Neurology
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A young woman had a frontal lobe astrocytoma 14 years after successful treatment of a posterior fossa medulloblastoma by surgery and whole-neuraxis irradiation. The association of these two tumors is rare, and it is unlikely that the second tumor was the result of metastasis and differentiation of residual or recurrent medulloblastoma. We review the evidence supporting this view and also the likelihood that the astrocytoma was induced by the prior radiation.
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A 24-year-old man had a massive right cerebral infarction after occlusion of the middle cerebral artery trunk by a shotgun pellet that embolized from the heart during external cardiac massage for cardiac arrest. The cerebral infarct was followed by massive edema, uncal herniation, and death.
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Review
Antifibrinolytic therapy in subarachnoid hemorrhage caused by ruptured intracranial aneurysm.
There are 25 published studies on the treatment with antifibrinolytic agents of subarachnoid hemorrhage (SAH) caused by ruptured intracranial aneurysm. Twelve of these studies were uncontrolled and, except for one, all reported reduced incidence of rebleeding. ⋯ Three studies showed no effect, and three reported a higher incidence of rebleeding in treated patients. Discrepancies may be due to the multiple clinical variables of SAH and to flaws in methodology; nevertheless, the data fail to demonstrate that antifibrinolytic therapy alters the natural history of the disease.
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Fourteen children with Arnold-Chiari malformation had history of respiratory distress, apnea, vocal cord paralysis or inability to swallow. Postmortem examination in 12 disclosed vascular lesions in the tegmentum of the medulla oblongata. ⋯ It is suggested that the malformation results in changes in the vascular supply of the herniated portion of the brainstem. Stretching of the arteries may result in irreversible damage to the brainstem with subsequent life-threatening disturbance of respiratory function.