ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

IN A SERIES of 1314 consecutive patients with cerebral aneurysms from a defined catchment area in eastern Finland (870,000 inhabitants), 561 patients(43%) had middle cerebral artery aneurysms (MCAAs). One or more associated aneurysms were common; 221 patients with MCAAs (39%) had multiple intracranial aneurysms (MIA). In other words, three-fourths (73%) of all patients with MIA had at least one MCAA. Multiple MCAAs, found in 111 patients (20%), were common in this Finnish population. One hundred of these patients had bilateral MCAAs, of whom 63 had mirror aneurysms, that is, aneurysms at the same site but on different sides. Thirty-five patients had “pure” mirror aneurysms, that is, they did not have any other aneurysms. Most MCAAs (81%) were located at the bifurcation. Three-fourths (72%) of the proximal MCAAs were associated with MIA. Giant aneurysms were significantly more common as single MCAAs than as any other single aneurysm. The frequency of intracerebral hematomas (42%) was by far higher in patients with MCAAs than in patients with ruptured aneurysms at other sites. Most of the intracerebral hematomas occurred in patients with bifurcation MCAAs that pointed laterally. Patients with MCAAs had surprisingly bad management outcomes despite good surgical results in patients with good Hunt and Hess grades. There were significantly more poor outcomes (Glasgow Outcome Scale score, 3-5) among patients with ruptured MCAAs than among those with any other anterior circulation aneurysms(32 and 25%, respectively). Also, the multiplicity of aneurysms increased the risk for poor outcome, which occurred in 39% of the patients who had MIA with one MCAA and 37% of those who had multiple MCAAs. Epilepsy, severe hemiparesis, and visual field deficits were the most common disabilities in long-term survivors, associated far more frequently with MCAAs than with aneurysm at other sites.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

CEREBRAL ISCHEMIA ASSOCIATED with subarachnoid hemorrhage may have severe consequences for neuronal functioning. The excitatory amino acid neurotransmitters glutamate and aspartate have been shown to be of particular importance for ischemia and ischemic neuronal damage. For seven patients who underwent early surgery for ruptured intracranial aneurysms, intracerebral microdialysis of glutamate and aspartate was performed to monitor local metabolic changes in the medial temporal (all seven patients) and subfrontal cortex (Patients 4 through 7). Samples were collected every 30 or 60 minutes, using an autosampler. The results show that extracellular glutamate and aspartate concentrations can rise to very high levels after surgery for subarachnoid hemorrhage and aneurysm. These increased levels of excitatory amino acids correlated well with the clinical course and neurological symptoms of the patients. Simultaneous sampling from two vascular territories (middle cerebral artery and anterior cerebral artery) also showed that a rise in extracellular glutamate and aspartate in one territory is not necessarily parallel with a rise in the other. The application of the microdialysis technique with an on-line assay system might be of value in the future for continuous monitoring of ischemic events to optimize treatment with, for example, blockers of glutamatergic neurotransmission.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ISCHEMIA IS ONE of the major factors causing secondary brain damage after severe head injury. We have investigated the value of continuous partial pressure of brain tissue oxygen (PbrO2) monitoring as a parameter for cerebral oxygenation in 22 patients with severe head injury(Glasgow Coma Scale score, ≤8). Jugular bulb oxygenation, intracranial pressure, and cerebral perfusion pressure were simultaneously recorded. O2and CO2reactivity tests were performed daily to evaluate oxygen autoregulatory mechanisms. PbrO2monitoring was started an average of 7.0 hours after trauma with a mean duration of 74.3 hours. No complications were seen, and the calibration of the catheters after measurement showed a zero drift of 1.2 ± 0.8 mm Hg and a sensitivity drift of 9.7 ± 5.3%. In 86% of the patients, PbrO2was<20 mm Hg in the acute phase. Mean PbrO2significantly increased during the first 24 hours after injury. Two distinct patterns of change of PbrO2over time were noted. The first pattern was characterized by normal stable levels after 24 hours, and the second was characterized by transiently elevated levels of PbrO2during the second and third days. PbrO2values ≤5 mm Hg within 24 hours after trauma negatively correlated with outcome. O2reactivity was significantly lower in patients with good outcomes. CO2reactivity showed no constant pattern of change over time and was not correlated with outcome. Increased hyperventilation was shown to decrease PbrO2in some patients. Accurate detection of the moment of cerebral death was possible on the basis of the PbrO2measurements. The correlation between PbrO2and other parameters, such as intracranial pressure and cerebral perfusion pressure, was weak. We conclude that PbrO2monitoring is a safe and clinically applicable method in patients with severe head injury. The early occurrence of ischemia after head injury can be monitored on a continuous basis. Deficiency of oxygen autoregulatory mechanisms can be demonstrated, and their occurrence is inversely related to outcome. For practical clinical use, the method seemed to be superior to jugular oximetry.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

NEUROFIBROMATOSIS (NF) DESCRIBES the most commonly inherited disorders affecting the nervous system. These autosomal dominant, neurocutaneous syndromes are associated with multiple tumors of the nervous system, including neurofibromas, schwannomas, meningiomas, and intracranial gliomas. Spinal cord involvement in NF is typically from extramedullary growth of spinal nerve root tumors. Intramedullary spinal cord tumors in NF have been reported as scattered, single cases in the literature. However, this association has not been clearly defined as have other nervous system neoplasms that are typically linked with NF. We present a series of nine patients with NF with intramedullary spinal cord tumors who were managed at our institution from 1984 to 1994. The patients' ages ranged from 4 to 31 years. There were seven male patients and two female patients. Three patients had NF-1 (von Recklinghausen's), five patients had NF-2, and one patient had NF, type uncertain. There were three cervicomedullary tumors, two cervical tumors, three cervicothoracic tumors, and one thoracic tumor. A histological examination revealed five ependymomas, three astrocytomas, and one intramedullary schwannoma. Two patients with malignant intramedullary spinal cord tumors have died with progressive disease. One other patient has required a subsequent operation for recurrent tumor. The other six patients are doing well, and their prognosis is expected to be related to their systemic disease. We conclude that there is a clinical entity of intramedullary spinal cord tumors associated with NF.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

UNDIAGNOSED AND UNTREATED odontoid fractures are relatively common in developing countries where treatment for minor injuries is not considered. As a result, patients frequently present with neurological deterioration secondary to delayed odontoid dislocation. Fifty-one consecutive patients with this problem were entered into a management protocol and reviewed for this report. After diagnosis, reducibility was analyzed by extension films, and all patients who could not be reduced were initially managed in cranial tong traction. Thirty-seven were reduced spontaneously or by traction alone, and 12 required transoral decompression. All underwent posterior C1-C2 fusion Postoperatively, all were treated in external orthoses. The neurological recovery was excellent in 34 patients. Seven patients could function but had some disability, three patients had disabling spasticity, and three remained bedridden. Four deaths occurred as a result of respirator-dependent patients being taken home for social and financial reasons. As a result of this case-controlled study, we recommend that the treatment protocol first analyze reducibility by extension x-rays and then try traction for as long as 14 days to attempt reduction in patients who did not reduce in extension. Failure of reduction is indication for transoral decompression, and all patients require C1-C2 fusion. The neurological recovery is related to initial impairment but can be satisfactory in >75% of patients.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID