1/45. Complete microsurgical excision of cervical extramedullary and intramedullary vascular malformations.Eleven patients with vascular malformations of the cervical spinal cord have been operated upon at the University of Zurich. Total microsurgical excision was achieved in all. One patient had a lesion which was entirely intramedullary. Nine patients had combined lesions, intramedullary and extramedullary. Only one patient had a lesion which was entirely extramedullary. There was one operative death from meningitis. Another patient improved slightly postoperatively, but eventually died of urological complications. One patient had the operation immediately following his only subarachnoid hemorrhage, and has thus been protected from neurological damage. One patient has had postoperative reversal of his progressive neurological deterioration and severe pain. Six patients severely impaired preoperatively improved dramatically. One patient who was quadriplegic preoperatively has regained function in her upper extremities. The treatment of choice in lesions such as these is complete microsurgical excision.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/45. MR demonstration of brain abscess rupture into the subarachnoid space and its possible implication in management.BACKGROUND: rupture of brain abscess into the subarachnoid space as a cause of meningitis is rare. early diagnosis improves the outcome. There is no previous report of MR demonstration of rupture of brain abscess into the subarachnoid space. CASE DESCRIPTION: Two young adults with chronic suppurative otitis media presenting with signs of increased intracranial pressure and meningeal irritation underwent magnetic resonance imaging, which showed brain abscess with evidence of rupture into the subarachnoid space and meningitis. This helped in early diagnosis and aggressive management. CONCLUSION: In cases of brain abscess where meningitis is suspected clinically, documentation of rupture of the abscess into the subarachnoid space will help in avoiding cerebrospinal fluid (CSF) examination that may be disastrous in these patients who already have increased intracranial pressure.- - - - - - - - - - ranking = 8keywords = subarachnoid (Clic here for more details about this article) |
3/45. Chronic post-traumatic erosion of the skull base.Delayed post-traumatic erosion of the skull base is reported in three patients who presented as adults with cerebrospinal fluid fistulae and a history of recurrent meningitis. These skull defects were associated with herniation of the subarachnoid space into the diploe of the skull base, the paranasal sinuses and the orbit. This rare complication of head injury is assumed to have occurred as the result of a dural tear at the time of trauma. Its site probably determines whether a resulting meningocele widens the intradiploic space or broaches the cranial floor.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
4/45. Rheumatoid meningitis: an autopsy report and review of the literature.We report the clinical and autopsy findings of a 71-year-old Japanese woman with rheumatoid meningitis. This patient developed subacute meningitis during an inactive stage of rheumatoid arthritis (RA), and despite intensive examinations no causative agents or underlying disease could be identified except for RA. Based on persistent hypocomplementaemia and increased serum levels of immune complexes she was suspected of having vasculitis, and was treated with intravenous methylprednisolone (1000 mg/day for 3 days) followed by oral prednisolone. Soon after beginning treatment with corticosteroid her symptoms improved, in parallel with a decrease in cell counts and interleukin-6 in the cerebrospinal fluid. During tapering of oral prednisolone she died of a subarachnoid haemorrhage which was ascribed to a relapse of the meningitis. autopsy demonstrated infiltration of mononuclear cells, including plasma cells, in the leptomeninges, mainly around small vessels, leading to a definite diagnosis of rheumatoid meningitis. When RA patients manifest intractable meningitis with a subacute course, this disease is important as a possible diagnosis even if the arthritis is inactive, and intensive treatment, including corticosteroid and immunosuppressants, should be positively considered as a therapeutic option as soon as possible because of the poor prognosis.- - - - - - - - - - ranking = 1.564299359379keywords = subarachnoid, subarachnoid haemorrhage, haemorrhage (Clic here for more details about this article) |
5/45. Aspergillotic aneurysm formation of cerebral artery following neurosurgical operation.A rare case of intracranial aspergillotic aneurysm following neurosurgical operation for facial spasm is presented. Severe meningitis had persisted several days prior to the subarachnoid hemorrhage which occurred on 70th postoperative day. angiography demonstrated a fusiform aneurysm at the peduncular segment of the superior cerebellar artery on the other side of operation. As the repeated cultures of CSF were negative, the pathogenetic factor causing aneurysm formation could not be identified before second operation of aneurysmal resection. Pathological study of the specimen revealed the arterial wall being deeply invaded by aspergillotic hyphae.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
