Cases reported "Brain Edema"

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11/24. Cervicomedullary junction decompression in a case of Marshall-Smith syndrome. Case report.

    The case is reported of a 2-year-old boy born with Marshall-Smith syndrome who had difficulty in swallowing and who exhibited spasticity and quadriparesis due to compression of the medulla and cervical spine. This is the first child with this rare condition reported to have brain-stem compression from bone abnormalities at the craniovertebral junction and who has required surgery.
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12/24. Neuro-otologic evaluation of the patient with acute, severe head injuries: correlations among physical findings, auditory evoked responses, and computerized tomography.

    Long-term clinical neurologic and otologic sequelae of traumatic head injury are well recognized. In this article, we describe the relationship among neurophysiologic, neuro-otologic, and neuroradiologic findings in a series of fifty patients with acute, severe head injury. Seventy percent of the patients had one or more otologic abnormalities, of which hemotympanum was most common. Outcome of computerized tomography (CT), auditory brainstem response (ABR), and otologic examination findings were not mutually dependent. For example, otologic disease was found in 50% of the patients with normal ABR. All but one patient in the series showed brain damage by CT; yet only 14% of the series had evidence of temporal bone fracture and, unexpectedly, one third of this group yielded normal otologic findings and a normal ABR. We conclude that combined application of otologic examination, CT scanning, and auditory evoked response assessment provides complementary information on structural and functional neuro-otologic status in persons with acute, severe head injury.
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13/24. Steroid-induced avascular necrosis of bone in neurosurgical patients.

    After administration of short-term high-dose prednisolone in two patients with brain tumors, avascular necrosis of the femoral head was noted 7 and 15 months later, respectively. Both patients required replacement of the femoral heads. Despite the extensive use of steroid therapy in neurosurgical practices, reports of avascular necrosis of bone have been exceedingly sparse. This pathological condition evolves several months later, and has received scant attention in the neurosurgical literature. Particularly in patients with hemiparesis, the hip joints on the affected side are thought to suffer from avascular necrosis more frequently. For this reason, sufficiently long-term observation for the early detection of this complication is necessary in patients treated with steroids.
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keywords = bone
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14/24. Avascular necrosis of bone following short-term dexamethasone therapy for brain edema. Case report.

    The authors present a case of avascular necrosis of both femoral and humeral heads which developed after short-term steroid treatment for brain edema. A vascular necrosis of bone may develop after short-term as well as after maintenance steroid therapy. early diagnosis with bone scanning and management may in some cases prevent joint destruction.
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keywords = bone
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15/24. Uncommon presentations in neuroblastoma.

    Two cases of neuroblastoma with unusual presentation are reported. In the first case it presented as a general swelling of the head and in the second case it presented as generalized pains in the bones particularly the pelvis and left leg.
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16/24. pathology and pathogenetic mechanisms in neurotuberculosis.

    The mechanisms and the changes described herein typically begin with a dense basal meningeal exudate often resulting from a "Rich focus" along the basal surface of the cerebrum or ventricular ependyma. In the interpeduncular fossa, when the exudate is copious, among other structures the proximal parts of the optic nerves and of the internal carotid arteries are seen surrounded and compressed by the exudate. This exudate is made up of small and large mononuclear cells, including epithelioid cells, which also act as macrophages and may fuse to form Langhans' giant cells. Further extension of this exudate along small proliferating blood vessels into the brain substance constitutes a border zone encephalitis with the development of focal and diffuse ischemic brain changes due to vasculitis. Entrapment and occasional arteritic occlusion of larger arteries, such as the middle cerebral in the Sylvian fissures, results in infarction. Blockage of the basal subarachnoid cisterns around the midbrain and pons by the dense basal exudate or narrowing of aqueduct and third ventricle by a small tuberculoma causes consequent hydrocephalus. Development of many or one large focal granuloma (i.e., tuberculoma) occurs in the cerebrum, cerebellum, and/or brain stem. Similar pathogenetic mechanisms produce tuberculous spinal meningitis myeloradiculopathy that may be secondary to or occur before cranial tuberculous meningitis. More extensive damage to the white matter may occur together with the infrequent onset of perivascular demyelination on the basis of a hypersensitivity reaction to tuberculoprotein (i.e., "allergic tuberculous encephalopathy"). Finally, there may be a part played by NO in the production of the vascular and perivascular inflammatory central nervous system changes and a role for the the potential beneficial action of corticosteroids, especially in cases of tuberculous encephalopathy.
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ranking = 129.79450816369
keywords = macrophage
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17/24. Synaptic degenerative changes in human traumatic brain edema. An electron microscopic study of cerebral cortical biopsies.

