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At least 991 records · Page 55Linked to original sources
PubMed2005

Bilateral chronic subdural hematoma cases showing rapid and progressive aggravation.

BACKGROUND: We have analyzed the records of our own hospitalized cases of bilateral chronic subdural hematoma (cSDH) to reveal the prognosis. METHODS: Ninety-eight cases of cSDH were operated at our hospital over a 6-year period, in which 14 cases were classified as being bilateral. Among these 14 cases, 6 cases showed a rapid and aggressive clinical course. Therefore, complicated risk factors, the initial data on coagulofibrinolytic examination, magnetic resonance imaging appearance, and prognosis were analyzed. RESULTS: Of the 6 cases, 5 showed a rapid aggravation as they awaited surgery. The period of the aggravation since the initial diagnosis harboring cSDH was 19 to 54 hours. One case was at first neurologically free from any disturbance but 17 hours later experienced a generalized seizure. All 6 cases experienced consciousness disturbance. In addition, 3 of them manifested oculomotor palsy. Two cases showed an abnormality of coagulofibrinolytic activity. No significant risk factors were revealed. In 4 cases, T(2)-weighted images (T2WIs) revealed the hematoma of a mixed high and low intensity, indicating that the hematoma consisted of both liquid and solid parts of a freshly formed blood clot. In 2 cases, the hematoma showed a low intensity in T(1)-weighted image (T1WI), indicating a recent bleeding of a significant amount. CONCLUSION: The bilateral cases of cSDH should be treated as early as possible with simultaneous decompression of bilateral hematoma pressure, even if the patient shows minimal neurologic deficits. Mixed high and low intensity in T2WI or low intensity in T1WI is the most predictable factor to show rapid aggravation.

Adolescent↗
PubMed2005

Clinical presentation and surgical management of dissecting posterior inferior cerebellar artery aneurysms: 2 case reports.

Intracranial dissection presenting with subarachnoid hemorrhage (SAH) most commonly involves the vertebral artery. The natural history of this lesion suggests frequent early rehemorrhage and need for urgent treatment. Isolated dissection of the posterior inferior cerebellar artery (PICA) is very rare. We present 2 cases of isolated PICA dissections presenting with SAH. Both patients were middle-aged men who presented with transient loss of consciousness, severe headache, and cranial neuropathies. Initial angiography showed dilatation and narrowing of PICA consistent with dissection and aneurysm formation. The vertebral arteries were normal and there was no other cause for the SAH. Repeat angiography 2 weeks after admission revealed significant enlargement of the aneurysmal dilation of the dissected segment of PICA in both patients. Both patients were treated operatively. One patient had clip reconstruction of the PICA with preservation of flow through the PICA. Follow-up angiography one year later showed no recurrence. The other patient underwent direct surgical trapping and resection of the dissected segment of PICA after passing balloon occlusion testing at the vertebral-PICA junction. Both patients have more than 2 years of clinical follow-up and remain well. Isolated PICA dissection seems to have a less ominous natural history compared to vertebral artery dissection. These lesions need to be followed carefully for evidence of aneurysmal enlargement. Direct surgical reconstruction of the dissected segment may be possible. Balloon occlusion testing may be very helpful in determining if the involved PICA segment can be sacrificed.

Aortic Dissection↗
PubMed2006

Leptomeningeal carcinomatosis in a patient with metastatic prostate cancer: case report and literature review.

BACKGROUND: Leptomeningeal metastasis is discovered at autopsy in approximately 5% of patients with systemic cancer. Until recently with the introduction of magnetic resonance imaging (MRI), premorbid diagnosis was extremely difficult. In particular, initial spinal fluid cytology is diagnostic in less than 50% of autopsy-verified patients, although repeated spinal fluid examinations may increase the yield significantly. Leptomeningeal metastasis in metastatic prostate cancer has been reported in only 14 patients previously. CASE DESCRIPTION: We recently studied such a patient and were able to establish a correct diagnosis based solely on the MRI and the presence of an elevated cerebrospinal fluid (CSF) prostate-specific antigen (PSA). Only 3 previous patients with leptomeningeal prostate metastasis have undergone CSF PSA evaluations. CONCLUSION: We believe that, in such patients, the combination of MRI and CSF studies can overcome the lack of sensitivity of CSF cytology.

