摘要:

&NA;Closed injuries to the neck, occasionally associated with mandibular fractures, can result in trauma to the internal carotid artery at the high cervical level opposite the uppermost cervical vertebrae. Such arterial injuries range from spasm to intimal tear with thrombus formation, medial tear, and aneurysm formation. These types of lesions may overlap. Ten patients are presented, five with traumatic carotid occlusions and five with traumatic aneurysms. The clinical diagnosis of traumatic cervical carotid occlusion may be difficult because of the absence of physical trauma to the neck. The diagnosis of aneurysm poses fewer problems. Oculopneumoplethysmography, computerized tomographic head scanning, and carotid arteriography with cross compression are the most useful diagnostic techniques. Thrombectomy should be carried out early, particularly in the presence of fluctuating neurological signs. Aneurysms that cannot be approached directly may necessitate carotid ligation.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Forty‐five patients with subarachnoid hemorrhage due to verified intracranial aneurysms were studied prospectively to determine whether delaying operations in those patients with abnormal cerebral perfusion, assessed by radionuclide dynamic scanning, would lower case management mortality. Twenty‐nine patients had intracranial operations when their radionuclide dynamic scans demonstrated normal perfusion. The one death in this group occurred in a patient who suffered a massive hemorrhage during operation as the bone flap was elevated. There were no instances of delayed spasm after operation. Of the 16 remaining patients who were treated without operation, 5 died. Only 1 of these deaths resulted from recurrent hemorrhage. This patient had normal cerebral perfusion but was not operated upon because of severe associated medical problems. Cerebral infarction occurred in 10 of the 16 unoperated patients, all of whom had persistently decreased cerebral perfusion. Four of these patients died of their infarctions or related causes. Although a trend related vessel caliber as seen on arteriograms and perfusion delay seen on dynamic scanning, individual exceptions were numerous. This study shows that radionuclide scanning, a safe procedure, is useful for identifying two types of patients: those with normal perfusion prone to rebleeding in whom an early operation is safe and those in whom perfusion is decreased. The latter group is prone to cerebral infarction, but rebleeding from the aneurysm is unlikely. Operation should be delayed in these patients until cerebral perfusion returns to normal or for several weeks if cerebral perfusion remains diminished.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;CSF dynamics were determined as a function of intracranial pressure in patients with pseudotumor cerebri. Servocontrolled variable rate lumbar infusions were used to determine net CSF‐absorptive capacities and resting pressures in 10 patients; serial studies were done in 5 of the patients. Nearly all of the patients had abnormally low CSF‐absorptive capacities. On the other hand, marked elevations in resting pressure were not a constant feature of the disease. Concurrent changes in the cerebrovascular bed could introduce errors into this manometric determination of CSF dynamics; the significance of this potential artifact is examined. The results of this study suggest that the CSF compartment may be of etiological importance in the pathophysiology of pseudotumor cerebri.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Cerebellar stimulators were inserted into seven children who had cerebral palsy and in whom extensive investigation. including computerized tomography, had revealed no structural brain abnormality. A team including physiotherapists, occupational therapists, speech pathologists, and respiratory physiologists assessed the children pre‐ and postoperatively; their somatosensory evoked potentials were also measured. The mean age at implantation was 8.6 years; follow‐up has ranged from 8 to 23 months (mean, 17.3 months). No adverse effects of the cerebellar stimulation have been noted. Detailed case histories obtained from the parents, together with formal assessment scores, indicate good improvement in six patients and mild but significant improvement in the seventh. Clinically, there has been gradual improvement in all seven patients. The charge density range associated with clinical improvement was 0.8 to 2.1μCi/cm2/phase. The stimulation equipment must be monitored very carefully to ensure that any variation from the desired output is acceptably small because it is probable that sizable deviation is a determining factor in lack of response to this therapy.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Previously published work indicated significant improvement in the symptoms of multiple sclerosis with dorsal spinal cord stimulation. In this study 23 patients with multiple sclerosis documented by history, examination, laboratory studies, and clinical course were treated with dorsal spinal cord stimulation and followed for 19 to 45 months (mean, 32 months). Preand postoperative clinical assessment was carried out using the Kurtzke Scale. Walking velocity, upper limb coordination, sphincter function, and sensory function were also evaluated quantitatively. No statistically significant objective improvement in any of these measures was demonstrated. Fifty per cent of the patients initially reported subjective symptomatic improvement, but this declined to 30% at last follow‐up. Fifteen of 23 patients experienced complications related mainly to the hardware used and required a total of 21 subsequent operative procedures for correction of these complications. These results do not support the continued clinical use of dorsal spinal cord stimulation in the symptomatic treatment of multiple sclerosis.