Convulsive seizures following subdural application of fibrin sealant containing tranexamic acid in a rat model.
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Animals↗
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Neural and dural optic nerve measurements with A-scan ultrasonography.
Ultrasonography has been shown to be of great value in studying drusen, cupping, and elevation of the optic disk, as well as mass lesions of the orbital optic nerve. We have found A-scan ultrasonography to be an accurate and simple method of measuring both the diameter of the retrobulbar optic nerve and the size of the subdural perineural space. We have found the intervaginal space of the retrobulbar optic nerve to be uniformly enlarged in papilledema, optic nerve lesions, and endocrine orbitopathy.
Humans↗
Epilepsy surgery: removing the thorn from the lion's paw.
In the United States, 10,000 to 20,000 patients have epilepsy uncontrolled by medication. The addition of a second-line drug to the primary regimen has a 2% to 11% chance of controlling the seizures. We present a series of 35 patients with intractable epilepsy who had surgical resection of their seizure focus. Seventy-five percent of the patients with temporal lobe epilepsy were made seizure free, with an additional 14% sustaining a greater than 90% reduction in seizures (decrease in number and frequency). Seventy-one percent of the patients with extratemporal lobe epilepsy (seizures originating outside the temporal lobe) had a worthwhile reduction (> 90%) in their seizures. Two patients sustained permanent clinically significant deficits as a result of their presurgical evaluation or resection. There were no deaths. Epilepsy surgery offers a cure for the "incurable" patient with a morbidity of 5% to 6%.
Adolescent↗
Differential diagnosis of recurrent lumbar disc herniation and postoperative deformation by myelography. An impossible task.
A series of 44 patients with persistent or recurring sciatic pain after myelography and operation for disc herniation were remyelographed and reoperated. Patients with lesions at a new level or at the same level but on the opposite side presented no diagnostic problems. However, in patients with myelographic changes at the same level and on the same side as at the first operation, it was impossible to distinguish disc herniation from postoperative extradural scarring. This was true whatever myelographic sign or combination of signs was chosen.
Cicatrix↗
Cervical intradural disc herniation.
STUDY DESIGN: A case report of anterior en bloc resected cervical intradural disc herniation and a review of the literature. OBJECTIVE: To discuss the pathogenesis of cervical intradural disc herniation. SUMMARY OF BACKGROUND DATA: Including this study case, only 17 cases of cervical intradural disc herniation have been reported. There have been few detailed reports concerning the pathogenesis of cervical intradural disc herniation. METHODS: A cervical intradural disc herniation at C6-C7, with localized hypertrophy and segmentally ossified posterior longitudinal ligament, is reported in a 45-year-old man who had Brown-Sequard syndrome diagnosed on neurologic examination. Neuroradiologic, operative, and histologic findings, particularly the pathology of the anterior en bloc resected posterior vertebral portion of C6 and C7, were evaluated for discussion of the pathogenesis. RESULTS: Adhesion of dura mater and hypertrophic posterior longitudinal ligament was observed around a perforated portion of the herniated disc, and histologic study showed irregularity in fiber alignment accompanied by scattered inflammatory cell infiltration and hypertrophy in the posterior longitudinal ligament. The cervical intradural disc herniation was removed successfully and followed by C5-Th1 anterior interbody fusion with fibular strut graft. Neurologic recovery was complete except for minor residual sensory disturbance in the leg 7 years after the surgery. CONCLUSIONS: Cervical intradural disc herniation is an extremely rare condition. The pathogenesis remains obscure. Only 16 cases have been reported in the literature, and there has been little discussion concerning the local pathology of the herniated portion. The pathogenesis of the disease in the patient reported here was considered to be the adhesion and fragility of dura mater and posterior longitudinal ligament. This was caused by hypertrophy, with chronic inflammation and ossification of the posterior longitudinal ligament sustaining chronic mechanical irritation to the dura mater, leading to perforation of the herniated disc by an accidental force.
Cervical Vertebrae↗
Intramedullary injection of contrast into the cervical spinal cord during cervical myelography: a case report.
STUDY DESIGN: A case of iatrogenic intramedullary contrast injection during a C1-C2 cervical myelography is reported. OBJECTIVE: To investigate the occurrence of iatrogenic intramedullary contrast injection during a current C1-C2 cervical myelography. SUMMARY OF BACKGROUND DATA: Intramedullary injection of contrast is a rare but serious complication of C1-C2 cervical myelography that has not been reported since the widespread use of magnetic resonance imaging and the NASCIS III study protocol. METHODS: A 39-year-old woman received an iatrogenic intramedullary contrast injection during a C1-C2 cervical myelography. RESULTS: During the procedure the patient reported right-side face, neck, and arm pain and parethesias. After the procedure, right arm weakness and diffuse hyperreflexia developed. Postmyelography imaging demonstrated intramedullary contrast and cord swelling. High-dose methylprednisolone was administered intravenously and the patient's symptoms improved. The literature and management of this rare complication are reviewed. CONCLUSIONS: Intramedullary cord injection is a rare complication of cervical myelography. The mechanism of spinal cord injury appears to involve a combination of physical compression from the injected liquid and neurotoxicity of the contrast material. Iohexol rather than metrizamide should be used when C1-C2 myelography is indicated in patients who are unable to undergo magnetic resonance imaging, or those whose pathology is inadequately demonstrated magnetic resonance imaging alone. In the event of contrast injection into the spinal cord, administration of high-dose methylprednisolone is recommended.
