RESUMEN
We report a case of isolated primary medullary hemorrhage with a review of the literature to analyze the clinical presentation and radiological character. A 46-year-old man with chronic alcoholism developed tegmental medullary syndrome secondary to spontaneous hemorrhages in the medulla oblongata. Magnetic resonance imaging study was carried out on the third day after the second event, which showed two distinct isolated hematomas in the medulla oblongata. Digital subtraction angiography was normal. The cause of hemorrhage was presumed to be cryptic vascular malformation. The primary medullary hemorrhage usually presents with a characteristic syndrome of sudden onset vertigo with neurological signs that correspond to various combination of medial and lateral medullary involvement. Usually, the prognosis is good only with conservative treatment.
Asunto(s)
Humanos , Persona de Mediana Edad , Alcoholismo , Angiografía de Substracción Digital , Hematoma , Hemorragia , Imagen por Resonancia Magnética , Bulbo Raquídeo , Pronóstico , Malformaciones Vasculares , VértigoRESUMEN
A 47-year-old man had suffered oscillopsia associated with palatal myoclonus for 10 years. High-field magnetic resonance imaging (MRI) revealed a cryptic vascular malformation within the "Guillain-Mollaret triangle" which was thought to be the responsible lesion.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Tronco Encefálico/anomalías , Imagen por Resonancia Magnética , Mioclonía/etiologíaRESUMEN
Usually cases of brain stem hemorrhage reveal high mortality and poor prognosis in spite of meticulous medical or surgical treatment. Recently we experienced stereotaxic evacuation of brain stem hemorrhage with Brown-Robert-Wells(B.R.W.) system in four cases. If there were residual hemorrhage after initial aspiration, those were evacuated with Urokinase irrigation via stereotaxically placed catheter in the hematoma. The entry point of our operation get on the crossing point of midpupillary line and 1cm behind coronal structure. Preliminary results : 1) Volume of removed hematoma : 5ml(average). 2) Dates of urokinase irrigation : 2 to 4 days after operation. 3) No hydrocephalus, no surgical mortality. 4) Average Glasgow coma scale was improved from 6 in preoperative state to 12 in postoperative state. 5) Operation was performed within 24 hours. 6) Advantages of our procedure. (1) Accurate, simple and safe. (2) Under local anesthesia. (3) Less traumatic procedure. (4) Could remove hematoma completely with Urokinase.