1/30. The association of laryngoceles with ventricular phonation.Laryngoceles represent dilatations of the laryngeal saccule that may extend internally into the airway, or externally through the thyrohyoid membrane. Unilateral laryngoceles are uncommon clinical entities and bilateral laryngoceles are rare. Certain activities like glass blowing and playing a wind instrument are associated with laryngocele development, as is laryngeal carcinoma in the ventricular area. This case describes development of bilateral laryngoceles in a patient who chronically uses ventricular phonation during speech. The pathogenesis involves repetitive elevation of intralaryngeal pressure during false vocal cord approximation, exposing the ventricles to abnormally high air pressures. The pathogenesis in this case, as well as in laryngoceles associated with occupational or anatomic risk factors, is discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/30. Spontaneous intercostal pulmonary hernia.A case of spontaneous intercostal pulmonary hernia as a result of vigorous coughing is reported in a 67-year-old man. The great majority of acquired pulmonary hernias are post-traumatic; rare cases are spontaneous, resulting from prolonged and/or repeated increased intrathoracic pressure. This hernia was successfully repaired with a polyglactin absorbable mesh and approximation of the ribs with heavy stitches. When required, surgical repair is the treatment of choice.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/30. Transdural cauda equina incarceration after microsurgical lumbar discectomy: case report.OBJECTIVE AND IMPORTANCE: Complications usually occur when they are least expected. We present an unusual case of nerve entrapment after microsurgical discectomy. CLINICAL PRESENTATION: A patient undergoing uneventful first lumbar microsurgical discectomy developed severe back and leg pain and a progressive neurological deficit during the first postoperative night. Herniation of cauda equina nerve roots had occurred through an unnoticed minimal defect in the dura, which had not caused cerebrospinal fluid leakage. The roots were incarcerated and swollen, and they filled the space of the resected nucleus pulposus. It was presumed that elevation of intra-abdominal pressure and consequent increased intraspinal pressure during extubation led to the herniation of arachnoid and cauda equina roots. The nerve roots were then trapped and incarcerated in the manner of bowel loops in an abdominal wall hernia. INTERVENTION: During reoperation, the nerve roots were repositioned into the dural sac. The patient recovered without further complications and without long-term sequelae. CONCLUSION: All dural tears that occur during intraspinal surgery, even if they are small and the arachnoid is intact, should be closed with stitches or at a minimum with a patch of muscle or gelatin sponge with fibrin glue. Care should be taken to avoid increased intra-abdominal pressure during extubation. Excessive pain and progressive neurological dysfunction occurring shortly after microsurgical lumbar discectomy or any intraspinal procedure is indicative of possible hemorrhage with subsequent compression of nerve roots. The case reported here provides anecdotal evidence that this situation can also be caused by a herniation of cauda equina nerve roots through a small dural defect that was not evident during the initial operation.- - - - - - - - - - ranking = 1.5keywords = pressure (Clic here for more details about this article) |
4/30. Initial treatment of descemetocele with hydrophilic contact lenses.A hydrophilic contact lens was used as the initial mode of therapy in 5 cases of descemetocele. The lens was left in place over the descemetocele continuously for periods ranging from 2 to 15 months. corneal perforation did not occur, and the anterior chamber remained formed in all cases. The device seemingly provides sufficient structural reinforcement to Descemet's membrane to prevent its distension by the intraocular pressure. It also maintains Descemet's membrane in a moist state and protects the descemetocele from the trauma of the lid margins during blinking. This series of cases indicates that a hydrophilic contact lens can be a very effective temporizing measure for the treatment of descemetocele, enabling the surgeon initially to cope with an ocular emergency in a very simple manner, and to convert the ultimate surgical repair to a scheduled, carefully planned procedure with a much greater potential for success.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/30. Low-pressure headaches and spinal cord herniation. Case report.Almost 40 cases of spontaneous transdural spinal cord herniation have been reported in the literature. These patients often present with gait disturbance and sensory changes, and their condition is diagnosed as brown-sequard syndrome. The pathogenesis of this condition has remained poorly understood. In particular, there is no agreement whether the dural defect is acquired or congenital. In the reported case, a 21-year-old man presented with a 3-year history of intermittent low-pressure headaches consistent with intracranial hypotension. Eventually, the headaches resolved but he developed myelopathy due to a spinal cord herniation. In this case, the authors hypothesize that the progressive spinal cord herniation through a spontaneous dural tear sealed the site of the cerebrospinal fluid leak, causing the resolution of headaches.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
6/30. Idiopathic spinal cord herniation associated with a large erosive bone defect: a case report and review of the literature.We report a case of idiopathic spinal cord herniation associated with a large bone defect. MRI and computed tomographic myelography revealed ventral deviation of the spinal cord and erosion of the vertebral body at T6-T7. Microscopic surgery revealed a dural defect. The etiology of this condition has not been clarified. In most previously reported cases, the peak portion of the herniation was around the intervertebral disc space. In addition, in our patient, it was hard to think that the intervertebral disc has become depressed due to the pressure exerted by the spinal cord. We considered that a certain condition of the intervertebral disc, such as herniation, was one of the causes of the dural defect, and cerebrospinal fluid pulsation pushed the spinal cord toward that portion, causing herniation.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/30. Laparoscopic repair of acquired lumbar hernia.Lumbar hernias are rare; approximately 300 cases have been described in the literature since their first description. They are typically subdivided by categories such as congenital or acquired and by their location. Acquired lumbar hernias may follow trauma, poliomyelitis, loin incision, and the use of iliac crest as a donor site for bone grafting. Although they tend to grow in size and have a 25% risk of incarceration and 8% risk of strangulation, surgery is indicated once the lesion is confirmed. Many techniques have been described for surgical repair of lumbar hernias, including primary repair, local tissue flaps, and conventional mesh repair. All these open techniques require a large incision plus extensive dissection to expose the area. The first laparoscopic repair of lumbar hernia was described in 1996. The laparoscopic approach for lumbar hernia has significant advantages: it enables exact localization of the anatomic defect, the mesh can be placed deep into the defect allowing intraabdominal pressure to hold it in position, and it also has all the well-known advantages of the laparoscopic approach. We present two cases of laparoscopically repaired acquired lumbar hernias.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/30. Case report and review of the literature: arachnoid cyst of the fourth ventricle presenting as a syndrome of normal pressure hydrocephalus.The Authors report a case of 4th ventricular arachnoid cyst that presented clinically with the criteria of normal pressure hydrocephalus (NPH). Only a few cases of intraventricular arachnoid cyst have been recorded in the literature; the present case is the second reported case diagnosed as a syndrome of NPH.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
9/30. Virtopsy post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) demonstrating descending tonsillar herniation: comparison to clinical studies.Descending cerebellar tonsillar herniation is a serious and common complication of intracranial mass lesions. We documented three cases of fatal blunt head injury using post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI). The results showed massive bone and soft-tissue injuries of the head and signs of high intracranial pressure with herniation of the cerebellar tonsils. The diagnosis of tonsillar herniation by post-mortem radiological examination was performed prior to autopsy. This paper describes the detailed retrospective evaluation of the position of the cerebellar tonsils in post-mortem imaging in comparison to clinical studies.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/30. Subfalcine herniation in the absence of a high pressure collection or mass: 'brain-slump'?Subfalcine brain herniation is well documented in the presence of raised intracranial pressure. However, we report a case of herniation occurring after decompression of bilateral chronic subdural haematomas, which did not appear to be related to high pressure. We suggest that after rapid decompression of a collection, the unsupported brain can herniate under the falx with serious consequences: 'brain-slump'.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
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