Neurologia medico-chirurgica
-
Neurol. Med. Chir. (Tokyo) · Jul 2004
Case ReportsShaken baby syndrome manifesting as chronic subdural hematoma: importance of single photon emission computed tomography for treatment indications--case report.
A boy with shaken baby syndrome first presented at age 3 months with acute subdural hematoma (SDH) and was treated by subdural tapping at a local hospital. Chronic SDH was identified at a rehabilitation center at age 19 months. The chronic SDH appeared to have developed within the preceding 16 months. ⋯ In this case, SPECT measurement of CBF was important in evaluating the pathophysiology of the delays in physical and mental growth. Atrophy of the bilateral hemispheres was the major mechanism in the decreased CBF, not the compression by chronic SDH. MR imaging and SPECT can determine the surgical indications for chronic SDH in patients with cortical atrophy.
-
Neurol. Med. Chir. (Tokyo) · Jul 2004
Manual occipital ventricular puncture for cerebrospinal fluid shunt surgery: can aiming be standardized?
The manual occipital ventricular puncture is a standard surgical procedure, but specific targeting has not received sufficient attention despite the experience of anatomical disorientation. This study tried to identify an exact site for the ideal trajectory with this method, especially in the sagittal plane, which avoids contact with the choroid plexus that may be the major source of complications. A total of 44 consecutive adult cases undergoing cerebrospinal fluid shunting through the occipital route for hydrocephalus were retrospectively reviewed for the following: correlations between burr hole site, direction of puncture, and location of the ventricular catheter based on postsurgical radiological studies; calculation of the ideal trajectory to place the catheter tip in the anterior horn of the lateral ventricle without contact with the choroid plexus through the standard occipital burr hole. ⋯ No correlation between the locations of the anatomical points and ventricular size was found. The present study could not define a standard external aim point. Tailored preoperative planning of the trajectory is recommended.
-
Neurol. Med. Chir. (Tokyo) · Jul 2004
Review Case ReportsRuptured vertebral artery-posterior inferior cerebellar artery aneurysm associated with pulseless disease--case report.
A 48-year-old woman with a 29-year history of pulseless disease presented with subarachnoid hemorrhage caused by a rare ruptured intracranial aneurysm of the right vertebral-posterior inferior cerebellar artery. The aneurysm was successfully clipped. ⋯ Almost all patients have ischemic disorders of the involved vessels, manifesting as syncope, visual disturbance, or a faint or absent pulse. The mechanisms responsible for pulseless disease and intracranial aneurysms are likely to be different.
-
Neurol. Med. Chir. (Tokyo) · May 2004
Comparative StudyAnalysis of subarachnoid hemorrhage according to the Japanese Standard Stroke Registry Study--incidence, outcome, and comparison with the International Subarachnoid Aneurysm Trial.
The data for subarachnoid hemorrhage (SAH) from the Japanese Standard Stroke Registry Study (JSSRS) were analyzed to evaluate the incidence of SAH according to age, neurological grading and outcome, and outcome of surgical clipping, for comparison with the International Subarachnoid Aneurysm Trial (ISAT). From the ISSRS data, the peak incidence of SAH was the sixth decade in males and the eighth decade in females. The overall mortality was 22%, and good outcome, better than 2 on the modified Rankin Scale (mRS), at discharge was achieved in 58% of cases. ⋯ From the ISAT data, 88% of patients were in grades 1-2 of the World Federation of Neurological Surgeons (WFNS) grading system in both surgical clipping and endovascular coiling groups, 94% in grades 1-3, and 98% in grades 1-4. Poor outcome, worse than 3 on the mRS, at 2 months occurred in 25.4% and 36.4% of patients with endovascular coiling and surgical clipping, respectively. Limiting the patients in the JSSRS to WFNS grades 1-2 showed poor outcome, worse than 3 on the mRS, occurred in 12.8%, and in grades 1-3 and 1-4 occurred in only 16.3% and 23.0%, respectively.
-
Neurol. Med. Chir. (Tokyo) · May 2004
Case ReportsSurgical management of combined stab injury of the spinal cord and the aorta--case report.
A 32-year-old man presented with a combined penetrating stab injury of the spinal cord and the aorta caused by a knife wound in his back at the low thoracic level. The knife had broken, and part of the blade had been retained in the wound, passing through the spinal canal and into the aortic lumen. ⋯ Because of the tamponade effect of the foreign body, it was necessary to delay removal of the blade until vascular control had been achieved. Any sign of a penetrating body passing through the spine should suggest careful evaluation to detect any visceral injury, and multidisciplinary treatment should be planned.