Acta neurochirurgica
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Acta neurochirurgica · Jan 2000
Review Case ReportsPure acute subdural haematoma without subarachnoid haemorrhage caused by rupture of internal carotid artery aneurysm.
A 52-year-old female presented with disturbance of consciousness and clinical signs of tentorial herniation. Computed tomography showed a pure acute subdural haematoma (SDH) over the left convexity without subarachnoid haemorrhage. Cerebral angiography showed a saccular aneurysm at the junction of the left internal carotid artery and the posterior communicating artery. ⋯ Rupture of an aneurysm adhered to either the dura or falx and located in the subdural space may cause pure SDH. Therefore, ruptured intracranial aneurysm should be considered as a cause of non-traumatic SDH. Immediate removal of the SDH and aneurysmal clipping is recommended in such patients, even those in poor neurological condition.
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Brain stem epidermoid cysts are extremely rare. We describe an unusual case of prepontine epidermoid cyst with a large part of the tumour insinuating itself into the pons. ⋯ Cases reported in the literature either had high mortality/morbidity or were only subtotally removed. Relevant literature is reviewed.
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Acta neurochirurgica · Jan 2000
Outcome in Cloward anterior fusion for degenerative cervical spinal disease.
The Cloward ventral interbody fusion is often employed for treatment of cervical degenerative disease. The present study was aimed at evaluating results and complications in this classical type of autologous bone graft procedure in a cohort of patients with radiculopathy (RP) or myeloradiculopathy (MRP). Indications for and limitations of the technique were investigated by retrospective data analysis in a series of 106 patients (30 females and 76 males). ⋯ In our hands, graft donor site complications dominate the side effects of surgery, and the percentage of non-unions is rather low. Because of the relatively frequent bone graft collapse and the late loss of postural correction of the spine, we cannot recommend the Cloward type fusion for multisegmental procedures. In such cases, an instrumented plate fusion should be carried out in order to prevent graft collapse and non-union, and to allow for a shorter convalescence period.
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Acta neurochirurgica · Jan 2000
Systemic administration of mexiletine for attenuation of cerebral vasospasm following experimental subarachnoid haemorrhage.
Mexiletine is a class Ib drug that is widely used to treat ventricular arrhythmias. This compound is mainly known as a sodium channel blocker, but studies have demonstrated that it can also activate ATP-sensitive K+ channels and block Ca2+ channels. Recent in vitro data from experiments on liposomes indicate that mexiletine is also a potent antioxidant. ⋯ Considerable vasorelaxation was seen in the prevention study, in which average arterial cross-sectional areas were reduced by only 17.86% and 39.29% in the mexiletine 80- and 20-mg/kg/day groups, respectively, compared with controls (p < 0.001). Compared with controls, average arterial cross-sectional areas were reduced by 53.58% and 64.29% in the mexiletine 80- and 20-mg/kg/day reversal groups, respectively. Our findings indicate that mexiletine induces potent relaxation in cerebrovascular arteries contracted with various agents, and that it prevents and partially reverses SAH-induced vasoconstriction.