ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The authors report a review of 1808 patients admitted for the treatment of craniocerebral injuries. Eighty‐four (4.6%) developed the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Two types of SIADH (severe and mild) were defined on the basis of laboratory findings and clinical signs. SIADH occurred in 0.6% of the patients with mild head injury. 10.6% of those with moderate head injury, and 4.7% of the patients with severe head injury. Regular measurements of serum electrolytes, osmolality, and urinary sodium depletion should be made during the treatment of patients suffering from head trauma because unexpected clinical deterioration may often have a reversible cause: SIADH. (Neurosurgery10:685‐688, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Among 140 cases of chronic extracerebral fluid collections treated surgically. 7 cases (5%) of intracerebral hematoma occurring immediately after drainage were encountered. In none of the patients was a preoperative intracerebral clot or contusion identified by either computed tomographic scan or angiography. One patient had pre‐existing systemic hypertension. Five of the patients had chronic subdural hematomas. I had a subdural hygroma and had been previously radiated for medulloblastoma, and I patient had a middle fossa arachnoid cyst. Four of the group had had craniotomies and three had undergone trephination for the primary lesion. The postoperative intracerebral hematomas were manifest by rapid deterioration of consciousness and focal neurological findings occurring usually immediately (but, in 2 cases, a few days after) the original procedure. Five patients underwent secondary craniotomy and 2 had external drainage. Despite rapid treatment. 2 of the patients died, 4 were left with severe disability, and only I survived intact. None of the patients had identifiable coagulopathy, and only I patient was hypertensive in the immediate postoperative period. The factors that all of the patients had in common were preoperative increased intracranial pressure and shift of the midline structures, as well as rapid surgical decompression of the initial lesion. Possible pathogenic mechanisms include hemorrhage into previously undetected areas of contusion, a sudden increase in cerebral blood flow combined with faulty autoregulation. and damage to parenchymal vessels secondary to rapid intra‐ or postoperative shift of the intracranial contents. Perhaps this devastating complication can be avoided if closed system drainage is used for the treatment of chronic surface collections. (Neurosurgery10:689‐693, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Intrauterine depressed skull fractures are reported only occasionally. In reviewing the literature it seems clear that pressure of the fetal head against the maternal bony structures, mainly the sacral promontory, accounts for most of the so‐called “spontaneous” congenital depressed skull fractures. Rather than true fractures, they are focal congenital moulding depressions. On the other hand, trauma to the mother's abdomen and traumatic delivery are accepted pathological mechanisms for such lesions; most commonly they are ascribed to inexpert application of the forceps blades or undue force by the obstetrician at the time of birth. In some cases, however, uncomplicated spontaneous vaginal or cesarean section deliveries have surprisingly and unexpectedly yielded infants with depressed skull fractures. Three such cases are reported, and the literature is reviewed. (Neurosurgery10:694‐697, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Fourteen children with repeated transient or sustained cerebrospinal fluid shunt dysfunction and with markedly increased intracranial pressure are presented. In all cases, the lateral ventricles had become very small soon after the insertion of a shunt valve that opened at a low pressure, but symptoms of shunt dysfunction did not occur until 6 months to 12 years later. The raised intracranial pressure was treated by subtemporal craniectomy alone (12 patients) or in combination with elevation of the shunt valve opening pressure (2 patients). Subtemporal craniectomy alone was sufficient to alleviate moderately increased intracranial pressure, but both methods were required when the pressure rise was severe. The high intracranial pressure is accompanied by impairment of the drainage of ventricular fluid, which is caused by collapse of the walls of the lateral ventricles around the proximal shunt catheter. But the sequence of events that leads to the severe rises in intracranial pressure characteristic of this syndrome is poorly understood. The possibility that an inflammation‐mediated brain swelling arising from mild systemic infections might further compromise already small ventricles and precipitate shunt dysfunction is suggested. (Neurosurgery10:698‐703, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Cryptic cerebrovascular malformations