1/65. 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 = edema (Clic here for more details about this article) |
2/65. Endovascular recanalization with balloon angioplasty and stenting of an occluded occipital sinus for treatment of intracranial venous hypertension: technical case report.OBJECTIVE AND IMPORTANCE: Dural sinus thrombosis can lead to intracranial venous hypertension and can be complicated by intracranial hemorrhage. We present a case report of a patient who underwent endovascular recanalization and stenting of a thrombosed occipital sinus. CLINICAL PRESENTATION: A 13-year-old patient with a history of chronic sinus thrombosis refractory to anticoagulant therapy presented with acute onset of aphasia and hemiparesis. Computed tomography and magnetic resonance imaging revealed hydrocephalus and cerebral edema. Angiography delineated multiple dural arteriovenous fistulae and persistent occlusion of the posterior sagittal, occipital, and bilateral transverse dural sinuses with retrograde cortical venous drainage. INTERVENTION: After embolization of the dural arteriovenous fistulae, a transvenous approach was used to recanalize and perform balloon angioplasty of the right internal jugular vein and the occipital and left transverse sinuses, resulting in subsequent clinical improvement. The patient's condition deteriorated 3 days later with reocclusion of both balloon-dilated sinuses. Repeat angioplasty and then deployment of an endovascular stent in the occipital sinus were performed, and reestablishment of venous outflow was achieved, resulting in a decrease of intracranial venous pressure from 41 to 14 mm Hg and neurological improvement. At the 3-month follow-up examination, the stented occipital sinus remained patent and served as the only conduit for extracranial venous outflow; the patient remained neurologically intact at the 12-month follow-up examination. CONCLUSION: This is the first report of mechanical recanalization, balloon angioplasty, and stent deployment in the occipital sinus to provide sustained venous outflow for the treatment of venous hypertension with retrograde cortical venous drainage in a patient with dural pansinus thrombosis refractory to anticoagulant therapy.- - - - - - - - - - ranking = 1keywords = edema (Clic here for more details about this article) |
3/65. blindness from bad bones.Progressive visual loss is the most common neurologic finding in osteopetrosis. Several mechanisms may explain this phenomenon, including compression of the optic nerves caused by bony overgrowth of the optic canals and retinal degeneration. We report a child with osteopetrosis and progressive visual loss, even though patent optic canals were demonstrated by computed tomography and digital holography. This patient's visual loss was caused by increased intracranial pressure secondary, to obstruction of cerebral venous outflow at the jugular foramen. This case points to the importance of a full evaluation of the skull base foramina in the diagnostic workup of visual loss in patients with osteopetrosis.- - - - - - - - - - ranking = 18.516677149836keywords = optic (Clic here for more details about this article) |
4/65. Idiopathic intracranial hypertension: a case report with optic nerve histopathology.We present the clinical and pathologic findings in an atypical case of idiopathic intracranial hypertension. A 51-year-old man had headaches, visual deterioration, papilloedema, and deafness. neuroimaging was normal, and cerebrospinal fluid pressure monitoring confirmed increased intracranial pressure. The patient was treated with a ventriculo-peritoneal shunt. Histopathology revealed grossly atrophic optic nerves with almost complete axonal loss. The prelaminar portion of the optic nerves was thickened by gliosis and hyalinized capillaries, which have not been described previously.- - - - - - - - - - ranking = 38.033354299671keywords = optic, edema (Clic here for more details about this article) |
5/65. Divergence paralysis & intracranial hypertension due to neurobrucellosis. A case report.CASE REPORT: A 22 year old female presented with sudden onset of uncrossed diplopia at distance, intracranial hypertension, esotropia and was evaluated. Microbiological tests of CSF and sera showed for brucellosis and the patient received therapy for this and her intracranial hypertension. The papilledema, headache, esotropia and diplopia all disappeared after therapy. CONCLUSIONS: Diagnostic tests for brucella must be considered for patients who have divergence palsy and papilledema, especially those living in endemic areas.- - - - - - - - - - ranking = 1257.1760253192keywords = papilledema, edema (Clic here for more details about this article) |
