WorldWideScience

Sample records for large acute subdural

  1. SPONTANEOUS RESOLUTION OF ACUTE SUBDURAL HAEMATOMA

    Directory of Open Access Journals (Sweden)

    Ramandeep Singh

    2013-11-01

    Full Text Available ABSTRACT: We report a case of a 47 year old man who presented with head injury due to road traffi c accident, with CT scan suggestive of large left sided acute SDH with comminuted fracture of occipital bone. Within a few hours, patient showed significant neurological improvement. Follow - up CT scan revealed rapid spontaneous resolution and redistributio n of the acute SDH. The proposed hypothesis explaining this rare phenomenon suggests intracranial and extra cranial redistribution as the cause of spontaneous resolution of acute SDH. The intracranial phenomenon is more common of the two. To our knowledge, this is the first case in the literature where both intracranial and extracranial phenomenon played a role in the same patient leading to rapid spontaneous resolution of acute SDH KEY WORDS: ● acute subdural hematoma ● spontaneous resolution ● intracr anial redistribution ● extracranial redistribution

  2. Acute subdural effusion in vasculitis

    Directory of Open Access Journals (Sweden)

    Raghavendra Seetharam

    2008-01-01

    Full Text Available We report a 29-year-old man with a unique presentation of vasculitis as acute unilateral subdural effusion and meningoencephalitis. Magnetic resonance imaging showed a brainstem lesion that spread to the thalamus over time. There were no systemic features of vasculitis other than a positive pathergy test. Histopathological examination from the pathergy site showed neutrophilic infiltrate and leucocytoclastic vasculitis. The condition was steroid responsive and he remained in remission at two years′ follow-up. The anatomy of the brainstem lesion, absence of other inflammatory and infective conditions on evaluation suggests a vasculitic pathology either as primary central nervous system angiitis or as neurological presentation of systemic vasculitis like Behηet′s disease although the international diagnostic criteria for Behηet′s were not fulfilled.

  3. Spontaneous acute subdural hematoma in a patient with multiple myeloma

    Directory of Open Access Journals (Sweden)

    Abrar Ahad Wani

    2012-01-01

    Full Text Available Acute spontaneous subdural hematoma in a patient of multiple myeloma receiving chemotherapy is an unknown event, needing an urgent neurosurgical management. We report this patient who presented with progressive neurological deterioration and a low platelet count. She was successfully managed by craniotomy and evacuation of subdural hematoma with intraoperative transfusion of platelets. The acute spontaneous subdural hematoma in her was probably related to the bleeding diathesis due to thrombocytopenia associated with chemotherapy.

  4. Acute Spontaneous Posterior Fossa Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Osama Shukir Muhammed Amin

    2014-02-01

    Full Text Available Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient’s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection.

  5. Endoscopic Surgery for Traumatic Acute Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Hiroyuki Kon

    2014-01-01

    Full Text Available Traumatic acute subdural hematoma (ASDH is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4. Computed tomography (CT demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

  6. Neuroendoscopic Removal of Acute Subdural Hematoma with Contusion: Advantages for Elderly Patients

    Directory of Open Access Journals (Sweden)

    Ryota Tamura

    2016-01-01

    Full Text Available Background. Large craniotomy for acute subdural hematoma is sometimes too invasive. We report good outcomes for two cases of neuroendoscopic evacuation of hematoma and contusion by 1 burr hole surgery. Case Presentation. Both patients arrived by ambulance at our hospital with disturbed consciousness after falling. Case 1 was an 81-year-old man who took antiplatelet drugs for brain infarction. Case 2 was a 73-year-old alcoholic woman. CT scanning showed acute subdural hematoma and frontal contusion in both cases. In the acute stage, glycerol was administered to reduce edema; CTs after 48 and 72 hours showed an increase of subdural hematoma and massive contusion of the frontal lobe. Disturbed consciousness steadily deteriorated. The subdural hematoma and contusion were removed as soon as possible by neuroendoscopy under local anesthesia, because neither patient was a good candidate for large craniotomy considering age and past history. 40%~70% of the hematoma was removed, and the consciousness level improved. Conclusion. Neuroendoscopic removal of acute subdural hematoma and contusion has advantages and disadvantages. For patients with underlying medical issues or other risk factors, it is likely to be effective.

  7. Acute subdural hematoma because of boxing.

    Science.gov (United States)

    Kushi, Hidehiko; Saito, Takeshi; Sakagami, Yuichiro; Ohtsuki, Jyoji; Tanjoh, Katsuhisa

    2009-02-01

    To identify factors determining the clinical characteristics and prognosis of acute subdural hematoma (ASDH) arising from boxing injuries by comparing with ASDH due to any nonboxing cause. Two groups were selected for this study: 10 patients with ASDH because of boxing injuries and 26 patients with nonboxer ASDH. All of the patients underwent neurologic examination by neurosurgeons. Primary resuscitation and stabilization as well as operative therapy were performed to all patients according to the European Brain Injury Consortium Guidelines. Two groups were compared in terms of age, the Glasgow Coma Scale at admission, neurologic findings, craniogram and brain computed tomography scan findings, operative findings, and prognosis. As potential prognostic indicators for boxers, the time interval until surgery, the Glasgow Outcome Scale, hematoma thickness, midline shift, and the site of bleeding were analyzed. The characteristics of patients because of boxing injuries are that patients were younger, had lucid interval, and had no cerebral contusion or contralateral brain injury. There was no significant difference in initial Glasgow Coma Scale, hematoma thickness, midline shift, and their prognosis. The most peculiar clinical presentation of boxers' ASDH was that all bleedings were limited from "bridging veins" or "cortical veins." The prognosis of boxers was most closely correlated with the site of bleeding (r2 = 0.81; p = 0.0001) and the midline shift (r2 = 0.67; p = 0.007). Our study shows that ASDH because of boxing is characterized by bleeding from bridging or cortical veins, and that the site of bleeding is a significant determinant of their prognosis.

  8. Cerebral atrophy after acute traumatic subdural orextradural hematomas in adults

    Institute of Scientific and Technical Information of China (English)

    冯海龙; 谭海斌; 黄光富; 廖晓灵

    2002-01-01

    @@ Cerebral atrophy is one of the serious sequelae ofsevere head injury. 1 Neuropathologicalinvestigation has revealed that cerebral atrophy iscaused by either diffuse axonal injury or cerebralhypoxia and ischemia. Secondary ipsilateral cerebralatrophy caused by acute subdural hematomas in infantshas been reported recently, but this unilateral cerebralatrophy after head injury in adult patients has rarelybeen reported.

  9. Symptomatic Acute-on-Chronic Subdural Hematoma: A Clinicopathological Study.

    Science.gov (United States)

    Castellani, Rudy J; Mojica-Sanchez, Gruschenka; Schwartzbauer, Gary; Hersh, David S

    2017-06-01

    The pathophysiology of acute-on-chronic subdural hematoma (ACSDH) is complex and incompletely understood. Evidence to date indicates that the overall process is initiated by rotational force with movement of the brain inside the skull, which exerts tensile strain and rupture of bridging veins, leading in turn to acute hemorrhage in the subdural potential space. This is followed by the proliferation of mesenchymal elements with angiogenesis and inflammation, which in turn becomes a substrate for repeated hemorrhage and expansion of the lesion. Given the prevalence of traumatic subdural processes in the forensic setting and the importance of proper assessment of timing, etiology, risk factors, and clinicopathological correlation, we studied 47 patients presenting to the University of Maryland Shock Trauma Center, all of whom underwent craniotomy with resection of the outer membrane due to symptomatic ACSDH. The surgically resected tissue was examined for histopathologic features in all cases. Our findings highlight that ACSDH is a condition precipitated by trauma that affects middle-aged and older adults, is relatively indolent, is unilateral or asymmetric, and has a low in-hospital mortality rate. Pathological analysis demonstrates a substantial outer membrane in all cases with varying degrees of inflammation and organization that cannot be precisely dated as a function of clinical presentation. The extrapolation of adult ACSDH to mixed acute and chronic subdural hemorrhage in the pediatric setting is problematic due to substantial differences in clinical presentation, severity of underlying brain injury, gross and microscopic findings, and outcome.

  10. [An operated case of a meningioma causing acute subdural hematoma].

    Science.gov (United States)

    Chonan, Masashi; Niizuma, Kuniyasu; Koyama, Shinya; Kon, Hiroyuki; Sannohe, Seiya; Kurotaki, Hidekachi; Midorikawa, Hiroshi; Sasaki, Tatsuya; Nishijima, Michiharu

    2013-03-01

    We report a rare case of a meningioma causing acute hematoma. A 67-year-old woman presented with sudden headache. No evidence of trauma was seen. CT demonstrated a subdural hematoma in the convexity of the fronto-temporal lobe. Magnetic resonance imaging showed marked signal heterogeneity in the convexity of the frontal lobe. One week later, the patient underwent hematoma evacuation and tumor resection including the attached dura mater. The histological diagnosis was meningothelial meningioma. The clot was connected directly to the tumor and the origin of the subdural hematoma was identified as the meningioma. Postoperative course was uneventful, and the headache improved. Meningiomas have a relatively benign course but rarely present with hemorrhage. Surgical exploration is the effective and recommended treatment.

  11. Subdural hemorrhages in acute lymphoblastic leukemia: case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Rui Yin; CaiXia Qiu; XiaoHui Dong; YeLong Chen

    2016-01-01

    Background:Acute lymphoblastic leukemia is a rare hematological malignancy.Pure subdural hemorrhages in a patient with acute lymphoblastic leukemia patient are extremely rare.Case presentation:This case presented acute spontaneous subdural hemorrhage without head trauma at first,and acute lymphoblastic leukemia was diagnosed later.The second time,the patient was admitted with multiple pure subdural hemorrhages in different locations and periods with a history of slight head trauma.Conclusions:Pure subdural hemorrhages can occur in a patient with acute lymphoblastic leukemia.More care would be needed for pure subdural hemorrhages without obvious head trauma,and patients with hematological malignancies should be protected from even mild head trauma.

  12. Meningioma associated with acute subdural hematoma: A review of the literature

    Directory of Open Access Journals (Sweden)

    Di Vitantonio Hambra

    2014-01-01

    Full Text Available Background: Classically meningiomas present with a gradual onset of symptoms and their acute presentation with hemorrhagic events seems to be a rare event. A review of the literature shows only 18 cases of meningioma associated with acute subdural hematoma. The possible mechanisms of hemorrhage are not yet fully understood. Case Description: We report a case of sphenoid wing meningioma associated with acute subdural hematoma, without history of trauma. The presence of meningioma was discovered during the surgery. The tumor and hematoma were removed without postoperative complications. Conclusions: The authors have discussed the etiology of an acute subdural hemorrhage and reviewed the pertinent literature.

  13. Acute subdural hematoma with swirl signs: clinical analysis of 15 cases

    Institute of Scientific and Technical Information of China (English)

    CAI Yong; ZHONG Xing-ming; WANG Yi-qi; YANG Jian-guo; ZHENG Hui-min

    2010-01-01

    From July 2003 to July 2009, 15 cases of subdural hematoma with swirl signs were treated in our hospital and their clinical data were retrospectively analysed.The mortality was compared between these patients and those with typical acute subdural hematoma who were treated at the same time in our hospital. Among the 15 cases, full recovery was achieved in 4 cases, slight disability in 2, gave disability in 2 and death in 7 (46.7%). The mortality of these patients was conspicuously higher than that of typical subdural hematoma (14/83, 16.9%, P<0.01). Subdural hematoma with swirl signs is often suggestive of hazardous pathogenetic condition and early diagnosis and prompt surgical intervention is essential to reduce mortality.

  14. Predictors for outcome after surgery for traumatic acute subdural hematoma

    Directory of Open Access Journals (Sweden)

    Atanasov Vladimir A.

    2016-09-01

    Full Text Available Introduction: Acute traumatic subdural hematoma (ASDH is one of the most frequent conditions in neurosurgery demanding emergency surgery. The aim of the study was to identify factors influencing outcome in patients who had surgery for evacuation of ASDH. Methods: From 2005 to 2012 eighty-five patients at age above 18 years had surgery for evacuation of ASDH. Outcome was measured according GOS at discharge and was dichotomized as “favorable outcome” (GOS 4 to 5 and “unfavorable outcome” (GOS 1 to 3. These factors were evaluated with univariate and logistic regression analysis for significance with outcome. Results: The mean age of the 85 patients was 62.7 years (SD±18.5. 45.9% patients were with favorable outcome and 54.1% had unfavorable outcome. Patients with GCS score 3-8 (54.1% had 80.4% unfavorable outcome whereas 78.6% of patients with GCS score 13-15 (32.9% had favorable outcome. All patients with nonreactive pupils (bilaterally or unilaterally - 31.8% had unfavorable outcome whereas patients (36.5% with both reactive pupils (36.5% had in 80.6% favorable outcome. All patients (40% with Rotterdam CT scores 5 and 6 had unfavorable outcome. The factors determining outcome were admission GSC score, Rotterdam CT scores, and prothrombin time. Conclusion: Patients who have GSC score of 3, unresponsive pupil(s or have Rotterdam CT scores 5 and 6 have little chance of survival. Patients with coagulopathy have two times more unfavorable outcome. The patients with ASDH should have surgery as soon as possible after correction of vital parameters in order to avoid deterioration which can be very rapid and irreversible.

  15. Isolated oculomotor nerve palsy resulting from acute traumatic tentorial subdural hematoma

    Directory of Open Access Journals (Sweden)

    Cui V

    2016-10-01

    Full Text Available Victoria Cui,1 Timur Kouliev2 1Washington University School of Medicine, St Louis, MO, USA; 2Emergency Department, Beijing United Family Hospital, Beijing, China Abstract: Acute subdural hematoma (SDH resulting from head trauma is a potentially life-threatening condition that requires expedient diagnosis and intervention to ensure optimal patient outcomes. Rapidly expanding or large hematomas, elevated intracranial pressure, and associated complications of brain herniation are associated with high mortality rates and poor recovery of neurological function. However, smaller bleeds (clot thickness <10 mm or hematomas occurring in infrequent locations, such as the tentorium cerebelli, may be difficult to recognize and patients may present with unusual or subtle signs and symptoms, including isolated cranial nerve palsies. Knowledge of neuroanatomy supported by modern neuroimaging can greatly aid in recognition and diagnosis of such lesions. In this report, we present a case of isolated oculomotor nerve palsy resulting from compressive tentorial SDH following blunt head trauma, review the literature concerning similar cases, and make recommendations regarding the diagnosis of SDH in patients presenting with isolated cranial nerve palsies. Keywords: head injury, oculomotor, palsy, subdural hematoma, trauma, tentorium, cerebral herniation, intracranial hemorrhage

  16. Venous or arterial blood components trigger more brain swelling, tissue death after acute subdural hematoma compared to elderly atrophic brain with subdural effusion (SDE) model rats.

    Science.gov (United States)

    Wajima, Daisuke; Sato, Fumiya; Kawamura, Kenya; Sugiura, Keisuke; Nakagawa, Ichiro; Motoyama, Yasushi; Park, Young-Soo; Nakase, Hiroyuki

    2017-09-01

    Acute subdural hematoma (ASDH) is a frequent complication of severe head injury, whose secondary ischemic lesions are often responsible for the severity of the disease. We focused on the differences of secondary ischemic lesions caused by the components, 0.4ml venous- or arterial-blood, or saline, infused in the subdural space, evaluating the differences in vivo model, using rats. The saline infused rats are made for elderly atrophic brain with subdural effusion (SDE) model. Our data showed that subdural blood, both venous- and arterial-blood, aggravate brain edema and lesion development more than SDE. This study is the first study, in which different fluids in rats' subdural space, ASDH or SDE are compared with the extension of early and delayed brain damage by measuring brain edema and histological lesion volume. Blood constituents started to affect the degree of ischemia underneath the subdural hemorrhage, leading to more pronounced breakdown of the blood-brain barrier and brain damage. This indicates that further strategies to treat blood-dependent effects more efficiently are in view for patients with ASDH. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Boxing sparring complicated by an acute subdural haematoma and brainstem haemorrhage.

    Science.gov (United States)

    Hart, Michael G; Trivedi, Rikin A; Hutchinson, Peter J

    2012-10-01

    A professional boxer developed an acute subdural haematoma after boxing sparring. Despite timely surgical decompression, he had a poor overall outcome predominantly from a delayed brainstem haematoma. Magnetic resonance imaging (MRI) was used to elucidate the pathophysiology of the patients' injury and clinical condition.

  18. Acute cervical spinal subdural hematoma not related to head injury.

    Science.gov (United States)

    Kim, Hee Yul; Ju, Chang Il; Kim, Seok Won

    2010-06-01

    We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm(3). She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

  19. [Life-threatening acute subdural haematoma after combinedspinal-epidural anaesthesia in labour].

    Science.gov (United States)

    Bakar, Bulent; Ozer, Esra; Tekkok, Ismail Hakki

    2015-01-01

    Only few reports in literature have pointed out to the possibility of a cranial subdural haematoma formation associated with dural puncture during spinal orepidural analgesia. We herein describe such a rare case who was diagnosed to have acute subdural haematoma after combined spinal-epidural anaesthesia used in labour. A 34-year-old, primigravid women with a gestation of 38 weeks underwent cae-sarean section under combined spinal-epidural anaesthesia and gave birth to a healthy boy. Thirty-two hours after delivery, her moderate headache progressed to a severe headache associated with nausea and vomiting and later was more complicated with a generalized tonic-clonic seizure and ensuing lethargy. Computed tomography of the brain demonstrated a right-sided fronto-temporo-parietal acute subdural haematoma with diffuse cerebral oedema. She under-went urgent FTP craniotomy and evacuation of the haematoma. Early postoperative cranial computed tomography showed a clean operative site. Eight days after subdural haematoma surgery, she became lethargic again, and this time cranial computed tomography disclosed anextradural haematoma under the bone flap for which she had to undergo surgery again. Two days later, she was discharged home with Karnofsky performance score of 90/100. At follow-up exam, she was neurologically intact and her cranial computed tomography and magnetic resonance were normal. As conclusion, with the use of this combined spinal-epidural anaesthesia, it should be kept in mind that headache does not always mean low pressure headache associated with spinal anaesthesia and that a catastrophic complication of subdural haematoma may also occur. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  20. Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour.

    Science.gov (United States)

    Bakar, Bulent; Ozer, Esra; Tekkok, Ismail Hakki

    2015-01-01

    Only few reports in literature have pointed out to the possibility of a cranial subdural haematoma formation associated with dural puncture during spinal or epidural analgesia. We herein describe such a rare case who was diagnosed to have acute subdural haematoma after combined spinal-epidural anaesthesia used in labour. A 34-year-old, primigravid women with a gestation of 38 weeks underwent caesarean section under combined spinal-epidural anaesthesia and gave birth to a healthy boy. Thirty-two hours after delivery, her moderate headache progressed to a severe headache associated with nausea and vomiting and later was more complicated with a generalized tonic-clonic seizure and ensuing lethargy. Computed tomography of the brain demonstrated a right-sided fronto-temporo-parietal acute subdural haematoma with diffuse cerebral oedema. She underwent urgent FTP craniotomy and evacuation of the haematoma. Early postoperative cranial computed tomography showed a clean operative site. Eight days after subdural haematoma surgery, she became lethargic again, and this time cranial computed tomography disclosed an extradural haematoma under the bone flap for which she had to undergo surgery again. Two days later, she was discharged home with Karnofsky performance score of 90/100. At follow-up exam, she was neurologically intact and her cranial computed tomography and magnetic resonance were normal. As conclusion, with the use of this combined spinal-epidural anaesthesia, it should be kept in mind that headache does not always mean low pressure headache associated with spinal anaesthesia and that a catastrophic complication of subdural haematoma may also occur. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  1. Posttraumatic retroclival acute subdural hematoma: Report of two cases and review of literature

    Directory of Open Access Journals (Sweden)

    Sridhar Krishnamurthy

    2010-01-01

    Full Text Available Traumatic retroclival hematomas are uncommon lesions usually associated with significant trauma. Majority of the reported hematomas are epidural; and in the pediatric population. Retroclival acute subdural hematomas (RSDH are very rare, with only two previous cases reported in English literature. An 18-year-old man presented with headache and no deficits following an accident. Computer tomography (CT scan and magnetic resonance imaging (MRI showed an acute RSDH extending into the spinal subdural space. He developed bilateral sixth nerve palsies, with symptoms of raised intracranial pressure within the next 24 hours. He underwent evacuation of hematoma with a good outcome. Another 19-year-old man presented with neck pain following a fall from a moving bus. He had no neurological deficits. CT scan showed a RSDH extending across the craniovertebral junction. He was managed conservatively with good outcome.

  2. Age related outcome in acute subdural haematoma following traumatic head injury.

    LENUS (Irish Health Repository)

    Hanif, S

    2009-09-01

    Acute subdural haematoma (ASDH) is one of the conditions most strongly associated with severe brain injury. Reports prior to 1980 describe overall mortality rates for acute subdural haematomas (SDH\\'s) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. The elderly are predisposed to bleeding due to normal cerebral atrophy related to aging, stretching the bridging veins from the dura. Prognosis in ASDH is associated with age, time from injury to treatment, presence of pupillary abnormalities, Glasgow Coma Score (GCS) or motor score on admission, immediate coma or lucid interval, computerized tomography findings (haematoma volume, degree of midline shift, associated intradural lesion, compression of basal cisterns), post-operative intracranial pressure and type of surgery. Advancing age is known to be a determinant of outcome in head injury. We present the results of a retrospective study carried out in Beaumont Hospital, Dublin, Ireland\\'s national neurosurgical centre. The aim of our study was to examine the impact of age on outcome in patients with ASDH following severe head injury. Only cases with acute subdural haematoma requiring surgical evacuation were recruited. Mortality was significantly higher in older patients (50% above 70 years, 25.6% between 40 and 70 years and 26% below 40 years). Overall poor outcome (defined as Glasgow outcome scores 3-5) was also higher in older patients; 74.1% above 70 years, 48% between 40 and 70 years and 30% below 40 years. Poor outcome in traumatic acute subdural haematoma is higher in elderly patients even after surgical intervention.

  3. Emergency anesthesia for evacuating a traumatic acute subdural hemorrhage in a child overdosed with hypertonic saline

    Directory of Open Access Journals (Sweden)

    Chulananda Goonasekera

    2016-01-01

    Full Text Available A previously healthy 1-year-old child with a traumatic acute subdural hemorrhage received 10 times higher dose of hypertonic saline inadvertently immediately before surgery. This case report describes deviations in fluid management needed to alleviate salt toxicity and its adverse effects during surgery under anesthesia perioperatively. The child made an uneventful recovery with no evident residual damage at follow-up.

  4. Acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery: a case report

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2012-03-01

    Full Text Available Abstract Introduction Spinal anesthesia is a widely used general purpose anesthesia. However, serious complications, such as intracranial subdural hemorrhage, can rarely occur. Case presentation We report the case of a 73-year-old Japanese woman who had acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery. Conclusion This case highlights the need to pay attention to acute intracranial subdural hemorrhage as a complication after spinal anesthesia. If the headache persists even in a supine position or nausea occurs abruptly, computed tomography or magnetic resonance imaging of the brain should be conducted. An intracranial subdural hematoma may have a serious outcome and is an important differential diagnosis for headache after spinal anesthesia.

  5. Hematoma subdural agudo traumático: estudo de 110 pacientes Acute traumatic subdural haematomas: study of 110 cases

    Directory of Open Access Journals (Sweden)

    Nicandro de Figueiredo Neto

    1996-06-01

    Full Text Available Apresentamos uma série consecutiva de 110 pacientes com hematoma subdural agudo traumático (HSDA admitidos no serviço de emergência do HBDF no período de 1°-janeiro a 1°-dezembro-1994. Todos os pacientes foram atendidos de acordo com o mesmo protocolo. Houve predominância do sexo masculino (79%, com idade variando entre 14 e 70 anos, sendo os atropelamentos (34% e os acidentes automobilísticos (20% as causas mais comuns. A maioria dos pacientes (85,7% foi admitida muito grave, com 8 pontos ou menos na Escala de Coma Glasgow (ECG, o que influenciou diretamente na mortalidade. A tomografia computadorizada de crânio foi o exame diagnóstico de escolha que mostrou serem as contusões e o inchaço cerebral ("swelling" as lesões intracranianas associadas mais freqüentes. A cirurgia foi realizada em 45,1% dos pacientes, e, em sua maioria, através de craniotomia fronto-têmporo-parietal ampla, com drenagem do hematoma, seguida de plástica da dura-mater. Em 54,9% as condições clínicas não permitiram a realização da cirurgia; neste grupo, cerca de 69,6% estavam em coma profundo à admissão, com 3 pontos na ECG. A letalidade cirúrgica foi de 61,2% e esteve diretamente relacionada à condição clínica inicial e à idade do paciente. A letalidade, incluindo todos os pacientes cirúrgicos e não cirúrgicos com HSDA, mesmo aqueles admitidos já com sinais de falência de tronco cerebral, foi de 79,5%. Além destes pacientes que faleceram, cerca de 7% evoluíram sem seqüelas ou com seqüelas mínimas; outros 11,4% com seqüelas de moderadas a paves e 2,1 % permaneceram em estado vegetativo persistente. Nossos dados estão de acordo com os da literatura no que se refere a elevada taxa de morbidade e mortalidade dos pacientes com HSDA.We report a series of 110 patients with acute traumatic subdural hematoma (ASDH admitted at HBDF emergency within 1994 (January Is1 to December PJ.All patients were treated according to the same protocol

  6. Acute subdural hematoma: potential soccer injury in an otherwise healthy child.

    Science.gov (United States)

    Lutfi, Riad; Mullett, Charles J; Nield, Linda S

    2009-09-01

    A 16-year-old adolescent boy presented with headache, dizziness, loss of consciousness, and a tonic-clonic seizure after heading a soccer ball in a competitive match. A computed tomographic scan of the head revealed an acute subdural hematoma with a mass effect. The patient was emergently referred to a tertiary care facility where he eventually recovered completely with conservative care. No predisposing medical conditions were found. To the best of our knowledge, this is the first report of an intracranial hemorrhage secondary to the heading of a soccer ball alone in an otherwise healthy child without any underlying predisposing central nervous system abnormalities.

  7. Acute subdural empyema. With special reference to CT findings and surgical treatment; case report

    Energy Technology Data Exchange (ETDEWEB)

    Sasahira, Masahiro; Takagi, Kenichi; Hashimoto, Kazumasa; Inou, Satoshi; Arai, Toshimoto (Dokkyo Univ., School of Medicine, Tochigi (Japan))

    1983-05-01

    The patient, a 19-year-old male, began suffering from severe headache, vomiting, and high fever. Two days later the patient was admitted in a semicomatose state and with left hemiplegia. Nuchal rigidity and choked disc were not noticed. WBC count was 12,500/mm/sup 3/. CT scan disclosed marked swelling of the right cerebral hemisphere with midline shift. Except for a small lucent space in the parafalcial region, no extracerebral collection was noted in either pre- or post-contrast scans. Plain craniograms showed clouding of the left frontal, ethmoidal, and sphenoidal sinuses. Carotid angiography revealed prolongation of the circulation time and stenosis of the supraclinoidal portion of the right carotid artery. Right fronto-parietal decompressive craniectomy was performed. Subdural empyema was found and evacuated. Curettage and drainage of the empyema in the paranasal sinuses were also done. A bone defect 4 mm in diameter was detected on the medial-upper wall of the left frontal sinus. The causative organism was confirmed as ..cap alpha..-Streptococcus. Both systemic and local antibiotics were administered and the patient recovered well and was discharged without any neurological deficit. The authors emphasized that cerebral angiography is necessary for its accurate diagnosis of subdural empyema in its acute stage and that emergency intracranial and rhino-otological operations should be concomitantly performed.

  8. Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis

    Directory of Open Access Journals (Sweden)

    Chul Hee Lee

    2014-05-01

    Full Text Available A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.

  9. Influence of operative timing on prognosis of patients with acute subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    ZhAO Hong; BAI Xiang-jun

    2009-01-01

    Objective: To study the influence of operative timing on the prognosis of patients with acute subdural hematoma (ASDH) in order to provide theoretical basis for clinical treatment.Methods: The clinical data of 202 patients with ASDH undergoing operations were collected, and the mortalities and functional survival rates were analyzed 2, 4, 6, and 8 hours after injury.Results: No significant difference was found in mortalities and functional survival rates at different operative timings. However, there was a clear trend that the shorter the operative timing was, the lower the mortality and the higher functional survival rate were. In addition, the mean time from injury to operation of non-survivors was significantly longer than that of survivors.Conclusions: Operative timing has potential influences on the prognosis of patients with ASDH. Surgical evacuation of ASDH should be performed as soon as possible once the operation indication emerges.

  10. Surgical Management of Traumatic Acute Subdural Hematoma in Adults: A Review

    Science.gov (United States)

    KARIBE, Hiroshi; HAYASHI, Toshiaki; HIRANO, Takayuki; KAMEYAMA, Motonobu; NAKAGAWA, Atsuhiro; TOMINAGA, Teiji

    2014-01-01

    Traumatic acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury (TBI). It acts as a space occupying lesion to increase intracranial pressure, and is often complicated by co-existing lesions, and is modified by cerebral blood flow (CBF) changes, coagulopathy, and delayed hematomas. Because of its complicated pathophysiology, the mortality of ASDH is still remaining high. In this review article, its epidemiology, pathophyiology, surgical treatment, and salvage ability are described. With regard to epidemiology, as the population ages, growing number of elderly patients with ASDH, especially patients with prehospital anticoagulant and antiplatelets, increase. Concerning pathophysiology, in addition to well-known initial intracranial hypertension and subsequent ischemia, delayed hyperemia/hyperperfusion, or delayed hematoma is being recognized frequently in recent years. However, optimal treatments for these delayed phenomenons have not been established yet. With regard to surgical procedures, all of craniotomy, decompressive craniectomy, and initial trephination strategies seem to be effective, but superiority of each procedure have not been established yet. Since Glasgow Coma Scale (GCS) scores, age, papillary reaction, and computed tomographic findings are strongly correlated to outcome, each factor has been investigated as an indicator of salvage ability. None of them, however, has been defined as such one. In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed. PMID:25367584

  11. Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.

    Science.gov (United States)

    Torné, Ramon; Rodríguez-Hernández, Ana; Romero-Chala, Fabián; Arikan, Fuat; Vilalta, Jordi; Sahuquillo, Juan

    2016-04-01

    Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH.

  12. Neurosurgical Treatment Variation of Traumatic Brain Injury: Evaluation of Acute Subdural Hematoma Management in Belgium and The Netherlands.

    Science.gov (United States)

    van Essen, Thomas A; de Ruiter, Godard C W; Kho, Kuan H; Peul, Wilco C

    2017-02-15

    Several recent global traumatic brain injury (TBI) initiatives rely on practice variation in diagnostic and treatment methods to answer effectiveness questions. One of these scientific dilemmas, the surgical management of the traumatic acute subdural hematoma (ASDH) might be variable among countries, among centers within countries, and even among neurosurgeons within a center, and hence be amenable for a comparative effectiveness study. The aim of our questionnaire, therefore, was to explore variations in treatment for ASDH among neurosurgeons in similar centers in a densely populated geographical area. An online questionnaire, involving treatment decisions on six case vignettes of ASDH, was sent to 93 neurosurgeons in The Netherlands and Belgium. Clinical and radiological variables differed per case. Sixty neurosurgeons filled out the questionnaire (response rate 65%). For case vignettes with severe TBI and an ASDH, there was a modest variation in the decision to evacuate the hematoma and a large variation in the decision to combine the evacuation with a decompressive craniectomy. The main reasons for operating were "neurological condition" and "mass effect." For ASDH and mild/moderate TBI, there was large variation in the decision of whether to operate or not, whereas "hematoma size" was the predominant motivation for surgery. Significant inter-center variation for the decision to evacuate the hematoma was observed (p = 0.01). Most pronounced was that 1 out of 7 (14%) neurosurgeons in one region chose a surgical strategy compared with 9 out of 10 (90%) in another region for the same scenario. In conclusion, variation exists in the neurosurgical management of TBI within an otherwise homogeneous setting. This variation supports the methodology of the international Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) initiative, and shaped the Dutch Neurotraumatology Quality Registry (Net-QuRe) initiative.

  13. Intervention of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma

    Directory of Open Access Journals (Sweden)

    Xiao-Xuan Fan

    2017-07-01

    Full Text Available Objective: To study the intervention effect of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma (ASDH. Methods: 160 SD rats were randomly divided into four groups, and the ASDH model rats were made by stereotactic autoblood injection, and sham operation group received craniotomy without blood injection. Sham operation group and model group were normally bred after model establishment, and 6 h after model establishment, the treatment group received intragastric administration of Peiyuan Huayu Decoction, and control group received intragastric administration of Piracetam Tablets, 1 time a day. On the 1d, 3d, 5d and 7d after model establishment, the general conditions of rats (activity, food intake and mental state were observed, blood was collected via auricula dextra, ELISA method was used to determine peripheral plasma NSE and S100毬 protein contents, routine HE staining was conducted after perfusion fixation, the neurons in blood injection side of brain tissue were counted, and the neuron damage was observed. Results: 26 rats were dead in the experiment. The general conditions of sham operation group were significantly better than those of other groups, treatment group was significantly better than model group and control group on the 5d group (P0.05; neuron count of sham operation group was basically stable, treatment group was not different from model group and control group on the 1d (P>0.05, treatment group was better than model group (P0.05 on the 3d, and treatment group was better than model group and control group on the 5d and 7d (P0.05, S100毬 protein and NSE contents decreased significantly on the 3d, and treatment group was significantly different from model group and control group (P<0.05, S100毬 protein and NSE contents increased on the 5d and 7d, the increase in treatment group was slower than that in model group and control group, and there was significant difference (P<0.05. Conclusion

  14. Contralateral acute epidural haematoma following evacuation of a chronic subdural haematoma with burr-hole craniostomy and continuous closed system drainage: a rare complication.

    Science.gov (United States)

    Panourias, Ioannis G; Skandalakis, Panajiotis N

    2006-06-01

    Chronic subdural haematoma (CSDH) is one of the most frequent causes for neurosurgical intervention. Although the prognosis is generally good and treatment modalities are well established, some devastating intracranial haematomas can complicate its evacuation. The authors report here a case of an acute epidural haematoma occurring after evacuation of a contralateral chronic subdural haematoma (CSDH) with burr-hole craniostomy and continuous closed system drainage without irrigation. Since this is a rare, but potentially life-threatening, complication, clinicians should suspect its occurrence when an unexpected postoperative course is demonstrated.

  15. Parietal subdural empyema as complication of acute odontogenic sinusitis: a case report

    Science.gov (United States)

    2014-01-01

    Introduction To date intracranial complication caused by tooth extractions are extremely rare. In particular parietal subdural empyema of odontogenic origin has not been described. A literature review is presented here to emphasize the extreme rarity of this clinical entity. Case presentation An 18-year-old Caucasian man with a history of dental extraction developed dysarthria, lethargy, purulent rhinorrhea, and fever. A computed tomography scan demonstrated extensive sinusitis involving maxillary sinus, anterior ethmoid and frontal sinus on the left side and a subdural fluid collection in the temporal-parietal site on the same side. He underwent vancomycin, metronidazole and meropenem therapy, and subsequently left maxillary antrostomy, and frontal and maxillary sinuses toilette by an open approach. The last clinical control done after 3 months showed a regression of all symptoms. Conclusions The occurrence of subdural empyema is an uncommon but possible sequela of a complicated tooth extraction. A multidisciplinary approach involving otolaryngologist, neurosurgeons, clinical microbiologist, and neuroradiologist is essential. Antibiotic therapy with surgical approach is the gold standard treatment. PMID:25146384

  16. Subdural Hematoma

    Science.gov (United States)

    2006-07-01

    presence of and severity of other associated brain injuries. As many patients can experience rapid clinical improvement after successful...greater than 21 days old. They have a tendency to present in older patients and after non-accidental trauma in children and may be associated with... whiplash force caused by violent shaking. Subdural hematomas in infants are only rarely caused by accidental injury. A heterogeneous subdural

  17. Blood constituents trigger brain swelling, tissue death, and reduction of glucose metabolism early after acute subdural hematoma in rats.

    Science.gov (United States)

    Baechli, Heidi; Behzad, Melika; Schreckenberger, Matthias; Buchholz, Hans-Georg; Heimann, Axel; Kempski, Oliver; Alessandri, Beat

    2010-03-01

    Outcome from acute subdural hematoma is often worse than would be expected from the pure increase of intracranial volume by bleeding. The aim was to test whether volume-independent pathomechanisms aggravate damage by comparing the effects of blood infusion with those of an inert fluid, paraffin oil, on intracranial pressure (ICP), cerebral perfusion pressure (CPP), local cerebral blood flow (CBF), edema formation, glucose metabolism ([18F]-deoxyglucose, MicroPET ), and histological outcome. Rats were injured by subdural infusion of 300 muL venous blood or paraffin. ICP, CPP, and CBF changes, assessed during the first 30 mins after injury, were not different between the injury groups at most time points (n=8 per group). Already at 2 h after injury, blood caused a significantly more pronounced decrease in glucose metabolism in the injured cortex when compared with paraffin (P<0.001, n=5 per group). Ipsilateral brain edema did not differ between groups at 2 h, but was significantly more pronounced in the blood-treated groups at 24 and 48 h after injury (n=8 per group). These changes caused a 56.2% larger lesion after blood when compared with paraffin (48.1+/-23.0 versus 21.1+/-11.8 mm(3); P<0.02). Blood constituent-triggered pathomechanisms aggravate the immediate effects due to ICP, CPP, and CBF during hemorrhage and lead to early reduction of glucose metabolism followed by more severe edema and histological damage.

  18. Rapid resolution of an acute subdural hematoma by increasing the shunt valve pressure in a 63-year-old man with normal-pressure hydrocephalus with a ventriculoperitoneal shunt: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Hayes Jackson

    2012-11-01

    Full Text Available Abstract Introduction Symptomatic subdural hematoma development is a constant concern for patients who have undergone cerebrospinal fluid shunting procedures to relieve symptoms related to normal-pressure hydrocephalus. Acute subdural hematomas are of particular concern in these patients as even minor head trauma may result in subdural hematoma formation. The presence of a ventricular shunt facilitates further expansion of the subdural hematoma and often necessitates surgical treatment, including subdural hematoma evacuation and shunt ligation. Case presentation We present the case of a 63-year-old North American Caucasian man with normal-pressure hydrocephalus with an adjustable valve ventriculoperitoneal shunt who developed an acute subdural hematoma after sustaining head trauma. Conservative treatment was favored over operative evacuation because our patient was neurologically intact, but simple observation was considered to be too high risk in the setting of a low-pressure ventriculoperitoneal shunt. Thus, the valve setting on the ventriculoperitoneal shunt was increased to its maximum pressure setting in order to reduce flow through the shunt and to mildly increase intracranial pressure in an attempt to tamponade any active bleeding and limit hematoma expansion. A repeat computed tomography scan of the head six days after the valve adjustment revealed complete resolution of the acute subdural hematoma. At this time, the valve pressure was reduced to its original setting to treat symptoms of normal-pressure hydrocephalus. Conclusions Programmable shunt valves afford the option for non-operative management of acute subdural hematoma in patients with ventricular shunts for normal-pressure hydrocephalus. As illustrated in this case report, increasing the shunt valve pressure may result in rapid resolution of the acute subdural hematoma in some patients.

  19. Bradycardia without hypertension and bradypnea in acute traumatic subdural hematoma is a sensitive predictor of the Cushing triad: 3 case reports

    OpenAIRE

    2016-01-01

    Acute traumatic subdural hematomas (SDHs) are very common. These hematomas are usually neurosurgical emergencies, although conservative therapy is indicated in certain cases. SDH can increase intracranial pressure (ICP) and compress or stretch the brainstem. Lately, it has been recognized that increased ICP can lead to hemodynamic instability and bradycardia. Bradycardia can be an early warning sign in many neurosurgical conditions. We observed bradycardia in serial cases of the patient witho...

  20. Reformatted images improve the detection rate of acute traumatic subdural hematomas on brain CT compared with axial images alone.

    Science.gov (United States)

    Amrhein, Timothy J; Mostertz, William; Matheus, Maria Gisele; Maass-Bolles, Genevieve; Sharma, Komal; Collins, Heather R; Kranz, Peter G

    2017-02-01

    Subdural hematomas (SDHs) comprise a significant percentage of missed intracranial hemorrhage on axial brain CT. SDH detection rates could be improved with the addition of reformatted images. Though performed at some centers, the potential additional diagnostic sensitivity of reformatted images has not yet been investigated. The purpose of our study is to determine if the addition of coronal and sagittal reformatted images to an axial brain CT increases the sensitivity and specificity for detection of acute traumatic SDH. We retrospectively reviewed consecutive brain CTs acquired for acute trauma that contained new SDHs. An equivalent number of normal brain CTs served as control. Paired sets of images were created for each case: (1) axial images only ("axial only") and (2) axial, coronal, sagittal images ("reformat added"). Three readers interpreted both the axial only and companion reformat added for each case, separated by 1 month. Reading times and SDH detection rates were compared. One hundred SDH and 100 negative examinations were collected. Sensitivity and specificity for the axial-only scans were 75.7 and 94.3 %, respectively, compared with 88.3 and 98.3 % for reformat added. There was a 24.3 % false negative (missed SDH) rate with axial-only scans versus 11.7 % with reformat added (p = negatives by greater than 50 %. Reformatted images substantially reduce the number of missed SDHs compared with axial images alone.

  1. Neuroprotective effect of suppression of astrocytic activation by arundic acid on brain injuries in rats with acute subdural hematomas.

    Science.gov (United States)

    Wajima, Daisuke; Nakagawa, Ichiro; Nakase, Hiroyuki; Yonezawa, Taiji

    2013-06-26

    Acute subdural hematoma (ASDH) can cause massive ischemic cerebral blood flow (CBF) underneath the hematoma, but early surgical evacuation of the mass reduces mortality. The aim of this study was to evaluate whether arundic acid improves the secondary ischemic damage induced by ASDH. Our results confirmed that arundic acid decreases the expression of S100 protein produced by activated astrocytes around ischemic lesions due to cytotoxic edema after ASDH as well as reducing infarction volumes and numbers of apoptotic cells around the ischemic lesions. In this study, we also evaluate the relationship of brain edema and the expression of Aquaporin 4 (AQP4) in an ASDH model. The expression of AQP4 was decreased in the acute phase after ASDH. Cytotoxic edema, assumed to be the main cause of ASDH, could also cause ischemic lesions around the edema area. Arundic acid decreased the infarction volume and number of apoptotic cells via suppression of S100 protein expression in ischemic lesions without changing the expression of AQP4.

  2. Significance of monitoring the initial intracranial pressure on hematoma irrigation with trephination therapy for acute subdural hematomas in critical conditions.

    Science.gov (United States)

    Otani, Naoki; Takasato, Yoshio; Masaoka, Hiroyuki; Hayakawa, Takanori; Yoshino, Yoshikazu; Yatsushige, Hiroshi; Miyawaki, Hiroki; Sumiyoshi, Kyoko; Sugawara, Takashi; Chikashi, Aoyagi; Takeuchi, Satoru; Suzuki, Go

    2010-01-01

    Acute subdural hematoma (ASDH) patients presenting in a severe condition tend to have poor outcomes due to the significant brain edema required to maintain the ICP at less than 20-25 mmHg. This study compared the surgical outcomes of 16 critically ill patients with ASDH who underwent hematoma irrigation with trephination therapy (HITT) based on their initial ICP values. The initial mean GCS score upon admission was four. A unilateral dilated pupil was seen in one and bilateral dilated pupils were seen in seven patients. The co-existence of a brain contusion was seen in seven patients, brain swelling was noted in six patients, and both basal cistern effacement and a midline shift greater than 5 mm were observed in all patients. The mean initial ICP value was 45 mmHg (range: 3 to 85 mmHg). Ten patients (62.5%) underwent a rapid external decompression to evacuate the hematoma. By using the Glasgow Outcome Scale upon discharge a score of good recovery (GR) was assigned to two (12.5 %), moderate disability (MD) to four (25.0 %), vegetative state (VS) to two (12.5 %), and death (D) to eight (50.0 %) patients. All six patients who showed an initial ICP greater than 60 mmHg died despite intensive care. Eight patients who showed an initial ICP less than 40 mmHg had a favorable outcome, but two patients deteriorated due to a traumatic cerebrovascular disorder. It seems that the initial ICP monitoring with HITT for ASDH patients in critical condition may be an important factor for predicting both surgical outcome and clinical course.

  3. 婴幼儿急性创伤性硬膜下血肿%Treatment of acute traumatic subdural hematomas in infants

    Institute of Scientific and Technical Information of China (English)

    周建军; 梁平; 李映良; 翟瑄; 周渝冬; 李禄生; 于增鹏; 夏佐中

    2010-01-01

    Objective To investigate the clinical features of acute traumatic subdural hematomas (SDH) in infants and discuss the treatment methods. Methods The clinical features of 48 infants under three years old with acute traumatic SDH admitted from 2002 to 2008 were retrospectively analyzed.Results There were 31 infants under one year old (65%). The most popular injury cause was accidental fall in 37 patients (77%). Of all patients, 12 patients (25%) had disturbance of consciousness,eight ( 17% ) had convulsion and eight ( 17% ) were combined with skull fractures. The treatment methods included craniotomy and evacuation of the blood clot in 18 patients ( including 13 patients underwent instant operation after admission ), burr hole craniotomy and external drainage of the chronic subdural hematoma in seven and conservative management in 23 with small subdural hematomas. All patients obtained good outcome except that two patients had motor dysfunction and one death. Conclusions The incidence of acute traumatic SDH in infants is high, especially in infants under one year old. It is easy to be disregarded at early stage and may deteriorate to chronic subdural hematoma or hydropsy. Early diagnosis and active surgical treatment may attain sound prognosis.%目的 探讨婴幼儿急性创伤性硬膜下血肿临床特点及治疗方法.方法 回顾分析2002-2008年期间收治的年龄<3岁的48例婴幼儿急性创伤性硬膜下血肿的临床特点.结果 婴儿31例,占65%;跌伤37例,占77%;12例(25%)有原发意识障碍,8例(17%)出现抽搐,8例(17%)合并颅骨骨折.18例行开颅血肿清除术(13例入院立即手术),7例行钻孔外引流,23例行保守治疗.1例因脑疝死亡,2例伴肢体运动功能减退,45例治愈.结论 婴幼儿急性创伤性硬膜下血肿发病率较高,尤其是婴儿,早期易被忽视,易转变为慢性硬膜下血肿或积液,早期诊断、积极外科治疗,预后良好.

  4. Acute Traumatic Subdural Hematoma: Surgical Management in the Presence of Cerebral Herniation-A Single-Center Series and Multivariate Analysis.

    Science.gov (United States)

    Hamed, Motaz; Schuss, Patrick; Daher, Frederick H; Borger, Valeri; Güresir, Ági; Vatter, Hartmut; Güresir, Erdem

    2016-10-01

    Traumatic acute subdural hematoma (aSDH) is a severe disease. Surgical treatment is still controversially discussed, especially in patients with additional signs of cerebral herniation. However, previously investigated patient populations were heterogeneous. We therefore performed an analysis of our institutional data in a large homogenous selection of patients with traumatic aSDH to analyze factors determining clinical outcome. Between 2010 and 2014, 196 patients with aSDH underwent surgical treatment in our department. Information including patient characteristics, treatment modality, radiologic features, and functional outcome were analyzed. Outcome was assessed according to the Glasgow Outcome Scale (GOS) at 6 months and was dichotomized into favorable (GOS score, 1-3) and unfavorable (GOS score 4-5) outcome. Furthermore, a multivariate analysis was performed to identify independent predictors of functional outcome. Overall, 26% of patients with aSDH achieved favorable outcome. In further analysis, unilateral or bilateral dilated pupils as a sign of cerebral herniation were present in 47% of the included patients. In the multivariate analysis, age >70 years and the presence of cerebral herniation were significant prognostic predictors for unfavorable outcome in patients with aSDH. However, 15% of patients with aSDH and signs of cerebral herniation achieved favorable outcome during follow-up. We provide detailed data on patients with aSDH and signs of cerebral herniation. Despite mydriasis, favorable outcome may be achieved in many patients. Nevertheless, careful individual decision making is necessary for each patient, especially when signs of cerebral herniation have persisted for a long time. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Risk factors related to hospital mortality in patients with isolated traumatic acute subdural haematoma:analysis of 308 patients undergone surgery

    Institute of Scientific and Technical Information of China (English)

    TIAN Heng-li; CHEN Shi-wen; XU Tao; HU Jin; RONG Bo-ying; WANG Gan; GAO Wen-wei; CHEN Hao

    2008-01-01

    Background Acute subdural haematoma (ASDH) is a common traumatic brain injury with a relatively high mortality rate.However,few studies have examined the factors predicting the outcome of isolated traumatic ASDH.This clinical study examined the hospital mortality and analyzed the risk factors for mortality in patients treated surgically for isolated traumatic ASDH.Methods We collected 308 consecutive patients who underwent neurosurgery for isolated traumatic ASDH between January 1999 and December 2007 and used multivariate Logistic regression analysis to evaluate the influence of 11 clinical variables on hospital mortality.Results The overall hospital mortality was 21.75% (67/308).Age (OR=1.807),preoperative Glasgow Coma Score (OR=0.316),brain herniation (OR=2.181) and the time from trauma to decompression (OR=1.815) were independent predictors of death,while no independent association was observed between hospital mortality and haematoma volume,midline shift,acute brain swelling or brain herniation duration,although these variables were correlated with hospital mortality in univariate analyses.Conclusions This study identified the risk factors for hospital mortality in patients who underwent surgical treatment for isolated traumatic ASDH.An increased risk of dealh occurs in patients who are over 50 years of age and have lower preoperative Glasgow Coma Scores,the presence of brain herniation and a long interval between trauma and decompression.The findings should help clinicians determine management criteria and improve survival.

  6. Encapsulated subdural empyema. A case report with special reference to CT findings and operative indications

    Energy Technology Data Exchange (ETDEWEB)

    Tokunaga, Yoshiharu; Inoue, Masaru; Ishizaka, Hiroaki; Koga, Hiroaki; Kawano, Teruaki; Mori, Kazuo

    1985-04-01

    A case of encapsulated subdural empyema was reported. This 1.5-year-old boy was admitted with the increasing confusion and convulsion. Eight months prior to admission, he had craniotomy for traumatic acute epidural hematoma on the left side. Following a coagulation of the middle meningeal artery which was the bleeding source, the dura was opened but no cortical damage was noted at that time. The computed tomographic (CT) scan on admission revealed a large subdural collection with a thin enhancing rim on the left side. Emergency craniotomy revealed a collection of subdural pus, which was irrigated and a catheter was put for continuous drainage. Postoperatively, the patient did well, however, following removal of the catheter, three weeks after the first operation, the subdural empyema was reexpanded with a very thick enhancing rim on CT scan. Ultrasonography also clearly demonstrated the formation of the thick membranes. The large craniotomy was performed and empyema with the outer and inner memberanes of 8mm thick was totally excised. Post-operative CT scan did not show any enhancing rim, indicating that enchancement was caused by newly formed vessels within the membranes per se. This findings are totally different from those observed in the brain abscess in which ring enhancement on CT continues months to years following so-called extracapsular excision of abscess. In the brain abscess, surrounding glial tissue with plenty neovascularization is left intact, even after the operation. (author).

  7. A Rare Complication of Subdural-peritoneal Shunt: Migration of Catheter Components through the Pelvic Inlet into the Subdural Space.

    Science.gov (United States)

    Çakir, Mürteza; Yilmaz, Atilla; Çalikoğlu, Çağatay

    2017-01-01

    Subdural-peritoneal (SP) shunting is a simple procedure to treat subdural hygromas; however, several rare complications such as shunt migration exist. A 15-year-old boy presented with headache, nausea, and vomiting, and underwent SP shunting for left frontoparietal chronic subdural effusion. Six weeks later, radiographic examinations revealed total migration of the shunt through the pelvic inlet. The migrated shunt was replaced with a new SP shunt. Four weeks later, radiographic examinations revealed shunt migration into the subdural space. The shunt catheter was removed and the subdural effusion was evacuated. Shunt migration may result from pressure differences between the abdomen and the cranium or from head movement, and insufficient fixation and/or large burr holes can facilitate shunt migration. Double firm anchoring and small-sized burr holes can prevent this complication. SP shunt is a simple procedure, and its assumed complications can be prevented through precaution.

  8. Subdural empyema in children.

    Science.gov (United States)

    Hendaus, Mohammed A

    2013-08-14

    Subdural Empyema in infants and children might be life threatening if not managed properly. A search of the Pub Med database was carried out using a combination of the following terms: Subdural empyema, children, and management. Neurosurgical textbooks were reviewed as well. The prevalence, etiology, clinical features, investigations and management of SDE are reviewed in this article. Conservative management with antibiotics and follow up imaging is recommended if there are no focal deficits, change in mental status or if the patient is responding well to antibiotics. Alternatively, craniotomy is warranted in addition to antibiotics therapy. The surgeon might opt for burr holes in case the patient is frail or in septic shock.

  9. Bilateral chronic subdural hematoma

    DEFF Research Database (Denmark)

    Andersen-Ranberg, Nina Christine; Poulsen, Frantz Rom; Bergholt, Bo

    2016-01-01

    OBJECTIVE Bilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors ar...

  10. Is Subdural Peritoneal Shunt Placement an Effective Tool for the Management of Recurrent/Chronic Subdural Hematoma?

    Science.gov (United States)

    Alvarez-Pinzon, Andres M; Valerio, Jose E; Delgado, Victor; Escalante, Jennifer A; Lopez, Nithia; Wolf, Aizik L

    2016-01-01

    Objective  To describe a surgical technique and to report using a retrospective study the efficacy of peritoneal shunts for the treatment of recurrent/chronic subdural hematoma (CSDH). We describe the considerations, complications, and outcomes related to this technique. Methods  In a retrospective cohort study, 125 charts with a diagnosis of subacute/chronic subdural hematoma were assigned for evaluation. Of the charts reviewed, 18 charts were found from subjects with a diagnosis of recurrent sub-acute or chronic subdural hematoma. All patients had undergone initial surgical treatment of their condition followed by peritoneal shunt placement to help alleviate intracranial pressure. Factors including the age, size of subdural hematoma, number of previous events, BMI, complications, survival, and clinical course were analyzed. Results  After subdural peritoneal shunt placement all patients had full neurological recovery with no complaints of headaches, lethargy, weakness, confusion or seizures. None of the cases had new subdural hematoma episodes after placement for a minimum of a two-year period (mean 26.1 months) (range 24.3-48.6 months). No postoperative complications were reported. The rates of postoperative hemorrhage, infection, distal catheter revision, and perioperative seizures was found to be zero percent. Shunt drainage was successful in all cases, draining 85% of the blood in the first 48 hours. There was no significant relationship between complications and the use of anticoagulants four weeks after surgery. Conclusions Peritoneal shunts, though rarely used, are a viable option in the treatment of sub-acute/chronic subdural hematomas. When pursuing this treatment, this technique is recommended to mitigate the risks of repeat surgical intervention and lessen perioperative time in high-risk patients. PMID:27335718

  11. Polymicrobial subdural empyema

    DEFF Research Database (Denmark)

    Greve, Thomas; Clemmensen, Dorte; Ridderberg, Winnie

    2011-01-01

    The authors report a case of a subdural empyema (SDE) caused by a coinfection with Streptococcus intermedius and Streptococcus pneumoniae, initially considered a S. intermedius infection only. An otherwise healthy 11-year-old female was admitted to the hospital after 5 days of illness. Symptoms....... The empyema was evacuated twice, day 8 and 18, with good results. Primary samples showed growth of S. intermedius only. The severity of the clinical picture elicited supplementary samples, which were additionally positive for S. pneumoniae by an in-house specific lytA PCR and/or a commercial antigen test....

  12. Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

    Directory of Open Access Journals (Sweden)

    Shusuke Yamamoto

    2015-01-01

    Full Text Available We present a very rare case of a patient with an infected subdural hematoma due to Propionibacterium acnes. A 63-year-old male complained of dizziness and was admitted to our hospital. He had a history of left chronic subdural hematoma due to a traffic accident, which had been conservatively treated. Physical, neurological and laboratory examinations revealed no definite abnormality. Plain CT scan demonstrated a hypodense crescentic fluid collection over the surface of the left cerebral hemisphere. The patient was diagnosed with chronic subdural hematoma and underwent burr hole surgery three times and selective embolization of the middle meningeal artery, but the lesion easily recurred. Repeated culture examinations of white sedimentation detected P. acnes. Therefore, he underwent craniotomy surgery followed by intravenous administration of antibiotics. The infected subdural hematoma was covered with a thick, yellowish outer membrane, and the large volume of pus and hematoma was removed. However, the lesion recurred again and a low-density area developed in the left frontal lobe. Craniotomy surgery was performed a second time, and two Penrose drainages were put in both the epidural and subdural spaces. Subsequently, the lesions completely resolved and he was discharged without any neurological deficits. Infected subdural hematoma may be refractory to burr hole surgery or craniotomy alone, in which case aggressive treatment with craniotomy and continuous drainage should be indicated before the brain parenchyma suffers irreversible damage.

  13. 急性硬膜下血肿短时自动消散现象及相关分析%Short-term auto-dissipation phenomena and related analysis of acute subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    李强; 赵佃林

    2012-01-01

    目的 剖析外伤性急性硬脑膜下血肿短时自动消散现象的伤因、病理及其相关因素.方法 对2006年2月~2012年1月我院12例短时自动消散急性硬脑膜下血肿的临床特点、动态CT扫描结果、治疗方法及预后效果进行分析.结果 12例患者均采取非手术治疗,头颅CT显示血肿均在3 d内消失,4例患者伤后5 h以内血肿完全吸收,5~24 h以内血肿吸收患者3例,第2天血肿吸收患者3例,第3天血肿吸收患者2例,吸收时间最短为4 h,中线结构恢复,脑室、脑池清楚,出院后无神经系统功能障碍.结论 急性硬脑膜下血肿短时自动消散是血液的重新分布,不但跟血肿形态、部位、密度和血肿量有关,而且受蛛网膜破裂、适当的高颅压、脑萎缩和伴有硬膜破裂的颅骨骨折等相关因素影响.%Objective To analyze the cause of injury, pathology and relevant factors of the phenomenon of traumatic acute subdural hematoma short term automatic lift. Methods 12 patients with traumatic acute subdural hematoma short term automatic lift were analysed on clinical characteristics, dynamic CT scans, treatment and prognosis effect. Results 12 patients were adopted in the nonoperative treatment, the CT scan showed the hematoma disappeared within 3 days, 4 patients within 5 h after injury had hematoma absorption, 3 cases within 5-24 hours after injury had hematoma absoiplion, 3 cases had hematoma absorption on the next day, 2 cases had hematoma absorption on the third day, the shortest time of absorption were 4 h, the midline structures were recovered, the vutricle and cisternal were cleared. All patients had no autonomic nervous system after hospital. Conclusion The acute subdural hematoma short-term automatic lift is a redistribution of blood, not only with the hematoma shape, location, density, and hematoma volume, but also by the arachnoid rupture, high in-tracranial pressure, cerebral atrophy and associated subdural rupture of

  14. Subdural hydatid cyst presenting as recurrent subdural hygroma

    Science.gov (United States)

    Wani, Abrar A.; Ramzan, Altaf U.; Nizami, Furqan A.; Malik, Nayil K.; Dar, Bashir; Kumar, Ashish

    2016-01-01

    Intracranial hydatid disease is an uncommon entity that usually is parenchymal in location. Presence of hydatid cyst in subdural location is being reported for the first time in the literature. A 13-year-old female child with the diagnosis of hydatid disease of brain was operated. She was advised to take albendazole which she did not take. In postoperative period she developed recurrent subdural hygroma for which multiple surgical interventions were done and finally cause of recurrent subdural hygroma was found to be hydatid cyst in the subdural space. The patient had initially undergone craniotomy for the excision of hydatid cyst. Later on she developed subdural hygroma for which the burr hole drainage was done twice. At time of third recurrence subduro-peritoneal (SDP) shunt was done. When she had recurrence again along with hydrocephalus, than VP shunt and revision of the SDP shunt was planned. While doing revision of SDP shunt, hydatid cyst was seen emerging from the burr hole site. A craniotomy was done to remove the hydatid cyst from the subdural space. Since then there has been no recurrent collection. Complete surgical excision is the best treatment modality to treat hydatid cyst of brain. Accidental spillage of the contents can have lead to recurrence, so every effort must be taken to prevent spillage of contents. Postoperatively all the patients must be put on antihelminthics. PMID:27366285

  15. Acute subdural hematoma and diffuse axonal injury in fatal road traffic accident victims: a clinico-pathological study of 15 patients Hematoma subdural agudo e lesão axonal difusa em vítimas fatais de acidente de trânsito: estudo clínico-patológico de 15 pacientes

    Directory of Open Access Journals (Sweden)

    Sebastião Nataniel Silva Gusmão

    2003-09-01

    Full Text Available OBJECTIVE: Although acute subdural hematoma (ASDH and diffuse axonal injury (DAI are commonly associated in victims of head injury due to road traffic accidents, there are only two clinico-pathological studies of this association. We report a clinical and pathological study of 15 patients with ASDH associated with DAI. METHOD: The patients were victims of road traffic accidents and were randomly chosen. The state of consciousness on hospital admission was evaluated by the Glasgow coma scale. For the identification of axons the histological sections of the brain were stained with anti-neurofilament proteins. RESULTS: Twelve of the 15 patients were admitted to hospital in a state of coma; in three patients, the level of consciousness was not evaluated, as they died before hospital admission. CONCLUSION: The poorer prognosis in patients with ASDH who lapse into coma immediately after sustaining a head injury, as described by several authors, can be explained by the almost constant association between ASDH and DAI in victims of fatal road traffic accidents.OBJETIVO: Embora o hematoma subdural agudo (HSDA e a lesão axonal difusa (LAD estejam frequentemente associados em vítimas de trauma crânio-encefálico causado por acidentes de trânsito, há somente dois estudos clínico-patológicos sobre esta associação. Relatamos o estudo clínico-patológico de 15 pacientes com HSDA associado com LAD. MÉTODO: Os pacientes, vítimas de acidentes de trânsito, foram selecionados aleatoriamente. O estado de consciência à admissão hospitalar foi avaliado pela escala de coma de Glasgow. Para a identificação dos axônios, os cortes histológicos do cérebro foram corados com antisoro anti-proteínas do neurofilamento. RESULTADOS: Doze dos 15 pacientes foram admitidos no hospital em estado de coma; em três pacientes, o nível de consciência não foi avaliado, pois eles faleceram antes da admissão hospitalar. CONCLUSÃO: O pior prognóstico em pacientes

  16. Spontaneous bilateral subdural haematomas in the posterior cranial fossa revealed by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Pollo, C.; Porchet, F. [Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne (Switzerland); Meuli, R. [Department of Radiology, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne (Switzerland)

    2003-08-01

    A 52-year-old woman treated for acute myeloproliferative disease developed progressive stupor. CT showed obstructive hydrocephalus resulting from unexplained mass effect on the fourth ventricle. MRI revealed bilateral extra-axial collections in the posterior cranial fossa, giving high signal on T1- and T2-weighted images, suggesting subacute subdural haematomas. Subdural haematomas can be suspected on CT when there is unexplained mass effect. MRI may be essential to confirm the diagnosis and plan appropriate treatment. (orig.)

  17. Compressive brainstem deformation resulting from subdural hygroma after neurosurgery: a case report

    Institute of Scientific and Technical Information of China (English)

    YU Shu-qing; WANG Ji-sheng; JI Nan

    2008-01-01

    @@ Acute and chronic subdural hygromas are common postoperative clinical complications of ventricular shunting, arachnoid cyst marsupialization and arachnoid cyst resection.1 This article introduces a case of subdural hygroma after resection of a space-occupying lesion in the left lateral ventricle that resulted in compressive brainstem deformation and reviewed the recent related literature. The conclusion is that in related surgical procedures, prevention of rapid cerebrospinal fluid loss and excessive fluctuations in intracranial pressure are especially important.

  18. Gerstmann's syndrome associated with chronic subdural haematoma: a case report.

    Science.gov (United States)

    Maeshima, S; Okumura, Y; Nakai, K; Itakura, T; Komai, N

    1998-08-01

    We report a patient who exhibited Gerstmann's syndrome in association with a chronic subdural haematoma. A 71-year-old right-handed woman presented with mild right arm and leg weakness that began 2 weeks prior to admission. Neurological examination on admission revealed a mild right hemiparesis. Neuropsychological examination revealed right-left disorientation, finger agnosia, agraphia, and acalculia, but no language disturbance. A computerized tomographic (CT) scan revealed a large left frontoparietal, extra-axial hypodense fluid collection containing scattered hypodense foci. A left parietal evacuation of the haematoma was performed. Following surgery the patient dramatically improved. We suggest that the direct compression by the chronic subdural haematoma or a hemispheric pressure difference caused Gerstmann's syndrome. This is an unusual report of a Gerstmann's syndrome following chronic subdural haematoma.

  19. Mozart's chronic subdural hematoma.

    Science.gov (United States)

    Drake, M E

    1993-11-01

    No commemoration of the bicentennial of Mozart's death would be complete without some consideration of that premature yet predictable demise. Mozart's premonitions of death are well known and apparently played a role in the composition of the K.626 Requiem and perhaps other works. His death has traditionally been ascribed to infectious causes, chiefly rheumatic fever or post-streptococcal glomerulonephritis, exacerbated by intemperance and chronic penury. Pathology has been difficult because of his supposed burial in a pauper's grave, the location and contents of which were later supposedly lost. Mozart's burial place in St. Mark's Cemetery in Vienna was known and, in the parlance of the day, "reorganized" a decade later, as the occupants of plots were disinterred to make room for the more recently decreased. A skull believed to the Mozart's was saved by the successor of the gravedigger who had supervised Mozart's burial, and then passed into the collections of the anatomist Josef Hyrtl, the municipality of Salzburg, and the Mozarteum museum (Salzburg). Forensic reconstruction of soft tissues related to this skull reveals substantial concordance with Mozart's portraits. The skull suggests premature closure of the metopic suture, which has been suggested on the basis of his physiognomy. A left temporal fracture and concomitant erosions raise the question of chronic subdural hematoma, which would be consistent with several falls in 1789 and 1790 and could have caused the weakness, headaches, and fainting he experienced in 1790 and 1791. Aggressive bloodletting to treat suspected rheumatic fever could have decompensated such a lesion to produce his death on December 5, 1791.

