Neurologia medico-chirurgica
-
Neurol. Med. Chir. (Tokyo) · Mar 1998
ReviewOutcome after external decompression for massive cerebral infarction.
Acute ischemic stroke involving the entire vascular distribution of a carotid or middle cerebral artery can cause massive cerebral edema. This study evaluated external decompression for the treatment of massive stroke and analyzed possible prognostic factors. Twenty-four patients with acute massive cerebral infarction, which had progressed to tentorial herniation and impending death, underwent external decompression after medical therapy failed to achieve an effective response. ⋯ Six patients with dominant hemisphere stroke had some measure of communicative skills in spite of aphasia. External decompression is a life-saving treatment for patients with massive cerebral infarction and can provide a reasonable quality of life even for those with dominant hemisphere strokes. Decompressive surgery should be considered and performed as soon as possible if computed tomography demonstrates signs of descending tentorial herniation.
-
Neurol. Med. Chir. (Tokyo) · Jan 1998
ReviewThe effect and management of delayed vasospasm after aneurysmal subarachnoid hemorrhage.
Delayed cerebral vasospasm after aneurysm rupture is one of the major complications of subarachnoid hemorrhage. The purpose of this review was to determine the true incidence of vasospasm. All literature on cerebral aneurysms from 1960 onwards was reviewed, and the figures extracted from publications that mentioned vasospasm. ⋯ The 21-aminosteroid tirilazad mesylate has been the subject of several trials. In one the overall outcome of all patients was improved, but the effect was essentially in males only. Further studies with larger doses in females are being analyzed.
-
Neurol. Med. Chir. (Tokyo) · Oct 1995
Review Case ReportsInstrumentational posterior fusion for atlanto-axial subluxation in a young child with Down's syndrome--case report.
A 3-year-old girl with Down's syndrome and myelopathy caused by atlanto-axial subluxation (AAS) was treated by C-1 to C-2 posterior fusion with a one-piece cervical device (OPCD). Instrumentation was required because the posterior arch of C-1 was too tiny and fragile to tolerate wiring. ⋯ She had been confined to bed by severe quadriparesis, but became able to walk without assistance 8 months after surgery. We recommend OPCD instrumentation and postoperative immobilization using a hard plastic corset for the treatment of AAS associated with Down's syndrome in young children.
-
Neurol. Med. Chir. (Tokyo) · Oct 1995
Review Case ReportsEpidural hematoma associated with cephalohematoma in a neonate--case report.
A female neonate presented with cephalohematoma over the temporoparietal region on the right side. Computed tomography (CT) revealed the presence of an underlying epidural hematoma (EDH) and associated skull fracture with communication between the hematomas. ⋯ CT revealed cure without the need for an operative procedure. Aspiration is indicated for neonatal EDH with mild symptoms and liquefied cephalohematoma.
-
Neurol. Med. Chir. (Tokyo) · Jul 1995
Review Case ReportsRuptured dissecting aneurysm of the peripheral anterior cerebral artery--case report.
A 27-year-old male presented with intracranial hemorrhage due to rupture of an idiopathic dissecting aneurysm in the A4 segment of the left anterior cerebral artery (ACA). This is a very rare location. He was successfully treated by resection of the aneurysm without neurological deficits. Surgical intervention is recommended for patients with intracranial hemorrhage due to ruptured dissecting aneurysm of the ACA to prevent rebleeding.