Aged↗
PubMed2006

Traumatic pseudoaneurysm of the pharyngeal artery: An unusual cause of hematemesis and hematochezia after craniofacial trauma.

BACKGROUND: Traumatic aneurysms of the internal maxillary artery are extremely rare. We report a case of traumatic pseudoaneurysm of the pharyngeal artery, a branch of the internal maxillary artery, presenting with hematemesis and hematochezia. CASE DESCRIPTION: An 18-year-old man presented with deep drowsy consciousness after a motor vehicle accident, in which he had a severe craniofacial injury. Three days later, he had hematemesis and hematochezia with a marked decrease in circulating hemoglobin level. External carotid arteriography performed to rule out vascular injury revealed active leakage from a false aneurysm of the pharyngeal artery. The lesion was successfully obliterated by superselective endovascular embolization. CONCLUSIONS: In patients with craniofacial injury associated with multiple traumas, traumatic pseudoaneurysm of the pharyngeal artery should be suspected as one of the possible causes of hematemesis and hematochezia. Selective endovascular embolization with cerebral angiography is an effective modality for the treatment and diagnosis of this lesion.

Accidents, Traffic↗
PubMed2006

Can midline brain shift be used as a prognostic factor to predict postoperative restoration of consciousness in patients with chronic subdural hematoma?

BACKGROUND AND PURPOSE: Our aim was to determine if midline brain shift could be used as a prognostic factor to predict postoperative restoration of consciousness in patients with CSDH. In these patients, we evaluated the relation (1) between midline brain shift as measured on CT and alteration of level of consciousness, and (2) between midline brain shift and restoration of consciousness after the operation. METHODS: Prospectively recorded data of 45 patients with CSDH were evaluated. We compared level of consciousness of patients measured by GCS score, brain displacement at PG and SP both in the preoperative and early postoperative period. RESULTS: Preoperatively, PG and SP shifts of the patients who were alert (GCS = 15) were significantly less than those of patients who had diminished consciousness. However, in patients with diminished consciousness (GCS < 15), the amount of lateral brain displacement and the degree of diminution of consciousness did not correlate. Those patients who had a preoperative SP shift of less than 10 mm had a significantly lesser chance to become alert after operation (2 of 5 patients) when compared with those patients who had a preoperative SP shift of 10 mm or more (21 of 23 patients). CONCLUSIONS: We conclude that preoperative SP shift may be used as a factor to predict restoration of consciousness in patients with CSDH; the likelihood of becoming alert after operation is increased if SP shift is 10 mm or greater, and is decreased if SP shift is less than 10 mm.

Adult↗
PubMedDate not supplied

[Subdural empyema of sinus origin caused by Gemella morbillorum, a strange etiology].

We present a case of frontal sinusitis complicated with a subdural empyema, in which the identified microorganism was Gemella morbillorum, a frequent host of the aerodigestive tract and occasionally related to infections. The problem was resolved successfully using endoscopic surgery and an external approach of the sinus. Afterwards it was completed with a subdural drainage through craniotomy. Subdural empyema is a rare complication of sinusitis although very severe. We want to emphasize the importance of early diagnosis of intracranial complications, the need of a detailed microbiology test the method used to obtain samples, and the convenience of a combined approach by the otolaryngologists and the neurosurgeons for its complete drainage.

Adult↗
PubMed2005

Hydrocephalus and racemose cysticercosis: surgical alternative by endoscopic third ventriculostomy.

BACKGROUND AND PURPOSE: Hydrocephalus is a frequent and potentially serious complication of neurocysticercosis. Its treatment often requires ventricular shunting. The complication rate is high due to obstruction or material infection, which may justify endoscopic third ventriculostomy (ETV). OBSERVATION: We report a case of obstructive hydrocephalus in a 46-year-old man in the context of racemose cysticercosis, presenting with headaches and transient disorders of consciousness. Imaging showed cystic lesions of the cisterna magna, responsible for hydrocephalus which was treated effectively by ETV. Treatment with albendazole decreased the volume of the cisterna magna cysts. RESULTS: The patient was followed for 6 years after ETV with no recurrence of hydrocephalus despite two more symptomatic episodes of the disease with extension of the cysts into the lumen of the fourth ventricle and into the perispinal subarachnoid spaces, effectively treated by albendazole each time. CONCLUSIONS: Treatment of obstructive hydrocephalus secondary to cerebral racemose cysticercosis by ETV seems to be an effective and safety technique. The role of ETV should be evaluated in this indication.