  20. Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma

    Directory of Open Access Journals (Sweden)

    Sasikala P.

    2014-03-01

    Full Text Available Movement disorders are atypical and rare presentation of chronic subdural hematomas. We report a case of 60 year man who presented with intention tremors and altered sensorium. The patient had Kernohan-Woltman notch phenomenon on clinical examination. CT scan brain showed a large left fronto-temporo-parietal chronic subdural hematoma with significant mass effect and midline shift. His symptoms relieved completely after surgical evacuation of the hematoma.

  1. [Computed tomographic semiotics of chronic subdural hematomas].

    Science.gov (United States)

    El'-Kadi, Kh A; Likhterman, L B; Kornichenko, V N

    1990-01-01

    Analysis of the results of investigation of 72 patients with verified chronic subdural hematomas (CSH) has revealed their CT dense characteristics, the peculiarities of their structure compared with the time of their formation, the patients' age, the clinical stage of disease, and operative findings. Direct and indirect CT signs of uni- and bilateral hemispherical chronic subdural hematomas were described.

  2. Postoperative course of chronic subdural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Toshiaki; Tsubone, Kyoji; Kyuma, Yoshikazu; Kuwabara, Takeo (Yokohama City Univ. (Japan). Faculty of Medicine)

    1983-10-01

    1) Fourty cases of chronic subdural hematoma were operated on by trephination, irrigation and external drainage. Postoperative neurological recovery and decrease of hematoma cavity on CT scan were followed. 2) Operations were effective for recovery of neurological grade in 28 cases, moderately effective in 7 cases and not effective in 5 cases. 3) Within the tenth postoperative day, more than half residual hematoma cavity existed in 53% of examined cases. After that, more than half residual cavity existed in only 17%. 4) Preoperative feature of neurologically unimproved cases were no definite history of head trauma and water like low density of hematoma cavity. Postoperative feature was persistence of more than three fourth of residual hematoma cavity on CT scan. 5) A group of unimproved cases described above are thought to have a feature of subdural hygroma rather than subdural hematoma. When possibility of subdural hygroma is high in preoperative differential diagnosis, indication of operation should be different from chronic subdural hematoma.

  3. Do cranial subdural hematomas migrate to the lumbar spine?

    Science.gov (United States)

    Moscovici, S; Paldor, I; Ramirez de-Noriega, F; Itshayek, E; Shoshan, Y; Spektor, S; Attia, M

    2011-04-01

    We report a patient with minor head trauma-related bilateral hemispheric subdural hematoma (SDH) and subsequent delayed spinal SDH or presumed migration to the lumbar spine. An acutely confused 88-year-old man presented to the Emergency Department after minor head trauma. Head CT scan revealed a small hemispheric SDH. The patient was admitted for observation. CT scan 6 hours later showed bilateral SDH with extension to the tentorium. Three days later SDH had resolved leaving bilateral subdural hygromas. Local leg weakness localized to the lumbar spine developed on day 6; spinal CT scan and MRI revealed a posterior L5-S1 collection. A pure subacute subdural hematoma compressing the cauda equina was drained after an L5 laminectomy. His lower leg weakness improved. The patient was discharged to rehabilitation two weeks after surgery. Patients with traumatic SDH who develop late-onset neurological deterioration attributable to any region of the spine should be evaluated for spinal SDH. Copyright © 2010 Elsevier Ltd. All rights reserved.

  4. History of Chronic Subdural Hematoma

    Science.gov (United States)

    2015-01-01

    Trephination or trepanation is an intentional surgical procedure performed from the Stone Age. It looks like escaping a black evil from the head. This technique is still used for treatment of chronic subdural hematoma (SDH). Now, we know the origin, pathogenesis and natural history of this lesion. The author try to explore the history of trephination and modern discovery of chronic SDH. The author performed a detailed electronic search of PubMed. By the key word of chronic SDH, 2,593 articles were found without language restriction in May 2015. The author reviewed the fact and way, discovering the present knowledge on the chronic SDH. The first authentic report of chronic SDH was that of Wepfer in 1657. Chronic SDH was regarded as a stroke in 17th century. It was changed as an inflammatory disease in 19th century by Virchow, and became a traumatic lesion in 20th century. However, trauma is not necessary in many cases of chronic SDHs. The more important prerequisite is sufficient potential subdural space, degeneration of the brain. Modifying Virchow's description, chronic SDH is sometimes traumatic, but most often caused by severe degeneration of the brain. From Wepfer's first description, nearly 350 years passed to explore the origin, pathogenesis, and fate of chronic SDH. The nature of the black evil in the head of the Stone Age is uncovering by many authors riding the giant's shoulder. Chronic SDH should be categorized as a degenerative lesion instead of a traumatic lesion. PMID:27169062

  5. Subdural injection: report of two cases

    Directory of Open Access Journals (Sweden)

    Cadavid-Puentes, Adriana

    2016-10-01

    Full Text Available Two cases are reported of accidental subdural injection during epidural procedures for pain control. The first one was a man with chronic lumbar pain who suffered such complication during an epidural injection of steroids using the interlaminar approach. The second one was a woman with intracranial hypotension syndrome who required the application of an epidural blood patch in order to control multiple CSF fistulae. The procedure had to be aborted twice due to the subdural pattern observed after injection of the contrast medium. Accidental subdural block is a rare complication of epidural injection for analgesic or anesthetic procedures.

  6. [Targeted small craniotomy and evacuation for subscute subdural hematomas: technical report of two cases].

    Science.gov (United States)

    Tanaka, Masaki; Kurita, Hiroki; Shiokawa, Yoshiaki

    2005-02-01

    The etiology and proper treatment of symptomatic subacute subdural hematomas remains to be elucidated. We describe two cases of this entity successfully treated with small craniotomy and evacuation. Both patients initially treated conservatively for traumatic thin subdural hematomas because of poor medical condition and mild neurological symptoms, but suffered abrupt neurological deterioration between 2 and 3 weeks after the admission. CT scan showed decreased density of hematomas with minimal increase in volume, and significant swelling of ipsilateral cerebral hemisphere. Urgent two-burr-hole small craniotomy was effective for evacuation of partially organized hematoma. During surgery, definite hematoma membrane was not confirmed. Postoperatively, brain swelling rapidly disappeared and both patients discharged ambulatory without neurological deficit. The present cases are a reminder of this peculiar type of hematoma in patients with delayed neurological deterioration after nonsurgical management of acute subdural hematoma. The rationale for use of small craniotomy is discussed in terms of current understanding of pathogenetic mechanism for this unusual condition.

  7. Relationship Between the Compression Degree of Cerebral Crural Cistern and Ambient Cistern and Prognosis in Patients with Traumatic Unilateral Acute Subdural Hematoma%创伤性单侧急性硬膜下血肿患者大脑脚池、环池受压程度与预后的关系

    Institute of Scientific and Technical Information of China (English)

    黄俊强; 杨立坚; 刘志雄

    2013-01-01

    [Objective]To explore the relationship between the compression degree of bilateral crural cisterns and ambient cisterns and prognosis in patients with traumatic unilateral acute subdural hematoma. [Methods]A total of 50 patients with traumatic unilateral acute subdural hematoma in our hospital were analyzed retrospectively. The compression degree of bilateral crural cisterns and ambient cisterns of patients were measured. GOS of patients during follow up was scored 6 months after injury. All data was analyzed by using SPSS 17. 0 software. [Results]The compression degree of ipsilateral and contralateral crural cisterns and ipsi-lateral and contralateral ambient cisterns were negatively correlated with the prognosis of patients( P <0. 05). The spearman correlation coefficient was -0. 869, -0. 689, -0. 577 and -0. 605, respectively. [Conclu-sion]The compression degree of four cisterns of patients with traumatic unilateral acute subdural hematoma is obviously correlated with the prognosis, and plays an important role in the evaluation of prognosis.%[目的]探讨创伤性单侧急性硬膜下血肿患者双侧大脑脚池、环池受压程度及与预后的关系.[方法]对本院50例创伤性单侧急性硬膜下血肿患者进行回顾性研究,测量患者双侧大脑脚池、环池受压程度,随访患者伤后6个月GOS评分,运用SPSS 17.0统计软件进行分析.[结果]血肿同侧大脑脚池、对侧大脑脚池、同侧环池、对侧环池这四个中脑周围池受压的程度均与患者预后呈负相关(P <0.05),spearman相关系数为分别为-0.869,-0.689、-0.577、-0.605.[结论]创伤性单侧急性硬膜下血肿患者中脑周围四个脑池受压程度与患者预后有明显相关关系,对于患者预后的评价有重大意义.

  8. [Transformation from chronic subdural hematoma into subdural empyema following cat bites: a case report].

    Science.gov (United States)

    Konno, Takuya; Yamada, Kei; Kasahara, Sou; Umeda, Yoshitaka; Oyake, Mutsuo; Fujita, Nobuya

    2015-01-01

    A 69-year-old man developed motor aphasia and right hemiparesis with severe headache, during the treatment of cellulitis and sepsis due to cat bites. Brain CT showed a low density, crescent-shaped lesion in the left subdural space, which was hypointense on brain diffusion-weighted imaging (DWI). One week later, when his neurological symptoms had worsened, the signal of the subdural lesion had changed to hyperintense on DWI. The lesion was capsule-shaped when enhanced by Gadolinium. The signal changes on DWI of the lesion indicated the existing hematoma had changed to an empyema, or so-called infected subdural hematoma, due to a hematogenous bacterial infection. Pasteurella multocida, a resident microbe in the oral cavity of cats, could be the responsible pathogen in this case. The patient recovered completely after treatment with intravenous high dose antibiotics. This is an important case report describing the transformation from a chronic subdural hematoma into a subdural empyema by DWI.

  9. A case of acoustic neurinoma associated with chronic subdural hematoma after gamma knife radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Sho, Atsuko; Asaeda, Masahiro; Ohtake, Minoru [Tottori Univ., Yonago (Japan). Inst. of Neurological Sciences] [and others

    2002-09-01

    A 72-year-old female presented with a unique case of acoustic neurinoma with a cystic component followed by the chronic subdural hematoma manifesting as trigeminal neuralgia, facial palsy and trunchal ataxia 7 months after gamma knife radiosurgery. Magnetic resonance imaging demonstrated a loss of central contrast enhancement at the postoperative residual tumor mass and a large cyst associated with a hematoma in the subdural space. A right suboccipital craniectomy was performed. A biopsy of the mass and the membrane was performed following aspiration of the brown-reddish fluid collection. The histological diagnosis was acoustic neurinoma with a hemorrhagic necrosis. The membranous tissue mimicked an outer membrane obtained from chronic subdural hematoma. The postoperative course was satisfactory and preoperative symptom have been alleviated. In this case, the chronic subdural hematoma occurred at posterior fossa during the development of cysts caused by the radiosurgery, because the subdural space had been connected with the subarachnoid space after the first operation. The development of cysts or hematoma should be taken into consideration as possible complications following treatment with gamma knife radiosurgery for acoustic neurinomas. (author)

  10. Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Chung Dae; Song, Chang Joon; Lee, Jeong Eun; Choi, Seung Won [Chungnam National University, Daejeon (Korea, Republic of)

    2009-02-15

    Spinal subdural hematoma is a rare disease. Simultaneous intracranial and spinal subdural hematoma is extremely rare and only 14 such cases have been reported. We report here on two cases of simultaneous intracranial and spinal subdural hematoma that occurred following a fall-down head injury and intracranial surgery, and we discuss the pathogenesis of the disease.

  11. Cerebral cysticercus granuloma associated with a subdural effusion.

    Directory of Open Access Journals (Sweden)

    Rajshekhar V

    2001-04-01

    Full Text Available The association of a solitary cerebral cysticercus granuloma with a subdural effusion is being reported. The granuloma and the effusion resolved following albendazole therapy. We speculate that the spread of the inflammatory changes around the granuloma to the subdural space could have led to the development of the subdural effusion.

  12. Spinal subdural hematoma following meningioma removal operation.

    Science.gov (United States)

    Jun, Hyo Sub; Oh, Jae Keun; Park, Young Seok; Song, Joon Ho

    2014-03-01

    Although blood contamination of cerebrospinal fluid (CSF) after an intracranial operation can occur, the development of a symptomatic spinal hematoma after craniotomy has been anecdotally reported and it is uncommon reported after a supratentorial meningioma removal operation. We report a case of spinal subdural hematoma following a supratentorial meningioma removal operation and discuss the mechanism of spinal subdural hematoma (SSDH) development. A 54-year-old woman presented with lumbago and radicular pain on both legs 4 days after a right parietooccipital craniotomy for meningioma removal. Only the straight leg raising sign was positive on neurologic examination but the magnetic resonance imaging (MRI) demonstrated a lumbosacral spinal subdural hematoma. The patient received serial lumbar tapping, after which her symptoms showed improvement.

  13. Reversible Parkinsonism secondary to chronic subdural hematoma

    Directory of Open Access Journals (Sweden)

    Wajid Nazir Wani

    2013-01-01

    Full Text Available Secondary parkinsonism is attributable to a wide variety of causes including supratentorial mass lesions. While tumors are known to present with parkinsonism, chronic subdural hematoma is rarely seen presenting as rapidly deteriorating parkinsonian features with complete disappearance following evacuation of hematoma. The authors present two such patients-70- and 78-year-old males who presented with sudden onset of parkinsonism features. Both failed to recollect any significant head injury. Imaging diagnosed the presence of chronic subdural hematomas, being unilateral in one and bilateral in other. Surgical evacuation resulted in complete resolution of parkinsonian symptoms. These cases reinforce earlier studies for chronic subdural hematoma to be one of the causes of reversible parkinsonism apparently from distortion of basal ganglia mechanically and bringing changes in dopaminergic function, harming the susceptible aging brain.

  14. Small subdural hemorrhages: is routine intensive care unit admission necessary?

    Science.gov (United States)

    Albertine, Paul; Borofsky, Samuel; Brown, Derek; Patel, Smita; Lee, Woojin; Caputy, Anthony; Taheri, M Reza

    2016-03-01

    With advancing technology, the sensitivity of computed tomography (CT) for the detection of subdural hematoma (SDH) continues to improve. In some cases, the finding is limited to one or 2 images of the CT examination. At our institution, all patients with an SDH require intensive care unit (ICU) admission, regardless of size. In this report, we tested the hypothesis that patients with a small traumatic SDH on their presenting CT examination do not require the intensive monitoring offered in the ICU and can instead be managed on a hospital unit with a lower level of monitoring. This is a retrospective study of patients evaluated and treated at a level I trauma center for acute traumatic intracranial hemorrhage between 2011 and 2014. The clinical and imaging profile of 87 patients with traumatic SDH were studied. Patients with small isolated traumatic subdural hemorrhage (tSDH) (medical stability during hospitalization, and did not require any neurosurgical intervention. It is our recommendation that patients with isolated tSDH (medical decline (4%) and neurologic decline (4%) but may still benefit from ICU observation. Patients with tSDH greater than 10 cm(3) overall demonstrated poor clinical courses and outcome and would benefit ICU monitoring.

  15. PATOBIOLOGÍA DEL HEMATOMA SUBDURAL CRÓNICO.

    Directory of Open Access Journals (Sweden)

    Rubén Sabogal Barrios

    2008-01-01

    Full Text Available Treatment of subdural cronic hematoma in all ages is a therapeutic challenge. Chronic subdural hematoma is a disease that can be fatal without surgical treatment. A variety of treatment options like subdural tapping, endoscopic washout, shunting and craniotomy have been discussed. In chronic subdural hematoma, spontaneous resolution with conservative treatment is not an common therapeutic method because it has causes high mortality, requires long periods of time, and finally, many patients need surgical treatment. The etiology, physiopathology and surgical alternatives in the treatment of subdural chronic hematoma is discussed.

  16. Recurrence of Subdural Haematoma in a Population-Based Cohort - Risks and Predictive Factors.

    Directory of Open Access Journals (Sweden)

    Linnea Schmidt

    Full Text Available To estimate the risks of and identify predictors for recurrent subdural haematoma in surgically and conservatively treated patients.The cohort comprised all individuals diagnosed with a first-time subdural hematoma in Denmark 1996-2011. Information on potential predictors was retrieved from the Danish health registers. Cumulative recurrence risks were estimated using the Aalen-Johansen estimator. Rate ratios (RR were estimated using Poisson regression.Among 10,158 individuals with a subdural hematoma, 1,555 had a recurrent event. The cumulative risk of recurrent subdural hematoma was 9% at 4 weeks after the primary bleeding, increasing to and stabilising at 14% after one year. Predictors associated with recurrence were: Male sex (RR 1.60, 95% CI:1.43-1.80, older age (>70 years compared to 20-49 years; RR 1.41, 95% CI: 1.21-1.65, alcohol addiction (RR 1.20, 95% CI:1.04-1.37, surgical treatment (RR 1.76, 95% CI:1.58-1.96, trauma diagnoses (RR 1.14, 95% CI:1.03-1.27, and diabetes mellitus (RR 1.40, 95% CI:1.11-1.74. Out of a selected combination of risk factors, the highest cumulative 1-year recurrence risks for subdural hematoma of 25% (compared to 14% for all patients was found in surgically treated males with diabetes mellitus.The recurrence risk of subdural hematoma is largely limited to the first year. Patient characteristics including co-morbidities greatly influence the recurrence risk of SDH, suggesting that individualized prognostic guidance and follow-up is needed.

  17. Subdural hematoma cases identified through a Danish patient register

    DEFF Research Database (Denmark)

    Poulsen, Frantz Rom; Halle, Bo; Pottegård, Anton;

    2016-01-01

    PURPOSE: This study aimed to assess the usefulness of Danish patient registers for epidemiological studies of subdural hematoma (SDH) and to describe clinical characteristics of validated cases. METHODS: Using a patient register covering a geographically defined area in Denmark, we retrieved...... moderate for patients recorded under code I620 (62%). cSDH represented 57% of verified cases, and aSDH the remaining 43%. cSDH differed markedly from aSDH with regard to a number of clinical characteristics, including a much lower mortality (OR 0.2, 95%CI 0.1-0.3). However, preadmission antithrombotic drug...... hospital contacts recorded under SDH International Classification of Diseases version 10 codes S065 and I620 in 2000-2012. Neurosurgeons reviewed medical records of all potential cases. Based on brain scan results, verified cases were classified by SDH type (chronic SDH (cSDH) or acute SDH (aSDH)). Thirty...

  18. Spontaneous resolution of acute traumatic subdural hematoma: a report of 12 cases and literature review%外伤性急性硬膜下血肿快速自行消散12例报道及文献复习

    Institute of Scientific and Technical Information of China (English)

    范志泉; 吴仰宗; 林元相; 邓志鸿

    2015-01-01

    目的 总结外伤性急性硬膜下血肿快速消散的临床资料、诊疗经过,复习相关文献以提高对本病的认识. 方法 回顾性分析福建省龙岩市第二医院神经外科自2005年6月至2014年6月收治的病史和发病时间明确、临床资料完整的急性硬膜下血肿快速消散患者12例的临床资料,总结分析其治疗和预后. 结果 所有患者均采用非手术治疗,伤后24 h内血肿完全消失4例,明显减少8例.所有患者伤后72 h内血肿完全消失.患者平均住院时间18d.预后良好,出院时神经系统功能无缺损. 结论 对神志清楚、中线移位<5 mm、血肿厚度均<10 mm且无环池明显受压或消失的急性硬膜下血肿患者可以严密观察病情,动态CT监测.其快速消散的机制可能与脑脊液对血肿的稀释和颅骨骨折有关.%Objective To analyze the clinical data and treatment of spontaneous resolution of acute traumatic subdural hematoma,and review the relative literatures to improve the knowledge of the disease.Methods The clinical manifestation,images,treatment and prognosis of 12 patients with spontaneous resolution of acute traumatic subdural hematoma,admitted to our hospital from June 2005 to June 2014,were concluded and analyzed.Results Non-surgical treatment was adopted in all the patients;complete obliteration ofhematoma within 24 h of injury was noted in 4 and obvious decrease was noted in 8;complete obliteration of hematoma in all patients was achieved within 72 h of injury.Average days of hospitalization was 18.All patients enjoyed good prognosis and no system function defects were noted at discharge.Conclusion Patients with acute traumatic subdural hematoma of sane,middle shift<5 mm,hematoma thickness<10 mm and no cistema apparent oppression or disappearance may need conservation management with close clinical observation and dynamic CT images.Whose possible mechanisms of spontaneous resolutionmay might be associated with the

  19. Association of Antithrombotic Drug Use With Subdural Hematoma Risk

    DEFF Research Database (Denmark)

    Gaist, David; Rodríguez, Luis Alberto García; Hellfritzsch, Maja

    2017-01-01

    Importance: Incidence of subdural hematoma has been reported to be increasing. To what extent this is related to increasing use of antithrombotic drugs is unknown. Objectives: To estimate the association between use of antithrombotic drugs and subdural hematoma risk and determine trends in subdural...... with antithrombotic drug use, subdural hematoma incidence rate, and annual prevalence of treatment with antithrombotic drugs. Results: Among 10 010 patients with subdural hematoma (mean age, 69.2 years; 3462 women [34.6%]), 47.3% were taking antithrombotic medications. Current use of low-dose aspirin (cases: 26...... hematoma incidence and antithrombotic drug use in the general population. Design, Setting, and Participants: Case-control study of 10 010 patients aged 20 to 89 years with a first-ever subdural hematoma principal discharge diagnosis from 2000 to 2015 matched by age, sex, and calendar year to 400...

  20. Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

    Directory of Open Access Journals (Sweden)

    Patrick Mulligan

    2013-01-01

    Full Text Available Background: Subdural hematoma (SDH is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005, yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44% were discharged home, 16 (36% discharged to nursing home or rehab, 6 (13% to hospice and 3 (7% died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

  1. Ictal kissing with subdural EEG recording.

    Science.gov (United States)

    Alsemari, Abdulaziz; Alotaibi, Faisal; Baz, Salah

    2013-01-01

    Ictal kissing has been described in the literature. Five cases were reported and associated with temporal lobe epilepsy lateralizing to the nondominant hemisphere. A case of ictal kissing was identified. The aim was to demonstrate the clinical, clinical and electrophysiological features (as recorded by subdural electrodes). The surgical procedure, histopathology, and imaging data were reviewed and correlated with the literature. A 29-year-old right-handed female, who presented with ictal right hand left arm dystonic posturing, and lip smacking, was studied. The automatism was usually followed by prolonged emotional gestures and by hugging and kissing her relative and/or attendant nurse. Magnetic resonance imaging of the brain showed right small cortical and subcortical lesions of the right inferior frontal lobe with gliosis but without mass effect and normal-sized hippocampi. The PET scan showed hypometabolism of the right temporal lobe. Neuropsychological evaluation showed deficit in her nonverbal memory. The subdural electrodes showed high amplitude spikes over right mesial temporal lobe strips. The offsite of the ictal discharges was usually at the right frontal strips. Right standard temporal lobectomy with amygdalohippocampectomy and right inferior frontal lesionectomy were performed. The patient continued to be seizure-free for one year postoperatively. Our case report supports with subdural EEG recording the findings of the few reported cases of ictal kissing behavior lateralized to the nondominant hemisphere. However, the affectionate kissing behavior was associated with spread of the epileptic discharges to the right frontal lobe.

  2. Association of Antithrombotic Drug Use With Subdural Hematoma Risk

    DEFF Research Database (Denmark)

    Gaist, David; Rodríguez, Luis Alberto García; Hellfritzsch, Maja

    2017-01-01

    Importance: Incidence of subdural hematoma has been reported to be increasing. To what extent this is related to increasing use of antithrombotic drugs is unknown. Objectives: To estimate the association between use of antithrombotic drugs and subdural hematoma risk and determine trends in subdural...... hematoma incidence and antithrombotic drug use in the general population. Design, Setting, and Participants: Case-control study of 10 010 patients aged 20 to 89 years with a first-ever subdural hematoma principal discharge diagnosis from 2000 to 2015 matched by age, sex, and calendar year to 400...... 380 individuals from the general population (controls). Subdural hematoma incidence and antithrombotic drug use was identified using population-based regional data (population: 484 346) and national data (population: 5.2 million) from Denmark. Conditional logistic regression models were used to estimate odds...

  3. Extramedullary Hematopoiesis: An Unusual Finding in Subdural Hematomas

    Directory of Open Access Journals (Sweden)

    Rong Li

    2011-01-01

    Full Text Available We present a case of a 59-year-old man who was found to have clusters of hyperchromatic, small, round nucleated cells within a subdural hematoma removed after a skull fracture. Immunohistochemistry study confirmed that the cells were hematopoietic components predominantly composed of normoblasts. In this paper, we describe the clinical and pathological findings. A brief review of published information on extramedullary hematopoiesis in subdural hematoma and the mechanisms of pathogenesis are also discussed. While extramedullary hematopoiesis is seen anecdotally by neuropathologists in chronic subdural hematomas, only a few cases are documented in the literature. Furthermore, extramedullary hematopoiesis in subdural hematoma can pose a diagnostic challenge for general pathologists who encounter subdural hematoma evacuations seldom in their surgical pathology practices.

  4. Spinal Subdural Staphylococcus Aureus Abscess: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Fligou Fotini

    2009-08-01

    Full Text Available Abstract Background Only 65 cases (including our case of spinal subdural abscesses have been reported to the literature, mostly to the lumbar spine. Staphylococcus aureus is the most common bacterial. The symptoms are not caracteristic and contrast – enhanced magnetic resonance imaging scan (MRI is the imaging method of choice. The early diagnosis is crucial for the prognosis of the patient. Case presentation We present a patient 75 years old who had a history of diabetes and suffered acute low back pain in the region of the lumbar spine for the last 4 days before his admission to the hospital. He also experienced lower leg weakness, fever and neck stiffness. After having a brain CT scan and a lumbar puncture the patient hospitalized with the diagnosis of meningitis. Five days after his admission the diagnosis of subdural abscess secured with contrast – enhanced MRI but meanwhile the condition of the patient impaired with respiratory failure and quadriplegia and he was admitted to the ICU. A laminectomy was performed eight days after his admission into the hospital but unfortunately the patient died. Conclusion Early diagnosis and treatment are very important for the good outcome in patients with subdural abscess. Although morbidity and mortality are very high, surgical and antibiotic treatment should be established as soon as possible after the diagnosis has secured.

  5. MRI findings in spinal subdural and epidural hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Braun, Petra [Department of Radiology, Hospital La Plana, Ctra. De Vila-real a Borriana km. 0.5, 12540 Vila-real (Castello) (Spain)], E-mail: PetraBraun@gmx.de; Kazmi, Khuram [Department of Radiology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 (United States); Nogues-Melendez, Pablo; Mas-Estelles, Fernando; Aparici-Robles, Fernando [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)

    2007-10-15

    Background: Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. Patients and Methods: From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. Results: Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. Discussion: MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.

  6. Infantile subdural empyema: The role of brain sonography and percutaneous subdural tapping in a resource-challenged region

    Directory of Open Access Journals (Sweden)

    Okezie Obasi Kanu

    2014-01-01

    Full Text Available Background This study explored the outcome of children with patent anterior fontanelles who were treated with trans-fontanelle ultrasound scan (TFUSS, which is more affordable and available than CT scan and MRI in the diagnosis of childhood intracranial pathologies and treatment of subdural empyema, in developing countries. Patients and Methods: Seventeen infants with post-meningitic subdural empyema, diagnosed using trans-fontanelle ultrasound alone and treated with subdural tapping over a 31-months period, were studied. Results: Eleven patients presented with grades II and III Bannister and William grading for level of consciousness in intracranial subdural empyema. Aspirate from 7 (41.2% patients were sterile. The most common organisms isolated were Streptococcus faecalis 3 (17.6%, Haemophilus Influenza 2 (11.8 and Staphylococcus aureus 2 (11.8, multiple organisms were isolated in three of the patients. Ninety-four percent (94% of the patients had good outcome. Five subjects developed hydrocephalus, one patient had a recurrence of subdural empyema, four patients had residual hemiparesis, two of the four patients had speech difficulties, while one patient (~6% died. Conclusion: While CT and MRI remain the gold standard for investigating intracranial lesions, transfontanelle ultrasonography is adequate for diagnosis of infantile subdural empyema in resource-challenged areas. Percutaneous subdural tap is an affordable and effective therapy in such patients with financial challenges.

  7. Progressive post traumatic tearing of an arachnoid cyst membrane resulting in intracystic and subdural haemorrhage.

    Science.gov (United States)

    Pascoe, Heather M; Phal, Pramit M; King, James A J

    2015-05-01

    We report the case of a 43-year-old man with a middle cranial fossa arachnoid cyst who presented post trauma with neurological symptoms. The initial CT scan of the brain did not detect acute changes in the arachnoid cyst but subsequent imaging revealed abnormalities which progressed over time. Arachnoid cysts are usually a benign and incidental finding. Rare complications such as intracystic haemorrhage and subdural haemorrhage can occur. It is important to be aware of these complications so that patients with arachnoid cysts are appropriately investigated when presenting with neurological symptoms.

  8. Streptococcal Subdural Empyema as a Complication of Varicella

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2005-01-01

    Full Text Available A 3-month-old male infant who presented with a group A streptococcal subdural empyema on day 5 of a varicella skin rash is reported from the University of British Columbia, Vancouver, BC, Canada.

  9. [Chronic subdural hematoma: a disease of elderly people].

    Science.gov (United States)

    Tagle, Patricio; Mery, Francisco; Torrealba, Gonzalo; Del Villar, Sergio; Carmona, Hans; Campos, Manuel; Méndez, Jorge; Chicharro, Ada

    2003-02-01

    The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis. To report the experience of a Neurosurgical Service in chronic subdural hematoma. One hundred patients (77 male, mean age 77 +/- 13 years) with chronic subdural hematoma were analyzed. The main clinical presentations were mental status changes (50%) and progressive focal neurological deficit (46%). Five cases presented as a transient neurological deficit. All patients were treated with burr hole drainage. Thirteen had recurrence of the hematoma and they were reoperated. The surgical mortality was 3%. Eighty seven patients were followed for a mean of 66 months. Eighty one of these had a complete recovery, 6 had permanent neurological deficit and 2 of these were unable to care for themselves. Bad prognosis was associated with the absence of a previous trauma to explain the hematoma and symptoms of dementia as the clinical presentation. Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome.

  10. Subdural haemorrhage following endoscopic third ventriculostomy. A rare complication.

    LENUS (Irish Health Repository)

    Kamel, M H

    2012-02-03

    Subdural collections or hematomas are frequently observed after shunt placement [7-9, 13], but rarely after ETV [6]. A review of literature revealed 7 cases [1, 5, 6, 10, 12], of which only 1 was symptomatic [5]. We will discuss the causes, management, and methods of prevention of this complication and we will present a case of symptomatic subdural haematoma, following endoscopic third ventriculostomy for illustration.

  11. A male infant had subdural effusion and paroxysmal supraventricular tachycardia during the febrile episode of Kawasaki disease: a case report and literature review.

    Science.gov (United States)

    Chou, Chia-Pei; Lin, I-Chun; Kuo, Kuang-Che

    2016-05-28

    Kawasaki disease is an acute, febrile, self-limiting, inflammatory systemic vasculitis seen in early childhood, most commonly in those below 5 years of age. In Kawasaki disease, the coronary arteries are most commonly affected, which may lead to asymptomatic coronary artery ectasia or formation of an aneurysm. Paroxysmal supraventricular tachycardia(PSVT) is a severe and rare cardiovascular complication of Kawasaki disease. A case of Kawasaki disease presenting with unusual findings, including subdural effusion and PSVT is reported. This is a 4-month-10-day-old boy presents with anterior fontanelle bulging and moderate bilateral subdural effusion at the acute stage of Kawasaki disease and PSVT at the subacute stage of Kawasaki disease. The subdural effusion was resolution after intravenous immunoglobulin(IVIG) administration. And the PSVT was subsided after administered 3 doses of adenosine, 1 dose of amiodarone loading and Propranolol twice per day use. At 1-year follow-up has made a complete recovery with no arrhythmia episodes, developmental effects or abnormal neurologic findings. Subdural effusion in the acute stage of Kawasaki disease may be an inflammatory response. It may resolves spontaneously after anti-inflammatory treatment such as IVIG infusion. PSVT is a severe cardiovascular complication of Kawasaki disease. In those who taking aspirin, we need to carefully observe the heart rhythm and PSVT side effects, especially in the first month.

  12. Zero drift of intraventricular and subdural intracranial pressure monitoring systems

    Institute of Scientific and Technical Information of China (English)

    CHEN Li; DU Hang-gen; YIN Li-chun; HE Min; ZHANG Guo-jun; TIAN Yong; WANG Cheng

    2013-01-01

    Objective:To assess zero drift of intraventricular and subdural intracranial pressure (ICP) monitoring systems.Methods:A prospective study was conducted in patients who received Codman ICP monitoring in the neurosurgical department from January 2010 to December 2011.According to the location of sensors,the patients were categorized into two groups:intraventricular group and subdural group.Zero drift between the two groups and its association with the duration of ICP monitor were analyzed.Results:Totally,22 patients undergoing intraventricular ICP monitoring and 27 receiving subdural ICP monitoring were enrolled.There was no significant difference in duration of ICP monitoring,zero drift value and its absolute value between intraventricular and subdural groups (5.38 d±2.58 d vs 4.58 d±2.24d,0.77 mmHg±2.18 mm Hg vs 1.03 mmHg±2.06mmHg,1.68 mmHg±155 mmHg vs 1.70mmHg±153 mmHg,respectively; all P>0.05).Absolute value of zero drift in both groups significantly rose with the increased duration of ICP monitoring (P<0.05) while zero drift value did not.Moreover,daily absolute value in the intraventricular group was significantly smaller than that in the subdural group (0.27 mm Hg±0.32 mm Hg vs 0.29 mm Hg±0.18 mm Hg,P<0.05).Conclusion:This study demonstrates that absolute value of zero drift significantly correlates with duration of both intraventricular and subdural ICP monitoring.Due to the smaller daily absolute value,ICP values recorded from intraventricular system may be more reliable than those from subdural system.

  13. Caesarean delivery complicated by unintentional subdural block and conversion disorder.

    Science.gov (United States)

    Elsharkawy, Hesham; Khanna, Ashish K; Barsoum, Sabri

    2013-01-01

    Combined spinal epidural (CSE) can provide excellent labor analgesia. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, a conversion disorder or a functional neurological disorder has been described with epidural and spinal anesthesia in obstetric patients. In this clinical report, we describe a 33-year-old G4P3 at 40 weeks gestation that received an unintentional subdural block as part of her labor analgesia and after an uneventful caesarean delivery presented with a conversion disorder. The rarity of the association between a subdural block and a conversion disorder complicated by the fact that the neurological deficit produced by the subdural block and that produced by a conversion disorder are similar in distribution made the clinical presentation and diagnosis a challenge for the obstetric anesthesia team. A functional neurological disorder of this nature complicating a subdural block in an obstetric anesthesia clinical practice has not been described so far.

  14. Early diagnosis and treatment for contralateral progressive epidural hematomas after decompressive craniectomy of acute traumatic subdural hematoma%急性硬脑膜下血肿减压术后对侧进展性硬脑膜外血肿的早期诊治

    Institute of Scientific and Technical Information of China (English)

    徐立; 江基尧; 唐超; 陈磊; 曹铖; 丁圣豪; 高国一; 包映晖; 潘耀华; 梁玉敏

    2012-01-01

    Objective To investigate the clinical features and the methods for early diagnosis and treatment of contralateral progressive epidural hematoma (EDH) after decompressive craniectomy ( DC) of acute traumatic subdural hematoma (SDH). Methods The clinical data of 23 patients with contralateral EDH after DC of acute traumatic SDH were analyzed retrospectively. Its clinical manifestations, results of CT scanning and outcome were summarized. Results The average interval time of confirmed diagnosis for contralateral progressive EDH after DC was (4±3)hours. The EDH was located in parietotemporal regions in 12 cases, parieto-occipital regions in 9 and fronto-temperal regions in 2. The main manifestations included intra-operative brain swelling in 8 cases, contralateral pupil dilation post-DC in 4, increasing of ICP value in 4 and no neurological change in 7. Conservative therapy was made for 1 patient, and second operation was made in 22 for the evacuation of EDH with that skull fracture was found in 21 below EDH. According to Glasgow Outcome Scale(GOS), scores of 5,4,3,2 and 1 were experienced in 5,7,7,1 and 3 patients respectively on discharge. Conclusions Majority of contralateral progressive EDH after DC of acute traumatic SDH are occurred in parietotemperal and perieto-occipital regions. And delayed bleeding from skull fracture at the site of the EDH is its main mechanism of such EDH. Early diagnosis and prompt management is contributed to the improvement of such cases.%目的 探讨颅脑外伤去骨瓣减压术(DC)后对侧进展性硬脑膜外血肿(EDH)的临床特点和早期诊治方法.方法 对23例颅脑外伤术后对侧进展性EDH患者的资料进行回顾性分析.结果 术后对侧进展性EDH的平均确诊时间为(4±3)h;EDH的部位为颞顶部12例,枕顶部9例,额颞部2例;主要表现为术中脑肿胀8例,术后对侧瞳孔散大4例,术后ICP逐渐增高4例,神经系统无明显异常改变者7例.保守治疗1例,再手术22例,21例确

  15. Acute Renal Failure in Snake Envenomation: A Large Prospective Study

    Directory of Open Access Journals (Sweden)

    Athappan Ganesh

    2008-01-01

    Full Text Available Venomous snakebite is a common problem in India. The aim of this study is to assess the prevalence, risk factors and prognostic factors in snakebite induced acute renal failure and to determine their outcome from a tertiary care center in India. A total of 1548 cases of snakebite admitted to adult medical wards of Government Rajaji hospital from January 2003 to December 2004, were studied from hospitalization to discharge or death. There were 1180 poisonous and 368 nonpoisonous snakebites. Among the poisonous, there were 1121 viperidae and 59 elapidae bites. A total of 159 (13.5% patients (M = 98, F = 61 developed acute renal failure; of them 72 (45.3% required dialysis and 36 (22.6% expired (of them, 23 required dialysis. ARF patients were older than non ARF (39.1 vs. 35.4 years, p = 0.03. Cellulites (OR 9.20, p = 0.032, regional lymphadenopathy (OR 22.0, p= 0.001, intravascular hemolysis (OR 3.70, p = 0.004 and bite to needle time more than 2 hours (OR 2.10, p = 0.001 were identified as independent risk factors for the development of acute renal failure. Bite to needle time more than 2 hours (OR 2.10, p = 0.01, presence of intravascular hemolysis (OR 13.0, p = 0.004 and hypotension (OR 22.2, p = 0.04 and the presence of bleeding manifestations (OR 7.91, p = 0.032 were identified as independent predictors of poor outcome in snakebite victims. We conclude that our study demonstrates several risk factors and predictors for the development and outcome of ARF in patients with snakebites.

  16. Chronic subdural haematoma after riding a roller coaster.

    Science.gov (United States)

    Yamakami, Iwao; Mine, Seiichiro; Yamaura, Akira; Fukutake, Toshio

    2005-01-01

    We report a 20-year-old man who developed a chronic subdural haematoma (CSDH) after riding a "giant" roller coaster. The patient had a past history of a subdural hygroma, diagnosed six weeks after a motorcycle accident. Three months after this accident, he rode on a roller coaster, but suffered no direct head trauma during the ride. Three weeks later, he developed a CSDH requiring surgical evacuation. Roller coaster riding, associated with high velocities and extreme acceleration/deceleration forces is a modern cause of CSDH in the young, which may be increasing due to ever-faster rides.

  17. CT and pathologic findings of a case of subdural osteoma

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun; Kim, Ji Eun; Yang, Hee Jin [Seoul Municipal Boramae Hospital, Seoul (Korea, Republic of)

    2002-09-01

    A 43-year-old female presented with persistent headache and dizziness which had first occurred two years earlier. The physical and neurological findings at admission were unremarkable, though plain radiography revealed the presence of a dense calcified mass in the left frontal area, and CT showed that a homogeneous high-density nodule was attached to the inner surface of the left frontal skull. The hard bony mass found and excised during surgery was shown at histopathologic examination to be a subdural osteoma. We describe the clinicopathologic findings of this entity and discuss the radiological features which suggest its subdural location.

  18. Zero drift of intraventricular and subdural intracranial pressure monitoring systems

    OpenAIRE

    2013-01-01

    【Abstract】Objective: To assess zero drift of intra-ventricular and subdural intracranial pressure (ICP) moni-toring systems. Methods: A prospective study was conducted in pa-tients who received Codman ICP monitoring in the neuro-surgical department from January 2010 to December 2011. According to the location of sensors, the patients were ca-tegorized into two groups: intraventricular group and sub-dural group. Zero drift between the two groups and its as-sociation with the duratio...

  19. The Nelaton Catheter Guard for Safe and Effective Placement of Subdural Drain for Two-Burr-Hole Trephination in Chronic Subdural Hematoma: A Technical Note.

    Science.gov (United States)

    Fichtner, Jens; Beck, Jürgen; Raabe, A; Stieglitz, Lennart Henning

    2015-09-01

    For chronic subdural hematoma, placement of a Blake drain with a two-burr-hole craniotomy is often preferred. However, the placement of such drains carries the risk of penetrating the brain surface or damaging superficial venous structures. To describe the use of a Nelaton catheter for the placement of a subdural drain in two-burr-hole trephination for chronic subdural hematoma. A Nelaton catheter was used to guide placement of a Blake drain into the subdural hematoma cavity and provide irrigation of the hematoma cavity. With the two-burr-hole method, the Nelaton catheter could be removed easily via the frontal burr hole after the Blake drain was in place. We used the Nelaton catheters in many surgical procedures and found it a safe and easy technique. This method allows the surgeon to safely direct the catheter into the correct position in the subdural space. This tool has two advantages. First, the use of a small and flexible Nelaton catheter is a safe method for irrigation of a chronic subdural hematoma cavity. Second, in comparison with insertion of subdural drainage alone through a burr hole, the placement of the Nelaton catheter in subdural space is easier and the risk of damaging relevant structures such as cortical tissue or bridging veins is lower. Thus this technique may help to avoid complications when placing a subdural drain. Georg Thieme Verlag KG Stuttgart · New York.

  20. Acute spontaneous tumor lysis in anaplastic large T-cell lymphoma presenting with hyperuricemic acute renal failure.

    Science.gov (United States)

    Hsu, Hsiang-Hao; Huang, Chiu-Ching

    2004-01-01

    Acute spontaneous tumor lysis (ASTL) syndrome, an extremely rare disease, requires prompt recognition and aggressive management because it is fulminant at its outset, associated with severe metabolic derangement, and potentially reversible. We describe an unusual case in which spontaneous tumor lysis occurred in anaplastic large T-cell lymphoma associated with acute uric acid nephropathy, persistent oliguria, and shock. This case contrasts markedly with previously reported cases of ASTL syndrome, which developed mainly in the pathologic type of Burkitt lymphoma. To our knowledge, this is the first reported occurrence of ASTL syndrome associated with anaplastic large T-cell type lymphoma. This report also chronicles our successful experience with continuous renal replacement therapy in the presence of compromised hemodynamic status.

  1. Subdural Hematoma: An Adverse Event of Electroconvulsive Therapy—Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ranganath R. Kulkarni

    2012-01-01

    Full Text Available Electroconvulsive therapy (ECT is commonly used in the management of medication nonresponsive depressive disorder, with proven efficacy in psychiatric practice since many decades. A rare complication of intracranial bleed following this therapeutic procedure has been reported in sporadic case reports in the English literature. We report a case of such a complication in a 42-year-old male, a known case of nonorganic medication nonresponsive depressive disorder for the last two years who required ECT application. Presenting symptoms included altered mental state, urinary incontinence, and repeated episodes of vomiting; following ECT procedure with magnetic resonance imaging (MRI of the brain suggestive of bilateral acute subdural hematoma. Despite the view that it may be used in neurological conditions without raised intracranial tension, it will be worthwhile to be vigilant during post-ECT recovery for any emergent complications.

  2. A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma.

    LENUS (Irish Health Repository)

    Kaliaperumal, Chandrasekaran

    2012-11-01

    The usage of a drain following evacuation of a chronic subdural haematoma (CSDH) is known to reduce recurrence. In this study we aim to compare the clinical outcomes and recurrence rate of utilising two different types of drains (subperiosteal and subdural drain) following drainage of a CSDH.

  3. Postdural puncture subdural hematoma or postdural puncture headache?: two cases report

    OpenAIRE

    Kale, Aydemir; Emmez, Hakan; Pişkin, Özcan; Durdağ, Emre

    2015-01-01

    Spinal anesthesia is widely used for many obstetric, gynecological, orthopedic, and urological operations. Subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates. Postdural puncture headache (PDPH) is a benign condition and the most frequent complication of spinal anesthesia. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. The true incidence of postdural puncture subdural hematoma (PDPSH) is ...

  4. Perforated Jejunal Diverticula Secondary to a Large Faecolith: A Rare Cause of the Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Peter John Webster

    2014-01-01

    Full Text Available Jejunal diverticula are uncommon and usually asymptomatic. Very rarely, they can lead to acute complications such as bleeding, obstruction, and perforation. This report describes our experience of a case of jejunal diverticula perforation secondary to a large faecolith, with particular focus on the aetiology and management of this rare condition.

  5. A rare complication of spinal anesthesia: Intracranial subdural hemorrhage

    Directory of Open Access Journals (Sweden)

    Cengiz Kaplan

    2015-02-01

    Full Text Available Spinal (subarachnoid anesthesia (SA is a widely used general-purpose anesthesia. Postdural Puncture Headaches (PDPHs represent one of the principal complications of spinal anesthesia. A 21-year-old man underwent inguinal herniorrhaphy and orchiectomy using spinal anesthesia. Postoperatively, our patient started to have a headache with nausea. The patient received symptomatic therapy, but the severe headache persisted even in the supine position, with his vital signs and neurological examination being normal. Cranial MRI showed a bilateral subdural hematoma from his frontal to temporal region. A postdural puncture headache is a frequent complication after spinal anesthesia. However, serious complications, such as an intracranial subdural hemorrhage, can rarely occur. [Arch Clin Exp Surg 2015; 4(1.000: 54-56

  6. Bilateral subdural hematoma secondary to accidental dural puncture

    Directory of Open Access Journals (Sweden)

    Sofía Ramírez

    2015-08-01

    Full Text Available We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.

  7. Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas.

    Science.gov (United States)

    Schwarz, Falko; Loos, Franz; Dünisch, Pedro; Sakr, Yasser; Safatli, Diaa Al; Kalff, Rolf; Ewald, Christian

    2015-11-01

    The optimal management of chronic subdural hematomas remains a challenge. Twist drill craniotomy or burr hole trephination are considered optimal initial treatments, but the reoperation rate for hematoma recurrence and other complications is still high. Therefore, evaluation of possible risk factors for initial treatment failure is crucial. In this context, we performed a study to define a possible subpopulation that may benefit from a more invasive initial treatment regime. We retrospectively reviewed the medical charts of 193 patients with 250 chronic subdural hematomas who had undergone burr hole trephination as first-line therapy in our institution between January 2005 and October 2012. To identify risk factors for reoperation, a multivariable logistic regression analysis was performed with reoperation as the dependent variable. Surgical complications, including acute rebleeding, infection and chronic hematoma recurrence, were analyzed separately using a logistic regression model. The mean age of the cohort was 71.4 years. The male/female ratio was 137:56. Reoperation was necessary in 56 cases (29%) for recurrent hematomas and surgical complications. Predictors for reoperation for surgical complications were midline shift (odds ratio [OR] (per mm) 1.16, 95% confidence interval [CI]: 1.05-1.29, p=0.006), arterial hypertension (OR 5.44, 95% CI: 1.45-20.41, p=0.012) and bilateral hematomas (OR 4.22, 95% CI: 1.22-14.58, p=0.023). There was a trend toward a higher risk of surgically-relevant hematoma recurrence in patients with prior treatment with vitamin K antagonists (OR 1.76, 95% CI: 0.75-4.13, p=0.191). Burr hole trephination is the therapy of choice in most chronic subdural hematomas, but the rate of recurrent hematomas is high. Every hematoma should be treated individually especially in relation to midline-shift and pre-existing conditions. Further prospective studies evaluating types of treatment and hematoma density are needed. Copyright © 2015 Elsevier B

  8. Advances in surgical treatment of chronic subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    张作洪; 刘建雄

    2003-01-01

    @@ Chronic subdural hematoma (CSDH) represents one of the most frequent types of intracranial hemorrhage. Management of the patients with CSDH has been evolved through a vast variety of methods and techniques. Although there is general agreement that surgical therapy is usually the preferred treatment, there are few other neurosurgical conditions that spark such strong discussions and differences of opinion concerning the optimal surgical technique.1,2 In this paper, we review advances in surgical treatment of CSDH.

  9. Chronic spinal subdural hematoma; Spinales chronisches subdurales Haematom

    Energy Technology Data Exchange (ETDEWEB)

    Hagen, T.; Lensch, T. [Radiologengemeinschaft, Augsburg (Germany)

    2008-10-15

    Compared with spinal epidural hematomas, spinal subdural hematomas are rare; chronic forms are even more uncommon. These hematomas are associated not only with lumbar puncture and spinal trauma, but also with coagulopathies, vascular malformations and tumors. Compression of the spinal cord and the cauda equina means that the patients develop increasing back or radicular pain, followed by paraparesis and bladder and bowel paralysis, so that in most cases surgical decompression is carried out. On magnetic resonance imaging these hematomas present as thoracic or lumbar subdural masses, their signal intensity varying with the age of the hematoma. We report the clinical course and the findings revealed by imaging that led to the diagnosis in three cases of chronic spinal subdural hematoma. (orig.) [German] Spinale subdurale Haematome sind im Vergleich zu epiduralen Haematomen selten, chronische Verlaufsformen noch seltener. Ursaechlich sind neben Lumbalpunktionen und traumatischen Verletzungen auch Blutgerinnungsstoerungen, Gefaessmalformationen und Tumoren. Aufgrund der Kompression von Myelon und Cauda equina kommt es zu zunehmenden Ruecken- oder radikulaeren Schmerzen mit anschliessender Paraparese sowie einer Darm- und Blasenstoerung, weshalb in den meisten Faellen eine operative Entlastung durchgefuehrt wird. Magnetresonanztomographisch stellen sich die Haematome meist als thorakale bzw. lumbale subdurale Raumforderungen dar, die Signalintensitaet variiert mit dem Blutungsalter. Wir berichten ueber den klinischen Verlauf und die bildgebende Diagnostik von 3 Patienten mit spinalen chronischen subduralen Haematomen. (orig.)

  10. Anticonvulsants for preventing seizures in patients with chronic subdural haematoma.

    Science.gov (United States)

    Ratilal, Bernardo O; Pappamikail, Lia; Costa, João; Sampaio, Cristina

    2013-06-06

    Anticonvulsant therapy is sometimes used prophylactically in patients with chronic subdural haematoma, although the benefit is unclear. To assess the effects of prophylactic anticonvulsants in patients with chronic subdural haematoma, in both the pre- and post-operative periods. We searched the Cochrane Injuries Group's Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), PubMed, LILACS, and the databases clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, and Current Controlled Trials. The search was through 27th March 2013. Randomised controlled trials comparing any anticonvulsant versus placebo or no intervention. Three authors screened the search results to identify relevant studies. No studies met the inclusion criteria for the review. No randomised controlled trials were identified. No formal recommendations can be made about the use of prophylactic anticonvulsants in patients with chronic subdural haematoma based on the literature currently available. There are no randomised controlled trials on this topic, and non-controlled studies have conflicting results. There is an urgent need for well-designed randomised controlled trials.

  11. Chronic subdural hematomas: a review of 94 cases

    Directory of Open Access Journals (Sweden)

    Murat Yilmaz

    2015-03-01

    Material and Methods: Consecutive patients operated with a diagnosis of chronic subdural hematoma between January 2003 and December 2012 were reviewed retrospectively. Etiology and medical status of the patients at the time of admission were noted. Exact localization of the chronic subdural hematoma was detected by computed tomography scans and follow-up was maintained with magnetic resonance imaging. The outcome of the patients was evaluated one month after injury, by assesing activities of daily living. Results: Ninety-four consecutive patients met the eligibility criteria for the study. The mean age was 65 (range 45 to 85 years. In 74 (78.7% patients, head injury was the supposed origin. In 20 (21.3% patients, no trauma was evident. Most common symptom reported at the time of admission was headache (100%, and the most common neurological finding was confusion (87.2%. The majority of the patients had a mild neurological deficit with a Glascow Coma Scale score over eight. In general, 90.4% of cases were sufficiently treated by a single operation, while 9.6% needed a second procedure. During the follow-up, 91.5% of the patients returned to daily living activities on the first month kontrol. Conclusion: Surgical treatment of chronic subdural haematoma can give a high rate of complete recovery to normal life. [Cukurova Med J 2015; 40(1.000: 22-27

  12. Duodenal obstruction following acute pancreatitis caused by a large duodenal diverticular bezoar

    Institute of Scientific and Technical Information of China (English)

    Ji Hun Kim; Jae Hyuck Chang; Sung Min Nam; Mi Jeong Lee; Il Ho Maeng; Jin Young Park; Yun Sun Im

    2012-01-01

    Bezoars are concretions of indigestible materials in the gastrointestinal tract.It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying.Cases of periampullary duodenal divericular bezoar are rare.Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar.Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported.Small bowel obstruction by a bezoar is also rare,but it is a complication that requires surgery.This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen,which mimicked pancreatic abscess or microperforation on abdominal computerized tomography.The patient underwent surgical removal of the bezoar and recovered completely.

  13. Migratory large vessel vasculitis preceding acute myeloid leukemia: a case report.

    Science.gov (United States)

    Chandratilleke, Dinusha; Anantharajah, Anthea; Vicaretti, Mauro; Benson, Warwick; Berglund, Lucinda J

    2017-03-16

    Large vessel vasculitis is a rare disorder usually occurring in the context of the autoimmune conditions of giant cell arteritis and Takayasu's arteritis. Case reports have described large vessel vasculitis occurring in individuals with myelodysplastic syndrome, preceding transformation to acute myeloid leukemia. A 56-year-old Afghanistan-born woman presented with fever, a tender left carotid artery, and raised inflammatory markers. Computed tomography revealed thickening of the wall of her left carotid artery. Her symptoms resolved spontaneously; however, they recurred weeks later on the contralateral side, along with abdominal pain after eating. Further imaging with computed tomography and positron emission tomography demonstrated resolution of her left carotid artery abnormality, but new wall thickening and inflammation in her right carotid artery, abdominal aorta, and superior mesenteric artery. She was diagnosed as having large vessel vasculitis, which resolved with corticosteroids and methotrexate. Five months later, she developed acute myeloid leukemia. She had no known history of myelodysplastic syndrome at the time of diagnosis with vasculitis. Large vessel vasculitis in older individuals presenting with atypical clinical features, such as a migratory pattern of affected vessels, vessel wall tenderness, and marked systemic inflammation, should prompt a search for underlying myelodysplasia. Clinicians should be vigilant for progression to acute myeloid leukemia.

  14. Subdural haematoma complicating shunting for normal pressure hydrocephalus in the setting of concomitant antiplatelet medication

    DEFF Research Database (Denmark)

    Birkeland, Peter; Lauritsen, Jens; Poulsen, Frantz Rom

    2016-01-01

    OBJECTIVE: To report on the occurrence and management of subdural haematoma after shunt implantation for normal pressure hydrocephalus and to determine the risk of recurrence in the setting of antiplatelet medication. METHODS: From a consecutive series of 80 patients implanted with a cerebrospinal...... fluid shunt for normal pressure hydrocephalus, records from 11 patients taking antiplatelet drugs, who subsequently had surgery for subdural haematoma were extracted and retrospectively reviewed. RESULTS: Patients were followed up for a mean of 1819 days after shunt implantation. Subdural haematomas...... reoperations done before the subdural collection disappeared. Only one patient had a late recurrence almost 11 years after shunt implantation. CONCLUSIONS: Subdural haematoma in the setting of a ventriculoperitoneal implantation for normal pressure hydrocephalus and concomitant antiplatelet medication can...

  15. Subdural porous and notched mini-grid electrodes for wireless intracranial electroencephalographic recordings

    Directory of Open Access Journals (Sweden)

    Salam MT

    2014-12-01

    demonstrated signal stability, 50% noise reduction, and up to 6 dB signal-to-noise ratio (SNR improvement as compared to commercial electrodes. The wireless icEEG recording system demonstrated on average a 2% normalized root-mean-square (RMS deviation. Following the long-term icEEG recording, brain histological results showed no abnormal tissue reaction in the underlying cortex. Conclusion: The proposed subdural electrode system features attributes that could potentially translate into better icEEG recordings and allow sampling of large of areas of epileptogenicity at lower risk to patients. Further validation for use in humans is required. Keywords: epilepsy, seizure, monitoring, surgery, electrodes

  16. The question is whether hemiparesis is more common in unilateral than bilateral chronic subdural hematoma.

    Science.gov (United States)

    Juković, Mirela; Petrović, Kosta; Till, Viktor

    2014-01-01

    Chronic subdural hematoma is an intracranial hemorrhagic lesion that illustrates various expressions in clinical and radiological practice. The aim of this study was to emphasize the correlation between the brain site of chronic subdural hematoma and clinical symptoms/signs of disease. Furthermore, the study denotes the significance of hemiparesis occurrence in the patients with unilateral chronic subdural hematomas more than in those with bilateral ones, associated with time required to diagnose hematoma. A three-year study included 72 patients with chronic subdural hematoma. According to their clinical and neurological symptoms on hospital admission, all patients underwent non-contrast brain computed tomography scan, which confirmed the diagnosis. The radiological parameters, including the site of chronic subdural hematoma, a hematoma width and midline shift were recorded to give precise data about the correlation with neurological symptoms. A special focus was put on the lag time between the onset of symptoms and signs to diagnosis of chronic subdural hematoma. The study proved that the patients with unilateral chronic subdural hematoma had more frequent occurrence of hemiparesis than the patients with bilateral chronic subdural hematoma. It took the left-sided chronic subdural hematomas less time (about 200 hours earlier) than the right-sided ones to present its symptoms although the average hematoma diameter value was almost the same. The site and the form of intracranial lesion-chronic subdural hematoma could have a great influence on neurological and functional condition in a patient. Although the length of time required for making diagnosis as well as clinical symptoms greatly differ and the latter are not always so clear, physicians should maintain a high level of suspicion for this disease and thus contribute to prompt diagnosis and better clinical outcome of patients.

  17. Spontaneous subdural hematoma and antiplatelet therapy: Does efficacy of Ticagrelor come with added risk?

    Science.gov (United States)

    Suryanarayana Sharma, Pattanagere Manjunatha; Tekkatte Jagannatha, Aniruddha; Javali, Mahendra; Hegde, Anupama Venkatasubba; Mahale, Rohan; Madhusudhan; Srinivasa, Rangasetty

    2015-12-01

    Antiplatelet therapy has established clinical benefit on cardiovascular outcome and has reduced the rates of re-infarction/in stent thrombosis following percutaneous coronary intervention in acute coronary syndromes. Major bleeding episodes can occur with antiplatelet therapy and intracranial hemorrhage (ICH) is one of the most feared complications resulting in significant morbidity and mortality. Identification of high risk groups and judicious use of antiplatelet therapy reduces the bleeding risk. Ticagrelor is a newer P2Y12 receptor antagonist with established clinical benefit. However, risks of having an ICH with these newer molecules cannot be ignored. Here, we report a case of spontaneous acute subdural hematoma developing in a patient on antiplatelet therapy with aspirin and ticagrelor. Early recognition, discontinuation of the medication and appropriate management resulted in resolution of hematoma and good clinical outcome. Authors have reviewed the antithrombotic drugs and their tendencies in causing intracranial bleeds from a neurophysicians perspective. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  18. Concurrent Intracranial and Spinal Subdural Hematoma in a Teenage Athlete: A Case Report of This Rare Entity

    Directory of Open Access Journals (Sweden)

    Daniel S. Treister

    2014-01-01

    Full Text Available A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH. Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space.

  19. Coleção subdural na criança: fisiopatologia e tratamento Subdural effusions in children: pathophysiology and treatment

    Directory of Open Access Journals (Sweden)

    Sebastião Gusmão

    1997-06-01

    Full Text Available Nove crianças portadoras de coleção subdural (CSD foram tratadas por meio de derivação subduro-peritoneal. Todas foram submetidas a controle com tomografia computadorizada do encéfalo. O tamanho da coleção subdural foi avaliado por medida de sua área no corte tomográfico por meio de morfologia quantitativa com planímetro. Ocorreu regressão completa ou quase completa da CSD em oito pacientes. Os resultados funcionais foram excelentes em quatro pacientes, bons em três e maus em dois. Foi feita uma revisão da fisiopatologia e do tratamento da CSD na criança.Nine children harboring subdural effusions were treated by subduro peritoneal shunt. These patients were followed-up by CT scans. The area of the subdural effusions was measured by quantitative morphology with a planimeter. With the surgical treatment, the subdural effusion disappeared completely or near completely in 8 patients. The patient's functional state were excellent in 4, good in 3 and bad in 2 in the postoperative follow-up. We aldo reviewed the literature as far as the pathophysiology and the treatment of the subdural effusions are concerned.

  20. A model of hemorrhagic shock and acute lung injury in Landrace-Large White Swine.

    Science.gov (United States)

    Xanthos, Theodoros T; Balkamou, Xanthippi A; Stroumpoulis, Kostantinos I; Pantazopoulos, Ioannis N; Rokas, Georgios I; Agrogiannis, Georgios D; Troupis, Georgios T; Demestiha, Theano D; Skandalakis, Panagiotis N

    2011-04-01

    Traumatic injury is a leading cause of death worldwide for people between 5 and 44 y of age, and it accounts for 10% of all deaths. The incidence of acute lung injury, a life-threatening complication in severely injured trauma patients remains between 30% and 50%. This study describes an experimental protocol of volume-controlled hemorrhage in Landrace-Large White swine. The experimental approach simulated the clinical situation associated with hemorrhagic shock in the trauma patient while providing controlled conditions to maximize reproducibility. The duration of the protocol was 8 h and was divided into 5 distinct phases-stabilization, hemorrhage, maintenance, resuscitation, and observation-after which the swine were euthanized. Lung tissue samples were analyzed histologically. All swine survived the protocol. The hemodynamic responses accurately reflected those seen in humans, and the development of acute lung injury was consistent among all swine. This experimental protocol of hemorrhagic shock and fluid resuscitation in Landrace-Large White swine may be useful for future study of hemorrhagic shock and acute lung injury.

  1. A Model of Hemorrhagic Shock and Acute Lung Injury in Landrace–Large White Swine

    Science.gov (United States)

    Xanthos, Theodoros T; Balkamou, Xanthippi A; Stroumpoulis, Kostantinos I; Pantazopoulos, Ioannis N; Rokas, Georgios I; Agrogiannis, Georgios D; Troupis, Georgios T; Demestiha, Theano D; Skandalakis, Panagiotis N

    2011-01-01

    Traumatic injury is a leading cause of death worldwide for people between 5 and 44 y of age, and it accounts for 10% of all deaths. The incidence of acute lung injury, a life-threatening complication in severely injured trauma patients remains between 30% and 50%. This study describes an experimental protocol of volume-controlled hemorrhage in Landrace–Large White swine. The experimental approach simulated the clinical situation associated with hemorrhagic shock in the trauma patient while providing controlled conditions to maximize reproducibility. The duration of the protocol was 8 h and was divided into 5 distinct phases—stabilization, hemorrhage, maintenance, resuscitation, and observation—after which the swine were euthanized. Lung tissue samples were analyzed histologically. All swine survived the protocol. The hemodynamic responses accurately reflected those seen in humans, and the development of acute lung injury was consistent among all swine. This experimental protocol of hemorrhagic shock and fluid resuscitation in Landrace–Large White swine may be useful for future study of hemorrhagic shock and acute lung injury. PMID:21535927

  2. Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion.

    Science.gov (United States)

    Turc, Guillaume; Maïer, Benjamin; Naggara, Olivier; Seners, Pierre; Isabel, Clothilde; Tisserand, Marie; Raynouard, Igor; Edjlali, Myriam; Calvet, David; Baron, Jean-Claude; Mas, Jean-Louis; Oppenheim, Catherine

    2016-06-01

    It remains debated whether clinical scores can help identify acute ischemic stroke patients with large-artery occlusion and hence improve triage in the era of thrombectomy. We aimed to determine the accuracy of published clinical scores to predict large-artery occlusion. We assessed the performance of 13 clinical scores to predict large-artery occlusion in consecutive patients with acute ischemic stroke undergoing clinical examination and magnetic resonance or computed tomographic angiography ≤6 hours of symptom onset. When no cutoff was published, we used the cutoff maximizing the sum of sensitivity and specificity in our cohort. We also determined, for each score, the cutoff associated with a false-negative rate ≤10%. Of 1004 patients (median National Institute of Health Stroke Scale score, 7; range, 0-40), 328 (32.7%) had an occlusion of the internal carotid artery, M1 segment of the middle cerebral artery, or basilar artery. The highest accuracy (79%; 95% confidence interval, 77-82) was observed for National Institute of Health Stroke Scale score ≥11 and Rapid Arterial Occlusion Evaluation Scale score ≥5. However, these cutoffs were associated with false-negative rates >25%. Cutoffs associated with an false-negative rate ≤10% were 5, 1, and 0 for National Institute of Health Stroke Scale, Rapid Arterial Occlusion Evaluation Scale, and Cincinnati Prehospital Stroke Severity Scale, respectively. Using published cutoffs for triage would result in a loss of opportunity for ≥20% of patients with large-artery occlusion who would be inappropriately sent to a center lacking neurointerventional facilities. Conversely, using cutoffs reducing the false-negative rate to 10% would result in sending almost every patient to a comprehensive stroke center. Our findings, therefore, suggest that intracranial arterial imaging should be performed in all patients with acute ischemic stroke presenting within 6 hours of symptom onset. © 2016 American Heart Association

  3. Long-Term Serological Follow-Up of Acute Q-Fever Patients after a Large Epidemic

    NARCIS (Netherlands)

    Wielders, C.C.; Loenhout, J.A.F. van; Morroy, G.; Rietveld, A; Notermans, D.W.; Wever, P.C.; Renders, N.H.; Leenders, A.C.; Hoek, W. van der; Schneeberger, P.M.

