Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsInfected acute subdural hematoma associated with invasive pneumococcal disease.
A previously healthy 68-year-old woman presented with a rare case of subdural empyema which developed at the site of preceding acute subdural hematoma (SDH). She was first admitted for treatment of an acute SDH after a fall. Since she was neurologically intact and the SDH volume decreased with conservative management, she was discharged 9 days after admission for follow up as an outpatient. ⋯ Infection of acute SDH resulting in subdural empyema by S. pneumoniae is extremely rare. However, invasive pneumococcal disease is not uncommon in the elderly and tends to cause intracranial bleeding. Considering the high mortality rate of invasive pneumococcal disease and the low vaccination rate among the elderly in Japan, neurosurgeons should ask about the pneumococcal vaccination status.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsNonconvulsive status epilepticus during perioperative period of cerebrovascular surgery.
Nonconvulsive status epilepticus (NCSE) is generally defined as a change in behavior and/or mental process from the baseline, which is associated with ongoing seizure activity or continuous epileptiform discharges on electroencephalography (EEG) in the absence of convulsive seizures. The present study investigated NCSE incidence using serial EEG during the perioperative periods of cerebrovascular surgery at a medium-sized, local hospital. A total of 54 patients were admitted to our department and underwent various neurosurgical procedures over a course of one year. ⋯ The EEG abnormalities included periodic lateralized epileptiform discharges in 1 patient, triphasic waves in 2 patients, and repeated ictal discharges in 1 patient. Improved mental status and consciousness level, together with disappearance of EEG abnormalities, after appropriate anticonvulsant treatment supported the diagnosis of NCSE. The present study stressed the importance of EEG if no adequate explanation for neurological deterioration can be determined from the clinical course, laboratory data, or neuroimaging examination.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsSpontaneous intracranial hypotension presenting without orthostatic headache complicated by acute subdural hematoma after drainage for chronic subdural hematoma--case report.
A 28-year-old man presented with a case of spontaneous intracranial hypotension (SIH) manifesting as a bilateral chronic subdural hematoma (CSDH) without orthostatic headache. He developed life-threatening acute SDH as a complication of CSDH drainage. Neurosurgeons should be aware that SIH patients do not always present with orthostatic headache. Brain magnetic resonance imaging with gadolinium may be recommended for young adults with non-traumatic CSDH before drainage to exclude SIH, even if they do not present with orthostatic headache.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsPerimedullary arteriovenous fistula at the craniocervical junction - case report - .
Perimedullary arteriovenous fistulas (AVFs) at the craniocervical junction are uncommon, and are often fed by the anterior spinal artery, with only a few cases fed by the intradural vertebral artery (VA). A 55-year-old man presented with a case of perimedullary AVF fed by the VA at the craniocervical junction manifesting as subarachnoid hemorrhage. Left vertebral angiography demonstrated an AVF supplied by branches from the VA. ⋯ Two feeding arteries were coagulated and dissected, followed by coagulation of a small feeder. The draining veins became discolored and shrank. 3D-CTA performed 2 months after the operation revealed disappearance of the AVF. Open surgery was successfully performed for the almost perimedullary AVF at the craniocervical junction, and is considered to be preferable for the treatment of this disease.
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A 69-year-old male presented with a rare dural cyst manifesting as numbness and pain in the limbs. Magnetic resonance imaging revealed a mass anterior to the medulla oblongata appearing as low intensity on T(1)-weighted and high intensity on T(2)-weighted imaging, with no enhancement. A cystic lesion ventral to the medulla oblongata was removed via the lateral suboccipital transcondylar approach. ⋯ The lesion was diagnosed as dural cyst. Dural cysts can be defined as cyst with the wall consisting of dura mater-like fibrous tissue, and attached to the dura mater. The origin of the present dural cyst was considered to be congenital.