No shinkei geka. Neurological surgery
-
Review Case Reports
[A case of acute subdural hematoma due to dural metastasis from malignant pleural mesothelioma].
A rare case of acute subdural hematoma due to dural metastasis from malignant pleural mesothelioma is reported. A 65-year-old man was brought to a nearby hospital complaining of lumbago. He suddenly complained of headache on the third hospital day and fell into a deep coma within a short while. ⋯ Histopathology showed that many tumor cell nests were found only within the dilated veins of the dura. There, acute subdural hematoma was assumed to have developed suddenly and there was massive bleeding from the capillaries of the inner vascular layer of the dura. The relevant literature about intracranial metastasis of malignant pleural mesothelioma was reviewed, and the mechanism of subdural hematoma due to dural metastasis from malignant tumor was discussed.
-
Two cases of traumatic intracerebral pneumocephalus, a rare complication of head trauma, are presented. Case 1: A 14-year-old boy had a strong concussion in his forehead due to a motorbike accident. Slightly obtunded on admission showing GCS 10, he became conscious in several days. ⋯ These two patients showed a small amount of cerebrospinal fluid (CSF) rhinorrhea before the operation. Following the surgical repair, no recurrence of pneumocephalus and CSF rhinorrhea has been seen in either case. Intracerebral pneumocephalus secondary to closed head trauma was thought to have been due to herniation of contused brain into a craniodural defect.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Two cases of ossified epidural hematomas were reported. Patients were nine and twelve year-old boys. Initially they were both followed up conservatively after injuries. ⋯ Both underwent craniotomy and histological ossification was found in the capsules of the hematomas. Epidural hematomas in children are known to ossify, and this condition may prevent natural absorption of epidural hematomas. Therefore, careful follow up of hematomas seems to be mandatory on conservative therapy of epidural hematomas in children.
-
To study the effect of nicardipine on the blood flow velocity of the internal carotid artery, on local cerebral blood flow (LCBF), and on carbon dioxide reactivity, an initial dose of 0.5 microgram/kg/min of nicardipine was administered in patients for scheduled craniotomy for cerebral aneurysm clipping under isoflurane anesthesia. This agent was administered until the mean arterial blood pressure decreased and could be maintained at about 75% of the initial value until the completion of aneurysm clipping. The measurements of hemodynamics and LCBF were performed after the exposure of the internal carotid artery (T0), and 10 min, 30 min after the starting of nicardipine (n = 13), (T1, T2 respectively), before aneurysm clipping (T3) and 30 min after its discontinuation (T4). ⋯ Mean arterial blood pressure decreased after nicardipine infusion. Local cerebral blood flow did not change during nicardipine infusion, but blood velocity increased significantly after nicardipine infusion from 43 +/-12 to 55 +/- 12 cm/sec (p = 0.024). Carbon dioxide reactivity did not change after nicardipine infusion but had a close correlation with LCBF before (rs = 0.64, p < 0.05), during (rs = 0.84, p < 0.01) and after hypotension (rs = 0.65, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
-
A case of bilateral fenestration of the vertebral artery at the level of the atlas in a patient who had occipital neuralgia and cervical myelopathy is presented. MRI and vertebral angiogram demonstrated the fenestrated vertebral artery compressing the upper cervical cord. Surgical decompression for the C-1 and C-2 sensory roots and the upper cervical cord was performed. ⋯ However, considering the pathway of the fenestrated vertebral artery, it is quite possible that the fenestrated vertebral artery might compress the neural structures, resulting in some clinical problems. Although occipital neuralgia may result from a variety of causes, this case was caused by the fenestrated vertebral artery compressing the C-1 and C-2 sensory roots. The authors wish to emphasize that microsurgical vascular decompression may be the only effective treatment in such cases as well as in facial spasm and trigeminal neuralgia.