Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Aug 1992
Risk factors for brain abscess in patients with congenital cyanotic heart disease.
Brain abscess is a serious complication of congenital cyanotic heart disease. We retrospectively evaluated the risk factors for brain abscess in 21 such patients treated between 1975 and 1990 in comparison with a control group. ⋯ Patients with congenital cyanotic heart disease may develop minute encephalomalacia due to severe hypoxemia and increased blood viscosity resulting from compensatory polycythemia. The increased blood viscosity and reduced blood flow in the microcirculation may induce cerebral thrombosis or exaggerate minute encephalomalacia during dehydration or cardiac dysfunction, and shunted blood containing infectious organisms at such sites may be followed by focal cerebritis.
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Neurol. Med. Chir. (Tokyo) · Jul 1992
Case ReportsForamen magnum meningioma and arachnoid cyst coinciding in the lateral cerebellomedullary cistern--case report.
An extremely rare foramen magnum meningioma associated with an arachnoid cyst in the lateral cerebellomedullary cistern occurred in a 65-year-old female presenting with dizziness. Neuroimaging revealed a meningioma at the left lateral edge of the foramen magnum and an arachnoid cyst mainly located in the right lateral cerebellomedullary cistern, compressing the medulla oblongata bilaterally. After fenestration of the cyst wall and tumor removal, the clinical symptoms ameliorated. We recommend that where a foramen magnum tumor coexists with an arachnoid cyst of the posterior fossa, the tumor should be removed after shrinking the cyst to obviate the need for brainstem retraction.
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Among 24 arteriovenous malformations (AVMs) involving the choroid plexus, 11 were plexal type AVMs predominantly located in the choroid plexus of the lateral ventricle, and 13 were parenchymal type AVMs mainly situated in the paraventricular cerebral parenchyma. 83% of all AVMs involved both the choroid plexus and the paraventricular cerebral parenchyma. Most cases presented with intracranial hemorrhage, particularly intraventricular hemorrhage. ⋯ Two plexal type AVMs resulted in residual AVMs supplied by the cisternal segment of the anterior choroidal artery, situated in the medial temporal lobe. To prevent postoperative hemorrhage from a small residual nidus, immediate postoperative angiography while the patient is still under general anesthesia should be performed to identify any residual nidus.
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Neurol. Med. Chir. (Tokyo) · Nov 1991
Comparative StudyDirect calorimetry using Swan-Ganz catheter for evaluation of general metabolic expenditure in acute cerebrovascular disease--comparison between direct Fick method and indirect calorimetry technique.
Oxygen consumption calculated by the direct Fick method using a Swan-Ganz catheter (D-VO2) and indirect calorimetry using a metabolic computer (ID-VO2), carbon dioxide production calculated by the latter method, and respiratory quotient were determined pre- and postoperatively in 12 patients with acute hypertensive intracerebral hemorrhage and eight patients with acute ruptured intracranial aneurysm. The mean D-VO2 value was slightly lower than the mean ID-VO2 value, but had a significantly positive correlation. ⋯ The total metabolic expenditure can be calculated from D-VO2 and daily urinary nitrogen excretion. Direct calorimetry using a Swan-Ganz catheter is a simple method to evaluate metabolic expenditure in acute hemorrhagic cardiovascular disease.
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Neurol. Med. Chir. (Tokyo) · Aug 1991
Case ReportsRuptured distal anterior cerebral artery aneurysms presenting as acute subdural hematoma--report of three cases.
The authors report three cases of distal anterior cerebral artery aneurysm presenting as acute subdural hematoma (SDH). Two patients were comatose on admission and died of massive SDH. ⋯ There was no accompanying subarachnoid or intracerebral hemorrhage in one case (pure SDH). These cases are 9.4% of 32 ruptured distal ACA aneurysms treated in our institute in the last 14 years, a higher incidence than reported previously.