    2015-01-01

    BACKGROUND: Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007-2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim

  4. Solitary subdural osteoma: A case report and literature review

    Science.gov (United States)

    Cao, Lei; Hong, Lichuan; Li, Chuzhong; Zhang, Yazhuo; Gui, Songbai

    2016-01-01

    Osteomas attached to the meninges unrelated to bone are extremely rare and their etiology has not been discussed previously in the English literature. Here, we report the case of a 54-year-old male patient with a right frontal subdural osteoma. The patient presented with a ~5-month history of intermittent dizziness. Non-contrasted computerized tomography demonstrated a densely calcified mass attached to the inner surface of the right frontal skull. Magnetic resonance imaging (MRI) revealed this mass could be enhanced by contrast MRI. Intraoperatively, the hard mass was noted to be attached to the inner layer of the dura mater, and not associated with the bone. Histopathological examination revealed lamellated bony trabeculae lined by osteoblasts and the intertrabecular marrow spaces occupied by adipose tissue, which contributed to the MRI enhancement. It was speculated that subdural osteomas arose from ectopic osteoblasts derived from the embryological neural crest cells. The context of intertrabecular bone marrow contributed to the enhancement on MRI. Simple excision is the treatment of choice for symptomatic lesions. PMID:27446388

  5. Subdural hematoma in a teenager related to roller-coaster ride.

    Science.gov (United States)

    Roldan-Valadez, Ernesto; Facha, M T; Martinez-Lopez, Manuel; Herrera-Mora, Patricia

    2006-07-01

    Reports about neurological injury related to roller-coaster rides mostly involve adults; we present a case of subdural hematoma in a pediatric patient presented 14 days after a roller-coaster ride. These rides show extreme up-and-down, to-and-fro, and rotatory acceleration/deceleration forces that could produce tensile and shearing stresses with tearing of bridging cerebral veins resulting in subdural hemorrhage. Pediatricians should consider roller-coaster riding a modern cause of subdural hematoma, as well as a possible cause of unexplained neurologic events in otherwise healthy adolescents.

  6. Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA.

    Science.gov (United States)

    Smith, Wade S; Lev, Michael H; English, Joey D; Camargo, Erica C; Chou, Maggie; Johnston, S Claiborne; Gonzalez, Gilberto; Schaefer, Pamela W; Dillon, William P; Koroshetz, Walter J; Furie, Karen L

    2009-12-01

    Acute ischemic stroke due to large vessel occlusion (LVO)-vertebral, basilar, carotid terminus, middle and anterior cerebral arteries-likely portends a worse prognosis than stroke unassociated with LVO. Because little prospective angiographic data have been reported on a cohort of unselected patients with stroke and with transient ischemic attack, the clinical impact of LVO has been difficult to quantify. The Screening Technology and Outcome Project in Stroke Study is a prospective imaging-based study of stroke outcomes performed at 2 academic medical centers. Patients with suspected acute stroke who presented within 24 hours of symptom onset and who underwent multimodality CT/CT angiography were approached for consent for collection of clinical data and 6-month assessment of outcome. Demographic and clinical variables and 6-month modified Rankin Scale scores were collected and combined with blinded interpretation of the CT angiography data. The OR of each variable, including occlusion of intracranial vascular segment in predicting good outcome and 6-month mortality, was calculated using univariate and multivariate logistic regression. Over a 33-month period, 735 patients with suspected stroke were enrolled. Of these, 578 were adjudicated as stroke and 97 as transient ischemic attack. Among patients with stroke, 267 (46%) had LVO accounting for the stroke and 13 (13%) of patients with transient ischemic attack had LVO accounting for transient ischemic attack symptoms. LVO predicted 6-month mortality (OR, 4.5; 95% CI, 2.7 to 7.3; PStroke Scale and age, independently predicted outcome. Large vessel intracranial occlusion accounted for nearly half of acute ischemic strokes in unselected patients presenting to academic medical centers. In addition to age and baseline stroke severity, occlusion of either the basilar or internal carotid terminus segment is an independent predictor of outcome at 6 months.

  7. Spontaneous Resolution of Non Traumatic Chronic Subdural Haematoma Despite Continued Antiplatelet Therapy: A Case Report.

    Science.gov (United States)

    Tiwari, Ajeet Ramamani; Maheshwari, Shradha; Balasubramaniam, Srikant; Devendra, Tyagi; Savant, Hemantkumar

    2015-06-01

    Spontaneous resolution of traumatic chronic subdural haematoma (CSDH) has been reported in literature. However, those with non traumatic CSDH are exceedingly rare and none reported with continued antiplatelet therapy where it itself is an aetiological agent for development of non traumatic CSDH. A 50-year-old male presented to us with a non haemorrhagic cerebellar infarct with a concomitant CSDH without history of any trauma. Patient's PT/INR, Bleeding time and Clotting time were normal. Patient was started on antiplatelet therapy (Tablet Aspirin 150 mg OD) for the acute infarct. MR Brain at 1 month showed an increased size of CSDH. However patient denied surgical evacuation hence we continued conservative line of management, however we continued anti-platelet therapy with close neurological and coagulation profile monitoring that remained within normal range throughout the period of observation. CT at 5(th) month showed complete resolution of CSDH. Patient was on antiplatelet drugs throughout the period of observation. Our case argues about the role of antiplatelet therapy in patients with CSDH with contrary lesions requiring anticoagulation.

  8. Feasibility and Acute Toxicity of Hypofractionated Radiation in Large-breasted Patients

    Energy Technology Data Exchange (ETDEWEB)

    Dorn, Paige L., E-mail: pdorn@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL (United States); Corbin, Kimberly S.; Al-Hallaq, Hania; Hasan, Yasmin; Chmura, Steven J. [Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL (United States)

    2012-05-01

    Purpose: To determine the feasibility of and acute toxicity associated with hypofractionated whole breast radiation (HypoRT) after breast-conserving surgery in patients excluded from or underrepresented in randomized trials comparing HypoRT with conventional fractionation schedules. Methods and Materials: A review was conducted of all patients consecutively treated with HypoRT at University of Chicago. All patients were treated to 42.56 Gy in 2.66 Gy daily fractions in either the prone or supine position. Planning was performed in most cases using wedges and large segments or a 'field-in-field' technique. Breast volume was estimated using volumetric measurements of the planning target volume (PTV). Dosimetric parameters of heterogeneity (V105, V107, V110, and maximum dose) were recorded for each treatment plan. Acute toxicity was scored for each treated breast. Results: Between 2006 and 2010, 78 patients were treated to 80 breasts using HypoRT. Most women were overweight or obese (78.7%), with a median body mass index of 29.2 kg/m{sup 2}. Median breast volume was 1,351 mL. Of the 80 treated breasts, the maximum acute skin toxicity was mild erythema or hyperpigmentation in 70.0% (56/80), dry desquamation in 21.25% (17/80), and focal moist desquamation in 8.75% (7/80). Maximum acute toxicity occurred after the completion of radiation in 31.9% of patients. Separation >25 cm was not associated with increased toxicity. Breast volume was the only patient factor significantly associated with moist desquamation on multivariable analysis (p = 0.01). Patients with breast volume >2,500 mL experienced focal moist desquamation in 27.2% of cases compared with 6.34% in patients with breast volume <2,500 mL (p = 0.03). Conclusions: HypoRT is feasible and safe in patients with separation >25 cm and in patients with large breast volume when employing modern planning and positioning techniques. We recommend counseling regarding expected increases in skin toxicity in women

  9. Empiema espinhal subdural relato de um caso: case report

    Directory of Open Access Journals (Sweden)

    Gerson Canedo de Magalhães

    1995-03-01

    Full Text Available A raridade do empiema subdural pode ser verflcada pela escassez de casos descritos na literatura. Os autores apresentam mais um caso, mostrando as dificuldades diagnosticas principalmente quando não há aparente porta de entrada. Enfatizam, nestas circunstâncias, a importância de certos sinais clínicos, o valor da punção lombar e da imagem por ressonância nuclear magnética na elucidação diagnóstica. Este último exame não foi mencionado anteriormente na literatura consultada sobre o assunto. O tratamento cirúrgico, associado à antibioticoterapia, mostrou- se bastante eficaz, principalmente se realizado precocemente.

  10. Subdural hematoma in pediatrics - early diagnosis and treatment

    OpenAIRE

    Carvalho, M.; Leal, E.; Santos,M.; Ramos, J.; Távora, L; Barata, D.

    2011-01-01

    Introdução: O hematoma subdural agudo não traumático é uma entidade rara em Pediatria. A presença de sintomas neurológicos de instalação aguda associada a anticoagulação obriga à exclusão desta entidade. Caso clínico: Apresentamos o caso de uma criança, do sexo masculino, de sete anos de idade, com prótese mitral mecânica, medicada com varfarina, que recorreu ao serviço de urgência por cefaleias intensas e progressivas, associadas a alteração no estado de consciência e...

  11. Brain shrinkage and subdural effusion associated with ACTH administration.

    Science.gov (United States)

    Satoh, J; Takeshige, H; Hara, H; Fukuyama, Y

    1982-01-01

    Sequential computed tomographic (CT) studies of 11 patients (aged five months to seven years) with intractable epilepsy treated with synthetic ACTH-Z showed brain shrinkage in all cases. Brain shrinkage started to appear on daily ACTH injections for seven days, reached the maximum within four weeks of administration (14 injections every day and then 7 injections every other day), and almost returned to the original status in seven out of nine cases which were followed up for one to three months after the therapy. The subjects aged less than two years showed more remarkable brain shrinkage than did those aged more than five years. Furthermore, two other cases were complicated by subdural effusion after ACTH therapy. It is the authors' assumption that both of these phenomena are caused by the high concentration of corticosteroid through a change of the water and electrolyte contents in the brain.

  12. Anticoagulation therapy a risk factor for the development of chronic subdural hematoma

    DEFF Research Database (Denmark)

    Aspegren, Oskar P.; Åstrand, Ramona; Lundgren, Maria I.

    2013-01-01

    Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy.......Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy....

  13. Bilateral subdural effusion and subcutaneous swelling with normally functioning csf shunt.

    Directory of Open Access Journals (Sweden)

    Mitra S

    2001-04-01

    Full Text Available We report a child with hydrocephalus due to tuberculous meningitis who developed a subcutaneous fluid collection around the ventriculoperitoneal shunt tube entry point, after one month of shunting. On investigation, he had decompressed ventricles with bilateral fronto parietal subdural hygroma. Bifrontal burr hole drainage helped resolution of both subdural effusion and subcutaneous scalp swelling. This complication is unique and its pathogenesis has been postulated.

  14. Rehabilitative management of oropharyngeal dysphagia in acute care settings: data from a large Italian teaching hospital.

    Science.gov (United States)

    Schindler, Antonio; Vincon, Elena; Grosso, Elena; Miletto, Anna Maria; Di Rosa, Rosalba; Schindler, Oskar

    2008-09-01

    A high incidence of oropharyngeal dysphagia (OD) in acute-care settings has been reported; however, no data on its management are found in the literature. Here we report the experience with rehabilitative management of OD in a large Italian hospital. The characteristics of inpatients with OD during 2004 have been studied prospectively. For each patient, demographic data, the department referring the patient, the disease causing OD, and the presence of a communication disorder were registered. The swallowing level at the beginning and at the end of rehabilitation were recorded. Of the 35,590 inpatients admitted to San Giovanni Battista Hospital of Turin during 2004, 222 of them were referred for the assessment and rehabilitation of OD. The inpatients with OD came from different departments and mainly had a neurologic disease. In 110 patients a communication disorder was present. The swallowing impairment was moderate to severe at the moment of referral, while on average patients were able to eat by mouth after swallowing therapy. Dysphagia rehabilitation in an acute care setting is requested from different departments because of its prevalence and severity; skilled specialists are needed for early assessment and the best management.

  15. CCL25/CCR9 interactions regulate large intestinal inflammation in a murine model of acute colitis.

    Directory of Open Access Journals (Sweden)

    Marc-Andre Wurbel

    Full Text Available CCL25/CCR9 is a non-promiscuous chemokine/receptor pair and a key regulator of leukocyte migration to the small intestine. We investigated here whether CCL25/CCR9 interactions also play a role in the regulation of inflammatory responses in the large intestine.Acute inflammation and recovery in wild-type (WT and CCR9(-/- mice was studied in a model of dextran sulfate sodium (DSS-induced colitis. Distribution studies and phenotypic characterization of dendritic cell subsets and macrophage were performed by flow cytometry. Inflammatory bowel disease (IBD scores were assessed and expression of inflammatory cytokines was studied at the mRNA and the protein level.CCL25 and CCR9 are both expressed in the large intestine and are upregulated during DSS colitis. CCR9(-/- mice are more susceptible to DSS colitis than WT littermate controls as shown by higher mortality, increased IBD score and delayed recovery. During recovery, the CCR9(-/- colonic mucosa is characterized by the accumulation of activated macrophages and elevated levels of Th1/Th17 inflammatory cytokines. Activated plasmacytoid dendritic cells (DCs accumulate in mesenteric lymph nodes (MLNs of CCR9(-/- animals, altering the local ratio of DC subsets. Upon re-stimulation, T cells isolated from these MLNs secrete significantly higher levels of TNFα, IFNγ, IL2, IL-6 and IL-17A while down modulating IL-10 production.Our results demonstrate that CCL25/CCR9 interactions regulate inflammatory immune responses in the large intestinal mucosa by balancing different subsets of dendritic cells. These findings have important implications for the use of CCR9-inhibitors in therapy of human IBD as they indicate a potential risk for patients with large intestinal inflammation.

  16. Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours

    Energy Technology Data Exchange (ETDEWEB)

    Warmuth-Metz, M.; Solymosi, L. [Abteilung fuer Neuroradiologie, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany); Kuehl, J. [Paediatric Oncology, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany); Krauss, J. [Paediatric Neurosurgery, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany)

    2004-03-01

    In malignant brain tumours which may disseminate staging, usually by cranial and spinal MRI is necessary. If MRI is performed in the postoperative period pitfalls should be considered. Nonspecific subdural contrast enhancement on spinal staging MRI is rarely reported after resection of posterior fossa tumours, which may be mistaken for dissemination of malignancy. We investigated the frequency of spinal subdural enhancement after posterior cranial fossa neurosurgery in children. We reviewed 53 postoperative spinal MRI studies performed for staging of paediatric malignant brain tumours, mainly infratentorial primitive neuroectodermal tumours 2-40 days after surgery. There was contrast enhancement in the spinal subdural space in seven cases. This was not seen in any of eight patients who had been operated upon for a supratentorial tumour. After resection of 45 posterior cranial fossa tumours the frequency of subdural enhancement was 15.5%. MRI showing subdural enhancement was obtained up to 25 days postoperatively. No patient with subdural enhancement had cerebrospinal fluid (CSF) examinations positive for tumour cells or developed dissemination of disease in the CSF. Because the characteristic appearances of subdural contrast enhancement, appropriate interpretation is possible; diagnosis of neoplastic meningitis should rarely be impeded. Because of the striking similarity to that in patients with a low CSF-pressure syndrome and in view of the fact that only resection of tumours of the posterior cranial fossa, usually associated with obstructive hydrocephalus, was followed by this type of enhancement one might suggest that rapid changes in CSF pressure are implicated, rather the effects of blood introduced into the spinal canal at surgery. (orig.)

  17. Strategies for the prevention of acute mountain sickness and treatment for large groups making a rapid ascent in China.

    Science.gov (United States)

    Luo, Yongjun; Yang, Xiaohong; Gao, Yuqi

    2013-10-30

    Approximately 26.8% of China's land area has an elevation of 3000 m above sea level or higher. Because of recent demands for economic development and new construction in highland areas, many people have relocated from the plains to high plateau regions and have to face the possibility of contracting acute mountain sickness. Therefore, prevention and treatment strategies are necessary to reduce the incidence of acute mountain sickness in people who rapidly ascend to plateau areas. This paper describes the Chinese experience when large numbers of people moved to the plateau and the steps that were taken to deal with this illness. These steps included implementing basic prevention measures, increasing medical awareness among populations ascending to high altitudes, and installing standardized medical management systems to prevent and treat acute mountain sickness before, during, and after ascent. The incidence of acute mountain sickness can be reduced by improving prevention and treatment and by implementing the recommendations described in this manuscript.

  18. Differential diagnosis of frontal lobe atrophy from chronic subdural hematoma or subdural hygroma on CT in aged patients. Usefulness of CT cisternogram

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Hideaki [Osaka Univ. (Japan). Faculty of Medicine

    1995-02-01

    Metrizamide CT cisternograms (CTC) were performed in order to examine the CSF passage to subarachnoid space, cerebral sulci and Sylvian fissure. The old aged 20 patients (from 63 to 88 years old) with the layer of low density area around bilateral frontal lobe (bi-frontal LDA) in plain CT finding were selected from 2000 aged patients hospitalized in Hanwa-Senboku Hospital. In these 20 patients, it was difficult to differentiate frontal lobe atrophy from the chronic subdural hematoma and subdural hygroma. Conservative therapy was applied in 19 patients for their old age or their complicated diseases. Only 1 patient was operated for subdural hygroma. The 20 patients were investigated in EEGs, severity of dementia, disturbance of consciousness, activity of daily life, their clinical course and prognosis. Only 2 of the 11 patients with type 1 CTC findings (cerebral sulci, Sylvian fissure and bi-frontal LDA were simultaneously enhanced by metrizamide) showed disturbance of consciousness and/or delirium for their serious somatic disorders. All of 6 patients with type 3 CTC findings (only bi-frontal LDA was not enhanced by metrizamide) showed disturbance of consciousness. Three patients with type 2 CTC findings (atypical findings) were reported independently. Subdural disorder elevating intracranial pressure were clarified in the cases with type 3 CTC findings. (author).

  19. A new predisposing factor for trigemino-cardiac reflex during subdural empyema drainage: a case report

    Directory of Open Access Journals (Sweden)

    Arasho Belachew

    2010-11-01

    Full Text Available Abstract Introduction The trigemino-cardiac reflex is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, trigemino-cardiac reflex has been reported to occur during neurosurgical skull-base surgery. Apart from the few clinical reports, the physiological function of this brainstem reflex has not yet been fully explored. Little is known regarding any predisposing factors related to the intraoperative occurrence of this reflex. Case presentation We report the case of a 70-year-old Caucasian man who demonstrated a clearly expressed form of trigemino-cardiac reflex with severe bradycardia requiring intervention that was recorded during surgical removal of a large subdural empyema. Conclusion To the best of our knowledge, this is the first report of an intracranial infection leading to perioperative trigemino-cardiac reflex. We therefore add a new predisposing factor for trigemino-cardiac reflex to the existing literature. Possible mechanisms are discussed in the light of the relevant literature.

  20. Coexistent of paradoxical herniation and subdural hygroma: a case report

    Institute of Scientific and Technical Information of China (English)

    Yi Feng; Yuhai Wang

    2015-01-01

    Background: Coexistent of paradoxical herniation and subdural hygroma (SDG) is very rare, confusing symptoms may mislead the therapies.Case presentation: We report a case of a 33-year-old man underwent decompressive craniectomy (DC),postoperatively, the patient developed progressive neurologic deterioration and midline shift opposite to the DC window, CT scan revealed a SDG beside the DC window, instead of attributing the midline shift to the SDG, we recognized the underlying paradoxical herniation according to the sunken skin flap and history of lumbar cistern drainage.Subsequently we treat him with intravenous fluid expansion therapy instead of draining from the SDG, the patient recovered in one day and no recurrence was found later.Conclusion: For patients underwent DC, we should pay attention to the occurrence of paradoxicalherniation, SDG following DC may be the consequence of paradoxical herniation caused by CSF reduce therapy in post-DC patient, intravenous fluid expansion therapy is recommended and would play a great role for the recovery of the patient rather than surgical management.

  1. Recurrence of chronic subdural hematoma after trepanation and drainage

    Institute of Scientific and Technical Information of China (English)

    张建平; 许文辉; 朱立平; 张翔

    2003-01-01

    Objective: To sum up the causes of recurrence of chronic subdural hematoma (CSDH) from failure of trepanation and drainage and explore its prevention and treatment.Methods: From October 1988 to June 2002 a total of 358 patients with CSDH were treated with trepanation and drainage in our hospital. Among them 15 patients had recurrence of CSDH after operation. The data of the 15 patients were reviewed retrospectively.Results: Of the 15 patients, 13 were cured by retrepanation and redrainage, one cured by removal of hematoma by craniotomy with bone flap, and one, a 1-year old child, gave up reoperation due to severe encephalatrophy. Conclusions: Most CSDHs which recur after trepanation and drainage can be cured by retrepanation and redrainage. For the patients with repeated recurrence of CSDH removal of hematoma capsule can be considered. The causes of recurrence of CSDH are related to disease course, the thickness of hematoma capsule, the severity of encephalatraphy and whether the hematoma cavity is drained or irrigated completely, and operation methods.

  2. Midline Shift Threshold Value for Hemiparesis in Chronic Subdural Hematoma.

    Science.gov (United States)

    Juković, Mirela F; Stojanović, Dejan B

    2015-01-01

    Chronic subdural hematoma (CSDH) has a variety of clinical presentations, with numerous neurological symptoms and signs. Hemiparesis is one of the leading signs that potentially indicates CSDH. Purpose of this study was to determine the threshold (cut-off) value of midsagittal line (MSL) shift after which hemiparesis is likely to appear. The study evaluated 83 patients with 53 unilateral and 30 bilateral CSDHs in period of three years. Evaluated computed tomography (CT) findings in patients with CSDH were diameter of the hematoma and midsagittal line shift, measured on non-contrast CT scan in relation with occurrence of hemiparesis. Threshold values of MSL shift for both types of CSDHs were obtained as maximal (equal) sensitivity and specificity (intersection of the curves). MSL is a good predictor for hemiparesis occurrence (total sample, AUROC 0.75, p=0.0001). Unilateral and bilateral CSDHs had different threshold values of the MSL for hemiparesis development. Results suggested that in unilateral CSDH the threshold values of MSL could be at 10 mm (AUROC=0.65; p=0.07). For bilateral CSDH the threshold level of MSL shift was 4.5 mm (AUROC=0.77; p=0.01). Our study pointed on the phenomenon that midsagittal line shift can predict hemiparesis occurrence. Hemiparesis in patients with bilateral CSDH was more related to midsagittal line shift compared with unilateral CSDH. When value of midsagittal line shift exceed the threshold level, hemiparesis occurs with certain probability.

  3. [Subdural empyema secondary to sinusitis. A pediatric case report].

    Science.gov (United States)

    Varas, A Herrero; García, I San Martín; Galarraga, L Moreno; Aguirre, M Herranz; Romero, J C García; Iturbe, E Bernaola

    2011-01-01

    We present the case of 9 year old male referred to the A and E service with right ocular proptosis and progressive migraine in the context of a sinusitis diagnosed two days earlier by compatible clinical and radiological tests, and receiving treatment with amoxicillin-clavulanic acid. Physcial exploration revealed right ocular proptosis with a slight limitation for conjugate gaze. Facing the suspicion of a possible neurological complication of the sinusitis, cranial computer aided tomography (CAT) was carried out, with right frontal subdural empyema observed. He was admitted for intravenous antibiotic treatment with cefotaxime, vancomicin and metronidazole. He was evaluated by child Neurosurgery, Maxillofacial Surgery and Otorhinolaryngology (ORL) services; the decision was taken to only drain the primary focus, while an expectant neurosurgical attitude was maintained. The patient evolved favourably with a progressive disappearance of the symptoms. Periodical magnetic resonances were carried out, which showed a clear improvement up until the complete resolution of the empyema. Following four weeks of antibiotherapy iv., and after clinical and radiological normalization, the patient was discharged.

  4. Chronic Subdural Hematoma: A Questionnaire Survey of Management Practice in India and Review of Literature.

    Science.gov (United States)

    Avanali, Raghunath; Bhadran, Biju; Krishna Kumar, P; Vijayan, Abhishek; Arun, S; Musthafa, Aneeze M; Panchal, Sunil; Gopal, Vinu V

    2016-12-01

    To identify the current management modalities practiced by neurosurgeons in India for chronic subdural hematoma. A questionnaire was prepared for the survey and sent via e-mail to neurosurgeons. It covered the following aspects of managing chronic subdural hematoma: 1) demographic and institutional details; 2) choice of surgical procedure; 3) surgical adjutants such as placing a subdural drain; 4) pre- and postoperative care; and 5) recurrences and management. Responses obtained were entered in a SPSS data sheet and analyzed. Response rate of the survey was 9.3%. The majority of neurosurgeons (75%) preferred to do burr whole drainage for primary chronic subdural hematoma and also for recurrences. Only one third of routinely placed a subdural drain. Considerable practice variations exist for medical and perioperative management. Bedside twist drill drainage, which is effective and less costly than operative room procedures, has not gained popularity in practice. The present survey points towards the importance of making management guidelines for this common neurosurgical entity. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. A clinical evaluation of endoscopically placed self-expanding metallic stents in patients with acute large bowel obstruction

    DEFF Research Database (Denmark)

    Pommergaard, H C; Vilmann, Peter; Jakobsen, H L;

    2009-01-01

    in 71.4% of the benign cases with a mortality rate of 28,6%. CONCLUSIONS: Placement of SEMS for acute large bowel obstruction with malignant etiology is an effective and safe procedure with low mortality and morbidity. However results for benign obstructions are questionable and more research is needed...

  6. Subdural Effusions with Hydrocephalus after Severe Head Injury: Successful Treatment with Ventriculoperitoneal Shunt Placement: Report of 3 Adult Cases

    Directory of Open Access Journals (Sweden)

    N. Tzerakis

    2010-01-01

    Full Text Available Background. Subdural collections of cerebrospinal fluid (CSF with associated hydrocephalus have been described by several different and sometimes inaccurate terms. It has been proposed that a subdural effusion with hydrocephalus (SDEH can be treated effectively with a ventriculoperitoneal shunt (V-P shunt. In this study, we present our experience treating patients with SDEH without directly treating the subdural collection. Methods. We treated three patients with subdural effusions and hydrocephalus as a result of a head injury. All the patients were treated with a V-P shunt despite the fact that there was an extra-axial CSF collection with midline shift. Results. In all of the patients, the subdural effusions subsided and the ventricular dilatation improved in the postoperative period. The final clinical outcome remains difficult to predict and depends not only on the successful CSF diversion but also on the primary and secondary brain insult. Conclusion. Subdural effusions with hydrocephalus can be safely and effectively treated with V-P shunting, without directly treating the subdural effusion which subsides along with the treatment of hydrocephalus. However, it is extremely important to make an accurate diagnosis of an SDEH and differentiate this condition from other subdural collections which require different management.

  7. Long-term follow-up of acute Q fever patients after a large epidemic

    NARCIS (Netherlands)

    Wielders, CCH

    2014-01-01

    Between 2007 and 2009, one of the largest Q fever epidemics documented worldwide occurred in the Netherlands. This epidemic originated from dairy goat farms and resulted in over 3,500 notified human acute Q fever cases. After an episode of acute Q fever, the causative bacterium Coxiella burnetii may

  8. Recurrent, symptomatic, late-onset, contralateral subdural effusion following decompressive craniectomy treated by cranial strapping.

    Science.gov (United States)

    Krishnan, Prasad; Roy Chowdhury, Siddhartha

    2015-01-01

    Subdural effusions following decompressive craniotomy for trauma are usually benign, ipsilateral to the craniotomy and resolve spontaneously. Far less common and more dangerous are contralateral subdural effusions causing external cerebral herniation. We report a case of recurrent contralateral effusion and highlight the management dilemmas. Arachnoid tear is probably the cause of these collections. Contralateral subdural effusions should be suspected in patients who have delayed neurological deterioration after an initial improvement particularly in the setting of increased "flap bulge" though they may also be found in patients who remain moribund after initial surgery. There are no clear-cut guidelines on their management due to their rarity. A variety of options like subduro-peritoneal shunt and drainage with simultaneous cranioplasty may be tried. In situations where resources or patient compliance is an issue, tapping the effusion followed by cranial strapping may be tried as was done in our case.

  9. Subdural effusions and lack of early pontocerebellar hypoplasia in siblings with RARS2 mutations.

    Science.gov (United States)

    Kastrissianakis, Katherina; Anand, Geetha; Quaghebeur, Gerardine; Price, Sue; Prabhakar, Prab; Marinova, Jasmina; Brown, Garry; McShane, Tony

    2013-12-01

    Mutations in the recently described RARS2 gene encoding for mitochondrial arginyl-transfer RNA synthetase give rise to a disorder characterised by early onset seizures, progressive microcephaly and developmental delay. The disorder was named pontocerebellar hypoplasia type 6 (PCH6) based on the corresponding radiological findings observed in the original cases. We report two siblings with the RARS2 mutation who displayed typical clinical features of PCH6, but who had distinct neuroimaging features. Early scans showed marked supratentorial, rather than infratentorial, atrophy, and the pons remained preserved throughout. One sibling also had bilateral subdural effusions at presentation. The deceleration in head growth pointed to an evolving genetic/metabolic process giving rise to cerebral atrophy and secondary subdural effusions. RARS2 mutations should be considered in infants presenting with seizures, subdural effusions, decelerating head growth and evidence of cerebral atrophy even in the absence of pontocerebellar hypoplasia on imaging.

  10. Independent Correlation of Serum Homocysteine with Cerebral Microbleeds in Patients with Acute Ischemic Stroke due to Large-Artery Atherosclerosis.

    Science.gov (United States)

    Wang, Bian-Rong; Ou, Zhou; Jiang, Teng; Zhang, Ying-Dong; Zhao, Hong-Dong; Tian, You-Yong; Shi, Jian-Quan; Zhou, Jun-Shan

    2016-11-01

    The severity of cerebral microbleeds (CMBs) affected the prognosis of patients with acute cerebrovascular disease. Considering the impact of CMBs on clinical decision, it is necessary to assess the risk factors of CMBs. We aimed to evaluate the independent risk factors of CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. 112 patients were enrolled in the study. The baseline information, the results of laboratory examination and cranial MRI were collected. The independent risk factors of CMBs in patients with acute ischemic stroke due to large-artery atherosclerosis were evaluated. CMBs were found in 56 (50%) patients. Older age and higher homocysteine (Hcy) level were associated with an elevated chance of occurrence of CMBs. Further, there was a positive correlation between CMBs grade and serum Hcy level. Serum Hcy level is strongly associated with the presence of CMBs in patients with acute ischemic stroke due to large-artery atherosclerosis. Serum Hcy level may be a potential therapeutic target for alleviating adverse clinical outcomes of CMBs. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

    Directory of Open Access Journals (Sweden)

    Cincu Rafael

    2009-01-01

    Full Text Available Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia and later on can manifest as rebleeding and neurological deterioration.

  12. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

    Science.gov (United States)

    Cincu, Rafael; de Asis Lorente, Francisco; Rivero, David; Eiras, José; Ara, José Ramón

    2009-01-01

    Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia) and later on can manifest as rebleeding and neurological deterioration. PMID:19838395

  13. HEMATOMA SUBDURAL EN PACIENTE CON LEUCEMIA MIELODE CRONICA: REPORTE DE CASO

    OpenAIRE

    Carlos Fernando Lozano-Tangua; Luis Rafael Moscote-Salazar; Gabriel Alcala-Cerra; Sandra Milena Castellar Leones; Diego Batero

    2009-01-01

    El hematoma subdural cronico se define como una colección sanguíneo fibrinoide en el espacio existente entre las meninges duramadre y aracnoides, debido a traumas, infecciones (empiema y meningitis), coagulopatías u otras causas. En este se puede precisar durante la intervención quirúrgica la presencia de cápsula o membranas. Entre las diversas causas de hematoma subdural crónico se encuentra la leucemia mieloide crónica que es un síndrome mieloproliferativo, donde se ve una acentuada prolife...

  14. Concepts of neurosurgical management of chronic subdural haematoma: historical perspectives.

    Science.gov (United States)

    Weigel, R; Krauss, J K; Schmiedek, P

    2004-02-01

    The history of chronic subdural haematoma (CSH), spanning from its possibly earliest beginnings throughout the centuries until the early 1980s, was investigated within the context of four different epochs. In the 'era of uncertainty', successful trephination, the modem method of choice for the treatment of CSH, was developed by neolithic men. Various historical sources indicate that patients with CSH might have undergone surgery at that time. CSH might have been one of the ailments that had spectacular courses of salvation after trephination. The entity of CSH was first described in the 'era of pioneers' in the seventeenth century by Johann Jacob Wepfer. The misconception of 'pachymeningitis hemorrhagica interna' was introduced by Rudolf Virchow in 1857. By the end of the nineteenth century it became more widely accepted that trauma was a possible cause of CSH. Successful neurosurgical treatment of CSH was first reported by Hulke in 1883. Putnam and Cushing, in 1925, focused on surgery as the treatment of choice for CSH. In the 'era of diagnostic refinement', the introduction of pneumencephalography and angiography allowed the diagnosis of CSH much earlier. Subsequently, the typical signs and symptoms of patients suffering from CSH changed from apathy and coma to headaches and discrete focal neurological symptoms. In the 'era of surgical routine', neurosurgical approaches became smaller and less invasive. Removal of the haematoma was identified as the primary goal of surgery. The use of closed system drainage markedly improved reexpansion of the brain after surgery. Burr hole craniostomy and twist drill craniostomy became the surgical treatment of first choice because of their low morbidity and mortality. There is growing evidence, however, that the neurosurgical learning curve has reached a plateau.

  15. Acute large bowel pseudo-obstruction due to atrophic visceral myopathy: A case report

    Directory of Open Access Journals (Sweden)

    Sean M. Wrenn

    2017-01-01

    Conclusions: Atrophic visceral neuropathy is a rare cause of intestinal pseudo-obstruction. While often presenting with chronic obstruction in younger populations, we present a rare late-onset acute presentation that may have been secondary to underlying hypothyroidism.

  16. The next extreme sport? Subdural haematoma in a patient with arachnoid cyst after head shaking competition.

    Science.gov (United States)

    Hopkin, J; Mamourian, A; Lollis, S; Duhaime, T

    2006-04-01

    A young man, engaged in a head shaking competition presented with headache, nausea and vomiting. Imaging revealed a subdural haematoma and ipsilateral arachnoid cyst. This novel mechanism of trauma underscores the predisposition to haemorrhage in patients with arachnoid cysts, even with minor trauma. Aetiology, imaging and possible treatment options are discussed.

  17. Subdural hemorrhage: A unique case involving secondary vitamin K deficiency bleeding due to biliary atresia.

    Science.gov (United States)

    Miyao, Masashi; Abiru, Hitoshi; Ozeki, Munetaka; Kotani, Hirokazu; Tsuruyama, Tatsuaki; Kobayashi, Naho; Omae, Tadaki; Osamura, Toshio; Tamaki, Keiji

    2012-09-10

    Extrahepatic biliary atresia (EHBA) is a rare disease characterized by progressive and obliterative cholangiopathy in infants and is one of the major causes of secondary vitamin K deficiency bleeding (VKDB) due to cholestasis-induced fat malabsorption. Breast feeding increases the tendency of bleeding in EHBA patients because breast milk contains low amounts of vitamin K. A 2-month-old female infant unexpectedly died, with symptoms of vomiting and jaundice prior to death. She had been born by uncomplicated vaginal delivery and exhibited normal growth and development with breastfeeding. There was no history of trauma. She received vitamin K prophylaxis orally. In an emergency hospital, a CT scan showed a right intracranial hematoma and mass effect with midline shift to the left. In the postmortem examination, severe atresia was observed in the whole extrahepatic bile duct. Histologically, cholestasis, periductal fibrosis, and distorted bile ductules were noted. The gallbladder was not identified. A subdural hematoma and cerebellar tonsillar herniation were found; however, no traumatic injury in any part of the body was observed. Together, these findings suggest that the subdural hemorrhage was caused by secondary vitamin K deficiency resulting from a combination of cholestasis-induced fat malabsorption and breastfeeding. Subdural hemorrhage by secondary VKDB sometimes occurs even when vitamin K prophylaxis is continued. This case demonstrated that intrinsic factors, such as secondary VKDB (e.g., EHBA, neonatal hepatitis, chronic diarrhea), should also be considered in infant autopsy cases presenting with subdural hemorrhage.

  18. Role of Subdural Electrocorticography in Prediction of Long-Term Seizure Outcome in Epilepsy Surgery

    Science.gov (United States)

    Asano, Eishi; Juhasz, Csaba; Shah, Aashit; Sood, Sandeep; Chugani, Harry T.

    2009-01-01

    Since prediction of long-term seizure outcome using preoperative diagnostic modalities remains suboptimal in epilepsy surgery, we evaluated whether interictal spike frequency measures obtained from extraoperative subdural electrocorticography (ECoG) recording could predict long-term seizure outcome. This study included 61 young patients (age…

  19. Recurrent subdural hygromas after foramen magnum decompression for Chiari Type I malformation.

    Science.gov (United States)

    Pereira, Erlick A C; Steele, Louise F; Magdum, Shailendra A

    2014-06-01

    A paediatric case of foramen magnum decompression for Chiari Type I malformation complicated by recurrent subdural hygromas (SH) and raised intracranial pressure without ventriculomegaly is described. SH pathogenesis is discussed, with consideration given to arachnoid fenestration. We summarise possibilities for treatment and avoidance of this unusual consequence of foramen magnum decompression.

  20. Combining stereo-electroencephalography and subdural electrodes in the diagnosis and treatment of medically intractable epilepsy.

    Science.gov (United States)

    Enatsu, Rei; Bulacio, Juan; Najm, Imad; Wyllie, Elaine; So, Norman K; Nair, Dileep R; Foldvary-Schaefer, Nancy; Bingaman, William; Gonzalez-Martinez, Jorge

    2014-08-01

    Stereo-electroencephalography (SEEG) has advantages for exploring deeper epileptic foci. Nevertheless, SEEG can only sample isolated cortical areas and its spatial limitation, with the inability to record contiguous cortical regions, may cause difficulties in interpretation. In light of these limitations, the authors describe the hybrid technique of SEEG and subdural strip electrode placement. The hybrid technique was used for a presurgical evaluation in four patients with intractable epilepsy. Initially, the depth electrodes were inserted with a robotic stereotactic system. Thereafter, a skin incision and a small craniectomy were performed at the entry point of the strip electrode trajectory. The dura was opened and, under live fluoroscopic guidance, strip electrodes were slid into the subdural space. In these patients, the additional subdural strip electrodes provided (1) information regarding the precise description of seizure spread in the cortical surface adjacent to the subdural space, (2) identification of epileptogenic zones located near the crown, (3) more precise definition of functional cortex and (4) a better delineation of the interface between epileptogenic zones and functional cortex. This hybrid technique provides additional data compared to either technique alone, offering superior understanding of the dynamics of the epileptic activity and its interaction with functional cortical areas.

  1. Acute but not chronic ethanol exposure impairs retinol oxidation in the small and large intestine of the rat

    DEFF Research Database (Denmark)

    Parlesak, Alexandr; Ellendt, K.; Lindros, K.

    2005-01-01

    BACKGROUND AND AIM: Ethanol has been shown to inhibit retinol oxidation at the level of alcohol dehydrogenase in liver and colon but not previously in the small intestine. In the present study we investigated how chronic alcohol feeding and acute ethanol exposure affects retinol dehydrogenase...... activity in the colon and small intestine of the rat. METHODS: Rats were fed ethanol in a liquid diet for six weeks. Control rats received a similar diet but with ethanol isocalorically replaced by carbohydrates. Retinol dehydrogenase was analyzed from cell cytosol samples from the small and the large...... higher, respectively). While chronic alcohol feeding did not affect these parameters, acute ethanol exposure reduced V(max) and V(max)/K(m) dose-dependently (p

  2. Acute, chronic and reproductive effects of petroleum and two petroleum substitutes on the large milkweed bug, Oncopeltus fasciatus

    Energy Technology Data Exchange (ETDEWEB)

    Merchant, E.R.; Walton, B.T.

    1983-12-01

    Effects of petroleum and two synthetic oils on mortality and reproduction of the large milkweed bug, Oncopeltus fasciatus (Dallas), were compared. Reproduction was investigated because of its importance in the maintenance of population levels and the sensitivity of the reproductive system to toxicants. Adult milkweed bugs were dosed topically with the test oils to measure acute toxicity. Chronic toxicity was determined by mean survival after chronic exposure, starting with the fifth instar. The ability of sublethal levels of the test oils to affect reproduction was measured by the number of eggs laid and their percent hatch. The two synthetic oils were found to be more acutely and chronically toxic than petroleum. Egg production was not affected by petroleum but was reduced approximately 20% by sublethal levels of both synthetic oils. Egg viability was not affected.

  3. Acute Cholangitis following Biliary Obstruction after Duodenal OTSC Placement in a Case of Large Chronic Duodenocutaneous Fistula

    Directory of Open Access Journals (Sweden)

    Yaseen Alastal

    2015-01-01

    Full Text Available Over-the-Scope Clip system, also called “Bear Claw,” is a novel endoscopic modality used for closure of gastrointestinal defect with high efficacy and safety. We present a patient with history of eosinophilic gastroenteritis and multiple abdominal surgeries including Billroth II gastrectomy complicated by a large chronic duodenocutaneous fistula from a Billroth II afferent limb to the abdominal wall. Bear Claw clip was used for closure of this fistula. The patient developed acute cholangitis one day after placement of the Bear Claw clip. Acute cholangitis due to papillary obstruction is a potential complication of Bear Claw placement at the dome of the duodenal stump (afferent limb in patient with Billroth II surgery due to its close proximity to the major papilla.

  4. Hematoma subdural intracraneal: una rara complicación después de la raquianestesia: relato de caso

    OpenAIRE

    Flora Margarida Barra Bisinotto; Roberto Alexandre Dezena; Daniel Capucci Fabri; Tania Mara Vilela Abud; Livia Helena Canno

    2012-01-01

    BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma after spinal anesthesia performed with a fine-gauge needle and single puncture. CASE REPORT: 48-year old female patient, ASA I, undergoing spinal anesthesia for surgery to correct urinary incontinence. The spi...

  5. [IMPROVEMENT AND CHOICE OF COLOSTOMY METHOD IN THE TREATMENT OF PATIENTS, SUFFERING AN ACUTE OBTURATIVE IMPASSABILITY OF LARGE BOWEL].

    Science.gov (United States)

    Kustryo, V I; Langazo, O V

    2015-11-01

    Colostomy was done in 49 patients, suffering an acute obturative impassability of large bowel (AOILB). In 28 patients (1st group) colostomy was conducted in accordance to standard method; in 21 (2nd group)--in accordance to the method, proposed by us. Application of the method proposed for surgical treatment of AOILB have guaranteed a reduction of postoperative paracolostomal complications rate in 6.8 times, of postoperative lethality--in 2.2 times, duration of the patient stationary treatment--in 1.4 times, the rate of dressings and the dressing material expanses--in 10 times.

  6. Large volume unresectable locally advanced non-small cell lung cancer: acute toxicity and initial outcome results with rapid arc

    Directory of Open Access Journals (Sweden)

    Fogliata Antonella

    2010-10-01

    Full Text Available Abstract Background To report acute toxicity, initial outcome results and planning therapeutic parameters in radiation treatment of advanced lung cancer (stage III with volumetric modulated arcs using RapidArc (RA. Methods Twenty-four consecutive patients were treated with RA. All showed locally advanced non-small cell lung cancer with stage IIIA-IIIB and with large volumes (GTV:299 ± 175 cm3, PTV:818 ± 206 cm3. Dose prescription was 66Gy in 33 fractions to mean PTV. Delivery was performed with two partial arcs with a 6 MV photon beam. Results From a dosimetric point of view, RA allowed us to respect most planning objectives on target volumes and organs at risk. In particular: for GTV D1% = 105.6 ± 1.7%, D99% = 96.7 ± 1.8%, D5%-D95% = 6.3 ± 1.4%; contra-lateral lung mean dose resulted in 13.7 ± 3.9Gy, for spinal cord D1% = 39.5 ± 4.0Gy, for heart V45Gy = 9.0 ± 7.0Gy, for esophagus D1% = 67.4 ± 2.2Gy. Delivery time was 133 ± 7s. At three months partial remission > 50% was observed in 56% of patients. Acute toxicities at 3 months showed 91% with grade 1 and 9% with grade 2 esophageal toxicity; 18% presented grade 1 and 9% with grade 2 pneumonia; no grade 3 acute toxicity was observed. The short follow-up does not allow assessment of local control and progression free survival. Conclusions RA proved to be a safe and advantageous treatment modality for NSCLC with large volumes. Long term observation of patients is needed to assess outcome and late toxicity.

  7. Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction.

    Science.gov (United States)

    Cariati, Paolo; Cabello-Serrano, Almudena; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas

    2016-10-01

    Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words:Meningitis, subdural empyema, odontogenic infections.

  8. [Chronic subdural hematoma with a markedly fibrous hypertrophic membrane. Case report].

    Science.gov (United States)

    Sato, M; Kuwana, N; Kojima, Y; Tanaka, N; Kitamura, H

    1990-01-01

    A 40-year-old female, who had taken low-dose oral contraceptives for 2 months before onset, developed transient dysarthria, left hemiparesis, and left hemihypesthesia. One month later, a computed tomography (CT) scan revealed a uniformly enhanced, convex-shaped, hypertrophic membrane with a lobulated lumen in the subdural space of the right parietal region. A right parietal craniotomy was performed. The membrane, consisting of elastic-hard, hypertrophic granulation tissue and yellowish, sticky fluid in the lumen, was readily freed and totally extirpated. Subsequently, the patient recovered without persistent symptoms. Light microscopic examination detected the sinusoidal channel layer and the fibrous layer in an alternating configuration, along with intramembranous hemorrhagic foci. Such hypertrophy must have been caused by repeated intramembranous hemorrhages and reactive granulation. Such findings of hematoma membrane have never previously been reported. Thus, this is an interesting case, clearly distinguished from typical chronic subdural hematoma.

  9. HEMATOMA SUBDURAL EN PACIENTE CON LEUCEMIA MIELODE CRONICA: REPORTE DE CASO

    Directory of Open Access Journals (Sweden)

    Carlos Fernando Lozano-Tangua

    2009-01-01

    Full Text Available El hematoma subdural cronico se define como una colección sanguíneo fibrinoide en el espacio existente entre las meninges duramadre y aracnoides, debido a traumas, infecciones (empiema y meningitis, coagulopatías u otras causas. En este se puede precisar durante la intervención quirúrgica la presencia de cápsula o membranas. Entre las diversas causas de hematoma subdural crónico se encuentra la leucemia mieloide crónica que es un síndrome mieloproliferativo, donde se ve una acentuada proliferación de glóbulos blancos de la serie granulocítica, que infiltran la sangre, médula ósea, cerebro entre otros tejidos. Presentamos brevemente un caso de esta interesante y no infrecuente asociación.

  10. Anatomy and development of the meninges: implications for subdural collections and CSF circulation.

    Science.gov (United States)

    Mack, Julie; Squier, Waney; Eastman, James T

    2009-03-01

    The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system.

  11. Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction

    Science.gov (United States)

    Cabello-Serrano, Almudena; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas

    2016-01-01

    Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words:Meningitis, subdural empyema, odontogenic infections. PMID:27703619

  12. Anatomy and development of the meninges: implications for subdural collections and CSF circulation

    Energy Technology Data Exchange (ETDEWEB)

    Mack, Julie [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Squier, Waney [John Radcliffe Hospital, Department of Neuropathology, Oxford (United Kingdom); Eastman, James T. [Lancaster General Hospital, Department of Pathology and Laboratory Medicine, Lancaster, PA (United States)

    2009-03-15

    The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system. (orig.)

  13. Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

    Directory of Open Access Journals (Sweden)

    J. Zhang

    Full Text Available A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

  14. Acute strength exercise and the involvement of small or large muscle mass on plasma brain-derived neurotrophic factor levels

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Correia

    2010-01-01

    Full Text Available OBJECTIVE: Blood neurotrophins, such as the brain-derived neurotrophic factor, are considered to be of great importance in mediating the benefits of physical exercise. In this study, the effect of acute strength exercise and the involvement of small versus large muscle mass on the levels of plasma brain-derived neurotrophic factor were evaluated in healthy individuals. METHODS: The concentric strengths of knee (large and elbow (small flexor and extensor muscles were measured on two separate days. Venous blood samples were obtained from 16 healthy subjects before and after exercise. RESULTS: The levels of brain-derived neurotrophic factor in the plasma did not significantly increase after both arm and leg exercise. There was no significant difference in the plasma levels of the brain-derived neurotrophic factor in the arms and legs. CONCLUSION: The present results demonstrate that acute strength exercise does not induce significant alterations in the levels of brain-derived neurotrophic factor plasma concentrations in healthy individuals. Considering that its levels may be affected by various factors, such as exercise, these findings suggest that the type of exercise program may be a decisive factor in altering peripheral brain-derived neurotrophic factor.

  15. The role of subgaleal suction drain placement in chronic subdural hematoma evacuation

    OpenAIRE

    Yadav, Yad Ram; Parihar, Vijay; Chourasia, Ishwar D.; Bajaj, Jitin; Namdev, Hemant

    2016-01-01

    Introduction: There is lack of uniformity about the preferred surgical treatment, role of drain, and type of drain among various surgeons in chronic subdural hematoma (CSDH). The present study is aimed to evaluate role of subgaleal drain. Materials and Methods: This was a prospective study of 260 patients of CSDH treated surgically. Burr-hole irrigation with and without suction drain was done in 140 and 120 patients, respectively. Out of 120 patients without suction drain 60 each were managed...

  16. The role of craniotomy and trephination in the treatment of chronic subdural hematoma.

    Science.gov (United States)

    Voelker, J L; Sambasivan, M

    2000-07-01

    The treatment of chronic subdural hematoma by craniotomy was the procedure of choice in the early part of this century. It has since been replaced by less invasive techniques but retains a limited role in the management of this condition. A new procedure involving a small craniectomy and marsupialization of the hematoma cavity to the temporalis muscle is described. The results of this treatment compare favorably with the more commonly performed drainage methods.

  17. High cervical spinal subdural hemorrhage as a harbinger of craniocervical arteriovenous fistula: an unusual clinical presentation.

    Science.gov (United States)

    Kasliwal, Manish K; Moftakhar, Roham; O'Toole, John E; Lopes, Demetrius K

    2015-05-01

    Craniocervical dural arteriovenous fistula (dAVF) is rare as compared with the typical thoracolumbar dAVFs of the spine and usually presents with hemorrhagic manifestation, predominantly intracranial subarachnoid hemorrhage. We describe the first case of craniocervical dAVF with initial presentation as neck pain and spinal subdural hemorrhage. Case report. We present the case of a 59-year-old woman who presented with sudden onset of neck pain at an outside institution emergency department (ED) and was discharged after negative cervical spine radiographs. Magnetic resonance imaging of the cervical spine performed because of persistent pain demonstrated presence of high cervical spinal subdural hematoma and she was managed conservatively. She subsequently presented to our ED a week later with headache and was found to have an intraventricular hemorrhage on computed tomography scan of the head, which on subsequent workup with an angiography revealed the presence of a craniocervical dAVF. Surgical obliteration of the fistula was performed with use of intraoperative angiography as an adjunct to confirm complete fistula obliteration. She had an excellent clinical outcome with no deficits at her last follow-up at 9 months. Even though hemorrhagic presentation is fairly common in craniocervical dAVFs, there is no report of a craniocervical dAVF presenting with spinal subdural hemorrhage. The present case further highlights the propensity of these vascular lesions to bleed and emphasizes the clinical importance of including these lesions in the differential diagnosis of hemorrhage in the vicinity of foramen magnum region, whether subarachnoid or subdural in location. Physicians treating spinal pathologies should be aware of this entity and clinical presentation, as an angiography needs to be considered in these cases to direct appropriate referral and treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Calcified subdural haematomas associated with arrested hydrocephalus - late sequelae of shunt operation in infancy

    Energy Technology Data Exchange (ETDEWEB)

    Barmeir, E.P.; Stern, D.; Harel, S.; Holtzman M.; Krije, T.J.

    1985-08-01

    Calcified chronic subdural haematoms (SDH) and features of arrested (compensated) hydrocephalus were demonstrated by skull radiography and cranial computed tomography (CT) in two children who had no neurological deficit. Ventricular surgical drainage had been performed 8 and 11 years prior to admission and the haematomas remained subsequently undetected. The following presentation will serve to illustrate the characteristic radiological features of this entity, the issue of management, and includes a review of the literature.

  19. Interhemispheric subdural empyema diagnosed by CT and cured by antibiotic therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hayakawa, I.; Fukui, M.; Furuhashi, N.; Kanda, T.; Tazaki, Y. (Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine)

    1981-09-01

    A case of interhemispheric subdural empyema cured by high doses of antibiotics was reported. A 23-year-old man was admitted with complaints of headache, fever and motor weakness of the left lower leg of 2 days' duration. The neurological examination revealed neck stiffness, motor weakness and sensory disturbance of left lower leg. The WBS count was 26,000/cumm, and ESR was 74 mm/hour. The CSF showed a pressure of 230 mm H/sub 2/O and contained 1001/3 cells (63% polymorphonuclears, 37% lymphocytes) in association with slight elevation of protein but with normal sugar content. The CSF culture was negative. Administration of high doses of antibiotics was started on the first hospital day. On the fourth hospital day, Jacksonian seizures occurred in the left lower extremity, and were controlled by anticonvulsants. CT scans with contrast enhancement revealed an area of low density in the right interhemispheric space with irregular marginal enhancement. Right carotid arteriography demonstrated a small oval avascular space along the interhemispheric cistern. The abnormalities on CT scan disappeared after one month, when the patient was discharged without neurological deficit. Unlike the previously reported cases with interhemispheric subdural empyema commonly associated with a collection of pus over the cerebral convexities, a localized interhemispheric subdural empyema as was found in the present case appears to be a very rare condition. The interhemispheric subdural empyema has been thought to be exclusively surgical indication and, to the best of our knowlage, there is no report in the literature of a case with successful medical treatment. However, successful treatment by antibiotics alone may become more practical if the diagnoses could be made in the early stage with the aid of CT scan.

  20. Abscesso subdural ao nível da cauda equina: relato de um caso

    Directory of Open Access Journals (Sweden)

    Antonio Cesar G. Borges

    1977-09-01

    Full Text Available É relatada a observação de um paciente de 42 anos, com paraplegia flácida devida a abscesso subdural ao nível da cauda equina. É realçada a pobreza de alterações sensitivas e esfincterianas neste caso e enfatizada a importância da cirurgia para obtenção de bons resultados.

  1. Chronic subdural hematoma associated with moyamoya phenomenon after radiotherapy for medulloblastoma; A case report

    Energy Technology Data Exchange (ETDEWEB)

    Fuse, Takahisa; Takagi, Takuji; Fukushima, Tsuneyuki; Mizuno, Shiroh; Hashimoto, Nobukazu; Suzuki, Osamu (Nagoya City Higashi General Hospital (Japan))

    1994-04-01

    A 9-year-old boy had been diagnosed at the age of 9 months as having a cerebellar medulloblastoma and had received 40 Gy of radiation therapy to the brain after removal of the tumor. Cerebral angiography at the time of initial diagnosis did not show any evidence of occlusive disease involving the internal carotid circulation. At the age of 6 years, the patient developed generalized seizures. On examination, he was drowsy and had right hemiparesis. CT scan demonstrated a low-density area in the left frontal lobe. Cerebral angiography showed a marked narrowing of the bilateral internal carotid arteries with moyamoya vessels. The patient was treated medically with aspirin (100 mg/day) and anticonvulsants. His neurological deficits improved gradually. At the age of 8 years, there was no recurrence of the tumor although a slight left subdural hematoma was seen on CT scan. On August 10, 1993, at the age of 9 years, he was admitted for treatment of a developing subdural hematoma. MRI showed a chronic subdural hematoma with thick outer and inner membranes. Cerebral angiography showed occlusion of the left internal carotid artery which fed the right frontal lobe through moyamoya vessels, marked narrowing of the right internal carotid artery distal to the ophthalmic artery, moyamoya vessels at the base, and cortical revascularization througth the ophthalmic, posterior cerebral and middle meningeal arteries. Trepanation and aspiration of the hematoma were performed. The outer membrane of the hematoma was about 2 mm thick and the hematoma cavity was filled with a partially organized hematoma. In this case, we speculate that development of the chronic subdural hematoma involved the following factors: (1) transdural external-internal carotid anastomosis after radiation-induced cerebrovasculopathy; (2) repeated mild head trauma due to gait disturbance after removal of the cerebellar tumor; and (3) administration of acetylsalicylic acid. (author).

  2. Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review

    OpenAIRE

    Akins, Paul T.; Axelrod, Yekaterina K; Ji, Cheng; Ciporen, Jeremy N.; Arshad, Syed T.; Hawk, Mark W.; Guppy, Kern H.

    2013-01-01

    Background: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). Case Description: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to ...

  3. Embolization of the Middle Meningeal Artery Effectively Treats Refractory Chronic Subdural Hematoma: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Gobran Alfotih

    2014-10-01

    Full Text Available Chronic subdural hematoma (CSDH formation mechanism is very complex, and has not entirely understood. It represents a frequent type of intracranial hemorrhage, and is very common disease in Neurosurgery practice, especially in older patients. Various surgical treatments have been proposed for the treatment of CSDH. The rate of recurrence in CSDH after surgery ranges from 5% to 30%, repeated surgery must be considered. But in some cases subdural collections are still persistent. Endovascular embolization of the middle meningeal artery (MMA is an option for treatment of refractory CSDH. We review all cases that were treated with embolization to assess the effect of this intervention. Our review revealed 6 papers with a total enrollment of 14 patients were treated with MMA embolization for refractory chronic subdural hematoma without any postoperative complication or recurrence. In this study we suggest MMA embolization as an alternative for treatment of non-curable CSDH, especially for old people with systematic diseases, who cannot tolerate repeat surgery.

  4. [Chronic subdural haematomas. The internal architecture of the haematoma as a predictor of recurrence].

    Science.gov (United States)

    García-Pallero, M Ángeles; Pulido-Rivas, Paloma; Pascual-Garvi, José M; Sola, Rafael G

    2014-10-01

    Introduccion. La arquitectura interna del hematoma subdural cronico (HSDC) es un factor muy importante que se debe tener en cuenta como predictor de recidiva. Objetivo. Analizar los factores posiblemente asociados a la recidiva de los HSDC, prestando especial atencion a dicha arquitectura. Pacientes y metodos. Hemos revisado 147 pacientes tratados desde 2010 hasta 2013. Dividimos los HSDC en cuatro tipos de acuerdo con la clasificacion de Nakaguchi de 2001. Ademas, hemos recogido diferentes caracteristicas clinicas y las hemos sometido a analisis estadistico para evaluar su posible asociacion con la tasa de recidiva de los HSDC. Resultados. La tasa de recidiva fue del 14,75% y la de mortalidad, del 4,76%. El tratamiento con anticoagulantes, el tipo de hematoma y el no usar drenaje subdural fueron factores de riesgo estadisticamente significativos para la recurrencia del HSDC. Segun la arquitectura interna, la tasa de recidiva fue del 36,36% para el tipo separado, del 15,90% para el laminar, del 8,82% para el homogeneo y del 0% para el trabecular. Dicha tasa fue significativamente mayor en el tipo separado respecto al homogeneo y trabecular. Conclusiones. El tratamiento con anticoagulantes y el no usar drenaje subdural son factores de riesgo de recurrencia de HSDC. Ademas, la division de los HSDC de acuerdo con la clasificacion de Nakaguchi puede ser util para predecir el riesgo de recurrencia, ya que la tasa de recidiva del tipo separado fue significativamente mayor que la del resto de tipos.

  5. Subdural empyema, retropharyngeal and parapharyngeal space abscess: Unusual complications of chronic otitis media

    Directory of Open Access Journals (Sweden)

    Erdevički Ljiljana

    2012-01-01

    Full Text Available Introduction. Otitic complications arise from expansion of the middle ear infection. Subdural empyema is a rare otitic complication, and both retropharyngeal and parapharyngeal abscesses have been described in just a few cases. Case report. A 30-year-old male was, admitted as an emergency case because of breathing difficulties, secretion from the ear, and fever. Clinical examination had shown a purulent, fetid secretion from the ear, swelling on the roof of epipharynx, left tonsil pushed medialy, immobile epiglottis, reduced breathing space. Computed tomography revealed thick hypodense content filling cavity, mastoid entering the posterior cranial fossa, descending down throw the parapharyngeal space to the mesopharynx. On the roof and posterior wall of the epipharynx hypodense collection was also present. Tracheotomy was conducted, and incision of the parapharyngeal and retropharyngeal abscess and radical tympanomastoidectomy were performed. The patient’s state deteriorated on the tenth postoperative day with hemiparesis and consciousness disorder. Magnetic resonance imaging was done. It showed subdural empyema of the left frontoparietal region and next to the falx, so craniotomy and abscess drainage were conducted. Conclusion. Parapharyngeal, retropharyngeal abscess and subdural empyema are rare otitic complications. Adequate antibiotic therapy and radical surgical treatment make possible an outcome with survival.

  6. Chronic Subdural Hematoma Associated with Thrombocytopenia in a Patient with Human Immunodeficiency Virus Infection in Cameroon

    Directory of Open Access Journals (Sweden)

    Clovis Nkoke

    2017-01-01

    Full Text Available Hematological abnormalities including thrombocytopenia are common in patients living with HIV infection. Patients with HIV infection related thrombocytopenia present generally with only minor bleeding problems. But cases of subdural hematoma are very rare. A 61-year-old female with a history of HIV infection of 9 years’ duration presented with a 3-month history of generalized headache associated with visual blurring and anterograde amnesia. There was no history of trauma or fever. She was treated empirically for cerebral toxoplasmosis for 6 weeks without any improvement of the symptoms. One week prior to admission, she developed weakness of the left side of the body. Clinical examination revealed left-sided hemiparesis. Computed tomography scan of the brain showed a 25 mm chronic right frontoparietotemporal subdural hematoma compressing the lateral ventricle with midline shift. There was no appreciable cerebral atrophy. A complete blood count showed leucopenia and thrombocytopenia at 92,000 cells/mm3. Her CD4-positive cell count was 48 cells/mm3 despite receiving combination antiretroviral therapy for 9 years. A complete blood count analysis suggestive of thrombocytopenia should raise suspicion of possibilities of noninfectious focal brain lesions like subdural hematoma amongst HIV infected patients presenting with nonspecific neurological symptoms. This will enable prompt diagnosis and allow early appropriate intervention.

  7. Analyzing transformation of myelodysplastic syndrome to secondary acute myeloid leukemia using a large patient database.

    Science.gov (United States)

    Shukron, Ofir; Vainstein, Vladimir; Kündgen, Andrea; Germing, Ulrich; Agur, Zvia

    2012-09-01

    One-third of patients with myelodysplastic syndrome (MDS) progress to secondary acute myeloid leukemia (sAML), with its concomitant poor prognosis. Recently, multiple mutations have been identified in association with MDS-to-sAMLtransition, but it is still unclear whether all these mutations are necessary for transformation. If multiple independent mutations are required for the transformation, sAML risk should increase with time from MDS diagnosis. In contrast, if a single critical biological event determines sAML transformation; its risk should be constant in time elapsing from MDS diagnosis. To elucidate this question, we studied a database of 1079 patients with MDS. We classified patients according to the International Prognostic Scoring System (IPSS), using either the French-American-British (FAB) or the World Health Organization (WHO) criteria, and statistically analyzed the resulting transformation risk curves of each group. The risk of transformation after MDS diagnosis remained constant in time within three out of four risk groups, and in all four risk groups, when patients were classified according to FAB or to the WHO-determined criteria, respectively. Further subdivision by blast percentage or cytogenetics had no influence on this result. Our analysis suggests that a single random biological event leads to transformation to sAML, thus calling for the exclusion of time since MDS diagnosis from the clinical decision-making process.

  8. Large-scale Purification and Acute Toxicity of Hygromycin B Phosphotransferase

    Institute of Scientific and Technical Information of China (English)

    QIN ZHUO; JIAN-HUA PIAO; YUAN TIAN; JIE XU; XIAO-GUANG YANG

    2009-01-01

    Objective To provide the acute toxicity data of hygromycin B phosphotransferase (HPT) using recombinant protein purified from E. coli. Methods Recombinant HPT protein was expressed and purified from E. coli. To exclude the potential adverse effect of bacteria protein in recombinant HPT protein, bacterial control plasmid was constructed, and bacteria control protein was extracted and prepared as recombinant HPT protein. One hundred mice, randomly assigned to 5 groups, were administrated 10 g/kg, 5 g/kg, or 1 g/kg body weight of HPT or 5 g/kg body weight of bacterial control protein or phosphate-buffered saline (PBS) respectively by oral gavage. Results All animals survived with no significant change in body weight gain throughout the study. Macroscopic necropsy examination on day 15 revealed no gross pathological lesions in any of the animals. The maximum tolerated dose (MTD) of HPT was 10 g/kg body weight in mice and could be regarded as nontoxic. Conclusion HPT protein does not have any safety problems to human health.

  9. A case of large atrial myxoma presenting as an acute stroke

    Directory of Open Access Journals (Sweden)

    Praneet Iyer

    2016-02-01

    Full Text Available Left atrial myxomas are rare primary cardiac tumors. Their incidence is estimated to be about 0.1% of total cases. Neurological complications resulting from cardiac myxomas are seen in 20–35% of patients. Transesophageal echocardiogram (TEE is preferred over transthoracic echocardiogram for evaluation of left atrial myxoma. Three-dimensional (3D echocardiography ensures better visualization of intracardiac structures. It has been used prior to surgery for diagnostic support in the surgical treatment of cardiac masses. We present a case of a 46-year-old Hispanic male who developed acute ischemic stroke of left frontal lobe and was also found to have multiple ‘silent’ cerebral infarcts in the MRI of the brain. On further workup, he was found to have a left atrial myxoma on 3D TEE. This was resected with the assistance of intra-operative 3D TEE imaging. We present this case to increase awareness and to stress at early evaluation of secondary causes of ischemic cerebrovascular accident, outside the realm of hypercoagulability. This case also exhibits the need for basic cardiac workup in young individuals who present with symptoms of intermittent palpitations or chest pain to minimize significant morbidity or mortality.

