1/18. Ruptured distal anterior choroidal artery aneurysm presenting with casting intraventricular haemorrhage.This report describes a rare case of a distal anterior choroidal artery aneurysm which developed intraventricular haemorrhage without subarachnoid haemorrhage as shown on computerized tomographic (CT) scan. A 69-year-old hypertensive man suddenly became unconscious. An emergency CT scan showed a severe intraventricular haemorrhage and a small round low-dense lesion within the haematoma at the right trigone. The haematoma with obstructive hydrocephalus made the lateral ventricles larger on the right than on the left. CT scan could not detect any subarachnoid haemorrhage. Right interal carotid angiography revealed a saccular aneurysm at the plexal point of the right anterior choroidal artery. We approached the aneurysm and the small round lesion through the trigone via a right temporo-occipital corticotomy. We could clip the aneurysmal neck and remove the intraventricular haematoma and the papillary cystic mass (corresponding to the small round lesion on CT scan) totally in one sitting. Histological examination revealed the aneurysm to be a true one and the papillary cystic mass to be a choroid plexus cyst.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
2/18. An unusual complication of tapping a ventriculoperitoneal shunt.A case is reported describing a complication of an unsuccessful attempt to aspirate the reservoir of a ventriculoperitoneal shunt system with a suspected shunt infection. This arose due to a misunderstanding of the anatomy of the shunt and resulted in an intracerebral haematoma. The complications of cerebrospinal fluid shunting and the difficulty in the diagnosis thereof are outlined. We discuss the role and method of shunt tapping in diagnosing shunt problems before reviewing the literature describing the rationale. The variation in shunt design is emphasized. Guidelines are then proposed not to dissuade physicians from tapping shunts but to ensure that the procedure is performed safely and in collaboration with neurosurgical units.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
3/18. Do adjustable shunt valves pressure our budget? A retrospective analysis of 541 implanted Codman Hakim programmable valves.Based on a retrospective study in which a total of 541 Codman Hakim Programmable Valves (CHPV) were implanted in 477 patients over a 6-year period, this cost analysis was performed. By using a valve with an adjustable opening pressure, valve exchange to alter the opening pressure and surgical evacuation of subdural haematomas and hygromas can be avoided. Dividing the added cost for using the CHPV by the cost of implanting a non-programmable Hakim valve results in 105.8 valve exchanges, which would have had to be avoided to break even financially. On 107 occasions a valve was adjusted by a magnitude of 50 mmH2O or more. This, if an adjustment of that magnitude is said to correspond to a valve exchange, is sufficient to break even. The analysis suggests that the extra cost of the valve is outweighed by the ability to adjust the opening pressure setting non-invasively.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
4/18. Spontaneous bilateral subdural haematomas in the posterior cranial fossa revealed by MRI.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.- - - - - - - - - - ranking = 2keywords = haematoma (Clic here for more details about this article) |
5/18. Chronic subdural collection after endoscopic third ventriculostomy.Endoscopic third ventriculostomy (ETV) is considered a safe technique for the treatment of obstructive hydrocephalus. We describe a case of chronic subdural haematoma (CSDH) after ETV, revealed by MRI four weeks after the procedure, and requiring surgical evacuation, in a 69 y.o. asymptomatic male patient. In our opinion, overdrainage may evolve also in endoscopic treatment of obstructive hydrocephalus. This complication could be the starting point of the subdural collection. We review the literature and discuss the causes that may lead to CSDH after ETV procedure.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
6/18. Intracerebral haematoma in hydrocephalic shunted patients not related to ventricular cannula. Report of three cases and review of the literature.Intracerebral haematoma (ICH) distantly from the site of insertion of a ventriculoperitoneal shunt or external drain is an extremely rare complication. In contrast to ICH caused by disruption of small cerebral vessels by the catheter, the cause of haematoma distantly from the shunt is unclear. We report three cases of ICH occurring distantly from the tubing path. We also discuss possible mechanisms and provide a literature review of this complication.- - - - - - - - - - ranking = 2keywords = haematoma (Clic here for more details about this article) |
7/18. Primitive megalencephaly in children: natural history, medium term prognosis with special reference to external hydrocephalus.We studied 74 children with primitive megalencephaly retrospectively with attention directed to familial megalencephaly, birth history, enlarged pericerebral subarachnoid space (SAS) (idiopathic external hydrocephalus), head and statural growth dynamics, developmental and school prognosis, morphological findings and development of subdural haematoma. In the megalencephalic children, no significant differences were found between those with normal or those with enlarged pericerebral SAS. Out of 62, 31 children (50%) were already megalencephalic at birth. Of 74, 37 children (50%) showed variable degrees of developmental delay which in 18 was transient. Eight out of 74 were mentally retarded. Of 52 children at school age, 42 attend normal schools and 10, of whom 7 are mentally retarded, attend special schools. Three children showed subdural haematoma resulting from apparently minor trauma or occurring spontaneously. We suggest that idiopathic external hydrocephalus represents a variant of primitive megalencephaly with transient increase of intracranial pressure and that it could predispose to the development of idiopathic (spontaneous or non-traumatic) subdural haematoma.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
8/18. Asymmetrical hydrocephalus following evacuation of a subdural haematoma.A case of asymmetrical hydrocephalus complicating the surgical evacuation of a subdural haematoma is reported.- - - - - - - - - - ranking = 1.6666666666667keywords = haematoma (Clic here for more details about this article) |
9/18. Eosinophilic meningitis and radiculomyelitis in thailand, caused by CNS invasion of gnathostoma spinigerum and angiostrongylus cantonensis.During the 6 year period from January 1980 to December 1985 44 patients with infection of the central nervous system by gnathostoma spinigerum or angiostrongylus cantonensis were admitted to the Division of neurology, Ramathibodi Hospital, Bangkok, thailand. In 16 patients the diagnosis could be confirmed serologically by means of ELISA techniques. In gnathostomiasis encephalitis, myelitis, radiculitis and subarachnoid haemorrhage formed the majority of clinical syndromes. Intracerebral haematoma and transitory obstructive hydrocephalus are described in this report as being caused by gnathostoma spinigerum infection for the first time. In angiostronglyus infections the clinical syndrome of meningitis was predominant, but one patient, whose angiostrongyliasis was proved serologically, also showed bilateral paresis of abducens nerve. The main laboratory finding was eosinophilic pleocytosis in the CSF (greater than 10%) which in patients originating or returning from South-East-asia, particularly thailand, is highly suggestive of these parasitic infections. Increasing transcontinental travel, influx of refugees and those seeking asylum as well as importation of food from South East Asian countries demand greater awareness of these parasitic infections even in Central europe.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
10/18. 'Expanding cerebral lacunae' in a hypertensive patient with normal pressure hydrocephalus.A hypertensive patient who had been treated successfully for normal pressure hydrocephalus (NPH), died from a left thalamic haemorrhage. Neuropathological examination showed recent and old thalamic haematomas and numerous parenchymal cavities or 'cerebral lacunae'. Two lacunae bulged into the lateral ventricles, and had all the characteristics of so called 'expanding lacunae'. They were surrounded by a single layer of epithelial-like cells, contained a normal, patent, arteriole, and presented as space occupying lesions. Only two similar cases have been reported previously. The complexity of the neuropathological features of 'cerebral lacunae' is emphasized and the relationships between cerebral hypertensive disease, NPH, and expanding lacunae are discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
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