Complete embolization of artery of Adamkiewicz to obliterate an intramedullary arteriovenous aneurysm

1975 ◽  
Vol 43 (4) ◽  
pp. 486-489 ◽  
Author(s):  
Robert E. Decker ◽  
Harry L. Stein ◽  
Joseph A. Epstein
Keyword(s):  
Case History ◽  
Bleeding Episode ◽  
Thoracolumbar Junction ◽  
Content Type ◽  
Artery Of Adamkiewicz ◽  
History Of ◽  
Fine Print

✓ A case history of an intramedullary arteriovenous aneurysm of the thoracolumbar junction is presented, and an unusual 14-year follow-up after the original sub-arachnoid bleeding episode is detailed. Embolization of anterior and mixed angiomas involving the artery of Adamkiewicz may be feasible when the artery is large and shunting is present.

Long-term natural history of hemorrhagic type moyamoya disease in 42 patients

2000 ◽  
Vol 93 (6) ◽  
pp. 976-980 ◽  
Author(s):  
Eiichi Kobayashi ◽  
Naokatsu Saeki ◽  
Hiromichi Oishi ◽  
Shinji Hirai ◽  
Akira Yamaura
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Bleeding Episode ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The purpose of this study was to delineate the long-term natural history of hemorrhagic moyamoya disease (MMD).Methods. A retrospective review was conducted among 42 patients suffering from hemorrhagic MMD who had been treated conservatively without bypass surgery. The group included four patients who had undergone indirect bypass surgery after an episode of rebleeding. The follow-up period averaged 80.6 months. The clinical features of the first bleeding episode and repeated bleeding episodes were analyzed to determine the risk factors of rebleeding and poor outcome.Intraventricular hemorrhage with or without intracerebral hemorrhage was a dominant finding on computerized tomography scans during the first bleeding episode in 29 cases (69%). During the follow-up period, 14 patients experienced a second episode of bleeding, which occurred 10 years or longer after the original hemorrhage in five cases (35.7%). The annual rebleeding rate was 7.09%/person/year. The second bleeding episode was characterized by a change in which hemisphere bleeding occurred in three cases (21.4%) and by the type of bleeding in seven cases (50%). After rebleeding the rate of good recovery fell from 45.5% to 21.4% and the mortality rate rose from 6.8% to 28.6%. Rebleeding and patient age were statistically significant risk factors of poor outcome. All four patients in whom there was indirect revascularization after the second bleeding episode experienced a repeated bleeding episode within 8 years.Conclusions. The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.

Symptom-based assessment of the severity of a concussion

2003 ◽  
Vol 98 (3) ◽  
pp. 477-484 ◽  
Author(s):  
David Erlanger ◽  
Tanya Kaushik ◽  
Robert Cantu ◽  
Jeffrey T. Barth ◽  
Donna K. Broshek ◽  
...  
Keyword(s):  
Empirical Support ◽  
Return To Play ◽  
Neurocognitive Testing ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Memory Problems ◽  
Management Protocol ◽  
History Of ◽  
Fine Print

Object. Current grading systems of concussion and return-to-play guidelines have little empirical support. The authors therefore examined the relationships of the characteristics and symptoms of concussion and the history of concussion to three indicators of concussion severity—number of immediate symptoms, number of symptoms at the initial follow-up examination, and duration of symptoms—to establish an empirical basis for grading concussions. Methods. Forty-seven athletes who sustained concussions were administered alternate forms of an Internet-based neurocognitive test until their performances were within normal limits relative to baseline levels. Assessments of observer-reported and self-reported symptoms at the sideline of the playing field on the day of injury, and at follow-up examinations were also obtained as part of a comprehensive concussion management protocol. Although loss of consciousness (LOC) was a useful indicator of the initial severity of the injury, it did not correlate with other indices of concussion severity, including duration of symptoms. Athletes reporting memory problems at follow-up examinations had significantly more symptoms in general, longer durations of those symptoms, and significant decreases in scores on neurocognitive tests administered approximately 48 hours postinjury. This decline of scores on neurocognitive testing was significantly associated with an increased duration of symptoms. A history of concussion was unrelated to the number and duration of symptoms. Conclusions. This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of symptoms. Neither a brief LOC nor a history of concussion was a useful predictor of the duration of postconcussion symptoms.

