1/84. anesthesia for cesarean section in two patients with brain tumours.PURPOSE: To describe two patients with brain tumours where general anesthesia was used for cesarean sections under emergency and urgent conditions. CLINICAL FEATURES (CASE #1): The first patient presented at 38 wk gestation with an acute intracranial tumour herniation, requiring emergency craniotomy and simultaneous cesarean section. General anesthesia was induced with thiopental and vecuronium, maintained with enflurane 1% in O2 100%. Maternal P(ET)CO2 was maintained at 25 mmHg. After delivering a healthy infant, she was given syntocinon, mannitol and dexamethasone i.v. anesthesia was maintained with fentanyl, nitrous oxide 50% in O2 and isoflurane 1% during frontal-lobe tumour resection. CLINICAL FEATURES (CASE #2): The second patient presented at 37 wk gestation for urgent cesarean section because of placental insufficiency. She had had a brain tumour resection four years earlier. An increase in intracranial pressure necessitated craniotomy for decompression at 20 wk gestation. She was further treated with dexamethasone, carbamazepine and radiation for control of cerebral oedema at 34 wk. cesarean section was performed under general anesthesia; rapid-sequence-induction with thiopental and succinylcholine, followed by isoflurane 1% in O2 100%. Syntocinon, fentanyl and atracurium i.v. were administered after delivery of a healthy infant. Although neurosurgeons stood by, their intervention was unnecessary. CONCLUSION: General anesthesia remains safe and dependable for operative delivery in parturients with intracranial tumour. Tracheal intubation allows maternal hyperventilation thereby controlling raised intracranial pressure. Hemodynamic stability is readily achieved to maintain cerebral perfusion. However, a multidisciplinary-team approach is critical for successful patient management.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/84. brain metastasis as first manifestation of ovarian cancer.brain metastasis from ovarian cancer, a rare and highly dismal event, develops mostly during or after postoperative chemotherapy. This report documents the clinical findings and magnetic resonance imaging of an uncommon case who presented signs of increased intracranial pressure as a first manifestation. Histologic examination of removed brain lesion demonstrated ovarian origin, while no evidence of a locally invasive lesion was found at exploratory laparotomy ('tentative' surgical stage Ia). The possibility of ovarian origin should be always considered in a woman with brain involvement.- - - - - - - - - - ranking = 0.33333333333333keywords = brain (Clic here for more details about this article) |
3/84. Acquired dural fistulae in benign intracranial hypertension: a short case report.Venous sinus thrombosis has been regarded as a known cause of intracranial hypertension. We report a case of long-standing raised intracranial hypertension (ICT) that presented with deteriorating vision in both eyes. Magnetic resonance (MR) imaging of the brain and cerebral angiography showed blockage of superior saggital sinus and sigmoid sinuses with bilateral dural arteriovenous fistulae (DAVF) formation.- - - - - - - - - - ranking = 0.16666666666667keywords = brain (Clic here for more details about this article) |
4/84. Correlation between jugular bulb oxygen saturation and partial pressure of brain tissue oxygen during CO2 and O2 reactivity tests in severely head-injured patients.PURPOSE: To correlate the jugular bulb oxygen saturation (SjvO2) and brain tissue oxygen pressure (PbtO2) during carbon dioxide (CO2) and oxygen (O2) reactivity tests in severely head-injured patients. methods AND RESULTS: In nine patients (7 men, 2 women, age: 26 /- 6.5 years, GCS of 6.5 /- 2.9), a polarographic microcatheter (Clark-type) was inserted into nonlesioned white matter (frontal lobe). PbtO2 and SjvO2 were monitored simultaneously and cerebral vasoreactivity to CO2 and O2 was tested on days three, five and seven after injury. Simultaneous measurements of vasoreactivity by transcranial Doppler (TCD) were undertaken. A total of twenty-one CO2 and O2 reactivity tests were performed. Critical values of PbtO2 (< 15 mm Hg) during induced hyperventilation could be observed four times in two patients. High PbtO2 values up to 80 mm Hg were observed during hyperoxygenation (FiO2 100%). CO2 vasoreactivity by means of PbtO2 was absent in four tests in which measurements by TCD showed intact responses. A stronger correlation between SjvO2 and PbtO2 during the O2 reactivity tests was observed (r = 0.6, p < 0.001), in comparison to values obtained during the CO2 reactivity tests (r = 0.33, p < 0.001). In addition, there was no statistically significant correlation (r = 0.22, p = 0.26) between CO2 reactivity values measured by TCD (4.5 /- 5.7%) and PbtO2 (3 /- 2.8%). CONCLUSIONS: Correlation between SjvO2 and PbtO2 during CO2 reactivity test is low, even if significant differences between normo- and hyperventilation values are present. In comparison to SjvO2, monitoring of PbtO2 might more accurately detect possible focal ischaemic events during rapidly induced hyperventilation in severely head-injured patients. The CO2 vasoreactivity by means of changes in Vm MCA seems to be higher in comparison to changes of PbtO2. These observations lead to the hypothesis that vasoreactivity measured by TCD overestimates the cerebrovascular response to CO2.- - - - - - - - - - ranking = 0.84739967281304keywords = brain, injury (Clic here for more details about this article) |