are defined as congenital vascular abnormalities that cannot be demonstrated by angiography. These lesions usually present with hemorrhage and, if special care is taken at operation and with the processing of the pathological material, these lesions can frequently be demonstrated. The present series includes eight examples of cryptic cerebrovascular malformation, with histological confirmation. The relevant literature is reviewed. (Neurosurgery10:704‐714, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Several centers throughout the United States are now using 1,3‐bis(2‐chloroethyl)‐l‐nitrosurea (BCNU) in various doses administered by intracarotid infusion for the treatment of malignant gliomas and cerebral metastases. Our experience with two patients may be helpful in defining the limitations of this modality of therapy. The first patient developed patchy necrosis in the white matter of the left cerebral hemisphere after receiving a cumulative dose of BCNU of 700 mg/m2by left intracarotid infusion at 6‐week intervals. The first recurrence of his neurological deficit began 3 weeks after the third infusion and progressed to massive edema of the left hemisphere and death. Complete radiographic regression of his tumor had been noted, and before this complication he had been able to return to work as an insurance salesman. The second patient with a large temporoparieto‐occipital glioblastoma developed blindness in the eye ipsilateral to the infused carotid artery, which was first noted 8 weeks after the intracarotid infusion of BCNU, 250 mg/m2. Her left hemiparesis had dramatically improved. However, 8 weeks after her infusion she returned to the hospital with headache and increasing lethargy. A computed tomographic scan showed extension of tumor outside the infused area, with an enhancing mass in the anterior corpus callosum and a second enhancing mass in the 4th ventricle. These three problems suggest modification of this apparently effective form of brain tumor chemotherapy. Administration of the infusion through a flow‐directed catheter placed distal to the origin of the ophthalmic artery from the carotid artery should protect the eye. Cerebral necrosis seems to be related to either cumulative doses of BCNU or repeated infusions, rather than to the initial dose. Animal studies to determine the optimal dose schedule as well as the interaction of BCNU and radiation therapy on normal cerebral tissue are needed. Because intracarotid infusion treats a limited area, perhaps infusion should be supplemented with systemic chemotherapy or whole brain radiation. (Neurosurgery10:715‐719, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;We studied 14 human epileptogenic foci with light and electron microscopy to establish their morphological patterns. Using silver staining techniques, we found dendritic areas devoid of spines, dendritic angulations, and nodular or segmentary dendritic swellings. When these findings were compared with the morphology of nonepileptic cortex, only the existence of dendritic swellings in the epileptic tissue was significant. Electron microscopy showed that the nodular dendritic swellings were due to an alteration in the normal arrangement of the microtubules. We hypothesize that an alteration in the microtubular arrangement causes a mechanical distortion of the dendritic membrane and subsequently may cause its depolarization. (Neurosurgery10:720‐724, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The anatomical structures involved in the origin and spread of generalized seizures in humans have not been fully elucidated. Cortical, centrencephalic, and corticoreticular theories have been proposed to explain the clinical and electroencephalographic findings in patients with primary, generalized epilepsy or secondarily generalized seizures. Our observations in patients undergoing forebrain commissurotomy for intractable, generalized seizures lead us to propose a telencephalic theory of generalized epilepsy. This theory stresses the importance of the cerebral cortex as the site of origin of seizure discharge and the function of the forebrain commissures in the rapid propagation and bilateral synchronization of such discharge. These observations plus a review of the data generated from animal models of epilepsy are presented as evidence for such a theory. Although none of our patients had classical petit mal epilepsy, our findings suggest a secondary role of the brain stem reticular formation in generalized seizures and may be cogent to the discussion of primary, generalized epilepsy. (Neurosurgery10:725‐732, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;George Gershwin, originator of many famous poems and musical compositions, died at age 38 of a temporal lobe glioma. The course of his cerebral disease is depicted and some diffuse gastric symptoms are discussed in light of the knowledge of the proper diagnosis. (Neurosurgery10:733‐736, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID