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PubMed1997

Bobble-head doll syndrome associated with subduroperitoneal shunt malfunction.

Bobble-head doll syndrome is known to be associated with aqueductal stenosis or cystic lesions of the III ventricle. The direction of movement is usually vertical. In the literature, only five cases of purely horizontal movement have been reported. Bobble-head doll syndrome manifested as a sign of shunt malfunction has been described in one case with a ventriculoperitoneal shunt. The authors report on a 10-year-old boy who showed subduroperitoneal shunt malfunction associated with horizontal bobble-head doll syndrome. The head bobbing disappeared immediately after shunt revision. Unlike the previously reported cases, in the present case the lesion was asymmetric, though the significance of this for the lateral movement is not clear. This case also showed more marked ventricular dilatation on subduroperitoneal shunt malfunction than in the pre-shunt state. The underlying mechanism of the ventricular dilatation is unknown.

Child↗
PubMed1997

Continuous external subdural drainage in the management of infantile subdural collections: a prospective study.

Continuous external subdural drainage (CESD) was suggested as a treatment step to be inserted prior to SP shunting, primarily because it makes it possible to avoid shunt placement in a significant number of patients. Thirty-three patients with symptomatic chronic subdural collection confirmed by computed tomography were included in this study. Unilateral CESD was performed in all cases, using a lumbar drainage set. The drains were left in place for no more than 10 days. A subduroperitoneal (SP) shunt was inserted in those patients in whom re-accumulation of the subdural collection had occurred. Of 33 patients, 17 were definitively treated by CESD and 16 subsequently needed an SP shunt. The cost of treatment with CESD was just less than half the cost of treatment with SP shunting. CESD can be used as a step before SP shunting in the management of chronic infantile subdural collections, since it is effective without further treatment in half the patients and safer than subdural tapping.

Chronic Disease↗
PubMed2002

Chronic subdural haematoma and the enigmatic eosinophil.

The membranes from 50 cases of chronic subdural haematomas were examined histologically and correlated with the duration of the lesion. Cases were divided into three groups based on duration from time of trauma and/or onset of clinical symptoms to date of surgery - Group I: 1 to 30 days, Group II: 31 to 90 days and Group III: >90 days. Infiltration with eosinophils was observed in the vascularised and hyalinised granulation tissue of the subdural membrane in 30 of the 50 cases (60%). There was a trend to correlation both of the frequency and the extent of eosinophilic infiltration with duration of haematoma. Thus, eosinophils were encountered in about half the cases with duration up to 3 months which increased to 80% in cases with duration more than 3 months. The extent of eosinophilic infiltration (mild, moderate or severe) also appeared to correlate with duration of haematoma in that mild infiltration was more common in Group I cases while moderate to severe infiltration were more frequently observed in Group II and III cases. No correlation was observed of the eosinophilic infiltrate with age and sex of the patients or with presence of other cellular inflammatory components of the membrane. Interestingly, a finding hitherto unreported in English literature was the demonstration of mast cells in 7 of 16 membranes (44%) which had been stained using toluidine blue. It is possible that the eosinophils appear at this unusual site due to chemotactic stimulus abetted by these mast cells as well as lymphocytes and haemosiderin pigment. The eosinophils may have an important role in the repair and healing process of these membranes.

Adolescent↗
PubMed2002

Cranioplasty with individual carbon fibre reinforced polymere (CFRP) medical grade implants based on CAD/CAM technique.

