ABSTRACT
BACKGROUND: Bilateral transverse basal skull fractures resulting from lateral crushing injuries involve fractures of the clivus that present clinically with multiple cranial nerve injuries and possible delayed vascular injuries due to the tight neural and vascular entry and exit routes present in this region. A case of a young patient with an extensive basal skull fracture is presented with description of the clinical signs and symptoms in relation to the neuroradiological findings. Clinico-anatomic correlations have been reiterated. CASE DESCRIPTION: A case of a young patient suffering a bilateral crush injury resulting in a basal transverse clivus and petrous bone fracture is presented. Multiple cranial nerve injuries, unilateral and bilateral, were present (CN III, VI, VII). This clinical presentation correlated well with the anatomical location and extension of the respective cranial nerves at the level of the skull base and along the fracture line extending bilaterally through the clivus and petrous bone. CONCLUSIONS: Initial neurological and neuroradiological investigations should be aimed at promptly detecting cranial nerve injuries and their correlating fracture injuries at the skull base. The possible development and progression of delayed neurological deficits should also be kept in mind and investigated.
Subject(s)
Cranial Fossa, Posterior/injuries , Skull Fractures/diagnosis , Adult , Cranial Fossa, Posterior/pathology , Cranial Nerve Injuries/diagnosis , Dominance, Cerebral/physiology , Hematoma, Epidural, Cranial/diagnosis , Humans , Male , Neurologic Examination , Tomography, X-Ray ComputedABSTRACT
On the basis of 100 patients operated during the last ten years at the Neurosurgical University Clinic of Zurich the experiences with the extra-intracranial bypass anastomosis for stroke patients are examined. The risks of this surgery are low (morbidity 2%, mortality 3%) and the patency rate is high (94.3%). The main purpose of this intervention is to prevent or minimize further strokes. This risk was decreased from 40% of non operated cases in the literature to 4.2% in this series. Severe neurological deficits are not improved by surgery. The procedure is therefore indicated for mild forms of cerebral ischemia (TIA's and mild strokes), when the disease is caused by an appropriate obstruction of the internal carotid artery and/or middle cerebral artery which are inaccessible to surgery of the neck. For this latter reason preoperative carotid angiography is mandatory. To avoid unnecessary angiography, the carotid Doppler ultrasound test and dynamic brain scanning are valuable, non invasive screening methods for indicating angiography in eah individual case.
Subject(s)
Cerebral Revascularization/methods , Cerebrovascular Circulation , Cerebrovascular Disorders/surgery , Microsurgery/methods , Adolescent , Adult , Aged , Carotid Artery, Internal/surgery , Cerebral Angiography , Cerebral Arteries/surgery , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/epidemiology , Child , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , RiskSubject(s)
Bone Lengthening/methods , Bone Transplantation , Femur/blood supply , Fibula , Humans , MicrosurgeryABSTRACT
Between 1973 and 1978 spontaneous lysis of obstructions in an external cerebral artery was detected in seven out of 3500 patients who suffered from symptoms of cerebrovascular failure in the territory of the internal carotid or vertebral artery. All patients underwent our routine cerebrovascular Doppler ultrasound examination. In the seven patients a high grade obstruction in the internal carotid artery (six cases) or in the brachiocephalic trunk (one case) was found by Doppler and/or angiography 1-3 days after the onset of the symptoms. On a second examination 4-30 days later these obstructions were no longer present either in the Doppler examination and on the angiograms, or in the surgically exposed vessel. These findings suggest that spontaneous lysis of the obstructions must have occurred. Furthermore vascular surgery should not be delayed more than 3-7 days without another reliable vascular examination.
Subject(s)
Arterial Occlusive Diseases/physiopathology , Carotid Artery Diseases/physiopathology , Cerebrovascular Disorders/physiopathology , Fibrinolysis , Adult , Aged , Arterial Occlusive Diseases/complications , Carotid Artery Diseases/complications , Carotid Artery, Internal , Cerebrovascular Disorders/etiology , Female , Humans , Male , Middle Aged , Remission, Spontaneous , Subclavian Artery , Vertebral ArterySubject(s)
Dura Mater/physiopathology , Intracranial Pressure , Brain Concussion/physiopathology , Brain Edema/physiopathology , Brain Injuries/diagnosis , Cerebral Hemorrhage/diagnosis , Cerebral Ventricles/physiopathology , Hematoma/diagnosis , Humans , Hydrocephalus, Normal Pressure/diagnosis , Manometry/methods , Skull/injuriesABSTRACT
Obstructions in the extracranial cerebral arteries can be detected noninvasively by directional Doppler ultrasound technique using 'indirect' and 'direct' criteria. The indirect criteria are based on measurement of flow in the common carotid and in the terminal branches of the ophthalmic artery before and after the common carotid artery and branches of the external carotid artery are compressed. With the direct criteria, internal and external carotid artery are differentiated by diastolic flow, and local inhomogenetics of flow (turbulence) are detected. Flow in the vertebral artery is picked up transorally in the oropharynx. The Doppler examination was used in 2230 patients of whom 436 underwent angiography. The results of Doppler and angiography correlated in more than 90% of the cases.
