1/19. Spinal subarachnoid hemorrhage attributable to schwannoma of the cauda equina.BACKGROUND: cauda equina syndrome occurring as a result of spontaneous spinal subarachnoid hemorrhage (SAH) from a spinal tumor is reported to be rare. CASE DESCRIPTION: A 28-year-old woman presented at our clinic with a history of severe back pain for 10 days, progressive paraparesis, and urinary retention. Her physical examination revealed a mass located intradurally at the level of L1-2 and a massive SAH. An L1-L2, laminectomy and a hemilaminectomy from D9 to D12 were performed and the SAH was evacuated and the cord was decompressed. CONCLUSION: At the first year follow-up, her restricted dorsal and plantar flexion continued. Post-gadolinium magnetic resonance imaging revealed no mass.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/19. A spectrum of exertional headaches.Headaches that have an explosive onset with exercise, including sexual activity, generally are benign in origin. A subarachnoid hemorrhage, a mass lesion in the brain, or an anomaly of the posterior fossa must be considered, however. The mechanisms that produce sexually induced or cough headaches of abrupt onset are unknown. It is known, however, that a rapid increase in intrathoracic pressure suddenly reduces right atrial pressure and presumably decreases venous sinus drainage from the brain. This situation results in a transient increase in intracranial pressure. jaw pain that occurs with chewing often is considered to be TMJ dysfunction when arthritic in quality and if subluxations of the jaw can be shown on the physical examination. giant cell arteritis and common or external carotid artery occlusive disease should be considered when the pain is ischemic in quality. An anginal equivalent is another possibility. Headaches that worsen with vigorous exercise are commonly migrainous. When their onset is apoplectic with exertion (particularly exertion against a closed glottis), the most likely diagnoses are increased intracranial pressure, a posterior fossa abnormality, or benign exertional headaches. Most cardiac induced headaches, but not all, are of a more gradual onset. If there are significant risk factors for coronary artery disease, an exercise stress test is appropriate. A therapeutic trial of nitroglycerin may help to establish a diagnosis if it improves the headache. Using antimigraine drugs as a diagnostic test is inappropriate because triptans and ergots are contraindicated in the presence of coronary artery disease, and a positive response is not diagnostic of migraine.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/19. Mediastinal neurilemmoma complicated with spinal subarachnoid hemorrhage.A 28-year-old woman suffered severe back pain and headache during exercising on three occasions during the prior two-month period. On admission, the physical examination revealed symptoms of meningeal irritation, nuchal rigidity, severe headache, continuous nausea, and vomiting. Cerebral computed tomography of the intracranial subarachnoidal space revealed no subarachnoid hemorrhage. Her cerebrospinal fluid was bloody. Spinal magnetic resonance imaging identified a posterior mediastinal tumor adherent to the left side of the 5th thoracic vertebra and an abnormally expanded blood vessel near the mediastinal tumor. In addition, a high signal intensity lesion appeared to be present on the surface of the spinal cord. A mediastinal neoplasm was removed through standard thoracotomy. During surgery, marked enlargement was noted in some veins (hemiazygos and 5th intercostal veins) which apparently had been constricted by the mediastinal tumor. Surgical and radiological findings suggested a relationship between the constricted venous return due to the tumor and the patient's spinal subarachnoid hemorrhage.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/19. Subarachnoid haemorrhage: a clinical overview.Subarachnoid haemorrhage affects up to 9,000 people a year in the UK (Lindsay and Bone 1997) and is a devastating condition. Although many patients make a good physical recovery, some are left with cognitive and perceptual deficits. Early rehabilitation and support is essential, and caring for these patients and their families is a major challenge for nurses.- - - - - - - - - - ranking = 0.16024849210778keywords = physical (Clic here for more details about this article) |
5/19. Haemorrhagic brain injury: a care study.Mark was only 20 years old when an unfortunate sequence of events dramatically altered his life. In July 1989 he sustained two subarachnoid haemorrhages within a fortnight, first from a left anterior communicating artery aneurysm and then from a right middle cerebral artery aneurysm. Both aneurysm were successfully clipped but Mark remained hemiplegic with severe physical and behavioural problems, including incontinence, sexual disinhibition, aggression and uninhibited spitting. In November 1989, he was transferred to a neuro-rehabilitation unit and his management there will be described, showing how his complex problems were managed within enforced environmental limitations.- - - - - - - - - - ranking = 0.16024849210778keywords = physical (Clic here for more details about this article) |
6/19. Homicidal cerebral artery aneurysm rupture.When a normally natural mechanism of death is induced by physical injury or intense emotional stress, it is appropriate to rule the manner of death as something other than natural. When the case-specific circumstances are such that the death occurs as a result of the criminal activity of another person, it is acceptable to rule such deaths as homicides. Presented herein is a case of homicidal cerebral artery aneurysm rupture occuring in an intoxicated, 46-year-old man who was punched in the face by another individual. The details of the case are presented, followed by a discussion of the controversies that exist when dealing with such cases. Guidelines for investigating similar deaths are presented, with emphasis on the timing of the trauma in relation to onset of symptoms due to aneurysm rupture.- - - - - - - - - - ranking = 0.16024849210778keywords = physical (Clic here for more details about this article) |
7/19. Multiprofessional follow up of patients after subarachnoid haemorrhage.Subarachnoid haemorrhage (SAH) is a life-threatening illness that affects people suddenly and without warning. Previous research has estimated that only 7% of SAH survivors suffer physical deficits (Stegan and Freckmann, 1991), whereas two-thirds of those classed as having made a good recovery actually experience a range of debilitating cognitive or emotional difficulties (Bindschaedler et al, 1997); Buchanan et al, 2000). At hope hospitals, a structures system was set up to help support the survivors of SAH through follow-up via the neurovascular team providing patients with information, guidance and early intervention including screening for potential cognitive and emotional difficulties and fast-track referral to neuropsychology services. Behavioural indices demonstrated that patients experienced a range of difficulties in everyday functioning such as problems that prevent a return to work and excessive fatigue, among others. Although this innovative system does address follow-up need, improvements could be made to ensure that all patients receive an equitable service.- - - - - - - - - - ranking = 0.16024849210778keywords = physical (Clic here for more details about this article) |
8/19. Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by physical exertion.The clinical characteristics of perimesencephalic nonaneurysmal subarachnoid hemorrhage (SAH) caused by physical exertion were analyzed to investigate the causes and mechanisms of perimesencephalic nonaneurysmal SAH. Nine of 209 patients with spontaneous SAH were identified as having perimesencephalic nonaneurysmal SAH. Perimesencephalic nonaneurysmal SAH in four males and three females was precipitated by exertion. Age, sex predominance, type of exertion, symptoms, loss of consciousness during bleeding, clinical grade, angiographic spasm, hydrocephalus, delayed ischemic deficit, rebleeding, hypertension, and outcome were evaluated in these seven patients. Outcomes were assessed using the glasgow outcome scale. patients showed male predominance (57.1%), relatively young age (mean 50 years), low frequency of hypertension (28.6%), good clinical grade (World Federation of Neurological Surgeons grade I or II), and excellent outcomes including no rebleeding, no symptomatic hydrocephalus, and no delayed ischemic deficits. The type of exertion was swimming in two patients, golfing in two patients, heavy lifting in two patients, and bending forward during gymnastics in one patient. physical exertion including components of the valsalva maneuver is an important predisposing factor for perimesencephalic nonaneurysmal SAH. Such physical exertion produces increased intrathoracic pressure, which blocks the internal jugular venous return, resulting in elevated intracranial venous pressure or mechanical swelling of the intracranial veins, and leads to venous or capillary breakdown.- - - - - - - - - - ranking = 0.9614909526467keywords = physical (Clic here for more details about this article) |
9/19. aorta coarctation presenting with intracranial aneurysm rupture.Most vascular diseases have a tendency to affect both heart and the brain. Intracranial aneurysms are more often found in patients with aorta coarctation than in general population, and aneurysm rupture occurs much earlier in these patients. Here, we report a case of aorta coarctation which was diagnosed with its cerebrovascular complications. Before presenting with cerebrovascular complications, the disease can easily be diagnosed with physical examination and non-invasive radiological investigations like echocardiography or cardiac magnetic resonance imaging.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/19. Unawareness of impaired face recognition.We report investigations of the face processing abilities of SP, a right-handed woman who had suffered a subarachnoid haemorrhage from a right middle cerebral artery aneurysm. Although she could correctly assign visual stimuli to the 'face' category without difficulty, SP performed poorly on all other face processing, tasks, including 'closure' (Mooney faces), perception of facial expression, unfamiliar face matching, and identification of familiar faces. Identification of familiar people from nonfacial cues (names) remained relatively well-preserved, but severe impairments were evident on all face recognition tasks. Her errors mostly involved either failures to find a face familiar at all, or misidentification as another familiar person. In face-name learning tasks, there was evidence of 'covert' recognition of faces she failed to recognize overtly. SP's face processing impairment remained stable across a 20-month period of investigation, yet throughout this period she did not think that she had any problems in face recognition, and continued to show lack of insight into this impairment even when directly confronted with its consequences on formal testing. In contrast, SP showed adequate insight into other physical and cognitive impairments produced by her illness, including poor memory, hemiplegia, and hemianopia. We propose that her lack of insight into her face recognition problems involves a deficit-specific anosognosia, resulting from impairment of domain-specific monitoring abilities.- - - - - - - - - - ranking = 0.16024849210778keywords = physical (Clic here for more details about this article) |
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