1/21. Extramedullary hematopoiesis within a frontoethmoidal encephalocele in a newborn with holoprosencephaly.We present the first report of extramedullary hematopoiesis (EMH) in an encephalocele. The patient was a new-born with semilobar holoprosencephaly, a frontoethmoidal encephalocele, and a large subdural hematoma. The encephalocele appeared as a hemorrhagic mass, protruding from the forehead to cover the right eye, without involvement of the sinuses or nasopharynx. Computerized tomography and magnetic resonance imaging studies ruled out other forms of holoprosencephaly and confirmed the continuity of the brain with the extruded mass. immunohistochemistry confirmed the presence of an atrophic epithelium covering the mass. Histologic examination of the encephalocele revealed EMH both within and adjacent to malformed cerebral cortex, with a tendency for the hematopoietic cells to line up in columns within malformed cerebral cortex. We propose that a single event during the fourth week of gestation could both interrupt closure of the neural tube, giving rise to the encephalocele, and impair migration of the neural crest, leading to holoprosencephaly secondary to failure of neural crest derivatives to induce basomedial telencephalic differentiation. EMH may have been induced from hematopoietic stem cells in the richly vascular meningeal component of the encephalocele, in response to anemia and hypoxia.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
2/21. life-threatening intracranial hypotension after diagnostic lumbar puncture.intracranial hypotension syndrome as a complication of diagnostic lumbar puncture is a rarely observed entity. intracranial hypotension syndrome is characterized by postural headache, neck pain/stiffness, blurred vision, nausea, vomiting, clouding of consciousness, dizziness and vertigo. The majority of cases resolve spontaneously with conservative treatment. Rarely, epidural blood patch is required. We report a 41-year-old man with multiple sclerosis, who developed intracranial hypotension syndrome after diagnostic lumbar puncture and who did not respond to conservative treatment. A subdural hematoma was subsequently found, when the patient showed considerable worsening of clinical conditions with life-threatening symptoms. Surgical evacuation of the subdural hematoma was not sufficient to improve significantly the patient's conditions, while complete symptoms remission was achieved 12 hours after epidural blood patch. We stress the need for epidural blood patch in any case of post-diagnostic lumbar puncture postural headache which does not resolve with conservative therapy.- - - - - - - - - - ranking = 2keywords = subdural (Clic here for more details about this article) |
3/21. Rapid spontaneous resolution of signs of intracranial herniation due to subdural hematoma--case report.An 83-year-old female presented with signs of intracranial herniation due to subdural hematoma (SDH) which resolved rapidly and spontaneously. This patient showed bilateral decerebrate postures due to left SDH on admission. Since she had serious neurological symptoms and critical systemic conditions caused by an asthma attack, conservative treatment including osmotherapy and mechanical ventilation was performed instead of surgical intervention. Her signs of intracranial herniation resolved only 6 hours after admission. Although the SDH did not diminish rapidly, she showed excellent neurological improvement even with conservative treatment only. Characteristic serial changes on computed tomography corresponding to the neurological improvements were seen. She was discharged with slight right hemiparesis and slight dementia that were present prior to this admission. The rapid resolution of signs of intracranial herniation was attributable to the spontaneous diminution of SDH. The diminution or disappearance of hematomas probably depended on the redistribution of cerebrospinal fluid into the hematoma in the present case.- - - - - - - - - - ranking = 5keywords = subdural (Clic here for more details about this article) |
4/21. Unusual intraventricular herniation of the suprasellar arachnoid cyst and its successful endoscopic management.A child with a benign intrinsic tectal tumor and obstructive hydrocephalus developed a huge intraventricular cystic lesion following insertion of a shunt, which was complicated by a subdural-subarachnoid bleeding. The lesion was identified to be an entrapped chiasmatic cistern, which disrupted the septum pellucidum in front of the third ventricle and filled gradually the anterior horn of the lateral ventricle. The condition was successfully treated endoscopically by fenestration of the cyst and a third ventriculostomy. Probable mechanisms of such unusual cyst formation and general management strategies in patients with obstructive hydrocephalus are discussed.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
