ABSTRACT
Acute spontaneous subdural hematoma of arterial origin is very rare. We report five patients who presented with a history of sudden onset of severe headache and vomiting and who developed progressive neurologic deficits, three becoming comatose. The symptomatologic onset was indistinguishable from other cerebrovascular disorders; none of the patients had a history of head trauma. In all our patients, the source of bleeding was identified at operation as a cortical artery located near the Sylvian region. Comparable cases in the literature are reviewed and the etiologic possibilities are discussed.
Subject(s)
Cerebral Arteries , Cerebral Cortex/blood supply , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/diagnosis , Hematoma, Subdural/etiology , Acute Disease , Aged , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
A 40-year-old man with mutism developed after clipping a left distal anterior cerebral artery aneurysm is presented. The most characteristic presenting symptom was complete absence of speech with unimpaired consciousness which occurred on the fourth day after operation. The patient recovered spontaneously within three weeks. In this paper we discuss the possible pathogenesis and anatomical location of mutism related to a distal anterior cerebral aneurysm in view of the literature.
Subject(s)
Intracranial Aneurysm/surgery , Mutism/etiology , Postoperative Complications , Adult , Angiography, Digital Subtraction , Humans , Intracranial Aneurysm/diagnostic imaging , Male , Tomography, X-Ray ComputedABSTRACT
An unusual case is presented in which a fragment of herniated lumbar disc was found within the sheath of the right S-1 nerve root. Diagnosis of intradural and intraradicular lumbar disc herniation is difficult, so that it is rarely suspected preoperatively. Surgical treatment results in a satisfactory clinical outcome.
Subject(s)
Diskectomy , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Nerve Compression Syndromes/surgery , Postoperative Complications/surgery , Spinal Nerve Roots/surgery , Humans , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/pathology , Laminectomy , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Male , Middle Aged , Myelography , Nerve Compression Syndromes/diagnostic imaging , Nerve Compression Syndromes/pathology , Postoperative Complications/diagnostic imaging , Postoperative Complications/pathology , Recurrence , Reoperation , Spinal Nerve Roots/diagnostic imaging , Spinal Nerve Roots/pathology , Tomography, X-Ray ComputedABSTRACT
Cranial bone defects in 27 patients were repaired with bone flaps preserved under the scalp. Head trauma (thirteen patients), cerebrovascular disorder (five patients), postoperative brain swelling (seven patients), and cerebral infective disease (two patients) accounted for the cranial defects. The bone flaps are reimplanted after 14-98 days. The follow-up period was 6 to 26 months. We have encountered no complications related to this technique in 27 consecutive cases.
Subject(s)
Bone Transplantation/methods , Brain Diseases/surgery , Brain Edema/surgery , Brain Injuries/surgery , Craniotomy/methods , Tissue Preservation , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Middle Aged , Suture TechniquesABSTRACT
As the spinal canal expands at T10 level naturally, it has been thought that the migration of a bullet within the spinal canal above this level is prevented and the migration of a bullet may only occur between T10 and S1 level. Here, a very rare case of a bullet traversing the length of the spinal canal is reported.
Subject(s)
Foreign-Body Migration/diagnostic imaging , Spinal Canal/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Wounds, Gunshot/diagnostic imaging , Adult , Foreign-Body Migration/physiopathology , Humans , Male , Spinal Canal/physiopathology , Thoracic Vertebrae/injuries , Tomography, X-Ray ComputedABSTRACT
During the last three years, seven patients with severe intraventricular hemorrhage admitted to our clinic were treated with direct intraventricular infusion of urokinase. In each case, hemorrhage extended into the entire ventricular cavity and cast formation as well as an expansion of third and fourth ventricles were found. On the average, both the third and fourth ventricles became clear on the third day and the lateral ventricle on the ninth day after hemorrhage. Five of the seven patients showed good recovery or only moderate disability, and two died. Infection, convulsion, rebleeding, and peripheral or secondary hemorrhage due to the side effects of urokinase was not encountered during therapy. We conclude that this procedure can be applied effectively and safely in severe intraventricular hemorrhage.
Subject(s)
Cerebral Hemorrhage/drug therapy , Cerebral Ventricles , Urokinase-Type Plasminogen Activator/administration & dosage , Adult , Aged , Cerebral Hemorrhage/diagnostic imaging , Cerebral Ventricles/drug effects , Female , Humans , Injections, Intraventricular , Male , Middle Aged , Neurologic Examination/drug effects , Prospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Urokinase-Type Plasminogen Activator/adverse effects , VentriculostomyABSTRACT
Ischaemia-induced lipid peroxidation is one of the most important factors producing tissue damage in spinal cord injury. In our study, the protective effects of Ginkgo biloba, thyroid releasing hormone (TRH) and methylprednisolone (MP) on compression injury of the rat spinal cord were investigated. For this study 45 rats in four groups, including control, MP, TRH and Gingko biloba, were used to determine the formation of malondialdehyde (MDA). All the animals were made paraplegic by the application clip method of Rivlin and Tator. Rats were divided randomly and blindly to one of four treatment groups (ten animals in each). MP and Ginkgo biloba treatments significantly decreased MDA levels (F = 54.138, P < 0.01). These results suggest that MP and Ginkgo biloba may have a protective effect against ischaemic spinal cord injury by the antioxidant effect.
Subject(s)
Flavonoids/therapeutic use , Hemostatics/therapeutic use , Lipid Peroxidation/drug effects , Methylprednisolone/therapeutic use , Plant Extracts , Spinal Cord Injuries/drug therapy , Thyrotropin-Releasing Hormone/therapeutic use , Animals , Blood Pressure/drug effects , Disease Models, Animal , Flavonoids/administration & dosage , Flavonoids/pharmacology , Ginkgo biloba , Heart Rate/drug effects , Hemostatics/administration & dosage , Hemostatics/pharmacology , Infusions, Intravenous , Male , Malondialdehyde/analysis , Methylprednisolone/administration & dosage , Methylprednisolone/pharmacology , Rats , Spinal Cord/chemistry , Spinal Cord Injuries/metabolism , Spinal Cord Injuries/prevention & control , Thyrotropin-Releasing Hormone/administration & dosage , Thyrotropin-Releasing Hormone/pharmacologyABSTRACT
112 cases of primary intracerebral hematomas treated surgically, 25 cases aspirated with urokinase infusion and 25 cases treated conservatively in the last five years were reviewed in detail. In the craniotomy group, 17 out of 44 survivors showed good recovery and returned to normal life, 18 of them went home needing no care, 8 went home needing partial care, and one was bedridden. The overall mortality rate in this group was 59.8%. In the urokinase group, 6 out of 21 survivors showed good recovery and returned to normal life, 11 of them went home needing no care, 3 went home needing partial care and one was bedridden. The overall mortality rate in this group was 16%. In the conservative group, 8 out of 19 survivors showed good recovery and returned to normal life, 9 of them went home needing no care, and two went home needing partial care. The overall mortality rate in this group was 24%. Although the mortality rate was lower in the urokinase group compared with the conservative group, there was no statistically significant difference between the two groups (P > 0.05). These results indicate that surgery is useless in deeply comatose patients and CT-guided aspiration with urokinase is a simple, effective, and safe method in appropriately selected patients.
