Neurologia medico-chirurgica
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Intradural paraclinoidal aneurysm still presents conceptual confusion and technical surgical problems. The clinical features of 68 consecutive patients with paraclinoidal aneurysms were analyzed. The pterional approach was used in all patients. ⋯ A favorable outcome was achieved in 17 of 19 patients undergoing coating. Coating without clipping might be better for some blister-like ICA aneurysms, even if ruptured. Paraclinoidal aneurysms can be clipped with favorable results using these techniques except for giant aneurysms and associated basilar artery aneurysm.
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Neurol. Med. Chir. (Tokyo) · Sep 1999
Case ReportsVery late-onset symptomatic cerebral vasospasm caused by a large residual aneurysmal subarachnoid hematoma--case report.
A 70-year-old female developed delayed ischemic neurological deficits at 35 days after subarachnoid hemorrhage (Hunt and Kosnik grade III, Fisher group 4) caused by a ruptured aneurysm of the left middle cerebral artery. Angiography indicated late-onset cerebral vasospasm probably due to the mass effect of a large hematoma remaining in the sylvian fissure and an intracerebral hematoma after surgery. Patients with a large subarachnoid hematoma after subarachnoid hemorrhage should receive therapy to prevent cerebral vasospasm until the mass effect of the hematoma has diminished.
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Neurol. Med. Chir. (Tokyo) · Sep 1999
Effect of cerebrospinal fluid shunting on experimental syringomyelia: magnetic resonance imaging and histological findings.
The histological changes associated with syringomyelia after reduction of the syrinx size were investigated after cerebrospinal fluid shunting in experimental syringomyelia in the rabbit. Five weeks after syringomyelia was induced by the injection of kaolin into the cisterna magna in Japanese white rabbits, ventriculosubgaleal shunting or syringoepidural shunting were performed. After 1 week magnetic resonance (MR) imaging and histological examination were then carried out. ⋯ Syrinx shrinkage occurred after shunting in this experimental model of syringomyelia. The selective vulnerability of gray matter even after shunting may explain discrepancies between imaging findings and clinical features in this disease. The study supports the potential benefit from early treatment, considering the associated morphological findings of regeneration.
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Neurol. Med. Chir. (Tokyo) · Aug 1999
Relationship between aneurysmal subarachnoid hemorrhage and climatic conditions in the subtropical region, Amami-Oshima, in Japan.
Epidemiological studies of the relationship between climate and the onset of aneurysmal subarachnoid hemorrhage (SAH) have been reported in the temperate and subarctic latitudes. However, the relationship between the incidence of aneurysmal SAH and the climatic variations in the subtropical region remains uncertain. Epidemiological analysis requires study of an extremely isolated area. ⋯ However, the occurrence of aneurysmal SAH tended to be higher in both females and the elderly during the winter and spring seasons and not during other seasons. This study indicates that seasonal and climatic conditions do not strongly contribute to the incidence of aneurysmal SAH in subtropical regions. However, elderly people are affected more by climatic conditions than young people.
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Neurol. Med. Chir. (Tokyo) · Jul 1999
Review Randomized Controlled Trial Clinical TrialExperience with vagus nerve stimulation for intractable epilepsy: some questions and answers.
Vagus nerve stimulation (VNS) is gaining increasing popularity and credibility as a treatment option for patients with intractable epilepsy. VNS is a relatively recent innovation, however, and like many other incipient developments, it has engendered a number of unresolved controversies and perplexities. ⋯ Although many enigmas persist, VNS has proven to be a safe, feasible, and potentially effective method of reducing seizures in select patient populations. It offers several advantages over extant treatments and, as a result, holds much promise for future therapy of medically refractory epilepsy.