No shinkei geka. Neurological surgery
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The effects of spinal cord stimulation (SCS) on the vegetative syndrome were studied in six patients. Factors affecting the results were mentioned with a view to establishing indications as to whether or not the SCS should be performed. "Persistent vegetative states" were thought to be identical with Ohta's "vegetative syndrome" which consists of eleven signs. Six of these signs--polyphasic cycle of waking and sleeping, urinary incontinence, being bedridden and being tube fed etc--were important criteria of the vegetative syndrome. ⋯ The other 4 patients showed little or no improvement. They all had diffuse cerebral atrophy or low density areas on CT and almost normal ABR. One of these patients, who suffered a cerebral contusion leading to transtentorial herniation with unilateral cerebral contusion on CT and unilateral disappearance of the fifth peak on ABR, showed no recovery from the vegetative syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
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We report a case of cerebral air embolism that occurred after chest trauma. The diagnosis was confirmed by CT and skull roentgenogram which demonstrated air bubbles in intracranial arteries. It is well recognized that cerebral air embolism is caused by various diagnostic and therapeutic procedures, and trauma. ⋯ In those cases CT scans were performed soon after the onset, twelve hours at the latest. Abnormal findings were detected in either bilateral hemispheres or in the right hemisphere only. Almost all lesions are located in the territory of the cortical branches, but in one case bilateral, thalamic infarction was noted, which is thought to be caused by embolism of thalamoperforators.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
[Intracerebral hemorrhage immediately following the operation of chronic subdural hematoma].
Complications following the operations for chronic subdural hematoma include recurrence of the hematoma, infection, seizure, and failure of the brain to expand due to cerebro-cranial disproportion. This report presents cases with intracerebral hemorrhage which is relatively rare complication. In case 1, a 35-year-old man developed status epilepticus immediately after the operation for chronic subdural hematoma. ⋯ In case 2, a 78-year-old woman whose CT scan had shown bilateral CSH and brain herniation, demonstrated intracerebral hemorrhage in the medial occipital lobe when examined post-operatively by CT scan. It is possible that the mechanisms of intracerebral bleeding following the operation for CSH are 1) diapedesis through increased permeability of parenchymal blood vessels due to the sudden increase in cerebral blood flow following the existence of longstanding extracerebral mass, and 2) hemorrhagic infarction due to recanalization of posterior cerebral artery compressed by the herniating medial temporal lobe. We should therefore avoid sudden decompression in the management of the cases which showed pre-operative consciousness disturbance or abnormal low or high density on CT scan, because these findings may be preoperative indications of brain fragility.
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Case Reports
[Ventriculoperitoneal shunt for hydrocephalus secondary to tuberculous meningitis: a case report].
A case of hydrocephalus secondary to tuberculous meningitis is reported. A 6-month-old baby was admitted to our hospital with a 10-day history of high fever. Neurological examination revealed no abnormal findings other than neck stiffness. ⋯ The patient was discharged without any neurological deficits one month after emplacement of the ventriculoperitoneal shunt. The antituberculous therapy has been continued, and there is no sign of infection propagated through the shunt 13 months following discharge from the hospital. The result suggests that a cerebrospinal fluid shunt can be placed for hydrocephalus even in the active stage of tuberculous meningitis under antituberculous therapy.
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A rare case of thrombosed AVM presenting temporal lobe epilepsy is reported. A 27-year old man was admitted to our hospital because of a 7-year history of temporal lobe epilepsy. He had also suffered from generalized seizure since he was 6 years old. ⋯ Conventional EEG showed focal spike discharges from the left fronto-central lead, and subdural EEG recordings showed intermittent spike discharges from the medial side of the left temporal lobe. A 5 cm temporal lobectomy was performed and a thick fibrous mass adjacent to the hippocampoamygdala complex was removed. Histopathological examination demonstrated a thrombosed AVM surrounded by gliotic neural tissue.