1/9. Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women.Improved acute and rehabilitative care and emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers of cord-injured women presenting for obstetrical care. Anaesthetists providing care to these women should be familiar with the complications resulting from chronic cord injury and aware that many may be aggravated by the physiological changes of normal pregnancy. These complications include reduced respiratory volumes and reserve, decreased blood pressure and an increased incidence of thromboembolic phenomena, anaemia and recurrent urinary tract infections. patients with cord lesions above the T5 spinal level are at risk for the life-threatening complication of autonomic hyperreflexia (AH) which results from the loss of central regulation of the sympathetic nervous system below the level of the lesion. Sympathetic hyperactivity and hypertension result in response to noxious stimuli entering the cord below the level of the lesion. Labour appears to be a particularly noxious stimulus and patients with injuries above T5 are at risk for AH during labour even if they have not had previous AH episodes. morbidity is related to the degree of hypertension and intracranial haemorrhage has been reported during labour and attributed to AH. We report our experience in providing care to three parturients with spinal cord injuries. Two patients had high cervical lesions, one of whom experienced AH during labour and was treated with an epidural block. The second was at risk for AH having had episodes in the past and received an epidural block to provide prophylaxis for AH. In both cases epidural blockade provided effective treatment and prophylaxis for AH.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/9. Severe hypertension during postpartum haemorrhage after i.v. administration of prostaglandin E2.Severe hypertension with arterial spasm was observed after i.v. administration of prostaglandin E2 (PGE2) during uterine exploration under general anaesthesia for control of postpartum haemorrhage. This hypertension was exceptional because PGE2 is known to cause a decrease in systemic arterial pressure. Different hypotheses for this paradoxical hypertensive crisis after PGE2 administration are discussed.- - - - - - - - - - ranking = 5keywords = haemorrhage (Clic here for more details about this article) |
3/9. hemifacial spasm caused by CP angle AVM associated with ruptured aneurysm in the feeding artery--case report.A 66-year-old male presented with clinical features of hemifacial spasm. Cerebral angiograms disclosed an arteriovenous malformation (AVM) in the cerebellopontine angle. The hemifacial spasm was caused by a dilated feeding artery of the AVM compressing the facial nerve at the root exit zone. Surgery was not initially performed because of his age and absence of AVM rupture. However, the AVM was associated with a small aneurysm in the feeding artery, which rapidly grew during 20 days after discharge and ruptured causing subarachnoid hemorrhage. The aneurysm was clipped and the feeding artery of the AVM partially obliterated. Careful angiographic examination for associated aneurysms and consequent surgical obliteration to prevent hemorrhage are suggested in cases of AVM.- - - - - - - - - - ranking = 14.490676734485keywords = subarachnoid (Clic here for more details about this article) |
4/9. subarachnoid hemorrhage.Spontaneous subarachnoid hemorrhage is most frequently caused by rupture of an aneurysm or arteriovenous malformation. Early clinical diagnosis is important to avert fatal hemorrhage. Surgical treatment should be carried out in patients in good neurologic condition.- - - - - - - - - - ranking = 14.490676734485keywords = subarachnoid (Clic here for more details about this article) |
5/9. Profound cerebral vasospasm without radiological evidence of subarachnoid hemorrhage: case report.Profound clinical and radiographic arterial vasospasm in all major intracerebral vessels was identified in a patient with an intraparenchymal hemorrhage that extended into the lateral, 3rd, and 4th ventricles. By computed tomographic criteria and on early cerebrospinal fluid examination, no subarachnoid blood was detected. The temporal appearance of vasospasm was consistent with that typically seen in subarachnoid hemorrhage. Despite hypervolemia and iatrogenic hypertension, cerebral infarction occurred contralateral to the hemorrhage. We conclude that patients without significant subarachnoid hemorrhage (as determined by computed tomographic scanning) may still be at risk for developing vasospasm.- - - - - - - - - - ranking = 101.4347371414keywords = subarachnoid (Clic here for more details about this article) |
