1/52. Central brain herniation secondary to juvenile diabetic ketoacidosis.We present the CT, MR, and autopsy findings of central brain herniation in a 9-year-old boy undergoing treatment for diabetic ketoacidosis (DKA). Severe cerebral edema resulting in central brain herniation is an uncommon complication of the treatment of DKA but carries with it high morbidity and mortality. Radiologic imaging and autopsy findings in this case revealed striking infarctions of central brain structures.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/52. coccidioidomycosis meningitis with massive dural and cerebral venous thrombosis and tissue arthroconidia.To our knowledge we report the first case of meningitis from coccidioides immitis associated with massive dural and cerebral venous thrombosis and with mycelial forms of the organism in brain tissue. The patient was a 43-year-old man with late-stage acquired immunodeficiency syndrome (AIDS) whose premortem and postmortem cultures confirmed C immitis as the only central nervous system pathogenic organism. Death was attributable to multiple hemorrhagic venous infarctions with cerebral edema and herniation. Although phlebitis has been noted parenthetically to occur in C immitis meningitis in the past, it has been overshadowed by the arteritic complications of the disease. This patient's severe C immitis ventriculitis with adjacent venulitis appeared to be the cause of the widespread venous thrombosis. AIDS-related coagulation defects may have contributed to his thrombotic tendency.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
3/52. Acute cerebellitis with near-fatal cerebellar swelling and benign outcome under conservative treatment with high dose steroids.Acute cerebellar swelling is an emergency because of brainstem compression as well as upward or downward cerebellar herniation. Few childhood cases are on record, with fatal outcome in three out of six. We report a girl with probable Epstein-Barr virus-associated cerebellar swelling who recovered completely with steroid treatment after a stormy course. review of the literature showed that all three patients, including our own, who recovered fully, received high-dose steroids in contrast to none of the four patients who died or survived with sequelae. neuroimaging and evoked potential studies are useful for early diagnosis and disease monitoring. We conclude that for the time being high-dose steroid treatment is advocated in patients with acute infectious or parainfectious cerebellar swelling.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
4/52. Acute changes in cerebral blood flow and metabolism during portasystemic shunting.This report describes the instantaneous changes in cerebral blood flow (CBF), determined by intravascular ultrasound and Doppler, in a patient with cirrhosis undergoing placement of a transjugular intrahepatic stent-shunt for uncontrolled variceal bleeding. Acute changes in CBF were observed during and after portasystemic shunting, which culminated in cerebral edema and cerebral herniation.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
5/52. A huge frontal meningioma associated with intraoperative massive bleeding and severe brain swelling--case report.A 58 year old female presented with progressive memory disturbance and personality change. Magnetic resonance (MR) imaging disclosed a huge mass lesion accompanied by prominent oedema in the right frontal lobe. Cerebral angiogram demonstrated a vascular-rich tumour and a major drainer through diploic vein. A right frontotemporal craniotomy was performed. We encountered massive bleeding from diploic vein and dura mater immediately at the craniotomy. We were also faced with severe brain swelling at the dural incision. The tumour was solid, highly vascularised, and fairly well demarcated. We performed total removal of the tumour as quickly as possible in order to reduce the intracranial hypertension and avoid the impending brain herniation. The patient had an uneventful recovery and was asymptomatic at 10 months follow-up.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
6/52. Respiratory failure as a seizure phenomenon. A case report.Recurrent acute respiratory failure in an epileptic subject is described. The first episode of respiratory failure occurred while the patient was having frequent epileptic fits and was probably secondary to cerebral oedema with temporal herniation. The second occurred suddenly after 27 days during which the patient had been free from seizures. It is suggested that this episode of acute respiratory failure was the result of an epileptic seizure without any motor symptoms.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
