1/11. Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature.OBJECT: In this study the authors sought to estimate the frequency, seriousness, and delay of rebleeding in a homogeneous series of 20 patients whom they treated between May 1987 and May 1997 for arteriovenous fistulas (AVFs) that were revealed by intracranial hemorrhage (ICH). The natural history of intracranial dural AVFs remains obscure. In many studies attempts have been made to evaluate the risk of spontaneous hemorrhage, especially as a function of the pattern of venous drainage: a higher occurrence of bleeding was reported in AVFs with retrograde cortical venous drainage, with an overall estimated rate of 1.8% per year in the largest series in the literature. However, very few studies have been designed to establish the risk of rebleeding, an omission that the authors seek to remedy. methods: Presenting symptoms in the 20 patients (17 men and three women, mean age 54 years) were acute headache in 12 patients (60%), acute neurological deficit in eight (40%), loss of consciousness in five (25%), and generalized seizures in one (5%). Results of the clinical examination were normal in five patients and demonstrated a neurological deficit in 12 and coma in three. Computerized tomography scanning revealed intracranial bleeding in all cases (15 intraparenchymal hematomas, three subarachnoid hemorrhages, and two subdural hematomas). A diagnosis of AVF was made with the aid of angiographic studies in 19 patients, whereas it was a perioperative discovery in the remaining patient. There were 12 Type III and eight Type IV AVFs according to the revised classification of Djindjian and Merland, which meant that all AVFs in this study had retrograde cortical venous drainage. The mean duration between the first hemorrhage and treatment was 20 days. Seven patients (35%) presented with acute worsening during this delay due to radiologically proven early rebleeding. Treatment consisted of surgery alone in 10 patients, combined embolization and surgery in eight, embolization only in one, and stereotactic radiosurgery in one. Three patients died, one worsened, and in 16 (80%) neurological status improved, with 15 of 16 AVFs totally occluded on repeated angiographic studies (median follow up 10 months). CONCLUSIONS: The authors found that AVFs with retrograde cortical venous drainage present a high risk of early rebleeding (35% within 2 weeks after the first hemorrhage), with graver consequences than the first hemorrhage. They therefore advocate complete and early treatment in all cases of AVF with cortical venous drainage revealed by an ICH.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/11. Cerebellar mutism caused by arteriovenous malformation of the vermis.Transient mutism following posterior fossa tumour resection in children is well known in the literature. To our knowledge, this phenomenon has never been reported without surgical intervention. We report a case of cerebellar mutism secondary haemorrhage from a vermian arteriovenous malformation (AVM), which resolved to ataxic dysarthria after 6 weeks. Embolization of the AVM was performed and the patient's clinical status continued to improve gradually till she became normal 6 months from the insult. The mutism was due to rupture of the AVM which might correlate the cerebellar mutism with the transient vasospasm of the blood vessels supplying the cerebellum. It is possible for a spontaneus posterior fossa bleed to result in transient mutism similar to post surgical mutism.- - - - - - - - - - ranking = 0.22396481164276keywords = haemorrhage (Clic here for more details about this article) |
3/11. Cerebral aneurysms of traumatic origin.This report reviews 41 cases of traumatic cerebral aneurysms, including four cases of our own which are presented in detail. They may follow penetrating or closed head injury, and are usually associated with significant additional intracranial damage. Almost half of the patients presented with a delayed subarachnoid hemorrhage within three weeks of the initial head injury, defining an important neurological syndrome. Those patients whose post-traumatic aneurysms have been surgically obliterated have an associated mortality which is half that of patients treated by nonsurgical methods.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
4/11. Sudden unconsciousness during a lesser occipital nerve block in a patient with the occipital bone defect.Occipital nerve block is usually considered to be a very simple and safe regional anaesthetic technique. We describe a case of sudden unconsciousness during a lesser occipital nerve block in a patient with an occipital bone defect. A 63-year-old man complained of headache, which was localized to the right occipital region. A right lesser occipital nerve block with a local anaesthetic was performed for treatment. During the lesser occipital nerve block, the patient suddenly became disturbed and lost consciousness. Two hours after the incident, the patient was fully awake without neurological sequelae. He had previously undergone a microvascular decompression for right trigeminal neuralgia. The patient had a bone defect following craniotomy. We believed that the loss of consciousness during lesser nerve block may be due to a subarachnoid injection. Occipital nerve block is relatively contraindicated in the presence of a bone defect.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
