1/31. rupture of several parasagittal bridging veins without subdural bleeding.This case reports on a fatal craniocerebral trauma involving numerous ruptured cerebral bridging veins that did not bleed subdurally, despite approximately 15 hours of survival. A 15-year-old girl was severely injured as the passenger of a car that crashed sideways into a tree. She-suffered a cerebral trauma of the "diffuse injury" type and was unconscious after the accident. Her computed tomographic scan at admission showed massive brain edema, axial herniation, and marked hypodensity of the bilateral carotid flow area. Despite intensive care measures, the clinical course was characterized by central decompensation with therapy-resistant cardiocirculatory insufficiency. The autopsy revealed ruptures of numerous parasagittal bridging veins. The injured vessels were not thrombosed, and yet there was absolutely no subdural bleeding. This unusual combination of findings is assumed to be caused by an isolated collapse of cerebral circulation occurring shortly after the accident and primarily attributed to a rapid increase of intracranial pressure.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/31. The importance of CT scans in planning the removal of orbital-frontal lobe foreign bodies.PURPOSE: To describe the management of foreign bodies in the orbit and frontal lobe. methods: Reports of two cases. RESULTS: Both patients underwent successful removal of an orbital-cerebral foreign body by anterior orbitotomy. CONCLUSION: Computed tomography was useful to confirm preoperatively that the foreign body was not adjacent to cerebral blood vessels and to monitor postoperatively for cerebral hemorrhage. A team approach is necessary in the management of orbital-frontal lobe foreign bodies.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/31. Subarachnoid haemorrhage following rupture of an ophthalmic artery aneurysm presenting as traumatic brain injury.head trauma may provoke subarachnoid haemorrhage. The question sometimes arises whether in patients with trauma and subarachnoid haemorrhage the latter is of traumatic or aneurysmal origin. We present a 49-year-old patient who fell from a truck, struck his head and was unconscious immediately. On the brain computed tomography (CT) scan subarachnoid haemorrhage was present, initially diagnosed as of traumatic origin. Four-vessel angiography revealed rupture of a left ophthalmic artery aneurysm. We review the literature and give recommendations for angiography in patients with trauma and subarachnoid haemorrhage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/31. In vivo histological changes occurring in hydroxyapatite cranial reconstruction--case report.Histological changes were observed in a hydroxyapatite plate and hydroxyapatite granules used to repair a craniotomy defect and removed after 2 years and 9 months of use. The hydroxyapatite plates and granules had completely fused to the cranium, with new bone formation on the dural side extending in a three-dimensional matrix along the pores with the haversian system in the center. New bone formation was less extensive under the artificial dura than under normal dura. This finding suggests that the dura has the ability to promote bone formation. A new vessel was found along the interconnecting pores. The interconnecting pores allow osteoconduction in the hydroxyapatite plate, so new bone formation can progress. Hydroxyapatite has osteoconduction properties and is biocompatible, so gains strength in vivo through new bone formation, and is the ideal material for artificial bones. Factors important to achieving good bone formation after cranial reconstruction surgery include presence of the dura, and pore size approximate to the haversian system (100-500 microns) and interconnecting pores in the hydroxyapatite plate.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/31. Cerebral endothelial injury in severe head injury: the significance of measurements of serum thrombomodulin and the von willebrand factor.thrombomodulin (TM), which is located in the surface of the endothelium in the arteries, veins, and capillaries of major organs such as the brain, lungs, liver, kidneys, skeletal muscles, and gastrointestinal tract, is one of several indicators of endothelial injury. von willebrand factor (vWf), which is synthesized by endothelial cells, is also an endothelial specific glycoprotein. The serum level of vWf increases in response to various stimuli without endothelial injury. An elevated serum level of vWf may suggest endothelial activation in severe head injury. We hypothesize that the degree of cerebral endothelial activation or injury depends on the type of head injury and that measuring the TM and vWf is useful for predicting delayed traumatic intracerebral hematoma (DTICH), produced by weakness of the vessel wall, occuring either as a direct or indirect effect of head injury. The values of vWf in focal brain injury (ranging from 332.5 /- 52.8% to 361.7 /- 86.2%) were significantly higher than those in diffuse axonal injury from 2 h to 7 days after the injury occurred (ranging from 201.6 /- 59.5% to 242.5 /- 51.7%). The serum level of TM in focal brain injury (ranging from 3.84 /- 1.54 to 4.12 /- 1.46 U/mL) was higher than that in diffuse axonal injury (ranging from 2.96 /- 0.63 to 3.67 /- 1.70 U/mL), but these differences were not statistically significant. In patients with DTICH, TM was significantly higher than in patients without DTICH (p < 0.01). The results of our study demonstrate that the degree of endothelial activation in focal brain injury was significantly higher than in diffuse brain injury. In addition, the serum level of TM in patients with DTICH was significantly higher than in patients without DTICH. These findings suggest that cerebral tissue injury is often accompanied by cerebral endothelial activation, and that these two phenomena should be distinguished from each other. The levels of serum TM and vWf appear to be good indicators of the cerebral endothelial injury and of endothelial activation in severe head injury.