ABSTRACT
We report a case of spontaneous intracerebral hemorrhage occurring in a young woman and revealing Addison's disease. This autoimmune primary adrenocortical insufficiency was associated with premature ovarian failure. Exhaustive research for nonhypertensive causes of intracerebral hemorrhage was negative. Initial coagulation studies disclosed severe hypofibrinogenemia and prolonged prothrombin time related to vitamin K-dependent coagulation factor deficit. Clotting abnormalities cleared at 4 months under treatment with hydrocortisone. Glucocorticoids are potent regulators of fibrinogen biosynthesis, increasing fibrinogen secretion. We conclude that primary adrenocortical insufficiency induced this hemorrhagic diathesis leading to spontaneous intracerebral hemorrhage. This latter has never been reported in Addison's disease. Primary adrenocortical insufficiency should be considered as a rare potential cause of nonhypertensive intracerebral hemorrhage.
Subject(s)
Addison Disease/diagnosis , Cerebral Hemorrhage/etiology , Addison Disease/complications , Adult , Female , Humans , Magnetic Resonance ImagingABSTRACT
STUDY OBJECTIVE: To determine whether etomidate-based induction can provide better hemodynamics than a standard thiopental sodium-based anesthetic induction. DESIGN: Prospective, single-blind clinical trial. SETTING: Multicenter university neurosurgical operating room. PATIENTS: 66 ASA physical status II and III inpatients undergoing neurosurgical procedures for intracranial tumor or other pathology. INTERVENTIONS: Patients were divided into two groups for anesthetic induction. The first group (control) was divided into two subgroups, with the first subgroup receiving "low-dose" etomidate (LET) 0.4 to 0.6 mg/kg titrated to an electroencephalographic (EEG) spectral edge frequency (SEF) of 10 to 12 Hz. The second subgroup received thiopental sodium (THIO) 3 to 6 mg/kg titrated to the same EEG endpoint. The study group was given high-dose etomidate (HET) 0.5 to 1.7 mg/kg titrated to an early burst suppression pattern. MEASUREMENTS AND MAIN RESULTS: Baseline (awake) measurements of mean arterial pressure (MAP) heart rate (HR), and SEF were obtained prior to anesthetic induction that was accomplished using a small bolus plus an infusion of the induction drug titrated to the EEG target. MAP, HR, and SEF were recorded just prior to laryngoscopy and intubation (T1), 30 seconds after laryngoscopy and intubation (T2), and 90 seconds after (T3) laryngoscopy and intubation. Times to reach EEG endpoint, along with total dose of anesthetic given, were also recorded. Compared with baseline values, the THIO group had the highest increase in both HR (22.9 +/- 4.4 bpm.) and MAP (16.8 +/- 4.2 mmHg) (P < 0.05) after laryngoscopy and intubation. The LET group also had significant increases compared with the HET group that demonstrated the least hemodynamic variability. No correlations could be made between age and dose of induction drug. CONCLUSIONS: Etomidate-based anesthetic induction, titrated to EEG burst suppression, produced stable hemodynamics during laryngoscopy and intubation as compared with lower dose, more "classic" inductions with etomidate or thiopental.
Subject(s)
Anesthesia, Intravenous , Anesthetics, Intravenous , Electroencephalography/drug effects , Etomidate , Laryngoscopy , Thiopental , Adult , Aged , Aged, 80 and over , Blood Pressure/drug effects , Etomidate/adverse effects , Female , Heart Rate/drug effects , Humans , Intubation, Intratracheal , Male , Middle Aged , Prospective Studies , Single-Blind Method , Thiopental/adverse effectsABSTRACT
OBJECTIVE: To assess the respective rates of intensive care maximalization, limitation and withdrawal practice in a neurosurgical intensive care unit. STUDY DESIGN: Prospective clinical study. PATIENTS: All patients who died in the unit during the year 1994 were included in this study. METHODS: Demographic data and medical history of these patients were collected, and treatments during the last days and the 24 hours before death were reviewed. RESULTS: Among the 49 cases collected during the study period, 16 patients (33%) received full intensive therapy until their death. In 29 (59%), death was preceded by some limitation of treatment, and in 4 (8%) life-sustaining treatment (mechanical ventilation, vasopressor infusion) had not been undertaken. CONCLUSION: This prospective study confirmed the results of several previous surveys. The medical decision to limit or to discontinue treatments is rather frequent in intensive care units. This is an illegal practice in French legislation and code of professional ethics. Recommendations by representative French medical associations on the modalities of decision making on limitation of therapy would be welcome.
