1/7. Disorders in cerebellar ocular motor control. II. Macrosaccadic oscillation. An oculographic, control system and clinico-anatomical analysis.A distinctive cerebellar ocular motor disorder, macrosaccadic oscillation, evolved simultaneously with an acute cerebellar syndrome in 4 patients, 2 with haemorrhagic metastatic melanoma deep in the vermis, a third with a presumed cerebellar haematoma and a fourth with focal demyelinating disease. Ocular oscillations were conjugate, horizontal, symmetrical, occurred in bursts of several seconds duration, had amplitudes of 30 degrees to 50 degrees, and were evoked whenever the patient attempted to shift visual fixation or pursue a moving target. Photo-electric recordings in one patient with tumour defined features of this disorder of saccadic eye movement: (i) oscillation was composed of saccades, (ii) frequency was 2 Hz, (iii) bursts occurred with amplitude first increasing and then decreasing, (iv) intervals between beginnings of saccades averaged 260 ms and (v) eye position did not exhibit systematic drift during the intersaccadic period. These features documented the inreased gain and instability of the visually guided saccadic system. By using increased feed-forward gain in a sampled-data control model we simulated the pattern of macrosaccadic oscillation. We belive that the acute loss of the calibrator function of the cerebellum accounts for the gain abnormality underlying macrosaccadic oscillation.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
2/7. Distal posterior inferior cerebellar artery aneurysms: clinical characteristics and surgical management.BACKGROUND: Aneurysms located on the distal posterior inferior cerebellar artery (pica) are rare, and their underlying clinical features and surgical management are poorly understood. We report our series of 16 patients with 18 distal pica aneurysms. METHOD: All patients with distal pica aneurysms were treated between March 1996 and August 2004. We excluded all pica aneurysms that involved the vertebral artery. patients were analysed in the light of their clinical profiles, radiological studies, intraoperative findings and outcomes. All patients underwent non-enhanced and contrast enhanced CT scans followed by 4-vessel cerebral angiography on admission. The hemorrhagic patterns on initial CT scans were assessed using the Fisher Grading Score. The outcomes were documented using the glasgow outcome scale at time of discharge and at three or twelve months follow-up. FINDINGS: The series included 6 men and 10 women. Massive intraventricular haemorrhage was found in 13 patients with proven CT subarachnoid haemorrhage, one patient revealed SAH without intraventricular components, one presented with only intraventricular blood in the occipital horns and 3 aneurysms were found incidentally without presence of blood. Fourteen aneurysms were saccular and four were fusiform. Nine cases were associated with another cerebrovascular lesion. A lateral transcondylar or a median suboccipital approach was used to secure the aneurysms in 15 patients, either by direct clipping (14 lesions) or vessel sacrifice (3 lesions). One aneurysm was treated by an endovascular approach. At long-term follow up, an excellent or good outcome was achieved in 75% of cases. One patient died due to pre-existing cardiopulmonary complications. CONCLUSIONS: Most of our cases of ruptured distal pica aneurysms presented with haematocephalus. These were frequently associated with another vascular abnormality and 22% were fusiform or multilobulated. These specific features require special management strategies entailing an appropriate surgical approach to the aneurysm, clipping method, haematoma removal, ventricular drainage and when suitable choice of endovascular interventions.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
3/7. fatal outcome following foetal cerebellar haemorrhage associated with placental thrombosis.Cerebellar haemorrhage is a rare prenatal event. Possible aetiologies for foetal intracranial haemorrhage include: trauma, asphyxia, infection, vascular defects, blood dyscrasias, ingestion of drugs and alloimmune and isoimmune thrombocytopenia. We report the ultrasonographic diagnosis of a cerebellar haematoma at 21 weeks of gestation. The foetus succumbed at 33 weeks of gestation following rupture of a subcapsular liver haematoma. An autopsy demonstrated a placental foetal thrombotic vasculopathy and thrombi in the chorionic vessels. We assume that hypercoagulability was responsible for the multiple infarcts in the foetus with haemorrhagic transformation in the cerebellum and liver. The differential diagnosis of foetal cerebellar haemorrhage includes maternal hypercoagulability; in this case multiple haemorrhagic/ischaemic events may be encountered during the pregnancy. A thorough investigation to elucidate the aetiology is pertinent in every case of foetal cerebellar haemorrhage in order to enable accurate counselling and correct management.- - - - - - - - - - ranking = 2keywords = haematoma (Clic here for more details about this article) |
4/7. meningioma of the foramen magnum presenting as subarachnoid haemorrhage and cerebellar haematoma.An unusual case of a posterior fossa meningioma which caused subarachnoid haemorrhage (SAH) and cerebellar haematoma is presented. The possible causes of tumoral bleeding and the surprising clinical course are discussed in the context of the few similar cases reported in the literature. The importance of cerebral CT scan ning in SAH without angiographic demonstration of an aneurysm or angioma is emphasized.- - - - - - - - - - ranking = 5keywords = haematoma (Clic here for more details about this article) |
5/7. Persistent absence of auditory brainstem responses with preserved hearing and recovery from a prolonged comatose state.A patient with hypertensive intracerebellar haemorrhage, who recovered from impending tonsillar herniation with emergency haematoma evacuation, showed persistent absence of auditory brainstem responses. The patient demonstrated a preserved stapedius reflex and hearing after recovery, indicating that the auditory brainstem pathway was not completely disrupted. We suggest that the loss of the auditory brainstem response (ABR) could be accounted for by impulse asynchrony along the auditory brainstem pathway. The existence of such a case implies that persistent absence of the ABR is not always indicative of irreversible brainstem damage and a poor outcome following severe brain injury.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
6/7. Extradural haematoma of posterior cranial fossa.Two cases of extradural haematoma of posterior fossa with an acute course are reported. After trauma, the two patients did not show any symptom for a time of 16 and 18 hours respectively. Both of them showed a status of coma at the moment of hospitalization. The haematoma was diagnosed by CT scan. Both of them were immediately operated in order to evacuate the haematoma. Afterwards, one of the patients presented cerebellar symptoms while the other did not show any neurologic deficiency. The authors have analysed cases of this rare form of post-traumatic pathology referred in the literature since 1941, examining them from a clinical, therapeutic and prognostic point of view. The best diagnostic and therapeutic procedures to follow on this subject are then stressed.- - - - - - - - - - ranking = 7keywords = haematoma (Clic here for more details about this article) |
7/7. Transient cerebellar mutism after evacuation of a spontaneous vermian haematoma.Cerebellar mutism after surgery for posterior fossa tumours in children is a well-described, though rare, entity. Most of these tumours are located in the region of the cerebellar vermis extending to the hemispheres. The authors report a case of cerebellar mutism in an 8-year-old boy who underwent surgical evacuation of a spontaneous vermian haematoma. We feel that his mutism was an extreme form of cerebellar dysarthria.- - - - - - - - - - ranking = 5keywords = haematoma (Clic here for more details about this article) |