  10. The level of circulating endothelial progenitor cells may be associated with the occurrence and recurrence of chronic subdural hematoma

    Directory of Open Access Journals (Sweden)

    Yan Song

    2013-01-01

    Full Text Available OBJECTIVES: The onset of chronic subdural hematoma may be associated with direct or indirect minor injuries to the head or a poorly repaired vascular injury. Endothelial progenitor cells happen to be one of the key factors involved in hemostasis and vascular repair. This study was designed to observe the levels of endothelial progenitor cells, white blood cells, platelets, and other indicators in the peripheral blood of patients diagnosed with chronic subdural hematoma to determine the possible relationship between the endothelial progenitor cells and the occurrence, development, and outcomes of chronic subdural hematoma. METHOD: We enrolled 30 patients with diagnosed chronic subdural hematoma by computer tomography scanning and operating procedure at Tianjin Medical University General Hospital from July 2009 to July 2011. Meanwhile, we collected 30 cases of peripheral blood samples from healthy volunteers over the age of 50. Approximately 2 ml of blood was taken from veins of the elbow to test the peripheral blood routine and coagulation function. The content of endothelial progenitor cells in peripheral blood mononuclear cells was determined by flow cytometry. RESULTS: The level of endothelial progenitor cells in peripheral blood was significantly lower in preoperational patients with chronic subdural hematomas than in controls. There were no significant differences between the two groups regarding the blood routine and coagulation function. However, the levels of circulating endothelial progenitor cells were significantly different between the recurrent group and the non-recurrent group. CONCLUSIONS: The level of circulating endothelial progenitor cells in chronic subdural hematoma patients was significantly lower than the level in healthy controls. Meanwhile, the level of endothelial progenitor cells in recurrent patients was significantly lower than the level in patients without recurrence. Endothelial progenitor cells may be related to the

  11. Spontaneous large renal pelvis hematoma in ureteropelvic junction obstruction presenting as an acute abdomen: Rare case report.

    Science.gov (United States)

    Sawant, Ajit; Kasat, Gaurav; Pawar, Prakash; Tamhankar, Ashwin

    2016-01-01

    Patients with ureteropelvic junction (UPJ) obstruction can present with flank pain or hematuria. We present 20-year-old male presenting with acute pain in lumbar and right fossa with tenderness and guarding, this case was clinically mimicking general surgical emergency. On computed tomography with urography and angiography, there was 15 cm × 11 cm × 10 cm size non-enhancing hyperdense lesion (average Hounsfield units - +64) in right renal pelvis suggestive of hematoma. Patient's diethylenetriaminepentaacetic acid diuretic renography was suggestive of right kidney glomerular function rate of 48.4 ml/min with the relative function of 43%, Peak to half peak was not achieved. The patient was managed by retrograde ureteropyelography and double J stenting. After 1 month, clot size decreased to 4 cm × 3 cm × 2 cm. The patient had undergone open reduction Anderson hynes dismembered pyeloplasty with the removal of pelvis clot after 6 weeks. We report the first case of UPJ obstruction presenting as an acute abdomen and spontaneous hematuria with large pelvis clot without rupture of the renal pelvis.

  12. Spontaneous large renal pelvis hematoma in ureteropelvic junction obstruction presenting as an acute abdomen: Rare case report

    Directory of Open Access Journals (Sweden)

    Ajit Sawant

    2016-01-01

    Full Text Available Patients with ureteropelvic junction (UPJ obstruction can present with flank pain or hematuria. We present 20-year-old male presenting with acute pain in lumbar and right fossa with tenderness and guarding, this case was clinically mimicking general surgical emergency. On computed tomography with urography and angiography, there was 15 cm × 11 cm × 10 cm size non-enhancing hyperdense lesion (average Hounsfield units - +64 in right renal pelvis suggestive of hematoma. Patient's diethylenetriaminepentaacetic acid diuretic renography was suggestive of right kidney glomerular function rate of 48.4 ml/min with the relative function of 43%, Peak to half peak was not achieved. The patient was managed by retrograde ureteropyelography and double J stenting. After 1 month, clot size decreased to 4 cm × 3 cm × 2 cm. The patient had undergone open reduction Anderson hynes dismembered pyeloplasty with the removal of pelvis clot after 6 weeks. We report the first case of UPJ obstruction presenting as an acute abdomen and spontaneous hematuria with large pelvis clot without rupture of the renal pelvis.

  13. Acute effects of a large bolide impact simulated by a global atmospheric circulation model

    Science.gov (United States)

    Thompson, Starley L.; Crutzen, P. J.

    1988-01-01

    The goal is to use a global three-dimensional atmospheric circulation model developed for studies of atmospheric effects of nuclear war to examine the time evolution of atmospheric effects from a large bolide impact. The model allows for dust and NOx injection, atmospheric transport by winds, removal by precipitation, radiative transfer effects, stratospheric ozone chemistry, and nitric acid formation and deposition on a simulated Earth having realistic geography. Researchers assume a modest 2 km-diameter impactor of the type that could have formed the 32 km-diameter impact structure found near Manson, Iowa and dated at roughly 66 Ma. Such an impact would have created on the order of 5 x 10 to the 10th power metric tons of atmospheric dust (about 0.01 g cm(-2) if spread globally) and 1 x 10 to the 37th power molecules of NO, or two orders of magnitude more stratospheric NO than might be produced in a large nuclear war. Researchers ignore potential injections of CO2 and wildfire smoke, and assume the direct heating of the atmosphere by impact ejecta on a regional scale is not large compared to absorption of solar energy by dust. Researchers assume an impact site at 45 N in the interior of present day North America.

  14. Anestesia subdural após punção peridural: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Vásquez Carlos Escobar

    2003-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anestesias condutivas peridurais são realizadas amplamente no nosso meio. A anestesia subdural acidental após punção peridural é uma complicação rara. O objetivo deste relato é descrever dois casos de injeção subdural que coincidentemente ocorreram de forma consecutiva realizadas pelo mesmo anestesiologista. RELATO DOS CASOS: Caso 1: Paciente do sexo masculino, 41 anos, estado físico ASA I, a realizar procedimento cirúrgico de retirada de cálculo renal. Optou-se por anestesia peridural. Após 30 minutos do início da anestesia, o paciente mantinha-se comunicativo mas sonolento com SpO2 de 100%, quando lentamente começou a apresentar diminuição da SpO2 chegando a 80%. Apresentava-se inconsciente com apnéia e anisocoria. A partir deste momento foi levantada hipótese diagnóstica de anestesia subdural acidental. O paciente foi então intubado e mantido em ventilação controlada mecânica. Terminada a cirurgia, foi encaminhado para a sala de recuperação, recebendo alta após 6 horas, sem nenhuma alteração clínico-neurológica. Caso 2: Paciente do sexo feminino, 82 anos, estado físico ASA II, programado para procedimento cirúrgico de fixação de fratura transtrocanteriana. Optou-se por anestesia peridural contínua. Assim como no caso anterior, após 30 minutos, a paciente começou a apresentar diminuição da SpO2 para 90%. Mostrava-se inconsciente e com anisocoria; entretanto, sem apnéia. Optou-se por manter a paciente sob vigilância constante, não sendo necessária intubação. A hipótese diagnóstica aventada também neste caso foi de anestesia subdural acidental. Terminada a cirurgia, a paciente foi encaminhada à sala de recuperação pós-anestésica, tendo alta após 4 horas, sem nenhuma alteração clínico-neurológica. CONCLUSÕES: Anestesia subdural acidental é uma complicação extremamente rara. A hipótese diagnóstica de anestesia subdural acidental, nestes casos, limitou

  15. Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample.

    Science.gov (United States)

    Phillips, Anna C; Der, Geoff; Shipton, Deborah; Benzeval, Michaela

    2011-09-01

    Exaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective. Copyright © 2011 Elsevier B.V. All rights reserved.

  16. Acute pseudo-obstruction of the large bowel with caecal perforation following normal vaginal delivery: a case report

    Directory of Open Access Journals (Sweden)

    Seenath Marlon

    2010-04-01

    Full Text Available Abstract Introduction Acute pseudo-obstruction of the large bowel following normal vaginal delivery is an extremely rare complication of normal vaginal delivery. It can be fatal if not recognized early. Only one previous report has been found in the English literature. Case presentation A 36-year old Caucasian, normally fit woman presented with abdominal distension and vomiting five days post-normal vaginal delivery at term. Localised peritonitis in the right iliac fossa developed in the next few days, and caecal perforation was found at laparotomy, without evidence of appendicitis or colitis. Conclusion Although very rare, Ogilvie's syndrome should be considered by obstetricians, general surgeons and general practitioners as a potential cause of vomiting and abdominal pain following normal vaginal delivery. Early recognition and management are essential to minimize the possibility of developing serious complications.

  17. THERAPY-RELATED T/MYELOID MIXED PHENOTYPE ACUTE LEUKEMIA IN A PATIENT TREATED WITH CHEMOTHERAPY FOR CUTANEOUS DIFFUSE LARGE B CELL LYMPHOMA.

    Science.gov (United States)

    Roberts, Evans; Oncale, Melody; Safah, Hana; Schmieg, John

    2016-01-01

    Mixed-phenotype acute leukemia is a rare form of leukemia that is associated with a poor prognosis. Most cases of mixed-phenotype acute leukemia are de novo. However, therapy-related mixed-phenotype acute leukemia can occur, and are often associated with exposure to topoisomerase-II inhibitors and alkylating agents. There are no known treatment guidelines for therapy-related mixed-phenotype acute leukemia. We present a patient with T/myeloid mixed-phenotype acute leukemia secondary to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma. The patient's leukemic cells express CD34, an immaturity marker, CD3, a T-cell marker, and myeloperoxidase, a myeloid marker, and her history of chemotherapy for previous lymphoma supports the diagnosis of therapy-related T/myeloid mixed phenotype acute leukemia. Clinicians should be aware that this entity could be associated with R-CHOP chemotherapy. Given the complexity in diagnosis, and lack of treatment guidelines, a further understanding of the pathological and genetic principles of therapy-related mixed-phenotype acute leukemia will assist in future efforts to treat and categorize these patients. Mixed phenotype acute leukemia is a rare entity that accounts for two to five percent of all acute leukemias. Therapy- related mixed phenotype acute leukemia is an exceedingly rare hematological neoplasm that accounts for less than one percent of acute leukemias. We describe a case of therapy-related T/myeloid mixed phenotype acute leukemia following rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma DLBCL. The patient is a 63-year-old female who presented with several cutaneous nodules diagnosed as primary cutaneous DLBCL. The patient received R-CHOP chemotherapy and achieved remission. She remained in remission for four years until she presented with

  18. Surgical management of a large peritoneal pseudocyst causing acute kidney injury secondary to abdominal compartment syndrome in a rare case of congenital absence of omentum during pregnancy.

    Science.gov (United States)

    Jones, Benjamin P; Hunjan, Tia; Terry, Jayne

    2016-09-01

    Complete congenital absence of the omentum is very rare with only one previously reported case. We present a unique case of the management of a pregnant woman with a large pelvic pseudocyst caused by complications related to congenital absence of omentum, resulting in acute kidney injury, likely secondary to acute compartment syndrome. This case highlights the importance of considering acute compartment syndrome in critically unwell pregnant women and reiterates the need to measure intra-abdominal pressure when clinically indicated. Given that pregnancy is in itself a state of intra-abdominal hypertension, obstetricians should maintain a high index of suspicion in the context of additional risk factors.

  19. Acute platelet changes after large meals of saturated and unsaturated fats.

    Science.gov (United States)

    O'Brien, J R; Etherington, M D; Jamieson, S

    1976-04-24

    Large amounts of saturated fats (S.F.) or unsaturated fats (U.S.F.) were given to healthy volunteers at a single meal. The heparin thrombin clotting-time, which may measure platelet factor 4 released from platelets into the plasma, was shortened after S.F. and prolonged after U.S.F. The antithrombin clotting activity decreased after S.F. and increased after U.S.F. The platelet-count decreased and the platelet volume increased after both S.F. and U.S.F.

  20. Large-scale analysis of acute ethanol exposure in zebrafish development: a critical time window and resilience.

    Directory of Open Access Journals (Sweden)

    Shaukat Ali

    Full Text Available BACKGROUND: In humans, ethanol exposure during pregnancy causes a spectrum of developmental defects (fetal alcohol syndrome or FAS. Individuals vary in phenotypic expression. Zebrafish embryos develop FAS-like features after ethanol exposure. In this study, we ask whether stage-specific effects of ethanol can be identified in the zebrafish, and if so, whether they allow the pinpointing of sensitive developmental mechanisms. We have therefore conducted the first large-scale (>1500 embryos analysis of acute, stage-specific drug effects on zebrafish development, with a large panel of readouts. METHODOLOGY/PRINCIPAL FINDINGS: Zebrafish embryos were raised in 96-well plates. Range-finding indicated that 10% ethanol for 1 h was suitable for an acute exposure regime. High-resolution magic-angle spinning proton magnetic resonance spectroscopy showed that this produced a transient pulse of 0.86% concentration of ethanol in the embryo within the chorion. Survivors at 5 days postfertilisation were analysed. Phenotypes ranged from normal (resilient to severely malformed. Ethanol exposure at early stages caused high mortality (≥88%. At later stages of exposure, mortality declined and malformations developed. Pharyngeal arch hypoplasia and behavioral impairment were most common after prim-6 and prim-16 exposure. By contrast, microphthalmia and growth retardation were stage-independent. CONCLUSIONS: Our findings show that some ethanol effects are strongly stage-dependent. The phenotypes mimic key aspects of FAS including craniofacial abnormality, microphthalmia, growth retardation and behavioral impairment. We also identify a critical time window (prim-6 and prim-16 for ethanol sensitivity. Finally, our identification of a wide phenotypic spectrum is reminiscent of human FAS, and may provide a useful model for studying disease resilience.

  1. Acute subdural hematoma secondary to distal middle cerebral artery aneurysm rupture in a newborn infant.

    Science.gov (United States)

    Iza-Vallejo, Begoña; Mateo-Sierra, Olga; Fortea-Gil, Fernando; Ruiz-Juretschke, Fernando; Martín, Yolanda Ruiz

    2009-05-01

    The authors present the case of a peripheral aneurysmal lesion that developed in a newborn baby and was successfully treated by endovascular parent artery occlusion. Given the natural history of aneurysms, which are prone to rupture and to cause deleterious intracerebral hemorrhage, with high mortality rates, aggressive and early management (endovascular or surgical) is recommended.

  2. Dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with high-dose-rate brachytherapy for large prostate volumes

    Energy Technology Data Exchange (ETDEWEB)

    Yang, George; Strom, Tobin J.; Shrinath, Kushagra; Mellon, Eric A.; Fernandez, Daniel C.; Biagioli, Matthew C. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (United States); Wilder, Richard B., E-mail: mcbiagioli@yahoo.com [Cancer Treatment Centers of America, Newnan, GA (United States)

    2015-05-15

    Purpose: to evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes. Materials and methods: one hundred and two prostate cancer patients with prostate volumes >50 mL (range: 5-29 mL) were treated with high-dose-rate (HDR) brachytherapy ± intensity modulated radiation therapy (IMRT) to 4,500 cGy in 25 daily fractions between 2009 and 2013. HDR brachytherapy monotherapy doses consisted of two 1,350-1,400 cGy fractions separated by 2-3 weeks, and HDR brachytherapy boost doses consisted of two 950-1,150 cGy fractions separated by 4 weeks. Twelve of 32 (38%) unfavorable intermediate risk, high risk, and very high risk patients received androgen deprivation therapy. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4. Results: median follow-up was 14 months. Dosimetric goals were achieved in over 90% of cases. Three of 102 (3%) patients developed Grade 2 acute proctitis. No variables were significantly associated with Grade 2 acute proctitis. Seventeen of 102 (17%) patients developed Grade 2 acute urinary retention. American Urological Association (AUA) symptom score was the only variable significantly associated with Grade 2 acute urinary retention (p-0.04). There was no ≥ Grade 3 acute toxicity. Conclusions: dosimetric coverage of the prostate and normal tissue sparing were adequate in patients with prostate volumes >50 mL. Higher pre-treatment AUA symptom scores increased the relative risk of Grade 2 acute urinary retention. However, the overall incidence of acute toxicity was acceptable in patients with large prostate volumes. (author)

  3. Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes

    Directory of Open Access Journals (Sweden)

    George Yang

    2015-06-01

    Full Text Available ABSTRACTPurposeTo evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes.Materials and MethodsOne hundred and two prostate cancer patients with prostate volumes >50 mL (range: 5-29 mL were treated with high-dose-rate (HDR brachytherapy ± intensity modulated radiation therapy (IMRT to 4,500 cGy in 25 daily fractions between 2009 and 2013. HDR brachytherapy monotherapy doses consisted of two 1,350-1,400 cGy fractions separated by 2-3 weeks, and HDR brachytherapy boost doses consisted of two 950-1,150 cGy fractions separated by 4 weeks. Twelve of 32 (38% unfavorable intermediate risk, high risk, and very high risk patients received androgen deprivation therapy. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.ResultsMedian follow-up was 14 months. Dosimetric goals were achieved in over 90% of cases. Three of 102 (3% patients developed Grade 2 acute proctitis. No variables were significantly associated with Grade 2 acute proctitis. Seventeen of 102 (17% patients developed Grade 2 acute urinary retention. American Urological Association (AUA symptom score was the only variable significantly associated with Grade 2 acute urinary retention (p=0.04. There was no ≥ Grade 3 acute toxicity.ConclusionsDosimetric coverage of the prostate and normal tissue sparing were adequate in patients with prostate volumes >50 mL. Higher pre-treatment AUA symptom scores increased the relative risk of Grade 2 acute urinary retention. However, the overall incidence of acute toxicity was acceptable in patients with large prostate volumes.

  4. Intracranial subdural osteoma: a rare benign tumor that can be differentiated from other calcified intracranial lesions utilizing MR imaging.

    Science.gov (United States)

    Barajas, Ramon F; Perry, Arie; Sughrue, Michael; Aghi, Manish; Cha, Soonmee

    2012-10-01

    We report the magnetic resonance (MR) imaging characteristics of subdural osteoma and other benign calcified intracranial lesions to highlight imaging features that differentiate between these disease entities. A 63-year-old woman presented with progressively altered mental status. Non-contrast CT demonstrated a densely calcified right middle cranial fossa extra-axial mass. MR imaging of the lesion demonstrated T1 and T2 hypointensity without evidence of contrast enhancement, parenchymal abnormality, or connection to adjacent venous structures. Diffusion weighted imaging demonstrated markedly decreased signal intensity and artificially reduced diffusion on apparent diffusion coefficient map. Histologically, the tumor was predominantly composed of lamellar bone and small fragments of residual dura consistent with subdural osteoma. This case demonstrates that radiological examination can provide additional insight into the origin of intracranial osteomas (extradural versus subdural versus sinonasal) and help distinguish from other diagnostic considerations including benign meningeal ossification and calcified meningioma prior to surgical resection.

  5. Technique of stepwise intracranial decompression combined with external ventricular drainage catheters improve the prognosis of acute post-traumatic hemispheric brain swelling patients

    Directory of Open Access Journals (Sweden)

    Lei eShi

    2015-09-01

    Full Text Available Background: Acute post-traumatic cerebral hemispheric brain swelling (ACHS is a serious disorder that occurs after traumatic brain injury (TBI, and it often requires immediate treatment. The aim of our clinical study was to assess the effects of stepwise intracranial decompression combined with external ventricular drainage catheters on the prognosis of ACHS patients.Methods: A retrospective study was performed on 172 cases of severe craniocerebral trauma patients with acute cerebral hemispheric swelling. The patients were divided into two groups: unilateral stepwise standard large trauma craniectomy (S-SLTC combined with external ventricular drainage (EVD catheter implants (n = 86 and unilateral routine frontal temporal parietal SLTC (control group, n = 86.Result: No significant differences in age, sex, or preoperative Glasgow Coma Scale score were observed between groups (P < 0.05. There were no significant differences in the ipsilateral subdural effusion incidence rates between the S-SLTC+EVD treatment group and the routine SLTC group. However, the incidence rates of intraoperative acute encephalocele and contralateral epidural and subdural hematoma in the S-SLTC+EVD group were significantly lower than those in the SLTC group (17.4% and 3.5% vs. 37.2% and 23.3%, respectively. The mean intracranial pressure (ICP values of patients in the S-SLTC+EVD group were also lower than those in the SLTC group at days 1 through7 (P<0.05. A positive neurological outcome (GOS score 4 to 5, 50.0% and decreased mortality (15.1% was observed in the S-SLTC+EVD group compared to the neurological outcome (GOS score 4 to 5, 33.8%; 36.0% in the SLTC group (P<0.05.Conclusions: Our data suggest that S-SLTC+EVD is more effective for controlling ICP, improving neurological outcome, and decreasing mortality rate compared with routine SLTC.

  6. 10 Levels thoracic no-intrumented laminectomy for huge spontaneous spinal subdural hematoma removal. Report of the first case and literature review

    Science.gov (United States)

    Visocchi, Massimiliano; La Rocca, Giuseppe; Signorelli, Francesco; Roselli, Romeo; Jun, Zhong; Spallone, A.

    2015-01-01

    Introduction Spontaneous idiopathic acute spinal subdural hematoma (SSDH) is a rare cause of acute back pain followed by signs and symptoms of nerve root and/or spinal cord compression, frequently associated with coagulopathies, blood dyscrasias and arterio-venous malformations. Standard management includes non-operative treatment and timely (within 24 h) surgical decompression. Presentation of case We report on the case of a huge 10 levels SSDH treated with decompressive thoracic no-instrumented laminectomy in a 45-year-old woman with good neurological recovery (from ASIA A to D). Discussion Spontaneous SSDHs without detectable structural lesion or anticoagulant therapy are very rare. Among 26 cases documented the literature harbouring SSDHs, the thoracic spine was found to be the preferred site, and the compression was usually extending over several vertebral levels. Nonoperative treatment for SSDH may be justified in presence of minimal neurologic deficits, otherwise, early decompressive laminectomy along with evacuation of hematoma are considered the treatment of choice in presence of major deficits. Conclusion To our knowledge, the present case is the most extensive laminectomy for a SSDH removal never described before. No postoperative instability occurs in 10 levels thoracic laminectomy in case the articular processes are spared. When major neurological deficits are documented, early decompressive laminectomy with evacuation of hematoma should be considered the best treatment for SSDH. PMID:26318128

  7. Subdural fluid collection and hydrocephalus following cervical schwannoma resection: hydrocephalus resolution after spinal pseudomeningocele repair: case report.

    Science.gov (United States)

    Benedetto, Nicola; Cagnazzo, Federico; Gambacciani, Carlo; Perrini, Paolo

    2016-12-01

    The authors report the case of a 31-year-old man who developed neck pain and headache 2 months after the uncomplicated resection of a cervical schwannoma. MR imaging revealed infratentorial subdural fluid collections and obstructive hydrocephalus associated with cervical pseudomeningocele. The clinical symptoms, subdural fluid collections, and ventricular dilation resolved after surgical correction of the pseudomeningocele. This report emphasizes that hydrocephalus may be related to disorders of cerebrospinal fluid flow dynamics induced by cervical pseudomeningocele. In these rare cases, both the hydrocephalus and the symptoms are resolved by the simple correction of the pseudomeningocele.

  8. Intracranial subdural hematoma after spinal anesthesia for cesarean section: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2014-01-01

    Full Text Available Subdural hematoma (SDH is a rare but serious complication of spinal anesthesia. We report a case of intracranial SDH in a patient developing 11 days after spinal anesthesia for cesarean section. The patient complained of headache on the 2nd post-operative day that was relieved by analgesics, bed rest and hydration. Later she presented with severe headache, vomiting, dizziness, dysarthria, irritability and somnolence. Diagnosis of the left sided SDH was confirmed radiologically and treated surgically. The patient recovered completely. The report highlights the need of considering the possibility of SDH in patients when postdural puncture headache is prolonged or recurs after a headache free period with neurological symptoms.

  9. Esthesioneuroblastoma: a case report of diffuse subdural recurrence and review of recently published studies.

    Science.gov (United States)

    Capelle, L; Krawitz, H

    2008-02-01

    Esthesioneuroblastoma is a rare malignancy arising from the olfactory epithelium. We present a case history of a 75-year-old man who presented with a Kadish stage C esthesioneuroblastoma and underwent craniofacial surgery and adjuvant radiotherapy. Two years later he was found to have diffuse subdural deposits with distant bone and nodal metastases, treated with further radiotherapy. The patient's condition subsequently deteriorated and he died. Given this unusual pattern of failure, we review the recent published studies regarding the natural history, treatment and outcome for this tumour.

  10. The False Falx and Tentorium Sign: Case Report of Subdural Haematoma and Sickle Cells Disease

    Directory of Open Access Journals (Sweden)

    Alvis-Miranda Hernando Raphael

    2014-10-01

    Full Text Available The increased density in the basal cisterns and the subarachnoid space on CT scans is a well-known characteristic of subarachnoid hemorrhage. Have been described diverse conditions that can emulate subarachnoid hemorrhage, such as purulent leptomeningitis, intrathecal contrast material and leak of high doses of intravenous contrast material to the subarachnoid space. We present the case of a male patient who presented a subdural hematoma in the setting of non-diagnosed sickle cell disease. To this patient was performed a panangiography which discard any aneurismal hemorrhage origin

  11. Hematoma subdural crónico: Análisis de 95 casos

    OpenAIRE

    Miguel Esquivel Miranda; Melissa Arias Quirós; Mayra Cartín Brenes; María José Suárez Sánchez; Lizbeth Salazar-Sánchez

    2012-01-01

    El Hematoma Subdural crónico es una patología relativamente frecuente que predomina en adultos  mayores. Es de inicio insidioso, su diagnóstico se basa en el cuadro clínico y estudios radiológicos como la tomografía axial computarizada (TAC), el manejo es predominantemente quirúrgico y su pronóstico es bueno. Se analiza en el presente estudio, una muestra de 95 expedientes clínicos de pacientes con dicho diagnóstico, síntomas iniciales, TAC pre y post diagnóstico, tratamiento y evoluciónChron...

  12. Clinical, Radiologic, and Pathologic Findings of Subdural Osteoma: A Case Report

    Science.gov (United States)

    Kim, Eun Young; Hyun, Dong Keun; Park, Hyeonseon; Oh, Se Yang; Yoon, Seung Hwan

    2016-01-01

    We present a case of a subdural osteoma. A 29-year-old female presented with a 3-year history of headaches. Computed tomography scan revealed a homogeneous high-density lesion isolated from the inner table of the frontal bone (a lucent dural line) in the right frontal convexity. Magnetic resonance imaging revealed an extra-axial lesion with a broad base without dural tail sign and punctate enhancement pattern characteristic of abundant adipose tissue. Upon surgical excision, we found a hard bony mass clearly demarcated from the dura. The mass displayed characteristics of an osteoma upon histological examination. The symptom was relieved after operation. PMID:27195262

  13. Hematoma subdural de medula espinhal associada ao uso de anticoagulante oral Hematoma subdural de la médula espinal asociado al uso de anticoagulante oral Spine subdural hematoma: a rare complication associated with vitamin K antagonist (VKA

    Directory of Open Access Journals (Sweden)

    Uri Adrian Prync Flato

    2009-01-01

    Full Text Available O hematoma subdural de medula espinhal (HSDME é uma complicação rara decorrente do uso de antagonistas de vitamina K (AVK e de diagnostico difícil. Este artigo apresenta um caso com complicação ameaçadora à vida: um paciente octogenário portador de fibrilação atrial de início recente em uso de AVK. A história e o exame físico inicialmente se apresentavam normais, associados com a elevação dos valores de coagulograma supraterapêuticos (INR > 10. Após 24 horas da admissão hospitalar, o paciente apresentou tetraparesia progressiva, evidenciando na ressonância nuclear magnética (RNM de medula espinhal um HSDME (Figura 1. Após reversão completa da hipocoagulação e intervenção neurocirúrgica o paciente obteve melhora do quadro neurológico.El hematoma subdural espinal (HSE es una complicación rara proveniente del uso de antagonistas de vitamina K (AVK y de diagnostico difícil. Este artículo presenta un caso con complicación amenazadora para la vida: un paciente octogenario portador de fibrilación auricular de inicio reciente, en uso de AVK. Inicialmente, la historia y el examen físico se presentaban normales, asociados a la elevación de los valores de coagulograma supra terapéuticos (INR > 10. Tras 24 horas del ingreso hospitalario, el paciente presentó tetraparesia progresiva. Al realizarse una resonancia nuclear magnética (RNM de médula espinal, se evidenció un HSE (Figura 1. Tras reversión completa de la hipocoagulación e intervención neuroquirúrgica el paciente obtuvo mejora del cuadro neurológico.Spinal subdural hematoma (SSDH is a rare condition, which is difficult to diagnose, related to Vitamin K Antagonist. This a case report of a life-threatening situation in a octogenarian patient with a history of recent atrial fibrillation that received K-Vitamin Antagonist (KVA therapy. The history and the clinical assessment were normal at the admission, associated with increase in the coagulation parameters

  14. Large-scale field application of RNAi technology reducing Israeli Acute Paralysis Virus Disease in honey bees (Apis mellifera, Hymenoptera; Apidae)

    Science.gov (United States)

    We present the first successful use of RNAi under a large-scale real-world application for disease control. Israeli acute paralysis virus, IAPV, has been linked as a contributing factor in coolly collapse, CCD, of honey bees. IAPV specific homologous dsRNA were designed to reduce impacts from IAPV i...

  15. The Use of the 'Preclosure' Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Funke, C., E-mail: claas_funke@hotmail.com; Pfiffner, R. [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology (Switzerland); Husmann, M. [University Hospital Zurich, Clinic of Angiology (Switzerland); Pfammatter, T. [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology (Switzerland)

    2013-04-15

    This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia. Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide{sup Registered-Sign} 6F, Abbott) was placed before arterial sheath (mean 9 F, range 6-12 F) introduction in 101 patients (74 men, 73 %, mean age 70.1 {+-} 12.6 years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6 month after the intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound. There were a total of 19 vascular complications (19 %) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2 %) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94 %); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered. With acceptable short- and mid-term outcomes, the 'preclose' technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectomy.

  16. Evolution and Prospects for Intracranial Pharmacotherapy for Refractory Epilepsies: The Subdural Hybrid Neuroprosthesis

    Directory of Open Access Journals (Sweden)

    Nandor Ludvig

    2010-01-01

    Full Text Available Intracranial pharmacotherapy is a novel strategy to treat drug refractory, localization-related epilepsies not amenable to resective surgery. The common feature of the method is the use of some type of antiepileptic drug (AED delivery device placed inside the cranium to prevent or stop focal seizures. This distinguishes it from other nonconventional methods, such as intrathecal pharmacotherapy, electrical neurostimulation, gene therapy, cell transplantation, and local cooling. AED-delivery systems comprise drug releasing polymers and neuroprosthetic devices that can deliver AEDs into the brain via intraparenchymal, ventricular, or transmeningeal routes. One such device is the subdural Hybrid Neuroprosthesis (HNP, designed to deliver AEDs, such as muscimol, into the subdural/subarachnoid space overlaying neocortical epileptogenic zones, with electrophysiological feedback from the treated tissue. The idea of intracranial pharmacotherapy and HNP treatment for epilepsy originated from multiple sources, including the advent of implanted medical devices, safety data for intracranial electrodes and catheters, evidence for the seizure-controlling efficacy of intracerebral AEDs, and further understanding of the pathophysiology of focal epilepsy. Successful introduction of intracranial pharmacotherapy into clinical practice depends on how the intertwined scientific, engineering, clinical, neurosurgical and regulatory challenges will be met to produce an effective and commercially viable device.

  17. A Motion Simulator Ride Associated With Headache and Subdural Hematoma: First Case Report.

    Science.gov (United States)

    Scranton, Robert A; Evans, Randolph W; Baskin, David S

    2016-02-01

    We report the first case report of symptomatic bilateral subdural hematomas (SDH) associated with riding a centrifugal motion simulator ride. A previously healthy 55-year-old male developed new onset daily headaches 1 week after going on the ride that were due to symptomatic bilateral SDH requiring operative intervention with a full recovery. There was no history of other trauma or other systemic or intracranial abnormality to account for the development of the SDH. We review the headaches and other clinical features associated with chronic SDH. Twelve cases of roller coaster headaches due to SDH associated with riding roller coasters have been reported. The pathophysiology is reviewed, which we believe is the same mechanism that may be responsible in this case. Although it is possible that this neurovascular injury is truly rare, it is also possible that this injury is underreported as patients and physicians may not make the association or physicians have not reported additional cases. The risk of this injury likely increases with age, as the size of the subdural space increases, and may support the maxim that "roller coasters and simulators are for kids."

  18. Psychiatric manifestation of chronic subdural hematoma: The unfolding of mystery in a homeless patient

    Directory of Open Access Journals (Sweden)

    Sujita Kumar Kar

    2015-01-01

    Full Text Available The clinical manifestation of chronic subdural hematoma is not limited to neurological deficits or cognitive impairment. It may present with behavioral abnormalities. When the behavioral abnormalities present without obvious neurological deficits and in the absence of trauma, it leads to misdiagnosis. A trivial trauma may cause intracranial bleed that is either missed or ignored in the clinical history. This case report highlights the clinical picture of a homeless patient who presented with withdrawn and disorganized behavior, apathy and poverty of speech in the absence of any neurological deficit. His clinical presentation led to a possibility of psychosis and he was started on antipsychotics. He had developed extrapyramidal side effects in low dose of antipsychotic without any clinical benefit in his clinical picture. Neuroimaging done to rule out any possible organicity-revealed bilateral subdural hematoma, which was later evacuated by neurosurgical intervention in multiple settings and the patient had improved. This case report unfolds the mystery behind the psychotic presentation in a homeless adult.

  19. Comparing twist-drill drainage with burr hole drainage for chronic subdural hematoma

    Directory of Open Access Journals (Sweden)

    LIN Xin

    2011-06-01

    Full Text Available 【Abstract】Objective: The surgical management of chronic subdural hematoma (CSDH is still a controver- sial issue, and a standard therapy has not been established because of the unclear pathogenic mechanisms in CSDH. The intention of this paper is to find a simple and efficient surgical procedure for CSDH. Methods: A retrospective study of 448 patients with CSDH by surgical treatment during 2005 to 2009 was con- ducted in order to compare the efficiency between two dif- ferent primary surgical methods, i.e. twist-drill drainage with- out irrigation in Group A (n=178 and one burr-hole with irrigation in Group B (n=270. The results were statistically analyzed. Results: The reoperation rates in Group A and Group B were 7.9% and 11.9% respectively. The good outcome rate was 88.8% and 75.5%, the complication was 7.9% and 20.7% in Group A and Group B, respectively. Conclusions: The burr-hole drainage with irrigation of the hematoma cavity is not beneficial to the outcome and prognosis. Irrigation is not important in the surgical treat- ment for CSDH. Thus in initial treatment, twist-drill drainage without irrigation of the hematoma cavity is recommended because it is relatively safe, time-saving and cost-effective. Key words: Hematoma, subdural; Brain injury, chronic; Drainage

  20. Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord

    Science.gov (United States)

    Sharpe, Abigail N.; Jackson, Andrew

    2014-02-01

    Objective. Electrical stimulation of the spinal cord has potential applications following spinal cord injury for reanimating paralysed limbs and promoting neuroplastic changes that may facilitate motor rehabilitation. Here we systematically compare the efficacy, selectivity and frequency-dependence of different stimulation methods in the cervical enlargement of anaesthetized monkeys. Approach. Stimulating electrodes were positioned at multiple epidural and subdural sites on both dorsal and ventral surfaces, as well as at different depths within the spinal cord. Motor responses were recorded from arm, forearm and hand muscles. Main results. Stimulation efficacy increased from dorsal to ventral stimulation sites, with the exception of ventral epidural electrodes which had the highest recruitment thresholds. Compared to epidural and intraspinal methods, responses to subdural stimulation were more selective but also more similar between adjacent sites. Trains of stimuli delivered to ventral sites elicited consistent responses at all frequencies whereas from dorsal sites we observed a mixture of short-latency facilitation and long-latency suppression. Finally, paired stimuli delivered to dorsal surface and intraspinal sites exhibited symmetric facilitatory interactions at interstimulus intervals between 2-5 ms whereas on the ventral side interactions tended to be suppressive for near-simultaneous stimuli. Significance. We interpret these results in the context of differential activation of afferent and efferent roots and intraspinal circuit elements. In particular, we propose that distinct direct and indirect actions of spinal cord stimulation on motoneurons may be advantageous for different applications, and this should be taken into consideration when designing neuroprostheses for upper-limb function.

  1. Subdural empyema following lumbar facet joint injection: An exceeding rare complication.

    Science.gov (United States)

    Fayeye, Oluwafikayo; Silva, Adikarige Haritha Dulanka; Chavda, Swarupsinh; Furtado, Navin Raoul

    2016-01-01

    Chronic low back pain is extremely common with a life time prevalence estimated at greater than 70%. Facet joint arthrosis is thought to be the causative aetiological substrate in approximately 25% of chronic low back pain cases. Facet joint injection is a routine intervention in the armamentarium for both the diagnostic and therapeutic management of chronic low back pain. In fact, a study by Carrino et al. reported in excess of 94,000 facet joint injection procedures were carried out in the US in 1999. Although generally considered safe, the procedure is not entirely without risk. Complications including bleeding, infection, exacerbation of pain, dural puncture headache, and pneumothorax have been described. We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated.

  2. Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome

    Directory of Open Access Journals (Sweden)

    Gabaeff, Steven C

    2011-05-01

    Full Text Available Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection. The forces required to cause brain injury were derived from an experiment of high velocity impacts on monkeys, that generated forces far above those which might occur with a shaking mechanism. These forces, if present, would invariably cause neck trauma, which is conspicuously absent in most babies allegedly injured by shaking. Subdural hematoma may also be the result of common birth trauma, complicated by prenatal vitamin D deficiency, which also contributes to the appearance of long bone fractures commonly associated with child abuse. Retinal hemorrhage is a non-specific finding that occurs with many causes of increased intracranial pressure, including infection and hypoxic brain injury. The evidence challenging these connections should prompt emergency physicians and others who care for children to consider a broad differential diagnosis before settling on occult shaking as the de-facto cause. While childhood non-accidental trauma is certainly a serious problem, the wide exposure of this information may have the potential to exonerate some innocent care-givers who have been convicted, or may be accused, of child abuse. [West J Emerg Med. 2011;12(2:144-158.

  3. Hematoma subdural crónico: Análisis de 95 casos

    Directory of Open Access Journals (Sweden)

    Miguel Esquivel Miranda

    2012-03-01

    Full Text Available El Hematoma Subdural crónico es una patología relativamente frecuente que predomina en adultos  mayores. Es de inicio insidioso, su diagnóstico se basa en el cuadro clínico y estudios radiológicos como la tomografía axial computarizada (TAC, el manejo es predominantemente quirúrgico y su pronóstico es bueno. Se analiza en el presente estudio, una muestra de 95 expedientes clínicos de pacientes con dicho diagnóstico, síntomas iniciales, TAC pre y post diagnóstico, tratamiento y evoluciónChronic subdural hematoma is a relatively common disease prevalent in elderly patients. It has an insidious onset, and its diagnosis is based on clinical and radiologic studies like computalized tomography( CT. Its´ management is usually surgical and it has a good prognosis. This study, analyzed a sample of 95 medical records of patients with this diagnosis, initial symptoms, pre and post CT diagnosis, treatment and outcome

  4. Histopathological study on fine carbon fiber powder injected into the subdural space of mice

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    AIM and METHODS: After the fine carbon fiber powder was injected into the right subdural space of the mice, dynamic observation was carried out on their movement and histopathological changes. RESULTS: 1-52 weeks after the injecting, no neurological changes concerning with the implanting of the carbon fiber powder were found in the experimental mice. The fine carbon fiber extensively located on the inter surface of the dura mater membrane of the right temporalis and the out surface of pie mater. Only slight inflammatory cells reaction was found under optical microscopes. The degree of inflammation reaction are Grade Ⅱ 1 week after injection and was Grade Ⅰ 2 weeks after injection, inflammation was disappeared 4 weeks after injection. No obvious fiber membrane was found around the implanted materials. No significant differences were found between the experimental and the control group.CONCLUSION: It was showed that the carbon fiber shares excellent histocompatibility after injected into the subdural space and subarechnoid cavity of the right temple of mice.

  5. In vitro acute exposure to DEHP affects oocyte meiotic maturation, energy and oxidative stress parameters in a large animal model.

    Directory of Open Access Journals (Sweden)

    Barbara Ambruosi

    Full Text Available Phthalates are ubiquitous environmental contaminants because of their use in plastics and other common consumer products. Di-(2-ethylhexyl phthalate (DEHP is the most abundant phthalate and it impairs fertility by acting as an endocrine disruptor. The aim of the present study was to analyze the effects of in vitro acute exposure to DEHP on oocyte maturation, energy and oxidative status in the horse, a large animal model. Cumulus cell (CC apoptosis and oxidative status were also investigated. Cumulus-oocyte complexes from the ovaries of slaughtered mares were cultured in vitro in presence of 0.12, 12 and 1200 µM DEHP. After in vitro maturation (IVM, CCs were removed and evaluated for apoptosis (cytological assessment and TUNEL and intracellular reactive oxygen species (ROS levels. Oocytes were evaluated for nuclear chromatin configuration. Matured (Metaphase II stage; MII oocytes were further evaluated for cytoplasmic energy and oxidative parameters. DEHP significantly inhibited oocyte maturation when added at low doses (0.12 µM; P<0.05. This effect was related to increased CC apoptosis (P<0.001 and reduced ROS levels (P<0.0001. At higher doses (12 and 1200 µM, DEHP induced apoptosis (P<0.0001 and ROS increase (P<0.0001 in CCs without affecting oocyte maturation. In DEHP-exposed MII oocytes, mitochondrial distribution patterns, apparent energy status (MitoTracker fluorescence intensity, intracellular ROS localization and levels, mt/ROS colocalization and total SOD activity did not vary, whereas increased ATP content (P<0.05, possibly of glycolytic origin, was found. Co-treatment with N-Acetyl-Cysteine reversed apoptosis and efficiently scavenged excessive ROS in DEHP-treated CCs without enhancing oocyte maturation. In conclusion, acute in vitro exposure to DEHP inhibits equine oocyte maturation without altering ooplasmic energy and oxidative stress parameters in matured oocytes which retain the potential to be fertilized and develop into

  6. Tuberculous brain abscess and subdural empyema in an immunocompetent child: Significance of AFB staining in aspirated pus

    Directory of Open Access Journals (Sweden)

    B Vijayakumar

    2012-01-01

    Full Text Available Tuberculous brain abscess and subdural empyema are extremely rare manifestations of central nervous system tuberculosis. Here, we report a case of an 11-year-old immunocompetent child who developed temporal lobe abscess and subdural empyema following chronic otitis media. A right temporal craniotomy was performed and the abscess was excised. The Ziehl Nielsen staining of the aspirated pus from the temporal lobe abscess yielded acid fast bacilli. Prompt administration of antituberculous treatment resulted in complete recovery of the child. Even though the subdural abscess was not drained, we presume that to be of tubercular aetiology. Ours is probably the first case of brain abscess and subdural empyema due to Mycobacterium tuberculosis reported in the same child. This case is being reported because of its rarity and to stress the importance of routine staining for tubercle bacilli in all cases of brain abscess, especially in endemic areas, as it is difficult to differentiate tuberculous from pyogenic abscess clinically as well as histopathologically.

  7. Evaluation of awake burr hole drainage for chronic subdural hematoma in geriatric patients: a retrospective analysis of 3 years

    Directory of Open Access Journals (Sweden)

    Serdal Albayrak

    2016-03-01

    Conclusion: Surgical interventions under local anesthesia in geriatric patients with chronic subdural hematoma can provide short operation time, early mobilization, early oral intake, avoidance of possible general anesthesia complications. Herewith, this intervention decrease mortality and morbidity in this age group. [Cukurova Med J 2016; 41(1.000: 69-73

  8. Core Outcomes and Common Data Elements in Chronic Subdural Hematoma: A Systematic Review of the Literature Focusing on Reported Outcomes.

    Science.gov (United States)

    Chari, Aswin; Hocking, Katie C; Broughton, Ellie; Turner, Carole; Santarius, Thomas; Hutchinson, Peter J; Kolias, Angelos G

    2016-07-01

    The plethora of studies in chronic subdural hematoma (CSDH) has not resulted in the development of an evidence-based treatment strategy, largely due to heterogeneous outcome measures that preclude cross-study comparisons and guideline development. This study aimed to identify and quantify the heterogeneity of outcome measures reported in the CSDH literature and to build a case for the development of a consensus-based core outcome set. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered with the PROSPERO international prospective register of systematic reviews (CRD42014007266). All full-text English language studies with >10 patients (prospective) or >100 patients (retrospective) published after 1990 examining clinical outcomes in CSDH were eligible for inclusion. One hundred two eligible studies were found. There were 14 (13.7%) randomized controlled trials, one single arm trial (1.0%), 25 (24.5%) cohort comparison studies, and 62 (60.8%) prospective or retrospective cohort studies. Outcome domains reported by the studies included mortality (63.8% of included studies), recurrence (94.1%), complications (48.0%), functional outcomes (40.2%), and radiological (38.2%) outcomes. There was significant heterogeneity in the definitions of the outcome measures, as evidenced by the seven different definitions of the term "recurrence," with no definition given in 19 studies. The time-points of assessment for all the outcome domains varied greatly from inpatient/hospital discharge to 18 months. This study establishes and quantifies the heterogeneity of outcome measure reporting in CSDH and builds the case for the development of a robust consensus-based core outcome set for future studies to adhere to as part of the Core Outcomes and Common Data Elements in CSDH (CODE-CSDH) project.

  9. A large outbreak of influenza B-associated benign acute childhood myositis in Germany, 2007/2008.

    Science.gov (United States)

    Mall, Sabine; Buchholz, Udo; Tibussek, Daniel; Jurke, Annette; An der Heiden, Matthias; Diedrich, Sabine; Schweiger, Brunhilde; Alpers, Katharina

    2011-08-01

    Benign acute childhood myositis (BACM) is a rare syndrome associated with various viral infections. Bilateral calve pain may lead to inability to walk. During winter 2007/2008, we investigated a nationwide outbreak of influenza-associated BACM (IA-BACM) to identify etiologic (sub)type, describe the course of disease, and explore how well the syndrome is known among physicians. We performed retrospective and prospective case finding in all German federal states. Physicians returned patient-based questionnaires containing information about sex, age, disease progression, patient-management, and number of BACM cases treated previously. We compared IA-BACM cases with influenza cases from the German virologic sentinel surveillance system for influenza. We investigated 219 children with IA-BACM. They coincided with the curve of influenza B of the German virologic sentinel surveillance system for influenza. Median age was 7 years, 74% (160/216) of cases were male, median time between the onset of fever and onset of BACM-symptoms was 3 days lasting for a median of 4 days. Almost half of the affected children had presented at hospitals. One case with beginning renal impairment occurred, but the patient recovered completely. Most reporting physicians had not seen BACM-patients previously. Multivariable analysis showed IA-BACM's strong association with influenza B, male sex, and age between 6 and 9 years. Influenza B caused a large BACM outbreak in Germany. Onset of BACM symptoms followed shortly after the onset of influenza symptoms. The course of this disease was almost exclusively mild and self-limiting. Diagnosis of this rare but distinct clinical entity by the alert physician can spare the patient potentially unneeded invasive testing and hospital admission.

  10. Continuous decoding of human grasp kinematics using epidural and subdural signals

    Science.gov (United States)

    Flint, Robert D.; Rosenow, Joshua M.; Tate, Matthew C.; Slutzky, Marc W.

    2017-02-01

    Objective. Restoring or replacing function in paralyzed individuals will one day be achieved through the use of brain-machine interfaces. Regaining hand function is a major goal for paralyzed patients. Two competing prerequisites for the widespread adoption of any hand neuroprosthesis are accurate control over the fine details of movement, and minimized invasiveness. Here, we explore the interplay between these two goals by comparing our ability to decode hand movements with subdural and epidural field potentials (EFPs). Approach. We measured the accuracy of decoding continuous hand and finger kinematics during naturalistic grasping motions in five human subjects. We recorded subdural surface potentials (electrocorticography; ECoG) as well as with EFPs, with both standard- and high-resolution electrode arrays. Main results. In all five subjects, decoding of continuous kinematics significantly exceeded chance, using either EGoG or EFPs. ECoG decoding accuracy compared favorably with prior investigations of grasp kinematics (mean ± SD grasp aperture variance accounted for was 0.54 ± 0.05 across all subjects, 0.75 ± 0.09 for the best subject). In general, EFP decoding performed comparably to ECoG decoding. The 7-20 Hz and 70-115 Hz spectral bands contained the most information about grasp kinematics, with the 70-115 Hz band containing greater information about more subtle movements. Higher-resolution recording arrays provided clearly superior performance compared to standard-resolution arrays. Significance. To approach the fine motor control achieved by an intact brain-body system, it will be necessary to execute motor intent on a continuous basis with high accuracy. The current results demonstrate that this level of accuracy might be achievable not just with ECoG, but with EFPs as well. Epidural placement of electrodes is less invasive, and therefore may incur less risk of encephalitis or stroke than subdural placement of electrodes. Accurately decoding motor

  11. Spontaneous chronic subdural hematoma development in chronic myeloid leukemia cases at remission phase under maintenance therapy, management strategy - a series with literature review

    Directory of Open Access Journals (Sweden)

    Raheja Amol

    2016-09-01

    Full Text Available Chronic subdural hematoma (CSDH is common squeal of trauma and rarely associated with anticoagulant therapy, antiplatelet, chemotherapeutic drugs, arteriovenous malformation, aneurysms and post-craniotomy. However its occurrence is very unusual with systemic haematological malignancy and mostly reported with acute myeloid leukemia; however incidence of SDH occurrence in chronic myelogenous leukemia (CML is very rare. CML is a haematological malignancy characterized by chromosomal alteration, pathologically represents increased proliferation of the granulocytic cell line without loss of capacity to differentiate. CML has three phases - remission phase, accelerated phase and blast crisis. About 85 % of patients present in remission phase of disease and carries a favorable prognosis. As intracranial, subdural hematoma usually occur in the accelerated phase or blast crisis phase or extremely uncommon during chronic remission phase, although only those affected, who are neglecting therapeutic medication or discontinued therapy or rarely as an adverse effect of medications. However, important role of neurosurgeon lies in early detection and correction of platelet count and associated hematological abnormality as quite sizeable proportion of cases may not need surgical intervention instead can be managed conservatively under regular supervision in association with oncologist colleague, but few cases may need urgent surgical intervention. So, selecting a subgroup of CML cases in the remission phase requiring surgical intervention, presenting with CSDH is not only challenging, as failure to make an informed and timely precise decision can lead to catastrophic worse outcome and even mortality. So, purpose of current article is to formulate the management therapeutic plan. Authors report three cases of CML in chronic remission phase, receiving treatment under guidance of Haemto-oncologist at our institute presented with spontaneous chronic SDH. The mean

  12. Acute on Chronic Pancreatitis Causing a Highway to the Colon with Subsequent Road Closure: Pancreatic Colonic Fistula Presenting as a Large Bowel Obstruction Treated with Pancreatic Duct Stenting

    Directory of Open Access Journals (Sweden)

    Justin Cochrane

    2015-01-01

    Full Text Available Context. Colonic complications associated with acute pancreatitis have a low incidence but carry an increased risk of mortality with delayed diagnosis and treatment. Pancreatic colonic fistula is most commonly associated with walled off pancreatic necrosis or abscess formation and rarely forms spontaneously. Classic clinical manifestations for pancreatic colonic fistula include diarrhea, hematochezia, and fever. Uncommonly pancreatic colonic fistula presents as large bowel obstruction. Case. We report a case of a woman with a history of recurrent episodes of acute pancreatitis who presented with large bowel obstruction secondary to pancreatic colonic fistula. Resolution of large bowel obstruction and pancreatic colonic fistula was achieved with pancreatic duct stenting. Conclusion. Pancreatic colonic fistula can present as large bowel obstruction. Patients with resolved acute pancreatitis who have radiographic evidence of splenic flexure obstruction, but without evidence of mechanical obstruction on colonoscopy, should be considered for ERCP to evaluate for PCF. PCF not associated with walled off pancreatic necrosis or peritoneal abscess can be treated conservatively with pancreatic duct stenting.

  13. Clinically silent subdural hemorrhage causes bilateral vocal fold paralysis in newborn infant.

    Science.gov (United States)

    Alshammari, Jaber; Monnier, Yan; Monnier, Philippe

    2012-10-01

    Bilateral congenital vocal fold paralysis (BVFP) may result from multiple etiologies or remain idiopathic when no real cause can be identified. If obstructive dyspnea is significant and requires urgent stabilization of the airway, then intubation is performed first and an MRI of the brain is conducted to rule out an Arnold-Chiari malformation that can benefit from a shunt procedure and thus alleviate the need for a tracheostomy. Clinically silent subdural hemorrhage without any birth trauma represents another cause of neonatal BVFP that resolves spontaneously within a month. It is of clinical relevance to recognize this potential cause of BVFP as its short duration may alleviate the need for a tracheostomy. In this article, we present such a case and review the literature to draw the otolaryngologist's attention to this possible etiology.

  14. Perindopril and residual chronic subdural hematoma volumes six weeks after burr hole surgery

    DEFF Research Database (Denmark)

    Poulsen, Frantz Rom; Munthe, Sune; Søe, Morten;

    2014-01-01

    OBJECTIVE: Recurrence rates of between 5% and 25% have been reported following surgery for chronic subdural hematoma (CSH). A previous study showed that the treatment with angiotensin converting enzyme (ACE) inhibitors decreases the risk of recurrence. To test the effects of ACE inhibitors...... perindopril 5mg or placebo treatment daily for three months prior to surgery. Cerebral CT scans were performed after six weeks, and clinical follow-ups were performed three months after surgery. Additionally, a retrospective analysis of the data and CT scans from all nonrandomized patients from the same time...... surgery revealed no difference between the placebo and perindopril-treated groups. In the retrospective group (245 patients), there was no correlation between the risk of recurrence and ACE inhibitor treatment. CONCLUSION: Our data suggest that perindopril does not diminish the size of residual CSHs six...

  15. Anticoagulants and antiplatelet agents and the risk of development and recurrence of chronic subdural haematomas.

    Science.gov (United States)

    Lindvall, Peter; Koskinen, Lars-Owe D

    2009-10-01

    Seventy-one patients from northern Sweden were diagnosed with chronic subdural haematomas (CSDH) and treated at the Department of Neurosurgery at Umeå University Hospital over 12 months. Fifty-four patients with CSDH had a history of head trauma (trauma group), while 17 patients had no previous head trauma (non-trauma group). In the non-trauma group 71% of patients were treated with anticoagulants or antiplatelet aggregation agents (AAA) compared to 18% in the trauma group. Considering only AAA, 59% of the non-trauma patients were treated with these drugs versus 17% of patients in the trauma group. The recurrence rate for all patients was 17%. These findings confirm that the use of anticoagulants and AAA is over-represented in patients with non-traumatic CSDH. In our study, recurrence was not associated with previous use of anticoagulants or AAA.

  16. Subdural hematoma

    Science.gov (United States)

    ... Seizures High-pitched cry, irritability Increased head size (circumference) Increased sleepiness or lethargy Persistent vomiting ... head injuries, so try to keep the person's neck still if you must move them before help ...

  17. Analysis of Epileptic Discharges from Implanted Subdural Electrodes in Patients with Sturge-Weber Syndrome.

    Directory of Open Access Journals (Sweden)

    Yasushi Iimura

    Full Text Available Almost two-thirds of patients with Sturge-Weber syndrome (SWS have epilepsy, and half of them require surgery for it. However, it is well known that scalp electroencephalography (EEG does not demonstrate unequivocal epileptic discharges in patients with SWS. Therefore, we analyzed interictal and ictal discharges from intracranial subdural EEG recordings in patients treated surgically for SWS to elucidate epileptogenicity in this disorder.Five intractable epileptic patients with SWS who were implanted with subdural electrodes for presurgical evaluation were enrolled in this study. We examined the following seizure parameters: seizure onset zone (SOZ, propagation speed of seizure discharges, and seizure duration by visual inspection. Additionally, power spectrogram analysis on some frequency bands at SOZ was performed from 60 s before the visually detected seizure onset using the EEG Complex Demodulation Method (CDM.We obtained 21 seizures from five patients for evaluation, and all seizures initiated from the cortex under the leptomeningeal angioma. Most of the patients presented with motionless staring and respiratory distress as seizure symptoms. The average seizure propagation speed and duration were 3.1 ± 3.6 cm/min and 19.4 ± 33.6 min, respectively. Significant power spectrogram changes at the SOZ were detected at 10-30 Hz from 15 s before seizure onset, and at 30-80 Hz from 5 s before seizure onset.In patients with SWS, seizures initiate from the cortex under the leptomeningeal angioma, and seizure propagation is slow and persists for a longer period. CDM indicated beta to low gamma-ranged seizure discharges starting from shortly before the visually detected seizure onset. Our ECoG findings indicate that ischemia is a principal mechanism underlying ictogenesis and epileptogenesis in SWS.

  18. Post-traumatic epidural and subdural hematomas of the spinal cord in MR imaging; Pourazowe nadoponowe i podoponowe krwiaki rdzenia kregowego w obrazie MR

    Energy Technology Data Exchange (ETDEWEB)

    Bronarski, J.; Wozniak, E.; Kiwerski, J. [Stoleczne Centrum Rehabilitacji, Konstancin (Poland)]|[Inst. Psychiatrii i Neurologii, Warsaw (Poland)

    1993-12-31

    Diagnostics of epi- and subdural hematomas of the spinal cord is discussed on the basis of 1992 records of Konstancin Rehabilitation Center. 54 patients with symptoms of partial or complete cord injury were submitted to MR imaging. In 4 cases (7.5%) epi- and subdural hematoma was found to contribute to neurological condition of the patient. MRI determines indications for surgical intervention. (author). 6 refs, 6 figs.

  19. Locked-in syndrome in a patient with acute obstructive hydrocephalus, caused by large unruptured aneurysm of the basilar artery (BA).

    Science.gov (United States)

    Kolić, Zlatko; Kukuljan, Melita; Vukas, Duje; Bonifačić, David; Vrbanec, Kristina; Franić, Ivana Karla

    2016-09-15

    We describe a case of acute obstructive hydrocephalus as a consequence of compression of the brainstem by a large aneurysm of the basilar artery (BA) in a 62-year-old male. After the insertion of the ventriculoperitoneal shunt (VPS), we encountered the "locked-in syndrome" clinical condition. "Locked-in syndrome" is a clinical state characterized by quadriplegia and anarthria with preserved consciousness, most commonly caused by ischemia in the ventral part of pons.

  20. Clinical reports of 52 cases of decranium by large bone flap on acute compound subdural hematoma%大骨瓣开颅手术治疗急性复合型硬膜下血肿52例报告

    Institute of Scientific and Technical Information of China (English)

    雷振海; 魏建文; 陈尚军; 李峰; 惠军; 王辉; 谢国强

    2005-01-01

    目的:探讨大骨瓣开颅手术治疗急性复合型硬膜下血肿的治疗效果.方法:选用改良的Kelly问号切口,前界至发际中线,后至顶结节,下至耳屏前1 cm;骨窗直径约10cm×12cm~12cm×15cm大小,充分暴露额叶前外侧及底部、外侧裂区、颞叶底部及顶叶,直视下彻底清除硬膜下积血及糜烂挫碎坏死的脑组织,必要时行充分的内外减压.结果:随访6个月,生存37例,占71.2%.其中康复良好23例,占44.3%;中度残废9例,占17.3%;重度残废3例,占5.8%;植物生存2例,占3.8%;死亡15例,占28.8%.结论:大骨瓣开颅手术治疗急性复合型硬膜下血肿,能充分暴露,彻底清除硬膜下积血及挫碎糜烂坏死的脑组织,减压充分,使患者顺利度过术后脑水肿期,提高治疗效果,降低病死率.

  1. Subdural and Cerebellar Hematomas Which Developed after Spinal Surgery: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Ufuk Utku

    2013-01-01

    Full Text Available Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2 mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings.

  2. Traumatic induced total myelomalacia of the cervical spinal cord associated with a space-occupying subdural hematoma.

    Science.gov (United States)

    Oehmichen, M; Meissner, C

    1999-01-01

    We report the case of a 20-year-old male driver who suffered from a trauma to the cervical vertebral column in a head-on collision with a tree. The injuries included subluxation of the 2nd and 3rd cervical vertebrae and fracture of the odontoid process of the axis with ventrally directed displacement of the proximal fragment and dorsally directed displacement of the distal fragment. Already at admission to hospital a space-occupying spinal subdural hematoma was diagnosed. Clinically, paraplegia was diagnosed with progressive loss of consciousness. Pneumonia led to death 40 days after the accident. Autopsy disclosed a total myelomalacia of the cervical spinal cord obviously resulting from an ischemia caused by a traumatic lesion of the dorsal truncus arteriosus spinalis as well as a compression by the spinal subdural hematoma.

  3. Recurrence of the Chronic Subdural Hematoma after Burr-Hole Drainage with or without Intraoperative Saline Irrigation

    OpenAIRE

    Kim, Dong Hwan; Kim, Hwan Soo; Choi, Hyuk Jin; Han, In Ho; Cho, Won Ho; Nam, Kyoung Hyup

    2014-01-01

    Objective Although standard method has not been established for the chronic subdural hematoma (CSDH), burr-hole trephination and closed system drainage with or without irrigation has been widely accepted as the treatment of choice. The aim of this study is to analysis the post-operative recurrence rates after burr-hole trephination of the CSDH according to the conduction of irrigation. Methods We retrospectively reviewed 184 patients with CSDH who underwent surgical treatment between January ...

  4. Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature

    Science.gov (United States)

    Ramos, Alexander D.; Rolston, John D.; Gauger, Grant E.; Larson, Paul S.

    2016-01-01

    Case series Patient: Male, 87 • Male, 62 Final Diagnosis: Spinal subdural abscess Symptoms: Fever • pain • weakness Medication: — Clinical Procedure: Laminectomy • durotomy • drainage • debridement Specialty: Neurosurgery Objective: Rare disease Background: Spinal subdural abscesses, also known as empyemas, are rare infectious lesions, the exact incidence of which is unknown. Presentation is typically dramatic, with back pain, fever, motor, and sensory deficits. Rapid identification and surgical intervention with laminectomy, durotomy, and washout provides the best outcomes. While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery. Case Report: Here we present 2 cases: 1) an 87-year-old man with type 2 diabetes, schizophrenia, mild cognitive impairment, and symptomatic lumbar spinal stenosis and 2) a 62-year-old man with a prior L3–4 spinal fusion with symptomatic lumbar spinal stenosis. In both cases, patients underwent laminectomy for spinal stenosis and developed epidural abscess. Following successful drainage of the epidural abscess, they continued to be symptomatic, and repeat imaging revealed the presence of a subdural abscess that was subsequently evacuated. Case 1 had significant improvement with residual lower-extremity weakness, while Case 2 made a complete neurological recovery. Conclusions: These cases illustrate patients at increased risk for developing this rare spinal infection, and demonstrate that rapid recognition and surgical treatment is key to cure and recovery. Review of the literature highlights pertinent risk factors and demonstrates nearly one-third of reported cases have an iatrogenic etiology. The cases presented here demonstrate that a subdural process should be suspected in any patient with intractable pain following treatment of an epidural abscess. PMID

  5. CT and MR imaging findings of subdural dermoid cyst extending into right foramen ovale: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, You Cheol; Park, Cheol Min; Lee, Si Kyeong [Seoul Medical Center, Seoul (Korea, Republic of)

    2006-12-15

    Intracranial dermoid cyst is a rare congenital benign disease, representing less than 0.5% of primary brain tumors. Nevertheless, if ruptured spontaneously or during surgery, it has a poor prognosis due to chemical meningitis. Therefore, it is essential to perform accurate diagnosis and proper treatment. We report an intracranial subdural dermoid cyst that may be misdiagnosed as extracranial or epidural lesion because of extension into the right foramen ovale, and describe the CT and MR imaging findings.

  6. Epidural anterior petrosectomy with subdural visualization of sphenobasal vein via the anterior transpetrosal approach--technical case report.

    Science.gov (United States)

    Ichimura, Shinya; Yoshida, Kazunari; Kagami, Hiroshi; Inaba, Makoto; Orii, Maaya; Kitamura, Yohei; Saga, Isako; Toda, Masahiro

    2012-10-01

    The drainage of the superficial middle cerebral vein (SMCV) is classified into four subtypes. The sphenobasal vein (SBV) drains from the SMCV to the pterygoid venous plexus at the temporal skull base. Epidural procedures in the standard anterior transpetrosal approach (ATPA) may damage the route of the SBV. We report a case in which modified surgical procedures via the ATPA were used to preserve the SBV. A 45-year-old man complained of right facial pain. Magnetic resonance images revealed a right cerebellopontine tumor suggestive of an epidermoid cyst. Right carotid angiography revealed that the SMCV drained into the pterygoid venous plexus via the SBV. The convexity dura mater of the temporal lobe was cut and the anterior part of the temporal lobe was retracted subdurally. The SBV was visualized from the subdural side. The basal dura mater of the temporal lobe posterior to the SBV was cut and the posterior part of the temporal lobe was retracted epidurally. After dissecting the dura mater medial to the greater petrosal nerve and to the edge of the petrous apex, the petrous apex was exposed and drilled out without injuring the SBV. The superior petrous sinus and the tentorium were cut. The tumor compressed the root exit zone of the trigeminal nerve. The tumor was grossly totally removed. The modified ATPA (epidural anterior petrosectomy with subdural visualization of the SBV) is effective in preserving the SBV.

