Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Comparative StudyLower extracellular glucose level prolonged in elderly patients with severe traumatic brain injury: a microdialysis study.
Age may be an independent predictor of outcomes in traumatic brain injury (TBI), but the causes of the poor outcomes in elderly patients remain unclear. To clarify the differences between elderly and young patients with TBI, brain metabolism parameters were monitored with the microdialysis method in 30 patients with severe TBI (Glasgow Coma Scale scores 3-8). The microdialysis probe was inserted in the penumbra area of the brain and extracellular levels of glucose, glutamate, glycerol, lactate, and pyruvate were measured hourly for the initial 168 hours (7 days) after operation. ⋯ The value of extracellular glucose concentration was significantly lower in the elderly group than in the young group, and continued until the 7th day after injury. Moreover, the lactate/pyruvate ratio peaked on the 5th day after injury in the elderly group, later than in the young group. We concluded that neural vulnerability persisted longer in elderly patients than in young patients with TBI, and this should be considered to prevent the occurrence of additional secondary brain injury.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Comparative StudyUsefulness of intraoperative computed tomography in surgery for low-grade gliomas: a comparative study between two series without and with intraoperative computed tomography.
We have routinely used an intraoperative CT (i-CT) system in over 800 neurosurgical procedures since 1997. To investigate the utility of i-CT in low-grade glioma (LGG) surgery, we investigated whether i-CT improved the extent of tumor resection and prognosis in 46 patients with histologically confirmed LGG consisting of 27 patients with World Health Organization grade II astrocytoma, 12 with oligodendroglioma, and 7 with oligoastrocytoma. The patients were divided into two groups, 23 who underwent tumor resection without i-CT (non i-CT group) and 23 who underwent surgery using i-CT (i-CT group). ⋯ There were no significant differences between pre- and postoperative Karnofsky performance status scores between the groups. Surgical resection using i-CT may improve the outcomes of patients with LGG. Additional resection or emergency treatment can be quickly performed as the surgical results are confirmed intraoperatively or immediately after the operation using i-CT.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsLumbar discal cyst with spontaneous regression and subsequent occurrence of lumbar disc herniation.
A 39-year-old man presented with an extremely rare discal cyst at the L3-4 level manifesting as a left L4 radiculopathy. Two months after onset, he suffered right L4 radiculopathy with new lumbar disc protrusion. ⋯ Most cases of discal cyst are surgically treated, with only two previous cases of spontaneous regression. The present case suggests clinical and radiological recovery of symptomatic lumbar discal cyst can be obtained by only conservative therapy.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsDural arteriovenous fistula between inferolateral trunk of the internal carotid artery and superficial sylvian vein.
A 40-year-old Brazilian man presented with headache followed by consciousness disturbance. Computed tomography showed subarachnoid hemorrhage with right frontal hematoma. Angiography revealed a dural arteriovenous fistula (dAVF) fed by the inferolateral trunk of the internal carotid artery and draining into the superficial sylvian vein with varix formation. ⋯ A ventriculoperitoneal shunt was needed for normal pressure hydrocephalus during his hospitalization. The modified Rankin scale at discharge was grade 2 with mild cognitive dysfunction. This case of dAVF may represent congenital dAVF.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsSurgical treatment of sacral perineural cyst--case report.
A 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. ⋯ Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cyst-subarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.