ABSTRACT
Although the clinical implications of anosmia can be significant, posttraumatic anosmia is generally given relatively little attention in the clinical setting. Patients who sustain craniofacial trauma are most at risk. The incidence of posttraumatic anosmia varies according to the severity of injury and has an overall estimated incidence of 7%. Factors that increase the risk of developing anosmia include anterior skull base fractures, bilateral subfrontal lobe injury, dural lacerations, and cerebrospinal fluid leakage. Recovery of function has been estimated to be approximately 10%. Time of recovery, if it occurs, varies between 8 weeks and 2 years. Presented herein are the clinical, radiographic, pathophysiologic, and anatomic substrata of posttraumatic anosmia.
Subject(s)
Facial Bones/injuries , Olfaction Disorders/etiology , Skull/injuries , Adolescent , Adult , Cerebrospinal Fluid Rhinorrhea/etiology , Dura Mater/injuries , Follow-Up Studies , Frontal Lobe/injuries , Humans , Lacerations/complications , Male , Recovery of Function , Risk Factors , Skull Base/injuries , Skull Fractures/complications , Smell , Taste Disorders/etiology , Time FactorsABSTRACT
This article opens with a case study and shows the complex nature of neurologic intensive care patients. After an historical perspective, the administrative organization and collaborative practice are discussed. The author also addresses the impact of outcome research and managed care on the current and future practice of the neurologic intensive care unit.
Subject(s)
Cerebellum/physiopathology , Cerebrovascular Disorders/physiopathology , Health Care Costs , Intensive Care Units/economics , Neurology , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/drug therapy , Electrocardiography , Health Maintenance Organizations , Heparin/administration & dosage , Heparin/therapeutic use , Humans , Injections, Intravenous , Intensive Care Units/organization & administration , Tomography, X-Ray Computed , United StatesABSTRACT
A massive hemispheric "high"-grade astrocytoma, diagnosed in a 6-week-old infant, was totally excised by means of two craniotomies. The child is still alive and well with minimal neurological dysfunction 1.5 years after operation. This case report illustrates the benefit of aggressive surgical excision (without radiation or chemotherapy) of massive malignant neonatal astrocytomas. While surgical deficits may be minimized by the plasticity of the developing nervous system, extensive excision may yield occasional long-term palliation.
Subject(s)
Brain Neoplasms/surgery , Glioblastoma/surgery , Brain Neoplasms/pathology , Cerebral Cortex/pathology , Cerebral Cortex/surgery , Glioblastoma/pathology , Humans , Infant , Magnetic Resonance Imaging , Postoperative Complications/pathology , Prognosis , Tomography, X-Ray ComputedABSTRACT
Within 3 months, a 13-year-old girl had two thoracotomies performed for resection of pulmonary primary and metastatic malignant fibrous histiocytoma (MFH). Seven months following the second operation, a right frontal cerebral metastasis was diagnosed as responsible for the sudden onset of a left hemiparesis. Although she recovered from the craniotomy, and tolerated radiation and chemotherapy, she succumbed 5 months later to recurrent pulmonary involvement. This case report uniquely records the spread of MFH to the brain in a child. The unusual appearance of this tumor in the pediatric age group and its rare presentation intracranially is explored within the context of the current pediatric literature.