6/9. Prinzmetal's variant angina associated with subarachnoid hemorrhage: A case report.Prinzmetal's variant of angina occurred in a 48-year-old man who sustained two attacks of subarachnoid hemorrhage within 10 days. The first anginal pain started at the same time that the second cerebrovascular accident developed, but subsequent anginal episodes were not accompanied by other symptoms or signs that indicated new development of subarachnoid hemorrhage. Twelve days later, when nuchal rigidity was fairly improved, the episodes of chest pain ended. A vasospasm of the large coronary arteries--probably due to the derangement of the autonomic nervous system caused by subarachnoid hemorrhage--was presumed to contribute to the occurrence of the variant angina. Based on this case and on review of the literature, we propose that coronary arterial spasm is one of several causes of the cardiac changes seen in subarachnoid hemorrhage.- - - - - - - - - - ranking = 115.92541387588keywords = subarachnoid (Clic here for more details about this article) |
7/9. Intraarterial papaverine for the treatment of vasospasm.The authors describe the use of intraarterial papaverine to treat vasospasm following subarachnoid hemorrhage. Two cases are reported: a 40-year-old woman with a posterior communicating artery aneurysm and a 67-year-old man with a posterior cerebral artery aneurysm. Both patients developed symptomatic, angiographically demonstrated vasospasm that responded to papaverine infusion.- - - - - - - - - - ranking = 14.490676734485keywords = subarachnoid (Clic here for more details about this article) |
8/9. neuroma of the spinal accessory nerve disclosed by a subarachnoid hemorrhage: case report.OBJECTIVE AND IMPORTANCE: neuroma of the 11th nerve disclosed by subarachnoid bleeding is a very rare condition. Clinical diagnosis is almost impossible, but previous episodes of muscle spasm and mild signs of subarachnoid hemorrhage with a hematoma in the cisterna magna should suggest magnetic resonance imaging as well as angiography. CLINICAL PRESENTATION: We present a case of an 11th nerve neuroma disclosed by subarachnoid bleeding. Previous episodes of muscle spasm and neck pain treated with nonsteroid anti-inflammatory drugs had been overlooked, preventing the neuroma from being diagnosed at that time. The computed tomographic scan showed an intracisternal hematoma spreading into the subarachnoid space. The hematoma appeared heterogeneous on the magnetic resonance image, and a tumor mass growing into the cisterna magna against the brain stem was also revealed. INTERVENTION: The tumor was totally removed by a suboccipital craniectomy and C1 laminectomy. It originated from the spinal root of the 11th nerve, from which it was able to be dissected without damage to the nerve. CONCLUSION: To our knowledge, this is the first reported case of an 11th nerve neuroma disclosed by a subarachnoid hemorrhage. Furthermore, this is the seventh documented case of an 11th nerve neuroma developing in the cisterna magna. We emphasize the importance of a high index of suspicion for the rare instances of hematic density limited to the cisterna magna, especially if associated with recurring episodes of localized neck pain and muscle spasm treated with nonsteroid anti-inflammatory drugs.- - - - - - - - - - ranking = 130.41609061037keywords = subarachnoid (Clic here for more details about this article) |
9/9. Ruptured de novo aneurysm induced by ethyl 2-cyanoacrylate: case report.OBJECTIVE AND IMPORTANCE: We report a rare case of a ruptured de novo aneurysm induced by ethyl 2-cyanoacrylate. CLINICAL PRESENTATION: A 44-year-old woman had undergone microvascular decompression for a right-sided facial spasm. The preoperative vertebral angiogram did not show any aneurysmal dilation. The right anteroinferior cerebellar artery, which was compressing the exit zone of the facial nerve, was detached and fixed to the dura mater with ethyl 2-cyanoacrylate. Nine years later, the patient suffered a subarachnoid hemorrhage caused by the rupture of a newly developed aneurysm of the right anteroinferior cerebellar artery. INTERVENTION: The aneurysm was clipped 2 days after onset of the subarachnoid hemorrhage. It consisted of two bulges in the arterial wall on the proximal side of the meatal loop. One bulge was stuck to the dura mater of the pyramis by ethyl 2-cyanoacrylate, which had been used in the microvascular decompression 9 years previously. CONCLUSION: This is the first reported clinical case of a de novo aneurysm induced by a cyanoacrylate adhesive. Ethyl 2-cyanoacrylate can damage the arterial wall and induce a de novo aneurysm.- - - - - - - - - - ranking = 28.981353468971keywords = subarachnoid (Clic here for more details about this article) |