  7. 慢性硬膜下血肿钻孔引流术后再出血的原因及治疗%Mechanism and treatment of intracapsular bleeding after burr hole subdural drainage for chronic subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    王良伟; 李监松; 徐光斌; 吴永; 潘晶晶; 王俊芳

    2015-01-01

    目的:探讨慢性硬膜下血肿钻孔引流术后再出血的原因及治疗原则。方法回顾性分析2011年7月~2013年6月收治的80例慢性硬膜下血肿钻孔引流术治疗患者的临床资料,其中4例患者出现包膜内出血形成血肿,患者均手术治疗并对血肿外包膜做病理检查。结果3例手术治疗后痊愈,1例因术后并发症死亡。包膜病理检查示,大量新生毛细血管扩张充血,有炎性细胞、胶原纤维和纤维细胞等,包膜内的毛细血管壁不完整。结论慢性硬膜下血肿外膜新生血管结构异常是慢性硬膜下血肿术后包膜内出血的原因之一,包膜内出血一经确诊应首选手术治疗。%Objective To explore mechanism and management of intracapsular bleeding after burr hole subdural drainage for chronic subdural hematoma ( CSDH) .Method The clinical data of 80 patients with CSDH treated with burr hole subdural drainage from July , 2011 to June,2013,were analyzed retrospectively .4 cases were treated with craniotomy because of hematoma in capsule after burr hole subdural drainage , light microscopy was used to observe the ultrastructure of the outer membrane of them .Results 3 patients were cured after craniotomy ,1 died because of complication .Light microscopy showed dilated and congested marcocapillaries with a wide vascular lumen in the outer membrane of the hematoma capsule , including inflammatory cells , collagenous fiber , fibrocyte and so on , endothelial cell in the marcocapillaries was discontinous or partically dissolved .Conclusions Variation of structure of these fragile new vessels may play an important role in bleeding of capsule after burr hole subdural drainage in treatment of CSDH.Craniotomy should be the first line treatment .

  8. Development and retranslational validation of an in vitro model to characterize acute infections in large human joints

    DEFF Research Database (Denmark)

    Pilz, Ingo H; Mehlhorn, Alexander; Dovi-Akue, David

    2014-01-01

    Bacterial infections can destroy cartilage integrity, resulting in osteoarthritis. Goal was to develop an in vitro model with in vivo validation of acute joint inflammation. Inflammation in cocultivated human synovial fibroblasts (SFB), chondrocytes (CHDR), and mononuclear cells (MNC) was success...... was significantly elevated in vitro on day 10 following maximum inflammation. Our in vitro model enables us to validate early inflammation of in vivo cell- and cytokine-specific regulatory patterns. This trial is registered with MISSinG, DRKS 00003536.......Bacterial infections can destroy cartilage integrity, resulting in osteoarthritis. Goal was to develop an in vitro model with in vivo validation of acute joint inflammation. Inflammation in cocultivated human synovial fibroblasts (SFB), chondrocytes (CHDR), and mononuclear cells (MNC......) was successively relieved for 10 days. Articular effusions from patients with (n = 7) and without (n = 5) postoperative joint infection in healthy patients (ASA 1-2) were used as model validation. Inflammation in vitro resulted in an enormous increase in IL-1 and a successive reduction in SFB numbers. CHDR however...

  9. Platinum microwire for subdural electrocorticography over human neocortex: millimeter-scale spatiotemporal dynamics.

    Science.gov (United States)

    Kellis, Spencer; Greger, Bradley; Hanrahan, Sara; House, Paul; Brown, Richard

    2011-01-01

    Platinum microwires, terminated at regular intervals to form a grid of contacts, were used to record electric potentials at the surface of the cerebral cortex in human subjects. The microwire grids were manufactured commercially with 75 μm platinum wire and 1 mm grid spacing, and are FDA approved. Because of their small size and spacing, these grids could be used to explore the scale of spatiotemporal dynamics in cortical surface potentials. Electrochemical impedance spectroscopy was used to characterize their recording properties and develop a frequency-dependent electrical model of the micro-electrodes. Data recorded from multiple sites in human cortex were analyzed to explore the relationship between linear correlation and separation distance. A model was developed to explore the impact of cerebrospinal fluid on signal spread among electrodes. Spatial variation in the per-electrode performance decoding articulated speech from face-motor and Wernicke's areas of cortex was explored to understand the scale of information processing at the cortex. We conclude that there are important dynamics at the millimeter scale in human subdural electrocorticography which may be important in maximizing the performance of neural prosthetic applications.

  10. iElectrodes: A Comprehensive Open-Source Toolbox for Depth and Subdural Grid Electrode Localization

    Science.gov (United States)

    Blenkmann, Alejandro O.; Phillips, Holly N.; Princich, Juan P.; Rowe, James B.; Bekinschtein, Tristan A.; Muravchik, Carlos H.; Kochen, Silvia

    2017-01-01

    The localization of intracranial electrodes is a fundamental step in the analysis of invasive electroencephalography (EEG) recordings in research and clinical practice. The conclusions reached from the analysis of these recordings rely on the accuracy of electrode localization in relationship to brain anatomy. However, currently available techniques for localizing electrodes from magnetic resonance (MR) and/or computerized tomography (CT) images are time consuming and/or limited to particular electrode types or shapes. Here we present iElectrodes, an open-source toolbox that provides robust and accurate semi-automatic localization of both subdural grids and depth electrodes. Using pre- and post-implantation images, the method takes 2–3 min to localize the coordinates in each electrode array and automatically number the electrodes. The proposed pre-processing pipeline allows one to work in a normalized space and to automatically obtain anatomical labels of the localized electrodes without neuroimaging experts. We validated the method with data from 22 patients implanted with a total of 1,242 electrodes. We show that localization distances were within 0.56 mm of those achieved by experienced manual evaluators. iElectrodes provided additional advantages in terms of robustness (even with severe perioperative cerebral distortions), speed (less than half the operator time compared to expert manual localization), simplicity, utility across multiple electrode types (surface and depth electrodes) and all brain regions. PMID:28303098

  11. [Subdural, extra-arachnoid block as a complication of stellate ganglion block: documentation with ultrasound].

    Science.gov (United States)

    Kapral, S; Krafft, P; Gosch, M; Fridrich, P; Weinstabl, C

    1997-10-01

    We present a patient who developed a high central neural block after stellate-ganglion-blockade. The underlying pathophysiology was assessed via sonographic imaging. Stellate ganglion block was performed in a 19-year old patient according to the standard technique. Multiple aspiration tests were negative and a test dose of 3 ml bupivacaine 0.25% was injected. After a 3 min interval another 5 ml were injected. Two minutes after the local anaesthetic administration the patient reported nausea and sensations in the upper extremity. Spontaneous respiration efforts stopped, and the patient became unconscious. Tracheal intubation was performed, and the patient was ventilated in a controlled mode for two hours. Heart rate as well as blood pressure remained within the normal range. Neurologic recovery occurred rapidly and extubation was performed about two and a half hours after the event. Our sonographic studies demonstrated a local anaesthetic depot directly at the root of C 6, with a mean diameter of 10 mm and a length of 5 to 6 cm (about a third smaller than expected). Sonographic studies and clinical symptoms of our patient are most likely to occur with a subdural extra-arachnoidal block. Ultrasonographic guided puncture enhances the patient's safety by the opportunity to directly visualise transverse process, nerval root as well as local anaesthetic depot. In case of depot formation directly at the nerval root, injection may be stopped and the needle repositioned. Furthermore, direct visualisation of the great vessels (A. vertebralis) prevents intravascular injection and haematoma formation.

  12. Age determination of subdural hematomas with CT and MRI: A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Sieswerda-Hoogendoorn, Tessa, E-mail: t.sieswerda@amc.nl [Section of Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, PO Box 24044, 2490 AA The Hague (Netherlands); Department of Radiology, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Postema, Floor A.M., E-mail: f.a.postema@amc.nl [Faculty of Medicine, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Verbaan, Dagmar, E-mail: d.verbaan@amc.nl [Department of Neurosurgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Majoie, Charles B., E-mail: c.b.majoie@amc.nl [Department of Radiology, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Rijn, Rick R. van, E-mail: r.r.vanrijn@amc.nl [Section of Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, PO Box 24044, 2490 AA The Hague (Netherlands); Department of Radiology, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)

    2014-07-15

    Objectives: To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans. Methods: We performed a systematic review in MEDLINE, EMBASE and Cochrane to search for articles that described the appearance of SDHs on CT or MRI in relation to time between trauma and scanning. Two researchers independently screened the articles, assessed methodological quality and performed data extraction. Medians with interquartile ranges were calculated. Differences were tested with a Mann–Whitney U or Kruskal–Wallis H test. Results: We included 22 studies describing 973 SDHs on CT and 4 studies describing 83 SDHs on MRI. Data from 17 studies (413 SDHs) could be pooled. There were significant differences between time intervals for the different densities on CT (p < 0.001). Time interval differed significantly between children and adults for iso- and hypodensity (p = 0.000) and hyperdensity (p = 0.046). Time interval did not differ significantly between abused and non-abused children. On MRI, time intervals for different signal intensities on T1 and T2 did not differ significantly (p = 0.108 and p = 0.194, respectively). Conclusions: Most time intervals of the different appearances of SDHs on CT and MRI are broad and overlapping. Therefore CT or MRI findings cannot be used to accurately date SDHs.

  13. Pathomorphological staging of subdural hemorrhages: statistical analysis of posttraumatic histomorphological alterations.

    Science.gov (United States)

    Walter, Till; Meissner, Christoph; Oehmichen, Manfred

    2009-04-01

    We examined 10 histomorphological alterations of 222 cases of subdural hemorrhages following mechanical closed brain injury (MBI) to determine the posttraumatic interval (PTI). These morphological features included red blood cells (RBCs), polymorphonuclear leukocytes (PMNs), macrophages (Ms), RBC-containing Ms, hemosiderin-containing macrophages, hematoidin, fibroblasts, endothelial cells, collagenous fibers and membrane formation. The interval between the time of brain injury and death ranged from a few minutes to 33 years. Following routine staining and immunohistochemical staining of macrophages (CD68), paraffin sections were examined by light microscopy for the presence of the selected histomorphological features. An apparent correlation was found between the frequency of a given histomorphological phenomenon and the length of the PTI. Half of the cases (group 1; n=111) were used to develop a multistage evaluation system, the other half (group 2; n=111) to check its accuracy of prediction. Applying this multistage evaluation model and a special software, 85 of the 111 control group cases (76.6%) could be correctly classified and further 21 cases (18.9%) being assigned to an interval close to the correct interval. Therefore, classification of the correct PTI or an interval close to the correct PTI could be achieved in 95.5% of all cases.

  14. Computational Study of Subdural Cortical Stimulation: Effects of Simulating Anisotropic Conductivity on Activation of Cortical Neurons.

    Directory of Open Access Journals (Sweden)

    Hyeon Seo

    Full Text Available Subdural cortical stimulation (SuCS is an appealing method in the treatment of neurological disorders, and computational modeling studies of SuCS have been applied to determine the optimal design for electrotherapy. To achieve a better understanding of computational modeling on the stimulation effects of SuCS, the influence of anisotropic white matter conductivity on the activation of cortical neurons was investigated in a realistic head model. In this paper, we constructed pyramidal neuronal models (layers 3 and 5 that showed primary excitation of the corticospinal tract, and an anatomically realistic head model reflecting complex brain geometry. The anisotropic information was acquired from diffusion tensor magnetic resonance imaging (DT-MRI and then applied to the white matter at various ratios of anisotropic conductivity. First, we compared the isotropic and anisotropic models; compared to the isotropic model, the anisotropic model showed that neurons were activated in the deeper bank during cathodal stimulation and in the wider crown during anodal stimulation. Second, several popular anisotropic principles were adapted to investigate the effects of variations in anisotropic information. We observed that excitation thresholds varied with anisotropic principles, especially with anodal stimulation. Overall, incorporating anisotropic conductivity into the anatomically realistic head model is critical for accurate estimation of neuronal responses; however, caution should be used in the selection of anisotropic information.

  15. 维生素K缺乏所致硬脑膜下血肿%Subdural Hematoma due to Vitamin K Deficiency

    Institute of Scientific and Technical Information of China (English)

    沈玉成; 金惠明

    1983-01-01

    @@ 新生儿晚期及婴儿期可由维生素K缺乏引起出血性疾病,往往伴有颅内出血,造成严重后遗症,总结我院23例新生儿及婴儿因维生素K缺乏所致硬脑膜下血肿病因,提出预防性治疗的重要性.%The authors present 23 cases of acute intracranial hemorrhage due to vitamin K deficiency in neonatea and infants.Its causes can be grouped as:(1)insufficient intake of vitamin K,characteristically seen in infants who are breast-fed or fed with rice water ete,(2)disturbance in adequate bacterial synthesis in the intestinal tract likely due to medication of tetracycline for upper respiratory infection,diarrhea or pneumonia,(3)that secondary to some other liver disease,and(4)lipolytic disturbance in absorption of vitamin K.In principle,the treatment is by means of puncture to drain the hematoma of its contents.When this fails,surgical removal of the hematoma by craniotomy is recommended.Decompression through excision of bone flap is suggested if necessary.While subdural hemorrhage arising from vitamin K deficiency is curable,its sequaiae are not.Therefor,timely preventive measures should be taken,which include prescription of oral vitamin K for the mother one week prior to delivery,for premature babies,as well as for neonates and infants with daily dosage of 1 mg/kg to prevent the disease at the critical juncture when the level of physiological thrombinogen begins to decline.

  16. Clinical application of magnetic resonance in acute traumatic brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Morais, Dionei F.; Gaia, Felipe F.P. [Hospital de Base de Sao Jose do Rio Preto, SP (Brazil). Servico de Neurocirurgia]. E-mail: centro@cerebroecoluna.com.br; Spotti, Antonio R.; Tognola, Waldir A. [Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), SP (Brazil). Dept. de Ciencias Neurologicas; Andrade, Almir F. [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Dept. de Neurocirurgia da Emergencia

    2008-07-01

    Purpose: To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. Method: Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8%) males and 21 (38.2%) females, with acute (0 to 5 days) and closed TBI. Results: Statistical significant differences (McNemar test): occurred fractures were detected by CT in 29.1% and by MRI in 3.6% of the patients; subdural hematoma by CT in 10.9% and MRI in 36.4 %; diffuse axonal injury (DAI) by CT in 1.8% and MRI in 50.9%; cortical contusions by CT in 9.1% and MRI in 41.8%; subarachnoid hemorrhage by CT in 18.2% and MRI in 41.8%. Conclusion: MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI. (author)

  17. [A case of acute ethanol intoxication with remarkable hyperglycemia by "ume-shu", a Japanese apricot liquor made with a large amount of sugar].

    Science.gov (United States)

    Sugano, Takayuki; Kojima, Naoki; Kaneko, Susumu; Ishida, Junro; Terada, Taizo; Inagawa, Hiroshi; Okada, Yasusei

    2002-07-01

    A 19-year-old woman ingested 2.2 L of "umeshu", a Japanese apricot liquor made with a large amount of sugar. She was unconscious and in shock. The estimated blood ethanol concentration was 607 mg/dl, and the blood glucose level was 576 mg/dl. Because her respiration and circulation was highly suppressed, blood purification was indicated. Continuous hemodiafiltration (CHDF) was performed instead of hemodialysis because her hemodynamics was unstable. After CHDF was instituted, her blood glucose level reduced to normal range, and her consciousness became alert. CHDF was effective in eliminating ethanol and stabilizing her hemodynamics within an early stage. Though acute ethanol intoxication is known to inhibit glucogenesis, leading to hypoglycemia, marked hyperglycemia was seen in this case. Ingestion of a large amount of glucose-rich liquor and being in shock seemed to be the causes of hyperglycemia.

  18. Large decrease in acute aquatic toxicity of linear alkylbenzene sulfonate in hard water and seawater by adding adsorbent.

    Science.gov (United States)

    Oya, Masaru; Takemoto, Yuka; Ishikawa, Yusuke

    2008-01-01

    LAS (Linear Alkylbenzene Sulphonate) shows relatively high aquatic toxicity in hard freshwater or seawater. In this paper, we studied the effect of adsorbent on the aquatic toxicity of LAS in hard freshwater and seawater. Daphnia magna and Artemia salina were used for acute aquatic toxicity test in freshwater and seawater, respectively. Kaolin was used as a model adsorbent and toxic surface tension (gamma(tox)) was used as an indicator of toxic condition. Results showed that the values of gamma(tox) of LAS to D. magna and A. salina were about 45-55 mN/m and 35-40 mN/m, respectively. Surface tension of LAS solution decreased and its aquatic toxicity increased with increasing the water hardness or the salinity. By adding adsorbent into the solutions, the surface activity and the aquatic toxicity were decreased greatly, and the effect of water hardness or salinity on surface tension and aquatic toxicity were removed. That is to say, the surface tension curve of soft freshwater corresponds with that of hard freshwater containing adsorbent and the surface tension curve at low salinity corresponds with that obtained for high salinity solutions containing the adsorbent. Therefore, our experimental data leads to the conclusion that the relatively high aquatic toxicity of LAS in concentrated solution of inorganic salts disappears in the presence of adsorbents. This is an important viewpoint in conducting environmental risk assessment of surfactants.

  19. Epidemiological and clinical studies on aseptic meningitis in 377 cases, 3. A study on brain CT scan in acute phase

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Masaaki; Kondo, Tomio; Takashima, Akira; Kono, Shinya; Yamashina, Manabu (Ogaki Shimin Hospital, Gifu (Japan))

    1984-02-01

    Brain CT scan performed in the acute phase of aseptic meningitis in 88 cases revealed abnormal findings in 5 consisting of 2 of cerebral edema, 2 of subdural hygroma and one of cerebral atrophy. Clinical findings showed no particular relation to the age, but cerebral edema was observed in the cases of possible cephalomeningitis diagnosed on the basis of accompanying convulsion and disturbance of consciousness. Abnormal findings were associated with 25% of symptoms diagnosed more than 4 days after onset.

  20. 慢性硬膜下血肿196例诊治%Experience of Treatment of Chronic Subdural Hematoma

    Institute of Scientific and Technical Information of China (English)

    宋志旺; 祁震宇

    2012-01-01

    目的 探讨慢性硬膜下血肿的临床特征及其诊治.方法 对2002年~2011年收治的196例慢性硬膜下血肿患者的临床资料进行回顾性分析.结果 慢性硬膜下血肿的临床表现以头昏头痛、肢体肌力下降、精神症状、大小便失禁、癫痫症状为主.治疗上167例采取钻孔引流术,29例采取开瓣血肿清除术.术后症状明显缓解,复查CT示血肿消失或明显减少.结论 慢性硬膜下血肿临床表现缺乏特异性,早期正确诊断并行钻孔引流术或开瓣血肿清除术是治疗慢性硬膜下血肿的主要方法,效果确切.%Objective To evaluate clinical character and diagnosis and treatment on chronic subdural hematoma(CSDH).Methods 196 cases of chronic subdural hematoma were analyzed.Results The classical presentation of CSDH included dizzy,hedache,body strength down,mental symptoms,incontinence and epilepsy symptoms.Of 196 patients,there were 167 cases treated with drilling drainage and 29 cases with open-flap hematoma.Postoperative symptoms were improved,head CT review showed hematoma decreased significantly or disappeared.Conclusion Typical presentation is still lacking for CSDH.Early correct diagnosis and conduct drilling drainage or open-flap hematoma is the main therapy of chronic subdural hematoma.

  1. Clinical study of cerebral blood flow in bilateral chronic subdural hematoma measured by {sup 99m}Tc-HMPAO SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Okuyama, Tohru; Saito, Koji; Fukuyama, Kohichi; Yamamoto, Kouki; Morimoto, Mamoru [Kushiro Neurosurgical Hospital, Hokkaido (Japan); Aburano, Tamio

    2000-08-01

    Cerebral blood flow (CBF) in 34 patients with bilateral chronic subdural hematoma was measured by {sup 99m}Tc-HMPAO SPECT before operation. The regional CBF was measured in 26 regions of the 10 cortical regions, putamen, thalamus and cerebellar hemisphere on both sides. According to the thickness of subdural hematoma, the thicker hematoma side was measured and examined as the thick hematoma side, and the other side as the thin hematoma side. Thirty four cases with bilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms :13 cases with headache (headache group), 10 cases with hemiparesis (hemiparesis group), 5 cases with tetraparesis (tetraparesis group) and 6 cases with consciousness disturbance or dementia (consciousness disturbance group), and into two groups according to the degree of midline brain shift on MRI: 14 cases of non-shifted group and 20 cases of shifted group. The average CBF of 34 patients in each region indicated a regional CBF reduction in the frontal, parietal and occipital cortices on the thin hematoma side, and in the putamen on the thick hematoma side. In the headache group, the regional CBF reduction on the thin hematoma side was found in the frontal, parietal and occipital cortices compared with the corresponding regions on the thick hematoma side, and in thalamus on the thick hematoma side. In the hemiparesis and tetraparesis groups, there was no statistically significant CBF reduction between the thick and thin hematoma sides. In the consciousness disturbance group, the CBF reduction in whole brain was remarkably significant. By the degree of the midline brain shift, the CBF reductions between the thick and thin hematoma sides were observed. Namely, in the shifted group, the CBF reductions were noted in the frontal, parietal and occipital cortices in the thin hematoma side, and in the putamen in the thick hematoma side. We concluded that the CBF reduction of bilateral chronic subdural hematoma

  2. Prolonged Subdural Infusion of Kynurenic Acid Is Associated with Dose-Dependent Myelin Damage in the Rat Spinal Cord.

    Directory of Open Access Journals (Sweden)

    Wojciech Dabrowski

    Full Text Available Kynurenic acid (KYNA is the end stage metabolite of tryptophan produced mainly by astrocytes in the central nervous system (CNS. It has neuroprotective activities but can be elevated in the neuropsychiatric disorders. Toxic effects of KYNA in the CNS are unknown. The aim of this study was to assess the effect of the subdural KYNA infusion on the spinal cord in adult rats.A total of 42 healthy adult rats were randomly assigned into six groups and were infused for 7 days with PBS (control or 0.0002 pmol/min, 0.01 nmol/min, 0.1 nmol/min, 1 nmol/min, and 10 nmol/min of KYNA per 7 days. The effect of KYNA on spinal cord was determined using histological and electron microscopy examination. Myelin oligodendrocyte glycoprotein (MOG was measured in the blood serum to assess a degree of myelin damage.In all rats continuous long-lasting subdural KYNA infusion was associated with myelin damage and myelin loss that was increasingly widespread in a dose-depended fashion in peripheral, sub-pial areas. Damage to myelin sheaths was uniquely related to the separation of lamellae at the intraperiod line. The damaged myelin sheaths and areas with complete loss of myelin were associated with limited loss of scattered axons while vast majority of axons in affected areas were morphologically intact. The myelin loss-causing effect of KYNA occurred with no necrosis of oligodendrocytes, with locally severe astrogliosis and no cellular inflammatory response. Additionally, subdural KYNA infusion increased blood MOG concentration. Moreover, the rats infused with the highest doses of KYNA (1 and 10 nmol/min demonstrated adverse neurological signs including weakness and quadriplegia.We suggest, that subdural infusion of high dose of KYNA can be used as an experimental tool for the study of mechanisms of myelin damage and regeneration. On the other hand, the administration of low, physiologically relevant doses of KYNA may help to discover the role of KYNA in control of

  3. A New Modified Twist Drill Craniostomy Using a Novel Device to Evacuate Chronic Subdural Hematoma.

    Science.gov (United States)

    Wang, Qing-Feng; Cheng, Cheng; You, Chao

    2016-03-01

    Compared with burr hole craniostomy (BHC), twist drill craniostomy (TDC) is increasingly popular because of its minimal invasiveness in evacuating chronic subdural hematoma (CSDH). However, the TDC technique varies and is continually developing; moreover, no consensus yet exists regarding the optimal protocol, and the efficacy and safety of TDC is still controversial, especially with respect to a specific method. This article introduces a new modified TDC technique using a novel device, the YL-1 puncture needle, and evaluates its efficacy and advantages compared with BHC.A retrospective study involving 121 patients with CSDH who underwent surgery at a single center was conducted, involving 68 patients undergoing modified TDC (TDC group) and 53 patients treated by BHC (BHC group). The neurological outcome was studied to evaluate the surgery efficacy, and the radiological outcome was assessed as a supplement to the surgery efficacy. In addition, complications, recurrence, and reoperation, as well as pneumocrania, operation duration, and length of stay, were studied to evaluate the advantages of the modified TDC compared with BHC. Independent sample t tests or rank-sum tests were used to compare the outcomes between the 2 groups.The neurological and radiological outcomes did not differ significantly between the TDC and BHC groups (P = 0.852 and P = 0.232, respectively), while the rates of complication and pneumocrania in patients who underwent the modified TDC were significantly lower than that in those who underwent BHC (P = 0.021 and P TDC were significantly shorter than those of the patients who underwent BHC (both P TDC with a YL-1 puncture needle is a minimally invasive surgical technique to treat CSDH; this procedure is as effective as BHC, but safer and simpler than BHC, and should be considered for patients with CSDH, especially the elderly.

  4. Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly.

    Directory of Open Access Journals (Sweden)

    Pasquale De Bonis

    Full Text Available BACKGROUND AND PURPOSE: In the last decade there has been an increasing use of antiplatelet/anticoagulant agents in the elderly. The aim of the study was to evaluate the association between exposure to anticoagulant/antiplatelet therapy and chronic subdural haematoma-CSDH. METHODS: Single institution case-control study involving 138786 patients older than 60 years who visited our academic tertiary care Emergency Department from January 1st 2001 to December 31st 2010. 345 patients with CSDH (cases were identified by review of ICD-9 codes 432.1 and 852.2x. Case and controls were matched with a 1:3 ratio for gender, age (± 5 years, year of admission and recent trauma. A conditional logistic model was built. A stratified analysis was performed with respect to the presence (842 patients or absence (536 patients of recent trauma. RESULTS: There were 345 cases and 1035 controls. Both anticoagulant and antiplatelet agents were associated with an increased risk of CSDH with an OR of 2.46 (CI 95% 1.66-3.64 and 1.42 (CI 95% 1.07-1.89, respectively. OR was 2.70 (CI 95% 1.75-4.15, 1.90 (CI 95% 1.13-3.20, and 1.37(CI 95% 0.99-1.90 for patients receiving oral anticoagulants, ADP-antagonists, or Cox-inhibitors, respectively. History of recent trauma was an effect modifier of the association between anticoagulants and CSDH, with an OR 1.71 (CI 95% 0.99-2.96 for patients with history of trauma and 4.30 (CI 95% 2.23-8.32 for patients without history of trauma. CONCLUSIONS: Anticoagulant and antiplatelet therapy have a significant association with an increased risk of CSDH. This association, for patients under anticoagulant therapy, appears even stronger in those patients who develop a CSDH in the absence of a recent trauma.

  5. Effects of large dose of dexamethasone on inflammatory mediators and pancreatic cell apoptosis of rats with severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To investigate the influence of high dose of dexamethasone on inflammatory mediators and apoptosis of rats with severe acute pancreatitis (SAP).METHODS: SAP rats were randomly assigned to the model group and treatment group while the normal rats were assigned to the sham operation group. The mortality, ascite volumes, ascites/body weight ratio and pancreas pathological changes of all rats were observed at 3, 6 and 12 h after operation. Their contents of amylase and endotoxin in plasma and contents of tumor necrosis factor (TNF-α), phospholipase A2 (PLA2) and IL-6 in serum were also determined. The microarray sections of their pancreatic tissues were prepared, terminal transferase dUTP nick end labeling (TUNEL) staining was performed and apoptotic indexes were calculated. RESULTS: There was no marked difference between treatment group and model group in survival. The contents of amylase and endotoxin in plasma and contents of TNF-α, PLA2 and IL-6 in serum, ascite volumes, ascites/body weight ratio and pancreas pathological scores were all lower in treatment group than in model group to different extents at different time points [P < 0.05, 58.3 (26.4) ng/L vs 77.535 (42.157)ng/L in TNF-α content, 8.00 (2.00) points vs 9.00 (2.00)points in pathological score of pancreas respectively;P < 0.01, 0.042 (0.018) EU/mL vs 0.056 (0.0195) EU/mL in endotoxin content, 7791 (1863) U/L vs 9195 (1298)U/L in plasma amylase content, 1.53 (0.79) vs 2.38 (1.10) in ascites/body weight ratio, 8.00 (1.00) points vs 11.00 (1.50) points in pathological score of pancreas; P < 0.001, 3.36 (1.56) ng/L vs 5.65 (1.08) ng/L in IL-6 content, 4.50 (2.00) vs 7.20 (2.00), 4.20 (1.60) vs 6.40 (2.30), 3.40 (2.70) vs 7.90 (1.70) in ascite volumes,respectively]. The apoptotic indexes of pancreas head and pancreas tail were all higher in treatment group than in model group at 6 h[P < 0.01, 0.00 (2.00)% vs 0.00(0.00)%, 0.20 (1.80) vs 0.00 (0.00) in apoptosis indexes, respectively

  6. Emergent intracranial balloon angioplasty and bailout self-expandable stent placement in acute large vessel occlusion of the anterior circulation: Experience of a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Young Jin; Seo, Jung Hwa; Jeong, Hae Woong [Busan Paik Hospital, Inje University, Busan (Korea, Republic of)

    2017-06-15

    To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS). The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed. The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b–3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0–2 and 5–6). Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT.

  7. Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction. Retrospective data from two large studies.

    Science.gov (United States)

    Malmberg, K; Herlitz, J; Hjalmarson, A; Rydén, L

    1989-05-01

    From two large scale studies in patients with suspected acute myocardial infarction we report the outcome in diabetics after treatment with either metoprolol or placebo. In the Göteborg Metoprolol Trial mortality at 3 months was reduced by metoprolol from 17.9% to 7.5% and late infarction was reduced from 16.4% to 3.8%. In the MIAMI Trial, mortality was decreased by metoprolol from 11.3% to 5.7% and the occurrence of late infarction was decreased from 4.5% to 3.1% during 15-day follow-up. Compared with the overall results, the effect of metoprolol on mortality appears particularly impressive in diabetics.

  8. Histopathological analysis of spontaneous large necrosis of adrenal pheochromocytoma manifested as acute attacks of alternating hypertension and hypotension: a case report.

    Science.gov (United States)

    Ohara, Nobumasa; Uemura, Yasuyuki; Mezaki, Naomi; Kimura, Keita; Kaneko, Masanori; Kuwano, Hirohiko; Ebe, Katsuya; Fujita, Toshio; Komeyama, Takeshi; Usuda, Hiroyuki; Yamazaki, Yuto; Maekawa, Takashi; Sasano, Hironobu; Kaneko, Kenzo; Kamoi, Kyuzi

    2016-10-12

    Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors. Hypertension secondary to pheochromocytoma is often paroxysmal, and patients occasionally present with sudden attacks of alternating hypertension and hypotension. Spontaneous, extensive necrosis within the tumor that is associated with catecholamine crisis is an infrequent complication of adrenal pheochromocytoma, but its pathogenesis remains unclear. A 69-year-old Japanese man developed acute-onset episodic headaches, palpitations, and chest pains. During the episodes, both marked fluctuations in blood pressure (ranging from 40/25 to 300/160 mmHg) and high plasma levels of catecholamines were found simultaneously. Radiological findings indicated a 4-cm left adrenal pheochromocytoma. These episodic symptoms disappeared within 2 weeks with normalization of plasma catecholamine levels. Two months later, the patient underwent adrenalectomy. Microscopic examinations revealed pheocromocytoma with a large central area of coagulative necrosis. The necrotic material was immunohistochemically positive for chromogranin A. Granulation tissue was adjacent to the necrotic area, accompanied by numerous hemosiderin-laden macrophages and histiocytes with vascular proliferation. Viable tumor cells, detected along the periphery of the tumor, demonstrated pyknosis, and the Ki-67 labeling index was 2 % in the hot spot. No embolus or thrombus formation was found in the resected specimen harboring the whole tumor. The Pheochromocytoma of the Adrenal gland Scaled Score was 2 out of 20. The patient's postoperative course was unremarkable for > 7 years. Presumed causal factors for the extensive necrosis of adrenal pheochromocytoma in previously reported cases include hemorrhage into the tumor, hypotension induced by a phentolamine administration, embolic infarction, high intracapsular pressure due to malignant growth of the tumor, and catecholamine-induced vasoconstriction. In the present case, histopathological

  9. Pola Kejadian Hematoma Subdural Pada Bayi Yang dirawat di Ruang Rawat Intensif Anak Rumah Sakit Dr. Hasan Sadikin

    Directory of Open Access Journals (Sweden)

    Enny Harliany Alwi

    2009-09-01

    Full Text Available Subdural hematoma (SDH is a common condition in infancy and young children with a poor prognostic. The more studies related SDH with nonaccidental injury. With the aim to identify the characteristics of SDH in infants below 1 year, a retrospective study of infants below 1 year diagnosed as subdural hematoma who were admitted to PICU Hasan Sadikin General Hospital from Januari 2000 to Desember 2003 has been conducted. Infants less than 1 month and SDH developed after neurosurgery intervention were excluded. Fourteen infants met the inclusion criteria's, consisted of 5 (36% girls and 9 (64% boys, most of them were on 1 month of age (57%. Anemia was found on all cases, thrombocyte normal except in 1 case thrombocytopenia (53,000/mm3. PT prolonged in 9 (100% cases and PTT in 5 (56% from 9 cases. Bilirubin total/direct elevated in 4 (80% from 5 cases, SGOT/SGPT elevated in 5 (83% from 6 cases. From 11 cases, 9 (82% cases were IgG anti-CMV positive and 6 (55% cases were IgM anti CMV positive. Conclusions, SDH can be caused by various etiologies, thus a comprehensive examinations to exclude child abuse are needed. The role of CMV infection should be considered as one of SDH etiology.

  10. "Rabbit Ear" scalp deformity caused by massive subdural effusion in infant following bilateral burr-hole drainage

    Directory of Open Access Journals (Sweden)

    Guru Dutta Satyarthee

    2013-01-01

    Full Text Available Subdural effusion (SDE in an infant is a rare clinical scenario, which may be secondary to a variety of etiologies. Massive SDE is an extremely rare complication of head injury. It usually runs a self-limiting course. Though neurosurgical intervention is occasionally needed, different methods of surgical procedure for management includes burr-hole alone, burr-holes with subdural drain placement, twist drill craniotomy with drain and even craniotomy. The authors report a rare case of progressive massive SDE, which despite bilateral burr-hole placement and drainage failed and presented with visual deterioration and massive bulge of scalp at burr-hole sites producing rabbit ear sign in a 10 month old infant. Ultimately cystoperitoneal shunt was carried out in a desperate attempt to prevent impending rupture of scalp sutures at sites of previous burr-hole placement. Astonishingly not only complete resolution of hygroma, but visual recovery also took place. Patient is doing well at 6 months following shunt with regaining normal vision and appropriate developmental milestones. A magnetic resonance imaging scan of brain at last follow-up revealed mild ventriculomegaly with subduro-peritoneal shunt in situ and rest of brain was unremarkable. Such cases have not been reported in literature until date.

  11. Rapid resolution of subdural hematoma after targeted epidural blood patch treatment in patients with spontaneous intracranial hypotension

    Institute of Scientific and Technical Information of China (English)

    Wang Jin; Zhang Dan; Gong Xiangyang; Ding Meiping

    2014-01-01

    Background Subdural hematoma (SDH) is a common complication of spontaneous intracranial hypotension (SIH).To date,the management of SDH caused by SIH remains controversial.In this paper,we reviewed the clinical course of SDH in patients with SIH,and discuss the underlying mechanism and attributing factors for rapid resolution of subdural hematomas after epidural blood patch (EBP) surgery.Methods We retrospectively reviewed a cohort of seventy-eight SIH patients diagnosed and treated with targeted EBP in our neurology center.Patients who received early CT/MRI follow-up after EBP operation were included.Results A series of four cases of SIH complicated with SDHs were evaluated.Early follow-up neuroimages of these patients revealed that SDHs could be partially or totally absorbed just two to four days after targeted epidural blood patch treatment.Conclusion Targeted epidural blood patch can result in rapid hematoma regression and good recovery in some patients with a combination of SDH and SIH.

  12. Subdural Fluid Collection and Hydrocephalus After Foramen Magnum Decompression for Chiari Malformation Type I: Management Algorithm of a Rare Complication.

    Science.gov (United States)

    Rossini, Zefferino; Milani, Davide; Costa, Francesco; Castellani, Carlotta; Lasio, Giovanni; Fornari, Maurizio

    2017-07-25

    Chiari malformation type I is a hindbrain abnormality characterized by descent of the cerebellar tonsils beneath the foramen magnum, frequently associated with symptoms or brainstem compression, impaired cerebrospinal fluid circulation, and syringomyelia. Foramen magnum decompression represents the most common way of treatment. Rarely, subdural fluid collection and hydrocephalus represent postoperative adverse events. The treatment of this complication is still debated, and physicians are sometimes uncertain when to perform diversion surgery and when to perform more conservative management. We report an unusual occurrence of subdural fluid collection and hydrocephalus that developed in a 23-year-old patient after foramen magnum decompression for Chiari malformation type I. Following a management protocol, based on a step-by-step approach, from conservative therapy to diversion surgery, the patient was managed with urgent external ventricular drainage, and then with conservative management and wound revision. Because of the rarity of this adverse event, previous case reports differ about the form of treatment. In future cases, finding clinical and radiologic features to identify risk factors that are useful in predicting if the patient will benefit from conservative management or will need to undergo diversion surgery is only possible if a uniform form of treatment is used. Therefore, we believe that a management algorithm based on a step-by-step approach will reduce the use of invasive therapies and help to create a standard of care. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Does hypernatremia cause subdural hematoma in children?: two case reports and a meta-analysis of the literature.

    Science.gov (United States)

    Ali, Syed Adnaan; Jaspan, Timothy; Marenah, Christine; Vyas, Harish

    2012-06-01

    Hypernatremia has been causally linked with subdural hematoma (SDH), but more recently this has been called into question. Conversely, there is a well-established link between SDH and injury. We wish to examine the evidence base that hypernatremia in infants and young children causes SDH.We present 2 cases of children with severe hypernatremia whose intracranial contents were assessed by imaging in the first case and postmortem examination in the second. Neither demonstrated SDH. The first case was important as the hypernatremia was iatrogenic occurring in a controlled hospital environment.We also searched the literature from 1950 to 2007, collecting data on all reported cases of hypernatremia in children younger than 7 years whose intracranial contents were examined by imaging, surgery, and/or postmortem examination. Of 124 cases reported in 31 articles, 112 cases developed hypernatremia in the community, and 12 in the hospital. Subdural hematoma was demonstrated in 7 cases, all of which had developed hypernatremia in the community under circumstances that would make it difficult to exclude nonaccidental injury. None of the 12 cases that developed hypernatremia in a controlled hospital environment had SDH.The evidence base supporting the hypothesis that hypernatremia causes SDH is poor, depending on isolated reports with uncertain histories.

  14. Contralateral development of acute subdural hematoma (SDH immediately following a burr-hole craniostomy for chronic SDH

    Directory of Open Access Journals (Sweden)

    Jae Sung Park, MD

    2016-12-01

    Conclusion: This report represents a contralateral ASDH that occurred less than an hour after a burr-hole trephination for CSDH. Several hypotheses concerning the etiology of this rare complication, albeit inconclusive, are worth contemplation. Excessive drain of CSDH must be refrained from in order not to encounter any unexpected complications.

  15. Chronic subdural hematoma of the posterior fossa associated with cerebellar hemorrhage: report of rare disease with MRI findings Hematoma subdural crônico de fossa posterior associado a hemorragia cerebelar espontânea: relato de doença rara com achados de RNM

    Directory of Open Access Journals (Sweden)

    Leodante B. Costa Jr

    2004-03-01

    Full Text Available Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 year-old woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.Hematomas subdurais da fossa posterior são lesões raras, mais comumente relacionadas com traumas graves. A ocorrência de hematomas subdurais crônicos na fossa posterior é muito rara, sendo descritos 15 casos até o momento, boa parte relacionada ao uso de anticoagulantes. Em nossa revisão da literatura, não pudemos encontrar nenhum relato da associação entre hematoma subdural crônico da fossa posterior e hemorragia cerebelar espontânea. Relatamos o caso de paciente de 64 anos com hematoma intraparenquimatoso cerebelar tratado conservadoramente e hematoma subdural crônico, tratado cirurgicamente, cerca de 1 mês após o acidente vascular cerebelar.

  16. Brain perfusion CT for acute stroke using a 256-slice CT: improvement of diagnostic information by large volume coverage

    Energy Technology Data Exchange (ETDEWEB)

    Dorn, F. [Technical University, Department of Radiology, Klinikum rechts der Isar, Munich (Germany); Institut fuer Radiologie, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Muenchen (Germany); Muenzel, D.; Meier, R.; Rummeny, E.J.; Huber, A. [Technical University, Department of Radiology, Klinikum rechts der Isar, Munich (Germany); Poppert, H. [Technical University, Department of Neurology, Klinikum rechts der Isar, Munich (Germany)

    2011-09-15

    To compare a 256-slice CT with a simulated standard CT for brain CT perfusion (CTP). CTP was obtained in 51 patients using a 256-slice CT (128 detector rows, flying z-focus, 8-cm detector width, 80 kV, 120mAs, 20 measurements, 1 CT image/2.5 s). Signal-to-noise ratios (SNR) were compared in grey and white matter. Perfusion maps were evaluated for cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) in hypoperfused areas and corresponding contralateral regions. Two reconstructed 10-mm slices for simulation of a standard CT (SDCT) were compared with the complete data sets (large-volume CT, LVCT). Adequate image quality was achieved in 50/51 cases. SNR were significantly different in grey and white matter. A perfusion deficit was present in 27 data sets. Differences between the hypoperfusions and the control regions were significant for MTT and CBF, but not for CBV. Three lesions were missed by SDCT but detected by LVCT; 24 lesions were covered incompletely by SDCT, and 6 by LVCT. 21 lesions were detected completely by LVCT, but none by SDCT. CTP imaging of the brain using an increased detector width can detect additional ischaemic lesions and cover most ischaemic lesions completely. (orig.)

  17. Design and testing of a controlled electromagnetic spinal cord impactor for use in large animal models of acute traumatic spinal cord injury.

    Science.gov (United States)

    Petteys, Rory J; Spitz, Steven M; Syed, Hasan; Rice, R Andrew; Sarabia-Estrada, Rachel; Goodwin, C Rory; Sciubba, Daniel M; Freedman, Brett A

    2017-09-01

    Spinal cord injury (SCI) causes debilitating neurological dysfunction and has been observed in warfighters injured in IED blasts. Clinical benefit of SCI treatment remains elusive and better large animal models are needed to assess treatment options. Here, we describe a controlled electromagnetic spinal cord impactor for use in large animal models of SCI. A custom spinal cord impactor and platform were fabricated for large animals (e.g., pig, sheep, dog, etc.). Impacts were generated by a voice coil actuator; force and displacement were measured with a load cell and potentiometer respectively. Labview (National Instruments, Austin, TX) software was used to control the impact cycle and import force and displacement data. Software finite impulse response (FIR) filtering was employed for all input data. Silicon tubing was used a surrogate for spinal cord in order to test the device; repeated impacts were performed at 15, 25, and 40 Newtons. Repeated impacts demonstrated predictable results at each target force. The average duration of impact was 71.2 ±6.1ms. At a target force of 40N, the output force was 41.5 ±0.7N. With a target of 25N, the output force was 23.5 ±0.6N; a target of 15Newtons revealed an output force of 15.2 ±1.4N. The calculated acceleration range was 12.5-21.2m/s(2). This custom spinal cord impactor reliably delivers precise impacts to the spinal cord and will be utilized in future research to study acute traumatic SCI in a large animal. Published by Elsevier Ltd.

  18. Under the Skull Plate Subdural Hemorrhage CT and MRI Contrast Research%颅骨内板下硬膜下出血CT与MRI对比研究

    Institute of Scientific and Technical Information of China (English)

    周俊杰; 方晓龙; 袁彪; 郑鹏

    2016-01-01

    目的:探讨分析CT与MRI两种检查在颅骨内板下硬膜下出血诊断中的价值。方法回顾分析我院2011年6-2015年9月经临床证实的176例颅骨内板下硬膜下出血CT与MRI表现,按出血厚度将患者分为三组:5mm以下组,5-10mm组,10mm以上组,比较CT与MRI两种检查结果。结果对5mm以下组少量硬膜下出血的显示MRI明显优于CT;5-10mm组中硬膜下出血的显示MRI略优于CT;10mm以上组硬膜下出血的显示MRI与CT一致。结论 MRI对颅骨内板下硬膜下出血的显示率极高,尤其是对等密度的、厚度越小的硬膜下出血的显示MRI优势越明显,可作为颅骨内板下硬膜下出血诊断的重要标准。%Objective To discuss and analyze the CT and MRI in the diagnosis value of under the skull plate subdural hemorrhage. Methods The CT and MRI characteristics of the 176 cases, recruited from our hospital from June 2011 to September 2015, with clinically conifrmed under the skull plate subdural hemorrhage were reviewed. According to the thickness of bleeding divided the patients into three groups: below 5mm group, 5-10mm group, more than 10mm group. Than compared the two results in CT and MRI.Results A small amount of subdural hemorrhage in below 5mm group showed that MRI is superior to CT. Subdural hemorrhage in 5-10mm group showed that MRI is slightly superior to CT. More than 10mm group showed that MRI and CT are basically identical.Conclusion The research showed the advantage of MRI in the diagnosis of under the skull plate subdural hemorrhage, especially for the peer density and smaller thickness of subdural hemorrhage. So MRI can be used as an important standard in under the skull plate subdural hemorrhage diagnosed.

  19. Do Gender and Race/Ethnicity Influence Acute Myocardial Infarction Quality of Care in a Hospital with a Large Hispanic Patient and Provider Representation?

    Directory of Open Access Journals (Sweden)

    Tomás Romero

    2013-01-01

    Full Text Available Background. Disparities in acute myocardial infarction (AMI care for women and minorities have been extensively reported in United States but with limited information on Hispanics. Methods. Medical records of 287 (62% Hispanic and 176 (38% non-Hispanic white (NHW patients and 245 women (53% admitted with suspected AMI to a southern California nonprofit community hospital with a large Hispanic patient and provider representation were reviewed. Baseline characteristics, outcomes (mortality, CATH, PCI, CABG, and use of pertinent drug therapy, and medical insurance were analyzed according to gender, Hispanic and NHW race/ethnicity when AMI was confirmed. For categorical variables, 2×2 chi-square analysis was conducted. Odds ratio and 95% confidence interval for outcomes adjusted for gender, race/ethnicity, cardiovascular risk factors, and insurance were obtained. Results. Women and Hispanics had similar drug therapy, CATH, PCI, and mortality as men and NHW when AMI was confirmed (n=387. Hispanics had less private insurance than NHW (31.4% versus 56.3%, P<0.001; no significant differences were found according to gender. Conclusions. No differences in quality measures and outcomes were found for women and between Hispanic and NHW in AMI patients admitted to a facility with a large Hispanic representation. Disparities in medical insurance showed no influence on these findings.

  20. A large web-based observer reliability study of early ischaemic signs on computed tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS.

    Directory of Open Access Journals (Sweden)

    Joanna M Wardlaw

    Full Text Available BACKGROUND: Early signs of ischaemic stroke on computerised tomography (CT scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. METHODOLOGY AND PRINCIPAL FINDINGS: We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. CONCLUSIONS: Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis.

  1. A Large Web-Based Observer Reliability Study of Early Ischaemic Signs on Computed Tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS)

    Science.gov (United States)

    Wardlaw, Joanna M.; von Kummer, Rüdiger; Farrall, Andrew J.; Chappell, Francesca M.; Hill, Michael; Perry, David

    2010-01-01

    Background Early signs of ischaemic stroke on computerised tomography (CT) scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. Methodology and Principal Findings We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs) to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC) analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. Conclusions Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis. PMID:21209901

  2. Clinical study of cerebral blood flow in unilateral chronic subdural hematoma measured by {sup 99m}Tc-HMPAO SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Okuyama, Tohru; Saito, Koji; Fukuyama, Kohichi; Yamamoto, Kouki; Morimoto, Mamoru [Kushiro Neurosurgical Hospital, Hokkaido (Japan); Aburano, Tamio

    2000-02-01

    Cerebral blood flow (CBF) measured by {sup 99m}Tc-HMPAO SPECT before operation was studied in 60 patients with unilateral chronic subdural hematoma. The regional CBF was measured in 26 regions of the fronto-occipital 10 cortices, putamen, thalamus and cerebellar hemisphere on both sides. Sixty cases with unilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 17 cases with headache (headache group), 34 cases with hemiparesis (hemiparesis group) and 9 cases with consciousness disturbance or dementia (consciousness disturbance group), and into three groups on the basis of the degree of midline brain shift on MRI: 7 cases of mild shift group, 24 cases of moderate shift group and 29 cases of severe shift group. The average CBF in 60 patients in each region indicated that the regional CBF was reduced in frontal, occipital cortices and cerebellum on the non-hematoma side, and in putamen and thalamus on the hematoma side. In the headache group, the regional CBF reduction on the non-hematoma side was found in only frontal and occipital cortices compared with the corresponding regions on the hematoma side. In the hemiparesis group, the regional CBF was reduced in frontal and occipital cortices on the non-hematoma side and in putamen and thalamus on the hematoma side. The part of CBF reduction in both hemispheres was also noted in the hemiparesis group. In the consciousness disturbance group, the CBF reduction was markedly noted in whole brain. The CBF reductions in frontal and occipital cortices on the non-hematoma side and in putamen, thalamus and cerebellum on the hematoma side was not mutually related with the degree of midline brain shift. We concluded that the disturbance of CBF in chronic subdural hematoma was started from frontal and occipital cortices on the non-hematoma side observed in the headache group, and which was extended to putamen and thalamus on the hematoma side and a part of both hemispheres observed in

  3. Treatment of chronic subdural hematomas with subdural evacuating port system placement in the intensive care unit: evolution of practice and comparison with bur hole evacuation in the operating room.

    Science.gov (United States)

    Flint, Alexander C; Chan, Sheila L; Rao, Vivek A; Efron, Allen D; Kalani, Maziyar A; Sheridan, William F

    2017-01-20

    OBJECTIVE The aims of this study were to evaluate a multiyear experience with subdural evacuating port system (SEPS) placement for chronic subdural hematoma (cSDH) in the intensive care unit at a tertiary neurosurgical center and to compare SEPS placement with bur hole evacuation in the operating room. METHODS All cases of cSDH evacuation were captured over a 7-year period at a tertiary neurosurgical center within an integrated health care delivery system. The authors compared the performance characteristics of SEPS and bur hole placement with respect to recurrence rates, change in recurrence rates over time, complications, length of stay, discharge disposition, and mortality rates. RESULTS A total of 371 SEPS cases and 659 bur hole cases were performed (n = 1030). The use of bedside SEPS placement for cSDH treatment increased over the 7-year period, from 14% to 80% of cases. Reoperation within 6 months was higher for the SEPS (15.6%) than for bur hole drainage (9.1%) across the full 7-year period (p = 0.002). This observed overall difference was due to a higher rate of reoperation during the same hospitalization (7.0% for SEPS vs 3.2% for bur hole; p = 0.008). Over time, as the SEPS procedure became more common and modifications of the SEPS technique were introduced, the rate of in-hospital reoperation after SEPS decreased to 3.3% (p = 0.02 for trend), and the difference between SEPS and bur hole recurrence was no longer significant (p = 0.70). Complications were uncommon and were similar between the groups. CONCLUSIONS Overall performance characteristics of bedside SEPS and bur hole drainage in the operating room were similar. Modifications to the SEPS technique over time were associated with a reduced reoperation rate.

  4. Large-scale field application of RNAi technology reducing Israeli acute paralysis virus disease in honey bees (Apis mellifera, Hymenoptera: Apidae.

    Directory of Open Access Journals (Sweden)

    Wayne Hunter

    Full Text Available The importance of honey bees to the world economy far surpasses their contribution in terms of honey production; they are responsible for up to 30% of the world's food production through pollination of crops. Since fall 2006, honey bees in the U.S. have faced a serious population decline, due in part to a phenomenon called Colony Collapse Disorder (CCD, which is a disease syndrome that is likely caused by several factors. Data from an initial study in which investigators compared pathogens in honey bees affected by CCD suggested a putative role for Israeli Acute Paralysis Virus, IAPV. This is a single stranded RNA virus with no DNA stage placed taxonomically within the family Dicistroviridae. Although subsequent studies have failed to find IAPV in all CCD diagnosed colonies, IAPV has been shown to cause honey bee mortality. RNA interference technology (RNAi has been used successfully to silence endogenous insect (including honey bee genes both by injection and feeding. Moreover, RNAi was shown to prevent bees from succumbing to infection from IAPV under laboratory conditions. In the current study IAPV specific homologous dsRNA was used in the field, under natural beekeeping conditions in order to prevent mortality and improve the overall health of bees infected with IAPV. This controlled study included a total of 160 honey bee hives in two discrete climates, seasons and geographical locations (Florida and Pennsylvania. To our knowledge, this is the first successful large-scale real world use of RNAi for disease control.

  5. Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001

    Science.gov (United States)

    Endara, Skye M; Ryan, Margaret AK; Sevick, Carter J; Conlin, Ava Marie S; Macera, Caroline A; Smith, Tyler C

    2009-01-01

    Background Infants in utero during the terrorist attacks of September 11, 2001 may have been negatively affected by maternal stress. Studies to date have produced contradictory results. Methods Data for this retrospective cohort study were obtained from the Department of Defense Birth and Infant Health Registry and included up to 164,743 infants born to active-duty military families. Infants were considered exposed if they were in utero on September 11, 2001, while the referent group included infants gestating in the same period in the preceding and following year (2000 and 2002). We investigated the association of this acute stress during pregnancy with the infant health outcomes of male:female sex ratio, birth defects, preterm birth, and growth deficiencies in utero and in infancy. Results No difference in sex ratio was observed between infants in utero in the first trimester of pregnancy on September 11, 2001 and infants in the referent population. Examination of the relationship between first-trimester exposure and birth defects also revealed no significant associations. In adjusted multivariable models, neither preterm birth nor growth deficiencies were significantly associated with the maternal exposure to the stress of September 11 during pregnancy. Conclusion The findings from this large population-based study suggest that women who were pregnant during the terrorist attacks of September 11, 2001 had no increased risk of adverse infant health outcomes. PMID:19619310

  6. Does acute maternal stress in pregnancy affect infant health outcomes? Examination of a large cohort of infants born after the terrorist attacks of September 11, 2001

    Directory of Open Access Journals (Sweden)

    Conlin Ava Marie S

    2009-07-01

    Full Text Available Abstract Background Infants in utero during the terrorist attacks of September 11, 2001 may have been negatively affected by maternal stress. Studies to date have produced contradictory results. Methods Data for this retrospective cohort study were obtained from the Department of Defense Birth and Infant Health Registry and included up to 164,743 infants born to active-duty military families. Infants were considered exposed if they were in utero on September 11, 2001, while the referent group included infants gestating in the same period in the preceding and following year (2000 and 2002. We investigated the association of this acute stress during pregnancy with the infant health outcomes of male:female sex ratio, birth defects, preterm birth, and growth deficiencies in utero and in infancy. Results No difference in sex ratio was observed between infants in utero in the first trimester of pregnancy on September 11, 2001 and infants in the referent population. Examination of the relationship between first-trimester exposure and birth defects also revealed no significant associations. In adjusted multivariable models, neither preterm birth nor growth deficiencies were significantly associated with the maternal exposure to the stress of September 11 during pregnancy. Conclusion The findings from this large population-based study suggest that women who were pregnant during the terrorist attacks of September 11, 2001 had no increased risk of adverse infant health outcomes.

  7. Large-scale field application of RNAi technology reducing Israeli acute paralysis virus disease in honey bees (Apis mellifera, Hymenoptera: Apidae).

    Science.gov (United States)

    Hunter, Wayne; Ellis, James; Vanengelsdorp, Dennis; Hayes, Jerry; Westervelt, Dave; Glick, Eitan; Williams, Michael; Sela, Ilan; Maori, Eyal; Pettis, Jeffery; Cox-Foster, Diana; Paldi, Nitzan

    2010-12-23

    The importance of honey bees to the world economy far surpasses their contribution in terms of honey production; they are responsible for up to 30% of the world's food production through pollination of crops. Since fall 2006, honey bees in the U.S. have faced a serious population decline, due in part to a phenomenon called Colony Collapse Disorder (CCD), which is a disease syndrome that is likely caused by several factors. Data from an initial study in which investigators compared pathogens in honey bees affected by CCD suggested a putative role for Israeli Acute Paralysis Virus, IAPV. This is a single stranded RNA virus with no DNA stage placed taxonomically within the family Dicistroviridae. Although subsequent studies have failed to find IAPV in all CCD diagnosed colonies, IAPV has been shown to cause honey bee mortality. RNA interference technology (RNAi) has been used successfully to silence endogenous insect (including honey bee) genes both by injection and feeding. Moreover, RNAi was shown to prevent bees from succumbing to infection from IAPV under laboratory conditions. In the current study IAPV specific homologous dsRNA was used in the field, under natural beekeeping conditions in order to prevent mortality and improve the overall health of bees infected with IAPV. This controlled study included a total of 160 honey bee hives in two discrete climates, seasons and geographical locations (Florida and Pennsylvania). To our knowledge, this is the first successful large-scale real world use of RNAi for disease control.

  8. Large-Scale Field Application of RNAi Technology Reducing Israeli Acute Paralysis Virus Disease in Honey Bees (Apis mellifera, Hymenoptera: Apidae)

    Science.gov (United States)

    Hunter, Wayne; Ellis, James; vanEngelsdorp, Dennis; Hayes, Jerry; Westervelt, Dave; Glick, Eitan; Williams, Michael; Sela, Ilan; Maori, Eyal; Pettis, Jeffery; Cox-Foster, Diana; Paldi, Nitzan

    2010-01-01

    The importance of honey bees to the world economy far surpasses their contribution in terms of honey production; they are responsible for up to 30% of the world's food production through pollination of crops. Since fall 2006, honey bees in the U.S. have faced a serious population decline, due in part to a phenomenon called Colony Collapse Disorder (CCD), which is a disease syndrome that is likely caused by several factors. Data from an initial study in which investigators compared pathogens in honey bees affected by CCD suggested a putative role for Israeli Acute Paralysis Virus, IAPV. This is a single stranded RNA virus with no DNA stage placed taxonomically within the family Dicistroviridae. Although subsequent studies have failed to find IAPV in all CCD diagnosed colonies, IAPV has been shown to cause honey bee mortality. RNA interference technology (RNAi) has been used successfully to silence endogenous insect (including honey bee) genes both by injection and feeding. Moreover, RNAi was shown to prevent bees from succumbing to infection from IAPV under laboratory conditions. In the current study IAPV specific homologous dsRNA was used in the field, under natural beekeeping conditions in order to prevent mortality and improve the overall health of bees infected with IAPV. This controlled study included a total of 160 honey bee hives in two discrete climates, seasons and geographical locations (Florida and Pennsylvania). To our knowledge, this is the first successful large-scale real world use of RNAi for disease control. PMID:21203478

  9. Evidence of basal temporo-occipital cortex involvement in stereoscopic vision in humans: a study with subdural electrode recordings.

    Science.gov (United States)

    Gonzalez, Francisco; Relova, José Luis; Prieto, Angel; Peleteiro, Manuel

    2005-01-01

    Stereoscopic vision is based on small differences in both retinal images known as retinal disparities. We investigated the cortical responses to retinal disparities in a patient suffering from occipital epilepsy by recording evoked potentials to random dot stereograms (RDS) from subdural electrodes placed in the parieto-occipito-temporal junction, medial surface of the occipital lobe (pericalcarine cortex) and basal surface of the occipital and temporal lobes (fusiform gyrus). Clear responses to disparity present in RDS were found in the fusiform cortex. We observed that the fusiform responses discriminate the onset from the offset of the stimulus, correlation from uncorrelation, and they show a longer latency than responses found in the pericalcarine cortex. Our findings indicate that the fusiform area is involved in the processing of the stereoscopic information and shows responses that suggest a high level of stereoscopic processing.

  10. Focal extra-axial hemorrahagic mass with subdural hemorrhage secondare to extramedullary hematopoiesis in idiopathic myelodysplastic sindrome.

    Science.gov (United States)

    Di Ieva, A; Di Lieva, A; Aimar, E; Tancioni, F; Levi, D; Debernardi, A; Pisano, P; Rahal, D; Nozza, A; Magagnoli, M; Gaetani, P

    2007-03-01

    Idiopathic myelodysplastic syndrome is a disease characterized by a clonal stem cell disorder in which megacaryocitic and granulocytic lineages are mainly involved; extramedullary myeloid metaplasia is due to abnormal location of myeloid tissue in other organs than bone marrow. Rarely the central nervous system is involved. When it happens, it is typical to find masses around the brain and pachymeningeal thickening, but it is very rare to find it associated with subdural haemorrhage, as in the case we describe in the present article. Considering our case and the literature we can suggest that radiological images associated with the clinical history of the patient suggestive for extramedullary hematopoiesis can be sufficient for a correct diagnosis and for a radiotherapy treatment, demanding surgery in the case of diagnostic doubts, massive hemorrahages or neurological decifits caused by the focal lesions.

  11. Subdural hematoma decompression model: A model of traumatic brain injury with ischemic-reperfusional pathophysiology: A review of the literature.

    Science.gov (United States)

    Yokobori, Shoji; Nakae, Ryuta; Yokota, Hiroyuki; Spurlock, Markus S; Mondello, Stefania; Gajavelli, Shyam; Bullock, Ross M

    2016-05-25

    The prognosis for patients with traumatic brain injury (TBI) with subdural hematoma (SDH) remains poor. In accordance with an increasing elderly population, the incidence of geriatric TBI with SDH is rising. An important contributor to the neurological injury associated with SDH is the ischemic damage which is caused by raised intracranial pressure (ICP) producing impaired cerebral perfusion. To control intracranial hypertension, the current management consists of hematoma evacuation with or without decompressive craniotomy. This removal of the SDH results in the immediate reversal of global ischemia accompanied by an abrupt reduction of mass lesion and an ensuing reperfusion injury. Experimental models can play a critical role in improving our understanding of the underlying pathophysiology and in exploring potential treatments for patients with SDH. In this review, we describe the epidemiology, pathophysiology and clinical background of SDH.

  12. The Efficacy of Titanium Burr Hole Cover for Reconstruction of Skull Defect after Burr Hole Trephination of Chronic Subdural Hematoma.

    Science.gov (United States)

    Im, Tae-Seop; Lee, Yoon-Soo; Suh, Sang-Jun; Lee, Jeong-Ho; Ryu, Kee-Young; Kang, Dong-Gee

    2014-10-01

    Although burr hole trephination is a safe and effective surgical option to treat patients with chronic subdural hematoma (CSDH), it often results in a small but undesirable scalp depression from burr hole defect. This study is to evaluate the efficacy of titanium burr hole cover (BHC) for reconstruction of skull defects in these patients. A hundred and ninety-six cases of burr hole trephinations for CSDHs between January 2009 and December 2013 were assigned into two groups; Gelfoam packing only (GPO) and reconstruction using titanium BHC group, according to the modalities of burr hole reconstructions. The incidences and depths of scalp depressions and incidences of postoperative complications such as infections or instrument failures were analyzed in both groups. We also conducted telephone surveys to evaluate the cosmetic and functional outcomes from patient's aspect. Significantly lower incidence (ptrephination of CSDH, and provides excellent cosmetic and functional outcomes without significant complications.

  13. Aspirin is associated with an increased risk of subdural hematoma in normal-pressure hydrocephalus patients following shunt implantation

    DEFF Research Database (Denmark)

    Birkeland, Peter; Lauritsen, Jens; Poulsen, Frantz Rom

    2015-01-01

    OBJECT: In this paper the authors investigate whether shunt-treated patients with normal-pressure hydrocephalus receiving aspirin therapy are at increased risk of developing subdural hematoma (SDH). METHODS: Records from 80 consecutive patients who had undergone implantation of a cerebrospinal...... fluid shunt for the treatment of normal-pressure hydrocephalus were retrospectively reviewed. RESULTS: Eleven cases of symptomatic SDH occurred, all among patients receiving aspirin or clopidogrel. The 5-year survival estimate was 0.3 (p ...% CI 3.1-53). CONCLUSIONS: Patients on an aspirin therapy regimen have a markedly increased risk of SDH after a shunt has been implanted for the treatment of normal-pressure hydrocephalus. Users of clopidogrel may have an even greater risk....

  14. A large-scale distribution of milk-based fortified spreads: evidence for a new approach in regions with high burden of acute malnutrition.

    Directory of Open Access Journals (Sweden)

    Isabelle Defourny

    Full Text Available BACKGROUND: There are 146 million underweight children in the developing world, which contribute to up to half of the world's child deaths. In high burden regions for malnutrition, the treatment of individual children is limited by available resources. Here, we evaluate a large-scale distribution of a nutritional supplement on the prevention of wasting. METHODS AND FINDINGS: A new ready-to-use food (RUF was developed as a diet supplement for children under three. The intervention consisted of six monthly distributions of RUF during the 2007 hunger gap in a district of Maradi region, Niger, for approximately 60,000 children (length: 60-85 cm. At each distribution, all children over 65 cm had their Mid-Upper Arm Circumference (MUAC recorded. Admission trends for severe wasting (WFH<70% NCHS in Maradi, 2002-2005 show an increase every year during the hunger gap. In contrast, in 2007, throughout the period of the distribution, the incidence of severe acute malnutrition (MUAC<110 mm remained at extremely low levels. Comparison of year-over-year admissions to the therapeutic feeding program shows that the 2007 blanket distribution had essentially the same flattening effect on the seasonal rise in admissions as the 2006 individualized treatment of almost 60,000 children moderately wasted. CONCLUSIONS: These results demonstrate the potential for distribution of fortified spreads to reduce the incidence of severe wasting in large population of children 6-36 months of age. Although further information is needed on the cost-effectiveness of such distributions, these results highlight the importance of re-evaluating current nutritional strategies and international recommendations for high burden areas of childhood malnutrition.