6/45. cerebrospinal fluid leak and meningitis associated with nasal continuous positive airway pressure therapy.Clear rhinorrhea is a common symptom in patients with obstructive sleep apnea (OSA) and may worsen with continuous positive airway pressure therapy. Clear rhinorrhea can also be the presenting symptom of cerebrospinal fluid (CSF) leak, which is evidence of a communication between the subarachnoid space and the nasal cavity or sinuses. While CSF leak has been reported to occur with nasal continuous positive airway pressure (nCPAP) therapy following trauma to the skull base, its association with OSA and nCPAP therapy in the absence of trauma has not been previously described. We report two patients with OSA in whom CSF leak developed following the institution of nCPAP therapy. In one patient, the rhinorrhea was complicated by meningitis. Both patients underwent successful repair of their defects. One patient successfully restarted nCPAP therapy, while the other refused it.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
7/45. optic nerve decompression. A clinical pathologic study.decompression of the perioptic meninges for intractable chronic papilledema was done in a patient with a right parietal temporal glioblastoma multiforme. The patient died 39 days postoperatively. Histologic study of the optic nerves indicated fistulas in the dura compatible with cerebrospinal fluid (CSF) egress and maintenance of a normal subarachnoid space around the nerve. Two additional patients with unilateral optic nerve decompression producing bilateral resolution of papilledema were studied. We contend that egress of CSF was the principle mode of action in these three cases. How long the dural fistula remains patent is unknown. Reports in the literature show considerable variation in the effects of optic nerve decompression. anatomic variation of the intracanalicular subarachnoid space together with differences in underlying pathologic condition, surgical technique, and patient response may explain discrepancies among the results reported.- - - - - - - - - - ranking = 2keywords = subarachnoid (Clic here for more details about this article) |
8/45. Misleading CT scans: a report of two cases.Two patients who appeared to have suffered from intracranial haemorrhage are presented. Their clinical histories and computed tomographic scans were supportive of the diagnosis of intracranial haemorrhage. However, both patients were found to have infected cerebrospinal fluid.- - - - - - - - - - ranking = 0.045619216280177keywords = haemorrhage (Clic here for more details about this article) |
9/45. syringomyelia and arachnoiditis.Five patients with chronic arachnoiditis and syringomyelia were studied. Three patients had early life meningitis and developed symptoms of syringomyelia eight, 21, and 23 years after the acute infection. One patient had a spinal dural thoracic AVM and developed a thoracic syrinx 11 years after spinal subarachnoid haemorrhage and five years after surgery on the AVM. A fifth patient had tuberculous meningitis with transient spinal cord dysfunction followed by development of a lumbar syrinx seven years later. arachnoiditis can cause syrinx formation by obliterating the spinal vasculature causing ischaemia. Small cystic regions of myelomalacia coalesce to form cavities. In other patients, central cord ischaemia mimics syringomyelia but no cavitation is present. Scar formation with spinal block leads to altered dynamics of cerebrospinal fluid (CSF) flow and contributes to the formation of spinal cord cystic cavities.- - - - - - - - - - ranking = 1.564299359379keywords = subarachnoid, subarachnoid haemorrhage, haemorrhage (Clic here for more details about this article) |
10/45. Vein of Galen aneurysm presenting with recurrent aseptic meningitis and subsequent spontaneous thrombosis.Clinical and laboratory findings are described in the case of a patient with a vein of Galen aneurysm who presented with recurrent aseptic meningitis for which no etiology could be identified. The patient subsequently developed thalamic and intraventricular hemorrhage associated with partial thrombosis of the dilated vein of Galen. review of the literature revealed no previously reported association of these conditions. Recurrent cerebral venous thrombosis involving the fistula is hypothesized as the cause of repeated inflammatory reactions near the subarachnoid space. More extensive thrombosis may then have precipitated the hemorrhage.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
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