Surg Neurol
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When a patient presents to the neurosurgeon with a traumatic intracerebral hematoma and has not deteriorated or developed new neurological deficit since the injury, the decision to remove the hematoma may be difficult. Of 244 patients with traumatic intracerebral hematomas, 85 were selected for intracranial pressure monitoring to assist in deciding whether surgical evacuation was indicated. None had deteriorated in conscious level or developed new neurological deficit since injury. ⋯ Intracranial pressure monitoring therefore failed to predict a late rise in intracranial pressure in 16.6% of those with low intracranial pressure initially. An analysis of computed tomography scanning and clinical features was therefore carried out to search for better predictors of the need for surgery. Our data suggest that basal cistern status, coma score, and the severity of edema surrounding the intracerebral hematoma should be used, in addition to intracranial pressure monitoring, to improve management of patients with traumatic intracerebral hematoma.
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Case Reports
Intracranial mycotic aneurysm associated with transsphenoidal surgery to the pituitary adenoma.
A case is reported in which a mycotic aneurysm of the supraclinoidal portion of the internal carotid artery formed as the result of suprasellar infection following transsphenoidal surgery. The source of infection was thought to be a maxillary sinusitis. The aneurysm was treated with systemic antibiotic therapy and disappeared 4 months after the operation. Repeated angiography showed the whole course from the formation to the disappearance of the aneurysm and was valuable in the treatment of intracranial mycotic aneurysms.
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Writer's cramp is a very disabling condition characterized by difficulty in fine movements of the hand such as writing, shaving, or performing surgery. It is associated with pain in the forearm and upper arm. Women with writer's cramp experience comparable difficulty. ⋯ Of the 20 who had writer's cramp, 13 had complete relief of writer's cramp and pain, 1 had no relief (Dr. Butts), and there were 6 lost to follow-up. At least one cause of writer's cramp is suggested, but no claim is made that this is the only cause.
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An air ventriculogram was discovered in the context of a minor head trauma evaluation. Its correct attribution to an antecedent epidural anesthesia rather than trauma precluded an unnecessary workup. The relationship between epidural anesthesia and pneumocephalus is emphasized. The development of air ventriculography as a diagnostic tool is discussed as well.