1/17. 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 = brain (Clic here for more details about this article) |
2/17. Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography.A 43-year-old man with dysphagia and a tendency to aspirate was found to have squamous cell carcinoma of the esophagus. Curative surgery was planned and preoperative computed tomography of the chest and abdomen was ordered. A ward nurse administered Gastrografin according to a "standing" order, 4 hours before the CT was to be done. The patient aspirated about 50 mL of Gastrografin, and went into cardiorespiratory arrest caused by pulmonary edema. He sustained severe brain damage and died. This is a first report of lethal aspiration of Gastrografin, given in preparation for CT. We advise alerting nurses who administer Gastrografin, especially to patients with dysphagia or impaired consciousness about the grave consequences that can result if the contrast agent is aspirated by the patient. We further advise that responsibility for using contrast agents in radiologic procedures be assumed by the radiologist and not by medical house staff.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
3/17. Aspiration and the laryngeal mask airway: three cases and a review of the literature.The primary limitation of the laryngeal mask airway (LMA) is that it does not reliably protect the lungs from regurgitated stomach content. We describe three cases of aspiration associated with the LMA, including the first brain injury, the first death, and the first associated with the intubating LMA, and review the 20 specific case reports of aspiration associated with the LMA that we were able to find described in the literature.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
4/17. Reversal of laryngotracheal separation: a detailed case report with long-term followup.Chronic aspiration is a difficult and potentially lethal problem. patients who have persistent soilage of the upper respiratory tract despite discontinuing oral intake may be offered surgical intervention to avoid life-threatening pulmonary infections. The Lindeman procedures (tracheoesophageal diversion and laryngotracheal separation) have gained popularity as surgical treatments for intractable aspiration because of their efficacy in preventing aspiration and their technical simplicity. A major downside of these procedures is the necessity for a tracheostoma and the loss of speech following surgery. Rarely, patients recover from the neurologic deficits which led to their intractable aspiration and desire reversal of their Lindeman procedure. While few "successful" reversals have been reported, detailed accounts of the long-term results of such patients are lacking. We describe a patient who underwent a laryngotracheal separation for intractable aspiration following a brainstem stroke. In the following six months he experienced significant neurologic recovery and, after careful evaluation, underwent surgical restoration of laryngotracheal continuity. Five years later he speaks fluently and has no dietary restrictions. Videofluooroscopic examination and quantitative voice analysis reveal near-normal laryngeal function.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
5/17. Neurogenic pulmonary edema: case reports and review.Neurogenic pulmonary edema (NPE) is a relatively common though often subclinical complication of a variety of central nervous system insults (trauma, hemorrhage, seizures, etc.) in children and adults. The syndrome probably results from massive centrally mediated sympathetic discharge and generalized vasoconstriction, and often presents in the emergency department (ED). The symptoms are likely to be mistaken for aspiration pneumonia. Treatment consists of ventilatory support, including positive end-expiratory pressure, and aggressive measures to reduce intracranial pressure. We present four cases of NPE and review its recognition and emergent management.- - - - - - - - - - ranking = 36.243991271573keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/17. Invasive pulmonary and central nervous system aspergillosis after near-drowning of a child: case report and review of the literature.Invasive aspergillosis is extremely rare in immunocompetent children. Here we describe the clinical, radiologic, and laboratory course of fatal invasive pulmonary and central nervous system aspergillosis in a previously healthy child after a near-drowning incident with submersion in a pond. Findings were compared with data from the literature, which is reviewed. serum aspergillus galactomannan levels were determined retrospectively and were compared with the results of routine microbiological and radiologic examinations, showing a significant diagnostic and therapeutic delay of the routine diagnostic approach in comparison with the use of the aspergillus galactomannan assay. This delay may have contributed to the fatal course. Serial determination of serum aspergillus galactomannan may be helpful in diagnosing invasive aspergillosis early in case of pulmonary disease after near-drowning and may contribute to an early appropriate treatment. Currently voriconazole, eventually in combination with caspofungin, should be considered as the drug of choice in the management of invasive aspergillosis after near-drowning.- - - - - - - - - - ranking = 181.21995635787keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/17. Monosporium apiospermum meningoencephalitis: a clinico-pathological case.Twenty nine cases of central nervous system infection due to Monosporium apiospermum have been reported. Six of them occurred after an aspiration pneumonia following a near drowning. The case of a 53 year old man is reported: M apiospermum was isolated from cerebrospinal fluid, sputum, urine and from the mud of the ditch where the patient had fallen. Though the treatment used recommended doses of intravenous, intrathecal and intraventricular amphotericin b, it was ineffective and the patient died 97 days after the near drowning. Necropsy showed that the ventricular infectious process was more prominent distant from the antifungal ventricular source.- - - - - - - - - - ranking = 36.243991271573keywords = central nervous system, nervous system (Clic here for more details about this article) |
8/17. pseudallescheria boydii infection of the central nervous system.pseudallescheria boydii is a rare cause of central nervous system infection characteristically presenting as a neutrophilic meningitis or multiple brain abscesses. Factors predisposing to central nervous system infection with this fungus include immunosuppression and near drowning. The organism is infrequently cultured from fluid obtained by lumbar puncture, delaying clinical recognition and appropriate antifungal therapy. All untreated patients with P boydii infection of the central nervous system died. We describe a patient who developed a persistent neutrophilic meningitis with focal neurologic deficits due to P boydii 6 months after a freshwater aspiration pneumonia. We also review the characteristic clinical and pathologic features of previously reported cases and emphasize the importance of early detection and treatment in the management of this frequently intractable disease.- - - - - - - - - - ranking = 254.20793890101keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
9/17. airway management in patients with central nervous system depression.In central nervous system (CNS) depressed patients, a sequential approach is necessary to prevent airway obstruction and aspiration of vomitus. Endotracheal intubation is indicated if the lash reflex is absent, response to stimulation is not purposeful, or airway obstruction develops when the patient's neck is flexed. Aspiration may result from CNS depression, abnormal glottic function, or extreme debilitation. It may occur in cannulated patients with improper cuff management or after decannulation while glottic reflexes are ineffective.- - - - - - - - - - ranking = 181.21995635787keywords = central nervous system, nervous system (Clic here for more details about this article) |
10/17. The patient who aspirates -- diagnosis and management.There is renewed interest, particularly by head and neck surgeons in the pathophysiology of swallowing. Some of the reasons for this are an increased number of patients in the following categories who have swallowing problems: 1) patients postoperative from procedures in the head and neck, e.g., partial laryngectomy, partial or complete excisions of the tongue, pharynx, or mandible; 2) patients with peptic ulcer, hiatal hernia, esophageal diverticula, and cardiospasm; 3) patients who survive severe central nervous system problems such as stroke, brain tumors, aneurysms, or degenerative disease; and 4) patients who survive serious accidents with severe neck trauma. This paper reviews the pathophysiology of swallowing and the methods of diagnosing and treating dysphagia and its complications.- - - - - - - - - - ranking = 36.743991271573keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
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