Pulmonary embolism in neurosurgical patients: diagnosis and treatment

1984 ◽  
Vol 60 (5) ◽  
pp. 972-975 ◽  
Author(s):  
Giorgio Di Ricco ◽  
Carlo Marini ◽  
Maurizio Rindi ◽  
Vitale Ravelli ◽  
Lodovico Lutzemberger ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Course ◽  
Early Stage ◽  
Respiratory Alkalosis ◽  
Content Type ◽  
Anticoagulant Drugs ◽  
Neurosurgical Patients ◽  
Lung Scanning ◽  
Fine Print ◽  
Better Than

✓ Pulmonary embolism was suspected in 45 neurosurgical patients who were treated between January, 1980, and December, 1981. Hypoxemia with respiratory alkalosis and sudden tachycardia gave rise to this suspicion more often than any other sign or symptom. Perfusion lung scanning confirmed the presence of pulmonary embolism in 23 of these cases. A retrospective analysis of the clinical course of these 23 patients suggested that one or more previous episodes of pulmonary embolism had occurred in 16 cases (69.6%), and had been either overlooked or misdiagnosed. Treatment was started immediately after diagnosis. Twenty-one patients were given heparin; however, two could not be treated because of contraindication to using anticoagulant drugs. Two patients died during treatment. The 21 surviving patients were assessed and 11 of them submitted again to perfusion lung scanning 1 week after diagnosis: 14 had improved, but seven did not show significant changes either clinically or on perfusion lung scanning. Nine treated patients developed hemorrhage, but it was readily controlled. In two of the nine patients, hemorrhage involved the surgical area. It is stressed that pulmonary embolism may be suspected and diagnosed in neurosurgical patients at an early stage. Heparin may be given and the survival rate appears to be better than previously reported figures.

Legionnaire's disease in postoperative neurosurgical patients

1983 ◽  
Vol 59 (4) ◽  
pp. 596-600 ◽  
Author(s):  
Mark C. Glazier ◽  
Richard B. Kohler ◽  
Robert L. Campbell
Keyword(s):  
Legionella Pneumophila ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Surgical Patients ◽  
Content Type ◽  
Neurosurgical Patients ◽  
Legionnaires Disease ◽  
High Doses ◽  
Fine Print

✓ Legionella pneumophila postoperative pneumonia may be an important cause of morbidity and mortality in selected surgical patients. This report presents five postoperative neurosurgical patients in whom the diagnosis of Legionnaires' disease was made. Their clinical course and treatment are presented. Clinical manifestations, methods of diagnosis, and treatment of L. pneumophila pneumonia are discussed. It is pointed out that neurosurgical patients who have received high doses of corticosteroids and who develop nosocomial postoperative pneumonias should be suspected of having Legionnaires' disease.

Management of symptomatic deep venous thrombosis and pulmonary embolism on a neurosurgical service

1986 ◽  
Vol 64 (4) ◽  
pp. 563-567 ◽  
Author(s):  
Karl W. Swann ◽  
Peter McL. Black ◽  
Mary F. Baker
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Femoral Vein ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Pulmonary Emboli ◽  
Content Type ◽  
Neurosurgical Patients ◽  
Fine Print

✓ The authors present a retrospective analysis of the management of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurosurgical patients at the Massachusetts General Hospital from January, 1978, through June, 1982. There were 44 cases of DVT and 13 cases of PE. Management modalities included observation only, femoral vein ligation, inferior vena cava clipping, transvenous placement of an inferior vena cava filter or umbrella, and anticoagulation therapy. Six (75%) of eight patients with symptomatic DVT who were managed by observation alone had subsequent pulmonary emboli, and three (38%) died. Femoral vein ligation was followed by PE in one of four cases and led to significant leg swelling in two others. Neither observation alone nor femoral vein ligation can be recommended as routine management options. Partial inferior vena cava interruption with a De Weese clip, Kim-Ray Greenfield filter, or Mobin-Uddin umbrella all successfully prevented pulmonary emboli. The major problem associated with these methods was leg edema, which occurred in 47% of patients with clip placement, 25% with filter placement, and 21% with a Mobin-Uddin umbrella. Anticoagulation therapy was associated with a complication rate of 29% and a mortality rate of 15%. Fatal PE and paradoxical hypercoagulability with gangrene of a lower extremity were the causes of death. In one patient, hemorrhage into a glioblastoma occurred following discontinuation of anticoagulation therapy when the coagulation parameters were normal. The authors conclude that: 1) management with observation alone of patients with symptomatic DVT places the patient at risk for the development of life-threatening pulmonary emboli; 2) the safety and timing of therapeutic anticoagulation in postoperative neurosurgical patients or patients with tumors is unclear; and 3) partial interruption of the inferior vena cava with a transvenous filter successfully prevents PE and may represent a safer alternative to anticoagulation therapy.

