World Neurosurg
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Case Reports
Acute-on-chronic vertex epidural hematoma with diastasis of the sagittal suture in an adult: a case report.
Vertex epidural hematoma (VEDH) is a rare intracranial mass constituting roughly 2.5% of all epidural hematomas. Bleeding usually derives from the superior sagittal sinus, and presentation is often acute-seldom chronic. Fractures are common, but diastasis of the sagittal suture in adults is unique. We hereby present a case combining these rare features along with diagnostic pitfalls and management. ⋯ VEDH can present as an intensifying headache even weeks after purported trauma. Axial computed tomography scans can be tricky because of the blind spot. Even large VEDH may be seen only in the very last few axial slices and may mimic other entities. Coronal reconstructions or additional magnetic resonance imaging come in handy. One-piece parietofrontal craniotomy is an option to approach this hematoma.
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Combined direct and indirect bypass have been described in the literature as a complementary technique.1 Direct superficial temporal artery-to-middle cerebral artery bypass is a cornerstone for adult moyamoya disease and syndrome as it provides immediate vascular supply.2 However, the donor vessel caliber and thus blood flow are subject to decrease over time, mainly due to new collateral formation.3 Encephaloduroarteriosynangiosis provides long-term blood supply and new collateral formation. We describe a case of progressive left internal carotid artery communicating segment atherosclerosis in a 34-year-old woman. An indirect bypass using the superficial temporal vein was chosen on the basis of absence of the left parietal branch of the superficial temporal artery.
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Case Reports
Spontaneous extrusion of ventriculo-pleural shunt catheter associated with pleural effusion: case report.
Ventriculopleural (VPL) shunts are used infrequently in management of hydrocephalus. The main complication associated with these shunts is pleural effusion. ⋯ To our knowledge, spontaneous extrusion of the distal catheter of a VPL shunt has not been previously reported in the literature. Physicians treating patients with hydrocephalus must be aware of this potential complication when a VPL shunt is inserted.