Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Case Reports
Ultrasound-guided evacuation of spontaneous intracerebral hematoma in the basal ganglia.
Real-time ultrasonography was used for the aspiration of intracerebral hematoma in the basal ganglia in 7 patients without signs of impending herniation. The ultrasound device was used to select the trajectory and target point for hematoma drainage. Ultrasound-guided aspiration was performed via a burr hole under local anesthesia. ⋯ The hematoma was then evacuated with urokinase irrigation. Ultrasound guidance allows simple, precise localization of the hematoma and the distance from the surface to the target can be calculated. Ultrasound-guided catheter placement for fibrinolysis and hematoma drainage is a simple and safe procedure.
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The aim of this study was to examine the intracranial pressure (ICP) and regional cerebral blood flow (rCoBF) changes during the acute stage of severe head injury and to improve outcome by modifying treatment modalities using real-time ICP and rCoBF data. Twenty patients with moderate or severe head injury that were monitored in our neurosurgical intensive care unit were included in this study. ⋯ When low rCoBF exists, hyperventilation may lead to a rapid further decline of rCoBF, however, some hyperemic brains respond well to hyperventilation treatment. Triple-H therapy is suitable for those with low rCoBF without significantly high ICP, which is an abnormal condition considered to be caused by vasospasm.
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To assess the efficacy of a device using extraocular electrodes as a retinal prosthesis by evaluating the responses evoked in the visual cortex to electrical stimulation. ⋯ The ERP electrodes can be easily attached to the globe and are effective in electrically stimulating the retina, evoking responses in the primary visual cortex. Threshold charge-density was within safe limits for neural stimulation.
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We report a case of massive intracerebral air embolism after cardiopulmonary resuscitation in a patient with a fatal head injury. There was no pneumothorax or extravascular pneumocephalus, however, air was found in the internal carotid artery. Massive cerebral air embolism may occur after entrance of air into the circulatory system via ruptured pulmonary vessels during cardiopulmonary resuscitation.
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Spinal cord infarction is a rare entity of varying etiology although most often associated with atherosclerotic aortic disease. Definitive diagnosis of (idiopathic) spinal cord infarction in the acute stage and in the absence of demonstrable predisposing factors is not always possible even with MRI. Diffusion-weighted MRI (dwMRI) may provide valuable information in the evaluation of spinal cord ischemia. ⋯ Apparent diffusion coefficient values were significantly low in the lesion, suggesting cytotoxic edema compatible with acute ischemia. The clinical course and other radiographic findings were also compatible with idiopathic spinal cord infarction. Diffusion-weighted MRI is an important diagnostic tool for examining patients with suspected spinal cord ischemia.