No shinkei geka. Neurological surgery
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Comparative Study
[Effects of traumatic subarachnoid hemorrhage on pathological properties in diffuse brain injury: a comparison with aneurysmal subarachnoid hemorrhage].
As a result of recent advances in continuous monitoring equipment, it has been reported that vasospasm (VS) and delayed ischemic neurological deficit (DIND) occur as frequently in traumatic subarachnoid hemorrhage (TSAH) as in subarachnoid hemorrhage due to ruptured intracranial aneurysm (ASAH), and these VS and DIND have been reported to affect the outcome of TSAH adversely in many cases. When we compared TSAH secondary to diffuse brain injury (DBI) with ASAH, however, these two conditions were evidently different from each other in nature. Then we compared laboratory data, clinical course, and outcomes of TSAH associated with DBI with those of ASAH, to determine whether TSAH results in poor outcomes of DBI. ⋯ The outcome of TSAH was, however, significantly poorer than that of ASAH. When SAH was traumatic, it disappeared by the time VS developed and, in addition, changes in CBF and the form and incidence rate of LDAs were different from those in ASAH. We concluded that, although TSAH is an adverse prognostic factor for DBI, it does not contribute to poor outcomes of DBI by giving rise to DIND caused by VS.
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The authors present a case of atlanto-axial rotatory fixation associated with Jefferson's fracture. A 52-year-old man was admitted to our hospital complaining of severe neck pain and torticollis after a traffic accident. Cervical x-ray films showed fracture of the atlas. ⋯ Although he was maintained in a halo device for 4 months, rotary fixation recurred. He underwent posterior fusion between the atlas and axis. We review the literature and discuss the diagnostic problems and methods of treatment for atlanto-axial rotatory fixation.
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Comparative Study
[Acute epidural hematoma of posterior fossa: comparative analysis between 20 cases in adults and 10 cases in children].
A comparative study of the clinical features was made among 30 patients, 10 children (less than 14) and 20 adults (older than 15) with traumatic acute epidural hematoma of the posterior fossa (PFEDH). The characteristic findings in both groups were as follows: 1) PFEDH accounted for 15% of 200 epidural hematoma cases. Incidence of PFEDH was 23.3% (10/43) in children and 12.7% (20/157) in adults. ⋯ Thus, intracranial complications associated with PFEDH occurred in a significantly higher number in adults than in children. 5) 20 cases (4 children, 16 adults) of 30 underwent surgery, and 10 cases (6 adults, 4 children) were given conservative treatment. Results (GOS); GR was observed in 22 cases (in all 10 children and in 12 adults), and MD in 8 cases. There were no SD, VS or cases ending in death.
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We report a case of intraorbital conjunctival cyst following a penetrating orbitocranial injury. The patient was a 28-year-old male who was hospitalized with exophthalmos, retrobulbar pain and upper gaze disturbance of his left eye. When he was 4 years old, a thin iron rod had penetrated intracranially through the inner angle of his left orbit. ⋯ Orbital conjunctival cysts have been reported to comprise about 10% of orbital epidermoid and dermoid cysts. Of these cysts, traumatic conjunctival cysts are rare, and only a few cases have been described. The etiology and therapy of orbital conjunctival cysts are discussed.
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Case Reports
[Bilateral chronic subdural hematomas presented with subarachnoid hemorrhage: report of two cases].
Computed tomography (CT) findings of chronic subdural hematomas are usually diagnostic, unless hematomas are isodense and bilateral. The authors report two cases of bilateral chronic subdural hematomas, in which CT scans on admission were both misdiagnosed as delayed subarachnoid hemorrhage (SAH). The first case was a 43-year-old woman who suffered from a sudden onset of headache and nausea. ⋯ In both cases, a retrospective study of the angiograms revealed the evidence of bilateral avascular areas over the convexities in the venous phase. The reason why these subdural hematomas were missed at the time of angiography was due to too much attention being paid to the arterial phase in an effort aimed only at identifying cerebral aneurysms. There are no reports of chronic subdural hematoma which demonstrated sudden onset of headache associated with xanthochromic CSF.