Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Apr 2009
Case ReportsBilateral acute subdural hematomas with intracerebral hemorrhage without subarachnoid hemorrhage, caused by rupture of an internal carotid artery dorsal wall aneurysm. Case report.
A 45-year-old man presented with bilateral acute subdural hematomas (ASDHs) without subarachnoid hemorrhage (SAH). He was found comatose in a parked car. Computed tomography showed left frontal intracerebral hemorrhage (ICH) and bilateral ASDHs but no signs of SAH. ⋯ We inferred that massive intracranial bleeding might have ruptured through the cortex and lacerated the arachnoid membrane. Aneurysm rupture generally results in unilateral SDH, whereas trauma is the usual cause of bilateral ASDHs with ICH. Our case suggests that ruptured aneurysm should be considered in patients with non-traumatic bilateral ASDHs without SAH.
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Neurol. Med. Chir. (Tokyo) · Apr 2009
Case ReportsMultiple cavernous hemangiomas of the skull associated with hepatic lesions. Case report.
A 55-year-old woman presented with multiple calvarial cavernous hemangiomas manifesting as right frontal swelling. Craniography and computed tomography showed an osteolytic lesion. Magnetic resonance imaging demonstrated multiple intraosseous lesions, and radioisotope bone scintigraphy identified even more numerous lesions. ⋯ Computed tomography of the abdomen revealed multiple hepatic lesions, which might be cavernous hemangiomas. Cavernous hemangioma is a rare bony tumor that should be considered in the differential diagnosis of skull tumors. A patient with multiple cavernous hemangiomas should undergo systemic examination to look for latent lesions, and regular follow-up examinations.
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Neurol. Med. Chir. (Tokyo) · Apr 2009
Case ReportsNon-traumatic atlanto-axial subluxation: Grisel's syndrome. Two case reports.
Two 8-year-old boys presented with complaints of torticollis and pain on neck turning. Both patients had a history of throat infection. Radiography and computed tomography demonstrated atlanto-axial subluxation. ⋯ The torticollis had resolved and reduction of atlanto-axial subluxation was confirmed within 2 weeks in both patients. Early diagnosis of Grisel's syndrome with appropriate antibiotics and a cervical collar, with halter traction if necessary, can achieve good outcome. Surgical treatment for the reduction of atlanto-axial subluxation should be reserved for persistent or recurrent cases.
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Neurol. Med. Chir. (Tokyo) · Apr 2009
Initial clinical experience of vasodilatory effect of intra-cisternal infusion of magnesium sulfate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
The vasodilatory effect of intra-cisternal infusion of magnesium sulfate solution was evaluated in 10 patients with symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) who underwent early clipping surgery. Cisternal drainage was installed in the prepontine and/or sylvian fissures. Carotid angiography was performed immediately after the onset of symptomatic vasospasm, then intra-cisternal infusion of 15 mmol/l magnesium sulfate in Ringer solution was started at 20 ml/hr and continued until day 14. ⋯ The magnesium infusion also caused decreased mean arterial blood velocity in the spastic arteries in 6 of the 7 measured patients (162 +/- 38 cm/sec to 114 +/- 42 cm/sec, p < 0.001). Finally, 5 of the 10 patients achieved good recovery, 1 patient had moderate disability, 1 patient became severely disabled due to meningitis, and 3 patients were vegetative or dead, due to failure of magnesium irrigation in 1 patient and advanced age in the other 2 (more than 80 years old). This preliminary study indicates that intra-cisternal infusion of magnesium sulfate solution has vasodilatory effect on the spastic cerebral arteries after aneurysmal SAH.
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A 26-year-old man presented with a xanthogranuloma located exclusively in the suprasellar region manifesting as general fatigue, bitemporal hemianopsia, and polyuria. Endocrinological examination disclosed severe hypopituitarism. ⋯ Histological examination found fibrous tissue with abundant cholesterol clefts, multinucleated giant cells, and hemosiderin deposits, but no epithelial cells. Xanthogranulomas of the sellar region are reported to be predominantly located in the sella turcica, but should be included in the differential diagnosis even in cases of suprasellar mass lesions.