Increased intracranial pressure without lateralizing signs: the midline syndrome.
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Biomedical subjects
Publications and source records attributed to D Yashon.
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Subacute necrotizing encephalomyelopathy appears to be a distinct pathological entity occurring in infancy and childhood. The neurological manifestations are diverse but the course is one of progressive deterioration. The aetiology is not known and no treatment is available. Histologically the lesion is characterized by multiple areas of necrosis and is remarkable because of a lack of glial or small cell reaction. There is a predilection for the brain-stem but the entire neuraxis may be involved. The mammillary bodies are generally spared. Capillary proliferation and status spongiosus are seen either separately or more commonly in combination. Areas may be found in which no neural tissue is spared or a nucleus may selectively be involved with sparing of adjacent white matter, or occasionally only white matter is involved. In this account the twenty-first, twenty-second and twenty-third cases, one of which had a lesion in the mammillary body, are reported. Possible aetiological mechanisms are discussed.
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Results in ten patients admitted with the diagnosis of complete traumatic quadriplegia and with fracture-dislocation of the cervical spine are reviewed. Emphasis is placed on aggressive emergency surgical treatment of these lesions such as tracheostomy, laminectomy and cord cooling, incorporated into a detailed protocol of overall management.
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Twelve patients with chronic intracerebral hematoma are reported. This condition may be unrecognized as possibly being benefited by relatively simple diagnostic and therapeutic measures. The neurological symptoms and signs may be acute but may also be intermittent and progressive. The etiology is usually systemic hypertension, but trauma, coagulopathies, and obscure etiologies have been implicated. After diagnosis by computerized tomographic scan and/or arteriography, aspiration of the liquid hematoma usually results in improvement. It is hypothesized that recovery is hastened by removal of the hematoma. Often complete recovery ensues, but mild to severe neurological signs may persist depending on the initial damage.
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