1/7. Intra-operative monitoring of brain tissue O2 (PtiO2) during aneurysm surgery.BACKGROUND: Regional cerebral blood flow may be compromised during aneurysm surgery. This may occur during vessel occlusion by temporary cliping or result from the malposition of an aneurysm clip. In this report we monitored intra-operatively the brain tissue oxygen concentration (PtiO2) to visualize regional ischaemic events. METHOD: During surgery of 10 intracranial aneurysms, monitoring of PtiO2 was performed using a polarographic microcatheter (Licox, GMS-Kiel-germany), which was placed in the vascular territory of the artery harboring the aneurysm. FINDINGS: No complications were observed after implantation of Licox electrodes. In 6 patients PtiO2 decreased during transient clipping. In two patients PtiO2 decreased below 2 mmHg without morphological or clinical signs cerebral ischemia. In four patients, without incidence during surgery, only minor oscillations were observed. CONCLUSION: Intra-operative monitoring of PtiO2 is a complimentary procedure to monitor cerebral perfusion and detect episodes of ischaemia. Given the rapid detection of these events, therapeutic intervention may be initiated before irreversible neuronal damage occurs.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. association between an aplastic basilar artery, unaccompanied by a primitive carotid-vertebrobasilar anastomosis, and multiple aneurysms on the dominant posterior communicating artery.basilar artery (BA) aplasia when unaccompanied by a primitive carotid-vertebrobasilar anastomosis is exceedingly rare. The association of BA aplasia with two aneurysms on the dominant posterior communicating artery (PCoA) has not been previously reported. This 40-year-old man presented in a state of drowsiness and responded to simple commands only after being coaxed. He had complete left cranial third nerve palsy, right hemiparesis, and persisting signs of meningeal irritation. A computerized tomography (CT) scan revealed subarachnoid and intraventricular hemorrhage. An angiogram revealed BA aplasia. The right PCoA followed a sinuous course with multiple loops and provided the dominant supply to the posterior circulation. This vessel harbored two aneurysms, one at the origin of the PCoA from the internal carotid artery and the other at the looping segment just proximal to the brainstem. The left PCoA was extremely thin. The pterional transsylvian approach was used to clip the two aneurysms on the PCoA. The hemodynamic changes produced by the BA aplasia may have produced alterations in the cerebral vasculature leading to aneurysm formation and consequent subarachnoid hemorrhage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. Neurological complications of hemolytic-uremic syndrome.Of 78 children identified with hemolytic-uremic syndrome at the Children's Hospital, boston, from 1976 to 1986, 16 patients (20.5%) had neurological manifestations during their hospitalization. The most common manifestations were significant alterations in consciousness (coma, stupor) in 12 patients, and either generalized or partial seizures in ten patients. Others included hemiplegia (4 patients), decerebrate posturing (3), cortical blindness (2), hallucinations (1), and dystonic posturing (1). Cranial computed tomographic scans were abnormal in eight of 11 patients scanned. The abnormalities included diffuse cerebral edema (4 patients), large vessel infarctions (3), diffuse multiple small infarcts (4), and multiple hemorrhages (1). Five patients died as a result of their central nervous system complications, and six had neurological sequelae at discharge. Five patients recovered and at discharge had no evidence of neurological dysfunction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/7. Severe fetal brain injury without evident intrapartum asphyxia or trauma.Two appropriate-for-dates term infants were born after uncomplicated labors and atraumatic deliveries. They were depressed at birth, developed seizures on the first day of life, and followed clinical courses compatible with hypoxic-ischemic encephalopathy. However, the umbilical cord vessel pH and blood gases were normal. The children are now severely retarded and have cerebral palsy. These cases prove that the events of labor and delivery may not be responsible for all cases of brain damage in surviving children.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/7. Deep venous thrombosis in the spastic upper limb.Deep venous thrombosis (DVT) of the upper extremity (UE) is an uncommon diagnosis, whereas DVT of the lower extremity is a well-known cause of morbidity and mortality in the rehabilitation patient. patients with UE DVT secondary to venous stasis, vessel wall abnormalities, hypercoagulability, venous instrumentation and cancer have been previously reported in the literature. To our knowledge no case of DVT in a spastic upper extremity has been noted. A case report of a patient with UE DVT in a spastic extremity secondary to traumatic brain injury is presented, with a discussion of the aetiology, diagnosis and management of this disorder.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/7. Profuse hemorrhage from cerebral vessels in tangential missile injuries.Tangential missile injuries are recognized as a cause of cerebral damage by in driven bone fragments, parenchymal lacerations and intracerebral haematomas. Severe blood loss from this type of injury was not reported. Four patients are described in whom high kinetic energy missiles caused severe tangential craniocerebral injuries. Their condition was aggravated by life threatening haemorrhage. The bleeding vessels were cerebral arteries or major veins entrapped in the fracture line and bleeding extracranially. This blood loss cannot be controlled by dressing and salvage could be achieved only by immediate resuscitation, vigorous fluid replacement and very rapid evacuation to a neurosurgical center.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
7/7. Iatrogenic vertebrobasilar insufficiency after surgery of the subclavian or brachial artery: review of three cases.OBJECTIVE AND IMPORTANCE: vertebrobasilar insufficiency resulting from disease of the subclavian artery is well recognized. Usually, this occurs as the "subclavian steal" syndrome in the context of chronic subclavian stenosis and is consequently well tolerated because of collateralization. Acute disruption of the hemodynamics of the aortic arch vessels, however, can produce disastrous sequelae. CLINICAL PRESENTATION: We present three cases of iatrogenic vertebrobasilar insufficiency sustained as complications of surgery of the left subclavian artery or its distal continuation. The cases were chosen from a review of approximately 400 emergency neurosurgery consultations requested at the los angeles County Hospital between November 1995 and February 1996. INTERVENTION: The first patient underwent repair of a traumatic brachial artery occlusion and awoke postoperatively with bilateral cortical blindness, right hemiparesis, and multiple cranial nerve deficits that were most likely caused by acute subclavian steal. The second underwent removal of a subclavian embolus and developed bilateral cerebellar infarction leading to persistent coma, possibly from inadvertent embolization of the vertebral artery during surgery. The third underwent resection and bypass grafting of a subclavian aneurysm. Good backflow was reported when the vertebral artery was disarticulated from the subclavian artery, and this vessel was not reimplanted into the graft. The patient suffered massive cerebellar infarction leading rapidly to brain death. CONCLUSION: There are myriad ways in which the inherent redundancy of the vertebrobasilar system may be jeopardized, and when this protective mechanism fails, the results can be disastrous. Flow through the vertebral arteries may be compromised by thrombosis, embolization, dissection, inappropriate ligation, excessive head rotation, hypotension, vasospasm, or acute subclavian steal. These examples illustrate the importance of understanding the complex physiology of posterior fossa circulation as the basis of pre-, intra-, and postoperative management of patients undergoing surgery of the subclavian artery.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |