Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 1990
Case Reports[Wide-spread spontaneous spinal subarachnoid hematoma. Case report].
A 56-year-old female experienced sudden excruciating pain extending from the upper neck to the lower back. She had mild disturbance of consciousness, and a lumbar puncture revealed bloody cerebrospinal fluid. The positive neurological findings were meningitis, spastic paraparesis, hyperesthesia of the left L3 dermatome, bilateral Babinski, disappearance of anal reflex, and urinary retention. ⋯ After the hematoma removal, non-pulsating tortuous vessels were observed on the surface of the spinal cord at the L1 level which ran into the intramedullary region. However, there was no further abnormality to define spinal arteriovenous malformation or fistula within the limits of exposure. The postoperative course was uneventful and about 2 months later she was able to walk by herself.
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Neurol. Med. Chir. (Tokyo) · Jan 1990
Case Reports[Arachnoid cyst of the fourth ventricle. Case report].
A 65-year-old female was admitted because of progressive vertigo, truncal ataxia, and unsteadiness of gait for the past 6 years. Computed tomography (CT) and magnetic resonance imaging revealed a non-enhanced, large midline cyst in the posterior fossa and slightly dilated lateral and third ventricles. Metrizamide CT cisternography showed no communication between the cyst and the subarachnoid space. ⋯ On light microscopic examination, the cyst wall was composed of arachnoid cells and connective tissues. Thus, this lesion was not an epithelial cyst but an arachnoid cyst occupying the fourth ventricle. An arachnoid cyst of the fourth ventricle is extremely rare, and only two cases were previously reported.
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Neurol. Med. Chir. (Tokyo) · Jan 1990
A two-dimensional, finite element analysis of vasogenic brain edema.
The authors constructed a two-dimensional model of vasogenic brain edema, using the finite element method (FEM). The model incorporates the following physical parameters: cerebrovascular hydraulic conductivity, metabolic water production, tissue hydraulic conductivity and compliance, tissue and plasma osmotic and hydrostatic pressures, cerebrospinal fluid hydrostatic pressure and absorption, intracerebral stress, and shift of brain tissue. ⋯ Computer simulation predicted the changes observed in interstitial pressure, extent of edema, intracerebral stress distribution, and shift of brain tissue. The results indicate that the FEM, applied to a model of vasogenic brain edema, can be used to predict the time course and regional distribution of fluid accumulation and the accompanying regional stress and deformation of brain tissue.
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Neurol. Med. Chir. (Tokyo) · Dec 1989
Case Reports Comparative Study[Comparison of five modes of dialysis in neurosurgical patients with renal failure].
In neurosurgical patients with renal failure, dialysis entails specific problems, chief of which is increased intracranial pressure and progressive brain edema as a result of rapid lowering of the serum osmolality. Another major problem is a tendency to hemorrhage, in response to either systemic heparinization or insufficient dialysis. The authors describe the results obtained with hemodialysis (HD), continuous arteriovenous hemofiltration (CAVH), continuous ambulatory peritoneal dialysis (CAPD), continuous peritoneal dialysis (CPD), and intermittent peritoneal dialysis (IPD). ⋯ Continuous dialysis appeared to be superior to intermittent dialysis in these neurosurgical patients in that it produced less brain edema and was less often associated with hemorrhage due to insufficient dialysis. In HD and CAVH, systemic heparinization was also thought to account for the high incidence of hemorrhage. However, CAVH with short half-life anticoagulants may be useful in patients who have abdominal complications and are therefore not suitable candidates for peritoneal dialysis.
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The outcome in 159 cases of head injury was evaluated in terms of the Glasgow Coma Scale (GCS) score, age, and computed tomographic (CT) findings. Children below the age of 10 accounted for 30% of the head-injured patients, and 69% were Saudis. 81% of the patients had a GCS score of 8 or higher, and in this group the outcomes were favorable. In contrast, 19% had an initial GCS score of 7 or less, tended to be older, and had worse outcomes, with a mortality rate of 68%. The initial GCS score, age, presence or absence of associated injuries, and the degree of midline shift according to CT were useful prognostic indices in patients with head injury.