No shinkei geka. Neurological surgery
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Case Reports
[A case of systemic lupus erythematosus associated with multiple intracranial aneurysms].
The author reports a case of systemic lupus erythematosus (SLE) with multiple intracranial aneurysms and subarachnoid hemorrhage. A 31-year-old woman was admitted to the department of internal medicine of Shizuoka General Hospital for the treatment of nephrotic syndrome due to systemic lupus erythematosus on 1984. She spend an uneventful life until April, 1985 when she suddenly complained of severe headache and nausea. ⋯ The incidence of subarachnoid hemorrhage in SLE was about two percent in the reported clinical cases. The mechanisms of the subarachnoid hemorrhage and the aneurysmal formation in SLE seemed to be due to angitic changes, which involved the vessels of the whole body systematically. The exact prognosis of SLE with subarachnoid hemorrhage is difficult to say, but it seems to be unfortunately poor due to multiplicity of the lesion and the difficulty of its treatment.
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Chronic cancer pain remains intractable by standard treatment in many patients and interferes with their mobility and independence. Epidural morphine infusion therapy is adopted for providing adequate analgesia in patients who are generally morphine independent and have intractable pain. A totally implantable pump system, Infusaid, has allowed continuous epidural morphine infusion without wound care or frequent percutaneous injections and with a potentially lowered risk of adverse reactions including respiratory suppression. ⋯ Urinary retention developed after the implantation in Case 2, but this improved following the reduction of morphine concentration. No other adverse reaction was observed. In Case 1, the system was effective for 6 months until his death from advancing malignancy, and the patient was able to return to work three months after discharge.(ABSTRACT TRUNCATED AT 250 WORDS)
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The entity of cerebrovascular diseases associated with the use of oral contraceptives is well known but quite rare in Japan in contrast to Western countries. We recently encountered a 38 years old female with cerebral venous thrombosis considered to be caused by oral contraception. This patient took oral contraceptives for 17 days following therapeutic abortion, and was transferred to our hospital because of disturbed consciousness. ⋯ There was no relationship between the dose of estrogen and the onset of cerebrovascular diseases. We believe that the onset of this pathological state is based on gynecological hypercoagulable state, and the oral contraception may play a role of a trigger. Oral contraception should be contraindicated in patients with gynecological hypercoagulable state, hypertension and/or smoking habit.
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Case Reports
[Intracranial hemorrhage associated with pregnancy--4 case reports and a review of the literature].
Four cases of intracranial hemorrhage associated with pregnancy are reported. They were a ruptured anterior communicating aneurysm, a ruptured AVM of cerebellar hemisphere, a lt-thalamic and putaminal hemorrhage and brain stem hemorrhage. As the mode of hemorrhage, one case was a subarachnoid hemorrhage, one case was a subarachnoid hemorrhage combined with a cerebellar hemorrhage and other two cases were intraparenchymal hemorrhage. ⋯ This case fully recovered, but the other three cases of severely impaired consciousness level were dead. Maternal prognosis was related to consciousness level. We mentioned the preferred neurosurgical and obstetrical management to the intracranial hemorrhage associated with pregnancy.
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There were thirty-two autopsied cases of ruptured aneurysms at the junction of the internal carotid and posterior communicating arteries in the file of Montefiore Medical Center from 1948 to 1983 (Table 1). The age range of the patients was 11-83 years. Seven were men and twenty-five were women. ⋯ These aneurysms did not produce a large intracerebral hematoma in the temporal lobe because they ruptured into the temporal horn. Among the post-operative cases (14 cases), only 3 cases had intraventricular hemorrhage. Correlation of these autopsy findings with CT Scans revealed that an intraventricular hematoma in the temporal horn could be interpreted as a large intracerebral hematoma in the temporal lobe.