No shinkei geka. Neurological surgery
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Therapies and prognoses covering fifteen cases of intracranial hematoma (ICrH) accompanying various types of bleeding tendency (BTD) were studied along with a secondary analysis of the pertinent references. Fifteen cases were divided into two groups, Group A comprising 11 cases of ICrH accompanying primary BTD, and Group B comprising four cases of ICrH accompanying secondary BTD caused by various underlying diseases. Group A included four cases of hemophilia A (Hp-A), two cases of factor XIII deficiency (FXIII-d), three cases of thrombocytopenia (Th-p) and two cases of vitamin K deficiency (VK-d). ⋯ Of these, two cases of the subacute type were able to be saved, while two cases of the acute type followed poor prognostic courses resulting, eventually, in death. The following were found to be responsible fatal factors: 1) causes of BTD which involved both mechanisms of coagulation and hemostasis, 2) non-removal of the underlying disease, in which case supplementary therapy tended to be futile, and 3) the underlying disease per se as a danger to the life of the patient. In conclusion, therapeutic rationale and prognosis in ICrH accompanying primary type of BTD will benefit from the implementation of an adequate augmentative therapy as in the ordinary type of ICrH.(ABSTRACT TRUNCATED AT 400 WORDS)
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Twenty-one patients were submitted to investigate serum complements (CH50, C3, C4) after aneurysmal subarachnoid hemorrhage during a 2 to 3-week period. As for the control, the same examination was carried out in patients with non-subarachnoid hemorrhage such as hypertensive intracerebral hemorrhage. There was no remarkable changes of serum complements in the control patients. ⋯ Ce and C4 level of the patients without symptomatic vasospasm did not change markedly after subarachnoid hemorrhage during the investigation, while they decreased severely in patients with severe vasospasm and major neurological deficit. The patients with mild symptomatic vasospasm without major neurological deficit showed transient decrease of C3 and C4 level in the period of 5 to 10 days after subarachnoid hemorrhage. These data show that sequential determinations of serum complements (C3 and C4) level after subarachnoid hemorrhage is a useful method for the choice of therapy, and for the prognosis of aneurysmal patients after subarachnoid hemorrhage.
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Cerebral arterio-venous difference in oxygen content (c-AVDO2) was calculated in 10 patients suffering from severe head injury with brain contusion as the chief morbid condition [consciousness on admission: under 10 on the Glasgow Coma Scale (GCS); 5 survived and 5 died), in order to re-evaluate the importance of c-AVDO2 as a factor of prognosis evaluation in patients with severe head injury. Indwelling catheters were placed in the femoral artery and jugular vein on the side of the brain contusion in all patients on admission, and blood samples were collected when necessary for calculation of c-AVDO2. Whenever blood samples were collected, GCS-based evaluation of consciousness and determination of auditory brainstem response (ABR) (a V-wave latency period of 5.67 + 0.40 msec. or more was considered to indicate prolongation) were performed. In 6 patients (2 survived and 4 died) who underwent monitoring of epidural pressure (EDP), this was confirmed on blood sample collection. c-AVDO2 was (1) compared between patients who survived and those who died, and studied in terms of (2) consciousness, (3) ABR and (4) EDP. ⋯ (1) The c-AVDO2 in the patients who died was significantly lower than that in the patients who survived. (2) All of the patients who showed a c-AVDO2 of 5 ml% or less at least once dies, suggesting that the critical point of poor absolute prognosis is 5 ml%.
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Review Case Reports
[A case of facial nerve neurinoma originated from the cerebellopontine angle portion].
Facial nerve neurinomas are relatively rare and most of them appear at the vertical portion of the facial nerve. Facial nerve neurinoma originated from the cerebellopontine (c-p) angle portion is less frequently reported. A 51-year-old woman was admitted to our hospital complaining of severe headache and nausea. ⋯ The most frequent symptom of facial nerve neurinoma in the temporal bone is facial nerve palsy, but that of facial nerve neurinoma in the c-p angle cistern is hearing loss, as in an acoustic neurinoma. Preoperative diagnosis of facial neurinoma in the c-p angle cistern using neurological symptoms alone is difficult. Furthermore, differential diagnosis from acoustic neurinoma in the c-p angle cistern using only skull x-rays and CT-scanning is also difficult.(ABSTRACT TRUNCATED AT 250 WORDS)