    The cerebral cortex of 9 patients with complicated brain trauma has been examined with the transmission electron microscope to study the distinctive degenerative synaptic changes induced by brain injury and associated vasogenic, moderate or severe, brain edema. The brain injury and the hematogenous edema fluid accumulated in the dilated extracellular space of cerebral cortex neuropil induced swelling and shrinkage of pre- and postsynaptic structures, increased amount of presynaptic axoplasmic granular substance and clumping, enlargement and depletion of synaptic vesicles. In severe brain edema, swollen and shrunken presynaptic endings with discontinuous limiting plasma appeared separated from the postsynaptic structures and detached from glial ensheathment (synaptic disassembly). Post-synaptic shaft dendrites and their spines showed swelling and vacuolization. Fragmen-tation and atrophic changes of spine apparatus were found in the dendritic spines. The clear and dark types of degeneration were observed in most cases examined, in both preand/or postsynaptic structures. Filamentous hypertrophy of presynaptic endings was observed only in two cases. Osmiophylic bodies, necrotic membranes, lipid inclusions and glycogen granules were seen in the synaptic terminals. Disappearance of synaptic densities was evident in some cases. phagocytosis of isolated presynaptic endings or of the entire synaptic contacts by astrocytes, microglial cells and by non-nervous invading cells, such as monocytes and macrophages, was found.
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ranking = 129.79450816369
keywords = macrophage
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18/24. Chasing the casing: a 38 Special suicide.

    Multiple self-inflicted gunshot wounds of the head are uncommon. Detailed history, scene investigation, autopsy findings, consideration of ballistics, and evidentiary proceedings are necessary to determine the manner of death in these cases. This report involves a pattern of atypical, self-inflicted bullet wounds of the head of a 26-year-old male. Investigation confirmed that a single eyewitness and several earwitnesses reported a single discharge of a firearm. The eyewitness testified that the decedent singly discharged a Smith & Wesson revolver, caliber .38 Special, to the right side of his head after interposing several objects between the muzzle and his skin immediately prior to discharge. He was declared brain dead two days later. At necropsy two contiguous atypical entry wounds were present in the right preauricular temple. The inferior wound was interpreted to be a near contact wound. The gray metal slug fragmented, creating separate tracks to the right maxillary sinus and the mid left posterior cerebrum, respectively. The larger, atypical wound of entry was associated with passage of the projectile through the right temporalis muscle and squamous temporal bone. The projectile, consisting of a slightly distorted empty metallic cartridge case containing a "live" primer, was recovered from its point of final lodgment in the right temporal lobe. The literature addressing paired entry wounds following single discharge of the firearm with interposed targets is relatively sparse. Cases reporting multiple bullet wounds involving suicide are only sporadically reported. This report summarizes the investigative findings supporting the determination of the manner of death and revealing the interesting origin of the "misplaced" casing.
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19/24. An autopsy case of traumatic sinus thrombosis.

    A 38-year-old male slipped accidentally and fell from a height of 4.6 m, and was admitted to a hospital. A radiograph indicated a linear fracture of the parietal bone across the sagittal sutura, and a computed tomography scan of the head showed severe subdural hematoma on both parietal sides, so an operation was performed to remove the hematoma. Five hours after the operation, brain death due to a cerebral herniation occurred, and he died six days later. autopsy revealed a linear fracture of the parietal bones, which crossed obliquely the sagittal sutura. A slightly lacerated wound of the dura mater was seen on the sagittal sutura, from where the latter half of that point to the left and right transverse sinuses were occluded completely with thrombosis. The brain was markedly swollen. From these findings, the victim was considered to have died from acute cerebral swelling due to traumatic thrombosis of the superior sagittal sinus.
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ranking = 2
keywords = bone
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20/24. Acute brain swelling during removal of supratentorial cystic lesion caused by contralateral extradural hematoma: case report.

    BACKGROUND: Protrusion of the cortex through a bone flap in the course of surgery is a very serious event and, if it persists, the procedure must be suspended, the cause sought, and the problem resolved. CASE DESCRIPTION: We report the case of a 13-year-old boy whose brain underwent sudden swelling during removal of a supratentorial cystic lesion. The operation was suspended at once and an emergency CT scan was performed. It revealed a large contralateral extradural hematoma, which was removed immediately. CONCLUSIONS: We considered the following possible mechanisms of the emergency: bleeding of bone at the site of the supposed piercing by the headrest pin and/or a vacuum mechanism consequent upon removal of the large cystic lesion. Our aims are to emphasize the importance of gauging the thickness of a child's skull before fixing the head in the headrest, especially when chronic intracranial hypertension is present, and the need to suspend the operation for CT scanning in the event of uncontrollable brain swelling.
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