ABSTRACT
Atlantoaxial rotatory subluxation [AARS] is rarely occurred in adults with trauma as the most common cause. In type A and B it is usually managed with close reduction and external brace; however, in nonresponsive cases, surgical interventions might be needed. Our patient is a 21-year-old man with neck pain and torticollis after a car turn- over. There was C1-C2 rotatory subluxation with left side locked facet and C1 rotation about 40 degrees relative to C2 on computed tomography without evident of ligamentous injury in magnetic resonance imaging [MRI]. However, during the first 48 hours, two tries of close reduction using Gardner cervical traction under fluoroscopy were failed. Thus, the patient underwent open reduction of the subluxation and atlantoaxial fixation [Harms technique] with subsequent relief of pain and torticollis. This a rare case of traumatic AARS type A with unilateral locked facet joint in an adult patient which needed surgical manipulation for reduction. The management of the AARS in adults should be individualized in each patient
ABSTRACT
Objectives: To evaluate the odds for unfavorable outcome of each risk factor and a combination of them in patients with aneurysmal subarachnoid hemorrhage [SAH] undergoing surgical clipping in Southern Iran
Methods: A total of 367 patients who were operated between March 2007 and March 2016 due to aneurysmal SAH were analyzed according to patients' factors, aneurysm characteristics and intra-operative data. Correlation between outcomes of patients measured by modified Rankin Scale at 6-months with each factor were analyzed. Market Basket analysis was also used to identify the odds of unfavorable outcome for combinations of factors
Results: A total of 367 patients, including 199 females and 168 males with a mean age of 47.27+/- 11.53 years, who underwent operation between March 2007 and March 2016 due to aneurysmal SAH were analyzed. Unlike gender, higher age was associated with unfavorable outcome. Ischemic heart disease, Duration of operation and amount of bleeding were also found to increase the odds of unfavorable outcome [p=0.01, 0.02, 0.04 respectively]. DM, Cigarette smoking and opium addiction as well as the location and multiplicity of aneurysms did not have an adverse effect on outcome. [p>/=0.05]
Conclusion: Among the numerous risk factors presumed to result in unfavorable outcome in aneurysmal SAH, only older age, duration of operation more than 60 minutes, previous known history of ischemic heart disease, poorer clinical grade and intra-operative bleeding more than 500 mL were found to be significant factors
ABSTRACT
Background and Importance: cavernous angiomas are typically superficial lesionscreated by anomalous vessels and found in the skin or mucosa, but intradural locations are rare especially in the spine. We report a case of the spinal intradural Cavernous angiomas of the lumbar spine
Case Presentation: a 53-year-old man presented with a 6-month history of low back pain and bilateral radicular pain. In examinations, the patient was shown to have numbness in the anterior aspect of the right thigh in L2 territoryand a decrease in lower limb tendon reflexes. Magnetic resonance imaging [MRI] revealed at L1-L2 level, a well-defined intradural lesion in conusmedularis measuring about 18*12mm that shows high signal intensity in T1 images and low signal intensity in T2 images, which causes compression on the cauda roots. Laminectomy of L1-2 was performedfor tumor removal and intradural exploration revealed a small oval shape, brownish cystic like mass surrounded by adherent nerve roots. Complete removal of this tumor was accomplished. Histologic diagnosis wascapillary hemangioma. After operation, the patient's symptoms were improved
Conclusion: we experienced and reported a rare spinal intradural vascular tumor of the lumbar spine. Histologicdiagnosis was Cavernous angiomas
ABSTRACT
Background: Ruptured cerebral aneurysms [ICAs] are the most common non-traumaticcause of subarachnoid hemorrhage [SAH] that is associated with life threateningcomplications such as Vasospasm, Infarction, and Hydrocephalus [HCP]. The activeparticipation of macrophage/monocyte-mediated inflammatory response in thepathogenesis of cerebral aneurysm as labeled with Monocyte ChemoattractantProtein-1[MCP-1] is suggested
Objective: To measure the serum level of MCP-1 in rupturedCAs in different time intervals
Methods: We measured the serum levels of MCP-1 inSAH patients who had CAs and compared it with that of MCP-1 in two control groups:including patients with SAH without CAs, and the normal population of blood donors.We also measured the MCP-1 levels in patients with CAs one week afterward toevaluate the effect of treatment. Serum level of MCP-1 was measured by a commercial ELISA assay
Results: Mean serum MCP-1 level in patients with SAH and CAs was188.2168 Pg/ml and 331.3982 Pg/ml in the normal population. There was nostatistically significant difference between serum levels of MCP-1 on the first[mean=188.2168 Pg/ml] and 7th days after SAH onset [mean=171.8450 Pg/ml][p=0.739]. Serum level of MCP-1 increased significantly as Glasgow Coma Scaledecreased [p=0.078] and Hunt and Hess score increased [p=0.089]
Conclusion: Ourresults did not show an increasing MCP-1 serum level in patients with aneurysmalSAH. There was a relationship between poor clinical grade and MCP-1 levels inpatients with CAs. MCP-1 may be a local inflammatory marker for cerebral aneurysmswithout systemic manifestation
ABSTRACT
Objective: To investigate the effects of intracranial pressure [ICP] monitoring on mortality rate and functional outcome of patients with severe traumatic brain injury [TBI]
Methods: This was historical cohort study being performed in Nemazee hospital of Shiraz during a 4-year period [from 2006 to 2010] including those patients with severe TBI who had undergone care based on ICP monitoring [case group] or clinical evaluation [control group].Patients and controls were matched regarding the age, sex, initial GCS, initial pupils, and CT findings. The functional outcome, complications and mortality rate were recorded and compared between those who underwent ICP monitoring and those who did not
Results: There was no significant difference between two study groups regarding the baseline characteristics. The rate of meningitis was significantly higher in those who underwent Ventriculostomy and ICP monitoring when compared to those who were managed without ICP monitoring. [14 [23.3%] vs. 7 [11.6%]; p=0.041]. We found that the mortality rate [28.3% vs. 11.6%; p=0.172] as well as the frequency of persistent vegetative state [5.0% vs. 5.0%; p=0.998] were comparable between two study groups. However the frequency of severe disability was higher in control group compared to case group [26.7% vs. 15.0; p=0.046]. In the same way, the frequency of good recovery [26.7% vs. 15.0; p=0.046] and favorable outcome [51.7% vs. 33.3%; p=0.021] was significantly higher in case group
Conclusion: Care based on ICP monitoring in patients with severe TBI was associated with increased frequency of good recovery and favorable outcome and decreased frequency of moderate disability. However higher meningitis rate was associated with Ventriculostomy and ICP monitoring