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PubMedDate not supplied

Intracranial complications of submucous resection of the nasal septum.

Submucous resection of the nasal septum (SMR) is a relatively simple and frequently performed operation. Yet, its intracranial complications, although rare, can be very serious and include anosmia, visual disturbances, cavernous sinus thrombosis, meningitis, cerebrospinal fluid rhinorrhea, pneumocephalus, subarachnoid hemorrhage, subdural empyema, and brain abscess. This article reviews intracranial complications of SMR, and the pathogenesis and prevention of such complications are discussed.

Adult↗
PubMed1977

Mucormycosis.

Three cases of mucormycosis are presented; two with unusual aspects: one with previously unreported involvement of the mandible, and one presenting as a cavernous sinus thrombosis. Review of the literature reveals a limited number of survivors. Survival in two of the cases presented here suggests that early diagnosis, aggressive therapy with surgery, and amphotericin B should improve the prognosis.

Aged↗
PubMed1993

[Posterior fossa dural arteriovenous fistula with isolated sinus segment].

Radiological and clinical analysis was performed in 5 patients with posterior fossa dural arteriovenous fistulas (DAVFs) with isolated sinus segment due to sinus thrombosis, and their patho physiological, diagnostic, and therapeutic concerns were discussed. Patients ranged in age from 36 to 73 years old with a mean of 57 years and included 2 males and 3 females. Two patients presented with ataxia, one with ataxia and bruit, one with atypical facial pain, and one with parietal dysfunction. One patient had a history of hemorrhagic event. DAVFs were located at transverse-sigmoid sinus (3 cases), superior petrosal sinus (1 case), and straight sinus (1 case). They were fed by many branches of external carotid artery including middle meningeal artery, ascending pharyngeal artery, posterior auricular artery, occipital artery, meningeal branches of vertebral artery and posterior cerebral artery, and meningohypophyseal trunk of internal carotid artery. Shunt flow drained into contralateral transverse-sigmoid or supratentorial sinuses via the isolated venous segment through markedly dilated cortical and/or deep venous systems, which caused altered normal venous drainage pattern and venous hypertension. Transarterial embolization in multiple stages (mean 3.4) using n-butyl cyanoacrylate (NBCA) could alleviate symptoms in all cases. DAVFs were almost totally obliterated in 3 patients. Further embolization in one case, and surgical excision in one case were planed because of some residual dilated cortical venous drainage. Posterior fossa DAVFs with isolated sinus segment accompany markedly dilated cortical and/or deep venous systems. They could cause cerebellar, brainstem, or cranial nerve dysfunctions, and sometimes present distant supratentorial symptoms or hydrocephalus due to abnormal venous drainage and venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1980

[Headache associated with underlying internal diseases].

The vascular system of the head is of great importance in most types of headache because of the sympathetic efferents supplying the vessels. From neuroanatomic data it is to be assumed that vascular diseases of different genesis and cardiovascular diseases may give rise to headaches. The connection between headache and hypertensin is discussed at length with reference to pathophysiology. Further, headache is presented as a symptom with reference to observations of our own cases of inflammatory diseases of the vessels, sinus thrombosis, vessel deformities, accidents in anticoagulant therapy with subdural and intraspinal haemorrhages, cerebrospinal lues and endocrinopathies. Tables and illustrations supplement the text.

Aortic Valve Stenosis↗
PubMed1996

Normal appearance of arachnoid granulations on contrast-enhanced CT and MR of the brain: differentiation from dural sinus disease.

