1/73. Heading injury precipitating subdural hematoma associated with arachnoid cysts--two case reports.A 14-year-old boy and a 11-year-old boy presented with subdural hematomas as complications of preexisting arachnoid cysts in the middle cranial fossa, manifesting as symptoms of raised intracranial pressure. Both had a history of heading the ball in a soccer game about 7 weeks and 2 days before the symptom occurred. There was no other head trauma, so these cases could be described as "heading injury." arachnoid cysts in the middle cranial fossa are often associated with subdural hematomas. We emphasize that mild trauma such as heading of the ball in a soccer game may cause subdural hematomas in patients with arachnoid cysts.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/73. Bilateral chronic subdural hematomas resulting in unilateral oculomotor nerve paresis and brain stem symptoms after operation--case report.An 85-year-old male presented with bilateral chronic subdural hematomas (CSDHs) resulting in unilateral oculomotor nerve paresis and brainstem symptoms immediately after removal of both hematomas in a single operation. Initial computed tomography on admission demonstrated marked thick bilateral hematomas buckling the brain parenchyma with a minimal midline shift. Almost simultaneous removal of the hematomas was performed with the left side was decompressed first with a time difference of at most 2 minutes. However, the patient developed right oculomotor nerve paresis, left hemiparesis, and consciousness disturbance after the operation. The relatively marked increase in pressure on the right side may have caused transient unilateral brain stem compression and herniation of unilateral medial temporal lobe during the short time between the right and left procedures. Another factor was the vulnerability of the oculomotor nerve resulting from posterior replacement of the brain stem and stretching of the oculomotor nerves as seen on sagittal magnetic resonance (MR) images. Axial MR images obtained at the same time demonstrated medial deflection of the distal oculomotor nerve after crossing the posterior cerebral artery, which indicates previous transient compression of the nerve and the brain stem. Gradual and symmetrical decompression without time lag is recommended for the treatment of huge bilateral CSDHs.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/73. Induced hypertension after head injury.The use of induced hypertension in head injury patients is controversial. We present the case of a 19-year-old man admitted with severe head trauma after a road accident and describe the beneficial effects that increasing arterial blood pressure had on the cerebral perfusion pressure, cerebral blood flow and jugular bulb oxygen saturation in this patient.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/73. electroconvulsive therapy and subdural hemorrhage.electroconvulsive therapy (ECT) was used to treat severe depressive illness in two patients, one of whom had undergone recent neurosurgery for subdural hemorrhage (SDH) and another with a concurrent SDH in the absence of raised intracranial pressure. Although the second patient died 1 month after the completion of ECT, in neither case did ECT extend the SDH or lead to other intracranial complications. It would seem that ECT can be performed safely in the presence of SDH without mass effect or after surgical drainage of SDH, although clinicians should proceed cautiously in close collaboration with neurosurgical colleagues, review neuroimaging scans at regular intervals during and after the course of ECT, and use the dose-titration method of treatment with unilateral electrode placement away from the site of the lesion or surgery to minimize adverse effects.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/73. Spontaneous resolution of chronic subdural hematoma.BACKGROUND: Spontaneous resolution of chronic subdural hematoma has rarely been reported in the literature, and its mechanism has not been fully investigated. Response to surgery has been very satisfactory; in fact, this is generally considered the treatment of choice. methods: From a series of 24 cases of chronic subdural hematomas, we observed five patients between 1996 to 1998. These patients showed headache and decrease of cognitive level, 4-5 weeks after minor head injury. Neurologic evaluation revealed only worsening of mental function according to Mini Mental State Examination (MMSE). Computed tomography (CT) scans showed brain atrophy and chronic subdural hematoma without increased intracranial pressure. These patients were treated by clinical observation and serial cerebral CT scans. RESULTS: After 7 to 10 days, all patients showed improvement of clinical signs. After 30 to 45 days, radiological disappearance or marked reduction in size of the hematoma and complete clinical recovery were obtained. No neurological deficits and no recurrences have been observed during follow-up (3 months to 2 years). CONCLUSIONS: We believe that age greater than 70 years, decreased cognitive level (MMSE = 21), brain atrophy, and absence of increase of intracranial pressure are clinical and radiological signs that allow one to choose conservative treatment.