1/32. Retrolabyrinthine presigmoid transpetrosal approach for selective subtemporal amygdalohippocampectomy.The retrolabyrinthine presigmoid transpetrosal approach is a modification of the subtemporal approach which is suitable for complete amygdalectomy. By drilling away the retrolabyrinthine presigmoid petrosal bone, at least 1 cm more space below and 1 cm more space medially is obtained than in the subtemporal approach, and temporal retraction pressure is diminished when approaching from below. Operative results according to the Engel's classification of seizure control, and pre- and postoperative Wechsler adult intelligence Scale (WAIS), revised WAIS, and Wechsler intelligence Scale for Children scores were measured in 16 patients treated by normal or modified subtemporal amygdalohippocampectomy. Postoperative follow-up ranged from 8 to 79 months. There has been no morbidity or mortality among these 16 patients, and postoperative seizure frequency has been diminished to less than 10% of the preoperative level in 15 of the 16. In eight patients, seizures have been eliminated totally. Subtemporal amygdalohippocampectomy achieved significantly increased performance and full scale intelligence quotient within 2 months after surgery, compared to preoperative levels. Subtemporal amygdalohippocampectomy is an alternative to the transsylvian approach, but is less invasive.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/32. "Pressure to laugh": an unusual epileptic symptom associated with small hypothalamic hamartomas.Gelastic seizures are the hallmark of the epilepsy syndrome associated with hypothalamic hamartomas. patients typically develop cognitive deterioration and refractory seizures. The authors describe three patients with small hypothalamic hamartomas without these features and thus identify a mild end to the clinical spectrum. All had the unusual symptom of "pressure to laugh," often without actual laughter. This symptom could be dismissed as psychogenic but should be recognized as a clue to the presence of this unusual lesion.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/32. Epileptic seizures attributed to cerebral hyperperfusion after percutaneous transluminal angioplasty and stenting of the internal carotid artery.Cerebral hyperperfusion syndrome as a complication of carotid endarterectomy (CEA) has been widely reported in the surgical literature. It may occur within hours to 3 weeks after CEA and is characterized by symptoms ranging from headaches, fits, confusion, focal neurological signs to intracerebral hemorrhage. Although percutaneous transluminal angioplasty (PTA) and stenting are increasingly performed as an alternative to CEA in the treatment of carotid artery stenosis, few cases of cerebral hyperperfusion injury following carotid stenting have been reported. We describe 2 cases of cerebral hyperperfusion syndrome following PTA and stenting for high-grade internal carotid artery (ICA) stenosis. Both cases involved a lesion of 95% in severity. The first case was a 73-year-old man who developed generalized convulsion 7 h following stenting to the left ICA. The second case was an 80-year-old woman who developed recurrent right periorbital headache and confusion 16 h after stenting to the right ICA, followed by left upper limb seizure 14 days later. Both patients fully recovered without any intracerebral hemorrhage or infarction. To our knowledge, this is the first report of cerebral hyperperfusion injury after carotid stenting without associated intracranial hemorrhage and with full recovery. In the patient with neurological symptoms following carotid stenting, it is important to consider cerebral hyperperfusion syndrome as a differential diagnosis to embolic or hemorrhagic stroke since early recognition and meticulous control of blood pressure may prevent progression to cerebral hemorrhage and death.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/32. Non-epileptic manifestations in patients with single enhancing computed tomography lesions.OBJECTIVES AND methods: Single enhancing lesions are common computed tomographic (CT) abnormality in patients with epilepsy. In this series we are reporting 13 unusual cases with varied non-epileptic neurological manifestations in patients with ring or disk enhancing CT lesions. RESULTS: Acute, stroke like non-vascular focal neurological deficits (hemiparesis in four patients, and crural monoparesis, Broca's aphasia, homonymous hemianopia, hemichorea in one patient each) were frequent non-epileptic manifestations. Episodic vascular type of headache was seen in three patients, one patient had headache because of raised intracranial pressure. One patient presented with acute confusional state. All these patients were treated symptomatically, and with oral corticosteroids. CT lesions disappeared in 8-12 weeks time in all patients except in one patient with chorea where the lesion calcified. Significant clinical improvements were noted in all the patients. CONCLUSIONS: Several non-epileptic manifestations can also be associated with single enhancing CT lesions, and like epileptic disorders these disorders also have a benign course. Corticosteroids, probably, hasten the clinical improvement and produce early resolution of the CT lesions.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/32. Neurocutaneous melanosis with epilepsy: report of one case.Neurocutaneous melanosis is a rare congenital syndrome characterized by the association of large or multiple congenital melanocytic nevi and benign or malignant melanotic tumors in the central nervous system. patients with neurocutaneous melanosis usually have neurological symptoms early in life that progress rapidly due to the development of increased intracranial pressure or malignant melanoma. We report a 2-month-old female infant with multiple congenital melanocytic nevi and frequent seizure attacks. magnetic resonance imaging of the brain demonstrated several regions compatible with melanotic deposits. During follow-up for one year, she had normal development and was seizure-free under the treatment of phenobarbital and valproic acid. We suggest that infants with large or multiple congenital melanocytic nevi should receive regular clinical check-up and brain imaging to exclude the possibility of central nervous system lesions.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/32. Low-pressure hydrocephalic state complicating hemispherectomy: a case report.Low-pressure hydrocephalic state (LPHS) has only recently been described as a distinct clinical entity occurring in patients with bioatrophic lesions of the brain. We report a patient in whom this syndrome developed after subtotal hemispherectomy for intractable epilepsy. methods: A 30-year-old man developed cerebrospinal fluid (CSF) rhinorrhea after subtotal hemispherectomy. After repair of the CSF dural fistula, clinical and radiological features of an LPHS developed. After external ventricular drainage for 26 days, a programmable low-pressure shunt system was instituted. RESULTS: Worsening neurologic status and ventriculomegaly in the face of normal intraventricular pressures is diagnostic of this condition. The clinical status clearly correlated with ventricular size and not ventricular pressure. CONCLUSION: LPHS is a clinically significant perioperative complication that rarely occurs after large brain excisions. Restoration of the baseline brain compliance is critical in the management of this condition.- - - - - - - - - - ranking = 8keywords = pressure (Clic here for more details about this article) |
7/32. Pulmonary thromboembolism presenting as epileptiform generalized seizure.A 69-year-old patient with a new-onset generalized epileptiform tonic-clonic seizure was successfully diagnosed with pulmonary thromboembolism in the prehospital setting even though the clinical picture suggested an unknown, primarily neurological, problem. Prehospital diagnostic procedures also included capnometry and D-dimer assay. The former showed lower than normal end-tidal carbon dioxide pressure values, and a value of the latter proved to be highly pathological. In the intensive care unit the diagnosis of massive pulmonary thromboembolism was confirmed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/32. Changes of blood pressure and heart rate variability precede a grand mal seizure in a pregnant woman.In order to evaluate blood pressure and heart rate variability as a potent diagnostic tool for different hypertensive pregnancy disorders we started a clinical trial recording these variables in early pregnancies predisposed for preeclampsia. During routine measurements one of the patients experienced a grand mal epileptic seizure. Since the parameters of both heart rate and blood pressure variability were sequentially altered immediately before the seizure, this case report provides an interesting insight into autonomic cardiovascular control in a developing convulsive fit and the pathophysiological generation of a grand mal seizure in pregnancy.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
9/32. Pulmonary hypertension during epileptic seizure with evidence of increased angiotensin ii in pulmonary artery.We experienced a 78-year-old man in whom transient pulmonary hypertension was documented during epileptic seizure. A Swan-Ganz catheter demonstrated that pulmonary arterial pressure rose immediately after the initiation of the seizure, which was followed by systemic hypertension. The plasma level of angiotensin ii increased in pulmonary circulation during the seizures; however, catecholamines did not change from the baseline. The patient responded well to treatment with an antiepileptic drug and losartan potassium.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/32. Neurologic events after partial exchange transfusion for priapism in sickle cell disease.We describe six boys with homozygous sickle cell disease, aged 7 to 13 years, in whom acute, severe neurologic abnormalities developed 1 to 11 days after partial exchange transfusion was performed to treat priapism that was unresponsive to more conservative therapy. Hemoglobin levels were 10.5 to 13.4 gm/dl (mean 12.1 gm/dl), and hemoglobin S levels were 18% to 33% (mean 27%) before the onset of neurologic complications. Severe headache was the initial finding in five patients, four of whom had increased intracranial pressure and three of whom required tracheal intubation and hyperventilation. Four patients had seizures; three had focal neurologic deficits for more than 24 hours. Cerebral arteriography demonstrated vascular abnormalities, including irregularity, stenosis, and complete occlusion of vessels. patients treated with regular erythrocyte transfusions had no recurrence of neurologic signs or symptoms when hemoglobin S levels were kept at 30% to 50%. The occurrence of serious neurologic complications after partial exchange transfusion in patients with homozygous sickle cell disease from three centers indicates the possibility of a causal relationship between the events. Early and thorough investigation of neurologic symptoms, especially severe headache, is warranted in this clinical setting.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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