Cases reported "Intracranial Hemorrhages"

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1/14. role of MR imaging in the diagnosis of complicated arachnoid cyst.

    BACKGROUND: arachnoid cysts are intra-arachnoidal cerebrospinal fluid collections that are usually asymptomatic, however, they may become acutely symptomatic due to enlargement of the cyst or the presence of hemorrhage. MATERIALS AND methods: We report a case of a child presenting with a 3-week history of headaches, nausea, and vision problems. There was no history of trauma. MRI clearly demonstrated a left middle cranial fossa arachnoid cyst with associated subacute intracystic and subdural hematoma that was causing mass effect and required surgery. RESULTS: This lesion was isodense to the brain on CT. CONCLUSION: We focus on the importance of MR imaging in the differentiation of these subacute/early chronic hemorrhagic collections that may be overlooked with CT.
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2/14. Experience with the high occipital transcortical approach in the treatment of intraventricular hemorrhage. Report of two cases.

    Two patients with intraventricular hemorrhage (IVH) were treated by direct removal of their intraventricular hematomas via a high occipital transcortical approach with successful results. This approach lies between the parietooccipital transcortical approach and the occipital transcortical approach. The patients were a 90-year-old woman with idiopathic IVH and a 60-year-old man with hemorrhage caused by bleeding in the thalamus. In both cases, the hematoma was tightly packed in the lateral ventricle. In the former case, the inferior horn of the lateral ventricle was extremely swollen, and the patient was at risk for development of uncal herniation. With the goals of complete elimination of the hematoma in the inferior horn and identification of the source of bleeding, a high occipital transcortical approach was applied, and the hematoma was removed under direct vision. With the patient in the lateral position, a minor craniotomy of approximately 3 cm was performed around the puncture site of the posterior horn (8 cm craniad from the inion and 3 cm lateral from the midline). A 1-cm cortical incision was made and the posterior horn was reached. First, the portion of hematoma at this site was removed, and then the remainder was completely removed from the interior horn and corpus. Using this method, the entire region of the lateral ventricle, including the inferior horn, corpus, and posterior horn, can be covered in a single operative field, and it is also possible to have sufficient working space for the operation.
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3/14. Intracranial meningiomas revealed by non-traumatic subdural haematomas: a series of four cases.

    OBJECTIVE: A review of the literature shows 33 cases of ipsilateral subdural haematomas (SDH) associated with meningiomas. We suggest that physiopathological mechanisms could be primary haemorrhages from abnormal vessels in the tumours and the opening of the intratumoral haematomas into the subdural space. Our working hypothesis relies on a series of 300 meningiomas operated upon in our department since 1990; of these, 4 were revealed by SDH. CLINICAL PRESENTATION: The four patients surgically treated in our department had developed a progressive impairment of consciousness. There was no history of trauma, blood dyscrasia or anticoagulant therapy. After diagnosis, the SDH was drained, and the meningeal tumour was totally resected once it had been discovered. In one case, the presence of a tumour was demonstrated by magnetic resonance imaging (MRI) performed only after the evacuation of a recurrent SDH. INTERVENTION: In each case, an acute SDH showing signs of recent bleeding was evacuated. The meningeal tumour discovered proved to be the source of the haemorrhage because of the numerous fresh blood clots both around and inside it. histology: In the four cases histology showed fresh intratumoral haemorrhages (ITH), large blood vessels with thin endothelial linings and haemosiderin deposits. In this review, SDH is associated with other haemorrhage sites in 24 of 37 cases (33 our 4 cases). ITH was present in 14 cases (40%). CONCLUSION: The treatment should consist of the extirpation of the meningioma at the same time as the evacuation of the haematoma. If primary ITH from abnormal vessels is the source of SDH, complete meningioma resection should prevent the recurrence of SDH. Subdural membranes and haematomas should therefore be inspected for their intrinsic pathology, especially when there is no history of trauma.
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keywords = subdural, space
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4/14. Atypical delayed intracranial haematoma following stereotactic biopsy of a right parietal anaplastic oligodendroglioma.

    The history of a 73-year-old woman with an anaplastic oligodendroglioma is presented, in whom cerebral magnetic resonance imaging (MRI) and brain single-photon emission tomography (SPECT) revealed an intracerebral lesion 17 months before, which was misinterpreted as cerebral infarction. Stereotactic biopsy confirmed the diagnosis, but 4 days after biopsy an unexpected fatal subdural and intraparenchymal bleeding occurred on the biopsy site. Neuroradiological aspects in the differential diagnosis of cerebral lesions as well as the role of small silent postbiopsy haematoma concerning further clinical deterioration are discussed.
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keywords = subdural
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5/14. prenatal diagnosis of fetal intracranial hemorrhage at 25 weeks of gestation.

