1/286. Clinical picture and management of subperiosteal hematoma of the orbit.A subperiosteal hematoma was seen in a 14-year-old boy following a blow to his head during a car accident. The involved orbit exhibited exophthalmus and inability of the eye to move above the horizontal. x-rays revealed a hairline fracture of the skull and a hemotympanum was found on the injured side. A subperiosteal hematoma of the orbital roof was suspected. Needle aspiration of the blood from the orbital hematoma resulted in an almost immediate cure of all orbital and occular problems.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/286. Spontaneous cervical hematoma: a report of two cases.Cervical hematomas are generally associated with trauma, surgery, and tumors. Although they are rare, they can be life-threatening because they put the patient at risk for great-vessel compression and upper airway obstruction. We describe two cases of spontaneous cervical hematoma--one in an 81-year-old man and the other in a 30-year-old woman. The man reported dysphonia, dysphagia, and neck swelling of 5 hours' duration. He had been taking 100 mg/day of aspirin for a cardiovascular condition. Examination revealed that the man had polycythemia vera. The woman was found to have neck ache, odynophagia, and cervical ecchymosis; portal hypertension, schistosomiasis, and blood dyscrasia were also found. Both patients denied trauma. A suspected diagnosis of cervical hematoma was confirmed by computed tomography, and treatment was instituted. The hematomas resolved in about 2 weeks. The treatment of cervical hematoma is controversial, although it is agreed that the evaluation of upper airway obstruction and its permeability is mandatory. Surgical treatment is generally reserved for complicated cases because of the risk of infection or bleeding.- - - - - - - - - - ranking = 1.0901064556435keywords = compression (Clic here for more details about this article) |
3/286. Growing skull fracture of the orbital roof. Case report.Growing skull fractures are rare complications of head trauma and very rarely arise in the skull base. The clinical and radiological finding and treatment of a growing fracture of the orbital roof in a 5-year-old boy are reported, and the relevant literature is reviewed. The clinical picture was eyelid swelling. Computed tomography (CT) scan was excellent for demonstrating the bony defect in the orbital roof. Frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing skull fracture of the orbital roof should be considered in the differential diagnosis in cases of persistent ocular symptoms. craniotomy with excision of gliotic brain and granulation tissue, dural repair and cranioplasty is the treatment of choice.- - - - - - - - - - ranking = 8keywords = fracture (Clic here for more details about this article) |
4/286. Two faces of orbital hematoma in intranasal (endoscopic) sinus surgery.Orbital hematoma and blindness can occur during or after sinus surgery. All orbital hematomas in 3500 endoscopic sinus ethmoidectomies were identified and evaluated for type, treatment, and sequelae. Fifteen orbital hematomas were identified, with 1 case of temporary blindness and no cases of permanent blindness. Two types of orbital hematoma were identified-slow (venous) and fast (arterial)-which differ in management. The venous type results from penetration of the lamina papyracea and disruption of veins. The arterial hematoma is caused by anterior or posterior ethmoid artery injury. The treatment approach to each is different, with blindness more likely occurring from a fast (arterial) hematoma. Of the 2 types of orbital hematoma that can occur during sinus surgery, surgical decompression and hemorrhage control are more likely with the fast arterial hematoma, which has not been the subject of any prior presentation. Cause and management of each will be discussed.- - - - - - - - - - ranking = 1.0901064556435keywords = compression (Clic here for more details about this article) |
5/286. Acute traumatic dissection and blunt rupture of the thoracic descending aorta: A case report.Rupture of the thoracic aorta following blunt trauma is increasing in incidence and remains a highly lethal injury. Blunt traumatic rupture and acute dissection of the thoracic aorta is very rare. A 50-year-old man involved in a motor vehicle accident on March 3, 1998 was admitted to our hospital one and a half hours following the accident. On admission, he was alert and his hemodynamics were stable. Chest roentgenogram demonstrated a widened mediastinum and multiple left-sided rib fractures. Enhanced chest CT revealed a periaortic hematoma just distal to the isthmus, dissection of the descending thoracic aorta and mediastinal hematoma. With the diagnosis of thoracic aortic rupture and acute DeBakey type IIIB dissection, an emergency operation was performed. Intraoperative transesophageal echocardiogram showed a mobile intimal flap and diminished caliber of the proximal descending aorta. Disruption and dissection of the descending thoracic aorta were found. Prosthetic graft interposition was accomplished with the aid of left atrium-left femoral artery bypass using a centrifugal pump and heparin-coated circuits and a blood collection device for blood conservation. The weak dissected aortic wall was glued and reapproximated with Gelatine-Resorcine-Formol glue. The postoperative course was uneventful.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
