1/6. Unusual arachnoid cyst of the quadrigeminal cistern in an adult presenting with apneic spells and normal pressure hydrocephalus--case report.A 67-year-old woman was admitted to our clinic with symptoms of normal pressure hydrocephalus, lower cranial nerve pareses, and pyramidal and cerebellar signs associated with respiratory disturbances. Computed tomography (CT) and magnetic resonance imaging revealed a 4.7 x 5.4 cm quadrigeminal arachnoid cyst causing severe compression of the tectum and entire brain stem, aqueduct, and cerebellum, associated with moderate dilation of the third and lateral ventricles. Emergency surgery was undertaken due to sudden loss of consciousness and impaired breathing. The cyst was totally removed by midline suboccipital craniotomy in the prone position. Postoperatively, her symptoms improved except for the ataxia and impaired breathing. She was monitored cautiously for over 15 days. CT at discharge on the 18th postoperative day revealed decreased cyst size to 3.9 x 4.1 cm. Histological examination confirmed the diagnosis of the arachnoid cyst of the quadrigeminal cistern. The patient died of respiratory problems on the 5th day after discharge. Quadrigeminal arachnoid cysts may compress the brain stem and cause severe respiratory disturbances, which can be fatal due to apneic spells. patients should be monitored continuously in the preoperative and postoperative period until the restoration of autonomous ventilation is achieved.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/6. Treatment of neurological complications in isolated ACTH deficiency by glucocorticoid replacement.The neurophysiological complications in ACTH deficiency have not been well documented. In this paper, we present a patient with isolated ACTH deficiency who developed various neurological signs. The neurophysiological abnormalities, including slow wave activity on electroencephalogram, delayed conduction velocity of the peripheral nerves and low amplitude of muscle action potentials, were improved by replacement of glucocorticoid. These findings suggested that glucocorticoid is directly involved in the function of the peripheral and central nervous systems.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/6. A complicated case of intracranial hypotension: diagnostic and management strategies.We report a case of a patient aged 66 years, with spontaneous intracranial hypotension presenting initially with postural headache, complicated by subdural haematomas and followed by progressive decline of his clinical condition evolving in obtundation state, cranial nerve involvement and gaze paralysis. The patient underwent a long course of different therapeutical approaches: medical and surgical treatment, intrathecal saline infusion and epidural blood patching (EBP). Rapid and dramatic relief of the patient's symptoms was obtained after a third lumbar EBP and he was discharged asymptomatic two weeks later.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/6. Chronic recurrent subarachnoid hemorrhage from a trigeminal nerve malignant peripheral nerve sheath tumor: case report.OBJECTIVE: Clinically significant intratumoral or peritumoral bleeding from trigeminal nerve tumors is very rare. CLINICAL PRESENTATION: We report the case of a 59-year-old man who presented with recurrent subarachnoid hemorrhage from a left trigeminal nerve malignant peripheral nerve sheath tumor. He presented with decreased consciousness, left facial hypesthesia, and left facial weakness. trigeminal neuralgia was present for 18 months. Cranial computed tomographic and magnetic resonance imaging scans revealed a left parapontine mass with cystic changes and intratumoral bleeding. Furthermore, signs of hemosiderosis of the subarachnoid space were noted. Lumbar puncture revealed fresh bleeding. angiography detected no aneurysm or other causes of bleeding. The patient became fully alert within hours, the facial weakness improved within a few days. There was no evidence of vasospasm or persisting hydrocephalus. He underwent left-sided suboccipital craniotomy for macroscopically total tumor removal. INTERVENTION: The patient underwent total tumor removal via a left suboccipital approach. Intraoperatively, evidence of recurrent intratumoral bleeding was noted. Histological examination revealed a malignant peripheral nerve sheath tumor (world health organization Grade III). Postoperatively, the hypesthesia improved significantly. The patient was transferred to radiotherapy for external beam radiation. CONCLUSIONS: This is the first report regarding a malignant peripheral nerve sheath tumor of the trigeminal nerve that caused clinically significant subarachnoid hemorrhage caused by intratumoral bleeding.- - - - - - - - - - ranking = 14keywords = nerve (Clic here for more details about this article) |
5/6. A prospective 1 year follow-up study with somatosensory potentials evoked by stimulation of the posterior tibial nerve in patients with supratentorial cerebral infarction.Somatosensory potentials evoked by stimulation of the posterior tibial nerve (tibial nerve SEPs) were studied in 40 patients with supratentorial non-haemorrhagic cerebral infarction and in 25 control subjects, SEPs were recorded twice in 39 patients and thrice in 35 patients. The first examination was carried out 4-19 days after the onset of the symptoms, the second examination 56-100 days after the stroke, and the third examination 348-393 days after the stroke. Increased side-to-side differences in the P57 and N75 peak latencies and absence of the P40 peak were the most frequent abnormal findings. The latency abnormalities were associated with involvement of the subcortical white matter of the rolandic region. The absence of the P40 peak was, in contrast, closely related to the extension of the infarcted area into the cortical gray matter of the rolandic region. When all SEP abnormalities were taken into account 55% of patients showed at least one abnormality in the tibial nerve SEP during the acute stage, 51% of patients had abnormal SEPs in the second examination and 43% of patients in the third examination. A nearly significant decrease was observed in the number of latency abnormalities, but the number of amplitude abnormalities, including absent responses, did not change during the 1 year follow-up period.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
6/6. Intracellular electrolytes in erythrocytes during and after shock: relation to impaired consciousness.Of 32 patients in shock and catabolic state following shock with impaired consciousness 31 exhibited raised sodium content in their erythrocytes. On the assumption that the erythrocyte membrane acts the same as nerve cell membrane, the hypofunction of erythrocyte membrane may result in impaired consciousness. The hypofunction of erythrocyte membrane is assumed by its increased permeability in shock. A positive osmotic discrepancy between measured and calculated levels denotes altered membranous permeability. Subjectively, impaired consciousness was evaluated by clinical grading. Meanwhile, as a trial of quantification of conscious levels, we applied a new technique of analysis of power spectrum obtained by computer on the autocorrelogram of the EEG during intermittent photic stimulation. This new analytic method was useful in evaluating objective changes of cerebral function. There was a good correlation between raised sodium content in erythrocytes and depressed power spectrum. The degree of increased sodium in erythrocytes seems to correlate with patients' clinical prognosis.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |