1/21. Fatal secondary increase in serum S-100B protein after severe head injury. Report of three cases.The S-100B protein is a small cytosolic protein that is found in astroglial or schwann cells. It is highly specific for brain tissue and is increasingly being investigated as a diagnostic tool to assess the neurological damage after head injury, stroke, subarachnoid hemorrhage, and cardiopulmonary bypass. The authors report on three patients with severe head injury with otherwise normal cerebral perfusion pressure, SaO2, PaCO2, and controlled intracranial pressure (ICP), in whom a secondary excessive increase in serum S-100B was observed. In all cases, the S-100B increase was followed by an increase in ICP. All three patients died within 72 hours after the excessive increase in S-100B. These findings indicate that major secondary brain damage may occur at a cellular level without being identified by current neuromonitoring techniques.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/21. subarachnoid hemorrhage following permissive hypercapnia in a patient with severe acute asthma.In this article, we describe a case of a subarachnoid hemorrhage (SAH) in an acute severe asthma patient following mechanical hypoventilation. A 49-year-old man was admitted to an intensive care Unit with an acute exacerbation of asthma. After 3 days of mechanical ventilation (hypercapnia and normoxaemia), it was noted that his right pupil was fixed, dilated, and unreactive to light. Computed tomography (CT) scan showed localized SAH within the basilar cisterns and diffuse cerebral swelling. On the fourth day, a new CT scan showed hemorrhage resorption and a cerebral swelling decrease. In the following days, the patient's condition continued improving with no detectable neurological deficits. A review of similar published reports showed that all patients performed respiratory acidosis, normoxaemia, and hypercapnia. The most frequent neurological sign was mydriasis, and all subjects showed cerebral edema. Since normoxaemic hypercapnia has been associated with absence, or less cerebral edema, we considered additional factors to explain cerebral edema and intracranial hypertension causes. Thus, intrathoracic pressures due to patient's efforts by forcibly exhaling, or during mechanical ventilation, would further increase intracranial pressure by limiting cerebral venous drainage. This case emphasizes the fact that patients with acute severe asthma who have developed profoundly hypercarbic without hypoxia before or during mechanical ventilation, may have raised critical intracranial pressure.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
3/21. Right temporal lobe glioblastoma presenting in the left orbit. Case report.Dissemination of gliomas outside the central nervous system without preceding neurosurgery is a rare phenomenon. Glial neoplasms presenting as bone lesions are even more rare. A case of glioblastoma multiforme (GBM) with initial presentation in the orbit following a single generalized seizure is described. Signs of intracranial hypertension resulted from subarachnoid tumor invasion. The patient was treated with whole-dose radiation therapy but survived for only 6 months following the initial presentation. An autopsy revealed a right temporal GBM with extensive subarachnoid spread and invasion in the left orbit and skull base. The literature on dissemination of primary tumors of the brain is reviewed.- - - - - - - - - - ranking = 2keywords = subarachnoid (Clic here for more details about this article) |
4/21. Anomalous optic disc elevation associated with ultrasonographic evidence of increased subarachnoid fluid.The presence of increased subarachnoid fluid around the optic nerve as measured by ultrasound has been shown to be associated with elevated intracranial pressure, as well as a number of other conditions. This finding has proved useful for distinguishing optic disc elevation secondary to papilledema from disc elevation attributable to other causes. This report describes a patient with anomalous optic disc elevation and increased subarachnoid fluid around the optic nerve.- - - - - - - - - - ranking = 6keywords = subarachnoid (Clic here for more details about this article) |
5/21. Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension. Case report.The authors present the case of a 55-year-old man suffering from intractable spontaneous intracranial hypotension, in whom conservative treatment with 19 weeks of bed rest was not effective. In this period the patient twice underwent surgery for bilateral chronic subdural hematoma, a complication of spontaneous intracranial hypotension. Conventional radionuclide cisternography, magnetic resonance imaging, and computerized tomography myelography did not demonstrate cerebrospinal fluid (CSF) leakage. Repeated radionuclide cisternography with the patient in an upright position revealed leakage of the tracer at upper cervical levels. Computerized tomography myelography with breath holding also showed CSF leakage of the contrast medium bilaterally at upper cervical levels. The patient underwent surgery, and bilateral C-2 and C-3 spinal nerve root pouches were sealed off from the subarachnoid space with oxidized cellulose cotton and fibrin glue. Epiarachnoid spaces around the root sleeves were also sealed to ensure complete resolution of the CSF leakage. After the surgery, the patient was completely free of the disease. In the case of intractable persistent spontaneous intracranial hypotension, surgical treatment is preferable to long-term conservative management. To identify CSF leakage, radionuclide cisternography with the patient in the upright position is useful. When obvious leakage is encountered, surgical sealing of the lesion should be performed via a subarachnoid approach.- - - - - - - - - - ranking = 2keywords = subarachnoid (Clic here for more details about this article) |
6/21. intracranial pressure within a developing intracerebral haemorrhage.We report the time course of intracranial pressure within a developing intracerebral haemorrhage. Simultaneous readings of intracranial pressure were obtained from a contralateral parenchymal monitor and ventricular fluid pressure monitor. This recording demonstrates the existence of large pressure gradients in patients with expanding mass lesions.- - - - - - - - - - ranking = 2.1746681940447keywords = haemorrhage (Clic here for more details about this article) |
