No shinkei geka. Neurological surgery
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Postoperative epidural hematomas developed far from the operative field are generally recognized as a complication of ventriculo-peritoneal shunt, ventricular drainage or suboccipital craniotomy. It is very rare but may occur after supratentorial craniotomy on the contralateral side. Five such cases are presented with a review of the relevant literature. ⋯ In hydrocephalus, these massive epidural hematomas are probably caused by dura-skull detachment when the brain volume is strikingly reduced by a decompressive procedure. On rare occasions, pins of head rest may detach the dura and cause epidural hematomas. When sudden brain swelling during craniotomy is encountered, attention should be directed not only to intracerebral hemorrhage but also epidural hematoma developed on the contralateral side.
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Findings of computerized tomography (CT) in 183 cases of head injury in children were investigated with special reference to CT findings of mild head injury. As was expected, CT findings of mild head injury fell within the normal range, in almost all cases. However, abnormal findings were noticed in 4 out of 34 cases (12%) in acute stage and 7 out of 76 cases (9%) in chronic stage. ⋯ These findings were invariably converted to cerebral atrophy from 10 days to 2 months after the impacts. In the cases with intracranial hematoma revealed by CT, only 32% of them showed clinical signs of Araki's type IV in their acute stage and 63% of them showed no neurological defects, that is Araki's type I & II. A case of extreme diffuse cerebral atrophy which followed acute subdural hematoma caused by tear of bridging veins without cortical contusion was presented.
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Case Reports
[Neurogenic pulmonary edema following severe head injury--case report (author's transl)].
A case of severe head injury associated with fulminant pulmonary edema considered as neurogenic which developed within short time after the injury was presented. A five-year-old boy who had no previous history of cardiopulmonary disease was struck on his right frontal region by car accident at 15.30 PM on July 5 of 1979. Immediately after the impact he lost his consciousness and subsequently transferred to a local hospital where bilateral dilated pupil and flaccid paralysis of the limbs were noted. ⋯ From these clinical findings the pulmonary edema was concluded as neurogenic. Direct or indirect injury to the hypothalamic efferent pathway at the level of lower brain stem seemed to be important as the cause of neurogenic pulmonary edema in this case. The possible pathophysiology of neurogenic pulmonary edema associated with brain stem injury and intracranial hypertension was discussed with other related literature.