Surg Neurol
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The role of lumbar puncture and computed tomography scanning for initial diagnosis of subarachnoid hemorrhage has been evaluated in a retrospective survey of 283 consecutive cases. The material has been divided into early-and late-diagnosed cases with 72 hours after bleeding as the demarcation line between groups. The early-diagnosed cases have been further subdivided into patients exhibiting contraindications for lumbar puncture, patients with a typical history of apoplectic headache, and patients presenting with a diffuse noncharacteristic history. ⋯ If neck stiffness is not considered, 4.68 computed tomography investigations per 100,000 individuals would be performed yearly in falsely suspected cases, a diminishingly small cost corresponding to less than 1% of all cranial computed tomography scans performed in this region. Early-diagnosed patients with a diffuse atypical history constitute a small, low risk group for lumbar puncture. It may be acceptable in such patients to diagnose subarachnoid hemorrhage either by means of computed tomography or lumbar puncture, depending on the availability of local computed tomography resources.
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Case Reports
Lead encephalopathy: symptoms of a cerebellar mass lesion and obstructive hydrocephalus.
The neurologic signs and symptoms of lead intoxication are quite varied. We review a case of lead poisoning in a 9-month-old child who presented clinically and radiographically with a posterior fossa mass effect and obstructive hydrocephalus. The predominance of edema of the cerebellum sufficient to achieve obstruction of the ventricular system represents a particularly unusual presentation of this disease process. Review of the literature for similar cases of lead encephalopathy is included.
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Biography Historical Article
Al-Zahrawi and Arabian neurosurgery, 936-1013 AD.
The authors highlight the neurosurgical contributions of an Arabic surgeon by the name of Abul-Qasim Al-Zahrawi, known in Western literature as Abulcasis. This man lived during the Middle Ages from 936 to 1013 AD and wrote a 30-volume treatise on medicine. ⋯ Abulcasis is known for his concepts of pain as a symptom and his emphasis on anatomy of the skull and brain in relation to the neurosurgical operations of that period. Because his works were translated from Arabic to Latin, Hebrew, and Turkish with only recent or limited translation into the modern occidental languages, the historic role played by this man has been largely unknown by neurosurgeons who are not fluent in these languages.
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Intracranial air secondary to craniocerebral trauma is not uncommon. Computed tomography scanning may show the air within specific intracranial compartments. We report a case of air within the superior sagittal sinus visualized with computed tomography and documented at operation.
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Three hundred and nine consecutive cases of intracranial hematomas due to aneurysmal rupture--representing 34% of the total number of patients with aneurysms observed in a 12-year period--were evaluated; of these, 211 were submitted to computed tomography scan. Hematomas were present on admission in 71% of patients and occurred at rebleeding in 29%. Ruptured middle cerebral artery aneurysms caused an intracranial hematoma more frequently than aneurysms in other locations. ⋯ Regardless of treatment, 24% of patients showed good results and 58% died. Presence of a large hematoma, ventricular hemorrhage, and shift of the ventricles represented significant risk factors, associated with a poor prognosis. A comparison between two groups of patients admitted within 3 days of hemorrhage--47 operated on early, and 149 with delayed treatment--showed that better results were achieved by early operations, especially for cases in Hunt's grades IV and V.