No shinkei geka. Neurological surgery
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Case Reports
[Acute epidural hematoma of the posterior fossa in a case of von Willebrand's disease].
A rare case of acute epidural hematoma of the posterior fossa associated with von Willebrand's disease is reported. A 9-year-old boy fell down and hit his occipital region against a floor. Soon after he came home and slept, but three hours later he began to vomit and became drowsiness. ⋯ By using fresh blood and anti-hemophilic globulin, the bleeding was controlled, and then the operation was achieved. In the postoperative course a new epidural hematoma was found in the left temporal region and a new but asymptomatic retinal hemorrhage was found in his right eye. He was discharged without any neurological deficits 25 days after operation.
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A case of growing skull fracture with rapid growth is presented. A 4-month-old male fell and struck the right side of his head. Skull X-ray just after injury showed a right parietotemporal linear skull fracture with the maximum width of 4 mm. ⋯ CT scan revealed subgaleal cerebral herniation surrounded by brain edema. He was operated 11 days after injury. It is thought that the contusional hematoma and following brain edema played an important role in the genesis of rapid growth of the skull fracture.
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The influences of continuous cerebrospinal fluid (CSF) drainage on vasospasm and hydrocephalus were analyzed retrospectively in 150 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms (32 cases of grade 1, 85 cases of grade 2, and 33 cases of grade 3 by the Hunt and Hess classification). One hundred and seven of these cases received CSF drainage (cisternal, ventricular, lumbar, or a combination of these). The volume of CSF drainage within the first week after onset was 975 +/- 513 ml (mean +/- SD). ⋯ Four of 43 cases with no drainage, 26 of 67 cases with a total drainage volume of less than 2000 ml, and 24 of 40 cases with a total drainage volume of more than 2000 ml developed hydrocephalus. There was a statistically significant dose-response (drainage volume-hydrocephalus) relationship (p less than 0.005, Mantel extension method). Vasospasm and hydrocephalus were statistically associated (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
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Prostaglandin (PG) E1 is a potent vasodilator on the peripheral vessels and also has an inhibitory action of platelet aggregation. Thus it is expected that PGE1 may be used for the treatment of cerebral vasospasm due to aneurysmal subarachnoid hemorrhage (SAH). Lipo-PGE1, lipid emulsified PGE1 less destroyed in the lung, has much longer half life time in the circulation than PGE1 which is rapidly inactivated in the lung. ⋯ The appearance and severity of symptomatic vasospasm were less in the Lipo-PGE1 treated group than the control, and the outcome of the Lipo-PGE1 treated patients with or without vasospasm improved significantly at 1 month follow-up examination. The cerebral blood flow (CBF) measurements were performed three times, at first (1st), second to third (2nd) and fourth to sixth (3rd) week after SAH. In the Lipo-PGE1 treated group, the 1st CBF measurement was done before administration of Lipo-PGE1 started and the 2nd examination was performed after the completion of administration.(ABSTRACT TRUNCATED AT 250 WORDS)