6/286. Seat-belt transection of the pararenal vena cava in a 5-year-old child: survival with caval ligation.Blunt traumatic disruption of the inferior vena cava is associated with high mortality and is rare in children. A seat-belted 5-year-old girl sustained, in a motor vehicle accident, pararenal caval transection, right renal vein transection, laceration of the right kidney, duodenal injury, and a second lumbar vertebral fracture. Damage-control surgery consisted of inferior vena caval and right renal vein ligation and temporary abdominal wall silo closure. She is alive and well 10 months after the accident, with no sequelae of caval ligation and with normal right renal function.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
7/286. Spinal epidural haematoma in haemophilia A with inhibitors--efficacy of recombinant factor viia concentrate.We report the case of a 21-year-old man with severe haemophilia A and factor viii inhibitors who presented with an extensive spinal epidural haematoma (C2-T12), probably induced by sit-up exercises. The bleed was defined by magnetic resonance imaging of the cervical and thoracic spine and prompt treatment with recombinant factor viia concentrate led to complete resolution at 4 weeks. Neurological sequelae were averted and surgical decompression was not necessary. We discuss the difficulties in diagnosis and management of such a case.- - - - - - - - - - ranking = 1.0901064556435keywords = compression (Clic here for more details about this article) |
8/286. Painless aortic dissection presenting as hoarseness of voice: cardiovocal syndrome: Ortner's syndrome.Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directly compress on an adjacent nerve, causing neuronal injury resulting in neurological symptoms. This may particularly take place when a distal intimal tear does not decompress the false lumen, resulting in formation of an expanding blind pouch. About 10% of aortic dissections are painless and may present with symptoms secondary to the complications of the dissection. Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to involvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial presenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiovocal syndrome. The hoarseness remained the only symptom throughout the entire course of the disease. The aortic dissection was not suspected initially. During surgical exploration, the recurrent laryngeal nerve was found compressed by the false lumen at the level of aortic arch. Aortic root replacement was performed successfully, resulting in complete resolution of the hoarseness. The neurological manifestations of aortic dissection, and the cardiovocal syndrome, are discussed.- - - - - - - - - - ranking = 1.0901064556435keywords = compression (Clic here for more details about this article) |
9/286. ligamentum flavum hematoma in the lumbar spine.A patient who presented with symptoms suggestive of nerve root compression secondary to an extradural mass was found to have a hematoma in the ligamentum flavum. Pathological examination of surgical specimens revealed an old hemorrhage, and hemosiderin deposits around organized granulation tissue within the ligamentum flavum. Vessels within the ligamentum flavum had, presumably, ruptured during minor trauma when the patient stood up.- - - - - - - - - - ranking = 1.0901064556435keywords = compression (Clic here for more details about this article) |
10/286. Cervical subarachnoid hematoma of unknown origin: case report.OBJECTIVE AND IMPORTANCE: Spontaneous spinal subarachnoid hematoma is rare, having been reported in the English literature in only seven other cases. We describe the first case of spontaneous subarachnoid hematoma located in the cervical spinal cord of a 43-year-old man. The pathologic examination showed no apparent source of bleeding, but there was evidence of cervical spondylotic myelopathy. CLINICAL PRESENTATION: The patient presented with a 10-day history of severe neck pain, followed by the onset of quadriparesis that was more evident on the left side, urinary retention, and sensory loss below C5. His medical history included hypertension. magnetic resonance imaging showed a massive hemorrhage in the cervical spinal canal. INTERVENTION: A C4-C5 subarachnoid hematoma was removed. The patient died due to respiratory distress and uncontrollable hypotension on day 6 after surgery. Surgical exploration, neuroradiologic examinations, and autopsy showed no evidence of vascular malformations, tumors, or other possible sources of bleeding. CONCLUSION: After excluding more common causes of spontaneous subarachnoid hematoma in this patient, we suggest that chronic spinal cord compression (spondylotic myelopathy) and arterial hypertension in this patient may have caused the pathogenesis of this rare clinical entity. Experimental data supporting this hypothesis are discussed.- - - - - - - - - - ranking = 1.0901064556435keywords = compression (Clic here for more details about this article) |
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