Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsAcute subdural hematoma without subarachnoid hemorrhage caused by ruptured A1-A2 junction aneurysm. Case report.
A 54-year-old man was admitted to our hospital with complaint of sudden headache. The patient had suffered two episodes of transient headache before admission. Computed tomography (CT) revealed acute subdural hematoma (ASDH) on the right side of the cerebral convexity with bilateral extension along the tentorium cerebelli without signs of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH). ⋯ The patient was discharged without neurological deficit. Ruptured aneurysms resulting in ASDH without SAH or ICH are very rare. Radiological investigation such as three-dimensional CT angiography should be performed to find the causative aneurysm in a patient with ASDH with a history of repeated headaches and without traumatic signs or episodes, and the appropriate treatment should be planned with expediency.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsTransient crossed cerebellar diaschisis due to cerebral hyperperfusion following surgical revascularization for moyamoya disease: case report.
Crossed cerebellar diaschisis (CCD) often occurs after ischemic or hemorrhagic stroke that damages the cortico-ponto-cerebellar pathway. However, CCD due to cerebral hyperperfusion following cerebrovascular reconstruction is rare. A 61-year-old woman presented with transient CCD due to cerebral hyperperfusion following bypass surgery for adult moyamoya disease. ⋯ This case strongly suggests that cerebral hyperperfusion after bypass surgery for moyamoya disease may cause transient CCD. Although the clinical significance is still obscure, this phenomenon indicates the cortico-ponto-cerebellar pathway is interrupted due to hyperperfusion, suggesting the development of hyperperfusion syndrome. Careful observation of cerebral hemodynamics after bypass surgery is warranted to avoid hyperperfusion-related complications.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Effectiveness of maximal safe resection for glioblastoma including elderly and low Karnofsky performance status patients: retrospective review at a single institute.
Elderly and low Karnofsky performance status (KPS) patients have been excluded from most prospective trials. This retrospective study investigated glioblastoma treatment outcomes, including those of elderly and low KPS patients, and analyzed the prognostic factors using the medical records of 107 consecutive patients, 59 men and 48 women aged from 21 to 85 years (median 65 years), with newly diagnosed glioblastoma treated at our institute. There were 71 high-risk patients with age >70 years and/or KPS <70%. ⋯ Multivariate analysis of 73 patients in the subtotal and partial groups found age ≤65 years (p = 0.047), 60 Gy irradiation (p = 0.009), O(6)-methylguanine-deoxyribonucleic acid methyltransferase-negative (p = 0.027), and more than subtotal removal (p = 0.003) were significant prognostic factors. The median postoperative KPS score tended to be better than the preoperative score, even in the high-risk group. We recommend maximal safe resection for glioblastoma patients, even those with advanced age and/or with low KPS scores.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsIschemic events due to intraoperative microemboli developing in the cerebral hemisphere contralateral to carotid endarterectomy in a patient with preoperative cerebral hemodynamic impairment.
A 74-year-old man with a history of asymptomatic right internal carotid artery (ICA) occlusion experienced amaurosis fugax in the left eye. Angiography showed left cervical ICA stenosis in addition to right cervical ICA occlusion. The right anterior and middle cerebral artery (MCA) territories were perfused from the left ICA via the anterior communicating artery. ⋯ Transient and slight motor weakness of the left upper extremity was noted on recovery from anesthesia. Diffusion-weighted magnetic resonance imaging demonstrated the development of new spotty ischemic lesions only in the right cerebral hemisphere. The present case suggests that intraoperative cerebral embolism causing postoperative neurological deficits can develop exclusively in the cerebral hemisphere contralateral to CEA if the hemisphere has preoperative hemodynamic impairment and collateral circulation via the anterior communicating artery from the ICA ipsilateral to CEA.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsParavertebral arteriovenous fistula treated by endovascular coil embolization.
A 41-year-old man, without underlying health problems or traumatic episodes, presented with a rare paravertebral arteriovenous fistula (AVF) causing radiculopathy manifesting as gradually progressive right grip weakness, and right thumb, index, and middle finger numbness. Digital subtraction angiography revealed a high flow, single hole paravertebral AVF fed by the right thyrocervical trunk that drained into the epidural venous plexus. The patient underwent endovascular embolization of the AVF via the transarterial approach. ⋯ Paravertebral AVF is usually asymptomatic because of a "reflux-impending mechanism" within the dural sleeves that prevents retrograde drainage into the perimedullary veins. However, in the present case, mechanical compression of the radicular nerve due to a dilated epidural venous plexus resulted in neurological symptoms. We conclude that endovascular surgery is an effective treatment strategy for paravertebral AVF.