Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsConsciousness recovery induced by intrathecal baclofen administration after subarachnoid hemorrhage -two case reports-.
Two patients with subarachnoid hemorrhage recovered consciousness after intrathecal baclofen administration using an implanted intrathecal baclofen pump delivering 50 microg per day using a simple infusion mode. Intrathecal baclofen resulted in significant reduction of spasticity 3 months after the implantation. Case 1 was reduced to a completely bedridden state with spasticity and could slightly move her fingers following commands. ⋯ Flatulence and dysuria happened during the screening test, but these symptoms were not repeated after implantation of a pump-catheter-system and continuous intrathecal baclofen infusion. Continuous intrathecal baclofen infusion caused both improvement in muscle tone and spasms and consciousness recovery from the vegetative state. This therapy is a strong candidate treatment for patients with spasticity and consciousness disturbance.
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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 ReportsArachnoidplasty for traumatic subdural hygroma associated with arachnoid cyst in the middle fossa. Case report.
A 5-year old boy presented with an arachnoid cyst in the middle cranial fossa with mild midline shift manifesting as headache and loss of activity. Computed tomography (CT) showed subdural hygroma. Burr-hole drainage was carried out and symptoms were improved postoperatively. ⋯ He underwent craniotomy, and tearing of the outer wall of the arachnoid cyst was observed. The ruptured cyst wall was tightly closed by arachnoidplasty to prevent cerebrospinal fluid leakage. Arachnoidplasty was effective for traumatic subdural hygroma with arachnoid cyst for reconstruction.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsCavernous sinus cavernous hemangioma largely extending into the sella turcica and mimicking pituitary adenoma: case report.
A 77-year-old female presented with a rare cavernous sinus cavernous hemangioma with extension to the sella turcica, neuroradiologically mimicking nonfunctioning pituitary macroadenoma. The lesion was partially removed via transsphenoidal surgery, and the histological diagnosis was cavernous hemangioma. After stereotactic radiosurgery using a cyber knife, the lesion decreased in size. Stereotactic radiosurgery may be a good option for cavernous sinus cavernous hemangioma with high risk of surgical bleeding.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsMalignant transformation 20 years after partial removal of intracranial epidermoid cyst--case report.
A 74-year-old woman presented with malignant progression of remnant epidermoid cyst manifesting as sudden onset of right ptosis and double vision. She had right oculomotor nerve paresis. She had a history of surgery for right cerebellopontine angle epidermoid cyst 20 years previously. ⋯ She has been without tumor recurrence for 17 months. Malignant change of epidermoid cyst is extremely rare, but rapid progress of the symptoms suggests malignant transformation. MR imaging with gadolinium is useful for diagnosis.