BACKGROUND: The authors present a new method for the reconstruction of large or complex-formed cranial bone defects using prefabricated, computer-generated, individual CFRP (carbon fibre reinforced plastics) medical grade implants. METHOD: CFRP is a composite material containing carbon fibres embedded in an epoxy resin matrix. It is radiolucent, heat-resistant, extremely strong and light (its weight is 20% that of steel), has a modulus of elasticity close to that of bone, and an established biocompatibility. The utilisation of a CAD/CAM (computer aided design/computer aided manufacture) technique based on digitised computed tomography (CT) data, with stereolithographic modelling as intermediate step, enabled the production of individual, prefabricated CFRP medical grade implants with an arithmetical maximum aberration in extension of less than +/-0.25 mm. Between 1995 and February 2002, 29 patients (15 men and 14 women; mean age, 39.9 years; range, 16 to 67 years) underwent cranioplasty with CFRP medical grade implants at the neurosurgical department of the University of Vienna. Twenty-four patients were repaired secondarily (delayed cranioplasty) while 5 were repaired immediately following craniectomy (single stage cranioplasty). All cases were assessed for the accuracy of the intra-operative fit of the implant, restoration of the natural skull contour and aesthetics and adverse symptoms. FINDINGS: The intra-operative fit was excellent in 93.1% and good in 6.9% of the implants. In two cases minor adjustments of the bony margin of the defect were required. The operating time for insertion ranged from 16 to 38 minutes, median 21 minutes. Postoperatively, 86.2% of the patients graded the restoration of their natural skull shape and symmetry as excellent while 13.8% termed it good. In one patient a non-space occupying subdural hygroma was found at the follow-up, but required no intervention. Two patients experienced atrophy of the frontal portion of the temporal muscle while one patient had a transient palsy of the frontal branch of the facial nerve. Over the mean follow-up period of 3.3 years (range, 0.08 to 6.8 years), there were no adverse reactions and no plate had to be removed. INTERPRETATION: Individual, prefabricated CFRP medical grade implants may be considered as an alternative to conventionally utilised materials for cranioplasty, in particular in the challenging group of patients with extensive cranial defects or more complex-formed defects of the fronto-orbital or temporo-zygomatic region, guaranteeing short operating times and excellent functional and aesthetic results, which justifies the expense of their production.

Adolescent↗
PubMed2003

A new subdural probe for combined intracranial pressure (ICP) and cerebral blood flow (CBF) monitoring.

We report the development of a new subdural probe for combined intracranial pressure (ICP) and cerebral blood flow (CBF) monitoring with near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution. For NIRS a conventional subdural ICP monitoring probe was supplied with two fiber bundles and 90-degree prisms. Injections of 25 mg ICG were performed. Regional values for the mean transit time of ICG (rmtt(ICG)), cerebral blood flow (rCBF) and cerebral blood volume (rCBV) were calculated. With prototypes of the probe in two patients with intracerebral haemorrhage 18 comparative measurements obtained simultaneously with conventional NIRS (optodes placed on the skin) and the subdural NIRS probe were performed. The new subdural NIRS probe allows combined monitoring of ICP and cerebral hemodynamics in the brain directly, without the influence of extracerebral tissue.

Blood Flow Velocity↗
PubMed1998

Spontaneous intracranial hypotension associated with subdural hematoma: diagnostic usefulness of percutaneous subdural tapping and magnetic resonance imaging.

A 55-year-old woman presented with headache which was characterized by aggravation in the upright position and relief in recumbency. Although intracranial hypotension syndrome was considered to be the most-likely possible entity, computed tomography (CT) scans demonstrated subdural fluid collections associated with findings reminiscent of transtentorial herniation. Because of these CT features, cerebrospinal fluid pressure measurement by a lumbar puncture was not performed. In stead, as an alternative method, she underwent percutaneous subdural tapping, which failed to obtain spontaneous drainage of liquid haematoma, indicating intracranial hypotension. In addition, gadolinium-enhanced magnetic resonance imaging study performed later supported the diagnosis of spontaneous intracranial hypotension. Thus, the usefulness and safety of percutaneous subdural tapping for the diagnosis of spontaneous intracranial hypotension is stressed.

Female↗
PubMed1998

Traumatic subdural pneumocephalus causing rise in intracranial pressure in the early phase of head trauma: report of two cases.

This paper presents two unique cases of subdural tension pneumocephalus which has deteriorated in the early phase of head trauma. Subdural pneumocephalus accounts for about 25% of all intracranial pneumocephalus cases. In the literature subdural pneumocephalus is describes as a benign and spontaneously resolving condition. Contrary to the available literature and our experience in 1341 trauma cases in the past ten years of whom 76 had subdural pneumocephalus, both cases deteriorated in the early hours following head trauma due to an increase in subdural air volume which was evacuated by craniotomy.

Adolescent↗
PubMed2000

Detection of epileptogenic focal cortical dysplasia by depth, not subdural electrodes.

