Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Comparative StudyComparative analysis of spinal hemangioblastomas in sporadic disease and Von Hippel-Lindau syndrome.
The clinical differences were evaluated in spinal hemangioblastoma between patients with sporadic disease and patients with von Hippel-Lindau (VHL) syndrome. The distribution of hemangioblastomas in the central nervous system was investigated in 56 patients treated between 1988 and 2008 at the University of Tokyo Hospital. The characteristics of spinal hemangioblastomas were compared in 35 patients including 17 with sporadic disease and 18 with VHL syndrome treated between 1988 and 2008 at our hospital and three affiliated institutions. ⋯ Tumor recurrence was correlated with partial removal of lesions (p = 0.05). One third of patients with VHL syndrome developed new lesions every 2 years. The major finding of this study is that the incidence of spinal hemangioblastoma, distributed through all spinal levels, may be as high as 88% in patients with VHL syndrome, which is much greater than previously reported.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Comparative StudyImpact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage.
The present study aimed to evaluate the impact of early surgical evacuation of sylvian hematoma caused by ruptured middle cerebral artery (MCA) aneurysm on clinical outcome after subarachnoid hemorrhage. Hospital records and computed tomography scans for 26 patients with MCA aneurysm who underwent surgical clipping between June 2001 and January 2008 were retrospectively reviewed. All patients presented with sylvian hematoma associated with subarachnoid hemorrhage and received surgery at 7.9 +/- 3.6 (mean +/- standard deviation) hours of ictus. ⋯ Better functional outcomes were obtained in patients with successful evacuation (p < 0.05), as assessed by improvement of hemiparesis on manual muscle testing scale at postoperative 1-month follow up and by the modified Rankin scale at postoperative 3 and 6 months. Clinical outcomes were also better in the achievement group. These results suggest that better clinical course and outcome can be expected in patients who undergo early successful hematoma evacuation with surgical clipping of a ruptured MCA aneurysm.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsMassive epistaxis from a thrombosed intracavernous internal carotid artery aneurysm 2 years after the initial diagnosis--case report.
A 77-year-old woman presented with a rare case of nontraumatic intracavernous internal carotid artery (ICA) aneurysm causing epistaxis. The thrombosed aneurysm was discovered incidentally, and was not treated. However, she suffered massive nasal bleeding 22 months after the initial diagnosis. ⋯ The present case shows that thrombosed intracavernous ICA aneurysm may still carry the risk of rupture. Radiological evidence of erosion of the sphenoid sinus wall and repeated minor bleeding may be important predicting signs for massive nasal bleeding. Parent artery occlusion including the aneurysm may be the best treatment for intracavernous ICA aneurysms if sufficient collateral blood flow to the territory of the affected ICA is expected.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Comparative StudyComparison of large intrasylvian and subpial hematomas caused by rupture of middle cerebral artery aneurysm.
The clinical characteristics of intrasylvian and subpial hematomas caused by rupture of middle cerebral artery (MCA) aneurysm were examined in 86 patients admitted to our department with subarachnoid hemorrhage (SAH) caused by ruptured MCA aneurysms. A retrospective study of 26 patients with a large hematoma associated with SAH treated surgically within 48 hours evaluated clinical grade at admission, secondary development of cerebral swelling, ratio of hematoma removal, and incidence of symptomatic vasospasm. ⋯ Removal of hematoma was more difficult and symptomatic vasospasm was more frequent in the intrasylvian hematoma group. The clinical features of subpial and intrasylvian hematomas caused by rupture of MCA aneurysm should be considered for the better management of associated SAH.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsSubarachnoid hemorrhage caused by a ruptured anterior spinal artery aneurysm.
A 51-year-old man presented with an extremely rare case of intracranial subarachnoid hemorrhage caused by rupture of an anterior spinal artery aneurysm manifesting as disturbance of consciousness following sudden onset of neck pain and numbness of the extremities. Cranial computed tomography revealed subarachnoid hemorrhage, mainly in the posterior fossa. Cerebral angiography studies on admission and on the 4th day demonstrated no definite abnormality as a bleeding source. ⋯ If subarachnoid hemorrhage of unknown etiology is encountered, spinal artery aneurysm should be considered as the bleeding source. Despite the controversy concerning the treatment strategy, ruptured spinal artery aneurysms can be treated conservatively because of the possibility of spontaneous regression. Follow-up angiography is required to evaluate the natural course of the lesion.