Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · May 1994
Case ReportsConcurrent subarachnoid hemorrhage due to ruptured aneurysm and hypertensive intracerebral hemorrhage--case report.
A 64-year-old female presented with hypertensive thalamic hemorrhage concurrent with subarachnoid hemorrhage (SAH) due to a ruptured aneurysm manifesting as sudden onset of right hemiparesis followed by severe headache. The aneurysm was located in the basilar artery at the origin of the superior cerebellar artery, remote from the thalamic hematoma. ⋯ The method and timing of surgery for such patients depend on hematoma size, location of the aneurysm and hematoma, and neurological status. The intracerebral hemorrhage remote from the ruptured aneurysm should be treated initially if necessary, and the aneurysm clipped after the brain swelling has reduced.
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Neurol. Med. Chir. (Tokyo) · Mar 1994
Case ReportsSerial transcranial Doppler flow velocity and cerebral blood flow measurements for evaluation of cerebral vasospasm after subarachnoid hemorrhage.
Serial transcranial Doppler (TCD) and cerebral blood flow (CBF) examinations were performed in 73 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm to evaluate cerebral vasospasm. Twenty-six (35.6%) of the 73 patients developed ischemic neurological symptoms associated with cerebral vasospasm, which were reversible in all except four patients (5.5%) who demonstrated low-density areas associated with vasospasm on computed tomographic scans. In general, the flow velocities in the middle cerebral arteries began to increase soon after onset of SAH, reaching the maximum between days 8 and 10, subsequently decreasing gradually. ⋯ CBF was measured two to 10 (mean 4.7) times within 3 weeks of SAH using the 133Xe intravenous injection method. The CBF value remained stable even during the period of major risk of vasospasm. However, the CBF was significantly lower in patients with symptomatic vasospasm on days 8, 9, 10, 13, 14, and 15, when compared with patients without symptomatic vasospasm.(ABSTRACT TRUNCATED AT 250 WORDS)
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Neurol. Med. Chir. (Tokyo) · Feb 1994
Review Case ReportsPrimitive trigeminal artery variant associated with intracranial ruptured aneurysm and cerebral arteriovenous malformation--case report.
A 48-year-old female presented with a unique combination of ruptured aneurysm of the right middle cerebral artery (MCA) manifesting as sudden loss of consciousness associated with arteriovenous malformation (AVM) in the right parietal lobe and left primitive trigeminal artery (PTA) variant. Angiography revealed the right MCA aneurysm, AVM fed by the right anterior cerebral artery and MCA, and contralateral PTA variant. The PTA variant was an anomalous posterior cerebral artery originating from the ipsilateral cavernous internal carotid artery. The neck of the aneurysm was successfully clipped and the AVM was totally removed.
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Neurol. Med. Chir. (Tokyo) · Feb 1994
Factors influencing the recurrence rate of intracranial meningiomas after surgery.
The postoperative recurrence rate was examined in 242 patients with intracranial meningiomas to identify correlations with age, location, histology, or extent of surgery (Simpson's grade). There was no significant difference in the recurrence rate among the histological subtypes, but malignant meningiomas and hemangiopericytomas tended to recur earlier. ⋯ The recurrence rates significantly decreased in the order Simpson's grade I surgery, grade II or III surgery, and grade IV surgery (p < 0.001). These results indicate that the most important factor to influence recurrence is the extent of surgical removal.
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Neurol. Med. Chir. (Tokyo) · Dec 1993
Comparative StudyClinical application of angioscopy during carotid endarterectomy for patients with internal carotid artery stenosis.
The accuracy of angioscopy in detecting atherosclerotic changes, such as plaque, ulcer, and mural thrombus, in the extracranial cerebral arteries was evaluated during carotid endarterectomy by comparison with angiographic and operative findings. Ten patients with internal carotid artery stenosis underwent intraoperative angioscopy during surgery. After clamping the carotid bifurcation, intra-arterial atherosclerotic lesions were observed with an angioscope (0.8 or 1.4 mm outer diameter) inserted through a small incision in the common carotid artery. ⋯ In one, an ulcer on angiograms was false positive, and in the other, false negative. These findings were confirmed intraoperatively. Our results suggest that preoperative carotid angioscopy is of great value in detecting ulcers more accurately than angiography, and in selecting candidates for carotid endarterectomy, although further development of equipment is needed.