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/31. Medicolegal diagnostic value and clinical significance of traumatic incomplete tears of the basilar artery.Ruptures of arteries of the vertebrobasilary system are relatively frequent in medicolegal practice, and their origin may be both natural and violent. tears that affects the whole thickness of the basilar artery cause subarachnoid hemorrhage (SAH), with an often rapid fatal outcome. 1-3 However, in some situations, arterial tears may be incomplete, involving the intima or both the intima and the media, but with preserved adventitia. 1, 4 Although such incomplete tears are not the source of immediate subarachnoid bleeding, their presence may be important from both a medicolegal and a clinical point of view.The aim of this article is to point out the significance of incomplete tears of basilar artery as a possible diagnostic sign of traumatic origin of SAH as well as a certain mechanism of injury, which involves forcible hyperextension and rotational movements of the head. The authors also describe their method of performing longitudinal section of the basilar artery, both at autopsy and for histologic examination, which is convenient for identifying multiple transversal incomplete tears of this blood vessel. The article is based on the analysis of three cases from the autopsy material of the Institute of forensic medicine in Belgrade.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/31. Knife blade penetrating stab wound to the brain--case report--.A 28-year-old man attempted to kill himself with a knife stab into the parietal area. neuroimaging showed no vascular impairment except slow venous flow around the knife due to tamponading. After obtaining informed consent, the knife was removed through a craniotomy without new brain injury. Postoperative neurological findings showed no deficit. Follow-up angiography revealed no vascular impairment. No infection occurred. Brain stab wounds cause numerous complications, such as intracranial hemorrhage, injury of important vessels, and infections. Minimal blade movement during removal and precautions to prevent massive hemorrhage are essential.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/31. Massive hemorrhage in acoustic neurinoma after minor head trauma--case report.Massive hemorrhage within an intracranial neurinoma occurs rarely. The authors describe a 62-year-old female with intratumoral bleeding which led to the discovery of an acoustic neurinoma. She developed a gait disturbance after a minor head injury. A computed tomographic scan obtained 2 months later demonstrated multiple high-density areas in the anterior portion of the left cerebellopontine angle. Preoperative diagnosis was acoustic neurinoma. The tumor had multiple cysts which contained a mixture of xanthochromic fluid and old, brownish hematomas, and was successfully removed. The intratumoral hemorrhage is thought to have resulted from traumatic rupture of the dilated vessels, although the trauma was slight. This is the first reported case of an acoustic neurinoma discovered through treatment for intratumoral hemorrhage occurring after a minor head injury.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/31. Intracerebral venous hemorrhage in "high-risk" carotid-cavernous fistula.Intracerebral hematoma associated with carotid-cavernous fistula is a rare occurrence. Based on a review of the literature and on the analysis of personal observation, the authors define as "high-risk fistula" a carotid-cavernous fistula at risk of intracerebral hemorrhage. Characteristic features of these are computed tomography demonstration of parenchymal vermicular enhancement of brain vessels, and an angiographic pattern of dilated and tortuous cerebral veins. When an intracerebral hemorrhage occurs in a patient with carotid-cavernous fistula an early but phased and combined neuroradiological-neurosurgical approach is suggested as the best way to treat this life-threatening situation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/31. Heterotopic ossification masquerading as deep venous thrombosis in head-injured adult: complications of anticoagulation.A 26-year-old man manifested clinical signs of a left iliofemoral thrombosis 12 weeks after closed head injury in a motor vehicle accident. The deep vein thrombosis was initially diagnosed by venography and appropriate anticoagulation therapy was instituted. After four days of treatment, there was no significant resolution of signs or symptoms and the circumference of the left thigh had increased with an associated decrease in hemoglobin. A CT scan of the involved thigh revealed hemorrhage and calcification within the quadriceps muscle. In retrospect, it was evident that the hemorrhage and heterotopic ossification had caused compression of the surrounding tissue and vessels thus mimicking a deep vein thrombosis on venography. Clinicians need to be aware of the similarity of the early clinical manifestations of heterotopic ossifications and deep vein thrombosis and the complications which could arise with anticoagulation therapy initiated too early in the course of the disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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