1/41. magnetic resonance imaging findings of Kernohan-Woltman notch in acute subdural hematoma.OBJECTIVE AND IMPORTANCE: We report the case of a 73-year-old patient who presented a right motor deficit caused by an ipsilateral acute subdural hematoma. A magnetic resonance imaging (MRI) demonstration of Kernohan-Woltman notch phenomenon was obtained. CLINICAL PRESENTATION: The woman sustained a major head injury at home, followed by loss of consciousness. On admission to the emergency room, she was comatose, anisochoric (left > right), and showed a reaction to pain with decerebrating movements of left limbs (glasgow coma scale (GCS) 4/15). A right severe hemiparesis was observed. Cerebral computed tomography scan showed a large right hemispheric subdural hematoma. INTERVENTION AND POST-OPERATIVE COURSE: A wide right craniotomy was performed and the subdural hematoma evacuated. During the post-operative period, the level of consciousness gradually improved. A MRI performed about 2 weeks after operation showed a small area of abnormal signal intensity in the left cerebral peduncle. On discharge, the woman was able to communicate with others, but her right hemiparesis was still severe.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
2/41. 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 = 0.71428571428571keywords = subdural (Clic here for more details about this article) |
3/41. dissection of the middle cerebral artery caused by invasion of malignant glioma presenting as acute onset of hemiplegia.A 57-year-old, previously healthy man who developed acute onset of hemiplegia is presented. Neuro-imaging studies on admission suggested dissection of the middle cerebral artery producing infarction in the frontotemporal region. In contrast to his stable clinical course, serial neuro-imaging studies disclosed rapid growth of malignant glioma, which was confirmed at surgery. Microscopic examination of the surgical specimen demonstrated invasion of glioma cells into the arterial wall associated with intramural haematoma formation of the middle cerebral artery. This case is the first to document dissection of an intracranial artery caused by invasion of tumour cells.- - - - - - - - - - ranking = 0.061133910020591keywords = haematoma (Clic here for more details about this article) |
4/41. Management of penetrating injury to the petrous internal carotid artery: case report.We report the management of a penetrating foreign body injury to the neck with a length of fencing wire traversing the internal carotid artery within the petrous temporal bone and entering the middle cranial fossa. Discussion points include methods of haemorrhage control, as well as ligation versus repair or bypass as the definitive treatment.- - - - - - - - - - ranking = 0.023293647049397keywords = haemorrhage (Clic here for more details about this article) |
5/41. Epidural haematoma. A retrospective study of 100 patients.A retrospective study was made of 100 consecutive patients with an epidural haematoma in order to establish which clinically demonstrable factors had influenced the prognosis quoad vitam et sanationem. Operations were performed on 92 of these patients, 29 (32%) of whom died; 8 patients died without operation, and in 2 of these cases the diagnosis was not made during life. A lucid interval was observed in 57 patients; absence of a lucid interval in combination with a lowered sensory level indicated associated intradural lesions (cerebral contusion, acute subdural haematoma), with consequently a less good prognosis. The prognosis was also adversely affected by deeper coma, occurrence of extensor spasms, bilateral stiff pupils, bilateral pyramidal symptoms and an age over 50. Some 33% of the patients treated by operation showed marked symptoms of compression (extensor spasms and/or bilateral stiff pupils); although these symptoms are usually described as indicative of a hopeless prognosis, 40% of the patients in this catagory survived. Contrary to the data in the literature, the interval between accident and operation within the first 24 hours did not influence the mortality, which was 50%. All patients operated on more than 24 hours after the accident, survived. A cranial fracture was absent in 13 patients, 11 of whom were under 30; absence of a cranial fracture was prognostically favourable. A catamnestic study revealed that 7 of the 58 accessible survivors had residual neurological dysfunctions; all these patients were up and about. The residual morbidity after early operation (within 24 hours) was the same as that after later operation. The data obtained were compared with those on a number of series recently published in the literature.- - - - - - - - - - ranking = 0.69561941860447keywords = subdural haematoma, subdural, haematoma (Clic here for more details about this article) |
