Surg Neurol
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Comparative Study
The role of antifibrinolytic therapy in the preoperative management of recently ruptured intracranial aneurysms.
In a retrospective study of the use of antifibrinolytic therapy in a series of patients with recently ruptured intracranial aneurysms, 131 patients were selected based on the following criteria: commencement of therapy within 3 days of the last subarachnoid hemorrhage (SAH); continuation of therapy for at least 6 days; and apparently uncomplicated surgery. Two main modalities of antifibrinolytic therapy were used: Group A, tranexamic acid (AMCA) 3 gm daily plus aprotinin k.i.u. (kallikrein inactivating units) daily (82 cases); Group B, AMCA 6 gm daily (41 cases). The remaining 8 patients were treated with epsilon-aminocaproic acid alone or in combination with aprotinin and were not considered to constitute a large enough group for statistical comparison. ⋯ The difference in the rate of severe cerebral ischemic complications was statistically significant (11 of 82 in Group A versus 12 of 41 in Group B, p less than 0.02), and in the main they were present preoperatively. The rates of rebleeding (approximately 10%) and of death from rebleeding (approximately 5%) are lower than in other published series on the natural history of this condition. In cases in which antifibrinolytics are indicated, present evidence indicates that low-dose AMCA plus aprotinin seems to be a rational combination for lowering the rebleeding, ischemic complication, and post-SAH hydrocephalus rates.
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Neurosarcoidosis characteristically presents with the onset of cranial nerve palsies or endocrine and electrolyte disturbances in a patient with known systemic sarcoid. However, the disease may occasionally manifest itself in patients with no evidence of somatic involvement and with a variety of neurological signs and symptoms. We present two cases that demonstrate several of the rare manifestations of the illness and review the literature on the diagnosis and treatment.
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Comparative Study
The management of postherpetic neuralgia with chlorprothixene.
Sixteen patients with established postherpetic pain were treated with chlorprothixene. Several other pain problems were simultaneously treated. Chlorprothixene was found to produce a favorable pain response in most patients with postherpetic pain while failing to be of value in other clinical pain problems. Chlorprothixene may be a satisfactory drug for the control of spinal or ophthalmic postherpetic pain.
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Two cases of carotid artery-cavernous sinus fistula of traumatic origin are presented. The diagnosis was suspected on computed tomography (CT) and confirmed by cerebral angiography. The CT findings included proptosis, a prominent superior ophthalmic vein, and marked enhancement of the cavernous sinus on the postcontrast CT scan.