1/15. Spinal intradural arachnoid cysts located anterior to the cervical spinal cord. Report of two cases and review of the literature.The authors describe two rare occurrences of radiographically, surgically, and pathologically confirmed spinal intradural arachnoid cysts (not associated with additional pathological entities) that were located anterior to the cervical spinal cord. These lesions have been reported previously in only eight patients. The patients described in this report were young adults who presented with progressive spastic tetraparesis shortly after sustaining mild cervical trauma and in whom no neurological deficit or bone fracture was demonstrated. The presence of an intradural arachnoid cyst was detected on postcontrast computerized tomography (CT) myelography and on magnetic resonance imaging; both diagnostic tools correctly characterized the cystic nature of the lesion. Plain radiography, plain tomography, and contrast-enhanced CT scans were not diagnostic. In both cases a laminectomy was performed, and the wall of the cyst was excised and fenestrated with subarachnoid space. Postoperatively, the patients made complete neurological recoveries. Based on a review of the literature, arachnoid cysts of the spinal canal may be classified as either extra- or intradural. Intradural arachnoid cysts usually arise posterior to the spinal cord in the thoracic spine region; however, these cysts very rarely develop in the cervical region. The pathogenesis of arachnoid cysts is unclear, although congenital, traumatic and inflammatory causes have been postulated. The authors believe that the formation of an arachnoid cyst cannot be explained by simply one mechanism because, in some reported cases, there has been accidental or iatrogenic trauma in association with congenital lesions. They also note that an intradural arachnoid cyst located anterior to the cervical spinal cord is an extremely rare disorder that may cause progressive myelopathy; however, the postoperative prognosis is good.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/15. Management of penetrating injury to the petrous internal carotid artery: case report.We report the management of a penetrating foreign body injury to the neck with a length of fencing wire traversing the internal carotid artery within the petrous temporal bone and entering the middle cranial fossa. Discussion points include methods of haemorrhage control, as well as ligation versus repair or bypass as the definitive treatment.- - - - - - - - - - ranking = 0.3257684583803keywords = haemorrhage (Clic here for more details about this article) |
3/15. A craniocervical injury-induced syringomyelia caused by central canal dilation secondary to acquired tonsillar herniation. Case report.The authors report on a 19-year-old man with an acquired tonsillar herniation caused by a craniocervical junction injury in which serial magnetic resonance (MR) images demonstrated patent and isolated segments of the central canal participating in the dilation and then formation of a cervical syrinx. The patient was involved in a motor vehicle accident; he developed tonsillar herniation as a complication of subarachnoid and epidural hemorrhage, predominantly observed around the cisterna magna and upper cervical canal. Repeated MR images obtained over an 11-month period indicated the for mation and acute enlargement of the syrinx. Ten months after the accident, the patient presented with sensory disturbance in both upper extremities and spasticity due to syringomyelia. He underwent craniocervical decompressive surgery and doraplasty, which reduced the size of syringomyelia. The authors postulate that the patent central canal may play a role in determining the location of a syrinx remote from a focus of cerebrospinal fluid obstruction.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
4/15. Laryngeal crepitus: an aid to diagnosis in non-fatal strangulation.Examination of victims exposed to strangulation is well known in clinical forensic medicine. Not all cases show the objective signs to be found at the examination, e.g. petechial haemorrhages in the eyes and face as well as bruises and abrasions on the neck. In cases without objective signs especially, examination of the laryngeal crepitus might be an aid to diagnosis in strangulation. Laryngeal crepitus is felt by the examiner when the larynx is moved from side to side with a slight posterior pressure. When absent, it is a clinical sign of a mass in the retrolaryngeal space or hypopharynx, probably due to a laryngeal trauma. This paper describes three cases of strangulation where the clinical examinations showed a temporary absence of laryngeal crepitus.- - - - - - - - - - ranking = 0.3257684583803keywords = haemorrhage (Clic here for more details about this article) |
5/15. Mechanisms in cerebral lesions in trauma to high cervical portion of the vertebral artery--rotation injury.Three cases have been described illustrating the mechanisms and effects of lesions from acute rotation injury to the vertebral artery. These indicate that the portion of artery at risk is in the C1 to C2 region, where stretching and shearing strains can produce intramural dissection and haemorrhage. Such changes can radically alter flow to produce acute arterial obliteration or later cerebral embolism. Such alteration can also produce a change in relationships between artery and surrounding structures and thus cause intermittent occlusion of a vertebral artery upon cervical rotation.- - - - - - - - - - ranking = 0.3257684583803keywords = haemorrhage (Clic here for more details about this article) |
