Cases reported "Intracranial Hypertension"

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11/18. Persistent intracranial hypertension caused by superior sagittal sinus stenosis following depressed skull fracture. Case report and review of the literature.

    intracranial hypertension caused by a compound depressed skull fracture on the posterior part of the superior sagittal sinus is a rare condition, and nonspecific symptoms and signs can delay appropriate diagnosis and treatment. The authors report on a case of intracranial hypertension that persisted despite conservative treatment, including anticoagulation therapy, which did not improve severe flow disturbance related to the venous sinus compression. Management of this rare condition is discussed and the literature is reviewed.
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ranking = 1
keywords = skull fracture, skull, fracture
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12/18. Rotating distraction osteogenesis in a child with secondary craniosyntostosis.

    Distraction osteogenesis has been acknowledged as a most effective surgical method to maximize intracranial space in patients with craniosynostosis by progressive displacement of the skull flap. However, it is difficult to control the growth direction of the skull flap even with application of four distraction bars. The authors of this study performed a cranioplasty procedure in a four-year-old girl with brachicephalic microcephaly, who showed a high lumbar puncture pressure of 21 cm H2O. After bilateral frontal craniectomy, the frontal bone and the midline of the superior orbital bone were fixed with a single wire, thus converting the linear displacement of distraction to a rotation flap and raising the skull flap superiorly. This rotational distraction osteogenesis resulted in a longer distance of distraction and upward rotation of the frontal skull flap with only two distraction bars. The authors suggest that rotating distraction osteogenesis has several merits: lesser depression of the bone flap, longer distance of distraction, and it is simpler and more economic than linear distraction. We also advocate that more aggressive surgical procedures should be considered for even older children with high intracranial pressure.
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ranking = 0.0083859782316513
keywords = skull
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13/18. Gorham's disease of skull base and cervical spine--confusing picture in a two year old.

    The unusual presentation of Gorham's disease of skull base and cervical spine in a two-year-old female child with radiological signs mimicking those of raised intracranial pressure is discussed. The differential diagnosis consists of skull base tumours, meningitis, osteomyelitis of the base of skull, congenital hydrocephalaus and congenital syndromes involving the skull base. Pathologically it can be very difficult to differentiate it from lymphangioma of the bone. Difficulty in establishing the diagnosis is discussed along with failure of radiotherapy and palmidronate therapy to cause arrest of the disease process and failure of surgery to provide stabilisation. We describe the course of the disease in this child over the period of last eight years. To the best of our knowledge this is the youngest case of Gorham's described so far.
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ranking = 0.016771956463303
keywords = skull
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14/18. Delayed pneumocephalus following shunting for hydrocephalus.

    Delayed pneumocephalus is a rare but well-reported complication of cerebrospinal fluid diversion procedures. In most cases the air enters the intracranial cavity via a skull base defect. We report a case of hydrocephalus secondary to aqueduct stenosis. The patient developed pneumocephalus 2 months after successful placement of a ventriculoperitoneal shunt. We describe an attempt at endoscopic diagnosis and repair of the fistula. This was unsuccessful, presumably because the defect was too small to localize even with the use of intrathecal fluorescein. We subsequently performed a conventional craniotomy and anterior fossa repair with placement of an antisiphon device. We suggest that in certain cases, when patients present with long-standing hydrocephalus, it may be advisable to insert either a high-pressure valve or antisiphon device as a primary measure.
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ranking = 0.0020964945579128
keywords = skull
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15/18. Depressed skull fracture overlying the superior sagittal sinus as a cause of benign intracranial hypertension. Case report.

