No shinkei geka. Neurological surgery
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Case Reports
[Ruptured vertebral artery dissecting aneurysm presented with vertebral artery occlusion: a case report].
We report a rare case of a ruptured vertebral artery dissecting aneurysm (VADA) with affected vertebral artery (VA) occlusion. A 66-year-old hypertensive man presented with subarachnoid hemorrhage. No cerebeller sign or cranial nerve palsy was found on admission. ⋯ On the three days after onset, the right VA was recanalized and visualized as a posterior inferior cerebellar artery (PICA)-involved VADA. Endovascular internal trapping of the right VA including PICA origin was performed. In conclusion, it is essential that patients of VA occlusion associated with subarachnoid hemorrhage should be carefully diagnosed considering the possibility of VADA.
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Review Case Reports
[Remote cerebellar hemorrhage after cervical spinal surgery: two case reports and literature review].
Remote cerebellar hemorrhage (RCH) following spinal surgery is extremely rare. We present two cases of RCH following cervical spinal surgery. The first case is a 71-year-old female. ⋯ Rapid loss of a great amount of cerebrospinal fluid might be the causative factor of RCH. RCH might occur after any type of spinal surgery with dural tear or intradural manipulation. Early diagnosis is particularly important for the treatment of RCH following spinal surgery and spinal drainage might be useful to manage cerebrospinal fluid leakage.
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The aim of this study was to examine the usefulness of an uncalibrated radial arterial pressure-based cardiac output monitor (FloTrac, Edwards Lifesciences, Irvine CA, USA) for dobutamine-induced hyperdynamic therapy in patients with cerebral vasospasm following subarachnoid hemorrhage (SAH). In 18 SAH patients diagnosed with vasospasm, the cardiac index (CI) was analyzed continuously via the radial FloTrac system. The time-course changes in hemodynamic variables following dobutamine infusion at each dose increment (3-24 microg/kg/min) for reversing vasospasm-related delayed ischemic neurological deficit (DIND) and infarction were measured. ⋯ However at high-dose (20-24 microg/kg/min), dobutamine depressed stroke volume which was compensated for by increasing the pulse rate, thus raising CI only slightly from the baseline values. These data suggest that step-up increase of dobutamine dosage is not always effective in raising CI in patients suffering from post-SAH vasospasm, but rather may cause some adverse effects associated with increased myocardial oxygen consumption as evidenced by high-dose infusion. The less-invasive FloTrac system might be useful as a device for tracking trends in hemodynamic outcomes of hyperdynamic therapy.