1/3. Change in cerebral blood flow velocity pattern during induced hypotension: a non-invasive indicator of increased intracranial pressure?A neurologically intact patient underwent spinal instrumentation under hypotensive anaesthesia 10 days after a mild closed head injury. Transcranial Doppler monitoring of the right middle cerebral artery revealed an abnormal flow pattern, suggesting increased intracranial pressure, impaired autoregulation, or both. patients with a mild head injury may have altered intracranial haemodynamics and the time course of recovery from these changes is unknown.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Trigemino-abducens synkinesis: an unusual case of aberrant regeneration.An unusual case of major head trauma is described involving injury to the right third, fifth, sixth and seventh cranial nerves in a basal skull fracture in a young woman. Two years later there persisted a total voluntary abducens nerve palsy, right facial hemianaesthesia and right temporalis and masseter palsy. However, involuntary abduction of the involved eye occurred on eating or chewing. electromyography of the lateral rectus muscle documented aberrant reinnervation to support the clinical findings. Extraocular muscle surgery improved the compensatory head posture and minimized the chewing-induced abduction. The mechanisms for acquired synkinesis and the anatomy of the involved nerves are reviewed. It is postulated that regenerating motor fibres of the trigeminal nerve were misdirected along proprioceptive channels to the lateral rectus in the case reported here.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/3. Bilateral first rib fractures associated with driver's air bag inflation: case report and implications for surgery.A case of bilateral fractures of the first rib occurring in an otherwise fit road traffic accident victim is described. The only other injuries sustained were of the peripheral limbs. The driver's air bag was inflated during the crash, leading to speculation as to whether this may have contributed to the mechanism of injury. The patient was well oxygenated and cardiovascularly stable with no evidence of neurovascular damage to the thoracic aorta or its branches. Aortic arch aortography was not performed before internal fixation of the peripheral fractures was undertaken under general anaesthesia. A review of the indications for angiography in such patients follows. The policy that patients with fractures of the upper first ribs do not require angiography unless there is other evidence of neurovascular damage is supported.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |