Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Linear fractures invisible on routine axial computed tomography: a pitfall at radiological screening for minor head injury.
Computed tomography (CT) is now widely used as the only screening method for fractures in patients with head injury. However, clear depiction of a fracture requires a discontinuity in the skull, so linear fractures parallel to the CT slice may not be visualized. ⋯ Two patients developed acute epidural hematoma or traumatic subarachnoid hemorrhage. Evaluation of head injury by only axial CT may miss such fractures and result in sequelae, so diagnosticians should be alert to the possible presence of this type of fracture.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsSpontaneous superficial temporal artery pseudoaneurysm in elderly women--three case reports.
Three women older than 75 years presented with spontaneous superficial temporal artery (STA) pseudoaneurysms manifesting as a pulsatile mass in the preauricular region. None of the patients had a history of trauma. ⋯ Spontaneous STA pseudoaneurysms are extremely rare. We suggest that all 3 aneurysms were associated with latent dissection and external force exerted by the frames of glasses.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsRemote cerebellar hemorrhage after foramen magnum decompression surgery for Chiari I malformation--case report.
A 47-year-old woman underwent decompressive suboccipital craniectomy and C1 laminectomy with duroplasty in the prone position for Chiari malformation type I and syringomyelia. The arachnoid membrane was not injured. Intraoperative echography showed good enlargement of the subarachnoid space. ⋯ Loss of CSF is the main pathogenesis of this condition. In our case, the most probable pathomechanism seems to involve stretching of the infratentorial cerebellar bridging veins due to cerebellar sagging because of dural opening in the prone position and drop in CSF pressure. Such a complication is rare but should be considered after foramen magnum decompression surgery if the patient shows unusual symptoms of repeated vomiting.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Surgical outcome and postoperative work status of lumbar discogenic pain following transforaminal interbody fusion.
The clinical outcome and resumption of work were investigated in 21 patients with lumbar discogenic pain (15 males and 6 females, mean age 37.2 years), who failed to respond to intensive conservative therapy, treated by transforaminal lumbar interbody fusion (TLIF) augmented with the pedicle screw system from January 2005 to December 2007. Perioperative assessment was performed using the modified Japanese Orthopaedic Association (mJOA) score, the Oswestry Disability Index, and the visual analogue scale (VAS). Type of occupation and work status of the patients were also assessed before and after surgery. ⋯ This study showed that postoperative overall resumption rate was 90%. However, only 23% of the heavy labor group returned to the previous work compared with 71% of the light labor group. TLIF is thought to be a safe and effective technique in patients with intractable chronic lumbar discogenic pain with an acceptable overall work resumption rate, whereas complete return to previous jobs was limited in the heavy labor group.
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Posterior decompression of the cervical spine is an accepted treatment for patients with cervical canal disease, but some patients experience postoperative axial pain and C5 or C6 palsy that affect their quality of life. Here we describe selective posterior decompression using a spinous process-splitting approach to prevent these complications performed in 17 patients with myelopathy treated at median 2.4 levels by selective posterior decompression via the transspinous approach. Clinical symptoms, axial pain, and C5 or C6 palsy were compared before and after treatment. ⋯ None of our 17 patients experienced significant postoperative axial pain after selective posterior decompression via the transspinous approach. Minimal spinal cord shift at the C5 level may have contributed to the reduced incidence of postoperative C5 or C6 palsy in our series. Selective posterior decompression is less invasive and effective in some patients with cervical canal disease.