the Sylvian cistern was opened widely to expose the aneurysms located ipsilateral to the craniotomy. ⋯ The contralateral nonruptured aneurysms were clipped in a routine fashion. We were able to clip or wrap with muscle all bilateral aneurysms in 15 cases, and we have concluded that this approach can be safely employed in selected patients with bilateral supratentorial aneurysms, and thus a second craniotomy can be avoided.
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Multicenter Study
Predictors of mortality in severely head-injured patients with civilian gunshot wounds: a report from the NIH Traumatic Coma Data Bank.
Predictors of outcome were examined in this prospective study of 151 patients severely injured by civilian gunshot wounds. Of the 151 patients, 133 (88%) died. Of the 123 patients with an initial Glasgow Coma Scale score of 3-5, 116 (94%) died, whereas of the 20 with an initial Glasgow Coma Scale score of 6-8, 14 (70%) died. ⋯ In those patients who survived long enough for intracranial pressure monitoring, intracranial hypertension predicted a very poor outcome. Computed tomographic scan characteristics such as midline shift, compression or obliteration of the mesencephalic cisterns, the presence of subarachnoid blood, intraventricular hemorrhage, and the presence of hyperdense or mixed-density lesions greater than 15 mL, either bilateral or unilateral, were all associated with a poor outcome. However, neither the caliber of gun nor the distance of the gun from the head significantly affected the risk of dying.
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Historical Article
The history of neurosurgical procedures for the relief of pain.
Pain has been a major medical problem from the beginning of recorded history. Since the earliest medical writings, there have been innumerable procedures designed to relieve pain and its suffering. In this study, we have reviewed both the early medical writings of various civilizations and the first modern publications, to compile a history of neurosurgical procedures for the relief of pain.