1/12. Arachnoid cyst with spontaneous rupture into the subdural space.Spontaneous rupture of an arachnoid cyst into the subdural space is an unusual complication. Only six cases have been reported in the literature. We report here an additional case and review the literature concerning arachnoid cysts. The possible pathogenesis of this condition is discussed.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
2/12. Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension. Case report.The authors present the case of a 55-year-old man suffering from intractable spontaneous intracranial hypotension, in whom conservative treatment with 19 weeks of bed rest was not effective. In this period the patient twice underwent surgery for bilateral chronic subdural hematoma, a complication of spontaneous intracranial hypotension. Conventional radionuclide cisternography, magnetic resonance imaging, and computerized tomography myelography did not demonstrate cerebrospinal fluid (CSF) leakage. Repeated radionuclide cisternography with the patient in an upright position revealed leakage of the tracer at upper cervical levels. Computerized tomography myelography with breath holding also showed CSF leakage of the contrast medium bilaterally at upper cervical levels. The patient underwent surgery, and bilateral C-2 and C-3 spinal nerve root pouches were sealed off from the subarachnoid space with oxidized cellulose cotton and fibrin glue. Epiarachnoid spaces around the root sleeves were also sealed to ensure complete resolution of the CSF leakage. After the surgery, the patient was completely free of the disease. In the case of intractable persistent spontaneous intracranial hypotension, surgical treatment is preferable to long-term conservative management. To identify CSF leakage, radionuclide cisternography with the patient in the upright position is useful. When obvious leakage is encountered, surgical sealing of the lesion should be performed via a subarachnoid approach.- - - - - - - - - - ranking = 0.2keywords = subdural (Clic here for more details about this article) |
3/12. intracranial pressure within a developing intracerebral haemorrhage.We report the time course of intracranial pressure within a developing intracerebral haemorrhage. Simultaneous readings of intracranial pressure were obtained from a contralateral parenchymal monitor and ventricular fluid pressure monitor. This recording demonstrates the existence of large pressure gradients in patients with expanding mass lesions.- - - - - - - - - - ranking = 0.058625488719165keywords = haemorrhage (Clic here for more details about this article) |
4/12. 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 = 1.9565286176759keywords = subdural, subdural haematoma, haematoma (Clic here for more details about this article) |
5/12. Bilateral multifocal uveal juvenile xanthogranuloma in a young boy with systemic disease.BACKGROUND: Juvenile xanthogranuloma is a rare non-Langerhans cell histiocytosis that could occasionally produce diffuse systemic disease in young children, but associated posterior uveal lesions are very uncommon. methods: Case report of an 8-month-old boy with macrocephaly who presented with chronic subdural haematoma and intracranial hypertension. A combination of nodular skin lesions and bilateral yellowish choroidal infiltration with limited retinal involvement suggested juvenile xanthogranuloma. RESULTS: The diagnosis was confirmed by a skin biopsy, and oral corticosteroid therapy was introduced. Progression of the disease to involve an anterior uveitis with hypopyon and numerous other systemic lesions, including the central nervous system, lung, liver, spleen, kidney and testis, was also suggestive of Letterer-Siwe disease. histiocytes were negative for Langerhans cell markers (S-100 and CD1a) and positive for macrophage marker (CD68). Electron microscopy failed to show Birbeck granules. Ocular lesions regressed under prolonged corticosteroid treatment, but resurgence of the other lesions required chemotherapy with vinblastine. CONCLUSION: In this atypical systemic variant of juvenile xanthogranuloma with bilateral uveal involvement, the immunohistochemical and ultrastructural findings were crucial in distinguishing juvenile xanthogranuloma from Langerhans cell histiocytosis.- - - - - - - - - - ranking = 0.32300686870823keywords = subdural, subdural haematoma, haematoma (Clic here for more details about this article) |
6/12. Post-traumatic superior sagittal sinus thrombosis. Case report and analysis of the international literature.The objective of this study is to focus attention on cerebral venous sinus thrombosis (CVST), a rather infrequent disease, especially when following closed head injury. Consequently we started from the clinical case report, concerning a patient admitted to our polyvalent ICU in the Hospital of Avezzano (AQ), italy. The patient was a 15-year-old girl, that developed superior sagittal sinus (SSS) thrombosis following closed head injury (pedestrian run down by a car): owing to slow and progressive onset of deep coma with severe intracranial hypertension, emergency decompressive craniectomy was performed. The result was satisfying: patient conditions progressively improved, with return to consciousness, to good mobility and to good mental status. At present, 1 year after trauma, only mild disability is left over (right hand prehensile strength loss, and slightly moving gait). In conclusion, considering the literature data (intracerebral haematoma and deep coma are poor outcome predictors) and clinical evolution, we decided an aggressive surgical approach to save the patient's life, with satisfying results.- - - - - - - - - - ranking = 0.018487405426505keywords = haematoma (Clic here for more details about this article) |
