1/10. 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 = 1keywords = herniation (Clic here for more details about this article) |
2/10. When does low mean high? Isolated cerebral ventricular increased intracranial pressure in a patient with a Chiari I malformation.OBJECTIVE: To present an unusual case of pseudotumor cerebri with increased intracranial pressure isolated to the cerebral ventricles resulting from a Chiari I malformation. MATERIALS AND methods: The patient received a complete ophthalmologic examination on initial presentation and subsequent visits, including visual acuity, pupillary examination, intraocular pressures, dilated fundus examination with assessment of degree of papilledema, and visual field testing. intracranial pressure was measured by lumbar puncture and subsequently by intracranial pressure bolt monitoring. magnetic resonance imaging (MRI) was used to diagnose the Chiari I malformation. RESULTS: The patient initially presented with bitemporal headaches, elevated opening pressure on lumbar puncture, and mild papilledema with a normal MRI. After lumboperitoneal shunt placement and several revisions, the patient presented with decreased vision OD secondary to Terson syndrome and worsening papilledema. Subsequent evaluation revealed normal lumbar opening pressures and a Chiari I malformation. She underwent ventriculoperitoneal shunt placement with resolution of her symptoms. CONCLUSIONS: Tonsillar herniation is a well-documented complication of lumboperitoneal shunt revision. Obstruction of cerebrospinal flow through the foramina of Magendie and Luschka can result in increased intracranial pressure isolated to the cerebral ventricles. In a patient with signs and symptoms of increased intracranial pressure but normal lumbar opening pressure, a Chiari I malformation should be suspected, particularly with a history of multiple lumboperitoneal shunt revisions.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
3/10. Fatal tonsillar herniation in pseudotumor cerebri.A 27-year-old woman with pseudotumor cerebri died after lumbar puncture secondary to tonsillar herniation. Five years earlier she had a respiratory arrest after lumbar puncture. MRI and autopsy ruled out the presence of an arnold-chiari malformation or a mass lesion of the posterior fossa, but midsagittal views suggested the presence of low-lying cerebellar tonsils.- - - - - - - - - - ranking = 0.71428571428571keywords = herniation (Clic here for more details about this article) |
4/10. Transient encephalopathy related to rapidly and markedly elevated blood pressure in acute stage of hypertensive cerebral hemorrhage--relationship to hypertensive encephalopathy--a case report.A seventy-two-year-old man with hypertensive cerebral hemorrhage acutely developed severe headache, nausea, vomiting, agitation, and disorientation with abrupt rise in blood pressure on the sixth day after the onset. At that time, there were no remarkable changes in focal neurologic deficits, and repeated brain CT scans revealed a small hematoma located in the right basal ganglia without further enlargement or herniation. Blood chemistry and arterial gas analysis were within the normal ranges except for a slight rise in blood urea nitrogen. Similar episodes occurred three times within two days, and each time the cerebral symptoms disappeared in accordance with lowering of blood pressure by antihypertensive therapy. Complication of hypertensive encephalopathy was strongly suggested. The authors discuss the pathophysiology of this encephalopathy in relation to cerebral hemorrhage.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
5/10. Resolution of syringomyelia and Chiari I malformation by ventriculoatrial shunting in a patient with pseudotumor cerebri and a lumboperitoneal shunt.A sneeze caused acute left arm pain in a 36-year-old woman with a lumboperitoneal (LP) shunt that had been placed 3 years earlier for relief of headaches caused by pseudotumor cerebri. Numbness progressed up the left arm, neck, and back of the head and finally into the left face along with weakness of the hand and arm. magnetic resonance imaging (MRI) and computed tomography revealed new tonsillar herniation and a large eccentric syrinx extending from C2 to T6. The functioning LP shunt was clamped, and a ventriculoatrial shunt was placed. pain lessened and motor function improved slightly. MRI revealed complete resolution of the syrinx and resolution of the tonsillar herniation. Theories of syringomyelia formation, the relationship to Chiari I malformation, and the implications of this case are discussed.- - - - - - - - - - ranking = 0.28571428571429keywords = herniation (Clic here for more details about this article) |
6/10. Lumboperitoneal shunting as a cause of visual loss in benign intracranial hypertension.The causes of visual loss in benign intracranial hypertension are related to long standing papilloedema, ischaemic optic neuropathy or haemorrhage into a subretinal neovascular membrane. decompression procedures generally preserve or improve visual acuity but surgical treatment with subtemporal decompression may lead to visual impairment. Such a deficit has been recorded in the past as occurring with ventriculography. Postulated mechanisms have included brain herniation, spasm of vessels supplying the visual cortices or retinal vascular disturbance. To our knowledge treatment with lumboperitoneal shunting has not previously been reported as leading to further significant visual loss in this condition. This report describes such an occurrence in a patient. Retinal vascular disturbance is postulated on the basis of several normal CT scans, normal CSF pressure measured after surgery and visual evoked responses suggesting retinal or optic nerve damage.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
7/10. Primary empty sella syndrome and benign intracranial hypertension.The combination of the empty sella syndrome (ESS) and benign intracranial hypertension (BIH) is illustrated by two case histories. The causal relationship between the ESS and the BIH can be explained by two mechanisms. Raised intracranial pressure could produce a herniation of the subarachnoid cistern into the sella turcica, if the diaphragma sellae is incomplete. Alternatively an infarction in a pituitary adenoma could result in both an ESS and cerebrospinal fluid flow obstruction, which could lead to BIH.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
8/10. Primary empty sella syndrome and benign intracranial hypertension.Two patients presenting with headache and radiological features of an enlarged sella turcica were found to have the primary empty sell syndrome. Whilst under observation, 1 patient developed papilloedema and was shown to have benign intracranial hypertension. The second patient also had raised intracranial pressure. A relationship between the empty sella syndrome and benign intracranial hypertension has previously been reported and it is suggested that in a patient with a congenitally incompetent diaphragma sella, chronically raised intracranial pressure caused herniation of the subarachnoid space into the sella turcica. Subsequently, sella turcica enlargement and remodelling occurs, sometimes with endocrine, visual and other sequelae. The clinical, radiological and CT scan features of the empty sella syndrome are discussed and the indications for major radiological studies are considered.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
9/10. Reversible empty sella in idiopathic intracranial hypertension: an indicator of successful therapy?Idiopathic intracranial hypertension is commonly associated with an empty sella, caused by herniation of subarachnoid cerebrospinal fluid through an absent or patulous diaphragma sellae. We describe the findings in two patients who presented with headache, papilledema, and visual disturbances. diagnosis of idiopathic intracranial hypertension was made on the basis of clinical symptoms and laboratory data. Initial imaging studies in each patient showed an empty sella. After treatment, one with acetazolamide and the other with lumboperitoneal shunting, the appearance of the sellar contents became normal.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
10/10. Craniocephalic disproportion with increased intracranial pressure and brain herniation: a new clinical syndrome in anemic patients: report of two cases.OBJECTIVE AND IMPORTANCE: We describe a new clinical syndrome in two patients with chronic anemia. The major manifestation of the syndrome is herniation of the brain resulting in death caused by longstanding craniocephalic disproportion. The disproportion was caused by extreme thickening of the cranium because of erythroid hyperplasia. CLINICAL PRESENTATION: Two patients with known chronic anemia presented with chronic increase in intracranial pressure with acute deterioration resulting in brain herniation. INTERVENTION: Despite maximum medical therapy, both patients died as a result of uncontrollable increase in intracranial pressure. CONCLUSION: patients with chronic anemia presenting with progressive headaches should be monitored for this newly described clinical phenomenon.- - - - - - - - - - ranking = 0.85714285714286keywords = herniation (Clic here for more details about this article) |
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