  15. Smac mimetic induces cell death in a large proportion of primary acute myeloid leukemia samples, which correlates with defined molecular markers

    Science.gov (United States)

    Lueck, Sonja C.; Russ, Annika C.; Botzenhardt, Ursula; Schlenk, Richard F.; Zobel, Kerry; Deshayes, Kurt; Vucic, Domagoj; Döhner, Hartmut; Döhner, Konstanze

    2016-01-01

    Apoptosis is deregulated in most, if not all, cancers, including hematological malignancies. Smac mimetics that antagonize Inhibitor of Apoptosis (IAP) proteins have so far largely been investigated in acute myeloid leukemia (AML) cell lines; however, little is yet known on the therapeutic potential of Smac mimetics in primary AML samples. In this study, we therefore investigated the antileukemic activity of the Smac mimetic BV6 in diagnostic samples of 67 adult AML patients and correlated the response to clinical, cytogenetic and molecular markers and gene expression profiles. Treatment with cytarabine (ara-C) was used as a standard chemotherapeutic agent. Interestingly, about half (51%) of primary AML samples are sensitive to BV6 and 21% intermediate responsive, while 28% are resistant. Notably, 69% of ara-C-resistant samples show a good to fair response to BV6. Furthermore, combination treatment with ara-C and BV6 exerts additive effects in most samples. Whole-genome gene expression profiling identifies cell death, TNFR1 and NF-κB signaling among the top pathways that are activated by BV6 in BV6-sensitive, but not in BV6-resistant cases. Furthermore, sensitivity of primary AML blasts to BV6 correlates with significantly elevated expression levels of TNF and lower levels of XIAP in diagnostic samples, as well as with NPM1 mutation. In a large set of primary AML samples, these data provide novel insights into factors regulating Smac mimetic response in AML and have important implications for the development of Smac mimetic-based therapies and related diagnostics in AML. PMID:27385100

  16. Role of Matrix Metalloproteinase-2, Matrix Metalloproteinase-9, and Vascular Endothelial Growth Factor in the Development of Chronic Subdural Hematoma.

    Science.gov (United States)

    Hua, Cong; Zhao, Gang; Feng, Yan; Yuan, Hongyan; Song, Hongmei; Bie, Li

    2016-01-01

    Chronic subdural hematoma (CSDH) is an inflammatory and angiogenic disease. Vascular endothelial growth factor (VEGF) has an important effect on the pathological progression of CSDH. The matrix metalloproteinases (MMPs) and VEGF also play a significant role in pathological angiogenesis. Our research was to investigate the level of MMPs and VEGF in serum and hematoma fluid. Magnetic Resonance Imaging (MRI) shows the characteristics of different stages of CSDH. We also analyzed the relationship between the level of VEGF in subdural hematoma fluid and the appearances of the patients' MRI. We performed a study comparing serum and hematoma fluid in 37 consecutive patients with primary CSDHs using enzyme-linked immunosorbent assay (ELISA). MMP-2 and MMP-9 activity was assayed by the gelatin zymography method. The patients were divided into five groups according to the appearance of the hematomas on MRI: group 1 (T1-weighted low, T2-weighted low, n=4), group 2 (T1-weighted high, T2-weighted low, n=11), group 3 (T1-weighted mixed, T2-weighted mixed, n=9), group 4 (T1-weighted high, T2-weighted high, n=5), and group 5 (T1-weighted low, T2-weighted high, n=8). Neurological status was assessed by Markwalder score on admission and at follow-up. The mean age, sex, and Markwalder score were not significantly different among groups. The mean concentration of VEGF, MMP-2, and MMP-9 were significantly higher in hematoma fluid than in serum (pMMP-2 was higher in hematoma fluid (pMMP-2 and MMP-9 are significantly elevated in hematoma fluid, suggesting that the MMPs/VEGF system may be involved in the angiogenesis of CSDH. We also demonstrate a significant correlation between the concentrations of VEGF and MRI appearance. This finding supports the hypothesis that high VEGF concentration in the hematoma fluid is of major pathophysiological importance in the generation and steady increase of the hematoma volume, as well as the determination of MRI appearance.

  17. Chronic subdural hematoma in elderly patient with EDTA-dependent pseudothrombocytopenia recently treated with aspirin and warfarin: case report.

    Science.gov (United States)

    Tosa, Masato; Fujita, Hiroshi; Ishihama, Yumiko; Nishimura, Shigeko; Ide, Takafumi

    2014-01-01

    A 78-year-old man who had a history of myocardial and cerebral infarction and who was treated with aspirin and warfarin, presented with left chronic subdural hematoma. Cerebral computed tomography showed severe brain compression of hematoma with midline shift, indicating the need for emergent surgery. The hematology and clotting tests upon admission revealed severe thrombocytopenia (platelet count, 1.3 × 10(4)/μL) with normal clotting activity. Because platelet aggregation was evident in the smear, we re-examined the patient for hematology using tubes that contained heparin, showing also low platelet count (2.3 × 10(4)/μL). The day on admission, we performed irrigation and drainage of the chronic subdural hematoma through single burr-hole craniostomy. During surgery, we used 10 units of platelet concentrates (PCs) for the reason that the patient was taking aspirin and coagulopathy derived from low platelet count could not be excluded. After surgery, we re-evaluated the hematology of the blood stored in tubes that contained ethylenediaminetetraacetic acid (EDTA) with or without kanamycin (KM). Treatment with KM dissociated EDTA-induced platelet aggregation and revealed platelet counts with highest accuracy (no KM treatment, 1.3 × 10(4)/μL; KM treatment, 15.2 × 10(4)/μL). This phenomenon is called EDTA-Dependent Pseudothrombocytopenia (PTCP) defined as falsely low platelet counts reported by automated hematology analyzers due to platelet aggretgation. Awareness of the phenomenon will enable neurosurgeons to manage patients with PTCP appropriately and clinical laboratory especially in emergency hospital is recommended to prepare for the hematological tubes being added KM in routine analysis, resulting in preventing mistaken diagnosis.

  18. Spontaneous development of bilateral subdural hematomas in an infant with benign infantile hydrocephalus: color Doppler assessment of vessels traversing extra-axial spaces

    Energy Technology Data Exchange (ETDEWEB)

    Amodio, John; Spektor, Vadim; Pramanik, Bidyut; Rivera, Rafael; Pinkney, Lynne; Fefferman, Nancy [New York University Medical Center, Department of Radiology, New York, NY (United States)

    2005-11-01

    We present an infant with macrocrania, who initially demonstrated prominent extra-axial fluid collections on sonography of the brain, compatible with benign infantile hydrocephalus (BIH). Because of increasing macrocrania, a follow-up sonogram of the brain was performed; it revealed progressive enlargement of the extra-axial spaces, which now had echogenic debris. Color Doppler US showed bridging veins traversing these extra-axial spaces, so it was initially thought that these spaces were subarachnoid in nature (positive cortical vein sign). However, an arachnoid membrane was identified superior to the cortex, and there was compression of true cortical vessels beneath this dural membrane. An MRI of the brain showed the extra-axial spaces to represent bilateral subdural hematomas. The pathogenesis of spontaneous development of the subdural hematomas, in the setting of BIH, is discussed. We also emphasize that visualizing traversing bridging veins through extra-axial spaces does not necessarily imply that these spaces are subarachnoid in origin. (orig.)

  19. Spontaneous Subdural Empyema Following a High-Parasitemia Falciparum Infection in a 58-Year-Old Female From a Malaria-Endemic Region

    Directory of Open Access Journals (Sweden)

    Pedro Pallangyo MD, MPH

    2016-08-01

    Full Text Available Malaria remains a significant public health problem of the tropical world. Falciparum malaria is most prevalent in the sub-Saharan African region, which harbors about 90% of all malaria cases and fatalities globally. Infection by the falciparum species often manifests with a spectrum of multi-organ complications (eg, cerebral malaria, some of which are life-threatening. Spontaneous subdural empyema is a very rare complication of cerebral malaria that portends a very poor prognosis unless diagnosed and treated promptly. We report a case of spontaneous subdural empyema in a 58-year-old woman from Tanzania who presented with high-grade fever, decreased urine output, and altered sensorium.

  20. Subdural intracranial pressure, cerebral perfusion pressure, and degree of cerebral swelling in supra- and infratentorial space-occupying lesions in children

    DEFF Research Database (Denmark)

    Stilling, M; Karatasi, E; Rasmussen, Mads

    2005-01-01

    UNLABELLED: To our knowledge comparative studies of intracranial pressure (ICP) and degree of cerebral swelling during craniotomy for supratentorial or infratentorial space occupying lesion in children are not available. In this prospective study subdural ICP, cerebral perfusion pressure (CPP......), dural tension, and the degree of cerebral swelling were analysed in supine and prone positioned children subjected to craniotomy for space occupying lesions. MATERIAL AND METHOD: 48 children with space occupying tumours were subjected to either isoflurane/nitrous oxide 50%/fentanyl (n = 22) or propofol....../fentanyl/air/oxygen (n = 26). 25 children were operated supratentorially in supine position, while 23 patients were operated infratentorially in the prone position. Subdural ICP, mean arterial blood pressure (MABP), and CPP were measured just before opening of the dura. Dural tension was estimated before opening of dura...

  1. Large-scale field application of RNAi technology reducing Israeli acute paralysis virus disease in honey bees (Apis mellifera, Hymenoptera: Apidae)

    National Research Council Canada - National Science Library

    Hunter, Wayne; Ellis, James; Vanengelsdorp, Dennis; Hayes, Jerry; Westervelt, Dave; Glick, Eitan; Williams, Michael; Sela, Ilan; Maori, Eyal; Pettis, Jeffery; Cox-Foster, Diana; Paldi, Nitzan

    2010-01-01

    ...), which is a disease syndrome that is likely caused by several factors. Data from an initial study in which investigators compared pathogens in honey bees affected by CCD suggested a putative role for Israeli Acute Paralysis Virus, IAPV...

  2. Effects of an alveolar recruitment maneuver on subdural pressure, brain swelling, and mean arterial pressure in patients undergoing supratentorial tumour resection: a randomized crossover study.

    Science.gov (United States)

    Flexman, Alana M; Gooderham, Peter A; Griesdale, Donald E; Argue, Ruth; Toyota, Brian

    2017-06-01

    Although recruitment maneuvers have been advocated as part of a lung protective ventilation strategy, their effects on cerebral physiology during elective neurosurgery are unknown. Our objectives were to determine the effects of an alveolar recruitment maneuver on subdural pressure (SDP), brain relaxation score (BRS), and cerebral perfusion pressure among patients undergoing supratentorial tumour resection. In this prospective crossover study, patients scheduled for resection of a supratentorial brain tumour were randomized to undergo either a recruitment maneuver (30 cm of water for 30 sec) or a "sham" maneuver (5 cm of water for 30 sec), followed by the alternative intervention after a 90-sec equilibration period. Subdural pressure was measured through a dural perforation following opening of the cranium. Subdural pressure and mean arterial pressure (MAP) were recorded continuously. The blinded neurosurgeon provided a BRS at baseline and at the end of each intervention. During each treatment, the changes in SDP, BRS, and MAP were compared. Twenty-one patients underwent the study procedure. The increase in SDP was higher during the recruitment maneuver than during the sham maneuver (difference, 3.9 mmHg; 95% confidence interval [CI], 2.2 to 5.6; P recruitment maneuver than in the sham maneuver (difference, -9.0 mmHg; 95% CI, -12.5 to -5.6; P recruitment maneuver. The BRS did not change with either maneuver. Our results suggest that recruitment maneuvers increase subdural pressure and reduce cerebral perfusion pressure, although the clinical importance of these findings is thus far unknown. This trial was registered with ClinicalTrials.gov, NCT02093117.

  3. Subacute subdural hematoma in a 45-year-old woman with no significant past medical history after a roller coaster ride.

    Science.gov (United States)

    Williams, Kim A; Kouloumberis, Pelagia; Engelhard, Herbert H

    2009-05-01

    Amusement park ride injuries have been newsworthy events for many years. The multitude and severity of these injuries has been reported many times over the past 20 years and includes spinal cord and vertebral injuries, subarachnoid hemorrhage, internal and vertebral artery dissections, and even a few cases of subdural hematoma (SDH). There has also been as many theories to explain these injuries as there have been injuries themselves including how G forces and rotational acceleration can cause both neuroparenchymal and neurovascular injury.

  4. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

    OpenAIRE

    Mekaj, Agon Y; Morina, Arsim A; Mekaj, Ymer H; Suzana Manxhuka-Kerliu; Miftari, Ermira I; Duci, Shkelzen B; Hamza, Astrit R.; Gashi, Musli M.; Mentor R Gjelaj; Kelmendi, Fatos M; Qamile Sh. Morina

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical...

  5. 外伤性硬膜下积液研究进展%Research progress of traumatic subdural effusion

    Institute of Scientific and Technical Information of China (English)

    何森; 黎明

    2016-01-01

    外伤性硬膜下积液是神经外科临床中的常见疾病。为更好地探讨疾病的诊断治疗,保障患者的生命健康,笔者结合其他学者的相关研究进行综述,首先是分析外伤性硬膜下积液的病因与发病机制,其中主要包括单向活瓣学说、血脑屏障破坏学说、高渗透压学说、颅内压平衡失调学说、脑脊液吸收障碍学说等;之后就结合患者临床诊断进行分析,由于疾病表现得不典型,临床诊断依赖于影像学检查;最后就治疗方案展开探讨。临床治疗的方法多样,主要分为保守治疗和手术治疗,现在多以保守治疗为主。保守治疗措施包括避免增高颅内压的因素,防治癫痫,维持内环境稳定,合理使用脱水剂,改善脑血液循环等;手术治疗包括经皮前囟穿刺术、钻孔引流术、腰大池穿刺置管持续引流术、硬膜下腔-腹腔分流术、蛛网膜造瘘及颞肌填塞术、开颅包膜切除术、脑室镜术等。%Traumatic subdural effusion is a common disease in the department of neurosurgery.To better explore the diagnosis and treatment of disease,to protect the patient’s life and health,the author combines related research of other scholars for summary.In the first,the etiology and pathogenesis of traumatic subdural effusion is analyzed,including one-way flapper theory,blood brain barrier damage theory,high osmotic pressure theory,intracranial pressure balance disorders theory,cerebrospinal fluid malabsorption doctrine.Then combined with the clinical diagnosis is analyzed,because the disease is not typical,the clinical diagnosis depends on imaging examination.Finally the treatment options are discussed.The clinical treatment methods are diversity,they are mainly divided into the conservative treatment and the operative treatment,and now it is given priority to with conservative treatment.The conservative treatment measures include avoiding increased intracranial

  6. Postoperative rehabilitation for chronic subdural hematoma in the elderly. An observational study focusing on balance, ambulation and discharge destination.

    Science.gov (United States)

    Carlisi, Ettore; Feltroni, Lucia; Tinelli, Carmine; Verlotta, Mariarosaria; Gaetani, Paolo; Dalla Toffola, Elena

    2017-02-01

    Chronic subdural hematoma (CSDH) can have a negative impact on autonomy of the elderly. Ambulatory and functional status may remain limited despite successful surgical evacuation. To evaluate the outcome of a postoperative assisted rehabilitation program. Single-institution short-term observational study. Inpatient (Neurosurgery Unit of a University Hospital). Thirty-five patients, aged 65 or older, who underwent burr-hole drainage for chronic subdural hematoma. Postoperatively all participants underwent a rehabilitation program, described in details, aimed at recovering standing position and gait as soon as possible. The program involved daily 30-minute individual sessions assisted by a physiotherapist, until discharge from hospital. The Markwalder's Grading Scale was used to assess the neurological status preoperatively and at discharge. The Trunk Control Test, the Standing Balance by Bohannon Scale and the Modified Rankin Scale were used to evaluate balance and general function (primary outcome) in the immediate postoperative and at discharge. We also recorded the rate of pre-CSDH walking patients who maintained ambulation at discharge and the discharge destination (secondary outcome). Total scores of Markwalder's Grading Scale, Trunk Control Test, Standing Balance by Bohannon Scale and Modified Rankin Scale improved (Pbalance. Excluding the patients who were dependent pre-CSDH, the others maintained gait function in 74.2% of cases. Only 45.7% of the patients were discharged home, the others being divided between inpatient medical settings and rehabilitation. The rehabilitation program was well tolerated by the patients. Our study showed a clear improvement in trunk control and standing balance and an overall favorable outcome for neurological and ambulatory status at discharge. Despite an assisted postoperative rehabilitation program, the residual impairment in general function was the main factor that prevents us to discharge more elderly patients home rather

  7. Hematoma subdural crónico: Resultados quirúrgicos en 2 años de trabajo

    Directory of Open Access Journals (Sweden)

    Ángel Jesús Lacerda Gallardo

    1999-04-01

    Full Text Available Disminuir al máximo la mortalidad por hematoma subdural crónico (HSDC, es un reto que se debe alcanzar en todo centro neuroquirúrgico, en el que pueden influir el diagnóstico precoz y la adecuada selección del proceder quirúrgico. Se presentan 20 pacientes, 16 masculinos (80 % y 4 femeninos (20 %, con una edad promedio para el grupo de 66,55 años, tratados quirúrgicamente por medio de la trepanación múltiple con lavado de la cavidad y drenaje cerrado al exterior. La angiografía carotídea constituyó el examen más utilizado para el diagnóstico 14 (70 %, seguida por la tomografía axial computadorizada (TAC 8 (40 %. La escala de Bender se empleó para clasificar a los enfermos según el estado neurológico al ingreso, y se halló que el 80 % estaba en los grados I y II. Los resultados se evaluaron según la escala de resultados de Glasgow, y presentaron 17 (85 %, una buena recuperaciónTo reduce as much as possible mortality from chronic subdural hematoma (CSDH is a goal that should be attained by every neurosurgical center. An early diagnosis and an adequate selection of the surgical procedure may influence on it. 20 patients, 16 males (80 % and 4 females (20 % with an average age by group of 66.55 years of age were surgically treated by multiple trephining with lavage of the cavity and closed drainage. The carotid angiography was the most used test for the diagnosis with 14 (70 %, followed by computerized axial tomography (CAT with 8 (40 %. Bender´s scale was utilized to classify the patients according to the neurological state at the time of admission . 80 % of them corresponded to degrees I and II. The results were evaluated by using the Glasgow´s scale. 17 (85 % had a good recovery

  8. Sustained inflation and incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation in a large porcine model of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Wunder Christian

    2006-06-01

    Full Text Available Abstract Background To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. Methods Severe lung injury (Ali was induced in 18 healthy pigs (55.3 ± 3.9 kg, mean ± SD by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV: FIO2 = 1.0, PEEP = 5 cmH2O, VT = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV: FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s followed by an incremental mean airway pressure (mPaw trial (steps of 3 cmH2O every 15 minutes were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step. Results The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 ± 100 vs. PCV: 58 ± 15 and TAli: 57 ± 12; p 2-reduction (HFOV: 42 ± 5 vs. PCV: 62 ± 13 and TAli: 55 ± 9; p Ali: 6.1 ± 1 vs. T75: 3.4 ± 0.4; PCV: TAli: 6.7 ± 2.4 vs. T75: 4 ± 0.5; p Conclusion A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

  9. Burr-hole Irrigation with Closed-system Drainage for the Treatment of Chronic Subdural Hematoma: A Meta-analysis.

    Science.gov (United States)

    Xu, Chen; Chen, Shiwen; Yuan, Lutao; Jing, Yao

    2016-01-01

    There is controversy among neurosurgeons regarding whether irrigation or drainage is necessary for achieving a lower revision rate for the treatment of chronic subdural hematoma (CSDH) using burr-hole craniostomy (BHC). Therefore, we performed a meta-analysis of all available published reports. Multiple electronic health databases were searched to identify all studies published between 1989 and June 2012 that compared irrigation and drainage. Data were processed by using Review Manager 5.1.6. Effect sizes are expressed as pooled odds ratio (OR) estimates. Due to heterogeneity between studies, we used the random effect of the inverse variance weighted method to perform the meta-analysis. Thirteen published reports were selected for this meta-analysis. The comprehensive results indicated that there were no statistically significant differences in mortality or complication rates between drainage and no drainage (P > 0.05). Additionally, there were no differences in recurrence between irrigation and no irrigation (P > 0.05). However, the difference between drainage and no drainage in recurrence rate reached statistical significance (P meta-analysis suggest that burr-hole surgery with closed-system drainage can reduce the recurrence of CSDH; however, irrigation is not necessary for every patient.

  10. Clinical Analysis of Risk Factors for Recurrence in Patients with Chronic Subdural Hematoma Undergoing Burr Hole Trephination.

    Science.gov (United States)

    Jeong, Seong Il; Kim, Si On; Won, Yu Sam; Kwon, Young Joon; Choi, Chun Sik

    2014-04-01

    Chronic subdural hematoma (CSDH) is one of the most common types of intra-cranial hemorrhages usually associated with trauma. Surgical treatment is the treatment of choice and burr hole trephination (BHT) is widely performed. The recurrence rate in the patients with CSDH is 3.7-30%. This study investigated the risk factors associated with the recurrence of patients with CSDH who underwent BHT. One hundred twenty-five patients with CSDH underwent BHT. Eight of 125 patients (6.4%) underwent reoperation for recurrent CSDH. We retrospectively analyzed demographic, clinical and radiological findings, catheter tip location and drainage duration as the risk factors for the recurrence of CSDH. Recurrence of CSDH in the high- or mixed-density groups was significantly higher than those in the low- or iso-density groups (p<0.001). Placement of catheter tip at the temporoparietal area was associated with a significantly higher recurrence rate of CSDH than placement at the frontal area (p=0.006) and the brain re-expansion rate (BRR) was much lower than placement at the frontal area (p<0.001). The operation may be delayed in high- and mixed-density groups, unless severe symptoms or signs are present. In addition, placing the catheter tip at the frontal area helps to reduce the incidence of postoperative recurrence of CSDH and to increase the BRR.

  11. Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review.

    Science.gov (United States)

    Zhang, Jian; Jin, Dan; Pan, Kong-Han

    2016-08-01

    Spinal leakage of cerebrospinal fluid (CSF) is considered to be the primary cause of spontaneous intracranial hypotension (SIH). Subdural haematoma (SDH) is a serious complication of SIH. This current report presents a case of bilateral SDH with SIH that was treated with epidural blood patching (EBP). A 43-year-old male complained of experiencing orthostatic headaches for 2 months without neurological signs. The patient worsened in a local hospital and was transferred to the Sir Run Run Hospital. Brain computed tomography showed bilateral SDH with a midline shift. The patient underwent emergency trephination in the left frontal temporal region. Postoperative magnetic resonance myelography showed a CSF leak originating at the T11-L2 level. As a consequence of clinical deterioration of the patient, EBP was subsequently performed at the T12-L1 level. The headache was rapidly relieved and later the SDH was completely absorbed. This case report and literature review aims to remind clinicians that SIH can cause SDH and that EBP is a viable treatment option. © The Author(s) 2016.

  12. Operative versus nonoperative treatment of acute Achilles tendon rupture: An analysis of 12,570 patients in a large healthcare database.

    Science.gov (United States)

    Wang, Dean; Sandlin, M Isiah; Cohen, Jeremiah R; Lord, Elizabeth L; Petrigliano, Frank A; SooHoo, Nelson F

    2015-12-01

    The purpose of this study was to compare the latest patient demographics and rerupture rates of operative versus nonoperative treatment of acute Achilles tendon rupture in the United States. Patients undergoing treatment of an acute Achilles tendon rupture from 2007 to 2011 were identified by cross-referencing ICD-9-CM and CPT codes through the PearlDiver Patient Record Database. In total, 12,570 patients were treated for an acute Achilles tendon rupture. The ratio of operative to nonoperative treatment increased from 1.41 to 1.65. Males were more likely to undergo surgery than females. There were no significant differences in short-term rerupture rate for operative (2.1%) versus nonoperative (2.4%) treatment. The proportion of patients who received operative treatment for an acute Achilles tendon rupture increased slightly during the 5 year period, suggesting that surgeons in the United States have been slower to adopt nonoperative treatment than their European counterparts. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  13. Spinal cord compression by spontaneous spinal subdural haematoma in polycythemia vera.

    Science.gov (United States)

    Kalina, P; Drehobl, K E; Black, K; Woldenberg, R; Sapan, M

    1995-06-01

    A woman with an eight-year history of polycythemia vera presented with numbness and weakness of both legs. A large spinal haematoma was revealed on magnetic resonance imaging which was treated clinically and which subsequently resolved.

  14. Acute hamstring injury in football players: Association between anatomical location and extent of injury-A large single-center MRI report.

    Science.gov (United States)

    Crema, Michel D; Guermazi, Ali; Tol, Johannes L; Niu, Jingbo; Hamilton, Bruce; Roemer, Frank W

    2016-04-01

    To describe in detail the anatomic distribution of acute hamstring injuries in football players, and to assess the relationship between location and extent of edema and tears, all based on findings from MRI. Retrospective observational study. We included 275 consecutive male football players who had sustained acute hamstring injuries and had positive findings on MRI. For each subject, lesions were recorded at specific locations of the hamstring muscles, which were divided into proximal or distal: free tendon, myotendinous junction, muscle belly, and myofascial junction locations. For each lesion, we assessed the largest cross-sectional area of edema and/or tears. We calculated the prevalence of injuries by location. The relationships between locations and extent of edema and tears were assessed using a one-sample t-test, with significance set at plocations. The proximal myotendinous junction was associated with a greater extent of edema in the LHBF and semitendinosus (ST) muscles (plocations in the LHBF had larger edema than distal locations (plocations in the ST muscle had larger tears than proximal locations (plocations (LHBF muscle) are more commonly affected and are associated with a greater extent of edema in acute hamstring muscle injury. Distal locations (ST muscle), however, seem to be more commonly associated with larger tears. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  15. 新生儿硬膜下出血的诊治分析%Analysis of Diagnosis and Treatment of Subdural Hemorrhage in Newborn

    Institute of Scientific and Technical Information of China (English)

    张本金; 唐国红

    2013-01-01

    Objective Discussion on how to effectively carry out the diagnosis and treatment of neonatal subdural hemorrhage, provide the reference for the clinical work. Methods A retrospective analysis of 9 cases of neonatal dural hemorrhage patients admitted to our hospital, to analyze the diagnosis and treatment measures. Results After the early diagnosis and the targeted for hemostasis, reducing intracranial pressure and anterior fontanelle puncture aspiration in the treatment of 6 cases of hematoma. 7 days later, 6 cases were completely disappeared, 2 cases of hematoma eased, 1 cases symptoms non improvement. Conclusion Neonatal subdural hemorrhage should be early diagnosis, early treatment, subdural puncture aspiration is the preferred method.%目的:探讨如何有效的对新生儿硬膜下出血进行诊断和治疗,为以后临床工作提供参考。方法回顾性分析我院收治的9例新生儿硬膜下出血患者,对其诊疗措施进行分析探讨。结果经过早期诊断和对其有针对性的进行止血、降低颅内压和前囟门穿刺抽吸术治疗,7d后6例血肿完全消失,2例血肿有所缓解,1例症状无改善。结论新生儿硬膜下出血应做到早诊断、早治疗,硬脑膜下穿刺抽吸术是其首选方法。

  16. Hematoma subdural após punção inadvertida da dura-máter: relato de caso

    Directory of Open Access Journals (Sweden)

    Wallace Lage Duarte

    2008-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A cefaléia pós-punção da dura-máter é complicação bastante conhecida das anestesias subaracnóidea e peridural, e o tratamento mais difundido é o tampão sangüíneo. O tampão sangüíneo alivia totalmente a cefaléia na grande maioria dos pacientes, e nos demais não há melhora ou, apenas, melhora parcial. Nesses casos, é prudente buscar diagnósticos diferenciais, como o hematoma subdural ou pneumoencéfalo. Os métodos de imagem são extremamente úteis nessas situações. O objetivo deste relato foi apresentar o caso de um paciente que desenvolveu hematoma subdural intracraniano após punção inadvertida da dura-máter em anestesia peridural. RELATO DO CASO: Paciente do sexo masculino, 47 anos, 147 kg, 1,90 m, estado físico ASA II, foi admitido para realização de dermolipectomia abdominal, após ter-se submetido à gastroplastia redutora. Durante anestesia peridural, houve perfuração acidental da dura-máter. O paciente evoluiu com sintomas de cefaléia pós-punção da dura-máter que foram tratados com tampão sangüíneo, com melhora parcial. Houve, posteriormente, piora da cefaléia, e a ressonância nuclear magnética de encéfalo mostrou hematoma subdural intracraniano, que foi tratado clinicamente. Houve melhora progressiva, com recuperação total após 30 dias. CONCLUSÕES: A ocorrência de hematoma subdural é complicação rara, mas grave da perfuração de dura-máter. O diagnóstico é difícil e deve ser sempre cogitado quando a cefaléia pós-punção da dura-máter não se resolve com o tampão sangüíneo ou piora com sua realização. No esclarecimento diagnóstico é fundamental o auxílio de um método de imagem.

  17. 老年慢性硬膜下血肿的微创治疗%Minimally invasive treatment for chronic subdural hematoma in the elderly patients

    Institute of Scientific and Technical Information of China (English)

    汤家才

    2009-01-01

    目的 探讨微创手术治疗老年人慢性硬膜下血肿的疗效.方法 对20例老年慢性硬膜下血肿患者采用微创手术清除颅内血肿、辅以促进受压脑组织复位等治疗措施.结果 术前血肿量平均100 ml,术后血肿清除或基本清除.受压脑组织复位时间24 h~7 d,平均3 d,均痊愈出院.20例患者术后随访3~12月,平均7月,根据日常生活活动能力(ADL)分级法,正常16例,生活自理4例;CT随访16例,正常13例,脑萎缩2例,轻度局限性硬膜下积液1例.结论 微创血肿清除术治疗老年人慢性硬膜下血肿疗效满意,复发率低.%Objective To explore the curative efficacy of minimally invasive treatment for chronic subdural hematoma in elderly patients. Methods From February 2005 to February 2008, the clinical data of 20 elderly pa-tients suffered from chronic subdural hematoma were analyzed retrospectively. The patients were all treated by mini-mally invasive operations, along with the supportive treatment for repnsition of the brain. Results The hematomas (mean volume, 100 ml) were all cleared away postoperation. Brain reposition was obtained 24 hours ~ 7 days(mean, 3 days) after operations. All patients were cured to discharge. 20 patients were followed up for 3 ~ 12 months (mean,7 months). According to the activities of daily living (ADL) grading system, 16 patients were classified as normal, and 4 independent. Follow-up examination with CT scans in 16 patients showed 13 cases of normal findings, 2 cases of brain atrophy, and 1 mild subdural effusion. Conclusion Minimally invasive evacuation of hematoma is suited to elderly patients with chronic subdural hematoma,providing a satisfactory effect and a low recurrence rate.

  18. Biomechanics of subdural hemorrhage in American football: review of the literature in response to rise in incidence.

    Science.gov (United States)

    Forbes, Jonathan A; Zuckerman, Scott; Abla, Adib A; Mocco, J; Bode, Ken; Eads, Todd

    2014-02-01

    The number of catastrophic head injuries recorded during the 2011 football season was the highest since data collection began in 1984--the vast majority of these cases were secondary to subdural hemorrhage (SDH). The incidence of catastrophic head injury continues to rise: the average yearly incidence from 2008 to 2012 was 238% that of the average yearly incidence from 1998 to 2002. Greater than 95% of the football players who suffered catastrophic head injury during this period were age 18 or younger. Currently, the helmet industry utilizes a standard based on data obtained at Wayne State University approximately 50 years ago that seeks to limit severity index--a surrogate marker of translational acceleration. In this manuscript, we utilize a focused review of the literature to better characterize the biomechanical factors associated with SDH following collisions in American football and discuss these data in the context of current helmet standard. Review of the literature indicates the rotational acceleration (RA) threshold above which the risk of SDH becomes appreciable is approximately 5,000 rad/s(2). This value is not infrequently surmounted in typical high school football games. In contrast, translational accelerations (TAs) experienced during even elite-level impacts in football are not of sufficient magnitude to result in SDH. This information raises important questions about the current helmet standard--in which the sole objective is limitation of TA. Further studies will be necessary to better define whether helmet constructs and quality assurance standards designed to limit RA will also help to decrease the risk of catastrophic head injury in American football.

  19. Intravenous fluid administration may improve post-operative course of patients with chronic subdural hematoma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Miroslaw Janowski

    Full Text Available BACKGROUND: The treatment of chronic subdural hematoma (cSDH is still charged of significant risk of hematoma recurrence. Patient-related predictors and the surgical procedures themselves have been addressed in many studies. In contrast, postoperative management has infrequently been subjected to detailed analysis. Moreover variable intravenous fluid administration (IFA was not reported in literature till now in the context of cSDH treatment. METHODOLOGY/PRINCIPAL FINDINGS: A total of 45 patients with cSDH were operated in our department via two burr hole craniostomy within one calendar year. Downward drainage was routinely left in hematoma cavity for a one day. Independent variables selected for the analysis were related to various aspects of patient management, including IFA. Two dependent variables were chosen as measure of clinical course: the rate of hematoma recurrence (RHR and neurological status at discharge from hospital expressed in points of Glasgow Outcome Scale (GOS. Univariate and multivariate regression analyses were performed. Hematoma recurrence with subsequent evacuation occurred in 7 (15% patients. Univariate regression analysis revealed that length of IFA after surgery influenced both dependent variables: RHR (p = 0.045 and GOS (p = 0.023. Multivariate regression performed by backward elimination method confirmed that IFA is a sole independent factor influencing RHR. Post hoc dichotomous division of patients revealed that those receiving at least 2000 ml/day over 3 day period revealed lower RHR than the group with less intensive IFA. (p = 0.031. CONCLUSIONS/SIGNIFICANCE: IFA has been found to be a sole factor influencing both: RHR and GOS. Based on those results we may recommend administration of at least 2000 ml per 3 days post-operatively to decrease the risk of hematoma recurrence.

  20. Hematoma subdural agudo espontâneo e hemorragia intracerebral em paciente com microangiopatia trombótica gestacional

    Directory of Open Access Journals (Sweden)

    Sâmia Yasin Wayhs

    2013-06-01

    Full Text Available Pré-eclâmpsia, síndrome HELLP (hemólise, elevação de enzimas hepáticas e plaquetopenia e fígado gorduroso agudo da gestação são as principais causas de microangiopatia trombótica e disfunção hepática grave durante a gestação, representando um spectrum do mesmo processo patológico. Relatou-se aqui o caso de uma gestante com 35 semanas internada em unidade de terapia intensiva no pós-operatório imediato de cesariana por morte fetal, com náuseas, vômitos e icterícia. Diagnosticaram-se pré-eclâmpsia pós-parto e fígado gorduroso agudo da gestação. Houve evolução tardia com hematoma subdural agudo e hemorragia intracerebral, sendo realizado tratamento neurocirúrgico. A paciente foi a óbito por anemia hemolítica refratária, com sangramento espontâneo em múltiplos órgãos. Pré-eclâmpsia, síndrome HELLP e fígado gorduroso agudo da gestação são processos patológicos que podem se sobrepor e se associar a complicações potencialmente fatais, como a hemorragia intracraniana aqui descrita. Sua detecção e diagnóstico precoces são fundamentais para a instituição de manejo adequado e sucesso do tratamento.

  1. Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery: optimal management of patients on antiplatelet therapy.

    Science.gov (United States)

    Okano, Atsushi; Oya, Soichi; Fujisawa, Naoaki; Tsuchiya, Tsukasa; Indo, Masahiro; Nakamura, Takumi; Chang, Han Soo; Matsui, Toru

    2014-04-01

    OBJECTIVE. Not much is known about surgical management of patients with chronic subdural haematoma (CSDH) treated with antiplatelet or anticoagulant therapy. The aims of this study were to review the surgical outcomes of patients with CSDH and assess the risks of antiplatelet in their surgical management. METHODS. We retrospectively analysed 448 consecutive patients with CSDH treated by one burr hole surgery at our institution. Among them, 58 patients had been on antiplatelet therapy. We discontinued the antiplatelet agents before surgery for all 58 patients. For 51 of these 58 patients (87.9%), early surgery was performed within 0-2 days from admission. We analysed the association between recurrence and patient characteristics, including history of antiplatelet or anticoagulant therapy; age (therapy; and previous medical history of head trauma, infarction, hypertension, diabetes mellitus, haemodialysis, seizure, cancer, or liver cirrhosis. RESULTS. Recurrence occurred in 40 patients (8.9%), which was one of the lowest rates in the literature. Univariate analysis showed that only the presence of bilateral haematomas was associated with increased recurrence rate while antiplatelet or anticoagulant therapy did not significantly increase recurrence risk. Also, the recurrence rate from early surgery (0-2 days from drug cessation) for patients on antiplatelet therapy was not significantly higher than that from elective surgery (5 days or more after drug cessation). However, multivariate analysis revealed that previous history of cerebral infarction was an independent risk factor for CSDH recurrence. CONCLUSIOns. Our overall data support the safety of early surgery for patients on the preoperative antiplatelet therapy without drug cessation or platelet infusion. Patients with a previous history of infarction may need to be closely followed regardless of antiplatelet or anticoagulant therapy.

  2. Risk factors for recurrence of chronic subdural hematoma after burr hole surgery: potential protective role of dexamethasone.

    Science.gov (United States)

    Qian, Zhongrun; Yang, Dianxu; Sun, Fei; Sun, Zhenguo

    2017-02-01

    Chronic subdural hematomas (CSDHs) are often found in neurosurgery, and display a recurrence rate of up to 37%. This study aimed to determine potential risk factors contributing to unilateral CSDH recurrence, and evaluate the role of postoperative management with dexamethasone (DX) in reducing recurrence. Between January 2010 and May 2015, a total of 242 consecutive patients with CSDH treated with burr-hole trephination were included in this study. Univariate and multivariate analyses were performed to determine risk factors potentially associated with the recurrence of CSDH. Then, patients at high risk were divided into DX and non-DX treatment groups, respectively. Chi-square test was used to assess the potential role of DX. CSDH recurrence was recorded in 39 patients (16.1%). Among various risk factors, advanced age (p = .01), preoperative midline displacement exceeding 10 mm (p < .001), and hematomas presenting with separated type (p = .03) were significantly associated with CSDH recurrence. Interestingly, patients who accepted therapy with DX had a lower rate of second drainage procedure (p = .017). In addition, DX effectively reduced disease recurrence in patients with the separated type of hematoma (p = .047), and seemed to be beneficial to those with advanced age and midline shift exceeding 10 mm, although statistical significance was not achieved. These findings indicated that advanced age, midline displacement, and mixed density hematoma are independent factors for unilateral CSDH recurrence. When the above factors are detected in patients, additional DX administration should be recommended after operation.

  3. Low-molecular-weight heparin versus aspirin for acute ischemic stroke with large artery occlusive disease: subgroup analyses from the Fraxiparin in Stroke Study for the treatment of ischemic stroke (FISS-tris) study.

    Science.gov (United States)

    Wang, Qiao Shu; Chen, Christopher; Chen, Xiang Yan; Han, Jing Hao; Soo, Yannie; Leung, Thomas W; Mok, Vincent; Wong, Ka Sing Lawrence

    2012-02-01

    The Fraxiparin in Stroke Study for the treatment of ischemic stroke (FISS-tris) study showed no superiority of low-molecular-weight heparin (LMWH) over aspirin for the primary end point (Barthel Index) in acute ischemic stroke due to large artery occlusive disease. This study aims to evaluate the efficacy of LMWH and aspirin in selected subgroups so as to generate hypotheses for further studies. The FISS-tris study was a multicenter, randomized trial to investigate the efficacy and safety of LMWH (nadroparin calcium 3800 antifactor Xa IU/0.4 mL subcutaneously twice daily) or aspirin (160 mg once daily) for the treatment of patients with acute ischemic stroke and large artery occlusive disease. The primary outcome was the Barthel Index score dichotomized at 85 6 months poststroke. Exploratory subgroup analysis was performed using different levels of baseline characteristics and the distribution of symptomatic arteries. Compared with aspirin, LMWH improved outcome among older patients >68 years (P=0.043; OR, 1.86; 95% CI, 1.02-3.41) without ongoing antiplatelet treatment on admission (P=0.029; OR, 1.85; 95% CI, 1.06-3.21) and with symptomatic posterior circulation arterial disease (P=0.001; OR, 5.76; 95% CI, 2.00-16.56). Our findings suggest that LMWH may be of benefit in certain subgroups of patients with acute cerebral infarct and large artery occlusive disease. Hence, further investigation of LMWH may be justified in subgroups such as the elderly, nonusers of antiplatelet agents, and patients with posterior circulation stenosis. URL: www.strokecenter.org/trials. Unique identifier: registration no. 493.

  4. Clinical, Paraclinical, and Antimicrobial Resistance Features of Community-Acquired Acute Bacterial Meningitis at a Large Infectious Diseases Ward in Tehran, Iran.

    Science.gov (United States)

    Heydari, Behrooz; Khalili, Hossein; Karimzadeh, Iman; Emadi-Kochak, Hamid

    2016-01-01

    In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult (> 18 years) individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients' medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients' outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia (33.33%) followed by Neisseria meningitidis (27.78%) and Haemophilus influenza (16.67%). The most common antimicrobial regimen was ceftriaxone plus vancomycin (69.44%) followed by ceftriaxone plus vancomycin plus ampicillin (11.11%). Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 (11.11%), 2 (5.56%), and 1 (2.78%) subjects, respectively. Regarding mortality, only 3 (8.33%) patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them.

  5. Acute pancreatitis

    Science.gov (United States)

    ... its blood vessels. This problem is called acute pancreatitis. Acute pancreatitis affects men more often than women. Certain ... pancreatitis; Pancreas - inflammation Images Digestive system Endocrine glands Pancreatitis, acute - CT scan Pancreatitis - series References Forsmark CE. Pancreatitis. ...

  6. Cystitis - acute

    Science.gov (United States)

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  7. Patient need at the heart of workforce planning: the use of supply and demand analysis in a large teaching hospital's acute medical unit.

    Science.gov (United States)

    Le Jeune, I R; Simmonds, M J R; Poole, L

    2012-08-01

    Timely medical assessment is integral to the safety and quality of healthcare delivery in acute medicine. Medical staff are an expensive resource. This study aimed to develop a modelling system that facilitated efficient workforce planning according to patient need on the acute medical unit. A realistic 24-hour 'supply' of junior doctors was calculated by adjusting the theoretical numbers on the rota for leave allowances, natural breaks and other ward duties by a combination of direct observation of working practice and junior doctor interviews. 'Demand' was analysed using detailed admission data. Supply and demand were then integrated with data from a survey of the time spent on the process of clerking and assessment of medical admissions. A robust modelling system that predicted the number of unclerked patients was developed. The utility of the model was assessed by demonstrating the impact of a regulation-compliant redesign of the rota using existing staff and by predicting the most efficient use of an additional shift. This simple modelling system has the potential to enhance quality of care and efficiency by linking workforce planning to patient need.

  8. [Postoperative bed header position after burr-hole drainage of chronic subdural haematoma: systematic review and meta-analysis of randomised controlled trials].

    Science.gov (United States)

    Alcalá-Cerra, Gabriel; Moscote-Salazar, Luis Rafael; Paternina-Caicedo, Ángel; Gutiérrez-Paternina, Juan José; Niño-Hernández, Lucía M; Sabogal-Barrios, Rubén

    2014-01-01

    Several studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis. All randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included. The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals. A total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 ([95% CI: 0.22-1.16]; P=.11), reoperations, 1.07 ([95% CI: 0.42-2.69]; P=.89) and medical complications, 1.15 ([95% CI: 0.7-1.91]; P=.58). No statistically significant heterogeneity was found in any of the analyses. There were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  9. Acute Bronchitis

    Science.gov (United States)

    ... Smoking also slows down the healing process. Acute bronchitis treatment Most cases of acute bronchitis can be treated at home.Drink fluids, but ... bronchial tree. Your doctor will decide if this treatment is right for you. Living with acute bronchitis Most cases of acute bronchitis go away on ...

  10. Mixed phenotype acute leukemia

    Institute of Scientific and Technical Information of China (English)

    Ye Zixing; Wang Shujie

    2014-01-01

    Objective To highlight the current understanding of mixed phenotype acute leukemia (MPAL).Data sources We collected the relevant articles in PubMed (from 1985 to present),using the terms "mixed phenotype acute leukemia","hybrid acute leukemia","biphenotypic acute leukemia",and "mixed lineage leukemia".We also collected the relevant studies in WanFang Data base (from 2000 to present),using the terms "mixed phenotype acute leukemia" and "hybrid acute leukemia".Study selection We included all relevant studies concerning mixed phenotype acute leukemia in English and Chinese version,with no limitation of research design.The duplicated articles are excluded.Results MPAL is a rare subgroup of acute leukemia which expresses the myeloid and lymphoid markers simultaneously.The clinical manifestations of MPAL are similar to other acute leukemias.The World Health Organization classification and the European Group for Immunological classification of Leukaemias 1998 cdteria are most widely used.MPAL does not have a standard therapy regimen.Its treatment depends mostly on the patient's unique immunophenotypic and cytogenetic features,and also the experience of individual physician.The lack of effective treatment contributes to an undesirable prognosis.Conclusion Our understanding about MPAL is still limited.The diagnostic criteria have not been unified.The treatment of MPAL remains to be investigated.The prognostic factor is largely unclear yet.A better diagnostic cdteria and targeted therapeutics will improve the therapy effect and a subsequently better prognosis.

  11. Large B- Cell lymphoma presenting as acute abdominal pain and spontaneous splenic rupture; A case report and review of relevant literature

    Science.gov (United States)

    Biswas, Saptarshi; Keddington, Judith; McClanathan, James

    2006-01-01

    Background Spontaneous rupture of the spleen is an uncommon dramatic abdominal emergency that requires immediate diagnosis and prompt surgical treatment to ensure the patients survival. Infections have been cited in most cases involving splenic rupture but are rare in hematological malignancies despite frequent involvement of the spleen. Methods and Materials We present a case of a splenic rupture caused by infiltration of B-cell lymphoma. A 43 year old gentleman presented with a 1 day h/o left upper quadrant pain; nausea and vomiting for 2 days with associated dizziness and anorexia. The CT showed abnormal spleen 20 × 11 cm with free fluid in the abdomen and enlarged retroperitoneal LNs. The patient underwent a splenectomy after initial resuscitation and the operative finding was that of a massively enlarged spleen with areas of tumor extruding through the splenic capsule. Result and conclusion Although the spleen is often involved in hematological malignancies, splenic rupture is an infrequent occurrence. In a recent literature review 136 cases were of splenic rupture secondary to hematological malignancy were identified. Acute leukemia and non Hodgkin lymphoma were the frequent causes followed by chronic myelogeneous leukemia. Male sex, adulthood, severe splenomegaly and cytoreductive chemotherapy were factors more often associated with splenic rupture. Emergency splenectomy remains the cornerstone treatment for splenic rupture. We present a case report of a "spontaneous splenic rupture" and discuss the presentation, etiology and treatment options along with discussion of relevant literature PMID:17129392

  12. Stability of ischemic core volume during the initial hours of acute large vessel ischemic stroke in a subgroup of mechanically revascularized patients

    Energy Technology Data Exchange (ETDEWEB)

    Finitsis, Stephanos [Universitaetsklinikum Hamburg-Eppendorf, Neuroradiologie, Hamburg (Germany); Aristotle University of Thessaloniki, Neuroradiology Department, Ahepa Hospital, Thessaloniki (Greece); Kemmling, Andrea; Fiehler, Jens; Brekenfeld, Caspar [Universitaetsklinikum Hamburg-Eppendorf, Neuroradiologie, Hamburg (Germany); Havemeister, Stephanie; Thomalla, Goetz [Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Neurologie, Kopf- und Neurozentrum, Hamburg (Germany)

    2014-04-15

    This study aimed to relate growth of the infarct core with time to recanalization in patients receiving mechanical recanalization in whom the time of recanalization is known. We analyzed data from patients with anterior circulation acute ischemic stroke who underwent mechanical recanalization. Demographic and angiographic characteristics, initial apparent diffusion coefficient (ADC) infarct volume, time-to-peak defect volume, revascularization grade, 24-48 h nonenhanced computed tomography (CT) infarct volume, symptom onset to recanalization time, diffusion-weighted imaging to recanalization time, and discharge National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were compared between minimal and substantial infarct growth groups. Substantial infarct growth was defined as an increase of infarct volume >10 cm{sup 3} assessed by subtracting initial ADC infarct core volume from infarct volume at 24-48 h CT. Of 25 patients, 9 had minimal infarct growth (median 0 cm{sup 3}, interquartile range (IQR) -3 to 5 cm{sup 3}) and 16 had substantial infarct growth (median 103 cm{sup 3}, IQR 48-132 cm{sup 3}). Patients with minimal infarct growth had a median time from symptom onset to recanalization of 329 min (IQR 314-412 min) and a median time from imaging to recanalization of 231 min (IQR 198-309 min). On univariate analysis, minimal infarct growth was related to male gender (p = 0.04), smaller initial ADC volume (p = 0.04), higher recanalization grade (p < 0.001), and lower discharge NIHSS (p = 0.04) and mRS grades (p = 0.04). There was no or minimal infarct core growth in at least one third of patients despite an exceptionally long median time from magnetic resonance imaging to recanalization of almost 4 h. (orig.)

  13. Hematoma subdural intracraniano pós-anestesia subaracnóidea: relato de dois casos e revisão de 33 casos da literatura

    Directory of Open Access Journals (Sweden)

    Jane Auxiliadora Amorim

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hematoma subdural intracraniano é uma complicação rara pós-anestesia subaracnóidea. Relatamos dois casos de mulheres que desenvolveram hematoma subdural crônico pós-anestesia subaracnóidea, diagnosticados após a evolução clínica prolongada de cefaleia pós-punção dural (CPPD e analisamos outros 33 casos encontrados em revisão da literatura. RELATO DOS CASOS: Nos 35 pacientes (idade entre 20-88 anos, 19 homens, 14 tinham mais de 60 anos (40% sendo 12 (86% homens. A relação se inverte no grupo de pacientes mais jovens (< 60 anos, no qual há duas vezes mais mulheres (14:7. Dois picos de maior incidência foram observados: 30-39 anos (31% e 60-69 anos (29%. O período de tempo decorrido entre o início dos sintomas até o diagnóstico variou entre 4 horas e 29 semanas. Cefaleia foi referida por 26/35 (74,3% casos; alteração do nível de consciência em 14/35 (40,0%; vômitos em 11/35 (31,4%; hemiplegia ou hemiparesia em 8/35 (22,9%; diplopia ou paresia do VI nervo craniano em 5/35 (14,3%; e distúrbio da linguagem em 4/35 (11,4%. Os fatores contribuintes foram: gravidez, múltiplas punções, uso de anticoagulantes, anormalidades vasculares intracranianas e atrofia cerebral. Em 15 casos, não foi citado qualquer fator contribuinte. Quatro em 35 pacientes (11,4% ficaram com sequelas neurológicas e 4/35 (11,4% morreram. CONCLUSÕES: A presença de qualquer um desses sinais ou sintomas mencionados serve de alerta para a possibilidade de ocorrer hematoma subdural intracraniano como complicação da punção dural, principalmente naqueles pacientes que apresentaram CPPD por mais de uma semana, quando uma investigação por neuroimagem se faz necessária.

  14. Acute Bronchitis

    Science.gov (United States)

    Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It ... chest tightness. There are two main types of bronchitis: acute and chronic. Most cases of acute bronchitis ...

  15. Bronchitis - acute

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/001087.htm Bronchitis - acute To use the sharing features on this page, please enable JavaScript. Acute bronchitis is swelling and inflamed tissue in the main ...

  16. A large-scale distribution of milk-based fortified spreads: evidence for a new approach in regions with high burden of acute malnutrition.

    Science.gov (United States)

    Defourny, Isabelle; Minetti, Andrea; Harczi, Géza; Doyon, Stéphane; Shepherd, Susan; Tectonidis, Milton; Bradol, Jean-Hervé; Golden, Michael

    2009-01-01

    There are 146 million underweight children in the developing world, which contribute to up to half of the world's child deaths. In high burden regions for malnutrition, the treatment of individual children is limited by available resources. Here, we evaluate a large-scale distribution of a nutritional supplement on the prevention of wasting. A new ready-to-use food (RUF) was developed as a diet supplement for children under three. The intervention consisted of six monthly distributions of RUF during the 2007 hunger gap in a district of Maradi region, Niger, for approximately 60,000 children (length: 60-85 cm). At each distribution, all children over 65 cm had their Mid-Upper Arm Circumference (MUAC) recorded. Admission trends for severe wasting (WFHspreads to reduce the incidence of severe wasting in large population of children 6-36 months of age. Although further information is needed on the cost-effectiveness of such distributions, these results highlight the importance of re-evaluating current nutritional strategies and international recommendations for high burden areas of childhood malnutrition.

  17. Short message service (SMS) texting as a method of communication during on call: prevalence and experience of medical staff in a large acute NHS Trust in the UK.

    Science.gov (United States)

    Matharu, J; Hale, B; Ammar, M; Brennan, P A

    2016-10-01

    With the widespread use of smartphones, text messaging has become an accepted form of communication for both social and professional use in medicine. To our knowledge no published studies have assessed the prevalence and use of short message service (SMS) texting by doctors on call. We have used an online questionnaire to seek information from doctors in a large NHS Trust in the UK about their use of texting while on call, what they use it for, and whether they send images relevant to patients' care. We received 302 responses (43% response rate), of whom 166 (55%) used SMS while on call. There was a significant association between SMS and age group (p=0.005), with the 20-30-year-old group using it much more than the other age groups. Doctors in the surgical specialties used it significantly less than those in other speciality groups (pcall was deemed to be safe and reliable (pcall.

  18. Hospital cost of pediatric patients with complicated acute sinusitis.

    Science.gov (United States)

    Padia, Reema; Thomas, Andrew; Alt, Jeremiah; Gale, Craig; Meier, Jeremy D

    2016-01-01

    Review costs for pediatric patients with complicated acute sinusitis. A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. A review of sub acute subdural hematoma (SASDH with our institutional experience and its management by double barrel technique (DbT: A novel technique

    Directory of Open Access Journals (Sweden)

    Soubhagya R Tripathy

    2016-01-01

    Conclusion: SASDH is an uncommon neurosurgical entity (0.89% of traumatic brain injury cases in our study and mimics both CSDH as well as ASDH. The true incidence of SASDH may have been underestimated due to its clinical imitation with CSDH. This study in a South Asian nation also provides the epidemiological data of this rare neurosurgical entity. Outcome of surgery is good; our retrospective study confirms that "DbT" is an adequate and safe treatment. However, a better designed, randomized control trial will be needed to reinforce our findings.

  20. Acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Bo-Guang Fan

    2010-01-01

    Full Text Available Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions : Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  1. Acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Bo-Guang Fan

    2010-05-01

    Full Text Available Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  2. Clinical Value of Chronic Subdural Effusion and CT Follow up in Elderly Patients with Traumatic Brain Injury%老年人脑外伤后慢性硬膜下积液与CT随访的临床价值

    Institute of Scientific and Technical Information of China (English)

    熊继新; 张晓磷

    2016-01-01

    Objective To investigate the elderly chronic subdural effusion after traumatic brain injury and follow-up CT value. Methods A retrospective analysis of our hospital from January 2009 to January 2009, 1235 cases of elderly patients with craniocerebral trauma of skull CT performance, for the elderly the onset of chronic subdural effusion after traumatic brain injury with CT follow-up results were summarized in this paper. Results After 1~2 years follow-up, check out the 87 cases of chronic subdural effusion, incidence of 7.04%. In unilateral or bilateral temporal top 45 cases, accounted for 51.7%, other parts accounted for 48.3%. Subdural effusion time:48 cases within 3 months, 55.2%;3~6 months, 21 cases (24.1%);13 cases of 6~12 months, 14.9%;More than 12 months in 5 cases, accounting for 5.7%. In patients with skull and intracranial lesions in 172 cases, 48 cases of chronic subdural effusion, accounting for 27.9%.9 cases in the later evolution for chronic subdural hematoma, accounting for 10.3%. Conclusion Because of the particularity of its anatomy and physiology, the elderly are prone to chronic subdural effusion after brain trauma, and is likely to evolve into chronic subdural hematoma, and late CT follow-up has important clinical significance.%目的:探讨老年人脑外伤后慢性硬膜下积液与CT随访价值。方法回顾性分析我院2009年1月~2013年1月1235例老年颅脑外伤患者的头颅CT表现,对老年人脑外伤后慢性硬膜下积液的发病情况与CT随访结果进行总结。结果经1~2年随访,检出慢性硬膜下积液87例,发病率为7.04%。发生于单侧或双侧颞顶部45例,占51.7%,其他部位占48.3%。出现硬膜下积液的时间:3个月内48例,占55.2%;3~6个月21例,占24.1%;6~12个月13例,占14.9%;12个月以上5例,占5.7%。172例存在颅骨与颅内损伤患者中,发生慢性硬膜下积液48例,占27.9%。9例在后期演变为慢性硬膜下血肿,占10.3%。

  3. Acute cholecystitis

    OpenAIRE

    Halpin, Valerie

    2014-01-01

    Acute cholecystitis causes unremitting right upper quadrant pain, anorexia, nausea, vomiting, and fever, and if untreated can lead to perforations, abscess formation, or fistulae. About 95% of people with acute cholecystitis have gallstones.It is thought that blockage of the cystic duct by a gallstone or local inflammation can lead to acute cholecystitis, but we don't know whether bacterial infection is also necessary.

  4. Paradigms for subdural grids' implantation in patients with refractory epilepsy Paradigmas para implante de placas subdurais em pacientes com epilepsia refratária

    Directory of Open Access Journals (Sweden)

    ARTHUR CUKIERT

    2000-09-01

    Full Text Available RATIONALE: The need for invasive monitoring in patients with refractory epilepsy has been greatly reduced by the introduction of new technologies such as PET, SPECT and MRI in the clinical practice. On the other hand, 10 to 30% of the patients with refractory epilepsy have non-localizatory non-invasive preoperative work-up results. This paper reports on the paradigms for subdural electrodes implantation in patients with different refractory epileptic syndromes. METHODS: Twenty-nine adult refractory epileptic patients were studied. Patients were divided into five different epileptic syndromes that represented the majority of the patients who needed invasive recordings: bitemporal (Group I; n=16 , bi-frontal-mesial (Group II, n=5, hemispheric (Group III; n=2, anterior quadrant (Group IV; n=3 and posterior quadrant (Group V; n=3. All of them were submitted to extensive subdural electrodes' implantation (from 64 to 160 contacts covering all the cortical surface potentially involved in epileptogenesis under general anesthesia. Results: All patients tolerated well the procedure. There was no sign or symptom of intracranial hypertension except for headache in 22 patients. In all except one Group II patient, prolonged electrocorticographic monitoring using the described subdural cortical coverage patterns was able to define a focal area amenable for resection. In all Groups II-V patients cortical stimulation was able to adequately map the rolandic and speach areas as necessary. CONCLUSION: Despite recent technological advances invasive neurophysiological studies are still necessary in some patients with refractory epilepsy. The standardization of the paradigms for subdural implantation coupled to the study of homogeneous patients' populations as defined by MRI will certainly lead to a better understanding of the pathophysiology involved in such cases and an improved surgical outcome.INTRODUÇÃO: O advento de novas tecnologias de imagem tais como o PET

  5. Misdiagnosis of Massive Chronic Subdural Hematonas in Elders by Clinical Analysis of 35 Cases.%老年大量慢性硬膜下血肿误诊35例临床分析

    Institute of Scientific and Technical Information of China (English)

    王镇

    2013-01-01

    Objective: To explore the massive chronic subdural hematonas in elders,provide the help to the clinical diagnosis and treatment.An intensive recognition of the disease.Method: The clinical charactristicas and causa of misdiagnosis of 126 elders with chronic subdural hematonas were retrospectively analygsed from January 2007 to December 2011 who operated on my hospital.Results:Of the 126 edlers,35 were misdiagnosis as other disease.Conclusion: he chronic subdural hematonas in elders is very easy to be misdiagnosed. An intensive recognition of the disease.Careful investigation and CT scanning are very important to reducing misdiagnosis.%目的探讨老年人大量慢性硬膜下血肿(CSDH)误诊原因,为临床正确诊治提供参考,以提高对CSDH的认识。方法对我院2007年1月-2011年12月共手术治疗老年CSDH126例,对其临床资料及误诊原因进行回顾性分析。结果其中35例被误诊为其他疾病。结论老年人慢性硬膜下出血极易误诊,为减少误诊,应提高对本病的认识,详细询问病史,认真查体及常规头颅CT检查。

  6. Thrombolysis in Acute Cerebrovascular Disease

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2003-01-01

    @@ Large-scale trials have shown that thrombolytic therapy reduces mortality and preserves left ventricular function in patients with acute myocardial infarction (AMI). That's a rationale for the use of thrombolytic agents in the management of ischemic stroke.

  7. Large dose of naloxone combined with ulinastatin in acute cardiogenic shock effect observation%大剂量纳洛酮联合乌司他丁在急性心源性休克的效果分析

    Institute of Scientific and Technical Information of China (English)

    陈显敏

    2015-01-01

    目的:探讨大剂量纳洛酮联合乌司他丁对急性心源性休克的临床治疗效果。方法选取2011年1月—2014年5月于该院心内科接受治疗的急性心肌梗死并心源性休克患者56例,将其随机分成纳洛酮治疗组组21例、乌司他丁治疗组17例、纳洛酮联合乌司他丁治疗组18例。通过心衰标志物脑钠肽以及炎性介导物肿瘤坏死因子-α、白细胞介素-6来评判各组的治疗效果。结果治疗7 d之后,3组患者关于评估疗效的3项指标较治疗前都显著下降(P <0.05);联合治疗组脑钠肽(138.79±54.21)对比纳洛酮组(250.46±66.53)疗效明显(t=3.58,P<0.05);对比乌司他丁治疗组评判指标下降同样显著(t=4.17,P<0.05),表明联合治疗组疗效更好。结论大剂量纳洛酮联合乌司他丁在急性心源性休克的治疗当中比单用这两种药具有更好的疗效,值得向临床推广应用。%Objective To investigate the large dose of naloxone combined with ulinastatin clinical therapeutic effect on acute car-diogenic shock. Methods from 2011 January to 2014 May in our hospital department of Cardiology for treatment of acute myocar-dial infarction patients with cardiogenic shock in 56 cases, were randomly divided into 21 cases of treatment group, naloxone group, ulinastatin treatment group 17 cases, naloxone combined with ulinastatin treatment group of 18 cases. The biomarker of brain natriuretic peptide and inflammatory mediators of tumor necrosis factor alpha, interleukin -6 to judge the curative effect of each group. Results after 7 days of treatment, the 3 indexes of 3 groups of patients for evaluating curative effect than before treat-ment were significantly decreased(P<0.05);Combined treatment group of brain natriuretic peptide(138.79 ± 54.21) contrast nalox-one group (250.46 ± 66.53) curative effect obviously (t=3.58, P < 0.05);the contrast of ulinastatin treatment group significantly de

  8. Acute nierschade

    NARCIS (Netherlands)

    Hageman, D.; Kooman, J.P.; Lance, M.D.; van Heurn, L.W.E.; Snoeijs, M.G.

    2012-01-01

    - 'Acute kidney injury' is modern terminology for a sudden decline in kidney function, and is defined by the RIFLE classification (RIFLE is an acronym for Risk, Injury, Failure, Loss and End-stage kidney disease).- Acute kidney injury occurs as a result of the combination of reduced perfusion in the

  9. Computed tomography in suppurative meningitis. CT and clinical findings in the acute stage

    Energy Technology Data Exchange (ETDEWEB)

    Yoshida, Akira; Fujiwara, Katsuhiko; Iino, Shigeru (Kyoto Prefectural Univ. of Medicine (Japan))

    1982-06-01

    Computed tomography abnormalities revealed in 18 of 29 patients (62%) with infantile supprative meningitis. The abnormalities included ventricular dilatation (12 cases), subdural edema (8), cerebral infarction (4), cerebral atrophy (3), encephalitis (2), and cerebral herniation (1). The comparative study of CT pictures and clinical findings in the acute stage of the disease showed that the high incidence of these abnormalities occurred in the following conditions: 1) The age was less than 1 year, 2) establishment of the diagnosis took more than 5 days, 3) glucose of the cerebrospinal fluid was less than 200 mg/dl, 4) protein of the cerebrospinal fluid was more than 200 mg/dl, and 5) convulsion occurred 24 hrs after institution of the treatment.

  10. Meningencefalites bacterianas agudas em crianças: complicações e sequelas neurológicas Acute bacterial meningoencephalitis in children: complications and neurologic sequelae

    Directory of Open Access Journals (Sweden)

    WLADIMIR NATALINO

    1999-06-01

    Full Text Available Foram estudadas 271 crianças com idade inferior a 15 anos, com diagnóstico de meningencefalite bacteriana aguda (MBA, no período 1980 -- 1990. Os pacientes foram divididos em dois grupos, conforme não tivessem recebido tratamento prévio (STP, 153 casos, e os que receberam tratamento prévio (CTP, 118 casos. Ocorreram diferenças significativas em relação a identificação do agente etiológico, que foi maior no grupo STP, e em relação a ocorrência de ventriculite, maior no grupo CTP. Ocorreu óbito em 19,5% dos 271 casos, com predomínio em crianças de idade abaixo de 12 meses (29,7% e nos pacientes com MBA por Streptococcus pneumoniae. As manifestações epilépticas e as paresias na fase aguda da MBA predominaram em crianças de idade abaixo de 1 ano. Foram identificados e tratados do ponto de vista neurocirúrgico as ventriculites, higroma subdural, hidrocefalia, empiema subdural e abscesso cerebral.We studied 271 children under age of 15 with diagnosis of acute bacterial meningencephalitis treated at Medical School in Ribeirão Preto, University of São Paulo, between 1980 and 1990. The patients were divided in two groups: 1 those who had not received previous antibiotics treatment (NTP, with 153 cases; and 2, those who had received previous antibiotics treatment (PT, with 118 cases. The etiological agent was more frequently identified in NPT group, while ventriculitis was more frequent in PT group. Mortality rate accounted for 19,5% of all cases, and 29.7% of children under 12 months of age. Acute meningitis caused by Streptococcus pneumoniae was frequently followed by increased mortality. Convulsive disorders and hemiparesis predominante among children under 12 months of age. On the neurosurgical point of view, ventriculitis, subdural hygroma, hydrocephalus, subdural empyema and brain abscess were identified and treated

  11. Acute left ventricle failure on induction of anesthesia: a case report of reverse stress cardiomyopathy-presentation, diagnosis and treatment.

