1/15. Cerebellar haemorrhage after supratentorial aneurysm surgery with lumbar drainage.Haemorrhage within the posterior fossa (PF) after supratentorial surgery is a very rare and exceedingly dangerous complication. Only 28 cases were found in the literature. Up to now, no pathogenetic factor has decisively proven to be the cause of this phenomenon. We present clinical details of a patient operated on for aneurysm of the anterior communicating artery. Lumbar drainage was used during surgery, with the loss of a large amount of cerebrospinal fluid (200 ml). Other causes in our case which may have led to cerebellar shift or a critical increase in transmural venous pressure with subsequent vascular disruption and haemorrhage were extreme head rotation during lengthy surgery and blood pressure peaks in the early postoperative period. Repeated computed tomography (CT) allowed immediate diagnosis of this complication and control of its conservative management. After postponed ventriculoperitoneal shunt, the patient recovered completely.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/15. Cerebellar haemorrhage and tension pneumocephalus after resection of a Pancoast tumour.We present an unusual case of cerebellar haemorrhage followed by tension pneumocephalus several days after thoracotomy for resection of a Pancoast tumour. The postoperative course of the 32-year-old patient was complicated by a cerebellar haemorrhage and hydrocephalus caused by compression of the fourth ventricle. Immediate surgical evacuation of the haemorrhage and placement of an external ventricular drain was performed. Respirator ventilation maintaining a continuous positive airway pressure was required. Following weaning and extubation the patient rapidly deteriorated and became comatose. A cranial CT scan revealed a dilated ventricular system filled with air, and air in the subarachnoid space. Recovery of consciousness was observed after aspiration of intracranial air through the ventricular drainage. Recurrent deterioration of consciousness after repeated air aspiration indicated rapid refilling of the ventricles with air.The patient underwent emergency surgical re-exploration of the thoracic resection cavity: dural lacerations of the cervico-thoracic nerve roots C8 and Th1 were identified. Subarachnoid-pleural fistula, cerebellar haemorrhage and tension pneumocephalus after discontinuation of continuous positive airway pressure respiration are unusual complications of thoracic surgery. We discuss the putative pathomechanisms and present a brief review of the literature.- - - - - - - - - - ranking = 1.6keywords = haemorrhage (Clic here for more details about this article) |
3/15. Distal posterior inferior cerebellar artery aneurysms: clinical characteristics and surgical management.BACKGROUND: Aneurysms located on the distal posterior inferior cerebellar artery (pica) are rare, and their underlying clinical features and surgical management are poorly understood. We report our series of 16 patients with 18 distal pica aneurysms. METHOD: All patients with distal pica aneurysms were treated between March 1996 and August 2004. We excluded all pica aneurysms that involved the vertebral artery. patients were analysed in the light of their clinical profiles, radiological studies, intraoperative findings and outcomes. All patients underwent non-enhanced and contrast enhanced CT scans followed by 4-vessel cerebral angiography on admission. The hemorrhagic patterns on initial CT scans were assessed using the Fisher Grading Score. The outcomes were documented using the glasgow outcome scale at time of discharge and at three or twelve months follow-up. FINDINGS: The series included 6 men and 10 women. Massive intraventricular haemorrhage was found in 13 patients with proven CT subarachnoid haemorrhage, one patient revealed SAH without intraventricular components, one presented with only intraventricular blood in the occipital horns and 3 aneurysms were found incidentally without presence of blood. Fourteen aneurysms were saccular and four were fusiform. Nine cases were associated with another cerebrovascular lesion. A lateral transcondylar or a median suboccipital approach was used to secure the aneurysms in 15 patients, either by direct clipping (14 lesions) or vessel sacrifice (3 lesions). One aneurysm was treated by an endovascular approach. At long-term follow up, an excellent or good outcome was achieved in 75% of cases. One patient died due to pre-existing cardiopulmonary complications. CONCLUSIONS: Most of our cases of ruptured distal pica aneurysms presented with haematocephalus. These were frequently associated with another vascular abnormality and 22% were fusiform or multilobulated. These specific features require special management strategies entailing an appropriate surgical approach to the aneurysm, clipping method, haematoma removal, ventricular drainage and when suitable choice of endovascular interventions.- - - - - - - - - - ranking = 0.4keywords = haemorrhage (Clic here for more details about this article) |
4/15. vertebral artery dissection and cerebellar infarction following chiropractic manipulation.vertebral artery dissection (VAD) associated with chiropractic cervical manipulation is a rare but potentially disabling condition. In this report, we present a young patient manifesting with repeated vertigo. Owing to the initial misdiagnosis, the patient later developed cerebellar stroke with inability to stand or walk. vertigo and disequilibrium are the usual presenting symptoms of this condition, which can result from inner ear or vestibular nerve dysfunction, vertebrobasilar insufficiency, and even lethal cerebellar infarction or haemorrhage; these last two, although rarely seen in young adults, can be caused by traumatic or spontaneous arterial injury, including injury secondary to chiropractic cervical manipulation. A number of cases of VAD associated with chiropractic cervical manipulation have been reported, but rarely in the emergency medicine literature. We present a case of this rare occurrence, and discuss the diagnostic pitfalls.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
