11/219. Flaccid quadriplegia from tonsillar herniation in pneumococcal meningitis.A young woman with fulminant pyogenic meningitis became quadriplegic, areflexic and flaccid due to herniation of the cerebellar tonsils and compression of the upper cervical cord. This state of spinal shock was associated with absent F-waves. intracranial pressure was greatly elevated and there was an uncertain relationship of tonsillar descent to a preceding lumbar puncture. Partial recovery occurred over 2 years. Tonsillar herniation can cause flaccid quadriplegia that may be mistaken for critical illness polyneuropathy. This case demonstrates cervicomedullary infarction from compression, a mechanism that is more likely than the sometimes proposed infectious vasculitis of the upper cord.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
12/219. Chiari malformation and sleep-disordered breathing: a review of diagnostic and management issues.Chiari Malformation (CM) encompasses several patterns of congenital or acquired cerebellar herniation through the foramen magnum. This may result in brain-stem compression that impacts control of breathing and is associated with obstructive and central apneas. A high clinical suspicion for sleep-disordered breathing is needed in the care of such patients after as well as before corrective surgery. To introduce a review of CM with a focus on the relevance to sleep medicine, we present a case of a 13-year-old female who was diagnosed with CM Type 1 in the course of an evaluation of symptomatic central sleep apnea. After initial improvement following surgery there was recurrence of brain-stem compression. The only clinical expression of which was polysomnographically evident recurrence of sleep apnea.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
13/219. Glial lesion of the infratemporal fossa presenting as a soft tissue middle ear mass - rudimentary encephalocele or neural crest remnant?We report about ectopic glial tissue of the skull base and the parapharyngeal space presenting as a soft tissue mass in the middle ear. An 11-year-old boy presented with bilateral conductive hearing loss since early childhood. The history included previously removed lesions consistent with ectopic neuroglial tissue of the tongue and the parapharyngeal space soon after birth, as well as surgery for cleft palate. High resolution computed tomography of the petrous bone and magnetic resonance imaging were useful in identifying the skull base defect and in characterizing the lesion's relation to the brain. There was no clinical, radiological or surgical evidence of any associated dural defect. The lesion was removed via a modified infratemporal approach. histology revealed neuroglial tissue with calcifications without any signs of mesodermal or entodermal origin. On the basis of this case the pathogenesis and diagnosis of ectopic brain tissue and its relation to the more commonly encountered meningoencephalic herniations are reviewed. Furthermore therapeutical implications are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
14/219. Bilateral defects of the tegmen tympani associated with brain and dural prolapse in a patient with pulsatile tinnitus.A pulsating ear drum is a rare otological finding and usually indicates a vascular pathology. We report the case of a woman who presented with pulsatile tinnitus following an upper respiratory tract infection. She was found to have bilateral pulsating tympanic membranes on otological examination, in association with bilateral dehiscence of the tegmen tympani and a spontaneous encephalocele on the right side and a meningocele on the left side, demonstrated on computerized tomography (CT) scan of her temporal bones.- - - - - - - - - - ranking = 0.011224195277485keywords = meningocele (Clic here for more details about this article) |
15/219. Trans-sphenoidal encephalocele in association with Dandy-Walker complex and cardiovascular anomalies.We present a case of trans-sphenoidal encephalomeningocele in association with a posterior cranial fossa malformation which fulfils the criteria for the Dandy-Walker complex [1]. Congenital cardiovascular defects were also present. An abnormality of neural crest development may be responsible for the combined occurrence of these anomalies.- - - - - - - - - - ranking = 0.011224195277485keywords = meningocele (Clic here for more details about this article) |
16/219. Occipital meningocele and Mondini deformity of the cochlea.We present two cases of a previously unreported association between occipital meningocele and Mondini deformity of the cochlea. The probability of the association is supported by the intimate relationship between the development of these structures; the existence of dysembryoplastic factors that can cause both abnormalities; and the universal existence of cochlear abnormalities in anencephalic foetuses. The importance of considering the association is emphasized, in terms of early identification and referral of children with hearing loss, and avoidance of duplication of investigations.- - - - - - - - - - ranking = 0.056120976387424keywords = meningocele (Clic here for more details about this article) |
