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PubMed1989

[Pulmonary embolism as a complication in neurosurgical patients].

The overall incidence of pulmonary embolism (PE) among neurosurgical in-patients, whose ages ranged from 23 to 80, was 0.7%. Our report here is based on five cases of patients with PE. Four of these five patients were over 50 years of age. They had been admitted because of such reasons as brain tumor, spinal cord injury, intracerebral hematoma, and venous sinus thrombosis. Deep vein thrombosis (DVT) was seen in four but none were diagnosed before they had developed PE. Decreased level of consciousness and prolonged bed rest appeared to be common risk factors for PE. Mean duration between admission and onset of PE was 31 days. Although non-specific, tachycardia, tachypnea and hypoxemia were the most common signs and symptoms. As a definitive diagnostic procedure, pulmonary angiography was performed in most of cases. One patient required surgical embolectomy and others were treated with anticoagulation or fibrinolytic agents. In order to prevent recurrent thromboembolic phenomena, ligation of the inferior vena cava was a useful mode of treatment when anticoagulation was not indicated. And this approach seemed to be valid in most neurosurgical patients. We conclude that PE and DVT were not uncommon complications among Japanese neurosurgical patients and they can be treated successfully in collaboration with a cardiovascular surgeon if the diagnosis can be made correctly.

Adult↗
PubMed1989

[Fracture of the temporal bone. Evaluation of 123 cases].

Out of 2,888 blunt head injuries that were treated at the Hermann Hospital Trauma Center of the University of Texas at Houston, only 123 temporal bone fractures were diagnosed in 110 patients. The clinical diagnosis was confirmed with high resolution computerized tomography of the temporal bones. Three main categories of fractures were identified: oblique in 74%, longitudinal in 13% and transverse in 13%. The clinical manifestations included hemotympanum in 83%, cerebrospinal fluid otorrhea in 21% and Battle's sign in 10.6%. One third of the patients had conductive hearing loss, 1/2 had mixed hearing loss and the rest sensorineural loss. On exploration, the most frequent middle ear pathology was incudostapedial joint dislocation. Immediate facial paralysis was observed in 64 patients. Only 11 patients needed facial nerve exploration following signs of denervation, the rest recovered spontaneously. Thirteen patients who had delayed facial paralysis also recovered spontaneously. One third of the patients had persistent unsteadiness 6 weeks following the injury. Other unusual complications encountered include 6 cases of abducent paralysis, 2 cases of trigeminal paralysis and 2 cases of aseptic sigmoid sinus thrombosis.

Adolescent↗
PubMed1989

[Role of MRI in the pediatric central nervous system disorders].

Recent rapid development of the MRI system has enabled us to diagnose precisely the disorders of the central nervous system (CNS) also in neonates and young children. Because of a long studying time, the use of oral chloral hydrate or other alternative drugs for sedation, such as secobarbital and meperidine, is necessary for young children under 6 years of age. The advantages of MRI are the optional plane imaging, a high contrast resolution, and the artifact-free imaging from the surrounding bones and air. MRI can detect myelination disorders and the lesions in the posterior fossa, the middle fossa, and the spinal canal. These abnormalities are difficult to depict with conventional X-ray CT scanning. MRI is useful also for the survey of various congenital anomalies of the brain and the spine. Furthermore, it is sensitive enough to detect the CNS blood flow and the cerebrospinal fluid (CSF) flow. Arteriovenous malformation, moyamoya disease, and sinus thrombosis are diagnosed by MRI without using contrast media, CSF flow void phenomena in the aqueduct and the Monro's foramina are indexes of the CSF pathway obstruction and of normal pressure hydrocephalus.

Adolescent↗
PubMed1989

[Fractures of the petrous bone. An evaluation of 123 cases].