5/84. Fatal secondary increase in serum S-100B protein after severe head injury. Report of three cases.The S-100B protein is a small cytosolic protein that is found in astroglial or schwann cells. It is highly specific for brain tissue and is increasingly being investigated as a diagnostic tool to assess the neurological damage after head injury, stroke, subarachnoid hemorrhage, and cardiopulmonary bypass. The authors report on three patients with severe head injury with otherwise normal cerebral perfusion pressure, SaO2, PaCO2, and controlled intracranial pressure (ICP), in whom a secondary excessive increase in serum S-100B was observed. In all cases, the S-100B increase was followed by an increase in ICP. All three patients died within 72 hours after the excessive increase in S-100B. These findings indicate that major secondary brain damage may occur at a cellular level without being identified by current neuromonitoring techniques.- - - - - - - - - - ranking = 0.41773137021155keywords = brain, injury (Clic here for more details about this article) |
6/84. Induced hypothermia in the management of cerebral oedema secondary to fulminant liver failure.The use of mild hypothermia in the management of blunt head trauma has been shown to significantly improve clinical outcomes. The use of moderate controlled hypothermia in the patient with severely raised intracranial pressure (ICP) secondary to fulminant hepatic failure (FHF) has similar potential benefits, but is not a widely accepted practice. We report a case where the use of hypothermia in the management of severely raised ICP both before and after liver transplantation was thought to effect a beneficial outcome.- - - - - - - - - - ranking = 0.00029489236588847keywords = trauma (Clic here for more details about this article) |
7/84. Right temporal lobe glioblastoma presenting in the left orbit. Case report.Dissemination of gliomas outside the central nervous system without preceding neurosurgery is a rare phenomenon. Glial neoplasms presenting as bone lesions are even more rare. A case of glioblastoma multiforme (GBM) with initial presentation in the orbit following a single generalized seizure is described. Signs of intracranial hypertension resulted from subarachnoid tumor invasion. The patient was treated with whole-dose radiation therapy but survived for only 6 months following the initial presentation. An autopsy revealed a right temporal GBM with extensive subarachnoid spread and invasion in the left orbit and skull base. The literature on dissemination of primary tumors of the brain is reviewed.- - - - - - - - - - ranking = 0.16666666666667keywords = brain (Clic here for more details about this article) |
8/84. flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign. Report of five cases.This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9-15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.- - - - - - - - - - ranking = 2.5481441684955keywords = brain injury, traumatic brain injury, traumatic brain, brain, injury, trauma (Clic here for more details about this article) |
9/84. Acoustic schwannoma and arachnoid cyst colocated in the cerebellopontine angle--case report.A 50-year-old female presented with a right acoustic schwannoma colocated with a cerebellopontine angle arachnoid cyst. The arachnoid cyst was distinct from the arachnoid cap surrounding the acoustic schwannoma. Initial excision of the arachnoid cyst created the space required to excise the schwannoma. The acoustic schwannoma had surprisingly dense adhesions to the brainstem, probably due to the constant pressure exerted by the cyst displacing the tumor towards the brainstem. The acoustic schwannoma was excised by meticulous dissection. Such a coexisting lesion should be suspected when a large cystic collection surrounds an acoustic schwannoma. Initial excision of the arachnoid cyst will prevent excessive cerebellar retraction.- - - - - - - - - - ranking = 0.33333333333333keywords = brain (Clic here for more details about this article) |
10/84. Gonadotrophin-independent puberty in a boy with a beta-HCG-secreting brain tumour.We report on a short-statured boy in whom therapy with recombinant human growth hormone was initiated at the age of 9.7 years for assumed idiopathic growth hormone deficiency. On recombinant human growth hormone, height improved from -1.9 (standard deviation score) to -0.9 within 1 year, and the patient entered puberty spontaneously at 10.7 years. At 11.6 years he showed low morning cortisol and thyroxine levels, but was otherwise well. He showed an inconspicuous growth, and puberty progressed adequately until the age of 13.4 years, when he developed signs of an increased intracranial pressure, and a suprasellar choriocarcinoma was diagnosed. This case confirms the fact that beta chorionic gonadotrophin secreting tumours will not be diagnosed by the characteristic clinical manifestation of gonadotrophin-independent puberty if they occur at a time when normal puberty is expected. Particularly, it raises the question of how often the CNS should be re-evaluated by magnetic resonance imaging in children with growth hormone deficiency and normal initial neuroradiological imaging, when they develop additional hormonal deficiencies but no other clinical symptoms of an intracranial process.- - - - - - - - - - ranking = 0.66666666666667keywords = brain (Clic here for more details about this article) |
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