Neurochirurgia
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Patients with cervical spine injury presenting with respiratory distress require airway management that does not compromise integrity of the atlanto-occipital joint. Endotracheal intubation by means of direct laryngoscopy is not suitable. The method of choice is nasotracheal intubation of the awake patient, using a flexible fibre bronchoscope. ⋯ Through the other nostril, oxygen is administered. Systemic analgo-sedation is strictly limited to fentanyl, 0.1 mg i.v. Topical anaesthesia of the larynx and cranial trachea is achieved by xylocaine, 2%, administered under direct vision through the instrumentation channel of the fibrescope.(ABSTRACT TRUNCATED AT 250 WORDS)
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Two cases of carotid artery injury due to shotgun blast are presented, one of which resulted in a carotid-cavernous sinus fistula. The diagnosis, natural history, and treatment of this condition is discussed, with emphasis on patient management.
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Spinal cord involvement by sarcoid is quite rare. Only fourteen cases of histologically proven sarcoid without meningeal infiltration have been reported. We present the first CT scan description and the second description of the findings on MR imaging of intramedullary sarcoidosis. ⋯ In a review of surgical reports, we could find only 2 cases of improvement in symptoms after surgical intervention. Additionally, we stress the importance of early diagnosis using the various neuroradiological methods described. We feel that if surgery is performed at an early stage, it may be possible to obtain successful resection of the mass and a good clinical outcome.
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Gadolinium-DTPA enhanced MRI was examined before and after surgery in 14 patients with particular attention to the enhancement of falx cerebri, tentorium cerebelli and dura mater. A marked enhancement was observed in 2 falx and 2 tentorium before surgery, whereas it was observed in 7 falx, 9 tentorium and 11 dura after surgery. ⋯ An increased enhancement of dural structures conceivably derives from the extravasation of Gd-DTPA through capillaries involved in the subdural neomembrane. In the postoperative MRI, the enhancement of dural structures should be taken into consideration.
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Clinical Trial Controlled Clinical Trial
Cerebral blood flow in patients with a subarachnoid haemorrhage during treatment with tranexamic acid.
Many clinicians currently use antifibrinolytic therapy (AFT) routinely in the management of subarachnoid haemorrhage (SAH). Many others do not, either because they remain unconvinced that AFT reduces the risk of rebleeding, or that the medication itself causes serious complications and in particular cerebral ischaemia. Nineteen randomly selected patients were studied, 9 receiving tranexamic acid (9 g a day) and the remaining 10 placebo, with SAH confirmed by CT scanning and by lumbar puncture. ⋯ The difference between the ipsi- and contralateral hemispheres was most pronounced in patients receiving active treatment. Analysis of variance showed that cerebral blood flow was reduced by the active treatment and especially more so on the ipsilateral side with the ruptured aneurysm. The usefulness of AFT should therefore be reconsidered.(ABSTRACT TRUNCATED AT 250 WORDS)