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Computerized tomography as a diagnostic procedure is characterized by its high sensitivity but limited specificity. This lack of specificity may result in an erroneous diagnosis and, possibly, in ill‐advised therapy unless clinical and objective data are carefully considered in interpreting the study. The most common pitfalls encountered are the phenomena of contrast enhancement of infarcts and mass effect associated with infarcts. Many different pathological processes can have similar enhancement patterns. The evolution of high density, acute hemorrhage to isodense areas in the chronic hematoma can become a serious diagnostic problem unless an appropriate history is available. The authors discuss 30 cases in which misinterpretation of CT scans resulted in erroneous diagnoses. Seventeen of these patients underwent operation.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The need for cadaver kidney donors far surpasses the present supply. The subject of how to increase the number of donors is extremely complex, involving not only the medical issue of determination of brain death, but also philosophical, religious, legal, political, psychological, and economic considerations and the opinions of leaders and lay groups. It now seems that the physician can rapidly and unequivocally ascertain brain death, that the law not only recognizes this but can facilitate organ retrieval, that adequate numbers of potential donors should be available, and that both the public and physicians generally favor retrieval. Our survey of patients seeking aid in the emergency room revealed that 19% had signed the donor statement on their driving license. Of the neurosurgeons and neurologists who responded to a questionnaire, 74% had requested donation and 37% had obtained permission for organ retrieval. Review of our case material revealed that 60% of individuals with head injuries alone who were hospitalized for over 3 days were suitable donors. Of the 54 kidneys retrieved during a 6‐month period, 49 (90%) were transplanted. Because most potential donors come to the attention of neurosurgeons and neurologists and because it seems ethically appropriate for physicians to consider transplantation when death is certain, we suggest that an organized effort be undertaken to develop a liaison with transplantation services to facilitate the process of obtaining adequate numbers of cadaver kidneys.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Although the advent of computerized cranial tomography (CT) has decreased the number of pneumoencephalograms performed for the diagnosis of hydrocephalus and lesions of the posterior fossa, brain stem, and ventricles, there are some patients in whom pneumoencephalography should still be done because it adds valuable information to that obtained with CT. When the temporal horn becomes obstructed, the choroid plexus and ependymal surface “upstream” from the obstructing mass continue to produce cerebrospinal fluid (CSF). The temporal horn can thus enlarge enough to appear as a mass on CT because of its reduced x‐ray attenuation coefficient. Pneumoencephalography is effective in this situation because air will flow past a mass that obstructs CSF and because the ventricular system dilates during pneumoencephalography. When pneumoencephalography is used in a patient with a trapped temporal horn, the partially trapped horn may enlarge approximately 24 hours later. With that precaution in mind, the neurosurgeon should find pneumoencephalography to be a useful adjunct to CT in delineating the cause of a trapped temporal horn. In the three patients reported here CT had indicated a unilateral trapped temporal horn; pneumoencephalography confirmed that finding and demonstrated both the location and the nature of the lesion. One patient had a Grade II astrocytoma fungating into the atrium of the right lateral ventricle, one had a mass extending into the right ventricle from the medial and superior ventricular wall with nodular encroachment on the ventricle, and one had a meningioma in the atrium of the right lateral ventricle.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Severe fracture/dislocation of the thoracic (T) or lumbar (L) spine is usually associated with complete neurological dysfunction below the level of injury. Three cases of severe spinal fracture/dislocation are presented in this report. Two of these patients suffered only partial neurological deficit, which improved after open reduction, internal fixation, and bone fusion. Severe fracture/dislocation of the T or L spine may be quite obvious on lateral roentgenograms. Occasionally, however, the fracture site may be obscured by the overlying shoulders, hips, or soft tissues. If no lateral displacement is evident on anteroposterior (AP) films, a false impression of normal alignment may be given, as was the case in two of our patients. A careful interpretation of the AP view will provide the diagnosis in such cases. The subtle AP radiographic changes suggesting fracture/dislocation of the T or L spine are detailed. The mode of injury, physical findings, prognosis, and surgical treatment of such severe injuries are also briefly reviewed.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Proximal internal carotid artery aneurysm may be treated successfully with internal carotid artery ligation. If this is not tolerated because of ischemic insufficiency, an alternative strategy is possible. This consists of extracranial‐intracranial bypass to increase the collateral circulation and perfusion pressure in the ipsilateral cerebral hemisphere before ligation. Experience with two cases is presented to show that such an approach is feasible.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID