Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Retrospective analysis of operative treatment of a series of 100 patients with subdural hematoma.
This retrospective study of medical records, surgical protocols, patient observation cards, and imaging files of 100 patients treated for subdural hematoma analyzed the type of hematoma, patient age and sex, operative technique, neurological status, cause of injury, duration of hospital stay, mortality rate, and the number of and reasons for reoperations to determine the effects on treatment outcomes. The time between the head injury and onset of neurological symptoms was analyzed versus the type of hematoma determined from computed tomography (CT) scans. Acute hematomas accounted for 38% of the cases, with subacute hematomas representing 20%, and chronic ones accounting for 42%. ⋯ No preceding injury was identified in 31.6% of acute hematomas, 50% of subacute hematomas, and 61.9% of chronic hematomas. Analysis of reoperations indicates that trepanation may be superior to craniotomy as primary surgery for subacute and chronic hematomas. Subdural hematoma surgeries take place at all times of the day, with most carried out outside the usual working hours.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Surgical results of microvascular decompression procedures and patient's postoperative quality of life: review of 139 cases.
Microvascular decompression (MVD) is effective for the relief of symptoms, but little is known about the impact of the MVD procedure on patient's quality of life (QoL) or which QoL factors are important. The surgical results of MVD and the impact of this procedure were evaluated on patient's QoL in 139 patients, 74 with hemifacial spasm (HFS) and 65 with trigeminal neuralgia (TN), who underwent MVD between 2004 and 2011 using the 36-Item Short Form Health Survey questionnaire. Symptoms had resolved in approximately 95% of patients after MVD. ⋯ No other significant relationships were observed between any of the factors or scores in any of the respective domains or periods. Subjective symptoms were the main self-reported causes of delayed recovery of QoL domains. Some QoL domains take a long time to recover and postoperative subjective symptoms might be major causes in addition to delayed relief of symptoms.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Prediction of cerebral vasospasm using early stage transcranial Doppler.
Transcranial Doppler (TCD) is widely used to monitor vasospasm after subarachnoid hemorrhage (SAH), but its ability to predict the future occurrence of the symptomatic vasospasm (SVS) remains controversial. We investigated the utility of TCD for predicting the future occurrence of SVS after SAH in 45 patients with aneurysmal SAH. TCD was performed on days 1, 3, 5, 7, 10, and 14 after SAH. ⋯ Increased MFV of M1 during the early stage of SAH may predict the future occurrence of SVS. The threshold value of 72.5 cm/sec MFV of M1 on SAH day 3 was one of the best predictor of future SVS. To prevent delayed cerebral ischemia, aggressive treatment for vasospasm is needed for patients with increased MFV in the early stages of SAH.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Executive dysfunction in patients with cerebral hypoperfusion after cerebral angiostenosis/occlusion.
Impairment of executive functions (EFs) was investigated in patients with cerebral hypoperfusion after cerebral angiostenosis/occlusion. Several EFs were measured in patients with cerebral angiostenosis/occlusion and healthy subjects. The vascular conditions, regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), mean transit time (MTT), time to peak (TTP), and delay time were assessed. ⋯ Patients with cerebral hypoperfusion after cerebral angiostenosis/occlusion had executive dysfunctions in working memory, sustained attention, response inhibition, cognitive flexibility, thought organization, planning, and implementation. Moreover, their executive dysfunctions were related with the decline in rCBF and rCBV. The prolonged TTP, MTT, and delay time suggested a slow blood flow and the poor compensation of collateral circulation, resulting in impairment of the EFs.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
ReviewConus medullaris-cauda arteriovenous malformation and Klippel-Trenaunay syndrome: what is the treatment goal?
A 29-year-old man with Klippel-Trenaunay syndrome (KTS) presented with a symptomatic conus medullaris-cauda arteriovenous malformation (AVM) manifesting as back and right limb pain, which abruptly worsened with the onset of right limb weakness and urinary retention. He was treated by multisession endovascular embolization resulting in improved neurological status. ⋯ Embolization treatment may represent a safe option to minimize complications and possibly improve the neurological status in patients with spinal AVM associated with KTS, if one or both legs are already impaired by hypertrophy or other vascular malformations. Genetic analysis may reveal an underlying angiogenesis change, so closer follow up might be indicated in selected patients.