1/62. Epidural haematoma. A retrospective study of 100 patients.A retrospective study was made of 100 consecutive patients with an epidural haematoma in order to establish which clinically demonstrable factors had influenced the prognosis quoad vitam et sanationem. Operations were performed on 92 of these patients, 29 (32%) of whom died; 8 patients died without operation, and in 2 of these cases the diagnosis was not made during life. A lucid interval was observed in 57 patients; absence of a lucid interval in combination with a lowered sensory level indicated associated intradural lesions (cerebral contusion, acute subdural haematoma), with consequently a less good prognosis. The prognosis was also adversely affected by deeper coma, occurrence of extensor spasms, bilateral stiff pupils, bilateral pyramidal symptoms and an age over 50. Some 33% of the patients treated by operation showed marked symptoms of compression (extensor spasms and/or bilateral stiff pupils); although these symptoms are usually described as indicative of a hopeless prognosis, 40% of the patients in this catagory survived. Contrary to the data in the literature, the interval between accident and operation within the first 24 hours did not influence the mortality, which was 50%. All patients operated on more than 24 hours after the accident, survived. A cranial fracture was absent in 13 patients, 11 of whom were under 30; absence of a cranial fracture was prognostically favourable. A catamnestic study revealed that 7 of the 58 accessible survivors had residual neurological dysfunctions; all these patients were up and about. The residual morbidity after early operation (within 24 hours) was the same as that after later operation. The data obtained were compared with those on a number of series recently published in the literature.- - - - - - - - - - ranking = 1keywords = compression, fracture (Clic here for more details about this article) |
2/62. hemifacial spasm due to tumor, aneurysm, or arteriovenous malformation.The authors report eight cases of so-called symptomatic hemifacial spasm. They had gross pathological lesions such as a tumor (one epidermoid, one neurinoma, and two meningiomas), vascular malformation (one medullary venous malformation and two arteriovenous malformations), and aneurysm. In all four cases with a tumor, no artery compressed the facial nerve at the root exit zone. In three of the four cases, the hemifacial spasm disappeared after removal of the tumor in contact with the facial nerve. Compression or encasement of the facial nerve by the tumor was the pathogenesis of the hemifacial spasm in these three cases. The remaining case with tumor (tentorial meningioma) did not have a mass or vessel that directly compressed the facial nerve at the root exit zone. However, the hemifacial spasm disappeared after the removal of the tumor. In a case with a medullary venous malformation with arterial component, an engorged draining vein compressed the root exit zone of the facial nerve. In the remaining three vascular cases--two cases of arteriovenous malformation and a case of saccular aneurysm--enlarged feeding arteries and an aneurysm directly compressed the root exit zone of the facial nerve. Not only arterial or venous but also mass compression can cause hemifacial spasm in some symptomatic cases. Surgical decompression of the facial nerve from the causative organic lesion is the primary choice of treatment.- - - - - - - - - - ranking = 1.4723384403864keywords = compression (Clic here for more details about this article) |
3/62. Self-inflicted orodental injury in a child with leigh disease.leigh disease is an inherited progressive mitochondrial neurodegenerative disease that affects the neurological, respiratory and cardiovascular systems and is associated with retardation of the intellectual and physical development. This report describes the case of a 4-year-old boy with leigh disease who presented with self-inflicted traumatic injury to the teeth, alveolar bone, lips and tongue during repeated episodes of intense orofacial spasms. Conservative management of the injury included repositioning the fractured alveolar bone, splinting the traumatized teeth and planning for a mouthguard. However, after a second incident of severe self-induced injury to the teeth and alveolar bone, extraction of the anterior teeth became inevitable to protect the child from further self-mutilation and to allow healing of the injured tissues.- - - - - - - - - - ranking = 0.1319153899034keywords = fracture (Clic here for more details about this article) |
4/62. Transection of the innominate artery for tracheomalacia caused by persistent opisthotonus.patients with cerebral palsy often develop opisthotonus. The trachea may be pinched between the innominate artery and the cervical spine. This compartmentalized thoracic inlet results in severe tracheomalacia. We successfully released tracheal compression by transection of the innominate artery. In case 1, a 4-year-old girl with cerebral palsy and opisthotonus was admitted due to respiratory distress. bronchoscopy revealed severe tracheomalacia 2 cm above the carina. An endotracheal stent was placed through a tracheostomy. Two months later, she developed tracheal bleeding and bronchoscopy demonstrated a trachea-innominate artery fistula. Magnetic resonance brain angiography showed the presence of Willis' circle, and transection of the innominate artery was justified. This was done through a low cervical skin incision. In case 2, a 6-year-old boy with cerebral palsy and opisthotonus had long-standing respiratory distress. Ventilatory support did not resolve the symptoms. The innominate artery was transected in the same fashion as in the first case. Case 1 has been free from respiratory distress for 4 months and case 2 for 3 years. Our experience suggests that the combination of tracheomalacia, opisthotonus causes severe respiratory distress. Transection of the innominate artery is a useful therapeutic strategy to release airway obstruction in this condition.- - - - - - - - - - ranking = 0.7361692201932keywords = compression (Clic here for more details about this article) |