6/65. Visual loss in idiopathic intracranial hypertension after resolution of papilledema.PURPOSE: To demonstrate that progressive visual field loss may occur after resolution of papilledema in patients with idiopathic intracranial hypertension and persistently elevated intracranial pressure. methods: A patient with idiopathic intracranial hypertension was evaluated with serial Humphrey automated static perimetry after initial treatment and resolution of papilledema. RESULTS: The patient developed recurrent headache and elevated cerebrospinal fluid pressure. optic nerve head appearance did not change. Automated perimetry demonstrated reproducible, worsening visual field loss; mean deviation decreased 11 dB in each eye. Visual field defects resolved after optic nerve sheath fenestration. CONCLUSIONS: Increased intracranial pressure caused visual field loss after resolution of papilledema. optic nerve sheath fenestration improved visual function in this patient.- - - - - - - - - - ranking = 4406.2883143338keywords = papilledema, optic, edema (Clic here for more details about this article) |
7/65. subarachnoid hemorrhage following permissive hypercapnia in a patient with severe acute asthma.In this article, we describe a case of a subarachnoid hemorrhage (SAH) in an acute severe asthma patient following mechanical hypoventilation. A 49-year-old man was admitted to an intensive care Unit with an acute exacerbation of asthma. After 3 days of mechanical ventilation (hypercapnia and normoxaemia), it was noted that his right pupil was fixed, dilated, and unreactive to light. Computed tomography (CT) scan showed localized SAH within the basilar cisterns and diffuse cerebral swelling. On the fourth day, a new CT scan showed hemorrhage resorption and a cerebral swelling decrease. In the following days, the patient's condition continued improving with no detectable neurological deficits. A review of similar published reports showed that all patients performed respiratory acidosis, normoxaemia, and hypercapnia. The most frequent neurological sign was mydriasis, and all subjects showed cerebral edema. Since normoxaemic hypercapnia has been associated with absence, or less cerebral edema, we considered additional factors to explain cerebral edema and intracranial hypertension causes. Thus, intrathoracic pressures due to patient's efforts by forcibly exhaling, or during mechanical ventilation, would further increase intracranial pressure by limiting cerebral venous drainage. This case emphasizes the fact that patients with acute severe asthma who have developed profoundly hypercarbic without hypoxia before or during mechanical ventilation, may have raised critical intracranial pressure.- - - - - - - - - - ranking = 3keywords = edema (Clic here for more details about this article) |
8/65. 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 = 4keywords = edema (Clic here for more details about this article) |
9/65. syndrome simulating pseudotumor cerebri caused by partial transverse venous sinus obstruction in metastatic prostate cancer.PURPOSE: To report a case of partial transverse venous sinus obstruction causing a syndrome resembling pseudotumor cerebri. METHOD: Case report. A 61-year-old man developed decreased vision, bilateral papilledema, and a highly increased cerebrospinal fluid opening pressure. brain magnetic resonance imaging (MRI) disclosed a small, extra-axial mass near the torcula, which was dismissed as an incidental meningioma because cerebral angiography showed sinus patency. RESULTS: The patient's vision worsened. biopsy of the enlarging mass disclosed metastatic prostate cancer. After radiation therapy, the mass shrank, magnetic resonance angiography disclosed reopening of the transverse sinuses, and papilledema resolved, but visual fields remained severely compromised. CONCLUSION: Partial blockage of the dural venous sinus by a small mass near the torcula can cause a sufficient increase in intracranial pressure to produce vision-threatening papilledema.- - - - - - - - - - ranking = 1885.7640379788keywords = papilledema, edema (Clic here for more details about this article) |
10/65. occipital lobe meningioma in a patient with multiple chemical sensitivities.BACKGROUND: The concurrent diagnosis of meningioma with increased intracranial pressure has not been reported previously in a patient who meets diagnostic criteria for multiple chemical sensitivities (MCS). methods: A patient who had been evaluated in an occupational medicine practice, and by several other physicians for sensitivity to chemical odors was found to have papilledema and a visual field deficit. The patient met the clinical criteria set forth by Cullen in 1987 for MCS. A magnetic resonance imaging (MRI) scan was performed. RESULTS: The MRI revealed a large occipital lobe meningioma, which was surgically resected. Removal of the meningioma had little effect on the patient's symptoms. She has been unable to return to her job as a custodian. DISCUSSION: The etiology of MCS has been disputed and is currently unresolved. Those who evaluate patients with MCS are reminded that meningiomas and other intracranial mass lesions can affect olfaction, and that patients with MCS can have treatable intracranial abnormalities.- - - - - - - - - - ranking = 628.5880126596keywords = papilledema, edema (Clic here for more details about this article) |
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