    The use of surgical treatment for depressed skull fractures that are located over major venous sinuses is a matter of controversy. However, if clinical and radiological findings of sinus obliteration and related intracranial hypertension are present, surgical decompression is indicated. The authors present the case of a 38-year-old man who had a depressed skull fracture overlying the posterior one-third portion of the superior sagittal sinus. The lesion was initially treated conservatively and the patient was readmitted 1 month later with signs and symptoms of intracranial hypertension. The role of radiological investigation in the detection of venous sinus flow and indications for surgical treatment are discussed. If venous sinus flow obstruction is revealed in the presence of signs and symptoms of intracranial hypertension, surgery is indicated as the first line of treatment.
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ranking = 1.2
keywords = skull fracture, skull, fracture
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16/18. Post-craniectomy intracranial hypotension: potential impact on rehabilitation.

    More aggressive neurosurgical management of intractably elevated intracranial pressure has resulted in increased survival of severely brain injured patients, many of whom are transferred for inpatient rehabilitation status post-craniectomy. Positional headache due to intracranial hypotension has been described in the literature, but is rarely reported as a complicating factor for patients receiving rehabilitation therapies. Low cerebrospinal fluid (CSF) pressure symptoms include postural headache, vertigo, nausea, vomiting, visual symptoms, auditory symptoms, and rarely cognitive changes. This report describes a patient who sustained a severe traumatic brain injury requiring craniectomy for management of increased intracranial pressure who subsequently developed intracranial hypotension. One month post-craniectomy, she developed postural headaches with cognitive and functional decline, which significantly impaired her rehabilitation. Aggressive efforts at conservative management including hydration and empiric blood patch were unsuccessful. Once the bone flap was replaced, she made rapid and dramatic functional gains, with total resolution of headache. This paper hypothesizes that the mechanism of low CSF pressure after extensive craniectomy is related to loss of hydrostatic pressure following removal of the skull vault. In rehabilitation of severely brain injured patients with craniectomies, it is important to recognize and appropriately treat this syndrome to avoid compromising patient care and prolonging hospitalization.
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ranking = 0.0020964945579128
keywords = skull
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17/18. Pancraniosynostosis after surgery for single sutural craniosynostosis.

    Three children who developed pancraniosynostosis after surgery to correct nonsyndromic single suture synostosis (2 sagittal, 1 unilateral coronal) were noted on prolonged follow-up to have a decreased rate of head growth, and beaten copper findings on plain radiographs of the skull. All had elevated intracranial pressure as recorded by lumbar puncture. The children were reoperated, and then cranial growth resumed, and the radiographic abnormalities resolved. Because of the risk of pancraniosynostosis after surgery for single suture craniosynostosis, extended neurosurgical follow-up for patients with craniosynostosis is warranted.
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ranking = 0.0020964945579128
keywords = skull
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18/18. Pagetic sarcoma of the calvarium: report of two cases.

    Two cases of calvarium sarcoma with intracranial extension, consecutive to Paget disease of the skull are presented. The neurosurgical implications of this rare complication of a common disease are reviewed. In both cases, the symptoms of malignant degeneration were unspecific and blurred by the presence of a well-known Paget disease. Increasing headaches, focal neurological deficits and signs of intracranial hypertension were observed. Skull x-rays and Computerised tomography did not allow to make the difference between Pagetic bone and sarcoma. In the second case, magnetic resonance imaging was the most accurate in determining the precise localisation of the tumour, and the subdural invasion. Extensive surgical resection was carried out, by craniectomy of the tumoural bone, followed by cranioplasty. Dural sinus involvement and tumour hypervascularisation caused important peroperative blood loss in both patients. In the second case, the tumour invaded the subdural space through a Pacchioni granulation. Survival of patients with Pagetic sarcoma seems shorter when compared to post-radiation or primitive osteosarcoma, despite adjuvant therapies, probably because of late diagnosis and incomplete surgical resection. The mean reported survival rate is 6 months. Although the first patient died within 4 months, in the second case, the authors obtained a more than two year survival with aggressive surgery alone. These cases also illustrate the polymorphism of sarcomatous degeneration of Pagetic calvarium, the interest of MRI, and the need for close surveillance of patients with known Pagets disease of the skull.
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ranking = 0.0041929891158257
keywords = skull
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