A syndrome characteristic of tangential bullet wounds of the vertex of the skull

1971 ◽  
Vol 34 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Adelola Adeloye ◽  
E. Latunde Odeku
Keyword(s):  
Operative Treatment ◽  
Cerebral Angiography ◽  
Sensory Loss ◽  
Thrombotic Occlusion ◽  
Content Type ◽  
Cortical Injury ◽  
Frontoparietal Cortex ◽  
Superior Longitudinal Sinus ◽  
Fine Print

✓ Six patients with tangential missile wounds of the vertex of the skull presented symptoms of limb paresis which were more marked proximally in the arms and distally in the legs where there was also sensory loss of a cortical type. Carotid cerebral angiography and operative treatment showed patency of the longitudinal sinus and injury to the medial aspects of the frontoparietal cortex. The term “longitudinal sinus syndrome” formerly applied to these cases is therefore a misnomer since the main underlying cause is cortical injury and not thrombotic occlusion of the superior longitudinal sinus, as previously suspected.

Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark
Keyword(s):  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Operative Procedure ◽  
Superficial Temporal Artery ◽  
Technical Problem ◽  
Temporal Artery ◽  
Content Type ◽  
Actual Operation ◽  
Fine Print

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

Direct percutaneous cerebral angiography in neurosurgical practice

1980 ◽  
Vol 52 (4) ◽  
pp. 525-528 ◽  
Author(s):  
Jerry Bauer ◽  
Jose Luis Salazar ◽  
Oscar Sugar ◽  
Ronald P. Pawl
Keyword(s):  
High Risk ◽  
Cerebrovascular Disease ◽  
Cerebral Angiography ◽  
Complication Rate ◽  
High Risk Population ◽  
Content Type ◽  
Pros And Cons ◽  
Sixth Decade ◽  
Symptoms And Signs ◽  
Fine Print

✓ A retrospective analysis of 1171 consecutive percutaneous retrograde brachial and carotid cerebral angiograms was performed on 635 patients, 50.7% of whom were in the sixth decade or older. Symptoms and signs of cerebrovascular disease were the most frequently investigated and diagnosed, accounting for 46.7% of all the angiograms. Despite this relatively high-risk population, we have found direct percutaneous cerebral angiography to have a very low risk. The pros and cons of direct percutaneous versus transfemoral cerebral angiography are discussed. The literature of the previous 10 years is reviewed, and the complication rate of these two techniques is compared.

Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression

1988 ◽  
Vol 68 (4) ◽  
pp. 559-565 ◽  
Author(s):  
Ian F. Pollack ◽  
Peter J. Jannetta ◽  
David J. Bissonette
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Pain Control ◽  
Symptom Control ◽  
Sensory Loss ◽  
Content Type ◽  
Cranial Nerve Dysfunction ◽  
Ablative Procedures ◽  
Fine Print

✓ Thirty-five patients with trigeminal neuralgia (TN) bilaterally underwent posterior fossa microvascular decompression (MVD) between 1971 and 1984. They comprised 5.0% of a larger series of 699 patients with TN who underwent MVD during that interval. Compared to the subgroup of 664 patients with only unilateral symptoms, the population with bilateral TN included a greater percentage of females (74% vs. 58%, p < 0.1), a higher rate of “familial” TN (17% vs. 4.1%, p < 0.001), and an increased incidence of additional cranial nerve dysfunction (17% vs. 6.6%, p < 0.05) and hypertension (34% vs. 19%, p < 0.05). Of the 35 patients with bilateral TN, 10 underwent bilateral MVD (22 procedures) and 25 underwent unilateral MVD (30 procedures). In the latter patients, pain on the nonoperative side was well controlled with medication alone or had previously been treated by ablative procedures. Good or excellent pain control was achieved after one MVD was performed in 40 of the 45 sides treated (89%), and was maintained 1, 5, and 10 years after surgery in 82%, 66%, and 60%, respectively, based on life-table analysis. Six of 10 patients with recurrent symptoms underwent repeat unilateral MVD. Good or excellent long-term pain control was maintained in all six. With these repeat procedures included, symptom control at 1, 5, and 10 years after initial surgery was maintained in 87%, 78%, and 78% of the treated sides, respectively. Overall, 26 of 35 patients (74%) maintained good or excellent pain relief throughout the duration of the study (mean follow-up period 75 months) without resumption of regular medication usage. Although preoperative neurological deficits resulting from previous ablative procedures were seen in the majority of patients before MVD, no patient developed new major trigeminal sensory loss or masseter weakness after MVD. Operative mortality was zero. The results indicate that posterior fossa MVD is an effective and relatively safe treatment for the majority of patients with bilateral “idiopathic” TN, avoiding the risks of bilateral trigeminal nerve injury seen with other approaches.