7/21. Terson syndrome: a case report suggesting the mechanism of vitreous hemorrhage.OBJECTIVE: To present a patient with Terson syndrome and to propose a mechanism for vitreous hemorrhage. DESIGN: Observational case report. PARTICIPANT: A 50-year-old woman with subarachnoid hemorrhage and unilateral vitreous hemorrhage. methods: Detailed examination with fluorescein angiography and funduscopy. MAIN OUTCOME MEASURES: Site of dye leakage on fluorescein angiography in the eye with vitreous hemorrhage. RESULTS: fluorescein angiography showed the leakage site at the margin of the disc in the eye with vitreous hemorrhage after the vitreous hemorrhage had been removed. CONCLUSIONS: The damage to peripapillary tissues demonstrated by fluorescein leakage suggests that intracranial hypertension affects peripapillary structures through the intervaginal space of the optic nerve sheath.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
8/21. Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large sylvian hematomas.OBJECTIVE: As a group, patients who present in poor neurological grade after aneurysmal subarachnoid hemorrhage (SAH) often have poor outcomes. There may be subgroups of these patients, however, in which one pathological process predominates and for which the initiation of specific therapeutic interventions that target the predominant pathological process may result in improved outcome. We report the use of prophylactic decompressive craniectomy in patients presenting in poor neurological condition after SAH from middle cerebral artery aneurysms with associated large sylvian fissure hematomas. Craniectomy allowed significant parenchymal swelling in the posthemorrhagic period without increased intracranial pressure (ICP) or herniation syndrome. methods: Eight patients (mean age, 56.5 yr; age range, 42-66 yr) presented comatose with SAH (five Hunt and Hess Grade IV, three Hunt and Hess Grade V). Radiographic evaluations demonstrated middle cerebral artery aneurysm and associated large sylvian fissure hematoma (mean clot volume, 121 ml; range, 30-175 ml). patients were brought emergently to the operating room and treated with a modification of the pterional craniotomy and aneurysm clipping that included a planned craniectomy and duraplasty. A large, reverse question mark scalp flap was created, followed by bone removal with the following margins: anterior, frontal to the midpupillary line; posterior at least 2 cm behind the external auditory meatus; superior up to 2 cm lateral to the superior sagittal sinus; and inferior to the floor of the middle cranial fossa. Generous duraplasty was performed using either pericranium or suitable, commercially available dural substitutes. RESULTS: All of the eight patients tolerated the craniectomy without operative complications. Postoperatively, all patients experienced immediate decreases in ICP to levels at or below 20 mm Hg (presentation mean ICP, 31.6 mm Hg; postoperative mean ICP, 13.1 mm Hg). ICP control was sustained in seven of eight patients, with the one exception being due to a massive hemispheric infarction secondary to refractory vasospasm. Follow-up (> or = 1 yr, except for one patient who died during the hospital stay) demonstrated that the craniectomy patients had a remarkably high number of good or excellent outcomes. The outcomes in the hemicraniectomy group were five good or excellent, one fair, and two poor or dead. CONCLUSION: The data gathered in this study demonstrate that decompressive craniectomy can be performed safely as part of initial management for a subcategory of patients with SAH who present with large sylvian fissure hematomas. In addition, the performance of decompressive craniectomy in the patients described in this article seemed to be associated with rapid and sustained control of ICP. Although the number of patients in this study is small, the data lend support to the hypothesis that decompressive craniectomy may be associated with good or excellent outcome in a carefully selected subset of patients with SAH.- - - - - - - - - - ranking = 5keywords = subarachnoid (Clic here for more details about this article) |
9/21. Computed tomography and magnetic resonance imaging findings of brain damage by hanging.We reported computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain damage of a 61-year-old man who attempted suicide by hanging. Unenhanced CT demonstrated multiple hyperdense areas indicating subcortical and subarachnoid hemorrhages and brain swelling. MRI demonstrated not only hemorrhagic findings, but also ischemic findings in the middle brain and cerebral cortex. Multifocal cerebral hemorrhages might be caused by venous hypertension due to compression of the jugular veins.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
10/21. Fatal subarachnoid hemorrhage after carotid stenting.BACKGROUND AND PURPOSE: Cerebral hyperperfusion syndrome with intracerebral hemorrhage (ICH) following carotid angioplasty and stent placement (CAS) of the internal carotid artery (ICA) is well known. We report the occurrence of fatal subarachnoid hemorrhage in a patient undergoing CAS. CASE REPORT: A 77-year-old woman experiencing a left-hemispheric transient ischemic attack underwent CAS for a 95% stenosis of the left ICA. CAS was performed without acute complications. At 5 hours the patient suddenly deteriorated. Her level of consciousness changed and she developed neck stiffness. CT of the brain revealed diffuse SAH with acute hydrocephalus. CONCLUSIONS: Like ICH, SAH may develop as a severe complication after CAS. There are no reliable clinical symptoms preceding this fatal complication. However, several factors such as long-standing severe carotid stenosis with contralateral occlusion and increasing blood pressure after CAS accompanied by the extensive use of antithrombotic agents may predispose to this fatal complication.- - - - - - - - - - ranking = 5keywords = subarachnoid (Clic here for more details about this article) |
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