Cases reported "Craniocerebral Trauma"

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1/72. Arterial-esophageal fistulae in patients requiring nasogastric esophageal intubation.

    A rare and potentially fatal cause of hematemesis is fistula formation between the esophagus and the vascular system. A case report of a 39-year-old woman with congenital aortic arch anomalies hospitalized for treatment of head injuries demonstrates the potential for iatrogenic esophageal trauma to initiate fistula formation between the esophagus and an anomalous arterial system. A literature review revealed 6 other cases of vascular-esophageal fistulae caused by nasogastric esophageal intubation. It is concluded that aortic arch anomalies increase the risk of esophageal injury and subsequent fistula formation from nasogastric esophageal intubation. In addition, the clinical features and pathologic findings of vascular-esophageal fistulae are reviewed.
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2/72. Multimodality monitoring and the diagnosis of traumatic caroticocavernous fistula following head injury.

    Increases in jugular bulb saturations (SjO2) following head injury are usually due to hyperaemia. Less commonly this may be due to the development of an arteriovenous fistula. We describe how SjO2 monitoring can be used in conjunction with transcranial Doppler ultrasound to make the distinction between these two conditions, which require distinct therapies. Multimodality monitoring in acute injury provides information regarding underlying pathophysiology and permits individualization of therapy.
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3/72. Transarterial intravenous coil embolization of dural arteriovenous fistula involving the superior sagittal sinus.

    BACKGROUND: We report a rare case of traumatic dural arteriovenous fistula involving the superior sagittal sinus successfully treated by transarterial intravenous coil embolization. CASE PRESENTATION: A 38-year-old woman presented with tension headache. She had a past history of severe head injury at the age of three. Computed tomography scanning showed a heterogenous low-density area in the right frontal lobe, and magnetic resonance imaging demonstrated abnormal vascular structures in the same area. Angiography revealed a dural arteriovenous fistula involving the lateral wall of the fully patent superior sagittal sinus. The fistula was fed by scalp, meningeal, and cortical arteries, and drained into a cortical vein leading to the superior sagittal sinus. Femoral transarterial intravenous embolization with microcoils completely occluded the dural arteriovenous fistula. CONCLUSION: Severe head injury may lead to asymptomatic dural arteriovenous fistulas after a long time. Transarterial intravenous coil embolization can be effective in the treatment of dural arteriovenous fistulas involving the superior sagittal sinus.
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4/72. Identification of an arteriovenous fistula in a child. Case report and review of the literature.

    BACKGROUND: A 6-year-old girl sustained a subarachnoid hemorrhage after a mild head injury and was discovered to have an arteriovenous fistula (AVF). INVESTIGATIONS AND TREATMENT: The etiology of subarachnoid hemorrhage was not evident on the initial brain CT. brain CT with CT angiography identified the lesion. The AVF was further imaged with brain MRI followed by cerebral angiography and successfully embolized. OUTCOME: The child did not suffer any neurological sequelae.
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5/72. rupture of the round window membrane.

    A perilymph leak into the middle ear through a ruptured round window membrane results in the symptoms of hearing loss, tinnitus and vertigo, either singly or in combination. The case histories of thirteen patients with such a fistula are described, these patients having in common a predisposing incident which had led to a rise of C.S.F. pressure. Symptomatology and the results of investigation are analysed and operative technique and results discussed. While it appears that vertigo uniformly responds very satisfactorily to operative treatment the improvement in hearing loss and tinnitus is more difficult to predict.
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6/72. Ventriculo-orbital fistula in closed head injury. Case report.

    A ventriculo-orbital fistula developing as a result of closed head injury produced intraorbital compression symptoms including downward deviation of the globe and inability of upward gaze. Percutaneous injection of Conray clearly demonstrated the fustula, which was successfully closed by frontal craniotomy.
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7/72. diagnosis and treatment of bilateral traumatic carotid-cavernous sinus fistulae.

    The authors report the diagnosis and successful treatment of a case of traumatic bilateral carotid-cavernous sinus fistula. Direct tamponade of the fistula with a Fogarty catheter and ligation of all cervical carotid vessels was carried out on the left side following ligation on the right side of the common carotid, the internal carotid extra- and intracranially, and of the external carotid artery. The pre-requisite for this procedure was the development of a functional collateral circulation via the posterior communicating arteries from the basilar system. The 18 months follow-up report and the rare reports in the world literature on the operative techniques and the results of treatment of similar cases are discussed.
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8/72. Post-traumatic intradiploic leptomeningeal fistula and cyst.

    A 59 year old female patient presented with ataxia and difficulty in walking. The neurological examination revealed right homonymous hemianopia and ataxia. Radiographic evaluation revealed a large occipital intradiploic cyst mainly in the left suboccipital area. There was also moderate hydrocephalus and encephalomalacia of the left occipital pole. Bone window studies also demonstrated a growing fracture extending from the upper pole of the cyst to the vertex. Both pathologies were attributed to child abuse the patient suffered when she was a child. At first surgery, decompression of the cerebellum was followed by duroplasty and acrylic cranioplasty to the posterior cranial fossa. A month later, a shunt had to be inserted for hydrocephalus. At 7 months postoperatively, the patient is well and free of any symptoms or recurrence.
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9/72. Traumatic middle meningeal artery pseudoaneurysm and subsequent fistula formation with the cavernous sinus: case report.

    BACKGROUND: A combination of pseudoaneurysm and arteriovenous fistula of the middle meningeal artery is rare. We describe a case of traumatic pseudoaneurysm of the middle meningeal artery, which subsequently formed a fistula with the cavernous sinus. CASE DESCRIPTION: A 23-year-old man suffered from blunt head trauma and skull fractures. Sixteen days later, he suddenly experienced headache and a bruit was auscultated over the left ear. Three-dimensional computed tomographic angiography revealed dilatation of the left middle meningeal artery. The dilation proved to be a pseudoaneurysm on cerebral angiograms and it was also found to have formed a fistula with the cavernous sinus. Both lesions were successfully obliterated by endovascular embolization using microcoils. CONCLUSION: Head injury may lead to asymptomatic pseudoaneurysm or dural arteriovenous fistula. Neurosurgeons should always bear in mind the possibility of such vascular injuries after blunt head trauma to prevent any hemorrhagic complications.
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10/72. Visualization of bilateral carotid cavernous sinus fistulas with duplex sonography.

    Duplex sonography used as a primary diagnostic tool in the case of a 17-year-old boy with a traumatic head injury revealed bilateral carotid cavernous sinus fistulas, with bilateral dilated venous convolutions next to the carotid siphon and dilated superior ophthalmic veins. A bilateral craniectomy allowed visualization of the entire circle of willis together with the dilated cavernous sinuses. Doppler spectral analysis of blood flow in the arterialized superior ophthalmic veins revealed an arterialized venous pattern with retrograde and increased blood flow. The same blood flow profile was found in the venous cavernous sinuses. These findings were confirmed by digital subtraction angiography. We planned to perform embolization of the patient's fistulas, but intracranial and subarachnoid hemorrhaging developed, and the patient died the day before the procedure was to have been performed. The entire pathologic state of carotid cavernous sinus fistulas, from their origin beside the carotid siphon to the superior ophthalmic veins, can be visualized with duplex sonography, particularly when patients have undergone craniectomy. We believe that patients with frontal or basilar skull fracture should undergo duplex sonographic examination to detect carotid cavernous sinus fistulas.
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