Neurologia medico-chirurgica
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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.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsAcute epidural-like appearance of an encapsulated solid non-organized chronic subdural hematoma.
We report the exceptional case of an encapsulated solid non-organized chronic subdural hematoma (SDH) in a 67-year-old woman that was admitted with acute hemiplegia followed by rapid deterioration in consciousness 5 months after a minor head trauma. Computed tomography (CT) showed an extracerebral biconvex shaped hyperdense mass that led to the misdiagnosis of an acute epidural hematoma. Urgent craniotomy revealed an encapsulated mass filled with solid fresh clot in the subdural space. ⋯ Histological analysis confirmed that the content of the hematoma corresponded to a newly formed clot that was enclosed between an inner membrane, composed of two collagen layers, and an outer membrane with a three layered structure. Chronic SDH may seldom present as an encapsulated solid non-organized lesion that consists of a fibrous capsule enclosing a fresh clot and lacking the thick fibrous septations that typically connect the inner and outer membranes of organized chronic SDH. This entity mimics the clinical course and radiological appearance of acute epidural hematomas and should be considered in the differential diagnosis of extracerebral hyperdense biconvex shaped lesions.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsCervical (non-terminal) myelocystocele associated with rapidly progressive hydrocephalus and Chiari type II malformation--case report.
An infant presented with a rare cervical (non-terminal) myelocystocele as a congenital skin-covered mass located in the midline of the posterior aspect of her neck. Magnetic resonance (MR) imaging and computed tomography showed a cystic mass filled with cerebrospinal fluid in the midline of the posterior aspect of the neck, with a fibrous streak extending from the bottom of the sac to the dorsal surface of the cervical cord. Brain MR imaging also showed a dilated ventricular system and Chiari type II malformation. ⋯ After the surgery, the patient experienced respiratory distress. Ultrasound tomography from the anterior fontanel revealed deterioration of hydrocephalus, so a ventriculoperitoneal shunt was inserted, and the respiratory distress improved. The present case illustrates the possibility of rapidly worsening of hydrocephalus and Chari type II malformation after surgical repair of cervical (non-terminal) myelocystocele.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Two-level anterior lumbar interbody fusion with percutaneous pedicle screw fixation: a minimum 3-year follow-up study.
The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent two-level ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. ⋯ ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Comparative StudyEffectiveness of brain hypothermia treatment in patients with severe subarachnoid hemorrhage: comparisons at a single facility.
The effectiveness of hypothermia treatment for severe subarachnoid hemorrhage (SAH) was evaluated at the same facility under the same director. A total of 187 patients with SAH, 67 admitted before the introduction of hypothermia treatment in May 1999 (early cases) and 120 treated thereafter (late cases), were transported to the National Cardiovascular Center and treated in the acute phase between November 1997 and September 2001. Brain hypothermia treatment was performed in 19 patients of the 120 late cases, 10 males and 9 females aged 33-72 years (mean 57. 6 years), treated by direct surgery in 15 and endovascular surgery in 4. ⋯ Hyperthermia after therapeutic hypothermia induced brain swelling and markedly affecting the outcome. Brain hypothermia treatment did not improve the outcome of severe SAH compared with the period before its introduction. The emphasis in treating severe SAH should be placed on the maintenance of normothermia to prevent brain swelling and elimination of factors that may induce cerebral vasospasm, rather than interventional hypothermia for aggressive brain protection.