1/14. Therapeutic plasma exchange for the acute management of the catastrophic antiphospholipid syndrome: beta(2)-glycoprotein I antibodies as a marker of response to therapy.We describe two patients with the catastrophic antiphospholipid syndrome associated with elevation of beta(2)-glycoprotein I antibodies and fulminant thrombotic diatheses. Both patients were treated with therapeutic plasma exchange (TPE), which resulted in a marked decrease in antibody titer accompanied by an improved clinical outcome in one patient (IgG antibody). In the second patient, the outcome was poor despite TPE (IgA antibody). There were no significant complications of TPE in either case. Because of the fulminant nature of the catastrophic antiphospholipid syndrome, we conclude that a trial of TPE is warranted for the acute management. Further studies are needed to clarify which patients may benefit from this treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/14. Nontraumatic spinal subdural haematoma occurring in a postpartum period.Spontaneous occurrence of spinal subdural haematoma (SSH) is very rare. While many neurological disorders can develop in pregnant patients in relation to haemostatic imbalance, there have been no reports in the literature suggesting that pregnancy and/or childbirth per se could be a single risk factor for acute SSH.A 38-year-old previously healthy woman gave birth to a baby via transvaginal normal delivery. The patient had no history of receiving anticoagulants. Eight days after delivery, she experienced sudden onset severe interscapular back pain, and the next day she developed dysesthesia in the both legs and mild urinary retention. Severe meningeal signs were noted. Lumbar puncture revealed bloody cerebrospinal fluid. Magnetic resonance images revealed SSH in the ventral position spreading from levels Th1 to Th7. The patient underwent conservative treatment after which the symptoms gradually improved. Serial MRI study at 17 and 69 days after onset showed spontaneous regression of the SSH. Spinal angiography did not show any vascular malformations, but simultaneous cerebral angiography revealed a co-existing cerebral aneurysm on the C2 segment of the left internal carotid artery. It is unlikely that the cerebral aneurysm was the origin of the SSH, based on the clinical and radiographic findings. Moreover, we confirmed the unruptured nature of the aneurysm during the clipping procedure at open surgery.We report the unique case of subacute SSH occurring 8 days after childbirth without other known risk factors. The possible etiology and magnetic resonance imaging (MRI) findings in this case, and the current controversy concerning therapy for SSH are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/14. Shaking infant trauma induced by misuse of a baby chair.A 2 month old infant presented with bilateral subdural haemorrhages and bilateral subhyaloid haemorrhage. The parent admitted to forceful bouncing of the child in a baby rocker. Experiments showed that violent rocking in the chair could produce extreme alternating acceleration/deceleration forces in excess of those induced by shaking alone. Such handling could not be interpreted as accidental mismanagement and the abusive nature of the process was graphically shown in video recordings of the experiment. Prosecution resulted in a conviction for cruelty, and a suspended sentence.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/14. Supratentorial arachnoidal cyst with intracystic and subdural haematoma.A case of a arachnoidal cyst with intracystic bleeding and subdural haematoma is reported. The association of an arachnoidal cyst in the middle cranial fossa with a subdural haematoma or intracystic bleeding is emphasised. The diagnosis of such lesions, the nature of the pathology and therapy are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/14. Further characterization of traumatic subdural collections of infancy. Report of five cases.Bilateral convexity and interhemispheric subdural hematomas are common neuroimaging patterns seen in infants who have sustained nonaccidental head injuries (NAHIs). These collections often appear aschronic or acute-on-chronic on computerized tomography (CT) studies. To determine the nature of these extraaxial fluid collections and their relationship to cerebrospinal fluid (CSF) dynamics, the authors studied five infants with suspected NAHI in whom symptomatic bilateral mixed- or low-density subdural collections were revealed on imaging studies; the patients underwent burr hole evacuation of the hematoma and external drainage. Once decompression was achieved, radiotracer was injected into the lumbar subarachnoid space, and the subdural drainage system was monitored for appearance of the isotope. In all five cases, the radiotracer moved rapidly from the lumbar subarachnoid space into the convexity subdural space and then into the external drainage system. This indicated the possibility that some of these mixed-density subdural collections were acute blood mixed with CSF rather than acute-on-chronic collections arising from rebleeding subdural membranes. The authors propose that, during infancy, tears in the loosely adherent arachnoid envelope at the main arachnoid granulation site along the superior sagittal sinus may result in a considerable amount of CSF mixing with acute blood in the subdural space, creating a