Out of 2,888 blunt head injuries that were treated at the Hermann Hospital Trauma Center of the University of Texas at Houston, only 123 temporal bone fractures were diagnosed in 110 patients. The clinical diagnosis was confirmed with high resolution computerized tomography of the temporal bones. Three main categories of fractures were identified: oblique in 74%, longitudinal in 13% and transverse in 13%. The clinical manifestations included hemotympanum in 83%, cerebrospinal fluid otorrhea in 21% and Battle's sign in 10.6%. One third of the patients had conductive hearing loss, 1/2 had mixed hearing loss and the rest sensorineural loss. On exploration, the most frequent middle ear pathology was incudostapedial joint dislocation. Immediate facial paralysis was observed in 64 patients. Only 11 patients needed facial nerve exploration following signs of denervation, the rest recovered spontaneously. Thirteen patients who had delayed facial paralysis also recovered spontaneously. One third of the patients had persistent unsteadiness 6 weeks following the injury. Other unusual complications encountered include 6 cases of abducent paralysis, 2 cases of trigeminal paralysis and 2 cases of aseptic sigmoid sinus thrombosis.

Adolescent↗
PubMed1989

[An infant with AIDS].

A four-month-old girl was hospitalized with pneumococcal sepsis from which she recovered. Subsequently she developed various other infectious diseases, including chronic diarrhoea caused by Cryptosporidium. After a period with neurological symptoms, later sagittal sinus thrombosis and cerebral atrophy, she died at age 13 months. It was found that the child suffered from AIDS. The mother was seropositive and the virus had probably been transmitted via the placenta. Rapid recognition of infants and young children with AIDS is necessary, for in the near future more cases of this disease will occur. Antiviral treatment may bring about improvement in children as well.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Clinical analysis of trigeminal neuropathy as initial manifestations--an etiological study].

The differential diagnosis of trigeminal neuropathy is quite challenging because there is a significant variety of causes for the disorder. We reviewed our cases of trigeminal neuropathy by studying first the initial manifestations in order to evaluate their underlying disorders. Sixty-four patients with trigeminal neuropathy came to our Out-Patients clinic. We have excluded from our analysis any patients with atypical pain, facial migraine, nasal sinusitis, pain from inflammation of dental pulp or facial bones, and pretrigeminal neuralgia. In 53 cases (83%) we identified the causes; 35 of them were cases of symptomatic trigeminal neuritis and 18 were trigeminal neuralgia while, in the remaining 11 cases, no definitive causative disorder was identified. Among the 35 patients with symptomatic neuritis, 10 cases were found to have malignant neoplasms including 5 cases of squamous cell carcinoma, 6 had a virus infection, 5 had traumatic origin, 4 had multiple sclerosis, 2 exhibited Tolosa-Hunt syndrome, 2 had MCTD, and there were single cases of sarcoidosis, serpentine aneurysm, cavernous sinus thrombosis, maxillary cyst and trigeminal neurinoma. The remaining 11 cases of neuritis whose causes were undetermined showed clinical features similar to trigeminal sensory neuropathy, an analogue of Bell's palsy, a benign self-limiting condition. Since the cases shared symptoms of impairment of taste, and, occasionally, of facial palsy, vestibular insufficiency, hearing disturbance, hypoglossal palsy or signs of cerebellar lesion, we strongly suspected a virus origin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

The acute painful eye.

A number of ocular and nonocular conditions may produce an acutely painful eye or orbit. A careful history and physical examination with special attention to the cornea, sclera, fundus, and cranial nerves will usually delineate the etiology of the pain. In particular, certain life- or vision-threatening conditions such as leaking internal carotid aneurysm, cavernous sinus thrombosis, orbital cellulitis, acute narrow-angle glaucoma, and temporal arteritis must be kept in mind.

Acute Disease↗
PubMed1987

Postoperative sequelae and complications of rhinoplasty.

