1/3. Falcotentorial meningioma accompanied by temporal lobe hematoma.We report a case of a falcotentorial meningioma accompanied by hematoma in the temporal lobe. A healthy 51 year-old-female with no history of hypertension presented with sudden onset of consciousness disturbance and right hemiparesis. Computed tomography revealed a hematoma 5.5 cm in diameter surrounded by thick edematous brain in the left temporal lobe and a tumor 3.5 cm in diameter in the pineal region. Bilateral carotid angiography detected occlusion of the Galenic vein and straight sinus. No causative abnormality of hemorrhage was apparent. However, the left basal vein of Rosenthal had disappeared, and anastomotic venous channels could be observed in the medial left temporal lobe, contiguous to the hematoma. Emergency craniotomy failed to detect any abnormality which could cause hemorrhage in the brain parenchyma surrounding the hematoma. Subtotal removal of the tumor, histologically diagnosed as fibrous meningioma, was achieved three months later employing an occipital transtentorial approach. Venous congestion caused by compression due to the tumor was considered to be one of possible causes of the hemorrhage.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
2/3. Sinking skin flap syndrome: a case of improved cerebral blood flow after cranioplasty.Sinking skin flap syndrome is defined as a series of neurologic symptoms with the skin depression at the site of cranial defect, which develop several weeks to months after large external cerebral decompression.The case of a 28-year-old female with the sinking skin flap syndrome is reported together with the evaluation of cerebral blood flow using xenon computed tomography (CT). Although her general condition stabilized within 7 months after the injury, the skin of the bilateral temporal regions was markedly depressed due to large bone defects. She was confined to bed and showed reduced levels of consciousness. We decided to treat this case by performing cranioplasty with a hydroxyapatite ceramic implant. Not only were good cranial contour reconstructed after cranioplasty, but neurologic conditions were also improved after cranioplasty.Regarding the change in cerebral blood flow in the present case, as measured with xenon CT, the cerebral blood flow 3 days after the injury was 18.7 /- 12.3 mL/100 mL/min and 26.5 /- 11.6 mL/100 mL/min in the left and right hemispheres, respectively. After the bilateral cranioplasty, it had increased by approximately 2-fold to 36.4 /- 23.2 mL/100 mL/min in the left hemisphere and approximately 1.5-fold to 43.8 /- 23.3 mL/100 mL/min in the right hemisphere as compared with the levels obtained 3 days after the injury.Therefore, xenon CT appears to be useful in the monitoring of regional cerebral blood flow in patients with cranial bone defects that are directly affected by atmospheric pressure and in predicting functional prognosis. For the sinking skin flap syndrome cases, cranioplasty is not only useful for cerebral protection and improvement of appearance, but cranioplasty is also useful for improving neurologic symptoms.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
3/3. An unusual missile-type head injury caused by a stone: case report and medicolegal perspectives.Missile head injury is predominantly caused by firearms; however, small blunt objects such as a stone can be propelled into the air and cause a low-velocity-type missile injury, as described in this case report. Since the cerebral damage in low-velocity missile injuries is usually focal, there might not be disturbance of consciousness until secondary brain damage occurs; therefore, adequate medical supervision is necessary to prevent and treat potentially fatal complications in a timely manner. This is a rare case of a penetrating missile wound of the head, most likely caused by the use of a stone propelled by a slingshot that penetrated the skull and lacerated the brain with the stone embedded within the substance of the brain. The deceased died at home 2 days later from focal suppurative meningitis with cerebral abscess formation and a subdural hemorrhage.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |