11/21. Bilateral intracerebral hypertonic haemorrhage.Bilateral hypertonic intracerebral haemorrhage is a rare pathological entity. CT-scan enables precise diagnostics, but in a case of bilateral intracerebral bleeding it is difficult to make decision whether to operate or not. In our group of 65 operated patients with intracerebral haemorrhage in the time interval 1985-1987 there was only one with bilateral bleeding. After the surgical removal of blood clots from one hemisphere the patient recovered.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
12/21. High altitude cerebral oedema.High altitude cerebral oedema is a severe form of acute mountain sickness occurring at heights above 4500 metres. The clinical features are of headache, impairment of consciousness and a variety of neurological signs. The condition occurs during acclimatisation and also at extreme altitudes above 7500 metres when it is often fatal. Case histories of cerebral oedema patients, pathological findings and treatment are reviewed. Other forms of altitude-related illness are also reviewed, including stroke and retinal haemorrhage.- - - - - - - - - - ranking = 0.61470024898864keywords = retinal haemorrhage, haemorrhage (Clic here for more details about this article) |
13/21. Active management of the unconscious eclamptic patient.Of the many complications which may develop after eclamptic seizures, prolonged unconsciousness is one of the most difficult for obstetricians to manage as the pathophysiology of this condition remains largely unknown. Computed axial tomography (CT scan) was performed on 20 unconscious eclamptic patients, and autopsy was obtained on an additional two patients. Changes compatible with cerebral oedema were demonstrated in 75% of patients; cerebral haemorrhage occurred in 9%. A programme of intensive neurological management aimed at optimizing cerebral perfusion and controlling intracranial pressure is outlined. We have reduced the mortality rate for unconscious eclamptic patients from 50% to 17% in our institution.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
14/21. Disseminated strongyloidiasis with uncommon manifestations in greece.strongyloidiasis is a human intestinal parasitosis caused by the nematode strongyloides stercoralis. In most cases the infection is subclinical, but rarely, disseminated strongyloidiasis may occur in debilitated or immunocompromised patients, and in those who receive immunosuppressive agents. In this report, we describe an unusual case of severe disseminated strongyloidiasis, with intestinal, pulmonary and neurological manifestations, in a previously healthy male. The onset of the disease was acute with headache and neck stiffness, due to subarachnoid-ventricular haemorrhage. During a protracted clinical course the patient developed diarrhoea, abdominal pain, recurrent paralytic ileus, pneumonitis and respiratory distress, malabsorption and weight loss, diagnosis was delayed due to the complicated course and rarity of the disease. The diagnosis finally established during evaluation for malabsorption by demonstrating larvae of S. stercoralis in the jejunal mucosal biopsy and faeces. Response to mebendazole treatment was prompt with complete recovery and resolution of all systemic manifestations. early diagnosis and treatment of strongyloidiasis in the intestinal phase is critical in the prevention of dissemination, which may prove lethal due to life-threatening complications.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
15/21. Cerebral form of high-altitude illness.Twelve cases of severe altitude illness are reported in which the neurological signs and symptoms dominated the clinical picture. Pulmonary oedema, retinal haemorrhage, thrombophlebitis and pulmonary embolism, bronchopneumonia, and coronary-artery disease were also present in several of the patients but the primary problem seems to have been cerebral oedema. Other published cases support this impression. patients who were returned to low altitude early in the disease fared well; two patients died, and in both cases evacuation had been delayed. The most effective prevention lies in slow ascent, though in one case reported here the rate of climb was well within the recommended limit. Recommended management is rapid descent to low altitude at earliest indication of cerebral or pulmonary oedema, intravenous dexamethasone or betamethasone in large doses, hydration, diuresis (frusemide has been most used), and perhaps other intravenous therapy with hyperosmolar materials such as mannitol, urea, 50% saline, or 50% sucrose. prognosis is good if descent and treatment are started early, but permanent damage may be anticipated if the patient is unconscious for any prolonged period before descent.- - - - - - - - - - ranking = 0.61470024898864keywords = retinal haemorrhage, haemorrhage (Clic here for more details about this article) |
