Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jun 2007
Case ReportsPerimesencephalic non-aneurysmal subarachnoid hemorrhage caused by cavernous sinus thrombosis: case report.
A 37-year-old man presented with perimesencephalic non-aneurysmal subarachnoid hemorrhage associated with cavernous sinus thrombosis. Anticoagulant therapy was administered to treat the cavernous sinus thrombosis, but provoked severe intracranial hemorrhage, severely disabling the patient. Perimesencephalic non-aneurysmal subarachnoid hemorrhage is a benign clinical entity with generally good prognosis, but the association with cavernous sinus thrombosis requires careful investigation prior to treatment.
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Neurol. Med. Chir. (Tokyo) · May 2007
Histological examination of false positive tissue resection using 5-aminolevulinic acid-induced fluorescence guidance.
Intraoperative 5-aminolevulinic acid (5-ALA)-induced fluorescence guidance for resection of malignant brain tumors was correlated with histological examination to investigate false positive findings in 42 patients with malignant glioma and six patients with metastatic brain tumor. Patients received a single 1 g oral dose of 5-ALA 2 hours before surgery. The tumor site was illuminated with a laser with a peak wavelength of 405 +/- 1 nm and output of 40 mW. ⋯ Intraoperative 5-ALA-induced fluorescence guidance is useful for the resection of initial malignant glioma since false positive results are rare, but only non-eloquent weak positive areas should be resected. In contrast, all weak positive areas of recurrent malignant gliomas must be resected. Weak positive areas of the peritumoral edema surrounding metastatic brain tumors should be removed carefully as false positive results are common.
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Neurol. Med. Chir. (Tokyo) · Mar 2007
Case ReportsSuccessful use of prolonged mild hypothermia in a patient with severe head injury and diffuse brain swelling. Case report.
A 19-year-old female was admitted to our hospital after severe head injury in a traffic accident. On admission, she had no spontaneous respiration, but did have heart beat with a blood pressure of 100/60 mmHg. Neurological examination demonstrated that the Glasgow Coma Scale score was 3 and her pupils were fixed and dilated. ⋯ Mild hypothermia with a target temperature of 33 degrees C was immediately induced, and was continued for 28 days to control the persistent increase in intracranial pressure (ICP). Subsequently, she recovered, and 20 months after admission, could speak and walk with slight hemiparesis on the left. Prolonged mild hypothermia may be effective to control persistent increase in ICP due to diffuse brain swelling.
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Neurol. Med. Chir. (Tokyo) · Feb 2007
Case ReportsGranulomatous pachymeningitis around the sella turcica (Tolosa-Hunt syndrome) involving the hypophysis--case report.
A 50-year-old female presented with right painful abducens nerve palsy persisting for 4 months and mild panhypopituitarism with diabetes insipidus for 6 months. T(1)-weighted magnetic resonance (MR) imaging of the sellar region showed a homogeneously enhanced mass lesion in the right cavernous sinus which seemed to extend from the swollen pituitary gland. T(2)-weighted MR imaging clearly showed the mass in the right cavernous sinus and the thickened dura mater of the sellar floor as hypointense, and the enlarged pituitary gland as isointense. ⋯ Corticosteroid therapy was begun after the biopsy. Her periorbital pain and diplopia were relieved, but diabetes insipidus persisted. Follow-up MR imaging showed a decrease in the volumes of the pituitary gland and the mass in the cavernous sinus.
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Neurol. Med. Chir. (Tokyo) · Jan 2007
Case ReportsSpinal subdural hematoma following intracranial aneurysm surgery: four case reports.
Four patients presented with rare spinal subdural hematoma (SDH) occurring after intracranial aneurysm surgery and manifesting as postoperative back pain. Magnetic resonance imaging performed from 4 to 11 days after the operation showed acute or subacute thoracolumbar SDH. No patient had risk factors for bleeding at this site (e.g., lumbar puncture, coagulation abnormality). ⋯ Computed tomography performed during the postoperative period showed a suspicious tentorial subdural hemorrhage in Case 1 and an interhemispheric subdural hemorrhage in Case 3. All four patients received conservative management and their lumbago improved. We hypothesize that CSF hypotension due to overdrainage of CSF and downward migration of intracranial SDH under the influence of gravity were involved in the formation of spinal SDH.