Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Apr 2003
Case ReportsAcute subdural hematoma after lumboperitoneal shunt placement in patients with normal pressure hydrocephalus.
Acute subdural hematoma (SDH) is a rare but disastrous complication after lumboperitoneal shunt placement. Four of 206 adult patients with normal pressure hydrocephalus (1.9%) who underwent lumboperitoneal shunt placement suffered acute SDH following head trauma. The interval between shunt placement and acute SDH was one month to 7 years. ⋯ The other two patients had a small SDH. None of the four patients had cerebral contusions. Patients with lumboperitoneal shunts, especially those not capable of independent daily activities, are at risk for acute SDH after even minor head trauma.
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Neurol. Med. Chir. (Tokyo) · Apr 2003
Review Case ReportsAcute surgery for ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery.
A 65-year-old woman presented with a ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery (MCA) manifesting as disturbance of consciousness and motor aphasia. Computed tomography revealed subarachnoid hemorrhage. Emergent angiography demonstrated segmental aneurysmal dilatation of the M3 portion of the left MCA. ⋯ Distal dissecting aneurysm may occur in the absence of infectious disease. Such ruptured distal dissecting aneurysm should preferably be treated surgically in the acute stage, immediately after detection of the aneurysm. The parent artery of the proximal and distal sides of the aneurysm should be trapped because of the probable weakness of the arterial wall, and bypass surgery performed to preserve the distal circulation.