Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Apr 2008
ReviewThe shaken baby syndrome: an odyssey. II Origins and further hypotheses.
Subdural bleeding in the so-called "shaken baby syndrome" is recognized as a hallmark of this syndrome, and is often noted as chronic in nature, indicating an earlier time of origin than clinical presentation. In infants and neonates, the timeframe for generating such chronic intracranial bleeding is therefore limited. ⋯ This possibility is explored further here, with emphasis on features peculiar to Homo sapiens predisposing to intracranial bleeding during this timeframe. Encephalization and bipedalism combine to render the infant and mother susceptible to injury at birth.
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Neurol. Med. Chir. (Tokyo) · Mar 2008
Case ReportsProlonged somatic survival of clinically brain-dead adult patient.
A 43-year-old woman suffered clinical brain death after severe head injury. The patient met the criteria for the diagnosis of clinical brain death on Day 3. Aggressive hemodynamic and respiratory managements coupled with triple hormone therapy were performed at the family's request, resulting in continued cardiac activity for a prolonged period. ⋯ Ventilatory support was discontinued on Day 168, when cardiac death was confirmed, and her kidneys and eyeballs were removed for transplantation. The patient survived for 165 days after the diagnosis of clinical brain death, which is an extremely prolonged period of somatic support for an adult patient after brain death. An extensive and informed discussion on the end-of-life treatment of clinically brain-dead patients is urgently required in Japan to establish treatment guidelines for such patients.
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Neurol. Med. Chir. (Tokyo) · Feb 2008
Case ReportsSimultaneous occurrence of subarachnoid hemorrhage due to ruptured aneurysm and remote brainstem hematoma--case report.
A 48-year-old woman presented with simultaneous aneurysmal subarachnoid hemorrhage (SAH) and remote intracerebral hemorrhage manifesting as sudden onset of severe headache, left hemiparesis, and diplopia. Emergent computed tomography revealed localized SAH in the interpeduncular cistern, and a remote brainstem hematoma in the right dorsolateral tegment. ⋯ Her postoperative neurological status was improved except for slight diplopia. The causes of this extremely rare case of simultaneous occurrence of aneurysmal SAH and remote brainstem hematoma in the dorsolateral tegment remain obscure.
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Neurol. Med. Chir. (Tokyo) · Feb 2008
Case ReportsAuditory alert system for fluorescence-guided resection of gliomas.
Protoporphyrin IX (PPIX) fluorescence-guided brain tumor resection using 5-aminolevulinic acid labeling is one of the most valuable tools available to determine the extent of glioma infiltration, but requires repeated spectroscopic evaluation of the tissue. The present method informs the surgeon of residual tumor in real time using spectrum analysis of PPIX fluorescence and an audible alert system. ⋯ Using this method, infiltration of glioma was detected and confirmed histologically in three of six glioblastomas. The surgeon can detect tumor infiltration far more objectively and with less effort using this system during tumor resection.
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Neurol. Med. Chir. (Tokyo) · Jan 2008
Delayed hyponatremia following transsphenoidal surgery for pituitary adenoma.
The incidence and risk factors of symptomatic and asymptomatic hyponatremia were investigated in 94 patients who underwent transsphenoidal surgery and serum sodium level monitoring between January 2002 and December 2006. The records were retrospectively reviewed to determine the incidence and risk factors (age and sex, tumor size, endocrinologic findings) of hyponatremia. Postoperatively, the serum sodium levels of the patients were measured at least once within 2 or 3 days. ⋯ Sex, tumor type, and tumor size did not correlate with development of delayed hyponatremia, but patients aged >/=50 years were more likely to develop hyponatremia. Postoperative hyponatremia after transsphenoidal surgery is more common than previously reported and may lead to fatal complications. Therefore, all patients should undergo serum electrolyte level monitoring regularly for at least 1 or 2 weeks after transsphenoidal surgery.