PURPOSE: To determine the imaging appearance and frequency with which arachnoid granulations are seen on contrast-enhanced CT and MR studies of the brain. METHODS: We retrospectively reviewed 573 contrast-enhanced CT scans and 100 contrast-enhanced MR studies of the brain for the presence of discrete filling defects within the venous sinuses. An anatomic study of the dural sinuses of 29 cadavers was performed, and the location, appearance, and histologic findings of focal protrusions into the dural sinus lumen (arachnoid granulations) were assessed and compared with the imaging findings. RESULTS: Discrete filling defects within the dural sinuses were found on 138 (24%) of the contrast-enhanced CT examinations. A total of 168 defects were found, the majority (92%) within the transverse sinuses. One third were isodense and two thirds were hypodense relative to brain parenchyma. Patients with filling defects were older than patients without filling defects (mean age, 46 years versus 40 years). Discrete intrasinus signal foci were noted on 13 (13%) of the contrast-enhanced MR studies. The foci followed the same distribution as the filling defects seen on CT scans and were isointense to hypointense on T1-weighted images, variable in signal on balanced images, and hyperintense on T2-weighted images. Transverse sinus arachnoid granulations were noted adjacent to venous entrance sites in 62% and 85% of the CT and MR examinations, respectively. Arachnoid granulations were found in 19 (66%) of the cadaveric specimens, in a similar distribution as that seen on the imaging studies. CONCLUSION: Discrete filling defects, consistent with arachnoid granulations, may be seen in the dural sinuses on 24% of contrast-enhanced CT scans and on 13% of MR studies. They are focal, well-defined, and typically located within the lateral transverse sinuses adjacent to venous entrance sites. They should not be mistaken for sinus thrombosis or intrasinus tumor, but recognized as normal structures.

Adult↗
PubMed2006

Preparedness of selected pediatric offices to respond to critical emergencies in children.

OBJECTIVE: To determine the preparedness of pediatric offices that had activated emergency medical services (EMS) for a critically ill child requiring airway management. METHODS: Fifteen patients who initially presented to pediatric or family practice offices but required EMS activation and cardiac and/or respiratory support were identified from a previous prospective study of airway management in children. Two to 4 years after the emergency requiring EMS activation, the offices were contacted to complete a written survey about office preparedness for pediatric emergencies. RESULTS: Eight of 15 offices (53%) returned a survey. Pediatricians staffed all responding offices, and all offices were within 5 miles of an emergency department. Airway emergencies were the most common emergencies seen in the offices. Availability of emergency equipment and medications varied. All offices stocked albuterol, and most (7/8) had an oxygen source with a flowmeter. However, only half of the offices had a fast-acting anticonvulsant, and a quarter had no anticonvulsant. Three offices lacked bag-mask (manual) resuscitators with all appropriate sized masks, and 3 offices lacked suction. The most common reasons cited for not stocking all emergency equipment and drugs were quick response time of EMS and proximity to an emergency department. CONCLUSIONS: Even after treating a critically ill child who required advanced cardiac and/or pulmonary support, offices were ill prepared to handle another serious pediatric illness or injury.

Airway Obstruction↗
PubMedDate not supplied

Diffusion-weighted MR imaging of an acute venous stroke: case report.

A patient with a superior sagittal sinus thrombosis had progressively worsening symptoms and signs that resolved after IV heparin therapy. MR imaging revealed abnormalities in diffusion, similar to those seen with acute arterial stroke. Abnormalities shown on a T2-weighted fast spin-echo and fluid-attenuated inversion recovery images resolved completely. The findings in this report contradict those from previous reports that suggest diffusion-weighted imaging with quantitative apparent diffusion coefficients may be used in selecting patients for dural venous sinus thrombolysis.

Adult↗
PubMed1992

[Neuro-Behçet's syndrome: encephalitis and cerebral venous thrombosis--clinical aspects and neuroradiology of 5 cases].

The value of brain CT-scan, magnetic resonance imaging (MRI) and angiography for diagnosis, differential diagnosis and follow up in Neuro-Behçet-Syndrome is assessed in 5 cases. Three of the patients presented with clinical signs of encephalitis. Further investigations led to the diagnosis of Behçet-Syndrome. CT-scan was negative in two of these cases, but MRI showed multiple, predominantly periventricular lesions with high signal intensity on T2-weighted spin-echo images in all three. Clinical symptoms improved with steroid and chlorambucil therapy in all three cases. In two patients the MRI-lesions resolved at least partially after 1.5 and 3 years of treatment respectively. In one patient the initial MRI-findings were still present after 7 months of treatment. The other two patients presented with headache, papilledema and increased CSF-pressure. The cause was superior sagittal sinus thrombosis, confirmed by angiography in both cases. Additional symptoms appeared later and led to the diagnosis of Behçet syndrome. One patient died of pulmonary aneurysms 28 months after the diagnosis had been established. The course of disease of the remaining patient is so far favorable.