Centers that perform presurgical epilepsy evaluations disagree on whether depth or subdural electrodes represent the optimal technique for invasive recording, especially in seizures originating outside the temporal lobe. A 13-year-old girl with a normal magnetic resonance imaging scan had unlocalized partial onset seizures, despite scalp and subdural grid ictal video/EEG recordings. Repeat video/EEG with depth electrodes showed a discrete site of continuous interictal spiking and seizure onset that was located 2-2.5 cm beneath the surface of the sensory cortex. The resected region showed focal cortical dysplasia and the patient had greater than 95% seizure frequency reduction at 3-year follow-up. We conclude that although subdural electrodes have many advantages when recording seizures outside the temporal lobes, depth electrodes may provide superior recordings when the epileptogenic region is beneath the cortical surface.

Cerebral Cortex↗
PubMed2001

Spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) is typically manifested by orthostatic headaches that may be associated with one or more of several other symptoms, including pain or stiffness of the neck, nausea, emesis, horizontal diplopia, dizziness, change in hearing, visual blurring or visual field cuts, photophobia, interscapular pain, and occasionally face numbness or weakness or radicular upper-limb symptoms. Cerebrospinal fluid (CSF) pressures, by definition, are quite low. SIH almost invariably results from a spontaneous CSF leak. Only very infrequently is this leak at the skull base (cribriform plate). In the overwhelming majority of patients, the leak is at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Sometimes, documented leaks and typical clinical and imaging findings of SIH are associated with CSF pressures that are consistently within limits of normal. Magnetic resonance imaging of the head typically shows diffuse pachymeningeal gadolinium enhancement, often with imaging evidence of sinking of the brain, and less frequently with subdural fluid collections, engorged cerebral venous sinuses, enlarged pituitary gland, or decreased size of the ventricles. Radioisotope cisternography typically shows absence of activity over the cerebral convexities, even at 24 or 48 hours, and early appearance of activity in the kidneys and urinary bladder, and may sometimes reveal the level of the leak. Although various treatment modalities have been implemented, epidural blood patch is probably the treatment of choice in patients who have failed an initial trial of conservative management. When adequate trials of epidural blood patches fail, surgery can offer encouraging results in selected cases in which the site of the leak has been identified. Some of the spontaneous CSF leaks are related to weakness of the meningeal sac, likely in connection with a connective tissue abnormality.

Cerebrospinal Fluid Pressure↗
PubMed1972

Subdural empyema.

Explore the source record for details and available documents.

Adolescent↗
PubMed1984

Subdurally recorded pattern and luminance EPs in the alert rhesus monkey.

Two rhesus monkeys (Macaca mulatta) were trained to fixate a TV screen on which checkerboard and bar patterns could be presented. Stainless steel skull electrodes and electrode bundles under the dura, each containing 7 leads permitting 7 recording sites at 5 mm intervals, were placed over the temporal-occipital cortex and used to obtain visually evoked potentials (VEPs). The following conclusions were reached: VEPs recorded with skull electrodes resemble scalp recorded VEPs. Subdural electrodes may yield larger VEP amplitudes than skull or scalp electrodes. Subdural VEPs vary more in shape with recording site than scalp or skull recorded VEPs. Apart from differences in shape there are topographical differences between luminance and pattern EPs; the luminance EP is localized near the occiput and the pattern EP is most pronounced at the temporal site overlying the foveal projection area. For a given recording site it can be seen that: (a) the amplitude of the pattern reversal EP is smaller than that of the pattern onset EP; (b) the shape of the reversal EP resembles the pattern offset EP; and (c) the shape of the pattern onset EP is rather invariant to check size and bar width. On the basis of the pattern EP the striate and prestriate cortical areas can be distinguished as follows: (a) the prestriate cortex yields a positive-negative-positive (PNP) response complex to pattern onset and the striate cortex a PN response complex; and (b) the striate cortex responds to finer patterns than the prestriate cortex.

Animals↗
PubMedDate not supplied

Effect of a subdural air collection on the sensory evoked potential during surgery in the sitting position.