Terminal ventriculostomy for syringomyelia

1977 ◽  
Vol 46 (5) ◽  
pp. 609-617 ◽  
Author(s):  
W. James Gardner ◽  
Herbert S. Bell ◽  
Pete N. Poolos ◽  
Donald F. Dohn ◽  
Marta Steinberg
Keyword(s):  
Clinical Course ◽  
Adult Life ◽  
Central Canal ◽  
Conus Medullaris ◽  
Fetal Life ◽  
Filum Terminale ◽  
Content Type ◽  
Fine Print

✓ The clinical course of 12 patients who underwent terminal ventriculostomy for syringomyelia is presented. Opening the central canal at the tip of the conus medullaris is a relatively benign procedure that improves the symptoms of syringomyelia and syringobulbia. This canal normally terminates at the tip of the conus, but in each of the 12 surgical specimens it continued into the filum terminale for distances up to 8 cm. In most cases the tip of the conus was located more caudally than normal, indicating some degree of tethering in fetal life. This belief is supported by the fact that the newborn, whose conus is tethered to a lipoma at the sacral level, may develop syringomyelia in adult life.

Angioplasty for basilar artery atherosclerosis

1992 ◽  
Vol 77 (6) ◽  
pp. 941-944 ◽  
Author(s):  
Arvind Ahuja ◽  
Lee R. Guterman ◽  
Leo N. Hopkins
Keyword(s):  
Basilar Artery ◽  
Balloon Angioplasty ◽  
Medical Management ◽  
Clinical Course ◽  
Anticoagulation Therapy ◽  
Transient Ischemic Attacks ◽  
Content Type ◽  
Severe Atherosclerosis ◽  
Percutaneous Transluminal ◽  
Fine Print

✓ A case is presented of severe atherosclerosis of the basilar artery, successfully treated with percutaneous transluminal balloon angioplasty. Crescendo daily transient ischemic attacks consisted of alternating hemiplegia and were refractory to medical management, including anticoagulation therapy. The clinical course, endovascular treatment, and results are described. Prior published experiences with this condition are reviewed.

Systemic candidiasis and endophthalmitis in neurosurgical patients

1976 ◽  
Vol 45 (1) ◽  
pp. 95-97 ◽  
Author(s):  
Arthur R. Cushman ◽  
Gerald Friedman ◽  
John Capsavage
Keyword(s):  
Broad Spectrum ◽  
Opportunistic Infections ◽  
Systemic Candidiasis ◽  
High Susceptibility ◽  
Content Type ◽  
Broad Spectrum Antibiotics ◽  
Neurosurgical Patients ◽  
Fine Print

✓ Three cases of systemic candidiasis in neurosurgical patients are presented. Two of the three patients also had endophthalmitis. All of the cases were treated with broad-spectrum antibiotics and glucocorticoids prior to the appearance of candidiasis. The authors stress the high susceptibility of neurosurgical patients to opportunistic infections of this type.

The physiopathology of respiration in neurosurgical patients

1979 ◽  
Vol 50 (6) ◽  
pp. 699-714 ◽  
Author(s):  
Elizabeth A. M. Frost
Keyword(s):  
Spinal Cord Injuries ◽  
Pediatric Neurosurgery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Regulation Of Respiration ◽  
Content Type ◽  
Neurosurgical Patients ◽  
Cord Injury ◽  
Injured Patients ◽  
Fine Print

✓ Regulation of respiration is summarized as to peripheral and central chemoreceptors, controllers of voluntary and automatic respiration, and stimulators (CO2, O2, and pH). The information that may be obtained from blood-gas analysis is reviewed and basic problems in acid-base imbalance described. Commonly employed respiratory patterns are discussed. Preoperative pulmonary assessment necessary in elective intracranial situations, spinal cord injuries, and pediatric neurosurgery is outlined. Some of the special problems of the patient with multiple trauma, including injury to the central nervous system are reviewed. Central and peripheral factors that cause respiratory difficulty in head-injured patients are tabulated, and an outline is given of diagnosis and therapy. There are many possible causes of intraoperative hypoxia and hypercarbia, and these complications with their prevention or treatment are examined. Criteria for extubation are established. Finally, postoperative pulmonary care in elective, emergency, and cord injury situations is discussed. The key to successful perioperative pulmonary care of the neurosurgical patient requires close cooperation between the neurosurgeon and anesthesiologist.

Calpain-calpastatin system of canine basilar artery in vasospasm

1993 ◽  
Vol 79 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Ikuya Yamaura ◽  
Eiichi Tani ◽  
Takaomi C. Saido ◽  
Koichi Suzuki ◽  
Nobutaka Minami ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Early Stage ◽  
Local Application ◽  
Neutral Protease ◽  
Control Group ◽  
Calpain Activity ◽  
Fresh Blood ◽  
Content Type ◽  
Canine Basilar Artery ◽  
Fine Print

