Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jul 2004
Case ReportsShaken baby syndrome manifesting as chronic subdural hematoma: importance of single photon emission computed tomography for treatment indications--case report.
A boy with shaken baby syndrome first presented at age 3 months with acute subdural hematoma (SDH) and was treated by subdural tapping at a local hospital. Chronic SDH was identified at a rehabilitation center at age 19 months. The chronic SDH appeared to have developed within the preceding 16 months. ⋯ In this case, SPECT measurement of CBF was important in evaluating the pathophysiology of the delays in physical and mental growth. Atrophy of the bilateral hemispheres was the major mechanism in the decreased CBF, not the compression by chronic SDH. MR imaging and SPECT can determine the surgical indications for chronic SDH in patients with cortical atrophy.
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Neurol. Med. Chir. (Tokyo) · Jul 2004
Manual occipital ventricular puncture for cerebrospinal fluid shunt surgery: can aiming be standardized?
The manual occipital ventricular puncture is a standard surgical procedure, but specific targeting has not received sufficient attention despite the experience of anatomical disorientation. This study tried to identify an exact site for the ideal trajectory with this method, especially in the sagittal plane, which avoids contact with the choroid plexus that may be the major source of complications. A total of 44 consecutive adult cases undergoing cerebrospinal fluid shunting through the occipital route for hydrocephalus were retrospectively reviewed for the following: correlations between burr hole site, direction of puncture, and location of the ventricular catheter based on postsurgical radiological studies; calculation of the ideal trajectory to place the catheter tip in the anterior horn of the lateral ventricle without contact with the choroid plexus through the standard occipital burr hole. ⋯ No correlation between the locations of the anatomical points and ventricular size was found. The present study could not define a standard external aim point. Tailored preoperative planning of the trajectory is recommended.
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Neurol. Med. Chir. (Tokyo) · Jul 2004
Review Case ReportsRuptured vertebral artery-posterior inferior cerebellar artery aneurysm associated with pulseless disease--case report.
A 48-year-old woman with a 29-year history of pulseless disease presented with subarachnoid hemorrhage caused by a rare ruptured intracranial aneurysm of the right vertebral-posterior inferior cerebellar artery. The aneurysm was successfully clipped. ⋯ Almost all patients have ischemic disorders of the involved vessels, manifesting as syncope, visual disturbance, or a faint or absent pulse. The mechanisms responsible for pulseless disease and intracranial aneurysms are likely to be different.