Procedimiento anestésico - quirúrgico en un lactante con higrohematoma subdural / Anesthetic - surgical procedure in an infant with subdural hygrohematoma

Se describe el caso clínico de un lactante de 47 días de nacido, quien fue atendido en el Cuerpo de Guardia de Pediatría del Hospital Provincial General Docente Antonio Luaces Iraola de Ciego de Ávila, por presentar aumento de la circunferencia cefálica, irritabilidad y agitación. Los exámenes realizados mostraron signos de hipertensión endocraneana descompensada, secundaria a colección del espacio subdural izquierdo. Se eliminó el higroma subdural y la recuperación fue favorable en las primeras 36 horas; luego comenzó a convulsionar y apareció nuevamente el deterioro neurológico, por lo cual se decidió reintervenir. Se realizó inducción anestésica con tiopental sódico fentanilo y rocuronio. El paciente evolucionó sin complicaciones.

The case report of a 47 days infant is described. He was assisted in the children emergency room of Antonio Luaces Iraola Teaching General Provincial Hospital in Ciego de Ávila, due to an increase of the cephalic circumference, irritability and agitation. The exams showed signs of upset endocranial hypertension, secondary to collection of the left subdural space. The subdural hygroma was eliminated and the recovery was favorable in the first 36 hours; then a covulsion began and the neurological deterioration appeared again, reason why it was decided to operate once more. Anesthetic induction was carried out with fentanyl sodium thiopental and rocuronium. The patient had a favorable clinical course without complications.

Changes of Motor Deactivation Regions in Patients with Intracranial Lesions

OBJECTIVE: There is a rich literature confirming the default mode network found compatible with task-induced deactivation regions in normal subjects, but few investigations of alterations of the motor deactivation in patients with intracranial lesions. Therefore, we hypothesized that an intracranial lesion results in abnormal changes in a task-induced deactivation region compared with default mode network, and these changes are associated with specific attributes of allocated regions. METHODS: Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) during a motor task were obtained from 27 intracranial lesion patients (mean age, 57.3 years; range 15-78 years) who had various kinds of brain tumors. The BOLD fMRI data for each patient were evaluated to obtain activation or deactivation regions. The distinctive deactivation regions from intracranial lesion patients were evaluated by comparing to the literature reports. RESULTS: There were additive deactivated regions according to intracranial lesions: fusiform gyrus in cavernous hemangioma; lateral occipital gyrus in meningioma; crus cerebri in hemangiopericytoma; globus pallidus, lateral occipital gyrus, caudate nucleus, fusiform gyrus, lingual gyrus, claustrum, substantia nigra, subthalamic nucleus in GBM; fusiform gyrus in metastatic brain tumors. CONCLUSION: There is increasing interest in human brain function using fMRI. The authors report the brain function migrations and changes that occur in patients with intracranial lesions.

Usefulness of Neuroimaging Study in Cephalohematoma of Newborn / 대한주산의학회잡지

PURPOSE: Cephalohematoma is a common birth injury that is absorbed spontaneously at most of the time. However, it sometimes can be accompanied with severe intracranial lesion which may ultimately lead to death. The aim of this study is to know when the CT and/or MRI study is useful by analyzing the risk factors for intracranial lesion associated with cephalohematoma in newborn. METHODS: From January 2006 to December 2010, 162 infants diagnosed with cephalohematoma were studied retrospectively. We examined the demographic and clinical data, and also examined the reasons for neuroimaging studies with CT/MRI findings. The risk factors for intracranial lesion associated with cephalohematoma were analyzed by uni- and multivariate analysis as well. RESULTS: Among 162 patients, many were groups of normal birth weight, first-born, singlet or vaginally delivered newborns. Of these patients, 13.6% had neurologic symptoms, 4.1% had other birth injuries, and 1.2% died with associated intracranial lesion. Parietal region was the commonest site and most were greater than 3 cm in diameter. Simple skull X-ray was performed in 56.8% and CT/MRI in 28.4%. Giant hematoma and neurologic symptom were the two common reasons for requesting CT/MRI. Intracranial lesions such as hemorrhage, hypoxic-ischemic encephalopathy, and infarction were shown in almost two thirds of patients who performed CT/MRI. Multivariate analysis showed that significant risk factors were being first-born, having large size hematoma (> or = 5 cm) or having seizure. CONCLUSION: CT and/or MRI is recommended in cephalohematoma of newborn, especially for first-born baby with large size hematoma (> or = 5 cm) or seizure.