6/41. Subarachnoid haemorrhage with "Ecstasy" abuse in a young adult.Abuse of the drugs like amphetamine, cocaine and "Ecstasy" may be complicated by intracerebral, subdural or subarachnoid haemorrhage. Contrary to historical opinion, drug-related intracranial haemorrhage (ICH) is frequently related to an underlying vascular malformation. We report the case of an 18-year-old man with a history of Ecstasy abuse preceding the onset of severe occipital headache. Cerebral computed tomography revealed right-sided subarachnoid haemorrhage and cerebral angiography showed right-sided middle cerebral artery aneurysm of 1 cm diameter. The patient was treated surgically with aneurysm clipping. Three weeks after onset of intracranial haemorrhage, neurological examination demonstrated normal findings. A history of severe headache immediately after using amphetamine, Ecstasy, or cocaine should alert doctors to the possibility of intracerebral haemorrhage. Arteriography should be part of the evaluation of most young patients with stroke or non-traumatic ICH.- - - - - - - - - - ranking = 0.35249996630172keywords = subdural, haemorrhage (Clic here for more details about this article) |
7/41. Complication of a large cranial defect. Case report.A patient with acute subdural hematoma was successfully treated with hemicraniectomy. He developed contralateral weakness 4 months after surgery which was reversed by cranioplasty. The presumptive mechanism is a gradient between atmospheric and intracranial pressure. Early cranioplasty is suggested to prevent this phenomenon.- - - - - - - - - - ranking = 0.14285714285714keywords = subdural (Clic here for more details about this article) |
8/41. Deterioration of pre-existing hemiparesis brought about by subsequent ipsilateral lacunar infarction.Mechanisms of post-stroke recovery are still poorly understood. Recent evidence suggests that cortical reorganisation in the unaffected hemisphere plays an important role. A 59 year old man developed a small lacunar infarct in the left corona radiata, which then caused marked deterioration in a pre-existing left hemiparesis that had resulted from an earlier right putaminal haemorrhage. Functional magnetic resonance imaging showed that the paretic left hand grip activated the ipsilateral left motor areas, but not the right hemispheric motor areas. This suggests that partial recovery of the left hemiparesis had been brought about by cortical reorganisation of the left hemisphere and intensification of the uncrossed corticospinal tract. The subsequent small infarct may have damaged the uncrossed tract, thereby causing the pre-existing hemiparesis to deteriorate even further.- - - - - - - - - - ranking = 0.023293647049397keywords = haemorrhage (Clic here for more details about this article) |
9/41. Haemorrhagic brain injury: a care study.Mark was only 20 years old when an unfortunate sequence of events dramatically altered his life. In July 1989 he sustained two subarachnoid haemorrhages within a fortnight, first from a left anterior communicating artery aneurysm and then from a right middle cerebral artery aneurysm. Both aneurysm were successfully clipped but Mark remained hemiplegic with severe physical and behavioural problems, including incontinence, sexual disinhibition, aggression and uninhibited spitting. In November 1989, he was transferred to a neuro-rehabilitation unit and his management there will be described, showing how his complex problems were managed within enforced environmental limitations.- - - - - - - - - - ranking = 0.023293647049397keywords = haemorrhage (Clic here for more details about this article) |
10/41. Risus sardonicus after thalamic haemorrhage.We describe an uncommon movement disorder after stroke. A 70-year-old man was admitted for a right thalamic haemorrhage and 1 week later developed bilateral contractions of the face. Electromyographic study revealed a bilateral facial dystonia. The association of this bilateral facial dystonia and vertical gaze palsy produced the aspect of a "risus sardonicus."- - - - - - - - - - ranking = 0.11646823524699keywords = haemorrhage (Clic here for more details about this article) |
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