Hemangioma calcificans

1979 ◽  
Vol 50 (1) ◽  
pp. 110-114 ◽  
Author(s):  
Michael V. DiTullio ◽  
W. Eugene Stern
Keyword(s):  
Cerebral Angiography ◽  
Previous History ◽  
Rare Entity ◽  
Content Type ◽  
Aged Woman ◽  
Pathological Evaluation ◽  
Middle Aged Woman ◽  
History Of ◽  
The Masses ◽  
Fine Print

✓ A middle-aged woman, with a previous history of medically suppressed absence attacks, presented with mild changes in mental status and a skull film demonstrating several areas of mottled, granular, intracranial calcifications. These lesions, although readily visible on computerized tomography, appeared avascular during the course of cerebral angiography. At the time of surgery the masses, which were densely calcified and generally circular, demonstrated numerous areas of superficial, white, verrucous excrescences. Microscopic, pathological evaluation confirmed the diagnosis of hemangioma calcificans. The literature describing this rare entity is briefly reviewed.

Cervical radiculopathy, entrapment neuropathy, and thoracic outlet syndrome: how to differentiate?

2004 ◽  
Vol 1 (2) ◽  
pp. 179-187 ◽  
Author(s):  
John E. McGillicuddy
Keyword(s):  
Older Patients ◽  
Thoracic Outlet Syndrome ◽  
Cervical Radiculopathy ◽  
Sensory Loss ◽  
Neuralgic Amyotrophy ◽  
Content Type ◽  
Arm Pain ◽  
Entrapment Neuropathies ◽  
The Common ◽  
Fine Print

✓ The common diagnoses of cervical radiculopathy and upper-extremity entrapment neuropathies can at times be difficult to differentiate. Additionally, thoracic outlet syndrome is often diagnosed when, in fact, the problem is radiculopathy or neuropathy. Another source of confusion, especially in older patients, is neuralgic amyotrophy, brachial plexitis, or the Parsonage—Turner syndrome. The differential diagnosis of unilateral arm pain, weakness, and/or sensory loss includes all of these problems. The clinical and electrodiagnostic features of each are discussed as an aid to distinguishing between these common and similar entities.

Brain scans and echoencephalography in the diagnosis of chronic subdural hematoma

1974 ◽  
Vol 40 (3) ◽  
pp. 347-350 ◽  
Author(s):  
Sheldon R. Hurwitz ◽  
Samuel E. Halpern ◽  
George Leopold
Keyword(s):  
Cerebral Angiography ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Content Type ◽  
Brain Scans ◽  
Subdural Hematomas ◽  
Fine Print

✓ Eighteen patients with chronic subdural hematomas were studied by both brain scans and echoencephalography. All cases were verified by cerebral angiography. Brain scanning was accurate in predicting hematomas in 93% of the cases, and echoencephalography in 44%. When hematomas were bilateral or when frontal clots caused no shift in the diencephalic midline, the routine echoencephalogram often was negative. The two procedures are complementary, and serial studies may be helpful in the study of changing clinical situations.

Magnetic resonance imaging—documented extravasation as an indicator of acute hypertensive intracerebral hemorrhage

1998 ◽  
Vol 88 (4) ◽  
pp. 650-655 ◽  
Author(s):  
Yasuo Murai ◽  
Yukio Ikeda ◽  
Akira Teramoto ◽  
Yukihide Tsuji
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Intracerebral Hemorrhage ◽  
Cerebral Angiography ◽  
Ct Scanning ◽  
Content Type ◽  
Hematoma Enlargement ◽  
Hypertensive Intracerebral Hemorrhage ◽  
Fine Print

Object. The aim of this study was to determine the usefulness of magnetic resonance (MR) imaging—documented extravasation as an indicator of continued hemorrhage in patients with acute hypertensive intracerebral hemorrhage (ICH). Methods. The authors studied 108 patients with acute hyperintensive ICH. Imaging modalities included noncontrast-enhanced computerized tomography (CT) scanning, gadolinium-enhanced MR imaging, and conventional cerebral angiography obtained within 6 hours after the onset of hemorrhage. A repeated CT scan was obtained within 48 hours to evaluate enlargement of the hematoma. Findings on MR imaging indicating extravasation, including any high-intensity signals on T1-weighted postcontrast images, were observed in 39 patients, and 17 of these also showed evidence of extravasation on cerebral angiography. The presence of extravasation on MR imaging was closely correlated with evidence of hematoma enlargement on follow-up CT scans (p < 0.001). Conclusions. Evidence of extravasation documented on MR imaging indicates persistent hemorrhage and correlates with enlargement of the hematoma.

