Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2008
Delayed hyponatremia following transsphenoidal surgery for pituitary adenoma.
The incidence and risk factors of symptomatic and asymptomatic hyponatremia were investigated in 94 patients who underwent transsphenoidal surgery and serum sodium level monitoring between January 2002 and December 2006. The records were retrospectively reviewed to determine the incidence and risk factors (age and sex, tumor size, endocrinologic findings) of hyponatremia. Postoperatively, the serum sodium levels of the patients were measured at least once within 2 or 3 days. ⋯ Sex, tumor type, and tumor size did not correlate with development of delayed hyponatremia, but patients aged >/=50 years were more likely to develop hyponatremia. Postoperative hyponatremia after transsphenoidal surgery is more common than previously reported and may lead to fatal complications. Therefore, all patients should undergo serum electrolyte level monitoring regularly for at least 1 or 2 weeks after transsphenoidal surgery.
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Neurol. Med. Chir. (Tokyo) · Jan 2008
Case ReportsTransanal prolapse of a ventriculoperitoneal shunt catheter--case report.
A 4-year-old girl presented with asymptomatic bowel perforation and transanal protrusion of a ventriculoperitoneal (VP) shunt catheter. She had undergone repair of myelomeningocele at birth and subsequent VP shunting for congenital hydrocephalus 1 month later. Seven months after VP shunting, she underwent revision of the peritoneal catheter. ⋯ One month after the first operation, intestinal obstruction recurred. Duplication of the terminal ileum was removed to prevent further recurrence of the intestinal obstruction. She underwent ventriculoatrial shunting 2 weeks after the second operation and was discharged without neurological sequelae.
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Neurol. Med. Chir. (Tokyo) · Jan 2008
Case ReportsSubarachnoid hemorrhage caused by rupture of a distal anterior inferior cerebellar artery aneurysm--three case reports.
Three female patients, two under 35 years old, presented with ruptured aneurysms of the distal anterior inferior cerebellar artery (AICA) manifesting as subarachnoid hemorrhage. The first patient had a ruptured saccular aneurysm of the meatal loop of AICA, which was treated by direct neck clipping. ⋯ The mechanism of development of distal AICA aneurysm remains unclear, and some cases indicate a complicated causal relationship between the aneurysms and vascular anomalies. Neurosurgeons need to carefully evaluate the vascular structure around the aneurysms by preoperative angiography in each case, and select the most appropriate strategy.
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Neurol. Med. Chir. (Tokyo) · Jan 2008
Case ReportsAsymptomatic carotid artery dissection caused by blunt trauma.
A 42-year-old man presented with asymptomatic traumatic carotid artery dissection 3 months after sustaining blunt injury with tracheal laceration. Magnetic resonance imaging performed as a screening procedure for asymptomatic carotid artery injury unexpectedly showed dissection of the carotid artery. ⋯ Intravascular ultrasonographic virtual histology defined the precise anatomic structure of the lesion and identified the internal flap as fibrotic. Careful clinical assessment of patients with blunt cervical trauma may permit diagnosis of carotid artery dissection and intervention prior to the development of cerebral ischemic symptoms.