This article has overviewed complications of rhinoplasty. Generally, these complications fall into two categories: aesthetic (that is, cosmetic sequelae that may require a revision rhinoplasty) and nonaesthetic. Of the nonaesthetic complications, infection has the widest span of severity. A localized Staphylococcus aureus abscess or Pseudomonas infection of the nose may occur postoperatively. Owing to the proximity of the nose to the cranium, a cavernous sinus thrombosis or basilar meningitis may result. Postoperative toxic-shock syndrome is a rare occurrence that surgeons should be aware of; most cases have occurred with the presence of nasal packing, but a case using only plastic nasal splints has been reported also. Bacteremia seems to be uncommon during rhinoplasty. Infection after rhinoplasty is generally much less frequent than one would expect from an operation in an unsterile field. Antibiotics are frequently utilized electively. Postoperative nasal-periorbital edema and ecchymosis are regarded as unavoidable but may be lessened significantly by postoperative head elevation and cold packs. The possibility of postoperative bleeding must be evaluated by the surgeon preoperatively. This sequela usually occurs either within 72 hours postoperatively or at around 10 days postoperatively. Many different causes exist for chronic postoperative nasal obstruction, from poorly supported nasal valves closing upon inspiration to an enhanced allergic rhinitis leading to chronic nasal mucosal edema. The latter may be treated by injection of steroid into the turbinates. Among aesthetic complications, supratip prominence, saddle deformity, and persistent hump are among the more commonly reported. Supratip prominence--"polly-beak"--can be caused by inadequate reduction of tip cartilaginous or soft-tissue elements, especially in relation to the reduction of the dorsum. An over-reduced dorsum will leave an otherwise normal nasal tip with a relative prominence. An accumulation of blood or a mucous cyst occurring under the skin of the tip will produce a prominence. Poor tip projection, tip ptosis, and alar collapse are the result of overreduction of tip elements. A dislocated alar cartilage can appear as an asymmetric nasal bossa. Saddle-nose deformity occurs after overaggressive bony and/or cartilaginous hump removal. Infractured nasal bones that subsequently drop into the piriform aperture can create a bony saddle. Persistent hump is due to inadequate reduction of a bony or cartilaginous hump. If the septal cartilage reduction is disproportionate to the bony septum reduction, the appearance of either a hump or a saddle is possible.(ABSTRACT TRUNCATED AT 400 WORDS)

Consumer Behavior↗
PubMed1988

[A case report of simultaneous multiple intracerebral hematomas].

A case of multiple spontaneous intracerebral hematomas is presented. A 67-year-old man with 7 years history of hypertension had sudden clumsiness in his right hand and an hour later dysarthria appeared. A CT scan taken 3 hours after the onset revealed two well demarcated high density areas in the left putamen and in the parietal subcortex. A diagnosis of multiple intracerebral hematomas was made. On neurological examination he was midly stuporous (13 points of Glasgow Coma Scale). Dysarthria, right hemiparesis and right extensor plantar response were seen. CT scan of 6 hours later disclosed the same findings as the previous study. He recovered well and neurologically free in a few days. On the following CT scans both hematomas were isodense 2 weeks later, and ring-like enhancement effect was noted. CT scan showed normal appearance 7 weeks later. On MRI using 0.5 T unit t-1 and t-2 weighted spin echo images of these hematomas also showed the similar chronological changes. The history, these CT and MRI studies suggest that two hematomas of this case occurred almost simultaneously in one cerebral hemisphere. No causative factors such as blood dyscrasias, AVM, angioma, septicemia, malignancies or sinus thrombosis was identified. We consider that a hypertensive intracerebral hematoma of the putamen was followed by the parietal intracerebral hematoma within a few hours, although amyloid angiopathy was not completely excluded because no cerebral biopsy of the lesion was performed.

Aged↗
PubMed1986

[Direct carotid angiography using a subcutaneous needle and injection of minimal dosage of contrast media--a special use of DSA].

A new simplified cerebral digital subtraction angiography (DSA) has been performed using a fine subcutaneous needle (21G-23G) and minimal volume (1.5 2 ml) contrast medium in 33 cases. Representative angiograms have been presented in 3 cases (one of occlusive cerebrovascular disease, cerebral aneurysm, and superior sagittal sinus thrombosis respectively). Advantages of this method are simple procedure, easy puncture with little carotid injury and almost none of patient's complaints accompanied by dye-injection. Therefore, this technique is very useful in emergency cases, as a screening test in an outpatient clinic, and also in senile cases. Periarterial injection of contrast media was experienced in 5 cases which would be overcome by using a little larger needle like 21G in the future.

Adult↗
PubMed1987

Otocerebral mucormycosis--a case report.

