1/130. Post-traumatic pituitary apoplexy--two case reports.A 60-year-old female and a 66-year-old male presented with post-traumatic pituitary apoplexy associated with clinically asymptomatic pituitary macroadenoma manifesting as severe visual disturbance that had not developed immediately after the head injury. Skull radiography showed a unilateral linear occipital fracture. magnetic resonance imaging revealed pituitary tumor with dumbbell-shaped suprasellar extension and fresh intratumoral hemorrhage. Transsphenoidal surgery was performed in the first patient, and the visual disturbance subsided. decompressive craniectomy was performed in the second patient to treat brain contusion and part of the tumor was removed to decompress the optic nerves. The mechanism of post-traumatic pituitary apoplexy may occur as follows. The intrasellar part of the tumor is fixed by the bony structure forming the sella, and the suprasellar part is free to move, so a rotational force acting on the occipital region on one side will create a shearing strain between the intra- and suprasellar part of the tumor, resulting in pituitary apoplexy. Recovery of visual function, no matter how severely impaired, can be expected if an emergency operation is performed to decompress the optic nerves. Transsphenoidal surgery is the most advantageous procedure, as even partial removal of the tumor may be adequate to decompress the optic nerves in the acute stage. Staged transsphenoidal surgery is indicated to achieve total removal later.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/130. An arachnoid cyst involving only the hypoglossal nerve: case report and review of the literature.We describe a patient with an arachnoid cyst, possibly of traumatic origin, at the hypoglossal canal producing atrophy of the tongue. An arachnoid cyst should be considered in the differential diagnosis of any patient with a localized cystic mass around the cranial nerves at the base of the skull.- - - - - - - - - - ranking = 1.6666666666667keywords = nerve (Clic here for more details about this article) |
3/130. Can early postnatal closed head injury induce cortical dysplasia.PURPOSE: Increased availability of surgically resected epileptogenic tissues reveals often unsuspected cortical dysplasia (CD). There is some controversy about the ontogenic stages in which these occur. Although most take place during neuroblast proliferation and migration, there is some evidence for some CD occurring during postmigrational intrinsic cortical organization. It has been shown that various kinds of focal cortical manipulations in rats, if performed within 3-4 postnatal days, lead to the genesis of various cortical malformations including a four-layered microgyrus or an unlayered CD. It is not known whether such events also might occur in the human brain. methods: Two children sustained minor head trauma within 4 postnatal days and later developed intractable epilepsy, which was relieved by surgery. Neuropathologic analysis of the resected tissues revealed an unsuspected microdysplastic cortex immediately adjacent to a focal, modest meningeal fibrosis, presumably secondary to the old closed head trauma. RESULTS: The main histologic features were a disorganized, unlayered cortex; abnormal clusters of neurons, often with complex, randomly oriented proximal dendritic patterns with absent apical orientation; the presence of a number of heterotopic small and large neurons in the white matter; absence of inflammatory infiltrates, of hemosiderine, of reactive gliosis, or of an excessive number of blood vessels. The morphologic features in these surgical specimens suggest that these focal malformations occur because of a regional disorder of postmigrational intrinsic cortical remodeling. CONCLUSIONS: The clinical histories and the pathologic findings lend some support to the hypothesis that minor morbid events occuring in the immediate postnatal period may lead to microdysplasia in the human similar to those induced in rat pups. The animal model could be helpful to clarify the genesis of some cases of CD and of the epileptogenicity often manifesting later in life.- - - - - - - - - - ranking = 0.012784033632491keywords = organ (Clic here for more details about this article) |
4/130. Secondary enuresis: post-traumatic stress disorder in children after car accidents.BACKGROUND: In our experience, secondary enuresis nocturna is a common complaint among children after a motor vehicle accident. However, as these children are often brought for examination as part of an insurance compensation claim, this complaint is not always reliable. OBJECTIVE: To describe a series of children in whom secondary enuresis occurred after a motor vehicle accident. methods AND RESULTS: Five children were brought to our clinic for evaluation of secondary nocturnal enuresis. review of past history revealed a car accident preceding the onset of the enuresis. All but one had additional behavioral symptoms typical of post-traumatic stress disorder. Four children had evidence of head trauma, and one had psychological but no physical trauma. CONCLUSIONS: nocturnal enuresis can occur after a motor vehicle accident due either to purely psychological trauma or organic head trauma. While nocturnal enuresis is generally attributed to organic causes, psychological mechanisms also play a significant role.- - - - - - - - - - ranking = 0.012784033632491keywords = organ (Clic here for more details about this article) |
5/130. The organized subdural blood clot in forensic case work - a case report.The medico-legal assessment of a subdural haematoma (recent or organized) usually requires some information regarding its cause. Quite often, especially in the absence of a known history of trauma, minor head injuries, which are no longer verifiable, are simply assumed to be the most likely causes. Considering the fact that a subdural haematoma could also be non-traumatic, e.g. in haemorrhagic disorders, cardiac conditions with persistent passive hyperaemia, true inflammatory and degenerative processes of the dura, etc., the medico-legal implication of a possible head injury would require the exclusion of such non-traumatic conditions capable of causing subdural bleeding. In this respect, the case of a 92-year-old man, who suffered from cerebral sclerosis with occasional episodes of confusion and agitation, is briefly discussed. He was reported to have fallen from his bed, was hospitalized and died 2 days later. A head injury was suspected. At autopsy, no skull fractures and no obvious bruises were discovered. Fresh bilateral temporal subdural haematomas were found. These appeared consistent with a suspected head injury sustained as a result of a fall. Fairly large partly organized adherent subdural clots in the parieto-occipital region completely remote from and unconnected with the fresh bitemporal haematomas were also found. Based on the gross pathology and the histology, an attempt is made to assess the possible cause of the organized clots. Some of the findings indicated a possible non-traumatic origin, a consideration which is likely to affect the forensic implications.- - - - - - - - - - ranking = 0.044744117713719keywords = organ (Clic here for more details about this article) |