hematohygroma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/14. Subdural haematoma: a complication of cochlear implantation.cochlear implants have transformed the treatment of sensorineural hearing loss. They have few major complications. The authors describe the case of a man fitted with a cochlear implant who suffered a postoperative subdural haematoma. The haematoma is thought to have been caused by bleeding from emissary veins opened by the drill passages used to anchor the sutures for the receiver/stimulator. The authors have abandoned tie down sutures in cochlear implants, preferring an appropriately deep well with squared-off rims, which would secure the implant in place. They have had no further complications of this nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/14. Primary cranial vault lymphoma presenting as a traumatic subdural hematoma.OBJECTIVE AND IMPORTANCE: The authors present a rare case of a primary cranial vault lymphoma, mimicking a subacute subdural hematoma after head trauma. CLINICAL PRESENTATION: A 78-year-old woman was admitted to the hospital with progressive left hemiparesis, headache and a gradually increasing soft lump over the right parietal region 1 week after head trauma due to falling from a high place. A computed tomography (CT) scan demonstrated a hyperdense parieto-occipital subdural and subgaleal lesion together with marked midline shift and white matter edema. INTERVENTION: Considering her trauma story and clinical progression, the patient underwent an emergency operation with the diagnosis of subdural hematoma. However, the lesion was found to be of a tumors nature and the histopathological diagnosis was high-grade malignant non-Hodgkin's lymphoma. CONCLUSION: The authors emphasize the rarity of primary cranial vault lymphoma and its importance in the differential diagnosis of cranial vault mass lesions extending either intra- or extracranially. This case may be considered as another example where magnetic resonance imaging (MRI) is the ultimate definitive test in the emergency ward whenever CT demonstrates any findings which are unclear.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/14. On the management of neonatal tentorial damage. Eight case reports and a review of the literature.From the history of 15 personal patients--8 reported here in extenso--and from 63 patients in the literature with the diagnosis of posterior fossa subdural haemorrhage during life, we discuss the possibility of detecting tentorial damage on computed tomography (CT) and ultrasound (US) scan. The association of a (peri)cerebellar haemorrhage with peritentorial bleeding around the straight sinus and a subdural haemorrhage between both occipital cerebral lobes is suggestive of tentorial laceration(s). Both coronal CT scan and sagittal US scan are very helpful in locating these haemorrhages near the falco-tentorial junction. The conservative management of one of our infants with very extensive but asymmetric posterior fossa haemorrhage, leading to resorptive hydrocephalus, is compared with both surgical and conservative treatment of patients from the literature. Two reasons that warrant neurosurgical intervention are: life-threatening brain-stem compression--as in one of our own patients--and acute obstructive hydrocephalus. craniotomy of the posterior fossa within the neonatal period does not prevent later-onset resorptive hydrocephalus. The communicating nature of this latter process is adequately demonstrated by lumbar isotope cisternography. Finally, neonatal posterior fossa subdural haemorrhage is one of the many causes of cyst-like structures behind the cerebellum.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/14. Fat deposition adjacent to chronic subdural hematoma: CT demonstration.Computed tomography of the head in a patient with bilateral chronic subdural hematomas demonstrated areas of fat density closely approximating the hematomas. The persistent fatty nature of the CT finding was confirmed by subsequent magnetic resonance and CT performed 1 month and 3 years later. Although an intracerebral hemorrhage with transient presence of fatty material has been described in an alcoholic hyperlipemic patient, this case shows fatty deposition adjacent ot subdural hemorrhage without any known predisposing factors.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/14. Nonacute subdural hematoma: fundamental interpretation of MR images based on biochemical and in vitro MR analysis.Few reports have described the nature of the appearance of nonacute subdural hematoma on magnetic resonance (MR) images. The authors analyzed MR images in 39 cases of nonacute subdural hematoma and subdural effusion by measuring in vitro proton relaxation times and the biochemical variables of hematoma fluids. T1 became proportionally shorter than T2 with an increase in hematocrit but the direct cause of the variation in T1 and T2 was the amount of methemoglobin. The free iron content, not the bound iron content, was another main cause for shortened T1 and T2. Paradoxical findings in the correlation between the total protein or albumin concentration and relaxation times were noted. It is possible that as the protein level in the supernatant increased, more free iron was bound to the protein, decreasing the influence of the free iron on the relaxation times.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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