Cerebral venous malformations

1990 ◽  
Vol 73 (4) ◽  
pp. 560-564 ◽  
Author(s):  
Daniele Rigamonti ◽  
Robert F. Spetzler ◽  
Marjorie Medina ◽  
Karen Rigamonti ◽  
David S. Geckle ◽  
...  
Keyword(s):  
Venous Malformation ◽  
Neurological Dysfunction ◽  
Neurological Deficits ◽  
Venous Angioma ◽  
Venous Malformations ◽  
Content Type ◽  
History Of ◽  
The Relationship ◽  
Fine Print

✓ Although cerebral venous malformations have been reported to cause epilepsy, progressive neurological deficits, and hemorrhage, their clinical significance remains controversial. In an attempt to clarify the natural history of the lesion and suggest an appropriate management strategy, the authors review their experience with 30 patients. In four patients with cerebellar venous angioma, an acute episode of ataxia was documented. The coexistence of a cavernous malformation was pathologically confirmed in the two patients who underwent surgery for bleeding presumed caused by the venous angioma. Infarction was shown in two patients and a tumor in two others. Follow-up periods ranged between 18 and 104 months, with only five patients symptomatic at the time of this report. Rebleeding had not occurred, nor had acute episodes of neurological dysfunction been documented. This clinical experience suggests that a venous malformation is frequently associated with other, more symptomatic conditions and is often erroneously identified as the source of the symptoms. Because the nature of the relationship between the venous malformation and the allied conditions remains ambiguous, it is recommended that patients harboring a “symptomatic” venous malformation undergo high-field magnetic resonance imaging to rule out underlying pathology, and that any such pathology be treated independently of the venous malformation.

Depression and functional outcome in patients with brain tumors: a population-based 1-year follow-up study

2005 ◽  
Vol 103 (5) ◽  
pp. 841-847 ◽  
Author(s):  
Arja Mainio ◽  
Helinä Hakko ◽  
Asko Niemelä ◽  
John Koivukangas ◽  
Pirkko Räsänen
Keyword(s):  
Brain Tumors ◽  
Functional Outcome ◽  
Population Based ◽  
Primary Brain Tumor ◽  
Karnofsky Performance Scale ◽  
Entire Study ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The authors analyzed changes in depression and contemporary functional states by using valid tools in a population-based study sample during a 1-year follow-up period. Methods. The study population consisted of 77 patients with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery. Each patient's depressive status, according to the Beck Depression Inventory (BDI), and functional outcome, based on the Karnofsky Performance Scale (KPS), were evaluated before the tumor was surgically treated as well as 3 months and 1 year after surgery. Before surgery 27 patients (35%) had BDI scores indicating the presence of depression. These scores were significantly higher in patients with a history of depression (p = 0.017) and in those with a lower functional outcome (p = 0.015). In the entire study sample the severity of depression decreased statistically significantly (p = 0.031) at 3 months postsurgery. A lower functional status (KPS score ≤ 70) in patients was significantly associated with high depression scores at the 3-month (p = 0.000) and 1-year (p = 0.005) assessments. The decrease in the level of depression was significant in patients with an anterior tumor (p = 0.049) and those with a pituitary adenoma (p = 0.019). Conclusions. Affective disorders among patients with brain tumors must be considered immediately after surgery, especially in persons with a depression history and in those with a coincident physical disability.

Natural history of postoperative aneurysm rests

1987 ◽  
Vol 66 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Isaac Feuerberg ◽  
Christer Lindquist ◽  
Melker Lindqvist ◽  
Ladislau Steiner
Keyword(s):  
Natural History ◽  
Content Type ◽  
Follow Up Studies ◽  
History Of ◽  
Microsurgical Techniques ◽  
Fine Print ◽  
Saccular Aneurysms

✓ In a series of 715 patients operated on by microsurgical techniques for intracranial saccular aneurysms between 1970 and 1980, part of the aneurysmal sac was not obliterated in 28 aneurysms in 27 patients (3.8% of 715 cases). Clinical follow-up evaluation for 8 years (range 4 to 13 years) and angiographic follow-up studies for 6 years (range 2 to 10 years) in these 27 cases revealed that one aneurysm rest increased in size and bled twice, five were spontaneously obliterated, two decreased in size, 13 remained unchanged, and in seven cases no late follow-up angiography was performed. The incidence of rebleeding from an aneurysm rest was 3.7% of the 27 in whom the sac was not obliterated and 0.14% of all 715 patients who were operated on.