Mucormycosis is an often fatal infection caused by ubiquitous organisms of the order Mucorales. Infection is most commonly seen in the immunocompromised host, particularly in the setting of diabetic ketoacidosis. The most common presentation is with rhinocerebral involvement. We here report a case of otocerebral mucormycosis occurring in an elderly man with maturity onset diabetes who was not acidotic. The unusual site of infection delayed diagnosis until the pons had been invaded by the infecting organism which was demonstrated as a hypodense area on CT scan. Consequently radical excision of infected tissue was not feasible and the patient died. At post-mortem examination there was extensive infection and infarction of the parotid gland, inner ear and pons associated with arterial invasion by the fungus and septic cavernous sinus thrombosis. The case is described to demonstrate the existence of other modes of neurological presentation of mucormycosis apart from the well recognized rhinocerebral form. Early diagnosis is the key to successful therapy.

Aged↗
PubMed1986

Isotope cisternography in patients with intracranial hypertension.

Cerebrospinal fluid flow (CSF) was studied using isotope cisternography in 52 patients with increased intracranial pressure (ICP), all of whom showed acute transient rises of ICP, i.e., plateau waves, in their continuous ICP recordings. The patients were assigned to two groups. Group I was comprised of 23 patients without hydrocephalus and high ICP resulting from brain tumors, benign intracranial hypertension, and superior sagittal sinus thrombosis. Group II included 29 patients with either communicating hydrocephalus or high ICP resulting from rupture of intracranial aneurysm. Plateau waves were frequently observed in patients with baseline pressures ranging from 21 to 40 mmHg in both groups. The isotope cisternographic pattern in the Group I patients showed a large accumulation of radioactivity over the cerebral convexities, while that in the Group II patients revealed a complete obstruction of the subarachnoid space over both cerebral convexities. The isotope clearance from the intracranial CSF showed a marked delay in both groups of patients with one exception. The results suggest that, in the limited range of increased ICP caused by delayed CSF absorption, plateau waves are most evident regardless of the isotope cisternographic pattern.

Adult↗
PubMed1985

[Acute parasellar compression syndrome disclosing hypophyseal adenoma. 3 cases].

Three cases of acute necrosis of a hypophyseal adenoma are reported with a review of the medical literature. The clinical presentation as an acute parasellar compression syndrome was the result of aseptic meningitis in 2 cases and of cavernous sinus thrombosis in the other; the usual symptoms of headaches, oculomotor paralysis and impairment of consciousness were observed. The diagnosis was suspected on clinical grounds, by the radiological changes of the pituitary fossa and confirmed by computerised axial tomography. All three patients had a favourable outcome. Surgery was only required in one case with threatening visual complications. Dissociated anterior pituitary deficiency persisted in all cases; two patients also had diabetes insipidus. In one case, the pituitary necrosis stabilised an acromegaly for a two year period.

Adenoma↗
PubMed1985

[Neurologic manifestations of osmolality disorders].

Irrespective of the etiology, a water and electrolyte imbalance provoking a hypo- or hyperosmolar state causes metabolic encephalopathy, as may occur with any metabolic disturbance. The pathophysiology of metabolic encephalopathy relies on a diffuse neuronal dysfunction which occasionally shows a focal maximum. To the clinician it presents in the form of nonspecific symptoms or signs, such as altered level of alertness or awareness of the environment, or impaired attention, cognition or orientation. When the onset of hypo- or hyperosmolality is rapid, delirium may develop or the level of consciousness can decrease to the point of coma. Myoclonic jerks, gait disturbance and focal or generalized fits are additional nonspecific signs. When the water and electrolyte imbalance coincides with or is caused by brain disease, the signs of the two conditions are added. On the other hand, complicating hemorrhages, sinus thrombosis, or brainstem herniation or compression may be taken for a primary structural brain lesion, and the water and electrolyte imbalance may easily be overlooked. Pathophysiology, symptoms and signs, and therapy of hypo- and hyperosmolar states are discussed. Central pontine myelinolysis is considered separately.

Brain Diseases, Metabolic↗

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