Adult↗
Subdural spinal granuloma resulting from Candida albicans without immunosufficiency: case report.
STUDY DESIGN: This was a case of spinal subdural granuloma of Candida albicans. A high cerebrospinal fluid protein level without pleocytosis (albuminocytologic dissociation) was observed. This case proved difficult to diagnose and treat. OBJECTIVES: To clarify the important issues in regard to the diagnosis and treatment of possible spinal subdural granuloma resulting from C. albicans. SUMMARY OF BACKGROUND DATA: Reports on subdural infection of C. albicans are very rare. Moreover, there are no reports of cases in which patients have survived this type of infection. METHODS: A 66-year-old man developed paralysis in the lower limbs, as well as vesicorectal disorder (anuresis). There were no obvious causes. Signs of meningeal irritation later appeared. A high cerebrospinal fluid protein level without pleocytosis was observed through a laboratory test. The cause of these disorders was unclear, and a final diagnosis could not be made on the basis of the test results and angiograph. Possible diagnoses included tumor, infection, and others such as Guillain-Barré syndrome. The authors therefore carried out surgery to reduce the pressure on the spinal cord and ultimately make a definitive diagnosis. RESULTS: The final diagnosis was spinal subdural granuloma of C. albicans. Granuloma was widespread (T3-T10). Surgery, various drug treatments, and hyperbaric oxygen therapy all contributed to saving the patient's life. CONCLUSION: This was a very rare case of spinal subdural granuloma resulting from C. albicans, and the authors had difficulty diagnosing and treating the patient. A distinctive gadolinium-enhanced MRI was obtained. The effect of treatment by drugs alone was limited. An intraoperative ultrasonography proved useful. The authors concluded that a combination of early surgery and hyperbaric oxygen therapy was effective.
Aged↗
Subdural hygromas after bone marrow transplantation: results of a prospective study.
BACKGROUND: Subdural hygromas after bone marrow transplantation (BMT) have been occasionally found in patients with persisting headache and vomiting. We assessed the incidence of subdural hygromas after BMT and tried to define possible risk factors associated with this complication. METHODS: Fifty bone marrow graft recipients surviving more than 30 days were consecutively enrolled into a prospective study. Cranial CT scans were performed before and 30 days after BMT. Clinical data and symptoms were recorded daily during the first 30 days after BMT. In patients with subdural hygromas, a magnetic resonance imaging scan and monthly follow-up cranial computed tomography scans were performed until fluid collections had resolved completely. RESULTS: In 9 of the 50 patients (18%) who survived 30 days after transplantation, newly acquired subdural hygromas were found. Patients with hygromas suffered significantly longer and more severely from headache and vomiting (P=0.01). Application of intrathecal methotrexate and arterial hypertension occurred significantly more often in patients with hygromas (P=0.01). In a stepwise logistic regression model, arterial hypertension and intrathecal methotrexate application were the only independent risk factors for the development of hygromas. Monthly follow-up cranial computed tomography scans showed that all hygromas resolved completely after a median of 60 days after diagnosis (range: 30-120 days). CONCLUSIONS: Subdural hygromas are a frequent complication after BMT within the first 30 days after transplantation. They are reversible and disappear within 2-3 months. The need for routine application of intrathecal methotrexate in standard risk leukemia patients should be critically addressed. Furthermore, close monitoring of blood pressure and immediate antihypertensive therapy might contribute to avoid formation of subdural hygromas.
Adolescent↗
Arachnoid cyst and subdural hygroma in a high school football player.
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Adolescent↗
Tuberculoma of the cervical spinal canal mimicking en plaque meningioma.
A previously healthy, HIV-negative, 40-year-old man presented with a 2-month history of progressive weakness of his left arm. Magnetic resonance imaging revealed an intradural, extramedullary plaque-shaped lesion at C6-T1 levels with high contrast enhancement. Based on the patient's clinical and radiologic findings, it was believed that the patient had an en plaque meningioma, and he was operated on. Histologic examination of the mass revealed granulomas with multinucleated and Langhans-type giant cells, typical of a tuberculoma. Intradural extramedullary tuberculomas should be considered in the differential diagnosis of en plaque meningioma as a rare entity.
Adult↗
External subdural drainage in the treatment of infantile chronic subdural hematoma.