Cerebral arterial dolichoectasia with seizure

1976 ◽  
Vol 44 (4) ◽  
pp. 509-512 ◽  
Author(s):  
Joseph R. Thompson ◽  
Philip R. Weinstein ◽  
Charles R. Simmons
Keyword(s):  
Cerebral Angiography ◽  
Cerebral Arteries ◽  
Hemiplegic Migraine ◽  
Content Type ◽  
Middle Cerebral Arteries ◽  
Brain Scan ◽  
History Of ◽  
Angiographic Demonstration ◽  
Fine Print

✓ Cerebral angiography, performed after a seizure in a patient with a life-long history of typical hemiplegic migraine, disclosed markedly dolichoectatic anterior and middle cerebral arteries. No abnormality of the adjacent capillary or venous structures was present. A positive brain scan was attributed to ischemia induced by vasospasm rather than to the corresponding large tortuous anterior and middle cerebral arteries. There were no permanent sequelae and the patient has been free of seizures on Dilantin and phenobarbital over a 3-year follow-up period. Angiographic demonstration or description of a similar ectatic set of anterior and middle cerebral arteries could not be found in the literature. The concurrence of seizures and hemiplegic migraine adds to the peculiarity of this case.

The treatment of nonobstructive (communicating) hydrocephalus by endoscopic cauterization of the choroid plexuses

1970 ◽  
Vol 33 (1) ◽  
pp. 1-18 ◽  
Author(s):  
John E. Scarff
Keyword(s):  
Personal Experience ◽  
Operative Mortality ◽  
Late Complication ◽  
Communicating Hydrocephalus ◽  
Content Type ◽  
Operative Method ◽  
Choroid Plexuses ◽  
History Of ◽  
Fine Print

✓ The author reviews his personal experience with 39 cases of nonobstructive (communicating) hydrocephalus treated by endoscopic cauterization of the choroid plexuses during the period 1942–1965. The paper includes a brief history of the development of this operative method, and a description of the author's ventriculoscope. The operative technique has been described in detail. The operative mortality was 10% overall, 5% in the last 20 cases. Hydrocephalus was initially arrested in 26 cases and has remained so in all cases, with a follow-up period of more than 10 years in 23 patients. Only one case developed a late complication requiring reoperation.

Gliofibroma

1991 ◽  
Vol 75 (4) ◽  
pp. 642-646 ◽  
Author(s):  
G. Jackson Snipes ◽  
Gary K. Steinberg ◽  
Barton Lane ◽  
Dikran S. Horoupian
Keyword(s):  
Computerized Tomography ◽  
Case History ◽  
Electron Microscopic ◽  
Microscopic Description ◽  
Content Type ◽  
History Of ◽  
Tomography Appearance ◽  
Fine Print

✓ The case history of an infant with a large gliofibroma is presented. Gliofibromas are rare mixed glialmesenchymal tumors that have been poorly characterized. The computerized tomography appearance and a detailed light and electron microscopic description are presented, along with immunoperoxidase studies of this tumor. This case is compared with gliofibromas described elsewhere in the literature.

Growing fracture of the skull and the role of computerized tomography

1981 ◽  
Vol 55 (3) ◽  
pp. 470-472 ◽  
Author(s):  
Richard H. Lye ◽  
J. V. Occleshaw ◽  
John Dutton
Keyword(s):  
Head Injury ◽  
Computerized Tomography ◽  
Case History ◽  
Rare Complication ◽  
Leptomeningeal Cyst ◽  
Content Type ◽  
History Of ◽  
Fine Print

✓ Growing fracture of the skull is a rare complication following head injury. The case history of a child with such a fracture, who developed a leptomeningeal cyst, is presented. The unusual features of this case are discussed in the light of previous reports. The usefulness of computerized tomography in obviating the need for more invasive preoperative investigations is demonstrated.

The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment

1990 ◽  
Vol 73 (3) ◽  
pp. 387-391 ◽  
Author(s):  
Stephen L. Ondra ◽  
Henry Troupp ◽  
Eugene D. George ◽  
Karen Schwab
Keyword(s):  
Mortality Rate ◽  
Arteriovenous Malformations ◽  
Original Population ◽  
Major Morbidity ◽  
Content Type ◽  
History Of ◽  
The Mean ◽  
The Brain ◽  
Fine Print

✓ The authors have updated a series of 166 prospectively followed unoperated symptomatic patients with arteriovenous malformations (AVM's) of the brain. Follow-up data were obtained for 160 (96%) of the original population, with a mean follow-up period of 23.7 years. The rate of major rebleeding was 4.0% per year, and the mortality rate was 1.0% per year. At follow-up review, 23% of the series were dead from AVM hemorrhage. The combined rate of major morbidity and mortality was 2.7% per year. These annual rates remained essentially constant over the entire period of the study. There was no difference in the incidence of rebleeding or death regardless of presentation with or without evidence of hemorrhage. The mean interval between initial presentation and subsequent hemorrhage was 7.7 years.

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