Clinical Assessment of the Patients Diagnosed with Intracranial Lesion at an Ophthalmology Clinic

PURPOSE: Intracranial lesions may produce ophthalmic symptoms as chief complaints. The purpose of this study is to help ophthalmologists make an earlier diagnosis of the presence of an intracranial lesion. METHODS: The medical records of the patients diagnosed with an intracranial lesion at the department of ophthalmology were reviewed retrospectively. RESULTS: The mean age of 38 patients (Male: Female=18: 20) was 42.2 years. Visual disturbance was the most frequent symptom at presentation (63.2%), and there was strabismus, visual field defects, diplopia, and other complaints. The underlying problem was that for 23 patients, there was an initial misdiagnosis for 10 of them as having a retinal lesion or an optic neuropathy in 10, paralytic strabismus in 9, and there were other misdiagnoses as well. There were afferent pupillary defects in 12 and optic disc abnormalities in 8 patients. The most common type of visual field defects was a bitemporal hemianopsia. The final diagnosis was the presence of a brain tumor in 28, cerebral infarction in 5, carotid-cavernous fistula in 3, aneurysm in one, and histiocytosis in one patient. CONCLUSIONS: The patients that presented with ophthalmologic symptoms were diagnosed as having variable intracranial lesions. Therefore, it is important for the ophthalmologist to pay closer attention so as to discover the specific intracranial lesion through the exam of the pupil, the optic disc, and the visual field test.

Preliminary study of StealthStation neuronavigation in the operation of intracranial lesions / 解放军医学杂志

Objective To evaluate the value of the StealthStation neuronavigation in the operation of intracranial lesions. Methods 22 patients with different intracranial lesions, including 14 cases of glioma, 2 cases of meningioma,4 cases of cavernous angioma,1 case of lymphoma and 1 case of metastatic cancer, were operated on with the aid of StealthStation neuronavigational system. The neuronavigational accuracy and surgical effect were analysed. Results All intracranial lesions were found accurately with StealthStation neuronavigational system, the predicted accuracy (PA) value was 2.53?0.73mm, accuracy sphere of intracranial lesions in the neuronavigational system was within 2mm in all patients. 13 cases out of 14 gliomas were totally removed under microscope, in 1 case removal was subtotal. In 2 patients, neurological symptoms became worse immediately after the operation but improved within 3 months after the operation. The other 12 patients recovered very well. In another 8 cases total removal under microscopy was successful, but one lymphoma patient showed exacerbation of neurological symptoms immediately after operation, but improved within 1 week after operation. The other 7 cases recovered very well. Conclusion The StealthStation neuronavigational system is reliable and accurate in neurosurgical operation, thus it is helpful to facilitate total resection of intracranial lesions with less operative complications.

Urodynamic Evaluation of Patients with Intracranial Lesions according to Lesion Site

PURPOSE: Typical urodynamic findings in patients with intracranial lesion is detrusor hyperreflexia with coordinated sphincter activity. However the findings of urodynamic study may be different from this typical findings, because neurological net effect on voiding function should be variable according to the degree and site of intracranial lesions, the presence of underlying disease and adequacy of initial management of voiding problems from onset of accident. This study was performed to evaluate the type of voiding dysfunction on the anatomic lesion of brain mainly. MATERIAL AND METHODS: In this study, we have retrospectively tried to evaluate the urodynamic findings in 108 patients who had intracranial lesion. Computerized tomography or magnetic resonance imaging was performed to localize the intracranial lesions. RESULTS: Mean patient age was 59.4 years(range 10 to 87). In 108 cases, cerebral infarct was in 47 cases, 29 cases of intracranial hemorrhage, 8 cases of Parkinsonism and 24 cases of other diseases. Patient were grouped according to the presenting voiding complaints, such as 46 cases of irritative symptom and 62 cases of obstructive symptom. Underlying diseases such as diabetic mellitus were 21 cases, which showed hyperreflexia or areflexia. In urodynamic study, detrusor hyperreflexia was noted in 64% of patients, detrusor hyperreflexia with impaired contractility in 14.8% and detrusor areflexia in 18.5%. Patients with detrusor sphincter dyssynergia(DSD) were 14 cases, but only 2 cases had true DSD. In 108 cases according to brain lesion, lesion sites were on basal ganglia in 23 cases and on basal ganglia and thalamus in the 22 cases. Urodynamic study revealed 14 cases of detrusor hyperreflexia in patients with basal ganglia lesion and 14 cases of detrusor hyperreflexia in patients with basal ganglia and thalamus lesion. The involvement of frontal lobe or diffuse lesion showed detrusor areflexia and others showed detrusor hyperreflexia mainly. Most of treatment method was medical therapy(63.9%). CONCLUSION: Presenting symptoms did not predict the urodynamic findings and treatment. Underlying diseases may exacerbate the symptom of the intracranial lesion induced voiding dysfunction. Our study indicates the need to consider bladder outlet obstruction as a cause of urinary retention in old men who suffered from a stroke. On the basis of this study, it is assumed that the effect of the basal ganglia on micturition is inhibitory in nature. Evaluation of underlying diseases and intracranial lesion seems to be helpful in making the protocol of treatment of voiding dysfunction with intracranial lesion.

Spontaneous Regression of an Intracranial Lesion

Spontaneous regression of an intracranial lesion, as seen in sequential CT or MRI images, does not necessarily indicate a self-limiting process such as trauma or vascular disease. This report describes two cases of intracranial enhancing lesions which, on follow-up, showed complete resolution of the changes seen on MRI, without any treatment other than the administration of corticosteroid for a short period. We review several reports of "disappearing CT lesions", and discuss the possible mechanism of disappearance of intracranial lesions.