Fifty-three cases with posterior fossa surgery were monitored using sensory evoked potentials (SEPs) and auditory evoked potentials (AEPs) simultaneously. Nine of them operated in the sitting position showed typical SEP changes during intracranial manipulations that were not attributable either to surgical or to anaesthetic handling. The SEP amplitude rapidly recovered when the patients were laid supine after operation. Skull X rays revealed intracranial air collections beneath the recording electrodes. The SEP changes were considered to be caused by conduction hindrance by the subdural air. In 1 patient, a way to overcome the air problem was demonstrated: bitemporal recording (T3-T4 montage) revealed little change in the SEP despite subdural air while the simultaneously recorded parieto-frontal record showed a drastic change.

Adolescent↗
PubMed1989

Subdural electrode as a dipole source for magnetoencephalography.

A subdural electrode was designed and constructed with 3 pairs of contacts to make 3 dipoles. The dipoles well approximate the expected magnetic behavior for a current dipole and can be used clinically to test localization capabilities of magnetoencephalography.

Electrodes↗
PubMed1996

Brain-stem auditory evoked potentials (BAEPs) from basal surface of temporal lobe recorded from chronic subdural electrodes.

BAEPs were recorded from the basal surface of the temporal lobe by subdural electrodes chronically implanted in 6 patients who were evaluated for surgical management of intractable partial seizures. Near-field recordings were obtained by recording between the subdural electrode closest and most distant to the brain-stem. Far-field recordings were obtained by recording between the subdural electrodes and an indifferent electrode over the spinal process of the seventh cervical vertebrae. The recordings were compared with standard ear-vertex recordings. After ipsilateral ear stimulation, the subdural electrode closest to the brain-stem recorded large amplitude waves I and II followed by less well-defined waves of longer latencies. Recordings to contralateral stimulation showed no clearly defined waves I and II and a large amplitude wave Vn. Waves III, IV, V, Vn and VI were of opposite polarity after ipsi- and contralateral stimulation. These findings indicate that waves I and II are generated ipsilaterally to the stimulation side, whereas wave Vn has a contralateral origin. Wave Vn may be generated in the brachium of the inferior colliculus, as suggested from dipole configuration studies. This conclusion is consistent with the classical anatomical observations that the supracollicular auditory pathways are predominantly crossed.

Acoustic Stimulation↗
PubMed1996

Subdural potentials at orbitofrontal and mesial prefrontal areas accompanying anticipation and decision making in humans: a comparison with Bereitschaftspotential.

Field potentials associated with the execution of a warned choice Go/No-Go reaction task were recorded from prefrontal supplementary (SMA) and primary motor cortex (MI) by using subdural electrodes in 5 epileptic patients during presurgical evaluation. The choice was between a Go and a No-Go imperative stimulus (S2) in the S1-S2 paradigm. Orbitofrontal and mesial prefrontal areas generated a slow preceding potential before S2 (most likely late CNV), and bilateral mesial prefrontal areas generated a transient potential, most likely related to decision making, upon S2 in both Go and No-Go conditions. In self-paced, repetitive movement, the Bereitschaftspotential was seen only at SMA and MI, but not in the prefrontal area. The present result, therefore, suggests that in humans orbitofrontal and mesial frontal areas play an important role in preparation for cognition and in decision making, whereas SMA and MI do so in motor preparation.

Adult↗
PubMed1981

Subdural metastases from prostatic adenocarcinoma.

Adenocarcinoma of the prostate commonly metastasizes to lymph nodes and bones, with occasional visceral deposits; lesions in the brain are rare. Although leptomeningeal carcinomatosis secondary to prostatic tumor has been reported, discrete cranial dural metastases from prostatic adenocarcinoma have not been described previously. The case of a patient having a unique adenocarcinoma of the prostate with bone, lymph node, and subdural metastatic lesions is presented.

Adenocarcinoma↗
PubMed1981

Chronic subdural empyema.

A review of the literature reveals that most chronic subdural empyemas occur within four to six months of the initial insult. It appears that only 1 case of a chronic subdural empyema, which occurred four years after extensive facial trauma, has been described. Our patient developed chronic subdural empyema thirteen years after drainage of a subdural hematoma. Current treatment modalities are reviewed.

Brain Abscess↗