7/52. Applying circular posterior-hinged craniotomy to malignant cerebral edemas.Malignant brain edemas are often fatal, regardless of whether they are treated conservatively with sedation, blood pressure management, mannitol-therapy, hyperventilation and hypothermia, or non-conservatively with routine trepanation. Unfortunately, temporal trepanation may result in significant brain damage through herniation of the cerebrum at the edges of the trepanation openings. In one case of a 26-year-old male with severe head injury, a circular posterior-hinged craniotomy (CPHC) was performed after an ineffective unitemporal trepanation for evacuation of an acute subdural hematoma. This ultimately successful operation prompted experimental and morphologic investigations on a new surgical procedure for lowering intracranial pressure (ICP). In 12 of 15 human cadavers, an experimentally ICP was lowered by a CPHC with between 9-21 mm of frontal elevation of the calvaria. Using computer simulation, the frontal elevations of the calvaria were "virtually" performed on 3D reconstructions from CT scans of skulls, and the intracranial volume gained was measured with a computer software program. The volume increase of the cranial cavity showed a relatively constant relation to the cranial capacity and was increased by 6.0% ( /-0.4%) or 78 cm(3) with a 10 mm elevation and by 12.4% ( /-0.7%) or 160 cm(3) with a 20 mm elevation. There were no significant differences with skulls of different ages or ethnic origin; however, a significant effect of gender (F = 7.074; P < or = 0.013) on the gained volume in percent of the cranial capacity for the 20 mm elevation was observed. This difference can be explained by the inverse relationship between volume increase and cranial capacity (r = -0.507; P < or = 0.004).- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
8/52. Prehospital cardiac arrest in diabetic ketoacidemia: why brain swelling may lead to death before treatment.An adolescent is reported with type 1 diabetes mellitus and diabetic ketoacidemia (DKA) who died from brain herniation prior to treatment with intravenous fluids and intravenous insulin. The pathophysiology of raised intracranial pressure (ICP) and water intoxication is discussed. As DKA evolves, water and electrolyte losses are replaced by very hypotonic fluids taken orally, leading to a physiologic excess of free water that would cause brain swelling prior to treatment. central nervous system acidosis may interfere with normal compensatory mechanisms that help prevent small increases in ICP. The pathophysiology of pre-treatment brain swelling has important implications for rehydration with intravenous fluids and treatment with insulin. Prevention of DKA is paramount as well as complete postmortem evaluation of patients who die from this disease.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
9/52. intracranial hypotension after intraoperative lumbar cerebrospinal fluid drainage.OBJECTIVE: Intraoperative lumbar cerebrospinal fluid drainage is frequently performed in a variety of neurosurgical procedures. A retrospective review is presented of the complications of lumbar cerebrospinal fluid drainage. methods: The records from 75 consecutive operations requiring intraoperative lumbar cerebrospinal drainage during a 1-year period at the Hospital of the University of pennsylvania were reviewed to assess the types of complications attributable to spinal drainage and their rates of occurrence. The operations were categorized into 46 aneurysm clippings, 21 craniotomies for tumors, and 8 other cranial base procedures. RESULTS: Two patients developed transient postoperative neurological complications as a result of intracranial hypotension that resolved after epidural blood patching, with a reexploration craniotomy to drain an epidural collection performed in one patient. A third patient in the study developed a persistent deficit when intracranial hypotension led to intraoperative transtentorial herniation, which resulted in an unusual constellation of multiple brainstem infarcts that caused cranial neuropathy. CONCLUSION: Complications of intraoperative lumbar cerebrospinal fluid drainage resulting in transient (2 of 75 patients, 3%) or persistent (1 of 75 patients, 1%) neurological deficits caused by intracranial hypotension occur infrequently and may be related to preexisting conditions such as hydrocephalus.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
10/52. Unexplained drowsiness and progressive visual loss: methanol poisoning diagnosed at autopsy.A patient was admitted to the emergency department with a reduced level of consciousness and deteriorating vision. Her pupils became fixed and dilated and she developed a third nerve palsy with extensor posturing of her limbs. biochemistry profile showed an increased serum osmolar gap with a raised anion gap metabolic acidosis. Supportive treatment was instituted, but she made no recovery and brainstem death was later confirmed. Post mortem examination and toxicology screen confirmed the cause of death as methanol poisoning leading to cerebral oedema and transtentorial herniation. We highlight some of the diagnostic difficulties associated with treating a patient with a reduced level of consciousness. The clinical and biochemical findings that are critical in establishing a diagnosis of methanol intoxication are discussed. The definitive management of methanol poisoning is reviewed.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
| | Next -> |