Endoscopy↗
PubMed2004

[Guillain-Barré syndrome with hallucinations and onirism: an underestimated association].

INTRODUCTION: Guillain-Barré Syndrome (GBS) is generally related to peripheral nervous system involvement, but certain variants with central nervous system manifestations have been described. CASE REPORT: In the present study we report 2 patients with GBS associated with hallucinations and onirism. Two men (age 64 and 49 years) presented GBS without proven infectious origin who required intensive care because of respiratory problems. The disease progressed and manifestations of encephalitis (hallucinations and onirism) appeared. The sensorimotor signs and encephalitis manifestations evolved in parallel with full recovery in the first patient and death after 11 months of intensive care in the second. CONCLUSION: GBS may be associated with stereotypic central nervous system symptoms, mimicking delirium tremens. The manifestations would be related to the severity of the initial period, but not to long-term prognosis.

Adult↗
PubMed2005

[Headache in patients with cerebral venous thrombosis].

Headache is the most frequent symptom of cerebral venous thrombosis. They do not have particular characteristics and can mimic other numerous varieties of headache. Frequently associated with other neurological symptoms, such as intracranial hypertension, seizures, focal deficits or disorders of consciousness, they are sometimes isolated, which stresses the need for investigations in all recent and unusual headache.

Headache↗
PubMed2006

[Pseudo-tumoral neuro-Behçet's disease].

INTRODUCTION: Clinical involvement of the central nervous system occurs in about 10 to 30 percent of patients with Behçet's disease. Neurological pseudo tumoral presentation is rare. CASE REPORT: We report a case of pseudo tumoral neuro-Behçet disease in a 38-year-old man, with past history of facial and dorsal folliculitis, who presented suddenly headache, right hemiplegia, aphasia and disturbed consciousness. Neuroradiological investigations showed a pseudo tumoral lesion in the left capsulo-thalamic region extending to the homolateral peduncle. The patient improved with steroid and immunosuppresseur therapy. CONCLUSION: The clinical and radiological presentation of neuro-Behçet's disease can mimic a brain tumor.

Administration, Oral↗
PubMed2003

Theory, methods and new directions in the psychophysiology of the schizophrenic process and schizotypy.

Theoretical and methodological issues in the psychophysiology of the schizophrenic process are reviewed. These include the importance of schizotypy with its compensatory abilities as well as deficits for elucidating the processes of development and prevention of schizophrenia. The importance of individual differences, syndromes and single case studies. The recognition that this is a dynamic and fluctuating illness and hence the relevance of functional neurophysiology, including the role of imbalances in hemispheric activation in ontogeny, developmental course, expression of symptoms, the effects of neuroleptics and recovery process, and the influence of stress a precipitant of breakdown. The role of thalamo-cortical activation systems. The particular value of electrocortical measures including the interrelations of electroencephalographic rhythms throughout the spectrum, and relations of gamma, dynamic core neuronal complexity, connectivity and sensory gating with experiences of unreality and disturbances of consciousness.

Animals↗
PubMed2003

[Indications, effectiveness and tolerance of the rehabilitation techniques aimed at improving recovery of awareness following a traumatic brain injury].

OBJECTIVE: In the context of a consensus conference, this review aims at identifying through a comprehensive review and critical analysis of the literature the different rehabilitation programs used to promote the level of consciousness of brain injured patients. METHOD: By using the following data banks: Medline, Embase, Francis, Pascal, 97 articles published between 1980 and 2001 were found and 19 of them were finally selected. These 19 articles were synthesized through critical assessment charts. Six others articles, among those, expert opinion, literature reviews and consensus conferences were not assessed through critical assessment charts. RESULTS-DISCUSSION: Two non invasive interventions have been identified: these are sensory stimulation and sensory regulation. Neurostimulation, a surgical technique has not been discussed here. Most of the authors claim (16/19) for positive results. However, the major part of these studies contains serious methodological flaws which do not resist to critical analysis. CONCLUSION: Because of these methodological flaws and despite the good results claimed by the authors, there is up to date no evidence that clearly demonstrate the effectiveness of sensory stimulation or sensory regulation programs. Further clinical research in this area is necessary.

Awareness↗