5/11. Blunt basal head trauma: aspects of unconsciousness.Two cases of street violence directed to the skull base level and transverse to the cervical axis are described. No skeletal damage. The violence resulted in the so-called "traumatic subarachnoid haemorrhage", an often used, unspecified forensic "diagnosis"; it was here revealed to be due to rupture of the wall of the posterior inferior cerebellar artery (p.i.c.a). However, this was only one of the possible explanations for the acute symptoms of unconsciousness (concussion) and almost immediate death. The careful examination of these two cases and of a series of control cases revealed that at the trauma, stress and strain may have occurred to arterial branches serving as feeding perforant vessels to the medulla oblongata; in these cases they were coursing directly from the p.i.c.a. region.--The type of direct impact has often been regarded as mild! However, its location suboccipitally as in these cases can become dangerous. The resulting direct or indirect deficit of brain stem functions are discussed in these cases as well as "concussion-related symptoms" resulting after other types of head and neck injury.- - - - - - - - - - ranking = 5.6402123182879keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
6/11. Inflammatory aneurysm due to neurocysticercosis.A 69-year old man presented with a subarachnoid hemorrhage associated with a large intracerebral hematoma in the right temporal lobe. The oblique views of cranio-orbital computerized tomographic angiography (CTA) were suspicious for an aneurysm on a middle cerebral artery branch. At surgery, a cystic mass was found in the Sylvian fissure, associated with an aneurysm on a distal branch of the anterior temporal artery. The aneurysm was not situated at a bifurcation of the artery and was located beneath the cyst. It was secured by trapping. Pathological examination revealed that the cystic lesion was neurocysticercosis and that the aneurysm was inflammatory. We report a ruptured inflammatory aneurysm of a distal branch of the anterior temporal artery associated with neurocysticercosis, and present the histological findings. We believe this is the first report of such an inflammatory aneurysm with histological confirmation.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
7/11. Improvement after treatment of hydrocephalus in aneurysmal subarachnoid haemorrhage: implications for grading and prognosis.Two patients with aneurysmal subarachnoid haemorrhage and hydrocephalus are presented. On admission they scored E1M4V1 and E1M3Vtube on the glasgow coma scale. The first patient recovered to E3M5Vtube after treatment of hydrocpehalus by extraventricular drainage. The second recovered to E2M5Vtube and later E4M6V4 after treatment of hydrocephalus with lumbar drainage. Based on the literature it is argued that these cases are no exception as to the improvement after treatment of hydrocephalus. The prognosis of patients with hydrocephalus after a subarachnoid haemorrhage, improves in parallel with the glasgow coma scale after treatment of hydrocephalus. Therefore decision making on whether or not to treat a patient with a subarachnoid haemorrhage should be postponed until after treatment of hydrocephalus, if present.- - - - - - - - - - ranking = 39.481486228016keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
8/11. Seizure heralding functional recovery in a patient with apallic syndrome: A case report with retrospective-prospective observation.BACKGROUND: It has been suggested that there exists a close relationship between seizure discharges and functional recovery from brain injury, and that paroxysmal bombardment in late seizures may herald functional recovery or may "kick-start" recovery. CASE REPORT: We report the case of a 52-year-old patient who, following a subarachnoid hemorrhage and multiple surgeries, experienced discernible apallic syndrome of long duration. His hospitalization is well documented. The patient underwent protracted, intense rehabilitation, but he remained in this prolonged state of loss of consciousness and behavioral passivity until he experienced a series of periodic seizures. Widespread improvement in his cognitive and functional abilities coincided closely with the seizure activity. The literature on this topic is reviewed. CONCLUSION: This case confirms the close relationship between seizure discharges and functional recovery reported in preclinical literature.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
9/11. Active management of the unconscious eclamptic patient.Of the many complications which may develop after eclamptic seizures, prolonged unconsciousness is one of the most difficult for obstetricians to manage as the pathophysiology of this condition remains largely unknown. Computed axial tomography (CT scan) was performed on 20 unconscious eclamptic patients, and autopsy was obtained on an additional two patients. Changes compatible with cerebral oedema were demonstrated in 75% of patients; cerebral haemorrhage occurred in 9%. A programme of intensive neurological management aimed at optimizing cerebral perfusion and controlling intracranial pressure is outlined. We have reduced the mortality rate for unconscious eclamptic patients from 50% to 17% in our institution.- - - - - - - - - - ranking = 0.22396481164276keywords = haemorrhage (Clic here for more details about this article) |
10/11. Subarachnoid injection during retrobulbar block: a case report.Subarachnoid injection during a retrobulbar block is a rare complication, requiring prompt recognition and management of life-threatening respiratory and cardiac depression. This case report describes a patient who began to decompensate 2 minutes after receiving a retrobulbar block. central nervous system symptoms progressed from restlessness and confusion to respiratory arrest and cardiac depression. intubation, ventilatory support, and treatment of mild bradycardia and hypotension were provided. One hour after the incident, the patient was fully awake and was extubated. brain stem anesthesia was suspected. Causes of respiratory arrest and unconsciousness after retrobulbar block include severe anaphylactic reaction, intravascular absorption, a major cardiovascular event, and subarachnoid injection of local anesthetic. The patient's symptoms in the case presented here suggested that the local anesthetic gained access to the cerebrospinal fluid. Anesthetists should be cognizant of the need to monitor and treat serious complications whenever a retrobulbar block is utilized.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
| | Next -> |