6/130. Profound retrograde amnesia following mild head injury: organic or functional?This paper describes a 56 year old female patient (JJ) who suffered a minor head injury at work and presented with profound retrograde amnesia for both public events and autobiographical material spanning her entire life. In addition, she complained of word-finding difficulties and anterograde memory impairment and neuropsychological assessment found evidence of mild executive dysfunction. Neurological investigations (CT and EEG) were essentially normal although changes indicative of small vessel disease were noted on MRI brain scan. Various forms and aetiologies of remote memory loss were considered including, simulated, psychogenic and organic amnesia, but differential diagnosis proved difficult. It is proposed that criteria used in clinical practice to differentiate functional and organic complaints are limited and this may be because (1) both factors can be involved in the aetiology of amnesia, and (2) a similar underlying brain mechanism, such as a retrieval deficit could underlie many instances of organic and psychogenic amnesia. Future research, complemented by functional brain imaging, is needed to explore the nature of retrieval deficits.- - - - - - - - - - ranking = 0.044744117713719keywords = organ (Clic here for more details about this article) |
7/130. Unusual occipital condyle fracture with multiple nerve palsies and Wallenberg syndrome.A 52-year-old male presented with an extremely rare fracture of the occipital condyle involving the jugular foramen with marked medial rostrad displacement of the fragments. He had ipsilateral VII through XII nerves palsies and Wallenberg syndrome. Conservative treatment did not improve the cranial nerve palsies. A high-resolution CT-scan is essential to visualize these fractures.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
8/130. Transient blindness following minor head injuries.Transient bliandness following minor head injury is a rare, although well known, and totally reversible entity. As the condition may have legal implications, a 5-year follow-up study was carried out on 4 young patients. Repeated ophthalmological, neurological and psychiatric examination both early nd late after injury did not reveal any organic or psychiatric diseases which might predispose to this disorder. The case reports, including one recurrent case, a follow-up study and a discussion of the aetiology are presented.- - - - - - - - - - ranking = 0.0063920168162456keywords = organ (Clic here for more details about this article) |
9/130. Mild head injury with isolated third nerve palsy.Traumatic isolated cranial nerve palsies are uncommon and when they do occur, they are usually associated with severe head trauma. Cranial nerve palsy associated with mild head injury is rare. A case is reported of complete left third nerve palsy associated with mild head injury. The rate of recovery for complete third nerve palsy is slow and prolonged. The ptosis recovered in 10 months; the divergent squint required botulinum toxin to the lateral rectus muscle followed by surgery.- - - - - - - - - - ranking = 2.6666666666667keywords = nerve (Clic here for more details about this article) |
10/130. The injured coach.The patient in this case was diagnosed as having an epidural hematoma (shown in x-ray at right). This results from hemorrhage between the dura mater and the skull. The hemorrhage may result from a traumatic insult to the side of the head, which can fracture the temporal bone and lacerate the middle meningeal artery. Since the hemorrhage is arterial in nature, the patient may deteriorate quickly. These patients may present with what is referred to as a "lucid interval." The patient typically has a significant blow to the head that results in a short period of unconsciousness. They then regain consciousness at a time that frequently coincides with the arrival of EMS. Once conscious, they are in a period known as the lucid interval. They will still have a headache, but may otherwise be acting normally and show no other physical findings on examination. Many such patients refuse treatment and transport. [table: see text] Inside the skull, however, the problem will grow. Broken arterial vessels are bleeding, causing an expanding hematoma. The patient typically will soon complain of a severe headache along with other associated complaints, such as nausea/vomiting, then will lose consciousness again and/or have a seizure. Initial physical findings may include contralateral weakness and a decreased Glasgow coma score. As the hematoma expands, cerebral herniation may occur, compressing the third cranial nerve, which presents as a "blown pupil." EMS providers should have a high suspicion of injuries that affect the side of the head and the base of the skull. It is important to not only assess such injuries, but also the mechanism of injury, and to know the complications or later presentation that can arise from such injuries. Given that this patient was alert, oriented, not obviously intoxicated, and accompanied by his wife, the providers in this case would have had no choice but to abide by a refusal of treatment and transport. However, that could lead to serious complications, such as ongoing minor neurological deficits, later on. If this is the case, contacting medical control should be the priority.- - - - - - - - - - ranking = 0.33333333333333keywords = nerve (Clic here for more details about this article) |
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