No shinkei geka. Neurological surgery
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Review Case Reports
[Acute epidural hematoma of the posterior fossa caused by forehead impact].
A rare case of acute epidural hematoma of the posterior fossa caused by forehead impact is reported. This 36-year-old man fell from a truck and hit his face. He was conscious and was brought to our center 30 minutes after the injury. ⋯ Opening of the dura revealed contusion in the occipital lobe. He died on the 17th postoperative day. The possible mechanism in the production of the posterior fossa hematoma in this case is discussed.
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The outcome of a consecutive series of 28 patients with giant aneurysm who had been followed without surgery from one month to 12 years after the diagnosis was made, are presented with reviewing their radiological and clinical features. Symptoms and signs were directly or indirectly attributable to the intracranial mass effect and nine patients (32%) presented subarachnoid hemorrhage. ⋯ The mortality rate in 28 cases for the above follow up period was 46% (13 in 28 cases) and major morbidity occurred in 11% (3 in 28 cases). The above outcome of non operated giant aneurysm cases may justify the surgical management of the giant aneurysm, but as the intracavernous giant aneurysm and thrombosed giant aneurysm are relatively harmless, surgical indication should be carefully decided, especially in the older patients.
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One hundred twenty cases of epidural hematoma without intradural lesion treated between 1975 and 1983 to which CT scan was available, were presented. Mortality rate was 1.7% and morbidity rate was 6.7%. In all cases of epidural hematoma including with and without intradural lesion in the same term (164 cases), mortality and morbidity rate were 7.3 and 10.4% respectively. ⋯ Seven operated cases of epidural hematoma does not show fractures on skull X-P nor initial unconscious. Clinical course of disturbance of consciousness were divided in five types as follows; I. no unconsciousness (22 cases, 18%), II. latent interval (17 cases, 14%), III. primary but no secondary unconsciousness (29 cases, 24%), IV. lucid interval (22 cases, 18%), V. unconscious throughout (16 cases, 14%) and unknown (14 cases, 12%). Cases which Glasgow Coma Scale Score were over 7 showed good recovery in Glasgow Outcome Scale.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[Bacterial intracranial aneurysms associated with infectious endocarditis--report of 3 cases].
Three cases of bacterial intracranial aneurysms associated with infective endocarditis are reported. All of the patients were successfully treated by various combinations of cardiac surgery, neurosurgery and chemotherapy with antibiotics. Case 1: A 39-year-old female was admitted with the complaint of sudden onset of severe headache following persistent fever of several month's duration. ⋯ Repeated angiography after valve replacement showed no further aneurysm. Case 3: A 30-year-old female was admitted on the diagnosis of infective endocarditis and meningitis. CT scan showed abnormal density areas in the right frontal lobe and the left temporal lobe.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[Acute epidural hematoma of the posterior fossa in a case of von Willebrand's disease].
A rare case of acute epidural hematoma of the posterior fossa associated with von Willebrand's disease is reported. A 9-year-old boy fell down and hit his occipital region against a floor. Soon after he came home and slept, but three hours later he began to vomit and became drowsiness. ⋯ By using fresh blood and anti-hemophilic globulin, the bleeding was controlled, and then the operation was achieved. In the postoperative course a new epidural hematoma was found in the left temporal region and a new but asymptomatic retinal hemorrhage was found in his right eye. He was discharged without any neurological deficits 25 days after operation.