7/12. extracellular fluid S100B in the injured brain: a future surrogate marker of acute brain injury?The authors describe the measurement of S100B protein in brain extracellular fluid (ECF) of patients with acute brain injury (traumatic brain injury and subarachnoid haemorrhage) using the technique of microdialysis. To our knowledge, this is the first report of S100B measurement in the human brain. Acute brain Injury (ABI) is a leading cause of death and disability and the need for a practical and sensitive biochemical marker for monitoring these patients is urgent. The calcium binding astrocyte protein, S100B, may be a candidate for this role. Previous serum studies have shown S100B to be a sensitive predictor of mortality and rise in intracranial pressure in ABI, but it has never before been measured directly within the brain. The ECF reflects the local biochemistry of the brain parenchyma, and the use of intracerebral microdialysis opens up the possibility of studying many novel surrogate markers of injury in the laboratory, in addition to the conventional markers it measures at the bedside (lactate, pyruvate, glucose, and glycerol). In this preliminary report of two cases, the authors demonstrate the quantification of S100B in ECF microdialysate, and investigate whether changes in hourly S100B profile can be related to secondary brain injury. It is shown that extracellular concentrations of S100B change markedly in response to secondary brain injury. Further investigation is required to determine whether extracellular S100B measurement in ABI could assist in patient management.- - - - - - - - - - ranking = 0.011725097743833keywords = haemorrhage (Clic here for more details about this article) |
8/12. Management of haemorrhagic type moyamoya disease with intraventricular haemorrhage during pregnancy.Moyamoya ("hazy puff-of-smoke") disease represents a rare condition with progressive narrowing and occlusion of basal cranial vessels with secondary specific neoangiogenesis; we report on a 25-year-old primigravida with known moyamoya disease who suffered from acute bilateral intraventricular haemorrhage at 24 weeks gestation. She underwent bilateral external ventricular drainage and intraventricular recombinant tissue plasminogen activator (r-TPA) lysis was performed. At 34 weeks' gestation, a healthy girl was delivered via Caesarean section. Encephalomyosynangiosis (EMS) and extra-intracranial (EC/IC) bypass surgery were performed six and eight months after delivery, respectively. The patient recovered almost completely and showed only mild residual deficits. Prompt diagnosis and immediate interdisciplinary treatment might have been the key for optimal maternal and neonatal outcome in our patient.- - - - - - - - - - ranking = 0.058625488719165keywords = haemorrhage (Clic here for more details about this article) |
9/12. Shunt-related craniocerebral disproportion: treatment with cranial vault expanding procedures.Two patients with intracranial arachnoid cysts, one with myelomeningocele-hydrocephalus and the other with a subdural fluid collection, were given a cerebrospinal (CSF) extracranial shunt. All four patients developed features of CSF overdrainage following shunting and were treated by cranial vault expanding procedures. Before undergoing decompressive craniotomy, the patients were treated by a variety of procedures, including changing of obstructed ventricular catheters (n=4), insertion or upgrading of programmable valves (n=3), and foramen magnum decompression (n=1). Clinical manifestations of these four patients were attributed to craniocerebral disproportion caused by chronic and progressive skull changes due to dampening of the CSF pulse pressure, which is necessary for maintaining normal cranial growth. On the basis of our previous experience with expanding craniotomies in cases of minimal forms of craniosynostosis, we treated these patients with bilateral parietal craniotomies, with satisfactory results. In conclusion, biparietal decompressive craniotomy constitutes a useful and safe procedure for relieving the clinical manifestations of some CSF overdrainage syndromes, especially in cases with slit-ventricle syndrome and craniocerebral disproportion that prove to be refractory to simpler management procedures.- - - - - - - - - - ranking = 0.2keywords = subdural (Clic here for more details about this article) |
10/12. Intraventricular streptokinase infusion in acute post-haemorrhagic hydrocephalus.Neonatal post-haemorrhagic hydrocephalus is a clinical condition with a high mortality and long-term morbidity. Its clinical management is difficult and not well standardized. We describe the case of a term baby suffering from acute intracranial hypertension caused by an intraventricular and thalamic haemorrhage. In this case, the external ventricular drain inserted to control intracranial pressure was ineffective because of repeated obstructions due to blood clots. Continuous intraventricular infusion of streptokinase of 20,000 U/day allowed quick lysis of the clots, drainage of the cerebrospinal fluid and relief from the coma. Although it did not prevent a permanent ventriculoperitoneal shunt, we obtained reabsorption of the intraventricular haemorrhage without rebleeding complications. We suggest the use of low-dose fibrinolytic infusion through an external drain for the treatment of acute intracranial hypertension following intraventricular haemorrhage in term infants.- - - - - - - - - - ranking = 0.035175293231499keywords = haemorrhage (Clic here for more details about this article) |
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