No shinkei geka. Neurological surgery
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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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Review Case Reports
[Spinal subdural abscess in the cervical region: a case report].
The authors present a patient with a spinal subdural abscess (SSA) in the cervical region and review the relevant literature. A 48-year-old man suffering from intractable high fever and back pain was admitted to our hospital with a diagnosis of meningitis. Despite antibiotic therapy, his condition deteriorated and he developed neurological deficits including left hemiparesis, sensory disturbance and bladder dysfunction. ⋯ The high fever and the back pain subsided immediately and his neurologic condition gradually recovered. The majority of SSA cases involve the thoracic or lumbar region and are rarely found in the cervical region. Because they are associated with a high morbidity, early diagnosis with MRI and urgent surgical interventions including decompressive laminectomy, copious irrigation and drainage followed by appropriate antibiotic therapy are vital.
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Hypoglycemic hemiparesis is rare and can be misdiagnosed as cerebral infarction or transient ischemic attack. Early diagnosis of these two disorders is critical because, if not treated with prompt glucose administration, hypoglycemia may lead to a fatal clinical course. We reported two cases of hypoglycemic hemiparesis with a reversible splenial lesion on MRI. ⋯ We emphasize that checking plasma glucose level is necessary even in cases with hemiparesis. Furthermore, we should be aware that not every hyperintensity lesion on DWI is due to ischemia. There are times when it could be due to hypoglycemia.
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Review Case Reports
[Operative neurosurgery: personal view and historical backgrounds. (5) Meningioma].
The author reports his experience of 410 surgeries of meningiomas on 365 cases during the last 13.5 years, including 51 surgeries on recurrent meningiomas and 8 surgeries with the change of initial approach on the same meningiomas. In the surgical management of meningiomas, following comments are to be emphasized: Appropriate approach and interruption of blood supply are of cardinal importance in surgical management of meningiomas. For the latter purpose, preoperative embolization of feeding arteries is recommended especially in deep seated and large meningiomas more than 3 cm in diameter for carrying out their surgical extirpation fast and radically. ⋯ Difficulties of management of recurrent meningiomas represented by atypical or anaplastic meningiomas WHO grade II or III which can not be managed only by surgical removal is discussed by presenting some example cases. Biological activity of meningiomas in different location can be quite different in multiple recurrent meningiomas. Meningiomas intractable to irradiation and/or chemotherapy are another challenging topic, being beyond the scope of this paper.