Surg Neurol
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Transsphenoidal meningoencephalocele is a rare congenital anomaly, reported only in 14 adult patients. It may be subdivided into intrasphenoidal, extending into the sphenoid sinus, and true transsphenoidal, traversing the floor of the sinus and protruding into the nasal cavity or nasopharynx. ⋯ Adult patients with intrasphenoidal meningoencephalocele often present with rhinorrhea and should be considered for transsphenoidal repair, whereas patients with true transsphenoidal meningoencephalocele should not undergo surgery, in view of the complex anatomy and the slow progression of symptoms.
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Poor results after lumbar spinal surgery have been recorded in compensation cases throughout the world medical literature. It seems that psychosocial factors play an important role in the delay in returning to gainful employment but that chronic postoperative lumbar and lower extremity pain is blamed for this state of affairs. The present series of late outcomes is based on actual physical examination by independent neurosurgical and orthopedic experts appointed by the Workman's Compensation Board, providing an impartial opinion as to the discrepancy between objective findings and failure to reintegrate into the work force. ⋯ Although motivational (that is, psychosocial) factors undoubtedly play a role in failure to return to work, the role of chronic pain cannot be ignored. Increased attention must be devoted to ascertaining the etiology of this pain and ways to prevent it.
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Temporary acute agitated delirium is a frequent complication after surgery for chronic subdural hematoma (CSH) in elderly patients. To clarify the pathogenic mechanism underlying this complication, we measured cerebral blood flow before and after surgery in elderly patients with CSHs. ⋯ In elderly patients with CSH, intense and prolonged hyperperfusion after surgery induces temporary acute agitated delirium. This postoperative hyperperfusion syndrome is exacerbated by hypertension.
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Review Case Reports
Distal superior cerebellar artery aneurysm in a patient with systemic lupus erythematosus: case report.
The authors describe a case of ruptured distal superior cerebellar artery (SCA) aneurysm in a patient with systemic lupus erythematosus (SLE). ⋯ Aneurysms arising from peripheral segments of cerebellar arteries are rare, and delayed surgical clipping has been recommended for these lesions. In addition, the outcomes of SLE patients with ruptured cerebral aneurysms are reported to be very poor due to the systemic complications of SLE. However, our patient had a favorable outcome with early endovascular treatment for the ruptured aneurysm and with appropriate medical treatment for the accompanying SLE. Therefore, early endovascular coil embolization is worthy of consideration among the options for therapeutic intervention in these conditions.
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Review Case Reports
Intradiploic hematoma after skull fracture: case report and literature review.
Intradiploic hematoma of the skull was first reported in 1934. The pathogenesis of this lesion is unclear. It is a very rare benign reactive process occurring after minor head trauma, with only seven cases reported in the literature to date. ⋯ The pathology of chronic diploic hematoma mimics aneurysmal bone cyst, giant cell tumor, giant cell reparative granuloma, fibrous dysplasia, eosinophilic granuloma, intradiploic epidermoid and dermoid cyst, cavernous hemangioma, circumscribed osteomyelitis, and tuberculous granuloma. Chronic diploic hematoma is a lesion that must be differentiated from various skull lesions both radiologically and histologically as it is amenable to treatment with a complete cure once excised.