World Neurosurg
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Observational Study
Transorbital ultra-sonographic measurement of optic nerve sheath diameter for intracranial midline shift in patients with head trauma.
Measurement of the optic nerve sheath diameter (ONSD) by using sonography is a straightforward, noninvasive technique to detect an increased intracranial pressure, which can even be conducted at the bedside. However, the correlation between ONSD and intracranial midline shift has not been studied. ⋯ Despite small numbers and selection bias, this study suggests that bedside ultrasound may be useful in the diagnosis of midline intracranial shift by measurement of ONSD.
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The lateral mesencephalic vein (LMV) represents an important connection between the infratentorial and supratentorial compartments. It joins the basal vein of Rosenthal and the petrosal system. In our experience with management of tentorial dural arteriovenous fistulas (DAVFs) we have often noted involvement of the lateral mesencephalic vein (LMV) in the venous drainage of these fistulas. ⋯ The LMV is a constant venous anastomosis between the supratentorial and infratentorial compartments. Detailed knowledge of the most common variations of the LMV surgical and radiological anatomy has important clinical implications. The vein is an important anatomic landmark during surgery of midbrain lesions. It is often involved in the tentorial DAVF drainage, and it is critical in understanding some "unexpected" venous complications during surgery for posterior fossa lesions.
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Chiari I malformation (CM-I) is defined by cerebellar tonsillar herniation through the foramen magnum. Patients typically present with chronic complaints, including headache, dizziness, and numbness, although there are few reports in the literature of pediatric patients presenting acutely with neurological deficit caused by CM-I. We report a child who presented acutely with hemiparesis and magnetic resonance imaging findings consistent with CM-I and spinal cord edema. ⋯ This case highlights an unusual presentation of CM-I with neurological deficit related to spinal cord edema, possibly precipitated by the "water-hammer" effect of this patient's coughing fits. Providers should be aware of the acute presentations of CM-I.
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Patients presenting with poor-grade aneurysmal subarachnoid hemorrhage (SAH) have commonly been reported to have a poor prognosis; however, several reports suggest a favorable outcome in a subgroup of patients. We analyzed our database to identify factors determining functional outcome after poor-grade SAH. ⋯ A favorable outcome was achieved in 24% of severely ill patients with poor-grade SAH. Therefore, treatment of patients with poor-grade SAH should not be omitted. Careful individualized decision making is necessary for each patient.