THE VALUE OF BRAIN CT SCANNING FOR ALERT PATIENTS FOLLOWING MILD HEAD INJURY

A standardized approch to serious head injury employing immediate CT scanning and aggressive medical and surgical therapy has improved outcomes in cases of intracranial lesions. Unfortunately, there is less agreement on how patients with mild head injury should be handled when first seen in an emergency department setting. The ideal policy in mild head injury would be diagnosis or rule-out intracranial lesions as quickly as possible. We reviewed the records of 126 mild head injury patients admitted during 6-month period to the Chonnam University Hospital to identify a group of mild head injury patients having lesions on brain CT scanning and to investigate the risk factors affecting abnormal lesions on brain CT scanning. All patients had alert mental status without neurological deficit and signs of skull fracture. Routine brain CT scans were obtained on all patients. Fifteen patients(12%) had 17 lesions on brain CT scans. Three patients needed surgery for their intracranial lesions. The initial Glasgow Coma Scale(GCS) was 15 in 107 patients and 14 in 19 patients. The incidence of abnormal brain CT lesions for each GCS was 9% in 15 and 26% in 14. The common symptoms of patients who had abnormal brain CT lesions was headache in 7(47%) cases, loss of consciousness in 7(47%) cases, amnesia in 4(27%) cases, dizziness in 4(27%) cases, vomiting in 3(20%) cases, and lethargy in 3(20%) cases. These data suggest that early brain CT scanning is necessary in alert patients who have GCS in 14, headache loss of consciousness, amnesia, dizziness, vomiting, or lethargy following mild head injury.

Clinical Analysis of Linear Skull Fractures

A retrospective analysis of 351 linear skull fractures, during the period of January 1, 1992 to December 31, 1993, reveals the following: 1) Motor-Vehicle-related accidents were responsible for most of the injuries(56%), in which pedestrians(47%) were the primary victims. 2) In 172 cases(49%), the Glasgow Coma Scale(GCS) ranged from 13 to 15. Patients wth parietal fractures usually rated on a lower scale than those with fractures on other sites. 3) Occipital fractures were most common(23%), which was followed by parietal(19%), temporal(15%), frontal(15%), and multiple fractures(8%). Occipital fractures were frequently due to a pedstrian T.A. or a fall from high elevation while temporal or parietal fractures were frequently due to bicycle and motorcycle accidents. 4) The incidence of associated intracranial lesions was 70%. Patients with occipital fractures had a lower percentage of associated intracranial lesions than those with parietal fractures. Coup injuries were found in 175 cases and contre coup injuries in 106 cases. In many cases, frontal, parietal and temporal fractures were found to be coup injuries whereas with occipital fractures, contre coup injuries. 5) Sixty-one percents of the patients were assessed in Glasgow Outcome Scale(GOS) grade I.

Delayed Traumatic Intracranial Lesion

A retrospective analysis of 33 cases with operated delayed intracranial lesion who were admitted to EU1 Ji General Hospital from January 1990 to December 1992 was made according to their age and sex, etiology, lesion site, time interval to finding delayed intracrainal lesion, brain CT findings, relationship of GCS in initial and delayed lesion, associated injuries, treatment and prognosis(GOS). The results were follows : 1) The young males on first to second decade were most frequently affected. 2) The most common caused was pedestrian accident by motor vehicle, followed by fall down. 3) The most common associated injury was skull fracture, followed by skeletal injury of extremity. 4) The most common delayed intracranial lesion was delayed epidural hematoma on youth. 5) The most frequent time interval when the delayed intracranial lesion may be occurred was from 12 hr to 24 hr after admission. 6) The most possible intial lesion which the delayed epidural hematoma may be occurred was scanty hematoma with pnumocephalus or CSF leakage. 7) The GOS(Glasgow Outcome Scale) of analysed 33cases were good in 60% and poor in 40%, i.e good recovery(42%), moderate disability(18%), severe disability(15 %), vegetative state(12%), death(12%).

Massive Gastrointestinal Bleeding Following Intracranial Lesion

"Stress ulceration" of the stomach and duodenum is a nonspecific term used to cover a wide variety of different entities. It has been known for many years that there is an association between gastrointestinal bleeding and intracranial lesion. This is not a common clinical problem, but it has been noted to be increasing over the recent years, possibly due to the increased survival of severe injured neurosurgical patients and neurosurgical procedures. Clinically recongnition of gastrointestinal bleeding or ulceration can be difficult, partcularly in the unconscious patient and prevention of this complication has not been successful. The treatment of that has been the subject of considerable controversy. Prognosis depends on a prevention of hemorrhagic shock or sepsis and promptly proper management. The authors analyzed the 21 cases of massive gastrointestinal bleeding in neurosurgical patients, who were admitted to the department of neurosurgery of National Medical Center from 1978 to 1980.