    Science.gov (United States)

    Ikram, Sohail; Saleem, Nashwa; Latif, Rana K

    2016-10-01

    Reverse takotsubo cardiomyopathy (TCM) is a less common variant of classic TCM that presents within a different patient profile and with its own hemodynamic considerations. A 46-year-old woman was admitted to our hospital for laryngoscopy and possible balloon dilatation for tracheal stenosis under general anesthesia. One year prior to this admission, the patient was admitted after a motor vehicle accident with subdural hematoma, subarachnoid hemorrhage, and fracture of the eighth thoracic vertebra. She underwent uneventful anesthesia for thoracic spine surgery and tracheostomy to help her wean from the ventilator during that admission. Since her previous admission, she developed posttraumatic anxiety and depression (a neuropsychiatric disorder triggered by subdural hematoma and subarachnoid hemorrhage) and was treated with antianxiety and antidepressant medication. At this admission, the patient developed acute left ventricle failure on induction of anesthesia secondary to reverse TCM. We report a case of reverse TCM, where posttraumatic emotional stress of a neuropsychiatric disorder combined with physical stress from anesthesia and laryngoscopy triggered TCM in a patient with previous uneventful anesthesia 1 year earlier.

  12. Acute Pancreatitis and Pregnancy

    Science.gov (United States)

    ... Acute Pancreatitis and Pregnancy test Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as ... pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for almost 1 ...

  13. Acute Pancreatitis and Pregnancy

    Science.gov (United States)

    ... Pancreatitis Acute Pancreatitis and Pregnancy Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as ... pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for almost 1 ...

  14. Acute Kidney Failure

    Science.gov (United States)

    ... out of balance. Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly over ... 2015. Palevsky PM. Definition of acute kidney injury (acute renal failure). http://www.uptodate.com/home. Accessed April ...

  15. Derivação ventricular e subdural bilateral com a válvula de Holter: nova técnica cirúrgica

    Directory of Open Access Journals (Sweden)

    Walter C. Pereira

    1965-06-01

    Full Text Available É relatada uma adaptação da ventrículo-auriculostomia, com válvula de Holter, para casos de bloqueios bilaterais dos orifícios de Monro e de coleções subdurais bilaterais. A técnica consiste na colocação de dois catéteres de borracha siliconiza-da nos ventrículos laterais ou espaços subdurais, mediante trepanações para-medianas na região parietal posterior; êstes catéteres são conectados a uma sonda em forma de T (sonda de Kehr que, por sua vez, é ligada à uma válvula de Holter, sendo os demais tempos cirúrgicos idênticos aos da ventrículo-auriculostomia convencional. Foram operados, com esta técnica, três pacientes: dois com craniofaringiomas e um com coleção subdural bilateral. Os resultados foram satisfatórios.

  16. Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

    Directory of Open Access Journals (Sweden)

    Yasuda Clarissa Lin

    2003-01-01

    Full Text Available O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3%, da cor branca (85,1% e da faixa etária na quinta década (mediana 57 anos. O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (international normalized ratio superiores a 1,25 e/ou trombocitopenia (p<0,001 e p=0,004, respectivamente e mortalidade menor para os pacientes com antecedente de traumatismo cranioencefálico (76% (p=0,044. Os resultados ressaltam a importância da avaliação pré-operatória com o coagulograma a fim de se corrigir possíveis alterações.

  17. Effect of Anatomically Realistic Full-Head Model on Activation of Cortical Neurons in Subdural Cortical Stimulation—A Computational Study

    Science.gov (United States)

    Seo, Hyeon; Kim, Donghyeon; Jun, Sung Chan

    2016-06-01

    Electrical brain stimulation (EBS) is an emerging therapy for the treatment of neurological disorders, and computational modeling studies of EBS have been used to determine the optimal parameters for highly cost-effective electrotherapy. Recent notable growth in computing capability has enabled researchers to consider an anatomically realistic head model that represents the full head and complex geometry of the brain rather than the previous simplified partial head model (extruded slab) that represents only the precentral gyrus. In this work, subdural cortical stimulation (SuCS) was found to offer a better understanding of the differential activation of cortical neurons in the anatomically realistic full-head model than in the simplified partial-head models. We observed that layer 3 pyramidal neurons had comparable stimulation thresholds in both head models, while layer 5 pyramidal neurons showed a notable discrepancy between the models; in particular, layer 5 pyramidal neurons demonstrated asymmetry in the thresholds and action potential initiation sites in the anatomically realistic full-head model. Overall, the anatomically realistic full-head model may offer a better understanding of layer 5 pyramidal neuronal responses. Accordingly, the effects of using the realistic full-head model in SuCS are compelling in computational modeling studies, even though this modeling requires substantially more effort.

  18. Serial Serum Leukocyte Apoptosis Levels as Predictors of Outcome in Acute Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Hung-Chen Wang

    2014-01-01

    Full Text Available Background. Apoptosis associates with secondary brain injury after traumatic brain injury (TBI. This study posits that serum leukocyte apoptosis levels in acute TBI are predictive of outcome. Methods. Two hundred and twenty-nine blood samples from 88 patients after acute TBI were obtained on admission and on Days 4 and 7. Serial apoptosis levels of different leukocyte subsets were examined in 88 TBI patients and 27 control subjects. Results. The leukocyte apoptosis was significantly higher in TBI patients than in controls. Brief unconsciousness (P=0.009, motor deficits (P≤0.001, GCS (P≤0.001, ISS (P=0.001, WBC count (P=0.015, late apoptosis in lymphocytes and monocytes on Day 1 (P=0.004 and P=0.022, resp., subdural hemorrhage on initial brain CT (P=0.002, neurosurgical intervention (P≤0.001, and acute posttraumatic seizure (P=0.046 were significant risk factors of outcome. Only motor deficits (P=0.033 and late apoptosis in monocytes on Day 1 (P=0.037 were independently associated with outcome. A cutoff value of 5.72% of late apoptosis in monocytes was associated with poor outcome in acute TBI patients. Conclusion. There are varying degrees of apoptosis in patients following TBI and in healthy individuals. Such differential expression suggests that apoptosis in different leukocyte subsets plays an important role in outcome following injury.

  19. Acute toxicity tests of nitazoxanide on fingerings of large yellow croaker%硝唑尼特对大黄鱼幼鱼的急性毒性试验

    Institute of Scientific and Technical Information of China (English)

    樊海平; 林煜; 钟全福

    2015-01-01

    Under the conditions of water temperature of 25-27℃ and pH of 8. 1-8. 2,compounding the solution by nita-zoxanide dissolved in dimethyl sulfoxide and using the hydrostatic test method,the acute toxicity of nitazoxanide on fingerings of large yellow croaker were studied. The test results showed that 24 h,48 h,72 h and 96 h median lethal concentration (LC50)of nitazoxanide on fingerings of large yellow croaker was 6. 69 mg/L,6. 45 mg/L,5. 64 mg/L and 5. 04 mg/L respectively,and safe concentration was 1. 69 mg/L. Nitazoxanide belongs to high toxic chemicals,but generally that of 1 mg/L in the 72-hour immersion bath can effectively remove trophozoite,therefore,the effective concentrations of insect repellent is within the range of the safe concentration and it is safe to use in production.%在水温25~27℃、pH 值8.1~8.2条件下,将硝唑尼特溶解于二甲亚砜制成溶液,采用静水试验法研究硝唑尼特对大黄鱼幼鱼的急性毒性。试验结果表明:硝唑尼特对大黄鱼幼鱼24 h、48 h、72 h 和96 h 的半致死浓度( LC50)分别为6.69 mg/L、6.45 mg/L 、5.64 mg/L 和5.04 mg/L;安全浓度为1.69 mg/L。硝唑尼特属高毒化学物质,但一般1 mg/L浸浴72 h即可有效驱除滋养体。因此,驱虫的有效浓度属安全浓度范围,在生产中使用是安全的。

  20. Endoscopic management of large multicompartmental intraventricular arachnoid cyst extending from foramen magnum to foramen of Monro

    Directory of Open Access Journals (Sweden)

    Yadav Y

    2010-01-01

    Full Text Available The treatment options for symptomatic arachnoid cysts are shunting, open craniotomy, and endoscopic fenestration. Endoscopic fenestration of large arachnoid cyst is safe and effective. Postoperative subdural hematoma and intraparenchymal hemorrhage can be avoided by endoscopic fenestration. This technique has the additional advantage of identifying and treating ventricular abnormalities, such as foramen of Monro stenosis and cerebral aqueduct occlusion. This report describes endoscopic dual fenestration in a child with large multicompartmental intraventricular arachnoid cyst extending from foramen magnum to foramen of Monro. The child presented with difficulty to hold the neck in upright position, irritability, vomiting, and large head. Follow-up postoperative magnetic resonance imaging at 3 months showed a significant reduction in size of the cyst. Clinically, the patient showed a gradual improvement at 10 months follow-up. Probably this is the first report of this nature.

  1. Clinical features, acute complications, and outcome of Salmonella meningitis in children under one year of age in Taiwan

    Directory of Open Access Journals (Sweden)

    Lee Meng-Luen

    2011-01-01

    Full Text Available Abstract Background Salmonella meningitis remains a threat to children below two years of age in both developing and developed countries. However, information on such infections has not been well characterized. We analyzed data related to twelve years of experience in order to clarify the comprehensive features of Salmonella meningitis in our patients, including admission characteristics, acute complications, and long-term outcome. Methods The records of patients with spontaneous Salmonella meningitis from 1982 to 1994 were retrospectively reviewed. The long-term outcome was prospectively determined for survivors at school age by the developmental milestones reported by their parents and detailed neurological evaluation along with intelligence, hearing, visual, speech and language assessments. Results Of the twenty-four patients, seizures were noted in fifteen (63% before admission and thirteen (54% during hospitalization. Acute complications mainly included hydrocephalus (50%, subdural collection (42%, cerebral infarction (33%, ventriculitis (25%, empyema (13%, intracranial abscess (8%, and cranial nerve palsy (8%. Three patients (13% died during the acute phase of Salmonella meningitis. The twenty-one survivors, on whom we followed up at school age, have sequelae consisting of language disorder (52%, motor disability (48%, intelligence quotient Conclusion Salmonella meningitis in neonates and infants had a wide spectrum of morbidity and acute complications, leading to a complicated hospital course and subsequently a high prevalence of permanent adverse outcome. Thus, early recognition of acute complications of Salmonella meningitis and a follow-up plan for early developmental assessment of survivors are vital.

  2. Acute tonsillitis.

    Science.gov (United States)

    Sidell, Doug; Shapiro, Nina L

    2012-08-01

    Acute tonsillitis is an inflammatory process of the tonsillar tissues and is usually infectious in nature. Acute infections of the palatine tonsils predominantly occur in school-aged children, but patients of any age may be affected. Tonsillitis of viral origin is usually treated with supportive care. Bacterial tonsillitis is most commonly caused by Streptococcus pyogenes. Polymicrobial infections and viral pathogens are also important sources of infection. Penicillins remain the treatment of choice for S. pyogenes tonsillitis, and augmented aminopenicillins have gained utility in concert with the increasing incidence of beta-lactamase producing bacteria. We describe the anatomic features and the immunologic function of the palatine tonsils, including a detailed discussion of history and physical examination findings, treatment recommendations, and possible complications of acute tonsillitis. Establishing an accurate diagnosis and initiating appropriate treatment are key components of managing this common pathologic process.

  3. 大骨瓣减压术后并发对侧硬膜下积液的非手术治疗%Prevention and effective treatment of opposite subdural effusion after decompressive craniecm

    Institute of Scientific and Technical Information of China (English)

    王虎; 梁恩和; 张昕; 陈荷红; 杨帆; 肖绪林; 王雪原

    2014-01-01

    Objective To explore the prevention and effective treatment of opposite subdural effusion after decompressive craniecm. Methods Retrospective analyses were conducted for 79 cases of opposite subdural effusion after decompressive craniecm. And the efficacies of various methods were compared. Results Among them, 78 cases were cured by enswathing with elastic bondage. And one case improved through cavity fluid drainage catheter. Conclusion Enswathing with elastic bondage is an effective, simple and economic method of managing opposite subdural effusion after decompressive craniecm.%目的 探讨大骨瓣减压术后对侧硬膜下积液的治疗及预防方法.方法 回顾分析天津市环湖医院2011年1月至2013年3月79例大骨瓣减压术后对侧硬膜下积液的处理方法,比较各种方法疗效.结果 78例通过术区局部弹力绷带包扎塑形,2周后复查头部CT示积液基本消失,1例弹力绷带包扎塑形及穿刺抽吸无效行积液--腹腔分流术,再次复查头部CT示积液明显减少.结论 大骨瓣减压术后硬膜下积液使用弹力绷带包扎塑形效果确切,是一种非常简单、安全、经济的方法,值得推广.

  4. [Functional mapping using subdural electrodes combined with monitoring during awake craniotomy enabled preservation of function and extensive resection of a glioma adjacent to the parietal lobe language sites: a case report].

    Science.gov (United States)

    Takebayashi, Kento; Saito, Taiichi; Nitta, Masayuki; Tamura, Manabu; Maruyama, Takashi; Muragaki, Yoshihiro; Okada, Yoshikazu

    2015-01-01

    Surgical resection of gliomas located in the dominant parietal lobe is difficult because this lesion is surrounded by multiple functional areas. Although functional mapping during awake craniotomy is very useful for resection of gliomas adjacent to eloquent areas, the limited time available makes it difficult to sufficiently evaluate multiple functions, such as language, calculative ability, distinction of right and left sides, and finger recognition. Here, we report a case of anaplastic oligodendroglioma, which was successfully treated with a combination of functional mapping using subdural electrodes and monitoring under awake craniotomy for glioma. A 32-year-old man presented with generalized seizure. Magnetic resonance imaging revealed a non-enhanced tumor in the left angular and supramarginal gyri. In addition, the tumor showed high accumulation on 11C-methionine positron emission tomography(PET)(tumor/normal brain tissue ratio=3.20). Preparatory mapping using subdural electrodes showed absence of brain function on the tumor lesion. Surgical removal was performed using cortical mapping during awake craniotomy with an updated navigation system using intraoperative magnetic resonance imaging(MRI). The tumor was resected until aphasia was detected by functional monitoring, and the extent of tumor resection was 93%. The patient showed transient transcortical aphasia and Gerstmann's syndrome after surgery but eventually recovered. The pathological diagnosis was anaplastic oligodendroglioma, and the patient was administered chemo-radiotherapy. The patient has been progression free for more than 2 years. The combination of subdural electrode mapping and monitoring during awake craniotomy is useful in order to achieve preservation of function and extensive resection for gliomas in the dominant parietal lobe.

  5. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

    Science.gov (United States)

    Mekaj, Agon Y.; Morina, Arsim A.; Mekaj, Ymer H.; Manxhuka-Kerliu, Suzana; Miftari, Ermira I.; Duci, Shkelzen B.; Hamza, Astrit R.; Gashi, Musli M.; Xhelaj, Mentor R.; Kelmendi, Fatos M.; Morina, Qamile Sh.

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008–2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety. PMID:25883478

  6. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012

    Directory of Open Access Journals (Sweden)

    Agon Y Mekaj

    2015-01-01

    Full Text Available Background: Chronic subdural hematoma (CSDH is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3% were males and 31 (22.7% females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%. The head trauma has been responsible for CSDH in 88 patients (64.3%, while the main symptom was headache (92 patients or 67.1%. One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%. The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.

  7. Value of Targeted Epidural Blood Patch and Management of Subdural Hematoma in Spontaneous Intracranial Hypotension: Case Report and Review of the Literature.

    Science.gov (United States)

    Rettenmaier, Leigh A; Park, Brian J; Holland, Marshall T; Hamade, Youssef J; Garg, Shuchita; Rastogi, Rahul; Reddy, Chandan G

    2017-01-01

    Spontaneous intracranial hypotension (SIH) is a more common than previously noted condition (1-2.5 per 50,000 persons) typically caused by cerebrospinal fluid (CSF) leakage. Initial treatment involves conservative therapies, but the mainstay of treatment for patients who fail conservative management is the epidural blood patch (EBP). Subdural hematoma (SDH) is a common complication occurring with SIH, but its management remains controversial. In this report, we discuss a 62-year-old woman who presented with a 5-week history of orthostatic headaches associated with nausea, emesis, and neck pain. Despite initial imaging being negative, the patient later developed classic imaging evidence characteristic of SIH. Magnetic resonance imaging was unrevealing for the source of the CSF leak. Radionuclide cisternography showed possible CSF leak at the right-sided C7-T1 nerve root exit site. After failing a blind lumbar EBP, subsequent targeted EBP at C7-T1 improved the patient's symptoms. Two days later she developed a new headache with imaging evidence of worsening SDH with midline shift requiring burr hole drainage. This yielded sustained symptomatic relief and resolution of previously abnormal imaging findings at 2-month follow-up. A literature review revealed 174 cases of SIH complicated by SDH. This revealed conflicting opinions concerning the management of this condition. Although blind lumbar EBP is often successful, targeted EBP has a lower rate of patients requiring a second EBP or other further treatment. On the other hand, targeted EBP has a larger risk profile. Depending on the clinic situation, treatment of the SDH via surgical evacuation may be necessary. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Relationship between the natural history of chronic subdural hematoma and enhancement of the inner membrane on post-contrast CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Nakaguchi, Hiroshi; Yoshimasu, Norio [Teraoka Memorial Hospital, Shinichi, Hiroshima (Japan); Tanishima, Takeo [Tokyo Kosei Nenkin Hospital (Japan)

    2003-02-01

    The purpose of this study was to determine the features and natural history of the inner membrane in CSDH (chronic subdural hemotoma) patients using pre- and post-contrast CT scans. Twenty-four patients with CSDH (28 hematomas) who underwent pre- and post-contrast CT scanning prior to surgery ware studied. CSDH was classified according to the internal architecture as the homogeneous (HM) type, the laminar (LM) type, the separated (SP) type, and the trabecular (TR) type. For each type, the enhancement of the inner membrane, the outer membrane, and trabeculae was evaluated. Enhancement of the inner membrane develops as the stage of CSDH progresses. Although the inner membrane was not enhanced in the HM type, it was enhanced in almost all of the patients with the other types (p <0.0001). In 13% of patients with the LM type, 29% with the SP type, and 40% with the TR type, the inner membrane was moderately or markedly enhanced. The outer membrane was not thickened in any patient. In 88% of the patients who had contralateral hemiparesis on admission and 42% of those who did not have hemiparesis, the inner membrane was clearly enhanced (p=0.0166). This indicated that blood flow to the inner membrane from the pia matter induced hypoperfusion of the brain parenchyma beneath the hematoma in addition to the effect of direct compression. Contrast CT scanning may be useful for diagnosing the extent of enlargement of the inner membrane, predicting the risk of local brain damage, and evaluating the stage in the natural history of CSDH. (author)

  9. ACUTE TOXICITY EFFECT OF THE AQUEOUS EXTRACT OF ...

    African Journals Online (AJOL)

    Administrator

    Acute And Toxicity Effect of The Aqueous Extract of Terminalia avicennioides. ACUTE TOXICITY ... that this valuable medicinal resources in plants are largely untapped because of .... Test of significance was done in rows. Same superscripts ...

  10. Role of Elastic Bondage in the Prevention of Subdural Effusion After Decompressive Craniectomy%弹力绷带在预防去骨瓣减压患者术后硬膜下积液中的作用

    Institute of Scientific and Technical Information of China (English)

    姚玉强; 苏亦兵; 乔京元; 阎涛; 史良; 于宁波

    2015-01-01

    Objective To evaluate whether early application of elastic bondage can reduce the incidence of subdural effusion after decompressive craniectomy. Methods We retrospectively reviewed 63 patients receiving decompressive craniectomy due to traumatic brain injury between January 2008 and December 2014.The experimental group (n=27) included patients who experienced early application (within 3 days) of elastic bondage after craniectomy between January 2012 and December 2014.The control group ( n=36 ) underwent decompressive craniectomy without early application of elastic bondage between January 2008 and December 2011.Comparisons were performed between the two groups on the incidence of postoperative subdural effusion. Results Of the 63 patients, the total incidence of postoperative subdural effusion was 42.9%.The occurrence of postoperative subdural effusion in the experimental group was statistically lower than that in the the control group [25.9%(7/27) vs.55.6%(20/36),χ2 =5.531, P=0.019] .Similarly, the incidence of interhemispheric effusion in the experimental group was also significantly lower than that in the control group [3.7%(1/27) vs.33.3%(12/36),χ2 =8.271, P=0.004].The incidences of post-operative subdural effusion in other locations between the two groups didn ’ t show significant differences.The volumes of subdural effusion in the two groups didn’t reach statistic significance ( t =-0.839, P =0.409). Conclusions Subdural effusion is one of the most common complications after decompressive craniectomy.Early application of elastic bondage may reduce the incidence of post-operative subdural effusion.%目的:探讨早期应用弹力绷带在去骨瓣减压术后硬膜下积液中的预防作用。方法回顾性分析2008年1月~2014年12月我科因颅脑外伤行去骨瓣减压术63例资料,2012年1月后术后早期(3天内)给予弹力绷带(弹力绷带组, n=27),2011年12月前术后早期未应用

  11. Diagnostic value of auxiliary examination for childhood purulent meningitis complicated with subdural effusion%辅助检查对化脓性脑膜炎并硬膜下积液患儿的诊断价值

    Institute of Scientific and Technical Information of China (English)

    毛丹丹; 廖建湘; 蒋莉

    2015-01-01

    目的:探讨化脓性脑膜炎( PM)并硬膜下积液的临床表现和炎症反应指标演变规律。方法收集2009年1月至2013年12月在深圳市儿童医院住院的化脓性脑膜炎162例,合并硬膜下积液者为硬膜下积液组,未合并硬膜下积液者为对照组,对2组临床资料进行分析。应用SPSS 17.0统计学软件进行数据处理。结果49例(30.25%)并硬膜下积液,37例(75.5%)于病程前10 d发生;婴儿期发生率最高,占48.84%(42例);硬膜下积液组和对照组在发热、抽搐、精神反应、前囟膨隆等临床表现方面差异无统计学意义;入院当日外周血白细胞增高不明显、C反应蛋白增高明显者,更容易发生硬膜下积液(Z=1.74、2.10,P均<0.05);而血小板普遍增高,累积异常率达93.75%,但2组间差异无统计学意义。入院时患者外周血白细胞计数影响因素众多,包括年龄、脑脊液培养结果以及入院前抗生素的应用,而C反应蛋白值仅受抗生素影响。结论硬膜下积液多发生于婴儿期,多数于病程前10 d出现。入院时测得PM患儿外周血白细胞较低、C反应蛋白明显升高,或病程中C反应蛋白再次升高,需警惕硬膜下积液的发生。血小板增高或许可以作为感染性疾病的临床特点之一。%Objective To explore the clinical and peripheral blood characteristics of childhood purulent meningitis complicated with subdural effusion. Methods A retrospective cohort chart review was performed. A total of 162 consecutive cases of purulent meningitis were identified in Shenzhen Children′s Hospital from January 2009 to De-cember 2013,all of them were divided into 2 groups according to whether complicating with subdural effusion, and the clinical characteristics of 2 groups were analyzed. The clinical characteristics were analyzed. The statistical data were determined by SPSS 17. 0 software. Results Forty-nine cases(30. 25%)of them were complicated with subdural effu

  12. Acute abdomen

    Directory of Open Access Journals (Sweden)

    Wig J

    1978-01-01

    Full Text Available 550 cases of acute abdomen have been analysed in detail includ-ing their clinical presentation and operative findings. Males are more frequently affected than females in a ratio of 3: 1. More than 45% of patients presented after 48 hours of onset of symptoms. Intestinal obstruction was the commonest cause of acute abdomen (47.6%. External hernia was responsible for 26% of cases of intestinal obstruction. Perforated peptic ulcer was the commonest cause of peritonitis in the present series (31.7% while incidence of biliary peritonitis was only 2.4%.. The clinical accuracy rate was 87%. The mortality in operated cases was high (10% while the over-all mortality rate was 7.5%.

  13. Sinusitis (acute)

    Science.gov (United States)

    2008-01-01

    Introduction Acute sinusitis is defined pathologically, by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks. Clinically, it is characterised by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever. It affects 1−5% of the adult population each year in Europe. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people with clinically diagnosed acute sinusitis, and with radiologically or bacteriologically confirmed acute sinusitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides, different doses [amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides], long-course regimens), antihistamines, cephalosporins or macrolides, decongestants (xylometazoline, phenylephrine, pseudoephedrine), doxycycline, saline nasal washes, steam inhalation, and topical corticosteroids (intra-nasal). PMID:19450327

  14. 大剂量山莨菪碱联合乌司他丁治疗重症胰腺炎%The study of treating acute pancreatitis with large dose of anisodamine combined with ulinastain

    Institute of Scientific and Technical Information of China (English)

    张更伟; 单爱军; 柳勋法; 龙连宫; 王进

    2014-01-01

    Objective To study the effects of large dose anisodamine (654-2) combined with ulinastain on severe acute pancreatitis (SAP).Methods 100 healthy adult SD rats which were fasted 12 hours before experiment and were allowed drinking water freely,were divided to 5 groups randomly (random number):normal control group,SAPgroup,SAP + Ulinastain group,SAP + Anisodamine group,SAP +Ulinastain + Anisodamine,there were 20 rats in every group.To observe the levels of diastase,phospholipase A2 (PLA2) and endotoxin and pathology of rats in every group.Another cohort of 60 SD rats were divided into 3 groups:SAP group,SAP + Ulinastain group,SAP + Ulinastain + large dose Anisodamine group,survival periods were observed.Results The levels of diastase,PLA2 and endotoxin in SAP rats were higher than those in 3 SAP with treatment groups (P < 0.05).The histopathological changes were most severe in SAP group.All of 3 markers in 3 SAP with treatment groups decreased obviously,and anisodamine alone was effective to treat SAP,but the effect of UTI + 654-2 was better than UTI or 654-2 alone,and histopathological changes were mild in this group treated with UTI + 654-2.Conclusions Anisodamine could effectively relax the Oddi sphincter thereby decreasing the hydrostatic pressure inside the bile duct and pancreatic duct.Ulinastain is a kind of proteinase inhibitor suppressing many kinds of enzymes and in tern to stabilize lysosomal membrane and inhibit the release of lysosomal enzyme.Combination of the large dose Anisodamine with Ulinastain could inhibit the overexpression of inflammationarv factors in SAP,thereby lessening the severity of viscera injury.%目的 研究大剂量山莨菪碱联合乌司他丁对急性胰腺炎大鼠的治疗效果.方法 健康成年SD大鼠100只,实验前12 h禁食,自由饮水,随机(随机数字法)分为5组:健康对照组、SAP组、SAP+乌司他丁治疗对照组、SAP+山莨菪碱治疗组、SAP乌司他丁加大剂量山莨菪碱治疗组各20只.观

  15. Acute Pancreatitis Concomitant Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Okay Abacı

    2013-03-01

    Full Text Available Acute pancreatitis is an inflammatory syndrome with unpredictable progression to systemic inflammation and multi-organ dysfunction. As in our case rarely, acute pancreatitis can be presented with the coexistance of acute coronary syndrome. To prevent a misdiagnosis of acute situation presented with chest or abdominal pain, physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations.

  16. 外伤性纵裂区血肿的显微外科治疗%Surgical management of traumatic interhemispheric subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    王玉海; 蔡桑; 蔡学见; 董吉荣; 朱军; 杨理坤; 王春莉; 张建东

    2011-01-01

    Objective To study the treatment and clinical outcomes of traumatic interhemispheric subdural hematoma ( TISH ). Method The clinical datum, surgical management and outcomes of 21 patients with TISH treated with mircrosurgery were analyzed retrospectively. Results According to Glasgow coma scale(GCS) ,good recovery was found in 16 cases, moderate disability in 2, severe disability in 1, vegetative survival in 1, and death in 1 during postoperative follow - up period (1-9 years ). There were confirmed sources of hemorrhage in all 21 cases. The whole cerebral longitudinal fissure hematoma was more frequently seen in patients with hemorrhage from rupture of the distal part of anterior cerebral artery and veins in the cerebral longitudinal fissure, the prognosis was usually good. Local hematoma, laceration and edema in the cerebral longitudinal fissure were more frequently seen in patients with hemorrhage from brain tissue laceration of the longitudinal fissure, the prognosis was usually poor. Conclusions Good understanding of surgical indications, commanding of surgical skills and timely surgical intervention are helpful in improving the prognosis of TISH patients.%目的 提高外伤性纵裂血肿的临床疗效.方法 回顾性分析21例经显微手术治疗的外伤性纵裂区血肿的临床资料、手术方法和手术疗效.结果 按GOS治疗结果评定,术后随访1-9年,恢复良好16例,中残2例,重残1例,植物生存1例,死亡1例.21例均有明确出血来源,大脑前动脉远段分支破裂出血和纵裂区静脉破裂出血者以全纵裂血肿多见且手术效果较好,纵裂区脑组织挫伤出血者以局部纵裂血肿和挫伤水肿为主,部分患者预后较差.结论 正确掌握外伤性纵裂区血肿的手术指征和手术技巧,及时手术治疗,有助于改善外伤性纵裂血肿患者的预后.

  17. Acute respiratory distress syndrome assessment after traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Shahrooz Kazemi

    2016-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is one of the most important complications associated with traumatic brain injury (TBI. ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors. Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013 done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis. Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH 48 (60% and Subdural hemorrhage (SDH was Next Level with 39 (48% Correlation between Glasgow Coma Scale (GCS and Respiratory Distress Syndrome (ARDS were significantly decreased (P< 0.0001. The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009 [(2.3±4.6 vs (4.02±7.07]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%. Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis

  18. Studies on acute hepatic insufficiency

    NARCIS (Netherlands)

    G.H. de Groot (Gerrit Harmen)

    1984-01-01

    textabstractAcute hepatic failure (AHF) is one of the most dramatic situations that a clinical physician can encounter. It is also one of the most frustating since death is the result in a large majority of the cases, despite all efforts of the medical and nursing staffs. Although a wide variety of

  19. HMX: Acute Toxicity Tests in Laboratory Animals.

    Science.gov (United States)

    1985-07-30

    loss of mobility and laboured breathing. Observations noted at post mortem examination included red staining around mouth and nose, subdural haemorrhage...was shaved from an area 4 x 6 cm across the scapular region with electric clippers. Two courses of intradermal injections were given, one on either

  20. Acute cerebellar ataxia

    Science.gov (United States)

    Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA ... Acute cerebellar ataxia in children, particularly younger than age 3, may occur several weeks after an illness caused by a virus. ...

  1. Acute arterial occlusion - kidney

    Science.gov (United States)

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  2. Acute Appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Qvist, Niels

    2017-01-01

    BACKGROUND: The classification of acute appendicitis (AA) into various grades is not consistent, partly because it is not clear whether the perioperative or the histological findings should be the foundation of the classification. When comparing results from the literature on the frequency...... patients were included. In 116 (89 %) of these cases, appendicitis was confirmed histological. There was low concordance between the perioperative and histological diagnoses, varying from 16 to 76 % depending on grade of AA. Only 44 % of the patients receiving antibiotics postoperatively had a positive...... peritoneal fluid cultivation. CONCLUSION: There was a low concordance in clinical and histopathological diagnoses of the different grades of appendicitis. Perioperative cultivation of the peritoneal fluid as a standard should be further examined. The potential could be a reduced postoperative antibiotic use...

  3. Acute intestinal pseudo-obstruction (Ogilvie's syndrome: A case report

    Directory of Open Access Journals (Sweden)

    Navas Nadukkandiyil, MD

    2014-12-01

    Full Text Available Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, is an acute clinical condition with clinical and radiological features of an acute large bowel obstruction in the absence of any mechanical cause. Patients presenting with Ogilvie's syndrome usually have underlying medical and surgical conditions predisposing them to the syndrome. In this article, we describe an elderly patient who presented with acute colonic pseudo-obstruction without any apparent cause.

  4. The Safety and Efficacy of Dexmedetomidine versus Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial

    Directory of Open Access Journals (Sweden)

    Wenming Wang

    2016-11-01

    Full Text Available Background: Chronic subdural hematoma (CSDH is a very common clinical emergency encountered in neurosurgery. While both general anesthesia (GA and monitored anesthesia care (MAC can be used during CSDH surgery, MAC is the preferred choice among surgeons. Further, while dexmedetomidine (DEX is reportedly a safe and effective agent for many diagnostic and therapeutic procedures, there have been no trials to evaluate the safety and efficacy of DEX vs. sufentanil in CSDH surgery. Objective: To evaluate the safety and efficacy of DEX vs. sufentanil in MAC during burr-hole surgery for CSDH.Methods: In all, 215 fifteen patients underwent burr-hole surgery for CSDH with MAC and were divided into three groups: Group D1 (n=67, DEX infusion at 0.5 μg·kg–1 for 10 min, Group D2 (n=75, DEX infusion at 1 μg·kg–1 for 10 min, and Group S (n=73, sufentanil infusion 0.3 μg·kg–1 for 10 min. Ramsay sedation scale (RSS of all three groups was maintained at 3. Anesthesia onset time, total number of intraoperative patient movements, hemodynamics, total cumulative dose of DEX, time to first dose and amount of rescue midazolam or fentanyl, percentage of patients converted to alternative sedative or anesthetic therapy, postoperative recovery time, adverse events, and patient and surgeon satisfaction scores were recorded.Results: The anesthesia onset time was significantly less in group D2 (17.36±4.23 vs. 13.42±2.12 vs. 15.98±4.58 min, respectively, for D1, D2, S; P<0.001. More patients in groups D1 and S required rescue midazolam to achieve RSS=3 (74.63% vs. 42.67% vs. 71.23%, respectively, for D1, D2, S; P<0.001. However, the total dose of rescue midazolam was significantly higher in group D1 (2.8±0.3 vs. 1.9±0.3 vs. 2.0±0.4 mg, respectively, for D1, D2, S; P<0.001. The time to first dose of rescue midazolam was significantly longer in group D2 (17.32±4.47 vs. 23.56±5.36 vs. 16.55±4.91 min, respectively, for D1, D2, S; P<0.001. Significantly fewer

  5. Acute Myopericarditis Mimicking Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Seval İzdeş

    2011-08-01

    Full Text Available Acute coronary syndromes among young adults are relatively low when compared with older population in the intensive care unit. Electrocardiographic abnormalities mimicking acute coronary syndromes may be caused by non-coronary syndromes and the differential diagnosis requires a detailed evaluation. We are reporting a case of myopericarditis presenting with acute ST elevation and elevated cardiac enzymes simulating acute coronary syndrome. In this case report, the literature is reviewed to discuss the approach to distinguish an acute coronary syndrome from myopericarditis. (Journal of the Turkish Society Intensive Care 2011; 9:68-70

  6. Large deviations

    CERN Document Server

    Varadhan, S R S

    2016-01-01

    The theory of large deviations deals with rates at which probabilities of certain events decay as a natural parameter in the problem varies. This book, which is based on a graduate course on large deviations at the Courant Institute, focuses on three concrete sets of examples: (i) diffusions with small noise and the exit problem, (ii) large time behavior of Markov processes and their connection to the Feynman-Kac formula and the related large deviation behavior of the number of distinct sites visited by a random walk, and (iii) interacting particle systems, their scaling limits, and large deviations from their expected limits. For the most part the examples are worked out in detail, and in the process the subject of large deviations is developed. The book will give the reader a flavor of how large deviation theory can help in problems that are not posed directly in terms of large deviations. The reader is assumed to have some familiarity with probability, Markov processes, and interacting particle systems.

  7. Rapid MRI evaluation of acute intracranial hemorrhage in pediatric head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Ryan, Maura E.; Jaju, Alok [Northwestern University Feinberg School of Medicine, Department of Radiology, Chicago, IL (United States); Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Medical Imaging, Chicago, IL (United States); Ciolino, Jody D. [Northwestern University, Biostatistics Collaboration Center, Department of Preventive Medicine Feinberg School of Medicine, Chicago, IL (United States); Alden, Tord [Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, Chicago, IL (United States); Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Neurosurgery, Chicago, IL (United States)

    2016-08-15

    Rapid MRI with ultrafast T2 sequences can be performed without sedation and is often used in place of computed tomography (CT) to evaluate pediatric patients for indications such as hydrocephalus. This study investigated the sensitivity of rapid magnetic resonance imaging (MRI) for detection and follow-up of acute intracranial hemorrhage in comparison to CT, which is commonly the first-line imaging. Patients presenting to a pediatric hospital with acute intracranial hemorrhage on CT and follow-up rapid MRI within 48 h were included. Rapid MRI studies consisted of three plane ultrafast T2 sequences either with or without axial gradient echo (GRE) sequences. Identification of hemorrhage on rapid MRI was assessed by readers both blinded and unblinded to prior CT results. One hundred two acute hemorrhages in 61 patients were identified by CT. Rapid MRI detection of subdural and epidural hemorrhages was modest in the absence of prior CT for comparison (sensitivity 61-74 %), but increased with review of the prior CT (sensitivity 80-86 %). Hemorrhage size was a significant predictor of detection (p < 0.0001). Three plane fast T2 images alone without GRE sequences were poor at detecting subarachnoid hemorrhage (sensitivity 10-25 %); rapid MRI with GRE sequences identified the majority of subarachnoid hemorrhage (sensitivity 71-93 %). GRE modestly increased detection of other extra-axial hemorrhages. Rapid MRI with GRE sequences is sensitive for most acute intracranial hemorrhages only when a prior CT is available for review. Rapid MRI is not adequate to replace CT in initial evaluation of intracranial hemorrhages but may be helpful in follow-up of known hemorrhages. (orig.)

  8. Large deviations

    CERN Document Server

    Hollander, Frank den

    2008-01-01

    This book is an introduction to the theory and applications of large deviations, a branch of probability theory that describes the probability of rare events in terms of variational problems. By focusing the theory, in Part A of the book, on random sequences, the author succeeds in conveying the main ideas behind large deviations without a need for technicalities, thus providing a concise and accessible entry to this challenging and captivating subject. The selection of modern applications, described in Part B of the book, offers a good sample of what large deviation theory is able to achieve

  9. Acute otitis externa

    OpenAIRE

    Hui, Charles PS

    2013-01-01

    Acute otitis externa, also known as ‘swimmer’s ear’, is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present.

  10. Acute otitis externa.

    Science.gov (United States)

    Hui, Charles Ps

    2013-02-01

    Acute otitis externa, also known as 'swimmer's ear', is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present.

  11. Acute otitis externa

    OpenAIRE

    2013-01-01

    Acute otitis externa, also known as ‘swimmer’s ear’, is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present.

  12. Imaging acute ischemic stroke.

    Science.gov (United States)

    González, R Gilberto; Schwamm, Lee H

    2016-01-01

    Acute ischemic stroke is common and often treatable, but treatment requires reliable information on the state of the brain that may be provided by modern neuroimaging. Critical information includes: the presence of hemorrhage; the site of arterial occlusion; the size of the early infarct "core"; and the size of underperfused, potentially threatened brain parenchyma, commonly referred to as the "penumbra." In this chapter we review the major determinants of outcomes in ischemic stroke patients, and the clinical value of various advanced computed tomography and magnetic resonance imaging methods that may provide key physiologic information in these patients. The focus is on major strokes due to occlusions of large arteries of the anterior circulation, the most common cause of a severe stroke syndrome. The current evidence-based approach to imaging the acute stroke patient at the Massachusetts General Hospital is presented, which is applicable for all stroke types. We conclude with new information on time and stroke evolution that imaging has revealed, and how it may open the possibilities of treating many more patients. © 2016 Elsevier B.V. All rights reserved.

  13. Clinical Analysis on 25 Cases Subdural Effusion Treated by Lumbar Puncture and Cerebrospinal Fluid-filter Air Auxotherapy%腰穿术脑脊液及过滤空气置换术治疗硬膜下积液25例临床分析

    Institute of Scientific and Technical Information of China (English)

    李虎

    2011-01-01

    Objective: Probing into the effect of lumbar puncture and cerebrospinal fluid-filter air auxotherapy on subdural effusion. Method: We carried on lumbar puncture and cerebrospinal fluid-filter air auxotherapy for 25 cases suffering from intracranial subdural effusion of variant period, variant regon, Then observed therapeutic effect and common side effect. Result: All subdural effusions got effective control. All intracranial hypertension got effective remission. Conclusion: The lumbar puncture and subarachnoid fluidfilter air auxotherapy for intracranial subdural effusion is characterized by safe, effective, cheap and simple.The risks of the auxotherapy are lower than operation , and it' s more rapid, more positive than conservation treatment.%目的:探讨腰穿术脑脊液-过滤空气置换术对颅内硬膜下积液的治疗情况.方法:25例不同时期,不同部位的颅内硬膜下积液病人行腰穿术脑脊液-过滤空气置换术疗法,观察治疗效果及常见副反应.结果:积液均得到有效控制,颅内压增高得到有效缓解.结论:腰穿术脑脊液-过滤空气置换术疗法治疗颅内硬膜下积液具有安全,有效,价廉,简便等优点,较手术风险低;较保守疗法更迅捷,更积极.

  14. Pentoxifylline Treatment in Acute Pancreatitis (AP)

    Science.gov (United States)

    2016-09-14

    Acute Pancreatitis (AP); Gallstone Pancreatitis; Alcoholic Pancreatitis; Post-ERCP/Post-procedural Pancreatitis; Trauma Acute Pancreatitis; Hypertriglyceridemia Acute Pancreatitis; Idiopathic (Unknown) Acute Pancreatitis; Medication Induced Acute Pancreatitis; Cancer Acute Pancreatitis; Miscellaneous (i.e. Acute on Chronic Pancreatitis)

  15. Acute Pancreatitis – Beyond Gallstones and Alcohol

    Directory of Open Access Journals (Sweden)

    Omid Sadr-Azodi

    2012-12-01

    Full Text Available Acute pancreatitis is the most common disorder of the pancreas. The incidence of the disease has increased markedly during the past decades. Whilst alcohol abuse and gallstone disease might explain a large proportion of the disease etiology, in one quarter of the patients, the cause remains unknown. Life-style and pharmaceutical drug use are potential risk factors for the disease. This brief review highlights the recent research on the role of these factors in the etiology of acute pancreatitis.

  16. Treatment of acute viral bronchiolitis.

    Science.gov (United States)

    Eber, Ernst

    2011-01-01

    Acute viral bronchiolitis represents the most common lower respiratory tract infection in infants and young children and is associated with substantial morbidity and mortality. Respiratory syncytial virus is the most frequently identified virus, but many other viruses may also cause acute bronchiolitis. There is no common definition of acute viral bronchiolitis used internationally, and this may explain part of the confusion in the literature. Most children with bronchiolitis have a self limiting mild disease and can be safely managed at home with careful attention to feeding and respiratory status. Criteria for referral and admission vary between hospitals as do clinical practice in the management of acute viral bronchiolitis, and there is confusion and lack of evidence over the best treatment for this condition. Supportive care, including administration of oxygen and fluids, is the cornerstone of current treatment. The majority of infants and children with bronchiolitis do not require specific measures. Bronchodilators should not be routinely used in the management of acute viral bronchiolitis, but may be effective in some patients. Most of the commonly used management modalities have not been shown to have a clear beneficial effect on the course of the disease. For example, inhaled and systemic corticosteroids, leukotriene receptor antagonists, immunoglobulins and monoclonal antibodies, antibiotics, antiviral therapy, and chest physiotherapy should not be used routinely in the management of bronchiolitis. The potential effect of hypertonic saline on the course of the acute disease is promising, but further studies are required. In critically ill children with bronchiolitis, today there is little justification for the use of surfactant and heliox. Nasal continuous positive airway pressure may be beneficial in children with severe bronchiolitis but a large trial is needed to determine its value. Finally, very little is known on the effect of the various

  17. 急性脑外伤患者137例MRI与CT检查优劣比较%Comparison of MRI and CT examination in 137 patients with acute traumatic brain injury

    Institute of Scientific and Technical Information of China (English)

    王越

    2014-01-01

    Objective:To explore the differences of MRI and CT examination in the diagnosis of acute traumatic brain injury in order to guide the clinical diagnosis.Methods:We selected 137 cases of patients with acute traumatic brain injury from March 2012 to January 2014,and these patients underwent MRI and CT examination.Results:In 137 cases,48 cases were diffuse axonal injury,including 6 cases of epidural complicated with subdural hematoma,12 cases of subdural hematoma,18 cases of epidural hematoma,12 cases of fracture and subarachnoid hemorrhage;6 cases were pure subarachnoid hemorrhage;99 cases were contusion and laceration of the brain,including 22 cases of cerebral contusion complicated with subarachnoid hemorrhage,28 cases of pure contusion and laceration of brain,5 cases with ventricular hemorrhage,axonal injury in 15 cases,subdural hematoma in 7 cases,22 cases of fracture and epidural hematoma.Through the CT examination,there were some patients with missed diagnosis in 3 cases of subdural hematoma,15 cases of axonal injury,6 cases of contusion and laceration of brain.Through MRI, there were some patients with missed diagnosis in 6 cases of fracture.Conclusion: MRI in the diagnosis of acute traumatic brain injury is better than that of CT,but in the examination of fracture is worse than CT.Acute traumatic brain injury patients can undergo MRI and CT examination in order to reduce the rate of misdiagnosis.%目的:探讨MRI与CT检查在诊断急性脑外伤的差异,指导临床诊断。方法:2012年3月-2014年1月收治急性颅脑损伤患者137例,均进行MRI与CT检查。结果:137例急性脑外伤患者中,弥漫性轴索损伤48例,其中硬膜外合并硬膜下血肿6例,硬膜下血肿12例,单纯硬膜外血肿18例,骨折及蛛网膜下腔出血12例;单纯蛛网膜下腔出血6例;脑挫裂伤99例,其中脑挫伤合并蛛网膜下腔出血22例,单纯脑挫裂伤28例,脑室内出血5例,轴索损伤15

  18. The relationship between neuron-specific enolase and prognosis of patients with acute traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Yun-yang LIU

    2015-03-01

    Full Text Available Objective To investigate the relationship between neuron-specific enolase (NSE levels in serum and cerebrospinal fluid (CSF of patients with acute traumatic brain injury (TBI and the prognosis of TBI patients.  Methods A total of 89 patients with acute TBI were divided into light, medium, heavy and severe TBI groups based on admission Glasgow Coma Scale (GCS score. Serum NSE expression levels were detected in all cases and NSE levels in CSF were detected in 18 cases within 12 h after TBI. The expression levels of serum NSE in 20 normal people, except cases of lung disease and nervous system damage, were detected as a control group. Results Compared with the control group, serum NSE expression levels of patients in each TBI group were elevated (P < 0.05, for all, and the NSE levels in severe and heavy TBI groups were higher than that in medium and light groups (P < 0.05, for all. The serum NSE expression levels of patients with cerebral contusion were higher than that of patients with diffuse axonal injury (DAI, P = 0.025, subdural hematoma (P = 0.031 and epidural hematoma (P = 0.021. Serum NSE expression levels were negatively correlated with GCS score (rs = - 0.327, P = 0.024 and Glasgow Outcome Scale (GOS score (rs = - 0.252, P = 0.049. The NSE expression levels of CSF in severe and heavy TBI patients were higher than that of serum (P = 0.039, 0.031.  Conclusions NSE expression changes can be evaluated as an auxiliary indicator in reflecting the degree of acute TBI, typing diagnosis and prognostic evaluation, and NSE levels of CSF is more sensitive than that of serum. DOI: 10.3969/j.issn.1672-6731.2015.03.013

  19. Acute bee paralysis virus [

    Lifescience Database Archive (English)

    Full Text Available Acute bee paralysis virus [gbvrl]: 14 CDS's (15780 codons) fields: [triplet] [frequ...osomal protein / MAP kinase List of codon usage for each CDS (format) Homepage Acute bee paralysis virus ...

  20. Acute kidney failure

    Science.gov (United States)

    Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute ... There are many possible causes of kidney damage. They include: ... cholesterol (cholesterol emboli) Decreased blood flow due to very ...

  1. Histoplasmosis - acute (primary) pulmonary

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000098.htm Histoplasmosis - acute (primary) pulmonary To use the sharing features on this page, please enable JavaScript. Acute pulmonary histoplasmosis is a respiratory infection that is caused by ...

  2. Acute Mesenteric Ischemia

    Science.gov (United States)

    ... Side Effects Additional Content Medical News Acute Mesenteric Ischemia By Parswa Ansari, MD, Department of Surgery, Lenox ... Abscesses Abdominal Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of ...

  3. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    OpenAIRE

    Olfa Kassar; Feten Kallel; Manel Ghorbel; Hatem. Bellaaj; Zeineb Mnif; Moez Elloumi

    2015-01-01

    Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patie...

  4. Accurate falls risk assessment and interventions for preventing falls in patients in the acute care setting within a private hospital in a large capital city: a best practice implementation project.

    Science.gov (United States)

    Szymaniak, Samara

    2015-09-01

    used to improve clinical practice, and the project was conducted over a five-month period, with the addition of a third audit cycle six months post completion of the implementation phase.Results were generated using the JBI-PACES module and were scrutinized by the project lead in conjunction with members of the project team. Results were discussed with key clinicians throughout the duration of the project. Baseline audit results provided the foundation for generating change and this data was then compared with the first follow-up audit to identify improvements in compliance with criteria. Again this data was compared with audits from six months post implementation to identify sustainability of the project. The results from the baseline audit highlighted that there was significant opportunity for improvement in all criteria audited. It was pleasing to report that in the first follow-up audit cycle, nearly all criteria showed an improvement in both medical and surgical fields. The greatest areas of improvement pertained to healthcare professionals receiving formal education (improvement of 46%), and patient and family education improved by 43%. To measure sustainability, a second follow-up audit was conducted using the same criteria and identified that strategies implemented had in fact been maintained, and the results were consistent with those from the first follow-up audit. The project used the pre- and post-audit strategy to translate evidence into practice, and not only demonstrated that implementation of evidence-based practice is possible in the acute setting but also showed improvement in the prevention of falls and harm from falls in that setting.

  5. Respostas cardiovasculares agudas no treinamento de força conduzido em exercícios para grandes e pequenos grupamentos musculares Acute cardiovascular responses in strenght training conducted in exercises for large and small muscular groups

    Directory of Open Access Journals (Sweden)

    Welton D'Assunção

    2007-04-01

    10RM were performed in the selected exercises. The performance rhythm in both exercises was controlled by a metronome, with an established time of two seconds for each of the eccentric and concentric phases. The HR was measured though a cardiofrequency meter and the SBP and the DBP through the auscultatory method. The two-way ANOVA with repeated measurements, followed by the post-hoc test by Tukey did not find differences (p > 0.05 for intra-exercises SBP. Therefore, at least in the present study, the muscular mass involved in the strength training did not influence the acute cardiovascular responses in trained normotensive subjects.

  6. Acute mastoiditis in children

    DEFF Research Database (Denmark)

    Anthonsen, Kristian; Høstmark, Karianne; Hansen, Søren;

    2013-01-01

    Conservative treatment of acute otitis media may lead to more complications. This study evaluates changes in incidence, the clinical and microbiological findings, the complications and the outcome of acute mastoiditis in children in a country employing conservative guidelines in treating acute...... otitis media....

  7. 慢性硬膜下血肿术后复发的多因素分析%Multivariate analysis of risk factors related to recurrent chronic subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    赵建华; 王超; 瞿准; 朱骏; 邱永明

    2011-01-01

    Objective To explore the risk factors related to recurrent chronic subdural hematoma (CSDH). Methods 171 cases with CSDH were retrospectively analyzed. Results 18 cases were recurrent after surgery with a recurrent rate of 10.5%. Single factor Χ2 analysis showed that the recurrence of CSDH was related to age, hematoma density, hematoma location, midline shift, Bender classfication, encephalatrophy classfication,drainage amount, and bleeding tendency (P < 0.05), regardless of gender,anesthesia mode,and injury history (P > 0.05). Age, hematoma density, midline shift, Bender classfication,encephalatrophy classfication,and bleeding tendency were found to be independently associated with the recurrence of CSDH by Logistic multifactorial analysis (P < 0. 05). Conclusions Patient age,hematoma density, midline shift, Bender classfication, encephalatrophy classfication, and bleeding tendency are prognostic factors fpatients for with CSDH. We should pay more attention to the recurrent risk factors,and implement corresponding prevention strategies.%目的 探讨慢性硬膜下血肿(chronic subdural hematoma,CSDH)术后复发的相关因素.方法 回顾性分析171例CSDH患者的临床资料.结果 本组CSDH患者术后共有18例复发,复发率为10.5%.单因素χ<'2>检验显示CSDH术后复发与年龄、血肿密度、血肿位置、中线移位、Bender分级、脑萎缩分级、引流量和出血倾向相关(P<0.05).与性别、麻醉方式和有无外伤史无关(P>0.05).Logistic多因素分析显示年龄,血肿密度、中线移位、Bender分级、脑萎缩分级和出血倾向为CSDH患者术后复发危险因素(P<0.05).结论 CSDH患者的年龄、血肿密度、中线移位、Bender分级和出血倾向与患者的预后密切相关,应针对复发的高危因素,做好相应的防治工作.

  8. "ACUTE FATTY LIVER OF PREGNANCY AND PREECLAMPSIA IN A TRIPLET GESTATION "

    Directory of Open Access Journals (Sweden)

    M. Ghaffarnejad

    2007-06-01

    Full Text Available Acute fatty liver of pregnancy (AFLP is a rare entity and a potentially fatal disorder. It is reported to be more common in multiple than singleton pregnancies. Sometimes it coincides with preeclampsia but the exact etiology is not yet understood. A 31-year-old G2 P1 patient admitted at 33 weeks of pregnancy with signs and symptoms of jaundice, gastroenteritis, hypertension, malaise, urinary incontinence and preterm contractions. She had history of idiopathic hypothalamic amenorrhea and by a recent trial with gonadotropins, she had got triplet gestation. After admission her general condition deteriorated. She underwent Cesarean section at once and all fetuses survived. She had severe postpartum hemorrhage. The results of laboratory tests indicated coagulopathy and liver function abnormalities. The AFLP was diagnosed on the third day of hospital stay. She was discharged one week later. Again she returned with complaint of severe sustained headache. Computed tomography showed subdural hemorrhage and drainage of hematoma was performed immediately. Finally the patient recovered from all of these critical conditions. This is the first report of AFLP in a patient with history of idiopathic hypothalamic amenorrhea. AFLP should be suspected in every pregnant patient with preeclampsia and gastroenteritis symptoms in the third trimester of pregnancy.

  9. Large N

    CERN Document Server

    Hooft, G

    2002-01-01

    In the first part of this lecture, the 1/N expansion technique is illustrated for the case of the large-N sigma model. In large-N gauge theories, the 1/N expansion is tantamount to sorting the Feynman diagrams according to their degree of planarity, that is, the minimal genus of the plane onto which the diagram can be mapped without any crossings. This holds both for the usual perturbative expansion with respect to powers of {tilde g}^2=g^2 N, as well as for the expansion of lattice theories in positive powers of 1/{tilde g}^2. If there were no renormalization effects, the tilde g expansion would have a finite radius of convergence. The zero-dimensional theory can be used for counting planar diagrams. It can be solved explicitly, so that the generating function for the number of diagrams with given 3-vertices and 4-vertices, can be derived exactly. This can be done for various kinds of Feynman diagrams. We end with some remarks about planar renormalization.

  10. IDH mutations in acute myeloid leukemia.

    Science.gov (United States)

    Rakheja, Dinesh; Konoplev, Sergej; Medeiros, L Jeffrey; Chen, Weina

    2012-10-01

    Acute myeloid leukemia is a heterogeneous group of diseases. Mutations of the isocitrate dehydrogenase (IDH) genes represent a novel class of point mutations in acute myeloid leukemia. These mutations prevent oxidative decarboxylation of isocitrate to α-ketoglutarate and confer novel enzymatic activity, facilitating the reduction of α-ketoglutarate to d-2-hydroxyglutarate, a putative oncometabolite. IDH1/IDH2 mutations are heterozygous, and their combined frequency is approximately 17% in unselected acute myeloid leukemia cases, 27% in cytogenetically normal acute myeloid leukemia cases, and up to 67% in acute myeloid leukemia cases with cuplike nuclei. These mutations are largely mutually exclusive. Despite many similarities of IDH1 and IDH2 mutations, it is possible that they represent distinct molecular or clinical subgroups of acute myeloid leukemia. All known mutations involve arginine (R), in codon 132 of IDH1 or codon 140 or 172 of IDH2. IDH1(R132) and IDH2(R140) mutations are frequently accompanied by normal cytogenetics and NPM1 mutation, whereas IDH2(R172) is frequently the only mutation detected in acute myeloid leukemia. There is increasing evidence that the prognostic impact of IDH1/2 mutations varies according to the specific mutation and also depends on the context of concurrent mutations of other genes. IDH1(R132) mutation may predict poor outcome in a subset of patients with molecular low-risk acute myeloid leukemia, whereas IDH2(R172) mutations confer a poor prognosis in patients with acute myeloid leukemia. Expression of IDH1/2 mutants induces an increase in global DNA hypermethylation and inhibits TET2-induced cytosine 5-hydroxymethylation, DNA demethylation. These data suggest that IDH1/2 mutations constitute a distinct mutational class in acute myeloid leukemia, which affects the epigenetic state, an important consideration for the development of therapeutic agents.

  11. Imaging of Acute Pancreatitis.

    Science.gov (United States)

    Thoeni, Ruedi F

    2015-11-01

    Acute pancreatitis is an acute inflammation of the pancreas. Several classification systems have been used in the past but were considered unsatisfactory. A revised Atlanta classification of acute pancreatitis was published that assessed the clinical course and severity of disease; divided acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis; discerned an early phase (first week) from a late phase (after the first week); and focused on systemic inflammatory response syndrome and organ failure. This article focuses on the revised classification of acute pancreatitis, with emphasis on imaging features, particularly on newly-termed fluid collections and implications for the radiologist.

  12. Acute cor pulmonale.

    Science.gov (United States)

    Jardin, François; Vieillard-Baron, Antoine

    2009-02-01

    Acute cor pulmonale is a form of acute right heart failure produced by a sudden increase in resistance to blood flow in the pulmonary circulation, which is now rapidly recognized by bedside echocardiography. In the clinical setting, acute cor pulmonale is mainly observed as a complication of massive pulmonary embolism or acute respiratory distress syndrome. In acute respiratory distress syndrome, the worsening effect of mechanical ventilation has been recently emphasized. As a general rule, the treatment consists in rapidly reducing resistance to blood flow in the pulmonary circulation, obtained by a specific strategy according to etiology.

  13. Acute loss of consciousness.

    Science.gov (United States)

    Tristán, Bekinschtein; Gleichgerrcht, Ezequiel; Manes, Facundo

    2015-01-01

    Acute loss of consciousness poses a fascinating scenario for theoretical and clinical research. This chapter introduces a simple yet powerful framework to investigate altered states of consciousness. We then explore the different disorders of consciousness that result from acute brain injury, and techniques used in the acute phase to predict clinical outcome in different patient populations in light of models of acute loss of consciousness. We further delve into post-traumatic amnesia as a model for predicting cognitive sequels following acute loss of consciousness. We approach the study of acute loss of consciousness from a theoretical and clinical perspective to conclude that clinicians in acute care centers must incorporate new measurements and techniques besides the classic coma scales in order to assess their patients with loss of consciousness.

  14. Acute pancreatitis in children and adolescents

    Institute of Scientific and Technical Information of China (English)

    Mitsuyoshi; Suzuki; Jin; Kan; Sai; Toshiaki; Shimizu

    2014-01-01

    In this Topic Highlight, the causes, diagnosis, and treat-ment of acute pancreatitis in children are discussed. Acute pancreatitis should be considered during the dif-ferential diagnosis of abdominal pain in children and requires prompt treatment because it may become life-threatening. The etiology, clinical manifestations, and course of acute pancreatitis in children are often differ-ent than in adults. Therefore, the specific features of acute pancreatitis in children must be considered. The etiology of acute pancreatitis in children is often drugs, infections, trauma, or anatomic abnormalities. Diagnosis is based on clinical symptoms(such as abdominal pain and vomiting), serum pancreatic enzyme levels, and im-aging studies. Several scoring systems have been pro-posed for the assessment of severity, which is useful for selecting treatments and predicting prognosis. The basic pathogenesis of acute pancreatitis does not greatly dif-fer between adults and children, and the treatments for adults and children are similar. In large part, our under-standing of the pathology, optimal treatment, assess-ment of severity, and outcome of acute pancreatitis in children is taken from the adult literature. However, we often find that the common management of adult pan-creatitis is difficult to apply to children. With advances in diagnostic techniques and treatment methods, severeacute pancreatitis in children is becoming better under-stood and more controllable.

  15. Acute necrotizing pancreatitis as fi rst manifestation of primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    Jeroen; I; Lenz; Jimmy; M; Jacobs; Bart; Op; de; Beeck; Ivan; A; Huyghe; Paul; A; Pelckmans; Tom; G; Moreels

    2010-01-01

    We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a kno...

  16. Juxta-Ampullary Intraluminal Diverticulum and Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Echenique-Elizondo M

    2004-05-01

    Full Text Available CONTEXT: Acute pancreatitis is usually due to well-known causes, such as biliary lithiasis and alcohol consumption. Anatomic abnormalities may represent a less frequent but important etiological factor. CASE REPORT: The case of a 27 year old women complaining of acute pancreatitis associated with a large duodenal juxta-papillary diverticulum is presented. CONCLUSIONS: Anatomic causes of pancreatitis must be considered in the diagnosis of the etiology of acute pancreatitis.

  17. Successful treatment of both double minute of C-MYC and BCL-2 rearrangement containing large B-cell lymphoma with subsequent unfortunate development of therapy-related acute myeloid leukemia with t(3;3)(q26.2;q21).

    Science.gov (United States)

    Nguyen, John C; Kubik, Melanie J; Broome, H Elizabeth; Curtin, Peter T; Dell'Aquila, Marie L; Wang, Huan-You

    2015-11-01

    Double minute chromosomes (DMs), although relatively frequently encountered in solid tumors, are rare in hematologic neoplasms such as acute myeloid leukemia (AML), and even rarer in lymphoid neoplasms. t(3;3)(q26.2;q21) is a very rare genetic alteration observed in myeloid neoplasm. Herein we report an interesting and unique case of concomitant C-MYC DMs and t(14;18)-containing large B-cell lymphoma, which was successfully treated with R-hyper-CVAD; unfortunately, the patient has developed a therapy-related AML (t-AML) 2 years since the start of his lymphoma treatment. His t-AML contains both t(3;3)(q26.2;q21) and monosomy 7, and the patient died of AML 10 months after the initial diagnosis of t-AML despite clinical remission. To the best of our knowledge, this is the first reported case of C-MYC DM-containing de novo large B-cell lymphoma, which was successfully treated with complete remission, but unfortunately died of t-AML harboring t(3;3)(q21;q26). Copyright © 2015 Elsevier GmbH. All rights reserved.

  18. Decitabine in Treating Children With Relapsed or Refractory Acute Myeloid Leukemia or Acute Lymphoblastic Leukemia

    Science.gov (United States)

    2013-01-22

    Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Promyelocytic Leukemia (M3); Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia

  19. Acute chylous peritonitis due to acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Georgios K Georgiou; Haralampos Harissis; Michalis Mitsis; Haralampos Batsis; Michalis Fatouros

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse.The development of chylous ascites is usually a chronic process mostly involving malignancy,trauma or surgery,and symptoms arise as a result of progressive abdominal distention.However,when accumulation of "chyle" occurs rapidly,the patient may present with signs of peritonitis.Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation,appendicitis or visceral ischemia.Less than 100 cases of acute chylous peritonitis have been reported.Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis.This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis,and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis.The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer,since,due to hypertriglyceridemia,serum amylase values appeared within the normal range.Moreover,abdominal computed tomography imaging was not diagnostic for pancreatitis.Following abdominal lavage and drainage,the patient was successfully treated with total parenteral nutrition and octreotide.

  20. Acute chylous peritonitis due to acute pancreatitis.

    Science.gov (United States)

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.

  1. Acute otitis media and acute bacterial sinusitis.

    Science.gov (United States)

    Wald, Ellen R

    2011-05-01

    Acute otitis media and acute bacterial sinusitis are 2 of the most common indications for antimicrobial agents in children. Together, they are responsible for billions of dollars of health care expenditures. The pathogenesis of the 2 conditions is identical. In the majority of children with each condition, a preceding viral upper respiratory tract infection predisposes to the development of the acute bacterial complication. It has been shown that viral upper respiratory tract infection predisposes to the development of acute otitis media in 37% of cases. Currently, precise microbiologic diagnosis of acute otitis media and acute bacterial sinusitis requires performance of tympanocentesis in the former and sinus aspiration in the latter. The identification of a virus from the nasopharynx in either case does not obviate the need for antimicrobial therapy. Furthermore, nasal and nasopharyngeal swabs are not useful in predicting the results of culture of the middle ear or paranasal sinus. However, it is possible that a combination of information regarding nasopharyngeal colonization with bacteria and infection with specific viruses may inform treatment decisions in the future.

  2. Acute pancreatitis in acute viral hepatitis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To elucidate the frequency and characteristics of pancreatic involvement in the course of acute (nonfulminant) viral hepatitis.METHODS: We prospectively assessed the pancreatic involvement in patients with acute viral hepatitis who presented with severe abdomimanl pain.RESULTS: We studied 124 patients with acute viral hepatitis, of whom 24 presented with severe abdominal pain. Seven patients (5.65%) were diagnosed to have acute pancreatitis. All were young males. Five patients had pancreatitis in the first week and two in the fourth week after the onset of jaundice. The pancreatitis was mild and all had uneventful recovery from both pancreatitis and hepatitis on conservative treatment.The etiology of pancreatitis was hepatitis E virus in 4,hepatitis A virus in 2, and hepatitis B virus in 1 patient.One patient had biliary sludge along with HEV infection.The abdominal pain of remaining seventeen patients was attributed to stretching of Glisson's capsule.CONCLUSION: Acute pancreatitis occurs in 5.65% of patients with acute viral hepatitis, it is mild and recovers with conservative management.