BACKGROUND: The management of chronic subdural hematoma (CSDH) in infants remains controversial. The purpose of this study was to analyze the clinical characteristics of CSDH in infancy and evaluate the efficacy of continuous external subdural drainage in the treatment of infantile CSDH. METHODS: We prospectively collected 36 consecutive infants with CSDH, to receive continuous external subdural drainage as the initial management. Medical records were reviewed for comparison of age, gender, cause of injury, clinical presentation, surgical management, and outcome. Diagnosis was made by computed tomography and/or magnetic resonance imaging. RESULTS: There were 20 boys and 16 girls, with ages ranging from 1 to 11 months (average, 5.9 months). The most common cause of CSDH was head injury (44.5%), followed by shaken baby syndrome (36.1%). The most common clinical presentations were seizure, bulging fontanel, and consciousness disturbance. Continuous external subdural drainage was the definite treatment in 34 patients (94.4%). The drains were left in place for no more than 9 days. Only two (5.6%) patients needed permanent subduroperitoneal shunting. No obvious complication was found. At follow-up (17-160 months; mean, 86.6 months), 23 (63.9%) had good recovery, 5 (13.9%) had moderate disability, 3 (8.3%) had severe disability, 4 (11.1%) were in a vegetative state, and 1 (2.8%) died. CONCLUSION: Continuous external subdural drainage was an effective treatment in infantile CSDH, with a low complication rate and good clinical outcome. It might be considered as a strategy before subduroperitoneal shunting in the treatment of CSDH in infants.
Craniocerebral Trauma↗
Subdural EEG patterns in children with taylor-type cortical dysplasia: comparison with nondysplastic lesions.
The authors compared interictal and ictal abnormalities from chronic intracranial recordings in children with Taylor-type cortical dysplasia (TTCD) and nondysplastic lesions. Interictal epileptiform discharges and ictal patterns were retrospectively analyzed in 13 children with TTCD and 12 children with nondysplastic lesions (tumor, 4; gliosis, 8). Features analyzed and compared between groups included the morphologic and temporal characteristics and field distribution of ictal and interictal patterns and rapidity of ictal propagation. The frequency of runs of interictal continuous epileptiform discharges (CEDs) or bursts of fast activity did not differ significantly between dysplastic and nondysplastic tissue. Fast frequencies characterized the majority of seizure onsets (49/67) in dysplastic patients and repetitive spikes were more frequent at seizure onset (31/56) in nondysplastic patients (P < 0.002). Field of ictal onset was limited to adjacent cortex and independent of histology. The interval between seizure onset and spread to adjacent or nonadjacent cortex was significantly shorter in dysplastic than nondysplastic patients. Interictal EEG patterns are not specific markers of dysplastic cortex but the morphology of ictal onset differs significantly with dysplastic cortex showing significantly more rapid propagation than nondysplastic cortex. These findings suggest that markers other than CEDs physiologically characterize dysplastic cortex and that children with TTCD exhibit more widespread excitability of neural pathways.
Brain Diseases↗
Time-invariant person-specific frequency templates in human brain activity.
The various human brain tasks are performed at different locations and time scales. Yet, we discovered the existence of time-invariant (above an essential time scale) partitioning of the brain activity into personal state-specific frequency bands. For that, we perform temporal and ensemble averaging of best wavelet packet bases from multielectrode electroencephalogram recordings. These personal frequency bands provide new templates for quantitative analyses of brain function, e.g., normal versus epileptic activity.
Algorithms↗
Effect of an external responsive neurostimulator on seizures and electrographic discharges during subdural electrode monitoring.
PURPOSE: Approved neural-stimulation therapies for epilepsy use prolonged intermittent stimulation paradigms with no ability to respond automatically to seizures. METHODS: A responsive neurostimulator that can automatically analyze electrocortical potentials, detect electrographic seizures, and rapidly deliver targeted electrical stimuli to suppress them was evaluated in an open multicenter trial in 50 patients, 40 of whom received responsive cortical stimulation via subdural electrodes implanted for epilepsy surgery evaluations. RESULTS: Four patients, ages 15 to 28 years, monitored at three institutions, with clinical and electrographic response to neurostimulation, are described. Electrographic seizures were altered and suppressed in these patients during trials of neurostimulation lasting < or =68 h, with no major side effects. In one patient, stimulation appeared also to improve the baseline EEG. CONCLUSIONS: Responsive cortical neurostimulation may be a safe and effective treatment for partial epilepsy. This information was derived from a small group of patients in an observation study. A double-blind, controlled Food and Drug Administration (FDA)-approved study of a permanently implanted responsive neurostimulation system to treat medically refractory partial seizures is under way.
Adolescent↗
A rare complication of extradural analgesia.
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Anesthesia, Epidural↗
Possible inadvertent subdural block following attempted stellate ganglion blockade.
A case is reported of suspected inadvertent subdural block following attempted stellate ganglion blockade for relief of cervicobrachial pain in a patient suffering from reflex sympathetic dystrophy. Possible complications due to neuraxial spread of local anaesthetics while performing a cervicothoracic ganglion blockade are considered.
Adult↗
Subdural block--further points.
An obstetric epidural performed for analgesia showed a changing pattern of neurological block. The original features suggestive of a subdural block were complicated when aspiration of cerebrospinal fluid from the catheter became possible. Subsequent management as a continuous subarachnoid catheter allowed delivery.
Adult↗
Another subdural block, or was it?
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Analgesia, Epidural↗