World Neurosurg
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Diabetes insipidus (DI) is a well-known complication of transsphenoidal pituitary adenoma surgery. However, the risk factors for DI after transcranial surgery have not been clarified. In this study, the clinical parameters for predicting DI after transcranial surgery were investigated. ⋯ The degree of deformation of the third ventricle and hypothalamus assessed by preoperative magnetic resonance imaging may help to predict postoperative DI. Postoperative hemorrhage might increase the incidence of postoperative DI, whether it is immediate postoperative DI or permanent DI.
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For the treatment and prevention of delayed cerebral ischemia after subarachnoid hemorrhage, the vasodilating agent nimodipine (NDP) is widely employed. This study investigates the effect of NDP on cerebrovascular autoregulation, assessed by pressure reactivity index (PRx), and brain tissue oxygenation (pbrO2) when given continuously intravenously as an intra-arterial bolus or during continuous intra-arterial therapy. ⋯ The pharmacologically induced alteration of the cerebrovascular autoregulation by NDP correlates with changes of pbrO2 and indicates a beneficial effect on cerebral blood flow if CPP is maintained. This effect is limited to a few hours after bolus treatment and milder for intravenous compared with intra-arterial application.
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Atlantoaxial rotatory subluxation (AARS) is a rare type of traumatic cervical spine injury in adults, commonly manifesting with painful torticollis and suboccipital headache. Early diagnosis is mandatory to avoid catastrophic consequences. We report a rare case of a patient with AARS who presented with nystagmus due to rotational vertebral artery occlusion. ⋯ Careful neurologic examination is of paramount importance in diagnosis and management of cervical spine injuries. Nystagmus, as a well-known manifestation of rotational vertebral artery syndrome, can be the presenting symptom of AARS.