Cases reported "Brain Injuries"

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1/4. Intracerebral injury following thermocoagulation of the trigeminal ganglion.

    An unusual postoperative complication of percutaneous thermocoagulation of the gasserian ganglion is reported. Computed tomography and magnetic resonance imaging of the brain disclosed an intracerebral lesion following the surgical procedure. Some rare abnormalities of the skull base could increase the risk of such complications. A meticulous surgical technique with fluoroscopic and neurophysiological control is mandatory in any percutaneous procedure on the trigeminal ganglion.
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2/4. Electrical stimulation across the midline and between basal ganglion nuclei.

    Paired unipolar electrodes were introduced into the pulvinar and ventrolateral thalamic nuclei in 3 patients. Stimulation was applied in 1 patient in an attempt to alter the vegetative state after a closed head injury, and increased alertness and ability to comply resulted with stimulation. Auditory evoked responses improved from almost flat to a recognizable pattern. In the 2nd patient, bilateral disabling intention tremor was relieved for several days after a few hours of stimulation. In the 3rd, brachial plexus avulsion pain was improved by stimulation from the contralateral pulvinar to the ventroposterior lateral thalamic nucleus.
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3/4. Traumatic cerebral edema relieved by stellate ganglion anesthesia.

    stellate ganglion neural blockade reverses within seconds anoxemia and edema by release of catecholamine vasoconstriction of the small arteries. The factor xii enzyme cascade is controlled by increased oxygenated arterial blood flow and a normal pH. My patient's rapid recovery reflects the effectiveness of this approach for treatment of traumatic cerebral edema. Continuing edema with its scar-forming process injures brain neuron function. A patient's level of recovery or survival requires such immediate and effective control of edema.
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4/4. Central herniation revealed by focal decrease in blood flow without elevation of intracranial pressure: a case report.

    Until recently, in standard hospital settings the tissue blood supply could be inferred only from indirect measures such as assessment of the clinical signs and intracranial pressure (ICP) monitoring. This critical parameter can now be imaged directly with stable xenon-enhanced computed tomographic (CT) imaging. The procedure requires only an additional 10 minutes after a standard head study, yet it provides potentially vital information about tissue perfusion. We describe here a patient in whom a frontal lobe hematoma produced a direct mass effect, causing an element of central herniation with relative sparing of lateral and posterior cortical regions. Although the ICP recordings remained unchanged, symptoms of brain stem compression became apparent. xenon/CT cerebral blood flow (CBF) mapping demonstrated a flow decrease mainly within the left frontal lobe and throughout central ganglionic structures. After removal of the left frontal hematoma, both clinical status and local and central flow improved. Because the xenon/CT method combines direct anatomical information with blood flow information in one examination, it may be a valuable clinical tool in providing a better understanding of pathophysiology in patients with head injuries and other mass lesions.
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