16/21. diabetes mellitus and hypopituitarism.A 38-year-old diabetic woman developed hyponatraemia and fatal non-ketotic coma after elective cholecystectomy. At the autopsy, it was revealed that the immediate cause of death was cerebral oedema with secondary pontine haemorrhage. The cerebral oedema was associated with severe hyponatraemia and atrophy of the endocrine organs, including the adrenal glands. Biochemical analysis of serum taken immediately before death indicated that the primary defect was pituitary insufficiency, a recognised but rare complication of diabetes.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
17/21. Changes in the basal ganglia and thalamus following reperfusion after complete cerebral ischaemia.We report specific changes bilaterally in the basal ganglia and thalamus following reperfusion after complete cerebral ischaemia. A 69-year-old man, resuscitated after cardiac arrest, showed symmetrical low-density lesions in the head of the caudate nucleus and lentiform nucleus on CT. MRI revealed methaemoglobin derived from minor haemorrhage in the basal ganglia and thalamus, not evident on CT. We suggest that this haemorrhage results from diapedesis of red blood cells through the damaged capillary endothelium following reperfusion.- - - - - - - - - - ranking = 0.33333333333333keywords = haemorrhage (Clic here for more details about this article) |
18/21. Acute vasoparalysis after subarachnoid haemorrhage and cerebral trauma: general reflex phenomenon?In patients with head trauma and consecutive acute diffuse cerebral swelling the sudden initial rise in intracranial pressure with subsequent impairment of cerebral blood flow is explained by engorgement due to vasoparalysis. How quickly hyperaemic brain swelling can occur is shown by a case report. The review of clinical and experimental data shows strong evidence that a general reflex phenomenon could be the result of this initial vasoparalysis in acute diffuse cerebral swelling in head trauma and acute aneurysmal subarachnoid haemorrhage.- - - - - - - - - - ranking = 0.83333333333333keywords = haemorrhage (Clic here for more details about this article) |
19/21. Unexpected neurological deficits following recovery from anaesthesia.Two cases of neurological dysfunction are presented. Neurological deficits after recovery from anaesthesia are unusual in young women perioperatively. In the first case, a 39-yr-old woman presented at 36-wk gestation with antepartum haemorrhage and in labour. pregnancy had been complicated by pre-eclampsia and she underwent emergency Caesarean section under general anaesthesia without complication. The trachea was extubated when she was awake but almost immediately she became hypertensive, obtunded and reintubation was required. Her pupils became fixed and dilated but the Computerised Axial Tomogram (CT) was normal. A coagulopathy was evident. She made a full neurological recovery within 24 hr. On the same day, a previously healthy 41-yr-old woman who had undergone uneventful surgery for uterine prolapse 24 hr previously developed headache, nausea and over the next four hours signs of progressive brainstem ischaemia. The CT scan showed oedema of the mid- and hindbrain. Brainstem death was confirmed 12 hr later and the post-mortem revealed acute dissection of the vertebral artery secondary to cystic medial necrosis. Such dramatic neurological sequelae are rare but the importance of identifying "at risk" groups is underlined as is early recognition of neurological injury postoperatively.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
20/21. Evaluation of regional cerebral blood flow changes on perifocal brain tissue SPECT before and after removal of arteriovenous malformations.In fifteen cases of arteriovenous malformation (AVM), serial examinations of regional cerebral blood flow (rCBF) using single photon emission computed tomography (SPECT) and N-isopropyl-(123I)p-iodoamphetamine were performed. On SPECT images, the nidus was visualized as a focal rCBF defect in all cases preoperatively and seven of these cases had abnormal decreased perfusion areas in the tissues adjacent to the nidus. In five cases, the postoperative SPECT images on the day after surgery revealed an abnormal increased perfusion area adjacent to the nidus and in one case the increased perfusion was accompanied by a massive intracerebral haemorrhage detected by brain computed tomography (CT). In seven cases, postoperative SPECT images showed widespread abnormal decreased perfusion areas in the surrounding tissues and brain CT revealed either intracerebral haemorrhage or significant cerebral oedema. In the other three cases, no remarkable rCBF changes were found in comparison with the pre-operative study. There was a tendency for the preoperative abnormal decreased perfusion area adjacent to the nidus to correlate with the postoperative hyperperfusion and for the postoperative abnormal decreased perfusion area to reflect brain damage.- - - - - - - - - - ranking = 0.33333333333333keywords = haemorrhage (Clic here for more details about this article) |
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