    OBJECTIVE: To determine whether magnetic resonance imaging (MRI) can give further information for the prenatal diagnosis of intracranial hemorrhage, when ultrasound (US) is not conclusive. methods: We report on a fetus in the 26th week of gestation with a grade-III hemorrhage in the right cerebral hemisphere, which was suspected on US examination and specified by MRI examination in a patient with pre-eclampsia. RESULTS: Doppler measurement of the umbilical artery, which showed the absence of end diastolic velocity, was indicative of placental insufficiency. The MRI specified the findings found by US examination and confirmed the poor outcome of the fetus. Labor was induced by prostaglandins in the 27th week of gestation. Postmortem examination showed a female fetus with a grade-III intracranial hemorrhage in the center of the right hemisphere with a diameter of 4 cm. A hemorrhage was also found in the subarachnoid space and in the occipital region of the left hemisphere. CONCLUSION: We suggest that fetuses at high risk of developing hypoxia should be sonographically evaluated and MRI should be considered when intracranial echogenicities are seen.
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6/14. warfarin-associated fetal intracranial hemorrhage: a case report.

    A 27-yr-old woman who had been taking warfarin for 10 yr after mitral valve replacement became pregnant. After knowing her pregnancy, she received heparinization for nine weeks instead of warfarin, and took oral anticoagulant again. At 24 weeks of gestation, fetal ultrasound and MRI showed a left subdural hematoma, and the pregnancy was terminated. Subdural hematoma was demonstrated on autopsy. Fatal bleeding of the fetus is a rare complication of maternal warfarin medication, occurring mostly in the second or third trimester. There is no alternative regimen available, so that regular monitoring by fetal ultrasound and strict control of warfarin dose with regular measurement of prothrombin time are the best way to prevent intrauterine fetal death due to bleeding.
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keywords = subdural
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7/14. Right thalamic hemorrhage resulting from high-voltage electrical injury: a case report.

    A 12-year-old boy was admitted with electrical burn and loss of consciousness. On physical examination his general condition was poor. Extensive burn areas, second and third degree, were present on his face, scalp, bilateral auricles, right cervical region, shoulders, right axilla, upper region of the thorax, and proximal region of the upper extremities. The total burned surface area was about 25%. Pupils were isocoric, but response to light was bilateral poor. He was stuporous and responsive only to pain. Deep tendon reflexes were exaggerated and plantar responses were bilateral extensor. Bilateral decorticate rigidity was noted. Computerized tomography of brain revealed brain edema and right thalamic hemorrhage. magnetic resonance imaging of brain, examined 25 days after admission, revealed right thalamic hemorrhage and mild right subdural effusion. He was discharged form hospital 40 days after admission. However, spastic quadriplegia and severe mental retardation remained as sequela. On the 4th month of follow-up, no improvement was noted in his neurological examination. On the 9th month of follow-up, his clinical condition was better, but bilateral electric cataract was diagnosed. Both eyes were operated on and intraocular lenses were implanted with good results. Now he is 16th month of follow-up: neurological examination revealed only mild hemiparesis on the left side and mild articulation disorder. His school performance was moderate and intelligence quotient was 71. magnetic resonance imaging of brain showed markedly improvement of the hemorrhage. To our best knowledge thalamic hemorrhage resulting from high-voltage electrical injury has not previously been reported in the literature.
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keywords = subdural
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8/14. eye patching biases spatial attention after thalamic hemorrhage in a patient without spatial neglect: a case report.

    Monocular patching has been advocated as a treatment for spatial neglect. eye patching, however, is also reported to increase spatial bias. Thus, patching brain injury patients for ocular conditions may also impair their attention. To learn if an eye patch may induce asymmetric attention in a patient without spatial neglect, we tested a woman with diplopia after a left thalamic-intraventricular hemorrhage. She had no spatial neglect on bedside attention tasks. Using a laser pointer, she bisected a blank space at near (279 mm) and far (914 mm) distances under 3 conditions: unpatched and wearing a right or left eye patch. Unpatched, she showed no bias. She erred further leftward with right patching at both distances. Right eye patching appeared to induce neglect of right space when the patient performed this task. With left patching, leftward error tended to increase in near space only. Clinicians prescribing eye patches to patients with brain injury even for purely ocular indications, should evaluate them for spatial neglect once the patch is in place.
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ranking = 0.012132406587409
keywords = space
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9/14. Neurosurgical intervention in a haemophilic child with a subdural and intracerebral haematoma.

    A case of a 3-year-old boy with severe haemophilia A who had a successful neurosurgical drainage of a combined spontaneous left temporal subdural and intra-parenchimal haematoma is reported. Surgical intervention was required because of clinical worsening during conservative treatment with dexamethasone and factor viii (FVIII) replacement therapy. Continuous FVIII infusion was given before, during and after the procedure. There were no surgical complications and neurological examination remains intact. Neurosurgical interventions may be reserved for special, high-risk cases, as the one presented.
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keywords = subdural
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10/14. 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.
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