17/219. Transtentorial herniation after unilateral infarction of the anterior cerebral artery.BACKGROUND: Fatal cerebral herniation is a common complication of large ("malignant") middle cerebral artery infarcts but has not been reported in unilateral anterior cerebral artery (ACA) infarction. CASE DESCRIPTION: We report a 47-year-old woman who developed an acute left hemiparesis during an attack of migraine. Cranial CT (CCT) was normal but demonstrated narrow external cerebrospinal fluid compartments. Transcranial Doppler sonography was compatible with occlusion of the right ACA. Systemic thrombolytic therapy with tissue plasminogen activator was initiated 105 minutes after symptom onset. Follow-up CCT 24 hours after treatment revealed subtotal ACA infarction with hemorrhagic conversion. Two days later, the patient suddenly deteriorated with clinical signs of cerebral herniation, as confirmed by CCT. An extended right hemicraniectomy was immediately performed. Within 6 months, the patient regained her ability to walk but remained moderately disabled. CONCLUSIONS: This is the first reported case of unilateral ACA infarct leading to almost fatal cerebral herniation. Narrow external cerebrospinal fluid compartments in combination with early reperfusion, hemorrhagic transformation, and additional dysfunction of the blood-brain barrier promoted by tissue plasminogen activator and migraine may have contributed to this unusual course.- - - - - - - - - - ranking = 1.1666666666667keywords = herniation (Clic here for more details about this article) |
18/219. The treatment of 'acquired tonsillar herniation' in pseudotumour cerebri.Acquired tonsillar herniation and syrinx formation are recognized complications of a lumboperitoneal shunt used to treat conditions of increased CSF volume. Treatment of this complication is by ventriculoperitoneal shunt or foramen magnum decompression. We describe the first case of acquired tonsillar herniation in a pseudotumour cerebri (following lumboperitoneal shunt insertion) that responded partly to ventriculoperitoneal shunt insertion and more completely to foramen magnum decompression. Our case demonstrates that a ventriculoperitoneal shunt is not always sufficient in treating this complication and reversing visual deterioration. foramen magnum decompression may therefore be a sight saving procedure in pseudotumour cerebri with acquired tonsillar herniation and may be important in understanding the pathogenesis of conditions of increased CSF volume.- - - - - - - - - - ranking = 1.1666666666667keywords = herniation (Clic here for more details about this article) |
19/219. Surgical treatment of frontoethmoidal encephalocele: a case report.This study reports a patient affected by congenital frontoethmoidal encephalocele. The cause of this malformation is unknown. A preoperative selective diagnosis evaluation is necessary. The workup should include an accurate clinical examination associated with radiological study (two- and three-dimensional computed tomography, magnetic resonance imaging, etc). The aim of the surgical treatment is to restore the functional brain tissue in the cranial cavity, perform dural repair, correct bone lack and other associated facial malformations (hypertelorism, orbital dystopia, etc.). A multidisciplinary team approach is necessary to resolve the brain herniation and to correct splanchnocranium malformations frequently associated with encephalocele. Cranial flap with orbital osteotomies has been performed; this operation permits correction of the hypertelorism and of the orbital dystopia associated with this malformation. In bone reconstructions, miniplates have been used as fixation devices. In adults we generally use titanium, but resorbable devices are required in children because of growing tissues. A restoration of craniofacial malformations with good aesthetic and functional results is achieved with early surgery.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
20/219. Auditory brainstem response and temporal bone pathology findings in a brain-dead infant.The criteria for assessing adult brain death have been already established, but those for infant brain death have not been yet established in japan. We report auditory brainstem response (ABR) and postmortem pathology of the temporal bone and brain of a brain-dead 9-month-old female. During the comatose state, her ABR showed only waves I and II bilaterally. autopsy revealed the presence of a left cerebellar astrocytoma, herniation and anoxic encephalopathy. The pathological examination of the temporal bone revealed the destruction of the inner ear particularly on the left side. In the auditory pathway of brain-dead patients, degeneration occurs first in the cerebrum, followed by the cochlear nerve. Thus, ABR is one of the useful means to assess brain death even in infants.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
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