Nō to shinkei = Brain and nerve
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A 76-year-old diabetic woman received epidural catheterization for sigmoid colectomy. Four months later she started to complain of fever and severe lumbago, and finally fell into coma and tetraplegia. She had severe neck stiffness, and lumbar puncture yielded yellowish pus. ⋯ Spinal epidural abscess often develops rapidly after Staphyloccocus aureus infection. In our case, however, neurological deficits appeared 144 days after insertion of epidural catheter. We must remember that spinal epidural abscess is an important cause of lumbago with high fever, even several months after surgical or catheterial intervention to the spine, for immunocompromised patients with diabetes or neoplasm.
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It has been reported that contrast-enhanced fluid-attenuated inversion-recovery (FLAIR) sequences were useful for detecting superficial abnormalities, such as meningeal disease, because they do not demonstrate contrast enhancement of cortical vessels with slow flow as do T1-weighted images. We reported the usefulness of contrast-enhanced FLAIR images to differentiate cerebral venous angioma from tumor in two patients. Case 1 was a 71-year-old man developed cortical hemorrhage. ⋯ Post-contrast FLAIR images showed no enhancement, and she was diagnosed as cerebral venous angioma. Contrast-enhanced fast FLAIR sequences was useful in differentiation between venous angiomas and tumors. Identification of these lesions was due to the flow-void phenomenon in vessels with slow-flowing blood such as venous angioma, which could not be differentiated from tumors on T1-weighted images.
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Acute subdural hematoma (ASDH) without subarachnoid or intracerebral hemorrhage following rupture of an intracranial aneurysm is rare. Only 34 cases of pure ASDH resulting from rupture of an intracranial aneurysm, and 5 cases of pure ASDH secondary to rupture of an anterior cerebral artery (ACA) aneurysm, have been reported in the literature. We report a case of a patient with a ruptured distal ACA aneurysm who presented pure ASDH on CT. ⋯ Evacuation of the subdural hematoma, with the clipping of the aneurysm was performed. Intraoperatively, adhesion between the dome of aneurysm and the falx cerebri was observed. The patient was discharged from the hospital without neurological deficits.
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Case Reports
[A case of vertebral dissecting aneurysm manifesting as subarachnoid hemorrhage following nuchal pain].
We report a case of subarachnoid hemorrhage (SAH) from vertebral dissecting aneurysm 4 days after first nuchal pain. The patient was a 46-year-old man with a sudden onset of nuchal pain. There were no obvious abnormalities detected on MR images in another hospital. ⋯ The incidence of the vertebral dissecting aneurysm presenting with nuchal pain alone due to dissection is reported to be 7% in the literature. The prognosis of non-hemorrhagic vertebral dissecting aneurysm followed by delayed SAH is considered to be fatal. Therefore, careful investigations for differential diagnosis should be taken into account since the diagnostic possibility exists that non-hemorrhagic vertebral dissecting aneurysm would be manifested by a symptom of headache/nuchal pain alone.