6/15. Delayed central nervous system superficial siderosis following brachial plexus avulsion injury. Report of three cases.Chronic subarachnoid hemorrhage may cause deposition of hemosiderin on the leptomeninges and subpial layers of the neuraxis, leading to superficial siderosis (SS). The symptoms and signs of SS are progressive and fatal. Exploration of potential sites responsible for intrathecal bleeding and subsequent hemosiderin deposition may prevent disease progression. A source of hemorrhage including dural pathological entities, tumors, and vascular lesions has been previously identified in as many as 50% of patients with SS. In this report, the authors present three patients in whom central nervous system SS developed decades after brachial plexus avulsion injury. They believe that the traumatic dural diverticula in these cases may be a potential source of bleeding. A better understanding of the pathophysiology of SS is important to develop more suitable therapies.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
7/15. Postmortem non-invasive virtual autopsy: death by hanging in a car.A body was found behind a car with a noose tied around its neck, the other end of the rope tied to a tree. Apparently the man committed suicide by driving away with the noose tied around his neck and was dragged out of the car through the open hatchback. postmortem multislice-computed tomography (MSCT) and magnetic resonance imaging (MRI) indicated that the cause of death was cerebral hypoxia due to classic strangulation by hanging, and not due to a brainstem lesion because of a hang-man fracture as would be expected in such a dynamic situation. Furthermore, the MRI displayed intramuscular haemorrhage, bleeding into the clavicular insertions of the sternocleidomastoid muscles and subcutaneous neck tissue. We conclude that MSCT and MRI are useful instruments with an increased value compared with 2D radiographs to augment the external findings of bodies when an autopsy is refused. But further postmortem research and comparing validation is needed.- - - - - - - - - - ranking = 0.3257684583803keywords = haemorrhage (Clic here for more details about this article) |
8/15. Retropharyngeal haemorrhage from a vertebral artery branch treated with distal flow arrest and particle embolisation.Retropharyngeal haematoma is a rare cause of rapid neck swelling that may result in fatal upper respiratory airway obstruction. Reported causes include trauma, surgery, retropharyngeal inflammation, carotid aneurysm, aberrant artery at the thoracic inlet and bleeding diathesis. We report a 90-year-old man who developed rapid and progressive neck swelling following a minor traumatic episode. Computed tomography showed a large low-density retropharyngeal haematoma extending from the skull base to the mediastinum, with suspected extravasation. The right vertebral artery angiogram confirmed contrast agent extravasation arising from a small branch artery. This was treated with temporary distal flow arrest and particle embolisation.- - - - - - - - - - ranking = 1.3030738335212keywords = haemorrhage (Clic here for more details about this article) |
9/15. magnetic resonance imaging and posttraumatic Lhermitte's sign.Two patients developed Lhermitte's sign after cervical spine fractures. The patients were otherwise without evidence of spinal cord dysfunction. Both patients were studied with magnetic resonance scans of the cervical spine. The magnetic resonance scans were normal. The possible etiology of Lhermitte's sign in these patients is discussed. The differential diagnosis including cervical spondylosis, combined systems degeneration, multiple sclerosis, neoplasm, and radiation myelopathy is reviewed. These patients should be carefully evaluated clinically, and flexion/extension lateral cervical spine films as well as a complete blood count and peripheral smear should be obtained. Magnetic resonance scanning may have an important role in evaluating these patients. Magnetic resonance is exquisitely sensitive in detecting demyelination; therefore, we speculate that subarachnoid scarring may be responsible for this symptom. gadolinium-enhanced magnetic resonance scanning may confirm the presence of such scarring in the future.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
10/15. Traumatic basal subarachnoid hemorrhage. Report of six cases and review of the literature.Basal subarachnoid hemorrhage due to rupture of normal extra- and intracranial arteries, in association with minor trauma to the face and neck and alcohol intoxication, has been well described but often goes unrecognized at autopsy. This results in the incorrect classification of the manner of death as natural. Six cases of subarachnoid hemorrhage due to mild-to-moderate blows to the head or neck are presented. All were men in the age range 28-61 years (mean, 38.8 years). Four had blood alcohol levels of 0.09-0.28 g % at autopsy, and five of six were comatose or dead within 30 min of the initiating trauma. Traumatic ruptures of otherwise normal extra- and intracranial arteries were identified in four cases. The site of rupture was not found in one case, and the final case had rupture of a fibrotic intracranial vertebral artery. Multiple sites of incomplete and complete rupture were found in four cases. Postmortem angiography was used in one case to demonstrate the site of rupture prior to removal of the brain. Postmortem angiography and careful gross and histologic examination of extra- and intracranial cerebral arteries is recommended in all cases of basal subarachnoid hemorrhage where minor trauma to the head or neck has occurred prior to collapse or death, especially if the decedent was intoxicated at the time of the trauma.- - - - - - - - - - ranking = 7keywords = subarachnoid (Clic here for more details about this article) |
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