Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Clinical TrialSpinal cord stimulation for treatment of patients in the minimally conscious state.
Minimally conscious state (MCS) is characterized by inconsistent but clearly discernible behavioral evidence of consciousness, and can be distinguished from coma and the vegetative state (VS). Ten MCS patients were evaluated neurologically and electrophysiologically over 3 months after the onset of brain injury, and were treated by spinal cord stimulation (SCS). A flexible four-contact, cylinder electrode was inserted into the epidural space of the cervical vertebrae, and placed at the C2-C4 levels. ⋯ Cervical SCS increased cerebral blood flow (CBF) diffusely in the brain, and CBF increased by 22.2% during the stimulation period compared with CBF before stimulation in MCS patients (p < 0.0001, paired t-test). Five-Hz cervical SCS could increase CBF and induce muscle twitches of the upper extremities. This SCS therapy method may be suitable for treating MCS.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Retrospective analysis of hinge technique for head trauma or stroke.
Hinge technique is a new method for cerebral decompression that allows the bone flap to move outward in response to brain swelling and essentially allows reconstruction of the cranial vault as a minor procedure under local anesthesia. This retrospective study assessed outcomes following the use of this new decompressive technique. During an approximately 7-year period (June 2004 to March 2011), 58 patients who had suffered head trauma or stroke underwent cerebral decompression using the hinge technique or conventional decompressive craniectomy. ⋯ Six patients in the decompressive craniectomy group and none of the patients in the hinge technique group developed bone flap infection (p = 0.02). The bone flap was removed in two cases in the hinge technique group due to low cerebral perfusion pressure as well as elevated intracranial pressure (ICP). The hinge technique with ICP monitoring was effective and safe for management for head trauma or stroke and was not associated with bone flap infection.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsDelayed neurological deficits induced by an epidural hematoma associated with a thoracic osteoporotic compression fracture.
A 79-year-old woman developed neurological deficits 6 weeks after the onset of a thoracic osteoporotic compression fracture. Magnetic resonance (MR) imaging of the thoracic spine revealed an epidural hematoma at the T10-L2 levels. ⋯ Spinal epidural hematomas are rare and associated delayed neurological deficits are extremely rare. Conservative treatment may be effective for epidural hematomas in neurologically intact patients, but epidural hematomas can be a cause of neural compression and symptomatic deterioration resulting in delayed neurological deficits during the follow-up period.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsTailored flow alteration treatment for intracranial internal carotid artery aneurysms: strategy beyond parent artery occlusion with bypass. Case report.
A 58-year-old woman with multiple right internal carotid artery (ICA) aneurysms detected incidentally was referred to us. Three-dimensional computed tomography (CT) angiography revealed a broad-necked paraclinoid aneurysm and an aneurysm on the C(1) segment. Aneurysm clipping with preservation of the anterior choroidal artery and posterior communicating artery was not possible because these vessels could not be adequately identified. ⋯ Reversal of the blood flow in the ICA via the EC-IC bypass primarily into the ophthalmic artery as the flow outlet by obliterating the cervical portion of the ICA was successful. To prevent ischemia in the territory fed by the perforating arteries of the ICA, tailored flow alteration treatment may be superior to simple parent artery occlusion of the ICA with/without bypass. The pattern of flow alteration should be deliberately based on individual anatomic variations, especially the preservation of flow outlets.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsTuberculum sellae meningioma causing progressive visual impairment during pregnancy. Case report.
A 29-year-old woman in the 17th week of pregnancy presented with blurred vision and visual impairment of both eyes. Magnetic resonance imaging revealed a tuberculum sellae meningioma. ⋯ Her visual acuity and field almost fully recovered immediately after the operation. She delivered a healthy normal baby on the expected day.