1/7. intracranial hypertension in neuroborreliosis.Neuroborreliosis is an infection of the nervous system caused by the spirochete borrelia burgdorferi, from which patients most commonly develop lymphocytic meningitis, radiculoneuritis, or cranial neuropathy. In this report a 9-year-old male with an unusual neurological complication of neuroborreliosis--benign intracranial hypertension (BIH)--is described. Clinical symptoms of BIH, which consist of increased CSF pressure in the absence of an intracranial mass or obstruction to the circulation of CSF, resolved completely after antibiotic therapy with ceftriaxone.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/7. Pseudotumor syndrome in treated arachnoid cysts.We report three patients with arachnoid cysts treated by cyst-peritoneal shunting in whom intracranial hypertension occurred during episodes of shunt malfunction. In one case this was associated with re-expansion of the arachnoid cyst, whilst in the other two cases this did not occur. The similarities between these two cases and patients with pseudotumor cerebri suggest a common pathogenic mechanism--specifically, a disturbance of the cerebrospinal fluid circulation.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
3/7. Preliminary experience with controlled external lumbar drainage in diffuse pediatric head injury.Our experience with the use of external lumbar subarachnoid drainage in 5 children with severe diffuse head injuries is presented. All patients had glasgow coma scale scores of 8 or less at 24 h after injury and were initially treated with ventriculostomies. Two children required surgical evacuation of focal mass lesions. Within 72 h of admission, all children manifested high intracranial pressures (ICP) refractory to maximal therapy, including hyperventilation, furosemide, mannitol, and barbiturate coma. After the institution of lumbar drainage, 3 of the 5 children had an abrupt and lasting decrease in ICP, obviating the need for continued barbiturates and hyperventilation. Three children survived, 2 of whom made good recoveries; 1 child is functional with disability. ICP varied passively with the height of the drainage bag in these surviving patients. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. We conclude that controlled external lumbar subarachnoid drainage is a potentially useful treatment for severe diffuse pediatric head injury when maximal medical therapy and ventricular cerebrospinal fluid (CSF) evacuation have failed to control high ICP. Posttraumatic CSF circulation disruption, white matter cerebral edema, and intracranial venous hypertension can be treated with this modality in the absence of focal mass lesions.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
4/7. The pseudotumor syndrome. Disorders of cerebrospinal fluid circulation causing intracranial hypertension without ventriculomegaly.We report a series of eight cases that show a close resemblance to, but are not identical with, pseudotumor cerebri (PTC) as normally defined. The majority of these cases are characterized by raised intracranial pressure without ventriculomegaly. They include two cases of cranial venous outflow obstruction in which clinical or radiologic abnormalities precluded the diagnosis of PTC proper (cases 1 and 2); one case of chronic meningitis in which an abnormal cerebrospinal fluid (CSF) composition precluded the diagnosis of PTC (case 3); two cases without either papilledema or a measured increase of CSF pressure, which in other respects, particularly in response to treatment, resembled PTC (cases 4 and 5); and three cases of what is thought to represent an infantile form of PTC (cases 6 through 8). The purpose of the analysis of these cases is twofold. First, it is argued that these cases throw light on the mechanism of PTC itself, supporting a concept of a disturbance of CSF circulation in this condition, and that they are themselves illuminated by considerations of typical PTC. Second, the cases are used to frame a proposed classification of the pseudotumor syndrome aimed at broadening the diagnostic criteria applied currently to PTC. It is suggested that the pseudotumor syndrome has a single underlying mechanism (disturbed CSF circulation) and that recognition of this mechanism not only clarifies the pathophysiologic processes of PTC but also has important diagnostic and therapeutic implications.- - - - - - - - - - ranking = 6keywords = circulation (Clic here for more details about this article) |
5/7. intracranial hypertension and adult respiratory distress syndrome: usefulness of tracheal gas insufflation.The management of increased intracranial pressure (ICP) in patients with an associated acute lung injury is difficult. High levels of PaCO2 as tolerated for permissive hypercapnia are deleterious for cerebral circulation. In such circumstances, tracheal gas insufflation (TGI), which was recently proposed to reduce PaCO2, may be of benefit. We report the cases of two patients with severe adult respiratory distress syndrome and head trauma complicated with elevated ICP. The introduction of TGI decreased PaCO2 by 17 and 26%, decreased ICP, and increased calculated cerebral perfusion pressure. We conclude that TGI could be added to a pressure-targeted strategy of ventilatory management when severe adult respiratory distress syndrome was associated to an intracranial hypertension.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
6/7. hydrocephalus and pseudotumour cerebri in the mucopolysaccharidoses.This paper reports two cases of cerebrospinal fluid circulation disorder in children with mucopolysaccharidosis. One patient developed pseudotumour cerebri and the other communicating hydrocephalus. It is suggested that both have a similar underlying abnormality of cerebrospinal fluid absorption with different modes of presentation.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
7/7. Raised intracranial pressure associated with hypercarbia after tourniquet release.We report a case of acute raised intracranial pressure soon after deflation of arterial tourniquets in a patient with limb injuries as well as a severe head injury. The likely mechanism was release of carbon dioxide into the circulation as the ischaemic limbs were re-perfused.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |