Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Mar 2005
Case ReportsSpontaneous intracranial internal carotid artery dissection treated by intra-arterial thrombolysis and superficial temporal artery-middle cerebral artery anastomosis in the acute stage--case report--.
A 22-year-old man presented with sudden onset of right retro-orbital headache followed by left hemiparesis. Right carotid angiography demonstrated almost total occlusion of the intracranial internal carotid artery (ICA) and severe stenosis of the middle cerebral artery (MCA), presumably caused by arterial dissection. Local arterial injection of urokinase was performed 2 hours after onset. ⋯ Magnetic resonance imaging showed small infarcts in the right cerebral cortex. Repeat angiography after 5 months showed recanalization of the right ICA and the right MCA. Combination of thrombolytic therapy and bypass surgery may be a useful treatment option for patients with sudden occlusion of the intracranial artery caused by dissection.
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Neurol. Med. Chir. (Tokyo) · Mar 2005
Case ReportsKnife blade penetrating stab wound to the brain--case report--.
A 28-year-old man attempted to kill himself with a knife stab into the parietal area. Neuroimaging showed no vascular impairment except slow venous flow around the knife due to tamponading. After obtaining informed consent, the knife was removed through a craniotomy without new brain injury. ⋯ No infection occurred. Brain stab wounds cause numerous complications, such as intracranial hemorrhage, injury of important vessels, and infections. Minimal blade movement during removal and precautions to prevent massive hemorrhage are essential.
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Neurol. Med. Chir. (Tokyo) · Mar 2005
Case ReportsGiant intrasellar arachnoid cyst manifesting as adrenal insufficiency due to hypothalamic dysfunction--case report--.
A 67-year-old man first noticed loss of pubic and axillary hair in 1992 and then a visual field defect in 2001. He experienced loss of consciousness attributed to hyponatremia in April 2002. Magnetic resonance imaging showed a giant intrasellar cystic mass, 40 mm in diameter, that had compressed the optic chiasm. ⋯ Histological examination identified the excised cyst membrane as arachnoid membrane. The patient's headaches resolved postoperatively, but the bitemporal hemianopsia and endocrinological function were unchanged. This arachnoid cyst associated with hypothalamic dysfunction might have been caused by an inflammatory episode in the suprasellar region.
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Neurol. Med. Chir. (Tokyo) · Nov 2004
Randomized Controlled Trial Clinical TrialParamedian suboccipital mini-craniectomy for evacuation of spontaneous cerebellar hemorrhage.
Patients with spontaneous cerebellar hemorrhage are usually treated by large suboccipital craniectomy for hematoma evacuation or by computed tomography-guided stereotactic aspiration of the hematoma. The present study evaluated the outcome and complications in 25 patients with spontaneous cerebellar hemorrhage treated by paramedian suboccipital mini-craniectomy and 21 patients treated by large suboccipital craniectomy. ⋯ However, patients treated by paramedian suboccipital mini-craniectomy were less likely to require blood transfusion, had a shorter operating time, and had less postoperative liquorrhea compared with those undergoing extensive suboccipital craniectomy. Paramedian suboccipital mini-craniectomy is a simple and effective method for hematoma evacuation that causes fewer complications.
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Neurol. Med. Chir. (Tokyo) · Nov 2004
Clinical TrialPrevention of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage by intraoperative cisternal fibrinolysis using tissue-type plasminogen activator combined with continuous cisternal drainage.
The efficacy of intraoperative cisternal irrigation using tissue-type plasminogen activator (tPA) combined with continuous cisternal drainage was assessed for the prevention of symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). Seventy consecutive patients underwent direct surgery for aneurysm clipping within 48 hours of SAH and had computed tomography (CT) findings classified as Fisher group III or IV with densities of more than 65 Hounsfield units (HU). Fibrinolysis of the cisternal clots was performed during surgery using 1.6 mg tPA in 55 cases or 3.2 mg tPA in 15 cases. ⋯ Symptomatic vasospasm occurred in three patients (4.3%) and two patients had low density areas on CT. Permanent deficit (hemiparesis) due to cerebral vasospasm remained in only one patient. Intraoperative cisternal irrigation with tPA combined with cisternal drainage is safe and effective for the prevention of symptomatic vasospasm following SAH.