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/73. Antihypertensive treatment for the neurological patient: a nursing challenge.The neuroscience nurse's role in hypertensive management for patients with neurological injury can be challenging. This is especially true for patients whose cerebral autoregulation is affected by chronic hypertension or a cerebral insult. Hypertensive management involves more than the mere administration of medications. The nurse is responsible for monitoring the effects of drugs, lowering the blood pressure to a safe level and observing for any neurological deficits which may ensue from cerebral hypoperfusion. The nurse must collaboratively be able to determine if the patient's hypertensive episodes are caused by ineffective antihypertensives or a new cerebral insult. knowledge of hypertension management helps maintain adequate cerebral perfusion and ultimate neurological functioning of the patient.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/73. Critical shunt-induced subdural hematoma treated with combined pressure-programmable valve implantation and endoscopic third ventriculostomy.The authors present 2 patients with VP shunt-induced subdural hematomas (SDH) treated with pressure-programmable valve implantation and endoscopic third ventriculostomies (TV). The first patient is an 11-year-old girl who developed a shunt-induced SDH. Revision of the shunt valve with a higher-pressure valve resulted in a prolonged deterioration of her consciousness. External ventricular drainage at low pressure led to clinical improvement. A pressure-programmable valve set at 50 mm H(2)O was implanted, and the pressure gradually increased. At a pressure of 120 mm H(2)O symptoms recurred, even though the subdural collection was beginning to decrease in size. An endoscopic TV was performed, and the valve pressure was then increased to 200 mm H(2)O without any neurological symptoms. The second patient, a 7-year-old boy with shunt-induced SDH, had recurrent SDH, even after shunt revision with placement of a higher-pressure valve, which resulted in prolonged lethargy. A pressure-programmable valve was implanted with concurrent endoscopic TV. Gradual valve pressure increases up to 200 mm H(2)O could be performed without recurrent symptoms. Eventually, the shunt system was ligated to resolve residual positional headache, and the TV has been patent for more than 3 years. In both patients, the pressure-programmable valve was useful, since the optimal CSF drainage pressure changed during the period of recovery from symptomatic subdural collections. Concurrent TV appeared to enable increasing the valve pressure gradually without any neurological symptoms. The advantages of this combined approach are discussed.- - - - - - - - - - ranking = 17keywords = pressure (Clic here for more details about this article) |
8/73. Dural arteriovenous malformation associated with recurrent subdural haematoma and intracranial hypertension.An unusual case of intracranial hypertension and symptoms of a left parieto-occipital mass lesion due to a dural arteriovenous malformation (AVM) with a large and dilated draining vein is reported. The patient also had a history of homolateral recurrent subdural haematoma, 11 years before. Subdural haematoma is rarely associated to a dural AVM. We suggest that the recurrent subdural haematoma was due to the very slow and intermittent venous bleeding from the preexisting dural malformation, which progressively enlarged in the following years to become very large. The symptoms of intracranial hypertension and papilloedema may be explained by the increased pressure in the dural sinus and the cerebral venous system. On the other hand, focal neurological symptoms in our case resulted from the mass effect due to an aneurysmally dilated draining vein in the left parieto-occipital region.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/73. Chronic subdural hematoma in a 50-year-old man with polycystic kidney disease.The following case describes two spontaneous chronic subdural hematomas in one patient. The hematomas occurred on opposite sides. The patient had good blood pressure control and a normal creatinine. He was not receiving any anticoagulants or antiplatelet drugs. An angiogram was done after the second subdural collection was drained. There was no evidence of a vascular lesion. The possibility remains that patients with adult polycystic disease may be predisposed to develop spontaneous subdural hematomas in light of another report of five other cases.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/73. Intracranial subdural hematoma after puncture of spinal meningeal cysts.A patient is reported with an intracranial subdural hematoma after puncture of spinal meningeal cysts. In this case, spinal meningeal cysts were diagnosed by myelography. No intracranial subdural hematoma was detected immediately after myelography. Deterioration in the patient's level of consciousness occurred after puncture of the cysts. The authors speculated that the cerebrospinal fluid pressure dropped rapidly when the spinal meningeal cysts were punctured. This displaced the cerebral bridging veins downward, tearing them and resulting in an intracranial subdural hematoma.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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