Effect of cerebral angiography on subsequent brain scintigraphy

1974 ◽  
Vol 41 (6) ◽  
pp. 688-690
Author(s):  
Edward B. Silberstein ◽  
Alan B. Ashare
Keyword(s):  
Contrast Medium ◽  
Cerebral Angiography ◽  
Content Type ◽  
Radiographic Contrast Medium ◽  
Radiographic Contrast ◽  
Fine Print

✓ The authors report examination of 27 brain scintigraphs performed 1 day following cerebral angiography, and 48 performed within 2 weeks. No artifactual areas of uptake were produced in the scintigraphs by the radiographic contrast medium.

Bacterial intracranial aneurysms

1980 ◽  
Vol 53 (5) ◽  
pp. 633-641 ◽  
Author(s):  
John G. Frazee ◽  
Leslie D. Cahan ◽  
James Winter
Keyword(s):  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Bacterial Endocarditis ◽  
Severe Headache ◽  
High Dose ◽  
Review Of The Literature ◽  
Content Type ◽  
Neurological Signs ◽  
Fine Print

✓ The treatment of 13 patients with bacterial intracranial aneurysms is reported. The incidence of bacterial intracranial aneurysms was 4% of all patients admitted with intracranial aneurysms and 3% of all patients admitted with bacterial endocarditis. Each patient had neurological signs or symptoms suggestive of intracranial disease prior to the diagnosis of an aneurysm. Alpha Streptococcus was the most common infecting organism. All patients were treated with specific, high-dose antibiotics, and five patients underwent surgery as well. There were no surgical deaths. Six of eight nonsurgically treated patients died. A review of the literature confirms a high mortality for patients treated with only antibiotics, and a low mortality for elective surgery. The authors conclude that 1) patients with bacterial endocarditis, who develop sudden severe headache, focal neurological signs or symptoms, or seizures, should undergo serial cerebral angiography every 7 to 10 days throughout their hospitalization; 2) if an aneurysm is identified it should be excised whenever possible; and 3) patients with proximal or multiple aneurysms should be considered for surgery.

Nonlesional central lobule seizures: use of awake cortical mapping and subdural grid monitoring for resection of seizure focus

2003 ◽  
Vol 98 (6) ◽  
pp. 1255-1262 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Jeffrey W. Britton ◽  
Frederic P. Collignon ◽  
Lisa M. Bates ◽  
Gregory D. Cascino ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Sensorimotor Cortex ◽  
Cortical Stimulation ◽  
Limited Resection ◽  
Awake Craniotomy ◽  
Sensory Loss ◽  
Precentral Gyrus ◽  
Content Type ◽  
Postcentral Gyrus ◽  
Fine Print

Object. Surgical treatment options for intractable seizures caused by a nonlesional epileptogenic focus located in the central sulcus region are limited. The authors describe an alternative surgical approach for treating medically refractory nonlesional perirolandic epilepsy. Methods. Five consecutive patients who were treated between 1996 and 2000 for nonlesional partial epilepsy that had originated in the central lobule were studied. The patients' ages ranged from 16 to 56 years (mean 28.6 years; there were four men and one woman). The duration of their epilepsy ranged from 8 to 39 years (mean 20.2 years), with a mean seizure frequency of 19 partial seizures per week. Preoperative assessment included video electroencephalography (EEG) and subtracted ictal—interictal single-photon emission computerized tomography coregistered with magnetic resonance imaging (SISCOM). Patients underwent an awake craniotomy stereotactically guided by the ictal EEG and SISCOM studies. Cortical stimulation was used to identify the sensorimotor cortex and to reproduce the patient's aura. A subdural grid was then implanted based on these results. Subsequent postoperative ictal electrocorticographic recordings and cortical stimulation further delineated the site of seizure onset and functional anatomy. During a second awake craniotomy, a limited resection of the epileptogenic central lobule region was performed while function was continuously monitored intraoperatively. One resection was limited to the precentral gyrus, two to the postcentral gyrus, and in two the excisions involved regions of both the pre- and postcentral gyri. In three patients a hemiparesis occurred postsurgery but later resolved. In the four patients whose resection involved the postcentral gyrus, transient cortical sensory loss and apraxia occurred, which completely resolved in three. Two patients are completely seizure free, two have experienced occasional nondisabling seizures, and one patient has benefited from a more than 75% reduction in seizure frequency. The follow-up period ranged from 2 to 5.5 years (mean 3.5 years). Conclusions. A limited resection of the sensorimotor cortex may be performed with acceptable neurological morbidity in patients with medically refractory perirolandic epilepsy. This procedure is an alternative to multiple subpial transections in the surgical management of intractable nonlesional epilepsy originating from the sensorimotor cortex.

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