Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Dec 2001
Case ReportsIntracerebral hematoma due to ruptured nontraumatic middle meningeal artery aneurysm--case report.
A 77-year-old woman suddenly lost consciousness and presented with right hemiparesis. Computed tomography showed a large subcortical hematoma in her left frontal lobe associated with subarachnoid hemorrhage. The first impression was hemorrhage due to a ruptured aneurysm of the middle cerebral or the internal carotid artery on the left. ⋯ Emergent surgical intervention confirmed that the hematoma was due to ruptured MMA aneurysm. Nontraumatic MMA aneurysm should be recognized as a possible causative lesion of intracranial hemorrhage despite the extremely low incidence. External carotid angiography should be performed in patients with intracranial hemorrhage in whom no vascular cause can be detected in the internal carotid system.
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Neurol. Med. Chir. (Tokyo) · Dec 2001
Case ReportsRupture of pial arteriovenous malformation associated with early thrombosis of the draining system following stereotactic radiosurgery--case report.
A 50-year-old man was treated with stereotactic gamma knife radiosurgery for an incidentally detected small callosal arteriovenous malformation (AVM) with stenosis of the main draining pathway. He suffered two episodes of intraventricular hemorrhage at 4 and 14 weeks after the radiosurgery. ⋯ Early occlusion of a part of the draining pathway after stereotactic radiosurgery might have induced AVM rupture. An impaired venous outlet, either consisting of one draining vein or with stenosis, present before treatment may be develop thrombosis in response to high-dose irradiation.
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Neurol. Med. Chir. (Tokyo) · Dec 2001
Continuous lumbar drainage for the preoperative management of patients with aneurysmal subarachnoid hemorrhage.
Continuous drainage of lumbar cerebrospinal fluid (CSF) was analyzed for the preoperative management of patients with aneurysmal subarachnoid hemorrhage (SAH) in 50 consecutive cases of surgically treated aneurysmal SAH. Patients were divided into a lumbar drainage group, in whom continuous lumbar CSF drainage was established for preoperative management, and a non-lumbar drainage group. Rebleeding from the aneurysm during the insertion of the lumbar drainage tube and during continuous lumbar drainage, effect on the control of the systolic blood pressure, and effect on the sedation of the patient were examined. ⋯ The rebleeding rate was 11.7% among patients in the non-lumbar drainage group, and 9.09% among patients in the lumbar drainage group. No rebleeding occurred during insertion of the lumbar drainage catheter. Continuous lumbar CSF drainage improved control of systolic pressure and sedation, and is a useful method of preoperative management for patients with aneurysmal SAH.