No shinkei geka. Neurological surgery
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Case Reports
[Bilateral carotid stenting for bilateral carotid artery stenosis improved vascular dementia].
We report a case of bilateral internal carotid artery (ICA) stenosis treated with stenting. A 78-year-old man suffered from vascular dementia and left hemiparesis, and, by magnetic resonance angiogram (MRA), was diagnosed as having bilateral ICA stenosis. Cerebral angiogram showed severe, bilateral ICA stenosis (right; 88%, left; 93%) and xenon single photon emission tomography (SPECT) showed severely decreased cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). ⋯ Both CBF and CVR were improved bilaterally after the operation. The patient was discharged without neurological deficits. Carotid stenting may be an alternative treatment for severe ischemia caused by severe, bilateral ICA stenosis.
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The natural history of asymptomatic unruptured aneurysms is not clear. We conducted a follow up study of 100 patients (since 1993) with 122 asymptomatic unruptured aneurysms that had not been operated on. We report five patients with previously documented asymptomatic unruptured aneurysms smaller than 10 mm in diameter that subsequently ruptured. ⋯ In our series, 2 of the 5 cases showed enlargement and the development of an aneurysmal bleb in the follow up MRA and 3D-CTA. The present study demonstrates that five asymptomatic unruptured aneurysms less than 10 mm in diameter subsequently ruptured. We ought to seriously consider the assertion published in the New England Journal of Medicine (Dec. 10, 1998), that unruptured aneurysms less than 10 mm in diameter have a very low probability of subsequent rupture.
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Review Case Reports
[Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report].
We report a case of a patient with a prolactin (PRL) producing ectopic pituitary adenoma presenting a unilateral exophthalmos. ⋯ As far as we are aware, this is the first case report of an ectopic pituitary adenoma causing unilateral exophthalmos. Although it is extremely rare, pituitary adenomas should be kept in mind in a differential diagnosis of exophthalmos.
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The authors report a rare case of intracranial glass injury due to a temporal head injury. This 72-year-old man slipped on a bathroom floor, impacting a glass door with his head and right shoulder. His right temporal scalp and right shoulder were cut by the broken glass. ⋯ According to the literature, most of the intracranial foreign bodies occur around the orbital, the frontal sinus, and the nasal areas. To our knowledge, this is the first report of an intracranial glass penetrating injury to the temporal lobe. Since the clinical manifestations occasionally do not correspond to the appearance of the laceration after glass penetrating injuries, serious caution concerning patients with intracranial glass penetrating injuries is important.
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Case Reports
[Middle meningeal artery embolization for refractory chronic subdural hematoma: 3 case reports].
The authors present three cases of refractory chronic subdural hematoma (CSDH) treated by embolization of the middle meningeal artery (MMA) after several unsuccessful drainage procedures. The patients were initially treated by the usual method of burr hole and irrigation of the hematoma. After recurrence, several percutaneous puncture and drainage procedures were unable to prevent re-collection of the hematoma. ⋯ No enlargement of the hematoma was seen after embolization and, gradually, complete resolution of the hematoma was obtained. The outcome of the patients was excellent in all three cases. This new therapeutic approach to recurrent CSDH is discussed.