Nō to shinkei = Brain and nerve
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The occurrence of air embolism in supine position operation is extremely rare. We reported a case of air embolism during the operation of a ruptured middle cerebral artery aneurysm in supine position. A 58-year-old woman was admitted to our hospital in semicomatous state. ⋯ A postoperative cerebral angiogram showed occlusion of a temporal branch of the right middle cerebral artery, P1 portion of the left posterior cerebral artery, and the right superior cerebellar artery. We speculated that high endotracheal pressure brought out pulmonary alveolar rupture, and in spite of supine position operation massive air, which flowed into systemic circulation from ruptured alveoli, caused cerebral infarction and cardiac arrest. We consider that unrecognized air embolism might be the one of the factors influencing the prognosis of severe subarachnoid hemorrhage, especially in the cases associated with neurogenic pulmonary edema.
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A very rare case of acute subdural empyema due to peptostreptococcus was reported. A 11-year-old-girl was admitted to our hospital with high grade fever, unconsciousness and rt hemiparesis. CT scans showed the mass effect caused by the subdural empyema over the left frontotemporal region. ⋯ Associated otorhinologic lesions must not be overlooked. Otorhinologic consultation should immediately be obtained so that the drainage of an infected paranasal or mastoid sinus can be performed at the time of craniotomy. This is critical to prevent the recurrence of the subdural empyema from further extension of the extracranial disease.
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Few reports have appeared in regard to cerebral perfusion pressure (CPP) accompanying fluctuations in intracranial pressure (ICP), arterial pressure (BP) and central venous pressure (CVP) as well as autoregulation of cerebral circulation in neonates and infants. Therefore, we report here on interesting findings we obtained from monitoring ICP, BP, and CVP during operations in 30 neonates or infants with congenital heart disease as our subjects. i) ICP fluctuates depending on arterial pressure and venous pressure, but changes in the latter display a clearer effect. ii) On inducing anesthesia the amplitude of ICP pulsating waves became gradually larger, but following intubation intracranial pressure was somewhat reduced and became stable. iii) Following thoracotomy CVP rose and at the same time intracranial pressure also increased somewhat. Before thoracotomy ICP pulsating waves resembled arterial pressure wave forms, but after thoracotomy they resembled central venous pressure wave forms. iv) In cases with two-peak ICP pulsating waves, when we conducted a study by blocking venous return from the internal carotid vein during the operation by the Queckenstedt method, ICP rose by increasing its amplitude, but the pulsating wave forms lost their venous component, and changed into a single peak consisting of an arterial component. v) In order to observe the relationship between changes in arterial pressure and ICP, when we looked at changes in ICP accompanying partial blockage of the descending aorta (DAo), simultaneously with the partial blocking of the DAo both AP and CVP rose, and ICP also rose accordingly. ⋯ This finding indicates that by blocking of the DAo, intracranial arterial and venous blood volume abruptly rapidly increase and since CVP also rises, therefore ICP rises to maintain a balance with these. As a result, this brings about the effect of normally maintaining the cerebral perfusion volume. vi) If we look at changes in ICP brought about by partial blocking of the ascending aorta, blockage of the artery brought about a further reduction in BP, and in this case since the arterial blood flow into the cranium also fell off markedly, we found that ICP also was reduced. The above results suggest that in the normal brains of neonates and infants even when under various conditions various fluctuations in corporeal circulation develop, cerebral perfusion volume adjusts itself in response to this, and thus autoregulation of cerebral blood flow is able to act in an adequate way.
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Review Case Reports
[Dissecting aneurysm of distal posterior inferior cerebellar artery--case report and review of the literature].
A rare case of dissecting aneurysm of distal posterior inferior cerebellar artery (PICA) is reported. A 51-year-old woman was admitted to our hospital complaining of severe headache and nausea. CT scan revealed subarachnoid hemorrhage which was thicker in the posterior fossa. ⋯ In all three cases found in the literature, the dissecting aneurysms are sited in the anterior medullary segment of PICA. Probably, this is the first report described a dissecting aneurysm on the more distal part-telovelotonsillar segment of PICA. The clinical features, pathogenesis and treatment of intracranial dissecting aneurysms are briefly discussed with reviewing the literature.
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Recent studies have demonstrated that intramuscular administration of thyrotropin-releasing hormone (TRH) or its analogue improves various clinical aspects of intractable epilepsy such as Lennox-Gastaut syndrome, West syndrome, and myoclonus epilepsy. Other clinical studies reported efficient property of intravenous TRH against status epilepticus. However, it is also true that intravenous TRH produces epileptic seizures in patients with epilepsy or organic brain damage. ⋯ With 50 mg/kg of TRH, the exaggerated seizure patterns were followed by marked suppression of electroclinical seizures. 50 micrograms of i.c.v. TRH (n = 5), like higher doses of i.v. TRH, caused a slight, but not a significant, build up of electroclinical ictal seizures, beginning immediately after the injection and lasting for about 30 min.(ABSTRACT TRUNCATED AT 250 WORDS)