No shinkei geka. Neurological surgery
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The coagulation and fibrinolytic function of 100 cases (male 75, female 25) of trauma limited to the head was evaluated in acute phase. The coagulation and fibrinolytic function was evaluated by 6 parameters, consisting of platelet counts, PT, APTT, fibrinogen, serum FDP, and protamine sulfate test. Head injury was categorized into 5 groups according to CT findings: subdural hematoma (SDH: 13 cases), cerebral contusion (CC: 46 cases), epidural hematoma (EDH: 21 cases), skull fracture only (Fr: 14 cases), and cerebral concussion (Co: 6 cases). ⋯ In 10 survival cases with DIC, the patients recovered from DIC. APTT was the most important to estimate the mortality of head injury. Thus, the evaluation of coagulation and fibrinolytic function in head injury in acute phase is not only important to know the occurrence of DIC, but also useful to predict the severity and prognosis of head injury.
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The continuous intracranial pressure monitoring has been widely applied in intensive or critical care, but there are various kinds of methods for its monitoring at present. One hundred and forty-one cases mostly with severe head injury were subject to the intracranial pressure recordings in the critical care ward in Department of Emergency Medicine, University of Tokyo Hospital, from October, 1980 through May, 1983, and in Neurosurgical Unit, Showa General Hospital, in April and May, 1984. The authors made several methodological trials for the monitorings in them and compared with one another from the aspect of clinical practice. ⋯ The ventricular fluid pressure was monitored in nine cases and was most dependable as well as the subarachnoid pressure. The ventricular cannulation and its maintenance were, however, difficult when the ventricles were compressed or deviated, which were often experienced in acute severe head injury and also in impending brain death just because of the same above mentioned reasons. These demerits were attempted to be conqured with epidural pressure monitorings such as the fiberoptic sensor (Ladd) in 17 cases, the intracranial catheter tip pressure transducer (Gaeltec) in nine cases and the sensor of bioimplantable polymer (Plastimed) in three cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[3 operated cases of congenital deficiency of Factor XIII associated with intracranial hematomas].
Three operated cases of congenital deficiency of factor XIII (fibrin-stabilizing factor) associated with intracranial hematomas were described and the diagnosis, replacement therapy of the factor were discussed. Congenital deficiency of factor XIII is quite rare coagulation disorder and only 100 patients were reported in the literatures in which we could find only one case who had craniotomy for associated intracranial hemorrhage. Case 1: A 41-year-old female with the history of unknown hemorrhagic diathesis complained of headache and right hemiparesis on August 2, 1980. ⋯ He vomited and became stuporous two days after injury, and was transferred to Ryukyu University Hospital. CT can revealed epidural hematoma at the left posterior fossa which extended to the supratentorium. The hematoma was successfully evacuated under infusion of fresh plasma and he showed uneventful recovery without rebleeding by postoperative appropriate replacement therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[Primary intracranial hypotension associated with chronic subdural hematoma--report of 2 cases].
Low spinal fluid pressure syndrome is characterized by orthostatic headache aggravated in upright position. It is classified into two from etiological standpoint i.e. primary and secondary (most often seen after lumbar puncture). On the other hand, low spinal fluid pressure is one of the promoting factors of chronic subdural hematoma. ⋯ Six cases including our two cases of primary intracranial hypotention associated with chronic subdural hematoma have been reported. When changes of characters of headache, especially mental symptoms and disturbances of consciousness occurred in patients with chronic orthostatic headache, association of chronic subdural hematoma should be suspected. In cases with chronic subdural hematoma associated with low spinal fluid pressure syndrome, the reaccumulation of hematoma tends to occur after burr hole opening and irrigation of hematoma.
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An autopsied case of ruptured saccular aneurysm at the junction of posterior inferior cerebellar artery and vertebral artery with which the aneurysm and basilar artery were occluded was reported. A 20-year-old female was admitted to our hospital because of consciousness disturbance and convulsion. CT scan revealed subarachnoid hemorrhage. ⋯ On autopsy, a ruptured saccular aneurysm at the junction of right vertebral and posterior inferior cerebellar arteries, and occlusion with thrombosis of vertebrobasilar artery were found. We discussed how the aneurysm and main arteries were embolized just after the attack of subarachnoid hemorrhage. It is considered that the severe increased intracranial pressure in posterior fossa after subarachnoid hemorrhage and decreased blood pressure caused hemostasis of ruptured aneurysm while spreading the thrombosis in main trunks of vertebrobasilar artery.