✓ Vasospasm was produced in the canine basilar artery by a two-hemorrhage method, while contraction was induced in the normal canine basilar artery by a local application of KCl or serotonin after transclival exposure. The control animals were injected with saline instead of fresh blood. The activation of μ-calpain, a Ca++-dependent neutral protease, in the basilar artery was studied by evaluating the conversion from its inactivated into its activated form on immunoblots. In addition, the activity of calpastatin, an intrinsic inhibitor of calpain, in the basilar artery was determined by assay. The majority of the μ-calpain was inactivated in the control group. In the spastic group, μ-calpain was generally activated markedly in the early stage of vasospasm and moderately thereafter. The contraction induced by KCl or serotonin application was classified into the early phasic and the later tonic stages; μ-calpain was usually activated in the phasic stage and inactivated in the tonic stage. Calpastatin activity was significantly decreased during vasospasm, whereas it was not significantly changed in KCl- or serotonin-induced contraction. The final activity of μ-calpain results from the balance of μ-calpain and calpastatin. This suggests that μ-calpain activity was enhanced continuously in the spastic group and transiently in the KCl or serotonin group, and that the continuous activation of μ-calpain during vasospasm probably induced more proteolytic changes compared to those in the KCl or serotonin group.

Neurosurgical hyponatremia: the role of inappropriate antidiuresis

1971 ◽  
Vol 34 (4) ◽  
pp. 506-514 ◽  
Author(s):  
John L. Fox ◽  
Joel L. Falik ◽  
Robert J. Shalhoub
Keyword(s):  
Differential Diagnosis ◽  
Sodium Concentration ◽  
Fluid Restriction ◽  
Urine Sodium ◽  
Content Type ◽  
Inappropriate Secretion ◽  
Neurosurgical Patients ◽  
Inappropriate Antidiuresis ◽  
Fine Print

✓ Of 80 consecutive neurosurgical patients, 23 exhibited inappropriate secretion of the antidiuretic hormone (ISADH); 11 of these patients required marked fluid restriction. Sodium concentration in the urine characteristically increased as serum values decreased. Only by following the urine sodium concentrations could the differential diagnosis of nutritional hyponatremia and ISADH be made. The role of ISADH in cerebral edema is stressed. The treatment recommended for ISADH is marked fluid restriction, whereas in nutritional hyponatremia, saline replacement is indicated.

Rapid resolution of acute epidural hematoma

1988 ◽  
Vol 68 (1) ◽  
pp. 149-151 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Epidural Hematoma ◽  
Clinical Course ◽  
Skull Fracture ◽  
Fracture Line ◽  
Concomitant Increase ◽  
Content Type ◽  
Rapid Resolution ◽  
Acute Epidural Hematoma ◽  
Fine Print

✓ Two cases of acute epidural hematoma with rapid resolution followed by a benign clinical course are reported. Because of the concomitant increase in the epicranial hematoma over a linear skull fracture in each case, the acute epidural hematoma was presumed to have been decompressed into the epicranial region through the fracture line.

Distribution of genes for parathyroid hormone (PTH)—related peptide, Indian hedgehog, PTH receptor and patched in the process of experimental spondylosis in mice

2002 ◽  
Vol 97 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Takanobu Nakase ◽  
Kenta Ariga ◽  
Wenxiang Meng ◽  
Motoki Iwasaki ◽  
Tetsuya Tomita ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Messenger Rna ◽  
Molecular Mechanisms ◽  
Early Stage ◽  
Indian Hedgehog ◽  
Molecular Signaling ◽  
Content Type ◽  
Chondrocyte Maturation ◽  
Related Peptide ◽  
Fine Print

Object. Little is known about the molecular mechanisms underlying the process of spondylosis. The authors determined the extent of genetic localization of major regulators of chondrogenesis such as Indian hedgehog (Ihh) and parathyroid hormone (PTH)—related peptide (PTHrP) and their receptors during the development of spondylosis in their previously established experimental mouse model. Methods. Experimental spondylosis was induced in 5-week-old ICR mice. The cervical spines were chronologically harvested, and histological sections were prepared. Messenger (m) RNA for PTHrP, Ihh, PTH receptor (PTHR; a receptor for PTHrP), patched (Ptc; a receptor for Ihh), bone morphogenetic protein (BMP)—6, and collagen type X (COL10; a marker for mature chondrocyte) was localized in the tissue sections by performing in situ hybridization. In the early stage, mRNA for COL10, Ihh, and BMP-6 was absent; however, mRNA for PTHrP, PTHR, and Ptc was detected in the anterior margin of the cervical discs. In the late stage, evidence of COL10 mRNA began to be detected, and transcripts for Ihh, PTHrP, and BMP-6 were localized in hypertrophic chondrocytes adjacent to the bone-forming area in osteophyte. Messenger RNA for Ptc and PTHR continued to localize at this stage. In control mice, expression of these genes was absent. Conclusions. The localization of PTHrP, Ihh, BMP-6, and the receptors PTHR and Ptc demonstrated in the present experimental model indicates the possible involvement of molecular signaling by PTHrP (through the PTHR), Ihh (through the Ptc), and BMP-6 in the regulation of chondrocyte maturation leading to endochondral ossification in spondylosis.

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