Subject(s)
Critical Care , Nervous System Diseases/therapy , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Life Support Care , Male , Middle Aged , Prospective Studies , Resuscitation Orders , Right to DieSubject(s)
Acidosis/chemically induced , Anticonvulsants/adverse effects , Valproic Acid/adverse effects , Aged , Female , Humans , Male , Middle Aged , Postoperative PeriodSubject(s)
Akathisia, Drug-Induced/etiology , Craniotomy , Epilepsy, Generalized/chemically induced , Hyperventilation/chemically induced , Shock/chemically induced , Valproic Acid/adverse effects , Acidosis/chemically induced , Adult , Aged , Anesthesia Recovery Period , Female , Humans , Infusions, Intravenous , Male , Middle Aged , Valproic Acid/administration & dosageSubject(s)
Critical Care , Neurosurgical Procedures , Postoperative Care , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Postoperative Complications/mortality , Prognosis , Recovery Room , Severity of Illness IndexABSTRACT
The authors report a patient operated on trans-nasosphenoidally for a pituitary adenoma (Cushing's disease) in whom a severe infection occurred with cavernous thrombophlebitis responsible for neurological complications.
Subject(s)
Adenoma/surgery , Intracranial Embolism and Thrombosis , Pituitary Neoplasms/surgery , Postoperative Complications , Sinusitis , Streptococcal Infections , Adult , Face , Female , Humans , Intracranial Embolism and Thrombosis/complications , Intracranial Embolism and Thrombosis/diagnostic imaging , Nasal Bone , Postoperative Complications/diagnostic imaging , Radiography , Sinusitis/complications , Sinusitis/microbiology , Sphenoid Bone , Surgical Procedures, Operative/methodsABSTRACT
Post-operative acute oliguric renal failure was treated over a period of 17 days by continuous arterio-venous haemodialysis in man operated on for intracranial tumor. The Authors dwell on the advantages of this dialysis system in neurosurgery.
Subject(s)
Acute Kidney Injury/therapy , Brain Neoplasms/surgery , Postoperative Complications/therapy , Renal Dialysis/methods , Temporal Lobe , Acute Kidney Injury/complications , Adult , Anuria/etiology , Humans , MaleABSTRACT
One hundred and thirty three patients of both sexes were operated on for pituitary tumors with transphenoidal microsurgery. Postoperative complications are discussed.
Subject(s)
Pituitary Neoplasms/surgery , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Sphenoid Bone , Surgical Procedures, Operative/methodsABSTRACT
Recording brainstem auditory evoked potential (BAEP) in post operative period after neurosurgery is easy. The presence of abnormal BAEP predicts unfavorable outcome in both cases with or without sedation. But in case of normal recording it is impossible to predict surely a favorable outcome.
Subject(s)
Evoked Potentials, Auditory, Brain Stem , Nervous System Diseases/surgery , Adult , Female , Humans , Male , Middle Aged , Monitoring, Intraoperative , PrognosisABSTRACT
The study of cerebral blood flow (DSC) in 29 patients with intracranial aneurysm is interesting to diagnose cerebral ischemia without clinical and radiological effect. A test with nimodipine sensitize this exam, confirm the efficacy of this drug in located ischemias. But may reveal a decrease of cerebral blood flow after nimodipine: it is probably an interesting therapeutic test.