5/15. fatal outcome following foetal cerebellar haemorrhage associated with placental thrombosis.Cerebellar haemorrhage is a rare prenatal event. Possible aetiologies for foetal intracranial haemorrhage include: trauma, asphyxia, infection, vascular defects, blood dyscrasias, ingestion of drugs and alloimmune and isoimmune thrombocytopenia. We report the ultrasonographic diagnosis of a cerebellar haematoma at 21 weeks of gestation. The foetus succumbed at 33 weeks of gestation following rupture of a subcapsular liver haematoma. An autopsy demonstrated a placental foetal thrombotic vasculopathy and thrombi in the chorionic vessels. We assume that hypercoagulability was responsible for the multiple infarcts in the foetus with haemorrhagic transformation in the cerebellum and liver. The differential diagnosis of foetal cerebellar haemorrhage includes maternal hypercoagulability; in this case multiple haemorrhagic/ischaemic events may be encountered during the pregnancy. A thorough investigation to elucidate the aetiology is pertinent in every case of foetal cerebellar haemorrhage in order to enable accurate counselling and correct management.- - - - - - - - - - ranking = 1.6keywords = haemorrhage (Clic here for more details about this article) |
6/15. Spontaneous haemorrhage in a cerebellar abscess: a unique complication.A case of spontaneous haemorrhage in a cerebellar abscess is reported. Only two reports of this complication have been found in the literature. An incidental acoustic schwannoma was also found close to the abscess.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
7/15. Cerebellar haemorrhage--diagnosis and treatment: a study of 75 consecutive cases.A retrospective study of 75 consecutive cases of spontaneous cerebellar haemorrhage was undertaken in order to evaluate the clinical features and natural history of this condition. A wide spectrum of clinical findings contributed to the poor clinical diagnostic accuracy of 23 per cent, with common misdiagnoses including brainstem stroke and vestibular or labyrinthine disturbance. Presentation with, or the later development of stupor or coma strongly correlated with poor outcome (severe disability or death; p = 0.002). The characteristics of conscious patients who remained stable were compared with those who subsequently deteriorated. The initial conscious state (alert, drowsy or confused), severity of symptoms and ataxia, and the size of haemorrhage on CT scan were not reliable prognostic indicators. However, the presence of bilateral gaze paresis, anarthria (present in eight cases), limb weakness, a systolic blood pressure above 200 mmHg and moderate hydrocephalus significantly correlated with a poor outcome. The presence of these signs warrants consideration of urgent surgical intervention at the time of diagnosis. Since no clinical or radiological findings excluded the possibility of further deterioration, careful monitoring in an intensive care unit is necessary within the first 48 h in those conscious patients who are likely to remain stable. Guidelines for making the clinical diagnosis and for selecting those patients who will require transfer to adequately equipped centres are suggested.- - - - - - - - - - ranking = 1.2keywords = haemorrhage (Clic here for more details about this article) |
8/15. Cerebellar haemorrhage as a complication after supratentorial craniotomy.Four cases are presented, in whom cerebellar haemorrhages appeared as a complication following supratentorial craniotomy for a giant aneurysm, for tumours in three cases. Two patients died. intracranial hypotension in combination with disturbed blood coagulation is discussed as possible pathogenesis. Because this seems to be a rare complication--similar cases have not yet been described in the literature--its timely diagnosis may be missed.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
9/15. Small cerebellar strokes may mimic labyrinthine lesions.Thirty nine cases of cerebellar infarct and haemorrhage were seen over a period of 3 years. Of these, 69% had no impairment of consciousness. Six cases had nystagmus and gait ataxia as their only abnormal signs. Small cerebellar strokes may present with only vertigo, unsteady gait, and unidirectional nystagmus, thus mimicking labyrinthine lesions. Care in managing vertigo attacks in patients with risk factors for cerebrovascular disease appears to be warranted.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
10/15. meningioma of the foramen magnum presenting as subarachnoid haemorrhage and cerebellar haematoma.An unusual case of a posterior fossa meningioma which caused subarachnoid haemorrhage (SAH) and cerebellar haematoma is presented. The possible causes of tumoral bleeding and the surprising clinical course are discussed in the context of the few similar cases reported in the literature. The importance of cerebral CT scan ning in SAH without angiographic demonstration of an aneurysm or angioma is emphasized.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
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