ISSN:0268-8697    

DOI:10.3109/02688698808999653

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Each type of cerebral vascular malformation has its own unique clinical, radiological and pathological features, and a different pattern of natural evolution. With greater awareness and advances in neuroimaging, there is increasing recognition of Cerebral Medullary Venous Malformations (MVM), angiographically characterised by an‘Umbrella’or‘Caput Medusae’appearance. The clinical and radiological features of four patients with angiographically demonstrable features of cerebral medullary venous malformations, seen in our departments are presented to illustrate the features of cerebral MVMs. Three patients have been managed conservatively and one has been treated with stereotactic radiosurgery.The literature on cerebral MVMs has been reviewed and presented in this paper. It appears that most are benign and even in those cases where there has been a haemorrhage the outcome seems to be much better than with arteriovenous malformations. The rationale behind radiosurgical treatment is discussed. Before embarking upon any form of interventional therapy the natural course of these lesions should be considered.

ISSN:0268-8697    

DOI:10.3109/02688698808999654

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

The authors propose a four-grade classification for intraventricular haemorrhage (IVH) caused by haemorrhagic cerebrovascular diseases. Grading is based on the distribution and volume of the haematoma in the ventricular system as revealed by computed tomography (CT). In Grade I IVH, CT shows no haematoma in the ventricular system, but the cerebrospinal fluid contains some fresh blood; Grade II IVH fills a circumscribed portion of one or both lateral ventricles. This grade is divided into two: Grade II, having a haematoma volume of, or less than 20 ml in the ventricular system and Grade 11, of more than 21 ml; Grade III IVH fills the entire length of one lateral ventricle and none, or circumscribed portion, of the other lateral ventricle; and Grade IV IVH entirely fills both lateral ventricles. This grading scale correlated with the mortality and morbidity of the IVH patients. Its application will assist in the selection of continuous ventricular drainage or direct evacuation of intraventricular haematoma as the management method.

ISSN:0268-8697    

DOI:10.3109/02688698808999655

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

One hundred and forty-eight patients with negative cerebral angiography after subarachnoid haemorrhage are reported. Good grade, normotension and normal CT are associated with a favourable outcome. In 89 patients with negative four-vessel angiography the overall annual risks of rebleeding and fatal rebleeding were 1.5% and 0.4% respectively. In 52 patients undergoing appropriate limited angiography corresponding risks were 2.5% and 1.9%. No fatal rebleeds occurred after 6 months. Initial CT scanning in 104 patients was abnormal in 34. Of these, 14 had SAH alone, in whom no episodes of rebleeding occurred, although SAH on CT was associated with an increased chance of a poor outcome. Twenty had other abnormalities, three of whom rebled, two (both with ICH on CT) being fatal. The annual risks of rebleeding and fatal rebleeding in patients with these CT abnormalities were 5.0% and 3.33% respectively. Fifty-two patients were hypertensive, of whom six rebled, four fatally. Two of the 89 normotensive patients rebled, neither fatally.

ISSN:0268-8697    

DOI:10.3109/02688698808999656

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

A series of 510 patients with proven aneurysmal subarachnoid haemorrhage (SAH) is reported. The incidence of recurrent haemorrhage during the period awaiting surgery was 13.7%. There was no significant difference in incidence between good and poor grade patients. Following rebleeding there was an immediate mortality of 34% in good grade patients and 52% in poor grade patients. In the long term only 44.4% of good grade and 8% of poor grade patients made a good recovery following a second bleed as compared to 70.6% and 52.8% respectively for those who did not re-haemorrhage.

ISSN:0268-8697    

DOI:10.3109/02688698808999657

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

A series of 480 patients who were alive upon admission following an aneurysmal subarachnoid haemorrhage (SAH) is reported. These patients represented 40% of the total Swedish incidence during a 3-year period. The three neurosurgical referral centres covering this population had a similar policy of early diagnosis and acute stage surgery in all patients considered of having a potential to survive without permanent disabling cerebral malfunction. At 2-year follow up 45% showed a good neurological recovery, the morbidity was 25% and the mortality was 30%. Some more lives might have been saved with an improved ultra-early referral system since there were 21 initially good-to-fair risk patients (4% of the total SAH population) who rebled fatally before surgery and within 48 h. For comparison, in the Kingdom of Denmark, with a general policy of delayed operation, out of 1076 patients who were alive upon admission, 27.5% made a good recovery, while the morbidity was 27%, and the mortality was 45.5%.

ISSN:0268-8697    

DOI:10.3109/02688698808999658

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

In 76 consecutive patients with spinal cord compression the process of diagnosis and referral was investigated. This investigation was carried out at the time of admission to the neurosurgical unit when it was possible to obtain fresh information about each patient's pre-admission management. All the patients had been referred from District General Hospitals and 71 had previously consulted their general practitioners. Sixty-two per cent took over a week from the time they first saw their own doctor to reach the referring hospital; after reaching hospital 47% of patients waited a week or more before they were referred to a neurosurgeon. During the process of referral, the proportion of patients able to walk unaided and control their sphincters fell from 68% to 10% while the proportion with complete cord lesions rose from 1.5% to 28%. In 48% of cases there had been delays in diagnosis and referral which appeared avoidable. The reasons for these delays and their effect on the eventual outcome are assessed.

ISSN:0268-8697    

DOI:10.3109/02688698808999659

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

A survey was done of all cases of head injury admitted to a neurorehabilitation unit which, while mainly servicing the regional acute head injury unit, receives patients from throughout Scotland. During the 4 calendar years 1983–1986, 183 new cases of head injury were treated. The patients were predominantly young adult males the great majority of whom had suffered severe head injuries. Most were directly transferred from neurosurgical units within 6 months of injury. The length of stay in the unit varied from less than 1 month for half of the patients to as long as 10 months. Eighty-four per cent of patients were discharged home. The limitations and constraints upon the service are described and the need for a rational approach to the development of head injury rehabilitation facilities in the United Kingdom are discussed.

ISSN:0268-8697    

DOI:10.3109/02688698808999660

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Computerised axial tomography (CT) and magnetic resonance imaging (MRI) should make detection of small trigeminal Schwannomas easier. Review of histories of five patients with trigeminal Schwannomas suggests that CT (and in one patient MRI) does not appear to lead to earlier detection of these turnours. Despite the availability of CT, three patients presented with large Schwannomas. A high index of clinical suspicion remains crucial to the diagnosis. Recent advances in diagnostic radiology have, however, considerably facilitated the logical planning of the operative approach. In that respect, it may be anticipated that the prognosis for these rare tumours will be improved.

ISSN:0268-8697    

DOI:10.3109/02688698808999661

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Early outcome results for 10 cases of modified hemispherectomy are presented. All patients had a history of infantile hemiplegia and intractable epilepsy. Pre-and postoperative measures for seizures and motor and cognitive and behavioural functioning are described. Early results are encouraging with no mortality and a low rate of complications. There was a complete cessation of seizures in seven patients and a considerable reduction in seizure frequency in two. Motor functioning was largely unaffected. Behaviour problems tended to improve at the cessation of seizures. IQ scores did not deteriorate as a consequence of operation and some patients showed considerable gains in IQ with the passage of time. Details of cognitive functioning are described.

ISSN:0268-8697    

DOI:10.3109/02688698808999662

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor