Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Jul 1993
ReviewPrimary pontine hemorrhagic events. Hemorrhage or hematoma? Surgical or conservative management?
The pathophysiology of primary pontine hemorrhagic events is unclear, but the traditional classification of hemorrhage or hematoma does not have either pathologic or clinical support. Reported cases of brain stem hemorrhage suggest that patients who suffer progressive deterioration from hemorrhagic pontine lesions may benefit from surgery even if they eventually become comatose, whereas those who suddenly lose consciousness and have profound neurologic deficit probably will not survive.
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Proper identification of compressive radiculopathy is essential before any treatment can be undertaken. The differential recognition of different pain patterns, sensory symptoms, and neurologic deficits provides the clinical guide to specific nerve root involvement. Appropriate radiology and imaging must correlate with symptoms and signs. Management includes surgical intervention when indicated for relief of radicular pain and restoration of function.
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Intracerebral hemorrhage as a result of a diagnostic or therapeutic procedure is a rare but potentially devastating event. The fear of hemorrhagic complications influences neurosurgical decision making. The incidence of iatrogenic intracerebral hemorrhage and risk factors for this complication are reviewed for neurosurgical procedures as well as for non-neurosurgical procedures with a known risk of intracerebral hemorrhage.
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Neurosurg. Clin. N. Am. · Jul 1992
ReviewIntracerebral hemorrhage due to cerebral arteriovenous malformations.
The most common presentation of a pial arteriovenous malformation (AVM) is spontaneous intracerebral hemorrhage (ICH). The peak incidence of ICH is early in the third decade of life. This article discusses the management of ICH of unknown etiology, ICH from angiographically visible AVM, and ICH from angiographically occult vascular malformations based on the current understanding of the natural history of these disease entities.
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Neurosurg. Clin. N. Am. · Apr 1992
ReviewUse of antimicrobial agents to treat central nervous system infection.
When dealing with infections of the central nervous system (CNS), the clinician is often faced with a daunting diagnostic and therapeutic challenge. The clinical presentation can vary from an insidious course that allows time for a full diagnostic examination to fulminant catastrophic events that require immediate therapeutic intervention. ⋯ Clinical experience and scientific investigation have laid the basis for rational empiric antimicrobial therapy of CNS infection. The role of antibiotics in the treatment of CNS infections is reviewed and updated, emphasizing current rationale for empiric therapy as well as the proper use of specific antibiotics for specific pathogens.