Résumé
Encapsulated acute subdural hematoma (ASDH) has been uncommonly reported. To our knowledge, a few cases of lentiform ASDH have been reported. The mechanism of encapsulated ASDH has been studied but not completely clarified. Encapsulated lentiform ASDH on a computed tomography (CT) scan mimics acute epidural hematoma (AEDH). Misinterpretation of biconvex-shaped ASDH on CT scan as AEDH often occurs and is usually identified by neurosurgical intervention. We report a case of an 85-year-old man presenting with a 2-day history of mental deterioration and right-sided weakness. CT scan revealed a biconvex-shaped hyperdense mass mixed with various densities of blood along the left temporoparietal cerebral convexity, which was misinterpreted as AEDH preoperatively. Emergency craniectomy was performed, but no AEDH was found beneath the skull. In the subdural space, encapsulated ASDH was located. En block resection of encapsulated ASDH was done. Emergency craniectomy confirmed that the preoperatively diagnosed AEDH was an encapsulated ASDH postoperatively. Radiologic studies of AEDH-like SDH allow us to establish an easy differential diagnosis between AEDH and ASDH by distinct features. More histological studies will provide us information on the mechanism underlying encapsulated ASDH.
Sujets)
Sujet âgé de 80 ans ou plus , Humains , Hémorragie cérébrale , Diagnostic différentiel , Urgences , Hématome , Hématome subdural , Hématome subdural aigu , Crâne , Espace subdural , TomodensitométrieRésumé
The azygous anterior cerebral artery (ACA) is a rare type of ACA anomaly. In the conventional angiography, cognition of its realm is difficult without considerable reading. Clinically, misreading its nature causes confusion during the surgical approach to its associated cerebral aneurysm. We report this rare clinical experience with an angiographic and surgical review.
Sujets)
Anévrysme , Angiographie , Artère cérébrale antérieure , Angiographie cérébrale , Cognition , Anévrysme intracrânienRésumé
Cerebral amyloid angiopathy(CAA) is characterized by the deposition of amyloid beta-protein in the walls of small to medium-sized arteries of the leptomeninges and cerebral cortex. While often asymptomatic, CAA can develop into intracerebral hemorrhage facilitated by arterial hypertension. We report the case of a 52-year-old man with CAA and arterial hypertension who developed recurrent cerebral hemorrhages on three different occasions and in multiple non-overlapping loci over a period of nine years. Based on our findings, we recommend brain biopsies for all patients undergoing evacuation of multiple recurrence or atypical pattern intracerebral hemorrhages.
Sujets)
Humains , Adulte d'âge moyen , Amyloïde , Peptides bêta-amyloïdes , Artères , Biopsie , Encéphale , Angiopathie amyloïde cérébrale , Cortex cérébral , Hémorragie cérébrale , Hypertension artérielle , RécidiveRésumé
OBJECTIVE: A prospective, randomized, controlled clinical study is performed to verify the effectiveness of epidural dexamethasone-soaked gelatin sponges to reduce postoperative pain following lumbar microdiscectomy. METHODS: Twenty-three patients (10 men and 13 women) undergoing lumbar microdiscectomy were included. Five pieces of gelatin sponge measuring 1 x 1 cm (Gelfoam; Pharmacia & Upjohn, Kalamazoo, MI, USA), soaked with either 5mg dexamethasone or an equal amount (2 mL) of saline, were left on the decompressed nerve root after unilateral hemilaminectomy, flavectomy and discectomy. RESULTS: Subjective visual analog scale(VAS) scores of leg pain in the dexamethasone group on the first, third and fifth postoperative days (2.5, 2.5, 1.7, respectively) were significantly lower than in the control group (5.0, 4.8, 3.6) ( P<0.05). No side effects related to the dexamethasone-soaked gelatin sponges were observed. CONCLUSION: The intraoperative application of dexamethasone-soaked gelatin sponges during lumbar microdiscectomy can provide effective postoperative analgesia without complications.
