No shinkei geka. Neurological surgery
-
Case Reports
[A case of subarachnoid hemorrhage with acute subdural hematoma due to head injury: a case report].
Acute intracranial hemorrhages can be caused by cerebrovascular disease or head injury. Diagnostic imaging is in both cases sometimes similar, so it is difficult to make an exact diagnosis. We report a case of acute subdural hematoma due to head injury after loss of consciousness due to an aneurysmal rupture. ⋯ Postoperative CT scan showed contusional hematoma at the left frontal lobe and plain skull X-ray films demonstrated a diastatic fracture of the right lambdoid suture. Acute subdural hematoma due to the rupture of a cerebral aneurysm is sometimes recognized, but the first CT findings are similar to those observed after head injury. When the clinical course of onset is unclear, we must keep in mind that the cause of acute subdural hematoma may be head injury, even if angiography demonstrates abnormal vessels.
-
Fibrin glue, a biologic adhesive, is made with highly concentrated human fibrinogen and clotting factors. It has become used frequently in neurosurgical procedures, in particular in the closure of the dura mata to prevent cerebrospinal fluid leakage. This report evaluates sealing effects of the fibrin glue on cerebrospinal fluid leakage through the dura. (1) Three manipulations for application of fibrin glue were used; i.e., layer, mixture and spray methods. ⋯ The fibrin plug tolerated water pressure over 200cmH2O, in every size of pore. In conclusion, the optimal method for using fibrin glue on the surface of the dura was a spray method. Fibrin plate/clot made by the spray method sealed the dural tear or pore so well that it sustained a water pressure of over 80cmH2O, which is far higher than normal pressure of the intracranial cerebrospinal fluid.
-
Case Reports
[Cervical spinal epidural abscess caused by methicillin-resistant Staphylococcus aureus (MRSA)].
Epidural abscess is an uncommon infectious disease. The cervical spine is the least frequent site of spinal epidural abscess. It has been reported that early diagnosis and surgical treatment prevent neurological deficit, but it is difficult to diagnose this disease clinically. ⋯ The pathological diagnosis was non-specific abscess in the subacute stage. MRSA was identified by the intraoperative pus culture. After the surgery, antibiotics were administered.(ABSTRACT TRUNCATED AT 250 WORDS)
-
The necessity of cerebral angiography was assessed in patients with thunderclap headache in whom subarachnoid hemorrhage had been ruled out on CT findings and the color of cerebrospinal fluid (CSF). ⋯ Even when CT and CSF studies reveal no abnormalities in the early stage after the onset of thunderclap headache, subarachnoid hemorrhage can not be ruled out. Therefore, cerebral angiography is recommended in patients with thunderclap headache.
-
Case Reports
[Completely thrombosed large aneurysm of the distal middle cerebral artery: a case report].
A 19 year old male was admitted for evaluation after a seizure. Physical and neurological examination was normal. CT demonstrated an enlarged, high density mass in the right parietal lobe. ⋯ A diagnosis of cavernous angioma with primary bleeding in the subcortical region of the right parietal lobe was made after radiological examination. Histological examination showed a completely thrombosed aneurysm. The mechanism of the complete thrombosis and the growth of this large aneurysm and the shortcomings of radiological examination are discussed.