No shinkei geka. Neurological surgery
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A 5-year-old boy had an intracerebral hematoma evacuated from the left parieto-occipital region at a local hospital. There was a difficulty in hemostasis during the operation. Postoperatively his neurological state gradually deteriorated. ⋯ Postoperative course was also uneventful although the plasma level of factor XIII did not go up higher than 26% in spite of its daily administration. Although factor XIII administration was terminated one month after cranioplasty, the patient showed good recovery and the level of factor XIII spontaneously normalized in 6 months. The cause of the extremely low level of factor XIII in this case is not known, but it could be ascribed to massive hemorrhage.
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Review Case Reports
[Lymphoplasmacyte-rich meningioma: a report of three cases and a review of the literature].
We report three patients (a 36-year-old man, a 41-year-old woman, and a 22-year-old man) with lymphoplasmacyte-rich meningioma who manifested characteristics on radiological and blood examinations. Two were hospitalized with gradual deterioration of hemiparesis and one with general convulsive seizure. Radiological examination revealed typical meningiomas of convexity in two and that of falx in one. ⋯ Abnormal findings in laboratory examination improved quickly, whereas perifocal edema remained for six months after tumor removal. The tumors were histologically confirmed to be meningioma with massive infiltrates of plasma cells and lymphocytes. Seventeen cases of lymphoplasmacyte-rich meningioma that have been reported to date including our three cases were reviewed.
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Case Reports
[Combined chronic subdural and acute epidural hematoma secondary to metastatic hepatocellular cancer: case report].
We report a case of combined chronic subdural and acute epidural hematoma caused by metastatic hepatocellular cancer of the dura mater. A 44-year-old woman, who had been under treatment for hepatic cancer for one year, presented with right hemiparesis. MRI revealed a chronic subdural hematoma on the left fronto-parietal region with subgaleal and epidural metastasis. ⋯ A huge epidural hematoma in the left parietal region was disclosed with CT scan. She died of hepatic failure despite the evacuation of the hematoma. This is the first reported case with a combined subdural and epidural hematoma secondary to metastatic brain tumor of the dura mater.
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Review Case Reports
[Multiple aneurysms of the PICA communicating artery: a case report].
A case with unusual type of aneurysms in the distal posterior inferior cerebellar artery (PICA) is reported here. Though only two cases with a single aneurysm of the PICA communicating artery have been reported previously, the present case is the first one with multiple aneurysms in the PICA communicating artery. A 61-year-old woman with a sudden onset of severe headache, vomiting and unconsciousness was transferred to our hospital. ⋯ Two small aneurysms were seen at the tips of hairpin curves of an anastomotic vessel, "the PICA communicating artery". Suboccipital craniotomy was performed, and the ruptured aneurysm was clipped and the unruptured one was wrapped with cotton-sheet. After the operation, her clinical recovery went well and she was discharged on foot.