Adult↗
PubMed1975

Carotid-cavernous fistula: a complication of maxillofacial trauma.

Fistulas of the internal carotid-cavernous sinus are an unusual arteriovenous malformation. Two types exist: (1) spontaneous fistulas and (2) traumatic fistulas. This paper deals with the traumatic variety which is seen more commonly in men as a direct result of severe maxillofacial injury. Recent anatomic studies are correlated with the physical findings associated with carotid-cavernous fistula, ie, headache, chemosis, exophthalmos, pulsatile bruit, and multiple cranial nerve paralyses. A case report illustrates these findings. The differential diagnosis which varies from tumors, to cavernous sinus thrombosis, to intraorbital aneurysm is discussed. The role of angiography in diagnosis is described. Present management consists of intracranial ligation of the internal carotid artery with use of a muscle embolus to occlude the fistula and selective ligation of the cervical carotid.

Adult↗
PubMed1988

The treatment and outcome of intracranial infections of otogenic origin.

Of 1321 patients with intracranial (IC) infection studied, the infection occurred as a direct result of middle ear disease in 36 (3%). The presenting clinical symptoms were those of diffuse meningeal irritation in 23 and of localized infection in the remaining 13. In the 23 patients with diffuse meningitis, the IC infection followed Acute Suppurative Otitis Media (ASOM) in only four and followed Chronic Suppurative Otitis Media (CSOM) in the remaining 19. Five of these 23 patients died soon after admission as their general condition was very severe. The final diagnosis in the 13 patients with localized meningeal inflammation was, brain abscess in seven, extradural abscess in four, lateral sinus thrombosis in two. All these patients underwent surgery, and except for one patient who died 3 days post-operative all recovered without sequelae.

Adolescent↗
PubMed2002

Complete superior and inferior sagittal sinus thromboses with multiple cranial nerve pareses and transient ischemic attack--case report.

A 27-year-old woman with headache and right peripheral facial nerve paresis persisting for over 25 days, and left hemiparesis for 2 days, which had all been gradually improving, was admitted to our hospital as she suddenly developed horizontal and vertical diplopia. She had right fourth and sixth cranial nerve pareses, papilledema, and right orbital venous congestion, and also experienced a seizure on the day of admission. Magnetic resonance (MR) imaging and MR venography revealed complete superior and inferior sagittal sinus thromboses and significant collateral venous channels, but no parenchymal lesion. Fourth and seventh cranial nerve pareses and the left hemiparesis resolved completely within 2 days, but she concurrently developed an episode of right hemiparesis, which lasted for 30 minutes. The patient recovered with medical therapy. MR venography showed recanalization of both sinuses. She was neurologically intact except for minimal right abducens nerve paresis at discharge, 40 days after admission. Multiple cranial nerve pareses with transient ischemic attack is an extremely rare manifestation of superior sagittal sinus thrombosis. Transient functional disturbance due to temporary reduction of tissue perfusion caused by overload of the collateral channels is more likely to be responsible for the transient ischemic attack and reversible ischemic neurological deficit.

Adult↗
PubMed1988

Superior vena cava syndrome: presenting symptom of silent otitis media.

An extensive lateral sinus thrombosis secondary to silent otitis media, in a patient with a nephrotic syndrome, is presented. The thrombotic process progressed asymptomatically until the occlusion of the superior vena cava. Removal of the intractable pathology within the mastoid and administration of appropriate antibiotic therapy, prevented the further propagation of the life-threatening condition.

Humans↗
PubMedDate not supplied

[Ulcerative colitis, thromboses of the cavernous sinuses and prostatic plexus and acute necrotizing hemorrhagic leukoneuraxitis: a case report of a syndromal association].

The authors describe a case of ulcerative colitis initially complicated by priapism due to cavernous sinus thrombosis and by prostatic plexus thrombosis and, subsequently, by a fatal acute necrotizing hemorrhagic leukoencephalitis. This complex and, apparently, until now unreported association supports the view that ulcerative colitis is the expression of a systemic disease. It also raises important pathogenetic problems which are discussed in connection with the vascular complications of ulcerative colitis reported in the literature.