5/62. Oblique sagittal magnetic resonance imaging visualizing vascular compression of the trigeminal or facial nerve.An oblique sagittal magnetic resonance (MR) imaging method was developed to provide better visualization of vascular compression of nerves. The MR images of 12 patients with trigeminal neuralgia and 24 with hemifacial spasm were analyzed. The oblique sagittal views were obtained along the nerve identified by the axial view at an angle of 105 degrees between the line along the dorsal brain stem and the line along the margin of the pontomedullary junction (in patients with hemifacial spasm) or by the midsagittal view through the midpons (in patients with trigeminal neuralgia). The T1- and T2-weighted, proton-density, and/or gradient-echo MR images were evaluated to optimize imaging conditions. The oblique sagittal gradient-echo MR image most clearly visualized vascular compression of the nerves as high-intensity lines in six patients with trigeminal neuralgia, which was confirmed intraoperatively in four. Fifteen (75%) of 20 oblique sagittal gradient-echo MR images demonstrated vascular compression of the facial nerves in patients with hemifacial spasm; 12 of these were confirmed intraoperatively. The control study used 15 oblique sagittal gradient-echo MR images of nonaffected contralateral and normal sites. Four false-positive findings were found. Oblique sagittal gradient-echo MR images are a useful planning aid, allowing differential diagnosis prior to microvascular decompression in trigeminal neuralgia and hemifacial spasm.- - - - - - - - - - ranking = 5.8893537615456keywords = compression (Clic here for more details about this article) |
6/62. Displaced fracture through the anterior atlantal synchondrosis.In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report.- - - - - - - - - - ranking = 0.92340772932379keywords = fracture (Clic here for more details about this article) |
7/62. hemifacial spasm associated with a cerebellopontine angle arachnoid cyst in a young adult.There are no reported cases of hemifacial spasm associated with an arachnoid cyst in the literature. We report the first case of hemifacial spasm with an ipsilateral cerebellopontine angle arachnoid cyst in a 25-year-old man. The patient underwent evacuation of the arachnoid cyst by a partial membranectomy without any beneficial effect, and finally got rid of the hemifacial spasm by reexploration and microvascular decompression of the facial nerve. The operative findings and results revealed that the cyst produced deviation of the ipsilateral posterior inferior cerebellar artery, which was secondarily in contact with the root exit zone of the facial nerve.- - - - - - - - - - ranking = 0.7361692201932keywords = compression (Clic here for more details about this article) |
8/62. Painful tic convulsif caused by a brain tumor: case report and review of the literature.Patient with painful tic convulsif caused by a brain tumor is presented. The patient was admitted with right trigeminal neuralgia and ipsilateral facial spasm, i.e., painful tic convulsif. Preoperative computed tomography scans showed no apparent abnormalities; however, surgery revealed that these symptoms were associated with a pearly tumor located in the cerebellopontine angle. Subtotal resection for the decompression of the right trigeminal and facial nerves was performed and resulted in complete relief of the symptoms. Histological examination demonstrated the tumor to be an epidermoid cyst.- - - - - - - - - - ranking = 0.7361692201932keywords = compression (Clic here for more details about this article) |
9/62. Rare causes of hemifacial spasm. Report of two cases.Two patients are presented whose sole symptom was hemifacial spasm. Cerebellar arachnoid cyst was diagnosed in one patient who was treated effectively by removal of the cyst and decompression of the facial nerve. The second patient had an AVM of the posterior fossa. Surgery was withheld in this case.- - - - - - - - - - ranking = 0.7361692201932keywords = compression (Clic here for more details about this article) |
10/62. Lower-limb vasospasm and renal failure during postoperative thromboprophylaxis. Case report.In a 73-year-old woman with trimalleolar fracture, secondary acute ischemia of the limb and renal failure developed in association with heparin-dihydroergotamine thromboprophylaxis. Earlier cases of thromboprophylaxis-related angiospasm are briefly reviewed. The condition is infrequent, but trauma of extremities and shock are risk factors. Renal failure is rare.- - - - - - - - - - ranking = 0.1319153899034keywords = fracture (Clic here for more details about this article) |
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