Sujets)
Humains , Mâle , Analgésie , Dexaméthasone , Discectomie , Gélatine , Jambe , Douleur postopératoire , Porifera , Études prospectivesRésumé
The authors report a case of cerebral salt wasting(CSW) syndrome followed by diabetes insipidus and meningitis after transsphenoidal approach for pituitary adenoma. Fluid and electrolyte imbalance occurs occasionally in neurosurgical patients due to DI or SIADH, however, CSW is different disease entity and the methods of treatment are different from those of DI or SIADH. A number of studies in recent years have shown that hyponatremia in many patients with intracranial disease might actually be caused by CSW in which a renal loss of sodium leads to hyponatremia and massive urinary water loss. CSW of this patient was resolved by fluid and salt replacement after 6 months.
Sujets)
Humains , Diabète insipide , Hyponatrémie , Syndrome de sécrétion inappropriée d'ADH , Méningite , Méningite bactérienne , Tumeurs de l'hypophyse , Pseudomonas , Sodium , Syndrome cachectiqueRésumé
The authors report a case of monostotic eosinophilic granuloma which occured in the skull. A 37 year-old woman was presented with headache and soft mass in the occipital region. Plain skull X-ray showed a "punched out" osteolytic lesion in the right paramedian posterior parietal bone. Computed tomography shows a soft tissue mass and irregular bone destruction in corresponding region. On magnetic resonance image, the mass was of high signal intensity, with subgaleal extension and looks like a shirt stud or "collar button" on T2-weighted image. Total excision of the tumor and postoperative radiotherapy(1000cGy) were performed. The woman had no headache complains nor showed any focal neurologic deficit during the six months follow-up period. We report a case of monostotic eosinophilic granuloma of the skull with review of the pertinent literatures.
Sujets)
Adulte , Femelle , Humains , Granulome éosinophile , Granulocytes éosinophiles , Études de suivi , Céphalée , Manifestations neurologiques , Os pariétal , CrâneRésumé
The auther studied 54 lumbar spondylolisthesis patients diagnosed and treated with transpedicular screw fixation and bony fusion at our Hosptial between January 1990 and December 1994, and analysed the outcome. The results may be summarized as follows: 1) Of the 54 cases, 17 were degenerative spondylolisthesis and 37 were spondylolytic spondylolisthesis. Occurrence peaked during the fifth and sixth decades. 2) Posterolateral fusion(P.L.F) was performed in 37 cases and posterior lumbar interbody fusion(P.L.I.F) in eight ; P.L.F and P.L.I.F in combination was performed in nine cases. The mean follow-up period was 25 months. 3) In no patients was significant neurologic injury or functional root loss seen. Complications included two instrument failures and one wound infection. 4) Radiologic and clinical outcome was better in degenerative than in spondylolitic spondylolisthesis. 5) The radiologic and clinical outcome of bony fusion types P.L.F and P.L.I.F was the same. 6) The surgical result as evaluated by Mc.Nab's criteria was satisfactory in 81% of patients.
Sujets)
Humains , Études de suivi , Rachis , Spondylolisthésis , Infection de plaieRésumé
Congenital dermal sinus (CDS) is a rare entity widely known to occur as a result of the of the failure of the neuroectoderm to separate from the cutaneous ectoderm during the process of neurulation at the third to fifth week of gestation. The lesion can occur at any level of the craniospinal axis, but are located predominantly at the lumbosacral and occipital region. CDS of thoracic region and cervical region are rare. The patient with CDS presents with meningitis and/or mass effect from the associated inclusion tumor. They are usually dermoid or epidermoid cyst. Teratoma is rarely associated with CDS. We report our experience of CDS an 11-month old boy associated with an intramedullary dermoid tumor at the thoracic region, and together we report a review of the literature.
Sujets)
Humains , Nourrisson , Mâle , Grossesse , Axis , Kyste dermoïde , Ectoderme , Kyste épidermique , Méningite , Plaque neurale , Neurulation , Spina bifida occulta , TératomeRésumé
The authors analyzed 53 cases with spontaneous intracerebellar hemorrhage diagnosed by brain CT scan and assessed the correlation between the mental status at admission, the outcome and the CT findings. The location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the mental status assessed by GCS at admission. The GCS score at admission, location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the outcome. We conclude that decreased GCS score at admission, large volume of hematoma, quadrigeminal cistern obliteration, presence of intraventricular hemorrhage and hydrocephalus could be considered as surgical indications and contributing factors for poor prognosis in the patients with spontaneous intracerebellar hemorrhage.