Neurologia medico-chirurgica
-
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.
-
Neurol. Med. Chir. (Tokyo) · Jan 2010
ReviewTechnical advancements and utilization of spine surgery--international disparities in trend-dynamics between Japan, Korea, and the USA.
Spine surgery has made radical advancements in the last two decades and provision has expanded a great deal. The history of the technical development is briefly reviewed. ⋯ Medico-socioeconomic conditions underlying the variations are discussed. Adequate surgeon training has to be supplied in a matched volume, and the number of surgeons to balance the need is estimated.
-
Neurol. Med. Chir. (Tokyo) · Jan 2010
Clinical TrialEfficacy of gabapentin for radiculopathy caused by lumbar spinal stenosis and lumbar disk hernia.
The efficacy of gabapentin monotherapy was investigated against both acute or chronic radicular pain caused by lumbar disk hernia (LDH) or lumbar spinal stenosis (LSS). Seventy-eight patients with radicular pain, 10 males and 68 females aged 23 to 76 years (mean 49.4 years), caused by LSS in 45 patients or LDH in 33 patients were treated with oral administration of gabapentin and were followed up for 3 months. The evaluation included neurological examination, Odom's criteria, visual analog pain scale (VAS), and walking distance. ⋯ Furthermore, walking distance was significantly longer at the 3rd month of the treatment protocol. Eight patients discontinued gabapentin therapy because of the side effects. Gabapentin could be an option in the conservative management of acute or chronic radicular pain.
-
Neurol. Med. Chir. (Tokyo) · Jan 2010
Comparative StudyImpact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage.
The present study aimed to evaluate the impact of early surgical evacuation of sylvian hematoma caused by ruptured middle cerebral artery (MCA) aneurysm on clinical outcome after subarachnoid hemorrhage. Hospital records and computed tomography scans for 26 patients with MCA aneurysm who underwent surgical clipping between June 2001 and January 2008 were retrospectively reviewed. All patients presented with sylvian hematoma associated with subarachnoid hemorrhage and received surgery at 7.9 +/- 3.6 (mean +/- standard deviation) hours of ictus. ⋯ Better functional outcomes were obtained in patients with successful evacuation (p < 0.05), as assessed by improvement of hemiparesis on manual muscle testing scale at postoperative 1-month follow up and by the modified Rankin scale at postoperative 3 and 6 months. Clinical outcomes were also better in the achievement group. These results suggest that better clinical course and outcome can be expected in patients who undergo early successful hematoma evacuation with surgical clipping of a ruptured MCA aneurysm.
-
Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsProptosis caused by partially thrombosed orbital varix of the superior orbital vein associated with traumatic carotid-cavernous sinus fistula--case report.
A 49-year-old female presented with proptosis and slight chemosis with diplopia on the right. The patient had a past history of skull base fracture occurring one year before the onset of the symptoms. Magnetic resonance imaging showed a partially thrombosed varicose aneurysm (varix) of the superior ophthalmic vein (SOV). ⋯ Proptosis was due to the direct mass effect of the thrombosed varix of the SOV. The thrombosed varix was removed after right carotid artery trapping with external carotid artery-middle cerebral artery (M(2)) high flow bypass. The symptoms subsided after the surgery.