Clinical neurology and neurosurgery
-
Clin Neurol Neurosurg · Jul 2009
ReviewThe complexity of neurobiological processes in acute ischemic stroke.
There is an urgent need for improved diagnostics and therapeutics for acute ischemic stroke. This is the focus of numerous research projects involving in vitro studies, animal models and clinical trials, all of which are based on current knowledge of disease mechanisms underlying acute focal cerebral ischemia. ⋯ In this review, we summarize the actual knowledge on the pathophysiology of acute ischemic stroke. We focus on the ischemic cascade, which is a complex series of neurochemical processes that are unleashed by transient or permanent focal cerebral ischemia and involves cellular bioenergetic failure, excitotoxicity, oxidative stress, blood-brain barrier dysfunction, microvascular injury, hemostatic activation, post-ischemic inflammation and finally cell death of neurons, glial and endothelial cells.
-
Clin Neurol Neurosurg · Jul 2009
Case ReportsIntraventricular thrombolysis for massive intraventricular hemorrhage due to periventricular arteriovenous malformations: no absolute contraindications as rescue therapy prior to surgical repair or embolization?
Intraventricular hemorrhage (IVH) after bleeding from a cerebral aneurysm or an arteriovenous malformation (AVM) results in a high mortality. A limited number of publications have shown that intraventricular thrombolysis with e.g. recombinant tissue plasminogen activator (rt-PA) can be a therapeutic option in IVH. However, this treatment is considered as an absolute contraindication prior to the treatment of the bleeding source. ⋯ Our observations, together with nine comparable published cases, illustrate that this treatment might be useful to clear the intraventricular blood and lower intracranial pressure. It might also improve neurological outcome and mortality in these selected patients. This suggests that hemorrhage from a periventricular AVM, even before surgical resection or endovascular embolization, is not necessarily an absolute contraindication for intraventricular thrombolysis in patients with massive IVH.
-
Clin Neurol Neurosurg · Jul 2009
Review Case ReportsAdult medulloblastoma and the "dural-tail" sign: rare mimic of a posterior petrous meningioma.
The authors describe clinical and radiological features of a 32-year-old male patient with a posterior fossa lesion. The radiological characteristics resembled an extra-axial lesion; a meningioma, with attachment to the tentorium and petrous bone. ⋯ We review literature of this atypical presentation of medulloblastoma and "dural-tail" sign, which can be associated with other benign or malignant lesions. The role of magnetic resonance spectroscopy in the diagnosis of primitive neuroectodermal tumors is discussed.
-
Clin Neurol Neurosurg · Jun 2009
A priority treatment of the intraventricular hemorrhage (IVH) should be performed in the patients suffering intracerebral hemorrhage with large IVH.
In patients suffering from intracerebral hemorrhage (ICH) with ventricular hemorrhage (IVH), the IVH severity is thought to be associated with prognosis. Therefore, treating IVH may be a beneficial therapeutic target. In this study, by examining the associations among IVH severity, hydrocephalus, initial level of consciousness and prognosis, we attempted to identify which grade of IVH severity should be considered for surgical treatment. ⋯ IVH severity influenced the occurrence of acute hydrocephalus and initial level of consciousness, which was significantly associated with prognosis. Our results suggest that priority treatment of the IVH should be given to those ICH patients with IVH admitted with a Graeb score of 6 or more.
-
Clin Neurol Neurosurg · Jun 2009
Case ReportsCellular schwannoma of the abducens nerve: case report and review of the literature.
Schwannomas of the abducens nerve are extremely uncommon tumors. Here, we report the case of a 26-year-old woman who presented with a 6th nerve palsy and was found to have a large tumor at the right side of her pons. Neuropathologic exam revealed a cellular schwannoma with a high proliferation index. The case is presented in its clinical, neurosurgical and neuropathologic aspects and the literature on 6th nerve schwannomas is reviewed.