Acute Disease↗
PubMed1994

Cerebrovascular disease in children.

Stroke although rare in children, is an important cause of morbidity in the paediatric age group. Over a period of 8 years, 43 children (17 boys and 26 girls) in the age groups of 1-16 years (mean 8.02 yrs) presented with stroke which constituted 10% of all strokes in the young and 0.7% of all paediatric admissions. The chief clinical features were hemiplegia (86%), convulsions (27%), fever (23%), dysphasia (23%), headache (11%) and altered level of consciousness (11%). Routine laboratory tests were non-contributory. Cranial computerized tomography (CCT) on 21 patients was abnormal in 95% and was useful in revealing the extent of infarction. Infarction was confined to middle cerebral artery territory, often involving basal ganglionic structures and was associated with focal or diffuse atrophy. Angiograms were abnormal in 78% of the patients (18/23) and were complimentary to the CCT. Etiological factors identified were: Moya-moya disease 6, arteritis 5, fibromuscular dysplasia 2, scorpion sting 2, and venous sinus thrombosis and small vessel occlusion one each. Though 23% of the patients had fever at onset, no obvious evidence of systemic or CNS infection was noticed. Stroke in children continues to pose a diagnostic challenge.

Adolescent↗
PubMed2002

HIV-assocated lymphoma: a case report.

We report the case of a 3(1/2) year old boy who presented with sudden onset of headache. Fever and swelling of the left eye. He had complete opthalmoplegia of the left eye and 6th cranial nerve paralysis in the right eye. He was thought to have cavenous sinus thrombosis but CT findings suggestive of lymphoma led to the correct diagnosis of HIV associated Lymphoma It view of the rising incidence of HIV infection and the protein clinical manifestations, it is advised that all patients with disseminated tumour masses should be screened for the HIV virus, and CT examination should be made available to patients.

Abdominal Neoplasms↗
PubMed1977

Neurological complications of osteopetrosis.

The clinical course of twins with osteopetrosis has provided a catalogue of the neurological complications that may occur with the disorder. Such a list has not previously been compiled: (1) Hydrocephalus - probably due to outflow obstruction in the posterior fossa. (2) Sagittal sinus thrombosis - due to bony encroachment, or to hematological causes. (3) Exophthalmos - due to bony encroachment in the orbit. (4) Foraminal occlusion at the base of the skull, producing compromise of cranial nerves and vessels. (5) Paraparesis - cause unknown, perhaps due to spinal stenosis. (6) Anemia - myelophthisic, although a hemolytic component due to hypersplenism has been identified, as well.

Anemia, Myelophthisic↗
PubMed1992

[Eclampsia complicated with cerebrovascular disease].

Ten eclamptic patients complicated by acute cerebrovascular disease were admitted during the past eight years from Feb. 1982 to Feb. 1990. There were six cases of superior sagittal sinus thrombosis, two cases of cerebral hemorrhage, one cases of subarachnoid hemorrhage and the other one of cerebral infarction. Among them, eight patients were cured. Our analysis demonstrates that it is advisable to terminate pregnancy by cesarean section as soon as possible. A comprehensive management proposed by good cooperation between neurologist, neurosurgeon and obstetrician is the key to get a good way to cure these patients.

Adult↗
PubMed1985

Intracranial calcification in the infant and neonate: evaluation by sonography and CT.

This study reports the sonographic and computed tomography (CT) findings in seven infants and neonates with intracranial calcifications and a spectrum of underlying disorders, including toxoplasmosis, cytomegalic inclusion disease, transverse/straight sinus thrombosis, and probable anoxia. Neurotropic infectious disease usually produced clumped or subependymal calcifications accompanied by sometimes bizarre ventricular configurations and prominent periventricular cystic encephalomalacia. Sonography failed to identify prospectively intracranial calcifications in two of the three patients without infection, although calcifications were visible in retrospect. Overall, CT provided optimum visualization of intracranial calcifications.

Brain Diseases↗