Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Preventive effect of aggressive blood pressure lowering on hematoma enlargement in patients with ultra-acute intracerebral hemorrhage.
The preventive effect of aggressive blood pressure lowering on hematoma enlargement was investigated in patients with ultra-acute spontaneous intracerebral hemorrhage (ICH). Retrospective review of 248 patients (145 males, 103 females) with spontaneous ICH treated in our hospital between 2005 and 2008 identified patients with ultra-acute ICH who were directly taken to our institute by ambulance within 3 hours after onset. Patients who could not be assessed twice by computed tomography (CT) within 24 hours after arrival were excluded. ⋯ The time course of SBP change was not significantly different in patients with and without hematoma enlargement. The incidence of hematoma enlargement in patients with ultra-acute ICH in this study was 15.0%, which was lower than that in other series in which blood pressure was not reduced aggressively. This finding suggests that aggressive SBP lowering to below 140 mmHg has a preventive effect on hematoma enlargement in patients with ultra-acute ICH.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsMotor cortex stimulation for intractable neuropathic facial pain related to multiple sclerosis.
A 33-year-old man presented with ongoing severe right facial pain and sensory disturbances caused by multiple sclerosis (MS). Neuroimaging demonstrated demyelinating lesions in the right dorsal pons and medulla oblongata. ⋯ The patient underwent motor cortex stimulation (MCS), resulting in >60% pain relief, reduction in the required doses of pain medications, and discontinuation of ketamine administration. MCS is effective for MS-related neuropathic facial pain.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsSplitting of the oculomotor nerve by the posterior communicating artery--case report.
A 62-year-old woman presented with subarachnoid hemorrhage manifesting as sudden onset of headache, but without visual symptoms or extraocular movement disturbances. Computed tomography angiography showed a 7-mm size aneurysm originating from the internal carotid-posterior communicating artery (PcomA). After the neck of the aneurysm was clipped, the PcomA was confirmed to have split the oculomotor nerve. Splitting of the oculomotor nerve by the PcomA was probably caused by arterial blood pulsation in the tortuous PcomA.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsTreatment of unruptured aneurysm of duplication of the middle cerebral artery--case report.
A 60-year-old woman presented with a rare unruptured aneurysm of duplication of the middle cerebral artery (DMCA) identified at examination for headache. Preoperative cerebral angiography revealed the DMCA and a small aneurysm at its origin. Surgical clipping was performed successfully via the trans-sylvian approach. DMCA aneurysms have a tendency to bleed even if small, but the anatomical configuration causes some technical difficulties.