5/21. Intrasphenoidal encephalocele associated with cerebrospinal fluid fistula and subdural hematomas: technical case report.OBJECTIVE AND IMPORTANCE: Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported. CLINICAL PRESENTATION: A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele. INTERVENTION: A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure. CONCLUSION: The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.- - - - - - - - - - ranking = 6keywords = subdural (Clic here for more details about this article) |
6/21. Acute haemorrhage into a microcystic meningioma leading to cerebral herniation.Low-grade (WHO level I) meningiomas are slow-growing, benign tumours typically presenting with unspecific symptoms (e.g. headache), seizures, cranial nerve compression and neuropsychological symptoms determined by location and size of the lesion. Haemorrhagic onset and sequelae are rare, and have been described infrequently. This is a case of a 50-year-old male presenting with signs of tentorial herniation secondary to hyperacute intratumoural haemorrhage (ITH) into a previously undiagnosed meningioma. Emergency surgical decompression and exstirpation of the lesion helped to achieve a favourable outcome. ITH has been described in all including benign intracranial neoplasms. Factors associated with a higher risk for haemorrhage in meningiomas are discussed. Though haemorrhages associated with meningiomas have been reported, ITH into low-grade meningiomas leading to herniation remains a rarity. Bearers of known lesions and their treating physicians who opt for conservative or delayed treatment should be aware of this remote complication.- - - - - - - - - - ranking = 0.11205887252969keywords = haemorrhage (Clic here for more details about this article) |
7/21. Acute subdural hematoma caused by an unruptured, thrombosed giant intracavernous aneurysm.INTRODUCTION: Acute subdural hematoma (SDH) is an infrequent complication after aneurysmal subarachnoid hemorrhage. SDH associated with unruputed intracavernous aneurysm has never been reported. methods: Single patient case report and review of relevent literature. RESULTS: A 65-year-old woman with an unruptured, thrombosed giant intracavernous aneurysm developed an acute SDH 2 days after admission for cavernous sinus syndrome. Despite emergent evacuation of the SDH, the patient never regained consciousness because of brain herniation. CONCLUSION: Acute SDH is a rare complication of ruptured, giant intracavernous aneurysms. Erosion of the cavernous sinus wall by acute enlargement of the aneurysm after thrombosis is the proposed mechanism for development of the SDH.- - - - - - - - - - ranking = 5keywords = subdural (Clic here for more details about this article) |
8/21. levodopa-responsive parkinsonism following central herniation due to bilateral subdural hematomas.A 66-year-old man suffered bilateral subdural hematomas progressing to central herniation, despite repeated surgical evacuations. This eventually resolved, leaving him with a severe parkinsonian syndrome that was responsive to levodopa. MRI and CT showed midbrain compression from central herniation, and a follow-up MRI revealed thinning of the pars compacta. The clinical and radiologic evidence suggested that midbrain compression from central herniation was the probable cause of parkinsonism in this patient.- - - - - - - - - - ranking = 5keywords = subdural (Clic here for more details about this article) |
9/21. Treatment of hemispheric collapse and herniation beneath the falx in a case of shunted hydrocephalus.A successfully treated case of inversion and herniation of a cerebral hemisphere beneath the falx is reported. This condition resulted from large subdural hematomas as a complication of shunting in advanced hydrocephalus. The subdural collections were evacuated gradually while ventricular cerebrospinal fluid was replenished through the externalized ventricular catheter. The patient showed substantial recovery of neurological function. Tolerance of such massive cerebral herniation demonstrates a remarkable ability of the thin hydrocephalic cortical mantle to function after extreme distortion.- - - - - - - - - - ranking = 2keywords = subdural (Clic here for more details about this article) |
10/21. The abnormal pupil in cheyne-stokes respiration. Case report.cheyne-stokes respiration commonly induces a rhythmic pupillary dilatation during hyperpnea and constriction during apnea. Failure of a pupil to dilate during hyperventilation indicates underlying sympathetic nerve paralysis. This report deals with an instance in which one pupil failed to constrict during apnea due to oculomotor nerve compression. The periodic respirations and anisocoria disappeared following surgical evacuation of a large ipsilateral subdural hematoma.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
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