Cases reported "Intracranial Hypertension"

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1/18. superior sagittal sinus obstruction and tuberculous abscess.

    Intracranial tumours such as meningiomas may occasionally produce raised intracranial pressure by occluding a venous sinus. More uncommonly, midline tumours in the occipital regions of the skull can produce elevated intracranial pressure by non-thrombotic compression of the superior sagittal sinus. We present a case of raised intracranial pressure secondary to non-thrombotic obstruction of the superior sagittal sinus by a midline tuberculous abscess.
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keywords = skull
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2/18. blindness from bad bones.

    Progressive visual loss is the most common neurologic finding in osteopetrosis. Several mechanisms may explain this phenomenon, including compression of the optic nerves caused by bony overgrowth of the optic canals and retinal degeneration. We report a child with osteopetrosis and progressive visual loss, even though patent optic canals were demonstrated by computed tomography and digital holography. This patient's visual loss was caused by increased intracranial pressure secondary, to obstruction of cerebral venous outflow at the jugular foramen. This case points to the importance of a full evaluation of the skull base foramina in the diagnostic workup of visual loss in patients with osteopetrosis.
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3/18. Right temporal lobe glioblastoma presenting in the left orbit. Case report.

    Dissemination of gliomas outside the central nervous system without preceding neurosurgery is a rare phenomenon. Glial neoplasms presenting as bone lesions are even more rare. A case of glioblastoma multiforme (GBM) with initial presentation in the orbit following a single generalized seizure is described. Signs of intracranial hypertension resulted from subarachnoid tumor invasion. The patient was treated with whole-dose radiation therapy but survived for only 6 months following the initial presentation. An autopsy revealed a right temporal GBM with extensive subarachnoid spread and invasion in the left orbit and skull base. The literature on dissemination of primary tumors of the brain is reviewed.
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keywords = skull
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4/18. Traumatic fracture of the clivus and vermian contusion in a child.

    The case of a fracture of the clivus in a 10-year-old boy following a road traffic accident is reported. He also suffered a contusion of the cerebellar vermis and the management dilemma in this case is highlighted. Fracture of the clivus in a child is extremely rare; this is the second reported case and the first reported with survival.
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ranking = 1.9360316358954
keywords = fracture
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5/18. Simple depressed skull fracture causing sagittal sinus stenosis and increased intracranial pressure: case report and review of the literature.

    The surgical management of depressed skull fractures is determined in part by whether a fracture is open or closed. Open fractures are usually elevated surgically, but closed fractures are most often treated nonoperatively, and the only 2 indications commonly described for operative treatment of closed fractures are hematoma evacuation and correction of cosmetic deformity. There is another indication, however, that is occasionally encountered when a depressed skull fracture injures a venous sinus. This injury can result in venous sinus stenosis, leading to venous hypertension and elevated intracranial pressure (ICP). A case is presented of closed depressed fracture of the midline skull, causing compressive stenosis of the superior sagittal sinus (SSS), venous hypertension, and encephalopathy. The fracture was surgically elevated to relieve the compression of the SSS and the encephalopathy resolved. The clinical identification, the imaging, and the risks and benefits of operative repair of this condition are reviewed. Increased ICP secondary to venous sinus injury is not commonly described in association with closed depressed skull fractures, but should always be considered in patients with the appropriate clinical findings when a fracture overlies a venous sinus, even in the absence of a hematoma.
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ranking = 671.49181043593
keywords = skull fracture, skull, fracture
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6/18. Resolution of intracranial hypertension after elevation of depressed cranial fracture over the superior sagittal sinus: case report.

    OBJECTIVE AND IMPORTANCE: It is common neurosurgical wisdom that depressed cranial fractures (DCFs) over the superior sagittal sinus (SSS) should not be elevated because of the risk of fatal venous hemorrhage.CLINICAL PRESENTATION: A 34-year-old man presented with severe headache and diplopia after a motor vehicle accident. Clinical examination demonstrated severe papilledema and bilateral abducens palsy. Imaging findings demonstrated a DCF over the posterior third of the SSS and absent flow distal to the fracture with dilated cortical venous drainage.INTERVENTION: Conservative treatment with acetazolamide only partially alleviated the patient's headache and diplopia. Definitive surgical treatment via elevation of the DCF was discussed and decided upon. Twelve days after injury, the patient underwent midline parieto-occipital craniotomy with successful elevation of the DCF off the posterior third of the SSS. Postoperative magnetic resonance venograms revealed restoration of patency in the SSS with reduced tortuosity of cortical veins. The patient's headache resolved, and his papilledema and diplopia resolved gradually.CONCLUSION: Elevation of DCF over the SSS can be attempted in cases in which favorable bone anatomy and the patient's clinical condition warrant. This may result in rapid and dramatic resolution of signs and symptoms of secondary intracranial hypertension.
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ranking = 2.3232379630744
keywords = fracture
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7/18. Superior sagittal sinus thrombosis associated with raised intracranial pressure in closed head injury with depressed skull fracture.

    A case of delayed signs of intracranial hypertension following closed head injury with a depressed cranial fracture and superior sagittal sinus thrombosis is reported. Conservative treatment of intracranial hypertension, including just repeated lumbar puncture and oral acetazolamide, was performed. Spontaneous recanalization of the superior sagittal sinus was observed. Pathogenesis and different modalities of treatment are discussed.
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ranking = 381.97655841042
keywords = skull fracture, skull, fracture
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8/18. Delayed intracranial hypertension and cerebellar tonsillar necrosis associated with a depressed occipital skull fracture compressing the superior sagittal sinus. Case report.

    Depressed skull fractures overlying the major venous sinus are often managed nonoperatively because of the high associated risks of surgery in these locations. In the presence of clinical and radiographic evidence of sinus occlusion, however, surgical therapy may be necessary. The authors present the case of a 9-year-old boy with a depressed skull fracture overlying the posterior third of the superior sagittal sinus. After initial conservative treatment, delayed signs of intracranial hypertension and a symptomatic tonsillar herniation with tonsillar necrosis developed. Possible causes as well as diagnostic and treatment options are reviewed.
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ranking = 572.38402812486
keywords = skull fracture, skull, fracture
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9/18. Shunt-related craniocerebral disproportion: treatment with cranial vault expanding procedures.

    Two patients with intracranial arachnoid cysts, one with myelomeningocele-hydrocephalus and the other with a subdural fluid collection, were given a cerebrospinal (CSF) extracranial shunt. All four patients developed features of CSF overdrainage following shunting and were treated by cranial vault expanding procedures. Before undergoing decompressive craniotomy, the patients were treated by a variety of procedures, including changing of obstructed ventricular catheters (n=4), insertion or upgrading of programmable valves (n=3), and foramen magnum decompression (n=1). Clinical manifestations of these four patients were attributed to craniocerebral disproportion caused by chronic and progressive skull changes due to dampening of the CSF pulse pressure, which is necessary for maintaining normal cranial growth. On the basis of our previous experience with expanding craniotomies in cases of minimal forms of craniosynostosis, we treated these patients with bilateral parietal craniotomies, with satisfactory results. In conclusion, biparietal decompressive craniotomy constitutes a useful and safe procedure for relieving the clinical manifestations of some CSF overdrainage syndromes, especially in cases with slit-ventricle syndrome and craniocerebral disproportion that prove to be refractory to simpler management procedures.
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ranking = 1
keywords = skull
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10/18. Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders.

    OBJECTIVE: This study assesses the clinical outcome after early combined cranioplasty (own frozen bone) and shunt implantation (Codman-Medos programmable VP shunt) in patients with skull bone defects and cerebrospinal fluid (CSF) circulation disorders.METHOD: medical records were reviewed retrospectively for the last 100 patients with CSF disorders after trauma or subarachnoid hemorrhage (SAH), who previously underwent decompressive craniotomy owing to therapy-resistant brain swelling. patients treated with early (5 to 7 weeks after injury) combined cranioplasty and shunt implantation were analysed and a follow-up for the survivors was obtained.RESULTS: In 60 patients with a daily CSF external drainage over 150 ml and dilated ventricles in CT scan, a programmable VP shunt was implanted simultaneously with the cranioplasty within 5.1 weeks after decompression. The neurological condition 6 months later was good (independent patients) in 39 cases (65%); 12 patients (20%) survived with a severe disability; three patients (5%) remained in a persistent vegetative state and only six patients (10%) died. There were few complications: bone or shunt infection (three cases), post-operative intracranial bleeding (one case), transitory neurological impairment after bone reimplantation (two cases), bone resorption (two cases) and shunt dysfunction (three cases).CONCLUSION: The early reimplantation of the patient's own skull bone combined to the employment of a programmable shunt system allowed us a dynamic adjustment of the intracranial pressure (ICP) changes. The combined treatment reduced the number of required surgical procedures, complications and unsatisfactory patient outcomes.
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ranking = 6
keywords = skull
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