  3. [Acute Sensory Neuropathies and Acute Autonomic Neuropathies].

    Science.gov (United States)

    Koike, Haruki

    2015-11-01

    From the perspective of neuropathies with an acute onset mimicking that of Guillain-Barré syndrome (GBS), cases with profound sensory and/or autonomic impairment without any significant weakness have been reported. Although the possibility of infectious or toxic etiologies should be carefully excluded, immune mechanisms similar to those in GBS are suggested to be involved in these so-called acute sensory neuropathies and acute autonomic neuropathies. The types of neuropathy include those with predominant sensory manifestations, predominant autonomic manifestations such as autoimmune autonomic ganglionopathy, and both sensory and autonomic manifestations such as acute autonomic and sensory neuropathy. Neuronopathy in the sensory and/or autonomic ganglia (i.e., ganglionopathy) has been commonly suggested in patients with these types of neuropathies. The presence of Anti-GD1b antibodies has been reported in some of the patients with acute sensory neuropathy with deep sensory impairment, whereas anti-ganglionic acetylcholine receptor antibodies are reported to be present in half of the patients with autoimmune autonomic ganglionopathy. The discovery of anti-ganglionic acetylcholine receptor antibodies significantly expanded the spectrum of autoimmune autonomic ganglionopathy. This is because some of the patients with chronic progression mimicking neurodegenerative diseases such as pure autonomic failure were positive for these antibodies. In contrast, pathologically significant autoantibodies have not been identified in acute autonomic and sensory neuropathy. Further studies are needed to clarify the pathogenesis and the spectrum of these types of neuropathies.

  4. 置氧法治疗对老年慢性硬膜下血肿患者脑组织结构和功能的保护作用%Protective effect of oxygen-exchange therapy on cerebral tissue structure and function in the elderly with chronic subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    董欣明; 袁玉会; 潘蔚然; 王成林

    2005-01-01

    into the needle guard to cause the blood discharged from hematom again. Oxygen was perfused repetitively, once for 10 mL, till there was no blood flow. Finally, 10 mL oxygen was perfused following moving of trochar and bandaging.Oxygen volume used in each case was recorded. After operation,the volume of normal saline infusion could be increased as large as possible. The duration of infusion was 2 weeks.MAIN OUTCOME MEASURES: Improvement in limb function.RESULTS: All the patients were involved in the result analysis.①Within 24 hours, volume of hematomwas decreased obviously detected with CT, and hematom completely disappeared in 3 cases,which was replaced by oxygen. Three weeks later, all the oxygen was absorbed, the structure of midline was symmetrical and the form of brain ventricles was normal. No pain was found and 5 casesof limb asthenia were also recovered. ②Advantage and disadvantage of foramen-vertebrate oxygen-exchange operation: Advantages were listed as follows: It was simple and spent shorter time,there were few complications, and patients had no limitation in movement after operation. The operation avoided the occurrence of thrombosis of lower limbs. Cranial pressure could not lower quickly. As the pressure resident in envelope, cerebraospinal fluid could not move into the envelope. Along with the absorption of oxygen,hematom was decreased gradually till completely disappeared. Occurrence of clinical symptoms resulting from cerebral blood perfusion was decreased so as to draw rein. The disadvantage of this operation was that it was not suitable for heart disease patients to undertake this operation at bedside, and headache or limb asthenia could not be alleviated immediately.CONCLUSION: The new operation-method of cranial foramen-vertebrate oxygen-exchange to treat chronic subdural hemtoma in the elderly is safe, reliable and feasible through preoperative CT localization.%背景:老年慢性硬膜下血肿以往均采用传统的颅骨钻孔冲洗引

  5. [Acute cerebellitis in infectious mononucleosis. One case (author's transl)].

    Science.gov (United States)

    Dandelot, J B; Samson, M; Augustin, P; Mihout, B; Parain, D

    1979-02-10

    A nineteen year old man present an original clinical case of acute cerebellitis in infectious mononucleosis. Eighteen months after the acute phase of the illness, there persisted a large deficit in the circulating B lymphocytes. A short review of pertinent litterature is presented and current physiopathological hypothesis are discussed. Briefly, delayed immunity and personal predisposition appear to play important etiological roles.

  6. [Acute rheumatic fever].

    Science.gov (United States)

    Maier, Alexander; Kommer, Vera

    2016-03-01

    We report on a young women with acute rheumatic fever. Acute rheumatic fever has become a rare disease in Germany, especially in adults. This carries the risk that it can be missed in the differential diagnostic considerations of acute rheumatic disorders and febrile status. If rheumatic fever is not diagnosed and treated correctly, there is a considerable risk for rheumatic valvular heart disease. In this article diagnosis, differential diagnosis and therapy of rheumatic fever are discussed extensively.

  7. Acute Idiopathic Scrotal Edema

    Directory of Open Access Journals (Sweden)

    Micheál Breen

    2013-01-01

    Full Text Available We report a case of acute idiopathic scrotal edema (AISE in a 4-year-old boy who presented with acute scrotal pain and erythema. The clinical features, ultrasound appearance, and natural history of this rare diagnosis are reviewed. In this report, we highlight the importance of good ultrasound technique in differentiating the etiology of the acute scrotum and demonstrate the color Doppler “Fountain Sign” that is highly suggestive of AISE.

  8. Pharm GKB: Leukemia, Nonlymphocytic, Acute [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym ANLL; Acute Nonlymphoblastic Leukemia; Acute Nonl...ymphoblastic Leukemias; Acute Nonlymphocytic Leukemia; Acute Nonlymphocytic Leukemias; Leukemia, Acute Nonly...mphoblastic; Leukemia, Acute Nonlymphocytic; Leukemia, Nonlymphoblastic, Acute; Leukemias, Acute Nonlymphoblastic; Leukemias, Acute... Nonlymphocytic; Nonlymphoblastic Leukemia, Acute; Nonlymphoblastic Leukemias, Acut...e; Nonlymphocytic Leukemia, Acute; Nonlymphocytic Leukemias, Acute PharmGKB Accessi

  9. Pharm GKB: Leukemia, Myeloid, Acute [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Amino Acid Translations are all sourced from dbSNP 144 Overview Alternate Names: Synonym AML - Acute... myeloblastic leukaemia; Acute Myeloblastic Leukemia; Acute Myeloblastic Leukemias; Acute... Myelocytic Leukemia; Acute Myelocytic Leukemias; Acute Myelogenous Leukemia; Acute Myelogenous Leukemias; Acute... granulocytic leukaemia; Acute myeloblastic leukemia; Acute myeloid leukaemia; Acute myeloid leukaemia - category; Acute... myeloid leukaemia, disease; Acute myeloid leukemia; Acute myelo

  10. Pharm GKB: Kidney Failure, Acute [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available iew Alternate Names: Synonym ARF - Acute renal failure; Acute Kidney Failure; Acute Kidney Failures; Acute K...idney Insufficiencies; Acute Kidney Insufficiency; Acute Renal Failure; Acute Renal Failures; Acute... Renal Insufficiencies; Acute Renal Insufficiency; Acute renal failure syndrome, NOS; Failure, Acute... Kidney; Failure, Acute Renal; Failures, Acute Kidney; Failures, Acute Renal; Insufficiencies, Acute... Kidney; Insufficiencies, Acute Renal; Insufficiency, Acute Kidney; Insufficiency, Acute

  11. Infant acute myocarditis mimicking acute myocardial infarction

    Science.gov (United States)

    Tilouche, Samia; Masmoudi, Tasnim; Sahnoun, Maha; Chkirbène, Youssef; Mestiri, Sarra; Boughamoura, Lamia; Ben Dhiab, Mohamed; Souguir, Mohamed Kamel

    2016-01-01

    Myocarditis is an inflammatory disease of the myocardium with heterogeneous clinical manifestations and progression. In clinical practice, although there are many methods of diagnosis of acute myocarditis, the diagnosis remains an embarrassing dilemma for clinicians. The authors report the case of 9-month-old infant who was brought to the Pediatric Emergency Department with sudden onset dyspnea. Examination disclosed heart failure and resuscitation was undertaken. The electrocardiogram showed an ST segment elevation in the anterolateral leads with a mirror image. Cardiac enzyme tests revealed a significant elevation of troponin and creatine phosphokinase levels. A diagnosis of acute myocardial infarction was made, and heparin therapy was prescribed. The infant died on the third day after admission with cardiogenic shock. The autopsy showed dilatation of the ventricles and massive edema of the lungs. Histological examinations of myocardium samples revealed the presence of a marked lymphocytic infiltrate dissociating myocardiocytes. Death was attributed to acute myocarditis. The authors call attention to the difficulties of differential diagnosis between acute myocarditis and acute myocardial infarction especially in children, and to the important therapeutic implications of a correct diagnosis. PMID:28210569

  12. Statins in Acute Ischemic Stroke: A Systematic Review

    National Research Council Canada - National Science Library

    Hong, Keun-Sik; Lee, Ji Sung

    2015-01-01

    Statins have pleiotropic effects of potential neuroprotection. However, because of lack of large randomized clinical trials, current guidelines do not provide specific recommendations on statin initiation in acute ischemic stroke (AIS...

  13. Simplified percutaneous large bore suprapubic cystostomy for acute ...

    African Journals Online (AJOL)

    C.O. Okorie

    in a sagittal direction – two finger breadths above the pubic symphysis. The main outcome ... There was no mortality and no adjacent visceral injury. ... Some tips and tricks that .... come in this series was extremely good in the author's hand.

  14. Acute myopericarditis masquerading as acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Wen Tian; Zixin Zhang; Xiaojuan Bai; Dingyin Zeng; Guoxian Qi

    2008-01-01

    Patients with abrupt onset of chest pain, ischemic ECG abnormalities and elevated levels of cardiac markers could be given a diagnosis of acute myocardial infarction. However, some other diseases should be taken into consideration in this clinical setting when coronary arteries are proven to be normal. Here we report a case of acute myopericarditis with clinical presentation of myocardial infarction and normal coronary anatomy. The Herpes Simplex Virus Ⅱ was considered as the organism causing myopericarditis and the patient was recovered by the treatment with valacicloavir. A precise diagnosis is a prerequisite of successful treatment and favorable prognosis.

  15. [Acute kidney injury

    NARCIS (Netherlands)

    Hageman, D.; Kooman, J.P.; Lance, M.D.; Heurn, L.W. van; Snoeijs, M.G.

    2012-01-01

    - 'Acute kidney injury' is modern terminology for a sudden decline in kidney function, and is defined by the RIFLE classification (RIFLE is an acronym for Risk, Injury, Failure, Loss and End-stage kidney disease).- Acute kidney injury occurs as a result of the combination of reduced perfusion in the

  16. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  17. Corticosteroids for acute rhinosinusitis

    NARCIS (Netherlands)

    Venekamp, R.P.

    2012-01-01

    Acute rhinosinusitis is a common reason for consultations in general practice, with typically 50 cases seen by a general practitioner annually. Traditionally, acute rhinosinusitis has been regarded as a bacterial infection of the paranasal sinuses. Therefore, numerous randomised controlled trials ha

  18. [Acute kidney injury

    NARCIS (Netherlands)

    Hageman, D.; Kooman, J.P.; Lance, M.D.; Heurn, L.W. van; Snoeijs, M.G.

    2012-01-01

    - 'Acute kidney injury' is modern terminology for a sudden decline in kidney function, and is defined by the RIFLE classification (RIFLE is an acronym for Risk, Injury, Failure, Loss and End-stage kidney disease).- Acute kidney injury occurs as a result of the combination of reduced perfusion in the

  19. Acute recurrent polyhydramnios

    DEFF Research Database (Denmark)

    Rode, Line; Bundgaard, Anne; Skibsted, Lillian

    2007-01-01

    Acute recurrent polyhydramnios is a rare occurrence characterized by a poor fetal outcome. This is a case report describing a 34-year-old woman presenting with acute recurrent polyhydramnios. Treatment with non-steroidal anti-inflammatory drugs (NSAID) and therapeutic amniocenteses was initiated ...

  20. Survey of the management of acute asthma in children.

    LENUS (Irish Health Repository)

    Widger, J

    2009-12-01

    Acute asthma is one of the most common reasons for children presenting to the emergency department. International guidelines for the management of acute paediatric asthma are widely available. In this study we examined how acute asthma in children is managed across hospitals in Ireland and compared Irish practice with standard international guidelines. We surveyed 54 paediatricians across 18 centres in Ireland. A total of 30 (55.5%) individual paediatricians across 17 (94%) centres replied. The majority of centres had a written protocol for the management of acute asthma. A large number of centres use MDI and spacer devices in acute management although doses used varied widely. Only 29% of centres had written asthma action plans available from the emergency department and 53% had plans available from the ward. Irish practice is largely inline with established guidelines. A national asthma strategy could further help to improve asthma care.

  1. Acute kidney injury during pregnancy.

    Science.gov (United States)

    Van Hook, James W

    2014-12-01

    Acute kidney injury complicates the care of a relatively small number of pregnant and postpartum women. Several pregnancy-related disorders such as preeclampsia and thrombotic microangiopathies may produce acute kidney injury. Prerenal azotemia is another common cause of acute kidney injury in pregnancy. This manuscript will review pregnancy-associated acute kidney injury from a renal functional perspective. Pathophysiology of acute kidney injury will be reviewed. Specific conditions causing acute kidney injury and treatments will be compared.

  2. [Chronic pancreatitis, acute pancreatitis].

    Science.gov (United States)

    Mabuchi, T; Katada, N; Nishimura, D; Hoshino, H; Shimizu, F; Suzuki, R; Sano, H; Kato, K

    1998-11-01

    MRCP has been recognized as a safe and noninvasive diagnostic method. In the present study we evaluated the usefulness of MRCP in diagnosis of chronic and acute pancreatitis. Two-dimensional fast asymmetric spin-echo (FASE) MRCP was performed in 40 patients with chronic pancreatitis and 13 with acute pancreatitis. In 29 patients (72.5%) with chronic pancreatitis and 9 (66.7%) with acute pancreatitis, main pancreatic duct (MPD) was visualized entirely. MRCP could demonstrate the characteristic findings of chronic pancreatitis such as dilatation and irregularity of MPD in most cases. In acute pancreatitis, MRCP indicated that MPD was normal in diameter, but irregular in configuration compared with that of the control group. MRCP may facilitate the diagnosis of chronic and acute pancreatitis.

  3. Application of damage control surgery in traumatic interhemispheric subdural hematoma%损伤控制理念在外伤性纵裂血肿治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    李帆; 李建红; 王伟; 王彦宏; 王向东; 赵志强; 邵双伟; 任新亮

    2013-01-01

    Objective To discuss the application of damage control surgery (DCS) in thetreatment of traumatic interhemispheric subdural hematoma (TISH).Methods The clinical data of 10 TISH patients who were treated with DCS were reviewed retrospectively.To summarize the concept and complications of DCS in treatment of TISH.Results All of 10 patients,2 underwent conservative treatment,4 underwent surgical operation,4 routine borehole drainage.According to Glasgow outcome score method,9 cases recovered well,1 case had mild disability.Conclusions Application of damage control surgery,chosing the right operation method,combining with the integration in the late treatment is safe,reliable method of treatment,can effectively reduce the mortality and complication rates of TISH.%目的 探讨损伤控制外科(DCS)理念在外伤性纵裂血肿(TISH)治疗中的应用.方法 回顾性分析采用DCS理念救治的10例TISH患者的临床资料,总结应用DCS理念救治TISH的适应证、并发症.结果 10例患者中2例行保守治疗,4例行开颅手术,4例行钻孔引流术.按格拉斯哥预后量表评分法,9例恢复良好,1例轻度残疾.结论 应用DCS理念,选择恰当的手术方式,结合后期的一体化治疗不失为比较安全、稳妥的救治方法,可有效地降低TISH的病死率和并发症发生率.

  4. Contributions to singing ability by the posterior portion of the superior temporal gyrus of the non-language-dominant hemisphere: first evidence from subdural cortical stimulation, Wada testing, and fMRI.

    Science.gov (United States)

    Suarez, Ralph O; Golby, Alexandra; Whalen, Stephen; Sato, Susumu; Theodore, William H; Kufta, Conrad V; Devinsky, Orrin; Balish, Marshall; Bromfield, Edward B

    2010-03-01

    Although the substrates that mediate singing abilities in the human brain are not well understood, invasive brain mapping techniques used for clinical decision making such as intracranial electro-cortical testing and Wada testing offer a rare opportunity to examine music-related function in a select group of subjects, affording exceptional spatial and temporal specificity. We studied eight patients with medically refractory epilepsy undergoing indwelling subdural electrode seizure focus localization. All patients underwent Wada testing for language lateralization. Functional assessment of language and music tasks was done by electrode grid cortical stimulation. One patient was also tested non-invasively with functional magnetic resonance imaging (fMRI). Functional organization of singing ability compared to language ability was determined based on four regions-of-interest (ROIs): left and right inferior frontal gyrus (IFG), and left and right posterior superior temporal gyrus (pSTG). In some subjects, electrical stimulation of dominant pSTG can interfere with speech and not singing, whereas stimulation of non-dominant pSTG area can interfere with singing and not speech. Stimulation of the dominant IFG tends to interfere with both musical and language expression, while non-dominant IFG stimulation was often observed to cause no interference with either task; and finally, that stimulation of areas adjacent to but not within non-dominant pSTG typically does not affect either ability. Functional fMRI mappings of one subject revealed similar music/language dissociation with respect to activation asymmetry within the ROIs. Despite inherent limitations with respect to strictly research objectives, invasive clinical techniques offer a rare opportunity to probe musical and language cognitive processes of the brain in a select group of patients. Copyright (c) 2009 Elsevier Srl. All rights reserved.

  5. Pharm GKB: Leukemia, Monocytic, Acute [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym Acute Monoblastic Leukemia; Acute Monoblastic Leukemias; Acute... Monocytic Leukemia; Acute Monocytic Leukemias; Acute monoblastic leukaemia; Acute monoblastic leukemia; Acute... monocytic leukaemia; Acute monocytic leukemia, morphology; Acute monocytoid leukemia; Leukemia, Acute... Monoblastic; Leukemia, Acute Monocytic; Leukemia, Monoblastic, Acute; Leukemia, Myeloid, Acute... Schilling-Type Myeloid; Leukemias, Acute Monoblastic; Leukemias, Acute Monocytic; M5a - Acute monoblastic leukaemia; M5a - Acute

  6. Relationship Between Acute Benzodiazepine Poisoning and Acute Pancreatitis Risk: A Population-Based Cohort Study.

    Science.gov (United States)

    Liaw, Geng-Wang; Hung, Dong-Zong; Chen, Wei-Kung; Lin, Cheng-Li; Lin, I-Ching; Kao, Chia-Hung

    2015-12-01

    We designed a population-based retrospective cohort study to investigate the association between the event of benzodiazepine (BZD) poisoning and the risk of acute pancreatitis.In the present study, 12,893 patients with BZD poisoning during 2000 to 2011 were enrolled and matched with 4 comparison patients according to mean age and sex. We determined the cumulative incidences and adjusted hazard ratios of acute pancreatitis.A significant association was observed between BZD poisoning and acute pancreatitis. After adjustment for potential risk factors, the patients with BZD poisoning had a 5.33-fold increased risk of acute pancreatitis compared with the controls without BZD poisoning (HR = 5.33, 95% CI = 2.26-12.60). The results revealed that acute pancreatitis in patients with BZD poisoning occurred in a follow-up time of ≤1 month (HR = 50.0, P risk of acute pancreatitis was no different between the patients with and without BZD poisoning when the follow-up time was >1 month (HR = 1.07, P > .05).This population-based study revealed the positive correlation between the event of BZD poisoning and an increased risk of acute pancreatitis. The findings warrant further large-scale and in-depth investigation.

  7. SP-A在急性肠损伤大鼠大肠和肺组织中表达的相关性研究%Correlative Study on Expression of SP-A in Lung And Large Intestine in Acute Intestinal Injury Rats

    Institute of Scientific and Technical Information of China (English)

    郑继生; 李志军; 沈延飞; 董雷; 李敏静; 丁志山; 蔡宛如

    2013-01-01

    目的:通过动态观测急性肠损伤(Acute intestinal injury,AⅡ)肺和大肠等组织中肺表面活性蛋白A(pulmonary surfactant protein A,SP-A)含量的变化,寻找其表达的规律及各组织的相关性.方法:60只SD大鼠随机分为六组:空白对照组、生理盐水组(normal saline group,NS组)、急性肠损伤12h组(AⅡ12h组)、急性肠损伤24h组(AⅡ24h组)、急性肠损伤36h组(AⅡ36h组)、急性肠损伤48h组(AⅡ48h组).采用结肠内注入醋酸(Acetic acid)法制备AⅡ大鼠模型,NS组注入等量NS,空白对照组不作任何处理.分别于注入醋酸后12、24、36、48 h及注入NS后48 h采集标本,空白对照组亦于48 h后采集标本,采用酶联免疫法(enzyme-linked immunosorbent assay,ELISA)检测大鼠BALF及各种组织中SP-A的含量.结果:①各组大鼠BALF中SP-A的含量明显高于肺、大肠、皮肤、肝组织,有极显著性差异(P<0.01);肺组织SP-A含量其次,与其他组织比有显著性差异(P<0.05),小肠组织中无SP-A表达.②NS组、空白对照组BALF、肺、大肠、肝中SP-A的含量较AII36h组高,差异有极显著性(P<0.01).③AⅡ时间延长,AⅡ各组BALF、肺组织、大肠组织中SP-A的含量下降,至AⅡ36h时含量降至最低;随后有回升趋势.④大肠组织与BALF、肺、皮肤、肝组织中SP-A含量的相关性比较,相关系数r分别为0.292,0.378,0.137,0.518.结论:①大鼠SP-A的合成与分泌具有一定特异性;②BALF、肺、大肠、肝组织中SP-A含量的变化与AⅡ的严重程度有一定的相关性;③大鼠大肠组织中SP-A表达的变化与肝、肺组织中SP-A表达的变化一致性较好.%Objective:By observing the content change of SP-A in lung,large and etc in ALI rats,so as to find the regularity expression and the correlation of substance.Methods:60 SD rats were randomly divided into six groups:blank group,normal saline group,AⅡ12 h group,AⅡ24 h group AⅡ36 h group AⅡ48 h group.The AⅡ rats

  8. Experimental study of effectiveness of local application of electroneurostimulation, cortexin and methylprednisolone in acute spinal cord injury

    Directory of Open Access Journals (Sweden)

    Tsymbaliuk V.I.

    2014-09-01

    Full Text Available The tasks were to investigate the effect of topical electroneurostimulation, cortexin and methy¬lprednisolone in acute spinal cord injury in electrophysiological experiments on laboratory rats. The animals un¬derwent half transection of the spinal cord in the lower-thoracic area to simulate Brown-Sequard’s syndrome. Drugs were administered subdurally once daily in the dose of 0.03 mg for cortexin and 0.7 mg for methylprednisolone during 72 hours. Electrophysiological studies were carried out using standard electrophysiological apparatus. Reliable changes of bioelectric indicators in neuromuscular complex during topical application of electrical stimulation, as well as in administered methylprednisolone, failed to be found. However, local application of cortexin in terms of traumatic spinal cord injury due the antioxidant and neurotrophic effect results in improvement of bioelectrical indicators; this is manifested in reliable (p<0.05 increase of amplitude of the background electromyogram impulses at rest by 33% and increase of spontaneous oscillations frequency by 29.82%.

  9. ERCP in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jijo V Cherian; Joye Varghese Selvaraj; Rajesh Natrayan; Jayanthi Venkataraman

    2007-01-01

    BACKGROUND:The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute pancreatitis has evolved over years since its introduction in 1968. Its importance in diagnosing the etiology of pancreatitis has steadily declined with the advent of less invasive diagnostic tools. The therapeutic implications of ERCP in acute pancreatitis are many fold and are directed towards management of known etiological factors or its related complications. This article highlights the current status of ERCP in acute pancreatitis. DATA SOURCES:An English literature search using PubMed database was conducted on ERCP in acute pancreatitis, the etiologies and complications of pancreatitis amenable to endotherapy and other related subjects, which were reviewed. RESULTS: ERCP serves as a primary therapeutic modality for management of biliary pancreatitis in speciifc situations, pancreatitis due to microlithiasis, speciifc types of sphincter of Oddi dysfunction, pancreas divisum, ascariasis and malignancy. In recurrent acute pancreatitis and smoldering pancreatitis it has a deifnite therapeutic utility. Complications of acute pancreatitis including pancreatic-duct disruptions or leaks, benign pancreatic-lfuid collections and pancreatic necrosis can be beneifcially dealt with. Intraductal ultrasound and pancreatoscopy during ERCP are useful in detecting pancreatic malignancy. CONCLUSIONS:The role of ERCP in acute pancreatitis is predominantly therapeutic and occasionally diagnostic. Its role in the management continues to evolve and advanced invasive procedures should be undertaken only in centers dedicated to pancreatic care.

  10. Efeitos da hipertensão arterial induzida sobre a complacência e pressão de perfusão encefálica em hipertensão intracraniana experimental: comparação entre lesão encefálica criogênica e balão subdural Efectos de la hipertensión arterial inducida sobre la complacencia y presión de la perfusión encefálica en hipertensión intracraneana experimental: comparación entre lesión encefálica criogénica y balón subdural Effects of induced hypertension on brain compliance and perfusion pressure in experimental intracranial hypertension: comparison between cryogenic brain injury and subdural balloon

    OpenAIRE

    Nelson Mizumoto; Humberto Katsuji Tango; Marcelo Lacava Pagnocca

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: O trauma cranioencefálico (TCE) pode elevar a pressão intracraniana (PIC) e reduzir a complacência encefálica (CE). Diferentes lesões são aplicadas em modelos de TCE que estudam as mesmas variáveis. Como são usadas indistintamente, o objetivo é comparar a PIC e a CE em dois modelos de TCE. MÉTODO: Dezoito cães machos, anestesiados, ventilados e distribuídos aleatoriamente em dois grupos: BS - balão subdural (n = 9) e LC - lesão criogênica (n = 9). Análise da PIC, CE...

  11. Acute oncological emergencies.

    LENUS (Irish Health Repository)

    Gabriel, J

    2012-01-01

    The number of people receiving systemic anti-cancer treatment and presenting at emergency departments with treatment-related problems is rising. Nurses will be the first point of contact for most patients and need to be able to recognise oncological emergencies to initiate urgent assessment of patients and referral to the acute oncology team so that the most appropriate care can be delivered promptly. This article discusses the role of acute oncology services, and provides an overview of the most common acute oncological emergencies.

  12. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    Directory of Open Access Journals (Sweden)

    Olfa Kassar

    2015-01-01

    Full Text Available Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patient and conservative treatment was attempted in the other patient. None treatment measures were effective and two patients died. Acute acalculous cholecystitis is a serious complication in neutropenic patients. Earlier diagnosis could have expedited the management of these patients.

  13. Acute Radiation Syndrome

    Science.gov (United States)

    ... Matters Information on Specific Types of Emergencies Acute Radiation Syndrome (ARS): A Fact Sheet for the Public ... is called the radiation dose. People exposed to radiation will get ARS only if: The radiation dose ...

  14. Acute mountain sickness

    Science.gov (United States)

    High altitude cerebral edema; Altitude anoxia; Altitude sickness; Mountain sickness; High altitude pulmonary edema ... Acute mountain sickness is caused by reduced air pressure and lower oxygen levels at high altitudes. The faster you ...

  15. Low back pain - acute

    Science.gov (United States)

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back ... lower back supports most of your body's weight. Low back pain is the number two reason that ...

  16. Acute Intermittent Porphyria (AIP)

    Science.gov (United States)

    ... attacks, but are usually not chronic. Wearing a Medic Alert bracelet is advisable for patients who have ... Week is ONE Month Away! Mar 17, 2017 Access to Care Toolkit for the Acute Porphyrias is ...

  17. Acute genital ulcers.

    Science.gov (United States)

    Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora

    2014-01-28

    Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.

  18. Treatment of acute gout.

    Science.gov (United States)

    Schlesinger, Naomi

    2014-05-01

    This article presents an overview of the treatment of acute gout. Nonpharmacologic and pharmacologic treatments, monotherapy versus combination therapy, suggested recommendations, guidelines for treatment, and drugs under development are discussed.

  19. Acute Lymphocytic Leukemia

    Science.gov (United States)

    ... for information in your local library and on the Internet. Good sources include the National Cancer Institute, the ... mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/basics/definition/CON-20042915 . Mayo Clinic Footer Legal Conditions and ...

  20. Acute Myelogenous Leukemia (AML)

    Science.gov (United States)

    ... for information in your local library and on the Internet. Good sources include the National Cancer Institute, the ... mayoclinic.org/diseases-conditions/acute-myelogenous-leukemia/basics/definition/CON-20043431 . Mayo Clinic Footer Legal Conditions and ...

  1. Acute heart failure syndrome

    African Journals Online (AJOL)

    tandfonline.com/ ... When heart failure develops gradually, there is time for the compensatory ... of this can be seen in acute brain injury, some forms of takotsubo syndrome or .... reduce blood pressure in cases presenting with elevated blood pressure.

  2. Acute management of stones

    DEFF Research Database (Denmark)

    Jung, Helene; Osther, Palle J S

    2015-01-01

    INTRODUCTION: Stone management is often conservative due to a high spontaneous stone passage rate or non-symptomatic calyceal stones that do not necessarily require active treatment. However, stone disease may cause symptoms and complications requiring urgent intervention. MATERIAL AND METHODS......: In this review, we update latest research and current recommendations regarding acute management of stones, with particular focus on imaging, pain management, active stone interventions, medical expulsive therapy, and urolithiasis in pregnancy and childhood. RESULTS: Acute stone management should be planned...

  3. Acute liver failure

    DEFF Research Database (Denmark)

    Larsen, Fin Stolze; Bjerring, Peter Nissen

    2011-01-01

    Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these.......Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these....

  4. Feigning Acute Intermittent Porphyria

    Directory of Open Access Journals (Sweden)

    Rania Elkhatib

    2014-01-01

    Full Text Available Acute intermittent porphyria (AIP is an autosomal dominant genetic defect in heme synthesis. Patients with this illness can have episodic life-threatening attacks characterized by abdominal pain, neurological deficits, and psychiatric symptoms. Feigning this illness has not been reported in the English language literature to date. Here, we report on a patient who presented to the hospital with an acute attack of porphyria requesting opiates. Diligent assessment of extensive prior treatment records revealed thirteen negative tests for AIP.

  5. Acute local radiation injuries

    Energy Technology Data Exchange (ETDEWEB)

    Gongora, R. (Institut Curie, 75 - Paris (France)); Jammet, H. (Commissariat a l' Energie Atomique, ISPN, 92 - Fontenay-aux-Roses (France))

    1983-01-01

    Local acute radiation injuries do not occur very often. Their origin is generally accidental. They show specific anatomo-clinical features. The clinical evolution and therapeutic behaviour are dependent on the dose level and topographical distribution. The dosimetric assessment requires physical methods and paraclinical investigations. From a study of 60 cases followed by the International Center of Radiopathology, the clinical symptomatology is described and the problems raised to the radiopathologist physician by local acute radiation injuries are stated.

  6. [Acute Kidney Injury].

    Science.gov (United States)

    Brix, Silke; Stahl, Rolf

    2017-02-01

    Acute kidney injury (AKI) is an important part of renal diseases and a common clinical problem. AKI is an acute decline in renal function. Due to a lack of therapeutic options, prevention and optimal management of patients with AKI are the most important strategies. Although seldom the sole cause of patients' death, AKI is associated with a significant increase in mortality. Our objective is to draw the attention towards the prevention of AKI of non-renal causes.

  7. 依达拉奉联合尼莫地平治疗急性大面积脑梗死的临床观察%Clinical Observation of Edaravone Combined with Nimodipine in the Treatment of Acute Large Area Cere-bral Infarction

    Institute of Scientific and Technical Information of China (English)

    郑超; 陈奕; 张凤; 王智超; 黄雪琴; 石钢

    2016-01-01

    目的:观察依达拉奉联合尼莫地平治疗急性大面积脑梗死的疗效和安全性。方法:78例急性大面积脑梗死患者随机分为对照组(38例)和观察组(40例)。对照组患者给予拜阿司匹林、降低颅内压药、维持水电解质平衡药、减轻脑水肿药、注射用血塞通注射液、银杏叶注射液、降脂和降压药、维持血糖药等常规治疗;观察组患者在对照组治疗的基础上给予依达拉奉注射液30 mg,加入0.9%氯化钠注射液100 ml中,静脉滴注(30 min内滴完),每日2次+尼莫地平注射液12 mg,加入0.9%氯化钠注射液500 ml中,静脉滴注,每日1次,滴速0.5~1 mg/h,连用10 d,后改为口服尼莫地片40 mg,每日3次。两组疗程均为15 d。观察两组患者的临床疗效,治疗前后血氧饱和度(SpO2)、血红蛋白(Hb)、总血红蛋白(HbT)、还原血红蛋白(MHb)及不良反应发生情况。结果:观察组患者总有效率显著高于对照组,不良反应发生率显著低于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者SpO2、Hb、HbT、MHb比较,差异均无统计学意义(P>0.05)。治疗后,两组患者SpO2、HbT、MHb均显著高于同组治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05);Hb显著低于同组治疗前,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论:在常规治疗的基础上,依达拉奉联合尼莫地平治疗急性大面积脑梗死的疗效显著,可有效恢复患者神经功能,保护脑组织,降低不良反应的发生。%OBJECTIVE:To observe the efficacy and safety of edaravone combined with nimodipine in the treatment of acute large area cerebral infarction. METHODS:78 patients with acute large area cerebral infarction were randomly divided into control group (38 cases) and observation group (40 cases). Control

  8. Systemic corticosteroids for acute sinusitis.

    Science.gov (United States)

    Venekamp, Roderick P; Thompson, Matthew J; Hayward, Gail; Heneghan, Carl J; Del Mar, Chris B; Perera, Rafael; Glasziou, Paul P; Rovers, Maroeska M

    2014-03-25

    .6; risk difference (RD) 17%, 95% CI 6% to 29%) and at days four to 14 (RR 1.2, 95% CI 1.0 to 1.5; RD 14%, 95% CI 1% to 27%). A sensitivity analysis including the four trials with placebo as a control treatment showed similar results but with a lesser effect size: at days three to seven (RR 1.2, 95% CI 1.1 to 1.3; RD 11%, 95% CI 4% to 17%) and days four to 14 (RR 1.1, 95% CI 1.0 to 1.2; RD 8%, 95% CI 2% to 13%). Statistical heterogeneity was high for many analyses. Subgroup analyses revealed that corticosteroid monotherapy had no beneficial effects. Furthermore, scenario analysis showed that outcomes missing from the trial reports might have introduced attrition bias (a worst-case scenario showed no statistically significant beneficial effect of oral corticosteroids). No trial reported effects on relapse or recurrence rates. Reported side effects in patients treated with oral corticosteroids were mild (nausea, vomiting, gastric complaints) and did not significantly differ from those receiving placebo. Oral corticosteroids as a monotherapy appear to be ineffective for adult patients with clinically diagnosed acute sinusitis. Current data on the use of oral corticosteroids as an adjunctive therapy to oral antibiotics are limited: almost all trials are performed in secondary care settings and there is a significant risk of bias. This limited evidence suggests that oral corticosteroids in combination with antibiotics may be modestly beneficial for short-term relief of symptoms in acute sinusitis, with a number needed to treat to benefit of seven for resolution or symptom improvement. A large primary care factorial trial is needed to establish whether oral corticosteroids offer additional benefits over antibiotics in acute sinusitis.

  9. Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children.

    Science.gov (United States)

    Laulajainen-Hongisto, Anu; Aarnisalo, Antti A; Jero, Jussi

    2016-10-01

    Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.

  10. Management of acute hepatitis B.

    Science.gov (United States)

    Shiffman, Mitchell L

    2010-02-01

    Acute hepatitis B virus (HBV) is a common cause of acute icteric hepatitis in adults. The vast majority of these patients resolve this acute infection and develop long-lasting immunity. In contrast, the vast majority of patients who develop chronic HBV have minimal symptoms and do not develop jaundice after becoming infected with HBV. These patients will frequently remain undiagnosed for years or decades. Approximately 1% of persons with acute HBV develop acute liver failure. Preventing acute HBV with vaccination is the best treatment. Although universal vaccination is now administered to newborns in many countries, the majority of adults have not been vaccinated and remain at risk. Because the majority of patients with acute HBV resolve this infection spontaneously, treatment with an oral anti-HBV agent is not necessary. However, the use of an oral anti-HBV agent is not unreasonable to use in a patient who is developing acute liver failure from severe acute HBV.

  11. Early CT signs of progressive hemorrhagic injury following acute traumatic brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Tong, Wu-song; Zheng, Ping; Xu, Jun-fa; Guo, Yi-jun; Zeng, Jing-song; Yang, Wen-jin; Li, Gao-yi; He, Bin; Yu, Hui [Pudong New Area People' s Hospital, Department of Neurosurgery, Shanghai (China)

    2011-05-15

    Since progressive hemorrhagic injury (PHI) was introduced in neurosurgical literatures, several studies have been performed, the results of which have influenced doctors but do not define guidelines for the best treatment of PHI. PHI may be confirmed by a serial computerized tomography (CT) scan, and it has been shown to be associated with a fivefold increase in the risk of clinical worsening and is a significant cause of morbidity and mortality as well. So, early detection of PHI is practically important in a clinical situation. To analyze the early CT signs of progressive hemorrhagic injury following acute traumatic brain injury (TBI) and explore their clinical significances, PHI was confirmed by comparing the first and repeated CT scans. Data were analyzed and compared including times from injury to the first CT and signs of the early CT scan. Logistic regression analysis was used to show the risk factors related to PHI. A cohort of 630 TBI patients was evaluated, and there were 189 (30%) patients who suffered from PHI. For patients with their first CT scan obtained as early as 2 h post-injury, there were 116 (77.25%) cases who suffered from PHI. The differences between PHIs and non-PHIs were significant in the initial CT scans showing fracture, subarachnoid hemorrhage (SAH), brain contusion, epidural hematoma (EDH), subdural hematoma (SDH), and multiple hematoma as well as the times from injury to the first CT scan (P < 0.01). Logistic regression analysis showed that early CT scans (EDH, SDH, SAH, fracture, and brain contusion) were predictors of PHI (P < 0.01). For patients with the first CT scan obtained as early as 2 h post-injury, a follow-up CT scan should be performed promptly. If the initial CT scan shows SAH, brain contusion, and primary hematoma with brain swelling, an earlier and dynamic CT scan should be performed for detection of PHI as early as possible and the medical intervention would be enforced in time. (orig.)

  12. Clinical observation on low dosages of mannitol in the treatment of elderly patients with acute large area ;cerebral infarction%小剂量甘露醇治疗老年大面积脑梗塞的临床探讨

    Institute of Scientific and Technical Information of China (English)

    李以虹; 匡霞

    2015-01-01

    目的:总结小剂量甘露醇在老年大面积脑梗塞治疗的临床经验。方法回顾性分析我院2010年10月至2014年1月54例经颅脑CT或MRI确诊的老年脑梗死患者,梗死面积>3 cm2,予小剂量甘露醇治疗,观察临床疗效,记录患者肝、肾功能及电解质变化结果,评估药物安全性。结果54例中有1例患者死亡,死亡率1.58%;43例显效,总有效率81.48%;有1例患者在住院期间脑水肿加重,予加用利尿剂治疗后好转;有2例(3.70%)患者肾功能轻度异常,1例(1.85%)患者出现转氨酶轻度升高,经保肝、护肾治疗后好转;27例患者出现不同程度低钠,低钾,予相应治疗后好转。结论在老年大面积脑梗塞治疗中,小剂量甘露醇可获得满意的治疗效果,减少药物副作用,降低急性脑水肿发生,治疗有效性及安全性良好。%Objective To study the clinical experience of small doses of mannitol in the treatment of elderly patients with acute large area cerebral infarction.Methods Retrospectively analyze the datas of 54 elderly patients with cerebral infarction during October 2010 and January 2014 who were diagnosed by craniocerebral CT or MRI, and when the infarction area was greater than 3cm2, they were given low dose of mannitol.The clinical curative effect was observed, recorded the change of the patient's liver and kidney function and electrolyte, and evaluated its safety.Results Among the 54 cases, 1 patient died, mortality rate was 1.58%.43 cases obtained effective efficacy, total effective rate was 81.48%.1 case of cerebral edema aggravated during hospitalization, and the situation improved after diuretics treatment.2 cases (3.70%) with mild abnormal renal function, 1 case (1.85%) had mild elevation of aminotransferase, and they healed after liver and renal protecting treatment.27 patients appeared different degree of low sodium, low potassium, and the situation improved

  13. Variation in Rates of Diagnosis of Acute Otitis Media.

    Science.gov (United States)

    Berwick, Donald M.; Thibodeau, Lawrence A.

    1980-01-01

    Over 13 weeks during two periods in 1978 the diagnostic rate for acute otitis media was monitored among febrile children in the emergency room of a large children's hospital. Temporal variation in diagnostic rates by physicians was largely attributable to differences among individual providers and independent of level of training. (Author/MLW)

  14. Acute respiratory distress syndrome.

    Science.gov (United States)

    Wilkins, Pamela A; Seahorn, Thomas

    2004-04-01

    Several combination therapies have been described throughout this article: in all likelihood, it is combination therapy that will allow improved survival of ARDS patients. As medicine moves into the future, clinical trials evaluating the efficacy of therapies for ARDS will be performed. In human critical care medicine, a large forward step was taken when ALI and ARDS were clearly defined. Unfortunately. as good as the definition is, ALI and ARDS occur secondary to many different underlying pathologic processes,perhaps obscuring the benefits of certain therapies for ARDS based on the underlying condition, for example, trauma versus sepsis. Selection of patients entering any ARDS trial is crucial: not only must those patients meet the strict definition of ARDS but the underlying disease process should be clearly identified. Identification of patients suffering from different disease processes before the onset of ARDS will allow for stratification of outcomes according to the intervention and the underlying pathology--comparing apples to apples and not to oranges. We are in a unique position in veterinary medicine. Although frequently financially limited by our clients, we have the opportunity to achieve several goals. First, we need to clearly define what constitutes ALI and ARDS in veterinary medicine. Do we want to rely on the human definitions? Probably not; however, as a group, we need to determine what we will accept as definitions. For example, we may not be able perform right heart catheterizations on all our patients to meet the wedge pressure requirement of human beings of less than 18 mm Hg. Do we agree that a PAOP of less than 18 mmHg is appropriate for animals, and is it appropriate for all animals? Will we accept another measure, for example, pulmonary artery diameter increases with echocardiographic evidence of acceptable left heart function? What is acceptable left heart function? As veterinarians, what do we consider to be hypoxemia? Is it the same in

  15. Treatment of acute septic arthritis.

    Science.gov (United States)

    Pääkkönen, Markus; Peltola, Heikki

    2013-06-01

    Acute septic arthritis is a rare, but potentially devastating disease. The treatment is initiated intravenously, but can be safely switched to oral after 2-4 days providing large doses of a well-absorbing antibiotic and, for time-dependent antibiotics, 4 times-a-day administration are used. Empiric treatment should always cover Staphylococcus aureus and common respiratory pathogens, whereas Kingella kingae and Salmonella are important only regionally. Studies conducted by our group have shown that a total course of 10 days may suffice for previously healthy children in a Western setting. Treatment of neonates, patients with immunodeficiency or cases caused by methicillin-resistant S. aureus, may deserve a different approach.

  16. [Acute hypertrygliceridemic pancreatitis].

    Science.gov (United States)

    Senosiain Lalastra, Carla; Tavío Hernández, Eduardo; Moreira Vicente, Victor; Maroto Castellanos, Maite; García Sánchez, Maria Concepción; Aicart Ramos, Marta; Téllez Vivajos, Luis; Cuño Roldán, José Luis

    2013-04-01

    Acute hypertriglyceridemic pancreatitis is the third cause of acute pancreatitis in the Western population. There is usually an underlying alteration in lipid metabolism and a secondary factor. Clinical presentation is similar to that of pancreatitis of other etiologies, but the course of acute hypertriglyceridemic pancreatitis seems to be worse and more recurrent. Some laboratory data can be artefacts, leading to diagnostic errors. This is the case of amylase, which can show false low levels. Treatment is based on intense fluidotherapy and analgesia. When there is no response to conservative management, other methods to lower triglyceride levels should be used. Several options are available, such as plasmapheresis, insulin, and heparin. The present article provides a review of the current literature on this entity.

  17. Acute pancreatitis in children

    Directory of Open Access Journals (Sweden)

    Jokić Radoica

    2012-01-01

    Full Text Available Introduction. Acute pancreatitis in children is mostly due to abdominal trauma, diseases or congenital anomalies of the biliary-pancreatic tree. Both exogenous and endogenous functions of the gland could be disturbed by various levels of damage. Clinical Finding and Diagnostics. Acute abdominal pain, gastrointestinal signs and general deterioration are the main clinical findings. The examination can be completed by blood and urine tests of amylase, electrolytes level, and the C-reactive protein. In addition to these tests, ultrasound, computed tomography and endoscopy are required as well. Therapeutic Methods. The therapy of choice is non-operative treatment using medicaments to control the pain, decrease the pancreatic activity and prevent further complications. If the conservative treatment fails, the surgical approach is necessary: drainage, resections, by-pass procedures, etc. Conclusion. Acute pancreatitis is a very serious disease in childhood. Clinical experience and rational approach are very important in the diagnostic and therapeutic methods.

  18. Treatment of acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Al-Mofleh Ibrahim

    1998-01-01

    Full Text Available There is no specific treatment for acute pancreatitis. Majority of patients with acute pancreatitis respond to medical therapy. Supportive measures and close observations represent the cornerstone of the medical therapy. Failure to respond to medical treatment may indicate choledocholithiasis or infected necrosis. Endoscopic papillotomy with stone retrieval is beneficial in patients with severe biliary pancreatitis. Image-guided fine needle aspiration and bacteriological examination of aspirate is reliable in detecting infection and deliniating causative pathogen. Surgical debridement is the method of choice for treatment of infected necrosis. In contrast, in pancreatic abscess, surgery is preserved for those, who do not respond to percutaneous drainage combined with antibiotics. The benefit of antisecretory and antiproteolytic agents is debatable. A combination of antioxidants, calcium channel antagonists and antibiotics may play a major role in the treatment of acute pancreatitis in the future.

  19. Acute management of stones

    DEFF Research Database (Denmark)

    Jung, Helene; Osther, Palle J S

    2015-01-01

    INTRODUCTION: Stone management is often conservative due to a high spontaneous stone passage rate or non-symptomatic calyceal stones that do not necessarily require active treatment. However, stone disease may cause symptoms and complications requiring urgent intervention. MATERIAL AND METHODS......: In this review, we update latest research and current recommendations regarding acute management of stones, with particular focus on imaging, pain management, active stone interventions, medical expulsive therapy, and urolithiasis in pregnancy and childhood. RESULTS: Acute stone management should be planned...... with careful consideration of stone size and location, symptoms, patient comorbidity and radiation dose. CONCLUSION: In case of infective hydronephrosis, compromised renal function or persistent pain despite adequate analgesic treatment acute intervention is indicated....

  20. Acute Esophageal Necrosis: An Uncommon Cause of Hematemesis

    Directory of Open Access Journals (Sweden)

    George Sarin Zacharia

    2014-07-01

    Full Text Available Acute esophageal necrosis or black esophagus is an uncommon clinical entity, diagnosed at the upper gastrointestinal endoscopy with the presence of strikingly black necrotic esophagus. Very often no definite etiology will be identified even though a large list of potential associations has been postulated. Upper gastrointestinal bleeding is the most common clinical presentation, others being epigastric pain, retrosternal chest discomfort and dysphagia. Only about a hundred cases of acute esophageal necrosis have been described in medical literature till this date. We report a case of acute esophageal necrosis in an elderly female who had presented with hematemesis.

  1. Pharmacological interventions for acute pancreatitis.

    Science.gov (United States)

    Moggia, Elisabetta; Koti, Rahul; Belgaumkar, Ajay P; Fazio, Federico; Pereira, Stephen P; Davidson, Brian R; Gurusamy, Kurinchi Selvan

    2017-04-21

    plus ulinastatin, thymosin, ulinastatin, and inactive control. Apart from the comparison of antibiotics versus control, which included a large proportion of participants with necrotising pancreatitis, the remaining comparisons had only a small proportion of patients with this condition. Most trials included either only participants with severe acute pancreatitis or included a mixture of participants with mild acute pancreatitis and severe acute pancreatitis (75 trials). Overall, the risk of bias in trials was unclear or high for all but one of the trials. seven trials were not funded or funded by agencies without vested interest in results. Pharmaceutical companies partially or fully funded 21 trials. The source of funding was not available from the remaining trials.Since we considered short-term mortality as the most important outcome, we presented only these results in detail in the abstract. Sixty-seven studies including 6638 participants reported short-term mortality. There was no evidence of any differences in short-term mortality in any of the comparisons (very low-quality evidence). With regards to other primary outcomes, serious adverse events (number) were lower than control in participants taking lexipafant (rate ratio 0.67, 95% CI 0.46 to 0.96; N = 290; 1 study; very low-quality evidence), octreotide (rate ratio 0.74, 95% CI 0.60 to 0.89; N = 770; 5 studies; very low-quality evidence), somatostatin plus omeprazole (rate ratio 0.36, 95% CI 0.19 to 0.70; N = 140; 1 study; low-quality evidence), and somatostatin plus ulinastatin (rate ratio 0.30, 95% CI 0.15 to 0.60; N = 122; 1 study; low-quality evidence). The proportion of people with organ failure was lower in octreotide than control (OR 0.51, 95% CI 0.27 to 0.97; N = 430; 3 studies; very low-quality evidence). The proportion of people with sepsis was lower in lexipafant than control (OR 0.26, 95% CI 0.08 to 0.83; N = 290; 1 study; very low-quality evidence). There was no evidence of differences in any of

  2. Acute stress may induce ovulation in women

    Directory of Open Access Journals (Sweden)

    Cano Antonio

    2010-05-01

    Full Text Available Abstract Background This study aims to gather information either supporting or rejecting the hypothesis that acute stress may induce ovulation in women. The formulation of this hypothesis is based on 2 facts: 1 estrogen-primed postmenopausal or ovariectomized women display an adrenal-progesterone-induced ovulatory-like luteinizing hormone (LH surge in response to exogenous adrenocorticotropic hormone (ACTH administration; and 2 women display multiple follicular waves during an interovulatory interval, and likely during pregnancy and lactation. Thus, acute stress may induce ovulation in women displaying appropriate serum levels of estradiol and one or more follicles large enough to respond to a non-midcycle LH surge. Methods A literature search using the PubMed database was performed to identify articles up to January 2010 focusing mainly on women as well as on rats and rhesus monkeys as animal models of interaction between the hypothalamic-pituitary-adrenal (HPA and hypothalamic-pituitary-gonadal (HPG axes. Results Whereas the HPA axis exhibits positive responses in practically all phases of the ovarian cycle, acute-stress-induced release of LH is found under relatively high plasma levels of estradiol. However, there are studies suggesting that several types of acute stress may exert different effects on pituitary LH release and the steroid environment may modulate in a different way (inhibiting or stimulating the pattern of response of the HPG axis elicited by acute stressors. Conclusion Women may be induced to ovulate at any point of the menstrual cycle or even during periods of amenorrhea associated with pregnancy and lactation if exposed to an appropriate acute stressor under a right estradiol environment.

  3. [Treatment of acute pancreatitis].

    Science.gov (United States)

    Naumovski-Mihalić, Slavica

    2009-01-01

    Acute pancreatitis is an autodigestive disease in which the pancreatic tissue is damaged by the digestive enzimes produces by the acinar cells and is associated with severe upper abdominal pain. The severity of acute pancreatitis ranges from edema to necrosis of the gland. The edematous form of the disease occurs in about 80-85% of patients and is self-limited, with recovery in few days. In the 15-20% of patients with the most severe form of pancreatitis, hospitalization is prolonged and commonly associated with infection and other complications including multiple organ failure. The main causes of acute pancreatitis in adults are gallstones, other gallbladder (biliary) diseases and alcohol abuse. Treatment of acute pancreatitis-depends on the severity oft he condition. Generaly, the patients need, hospitalisation with administration of intravenous fluid to help restore blood volume, pain control, supplemental oxygen as required and correction of electrolite and metabolic abnormalities. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and sistemic infection. Begin oral feeding once abdominal pain has resolved and the patients regains appetite. The diet should be low in fat and protein. Patients suffering from infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. During recent years the management of acute pancreatitis has changed. This has been due particulary in response to the general availability of computed tomography, improved intensive care facilities, knowledge about the central role of pancreatic infection and refinements in surgical and other interventional techniques.

  4. The study on vascular reserve of large cerebral arteries in acute cerebral ischemia patients with intracranial stenosis%伴有颅内动脉狭窄的缺血性脑卒中患者脑血管储备能力研究

    Institute of Scientific and Technical Information of China (English)

    黄立安; 董晓梅; 徐安定; 宋雪文; 凌雪英; 周环

    2011-01-01

    Objective To study the vascular reserve of large cerebral arteries in patients with acute cerebral thrombosis with more than 50% stenosis of the intracranial arteries. Methods Seventeen patients with acute cerebral thrombosis with magnetic resonance artery( MRA )/ transcranial doppler ultrasonography ( TCD ) confirmed stenosis of the intracranial arteries, were recruited in the study. Patients were examined by TCD before admission and 2 hour after oral Diamox treatment two days later. The changes of the blood flow before and after Diamox were compared in 187 large arteries.Results The cerehral blood flow was increased obviously following diamox. The blood flows in the right internal carotid artery( RICA ), right middle cerebral artery ( RMCA ) , right posterior cerebral artery( RPCA ) were increased after diamox but the difference did not reach statistically significance( P = 0.086,0.258 ,0.084 )but, other arteries increased cerebral blood flow significantly( P < 0.05 ). There was more increase in blood flow in non-stenosis arteries than in stenosis arteries but the difference did not reach statistically significance ( P = 0.08 ). There were no significant differences in the blood flow changes hetween moderate stenosis arteries and severe stenosis arteries ( P = 0.65 ). Conclusions Diamox test in TCD can precisely measure the large cerebral artery vascular reserve. Stenosis arteries have a decline tendency in vascular reserve compared with non-stenosis arteries. However,there is not significant difference in vascular reserve between moderate stenosis arteries and severe stenosis.%目的 对伴有颅内动脉狭窄的缺血性脑卒中患者采用口服乙酰唑胺实验研究颅内大动脉血流储备能力.方法 对17例经磁共振血管显影(magnetic resonance angiography, MRA)/或经颅多谱勒超声(transcranial doppler ultrasonography, TCD)证实颅内动脉狭窄大于50%的缺血性脑卒中患者,按TOAST分型为动脉粥样硬

  5. Acute dental pain II

    DEFF Research Database (Denmark)

    Jonasson, Peter; Kirkevang, Lise-Lotte; Rosen, Annika

    2016-01-01

    Acute dental pain most often occurs in relation to inflammatory conditions in the dental pulp or in the periradicular tissues surrounding a tooth, but it is not always easy to reach a diagnose and determine what treatment to perform. The anamnesis and the clinical examination provide valuable...... dental pain, they expect that the dentist starts treatment at once and that the treatment should provide pain relief. In this situation many patients are fragile, anxious and nervous. If the dentist is able to manage emergency treatment of acute dental pain this will build confidence and trust between...

  6. Acute Prevertebral Calcific Tendinitis.

    Science.gov (United States)

    Tamm, Alexander; Jeffery, Caroline C; Ansari, Khalid; Naik, Sandeep

    2015-11-01

    We present a case of neck pain in a middle-aged woman, initially attributed to a retropharyngeal infection and treated with urgent intubation. With the help of computed tomography, the diagnosis was later revised to acute prevertebral calcific tendinitis, a self-limiting condition caused by abnormal calcium hydroxyapatite deposition in the longus colli muscles. It is critical to differentiate between these two disease entities due to dramatic differences in management. A discussion of acute prevertebral calcific tendinitis and its imaging findings is provided below.

  7. Congenital acute megakaryocytic leukemia

    Directory of Open Access Journals (Sweden)

    N B Mathur

    2011-01-01

    Full Text Available Congenital leukemia (CL is an extremely rare disorder in the newborn, significant proportion of which is of myeloid origin, primarily of M4 or M5 morphology. As compared to pediatric leukemia, CL is a more aggressive disease. Acute myeloid leukemia (AML-M7 or acute megakaryocytic leukemia is a rare type of AML with an incidence of 0.5 per million per year. Median age of presentation is 6 years, and children may present with a broad variety of symptoms including low-grade fever, diarrhea, easy bruising, failure to gain weight and life-threatening conditions.

  8. Acute multiple infarction involving the anterior circulation.

    Science.gov (United States)

    Bogousslavsky, J; Bernasconi, A; Kumral, E

    1996-01-01

    To evaluate the frequency and clinical, topographic, and etiologic patterns of acute multiple infarction involving the anterior circulation. Data analysis from a prospective acute stroke registry in a community-based primary care center. Among 751 patients with first ischemic stroke in the anterior circulation over a 4-year period, 40 patients (5%) had acute multiple infarcts involving the anterior circulation. On computed tomography and magnetic resonance imaging with gadolinium enhancement, there were four topographic patterns of infarction: (1) superficial infarcts (11 patients [28%]); (2) superficial and deep infarcts (12 patients [30%]); (3) deep infarcts (three patients [8%]); and (4) infarcts involving the anterior and the posterior circulation (14 patients [35%]). Both cerebral hemispheres were involved in one fourth of the cases. A specific clinical picture was found in up to 20% of the patients. This included global aphasia with left hemianopia, hemisensory loss or hemiparesis (in right-handed patients), transcortical mixed aphasia with hemianopia, and acute pure cognitive impairment ("dementia"). Large-artery disease was found in 13 patients (33%); a cardiac source of embolism was found in 11 patients (28%); and both were found in three patients (8%). Bilateral infarcts were related to cardioembolism (four patients) and bilateral large-artery disease (three patients). One month after stroke, one fourth of the patients were independent, one third had some disability, and 40% were either dead or completely dependent. Acute multiple infarcts involving the anterior circulation may be bilateral more frequently than is currently thought, and they are often associated with posterior circulation infarcts. They mainly involve the pial hemispheral territories, commonly being caused by cardioembolism or bilateral carotid atheroma. They may be associated with a specific neurologic-neuropsychological dysfunction pattern in up to one fifth of the patients, allowing

  9. Pharm GKB: Leukemia, Promyelocytic, Acute [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym APL - Acute promyelocytic leukaemia; APL - Acute ...promyelocytic leukemia; APML - Acute promyelocytic leukaemia; APML - Acute promyelocytic leukemia; Acute Promyelocytic Leukemia; Acut...e Promyelocytic Leukemias; Acute myeloid leukaemia, PML/RAR-alpha; Acute myeloid le...ukemia, PML/RAR-alpha; Acute myeloid leukemia, t(15;17)(q22;q11-12); Acute promye...locytic leukaemia (clinical); Acute promyelocytic leukaemia, FAB M3; Acute promyelocytic leukaemia, PML/RAR-alpha; Acute

  10. Pharm GKB: Leukemia, Erythroblastic, Acute [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym AML M6; Acute Erythroblastic Leukemia; Acute Erythroblastic Leukemias; Acu...te erythraemic myelosis [obs]; Acute erythremia [obs]; Acute erythremic myelosis [obs]; Acute... erythroid leukaemia; Acute erythroid leukemia; Acute myeloid leukaemia, M6 type; Acute myeloid le...Erythroblastic Leukemia, Acute; Erythroblastic Leukemias, Acute; Erythroleukaemia...; Erythroleukemia; Erythroleukemias; FAB M6; Leukemia, Acute Erythroblastic; Leukemia, Myeloid, Acute, M6; Leukemias, Acute

  11. Loperamide-Induced Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Halla Vidarsdottir

    2013-01-01

    Full Text Available Acute pancreatitis is a common disease leading to hospitalizations, most often caused by gallstones or alcohol. We present a case of a patient diagnosed with acute pancreatitis considered to be due to loperamide treatment for diarrhea.

  12. Acute myeloid leukemia (AML) - children

    Science.gov (United States)

    Acute myeloid leukemia is a cancer of the blood and bone marrow. Bone marrow is the soft tissue inside ... develops quickly. Both adults and children can get acute myeloid leukemia ( AML ). This article is about AML in children.

  13. General Information about Adult Acute Myeloid Leukemia

    Science.gov (United States)

    ... Adult Acute Myeloid Leukemia Treatment (PDQ®)–Patient Version General Information About Adult Acute Myeloid Leukemia Go to ... acute granulocytic leukemia, and acute nonlymphocytic leukemia. Enlarge Anatomy of the bone. The bone is made up ...

  14. [Acute arsenic poisoning].

    Science.gov (United States)

    Montelescaut, Etienne; Vermeersch, Véronique; Commandeur, Diane; Huynh, Sophie; Danguy des Deserts, Marc; Sapin, Jeanne; Ould-Ahmed, Mehdi; Drouillard, Isabelle

    2014-01-01

    Acute arsenic poisoning is a rare cause of suicide attempt. It causes a multiple organs failure caused by cardiogenic shock. We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature treatment.

  15. [Acute plasma cell leukemia].

    Science.gov (United States)

    Monsalbe, V; Domíngues, C; Roa, I; Busel, D; González, S

    1989-01-01

    Plasma Cell Leukemia is a very rare form of plasmocytic dyscrasia, whose clinical and pathological characteristics warrant its recognition as a distinct subentity. We report the case of a 60 years old man who presented a rapidly fatal acute plasma cell leukemia, with multiple osteolytic lesions, hipercalcemia, renal and cardiac failure.

  16. Acute liver failure

    DEFF Research Database (Denmark)

    Bernal, William; Lee, William M; Wendon, Julia

    2015-01-01

    Over the last three decades acute liver failure (ALF) has been transformed from a rare and poorly understood condition with a near universally fatal outcome, to one with a well characterized phenotype and disease course. Complex critical care protocols are now applied and emergency liver...

  17. [Acute pancreatitis and pregnancy].

    Science.gov (United States)

    Scollo, P; Licitra, G

    1993-12-01

    Aetiologic factors (gallstones, hyperlipidemia I-IV, hypertriglyceridaemia) make their occurrence, mainly, in the third trimester of gestation. Two cases of acute pancreatitis in pregnancy are described; in both cases patients referred healthy diet, no habit to smoke and no previous episode of pancreatitis. An obstructive pathology of biliary tract was the aetiologic factor. Vomiting, upper abdominal pain are aspecific symptoms that impose a differential diagnosis with acute appendicitis, cholecystitis and obstructive intestinal pathology. Laboratory data (elevated serum amylase and lipase levels) and ultrasonography carry out an accurate diagnosis. The management of acute pancreatitis is based on the use of symptomatic drugs, a low fat diet alternated to the parenteral nutrition when triglycerides levels are more than 28 mmol/L. Surgical therapy, used only in case of obstructive pathology of biliary tract, is optimally collected in the third trimester or immediately after postpartum. Our patients, treated only medically, delivered respectively at 38th and 40th week of gestation. Tempestivity of diagnosis and appropriate therapy permit to improve prognosis of a pathology that, although really associated with pregnancy, presents high maternal mortality (37%) cause of complications (shock, coagulopathy, acute respiratory insufficiency) and fetal (37.9%) by occurrence of preterm delivery.

  18. Acute stress disorder revisited.

    Science.gov (United States)

    Cardeña, Etzel; Carlson, Eve

    2011-01-01

    Acute stress disorder (ASD) was introduced into the Diagnostic and Statistical Manual (DSM) taxonomy in 1994 to address the lack of a specific diagnosis for acute pathological reactions to trauma and the role that dissociative phenomena play both in the short- and long-term reactions to trauma. In this review, we discuss the history and goals of the diagnosis and compare it with the diagnoses of acute stress reaction, combat stress reaction, and posttraumatic stress disorder (PTSD). We also evaluate the research on the validity and limitations of ASD as a diagnosis, the relationship between peritraumatic dissociation and other symptomatology, the extent to which PTSD is predicted by previous ASD or peritraumatic dissociation, and other important issues such as impairment and risk factors related to ASD. We conclude with our recommendations for changes in DSM-5 criteria and the development of more sophisticated research that considers ASD as but one of two or possibly three common acute posttraumatic syndromes. © 2011 by Annual Reviews. All rights reserved

  19. Acute hemiplegia in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Okuno, Takehiko; Takao, Tatsuo; Itoh, Masatoshi; Konishi, Yukuo; Nakano, Shozo (Kyoto Univ. (Japan). Faculty of Medicine)

    1983-04-01

    The results of CT in 100 patients with acute hemiplegia in childhood are reported here. The etiology was various: 2 patients had infratentorial brain tumors, 56 had cerebral vascular diseases, 3 had head injuries, 16 had intracranial infectious diseases, one had postinfectious encephalomyelitis, one had multiple sclerosis, 2 had epilepsy, and the diagnosis of 19 were unknown. Eleven patients had a normal CT and a good prognosis. As for the type of onset, there were patients of type 1 with fever and 42 with convulsions and unconsciousness; those of type 2 with convulsions and unconsciousness were 12, and those of type 3 without fever and convulsions were 46. This classification is assumed to be useful, as the type of onset is characteristic of the etiology. Six patients were diagnosed correctly by repeated examinations, although the first CT did not reveal any remarkable findings. Capsular infarction, occlusion of the posterior cerebral artery in acute hemiplegia in childhood, abnormal findings of the internal capsule, thalamus, and midbrain in a patient with postinfectious encephalomyelitis, and a diffuse low density in the CT of the unilateral hemisphere in the patients with acute encephalopathy and acute hemiplegia of an obscure origin have been found after the introduction of computerized tomography.

  20. Acute cough in adults

    Institute of Scientific and Technical Information of China (English)

    Jochen W L Cals; Nick A Francis

    2010-01-01

    @@ A healthy, non-smoking 54 year old woman consults with a severe acute cough. It started two weeks ago with symptoms of a common cold, but she is worried about its duration and would like something to "clear it up. "