Continuous hemodialysis for the management of acute renal failure in the presence of cerebellar hemorrhage

1998 ◽  
Vol 89 (4) ◽  
pp. 649-652 ◽  
Author(s):  
Daniel M. Caruso ◽  
A. Giancarlo Vishteh ◽  
Karl A. Greene ◽  
Marc R. Matthews ◽  
Carlos A. Carrion
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Posterior Fossa ◽  
Medical Condition ◽  
Morbidly Obese ◽  
Cerebellar Hemorrhage ◽  
Content Type ◽  
General Medical Condition ◽  
Life Threatening ◽  
Fine Print

✓ In this report the authors describe the use of continuous venovenous hemodialysis (CVVHD) in a medically unstable patient who suffered from a spontaneous cerebellar hemorrhage. Conventional dialysis techniques carry the risk of developing the dialysis disequilibrium syndrome (DDS) when performed in the presence of a variety of intracranial diseases. The CVVHD technique was used successfully in a morbidly obese, short-statured woman with a spontaneous hypertensive intraparenchymal cerebellar hemorrhage. The woman experienced acute renal failure several days after her hemorrhage and her general medical condition prevented her from undergoing surgical evacuation. The CVVHD did not result in elevations in intracranial pressure (ICP) and the patient made a full recovery from both acute renal failure and life-threatening posterior fossa hemorrhage. This case is noteworthy because of the absence of abnormally high ICP elevations or development of DDS in a patient with a large acute posterior fossa intraparenchymal brain hemorrhage and acute renal failure whose case was managed with CVVHD in the acute period.

Strategies for Treatment and Prevention of Acute Renal Failure

2002 ◽  
Vol 15 (5) ◽  
pp. 392-404
Author(s):  
Mary K. Stamatakis
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Medical Condition ◽  
Extracellular Fluid ◽  
Pharmacologic Therapy ◽  
Treatment And Prevention ◽  
Life Threatening

Acute renal failure (ARF) is a potentially life-threatening medical condition that often complicates the hospitalization of critically ill patients. A variety of therapeutic strategies has been studied for both preventing ischemic and nephrotoxic injury to the kidney and improving renal function in established ARF. This article summarizes the role of pharmacologic therapy in the treatment of ARF. Strategies to reduce extracellular fluid volume and preserve renal function with loop diuretics, low-dose dopamine, and renal replacement therapy will be discussed. The value of preventative therapy has increased, and identifying patients at high risk for development of ARF is critical. Modification of drug regimens, administration of less nephrotoxic medications, and volume expansion prior to nephrotoxin administration can minimize toxicity to the kidney. The search for new agents that can improve survival, decrease the need for renal replacement therapy, and hasten the recovery of renal function in ARF is ongoing.

Acute renal failure following cerebral angiography and infusion computerized tomography

1980 ◽  
Vol 52 (1) ◽  
pp. 111-112 ◽  
Author(s):  
Joe S. Robinson ◽  
Daniel D. Arzola ◽  
Robert A. Moody
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Computerized Tomography ◽  
Cerebral Angiography ◽  
Contrast Material ◽  
Content Type ◽  
Fine Print

✓ The authors report a case in which acute renal failure developed following angiography and computerized tomography with infusion of contrast material performed within the same day.

Responsiveness of life-threatening refractory emesis to gabapentin—scopolamine therapy following posterior fossa surgery

2005 ◽  
Vol 102 (3) ◽  
pp. 547-549 ◽  
Author(s):  
Thomas Guttuso ◽  
Philip Vitticore ◽  
Robert G. Holloway
Keyword(s):  
Posterior Fossa ◽  
Complete Resolution ◽  
Failure To Thrive ◽  
Posterior Fossa Surgery ◽  
Anecdotal Evidence ◽  
Content Type ◽  
Nausea And Emesis ◽  
Life Threatening ◽  
Refractory Emesis ◽  
Fine Print

✓ Craniotomy-associated chronic emesis can be refractory to currently approved antiemetic therapy. The authors describe a man who suffered 4 weeks of severe refractory emesis, failure to thrive, and a 40-lb weight loss after he underwent resection of a posterior fossa cholesteatoma. The patient experienced complete resolution of emesis and anorexia in response to combined gabapentin—scopolamine therapy. This case provides anecdotal evidence for the use of gabapentin—scopolamine therapy in patients with chronic, refractory nausea and emesis, particularly following posterior fossa surgery, during which medullary nausea and emesis centers may be affected.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Isolated symptomatic cervical spinous process fracture requiring surgery

1991 ◽  
Vol 75 (1) ◽  
pp. 131-133 ◽  
Author(s):  
Leonard F. Hirsh ◽  
Luis E. Duarte ◽  
Eric H. Wolfson ◽  
Wilhelm Gerhard
Keyword(s):  
Medical Condition ◽  
Spinous Process ◽  
Complete Recovery ◽  
Neurological Injury ◽  
Pertinent Literature ◽  
Content Type ◽  
Residual Symptoms ◽  
Economic Forces ◽  
Spinous Process Fracture ◽  
Fine Print

✓ Isolated cervical spinous process fractures are common, but are usually considered to be inconsequential. Although such fractures may produce pain, complete recovery without residual symptoms is expected after conservative treatment, and neurological injury does not usually occur. The case of a patient with a persistently symptomatic C-2 spinous process fracture that required surgical treatment for pain relief is reported. A review of the pertinent literature illustrates with unusual clarity the interactions of social, political, and economic forces associated with this medical condition.

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.

Meningeal melanocytoma

1998 ◽  
Vol 88 (1) ◽  
pp. 116-121 ◽  
Author(s):  
David B. Clarke ◽  
Richard Leblanc ◽  
Gilles Bertrand ◽  
Gilbert R. C. Quartey ◽  
G. Jackson Snipes
Keyword(s):  
Histological Examination ◽  
Posterior Fossa ◽  
Clinical Presentation ◽  
Residual Tumor ◽  
Posterior Fossa Decompression ◽  
Content Type ◽  
Meningeal Melanocytoma ◽  
Radiological Appearance ◽  
Histological Features ◽  
Fine Print

✓ Meningeal melanocytomas are rare tumors of the central nervous system that are found almost exclusively in the posterior fossa and spinal cord and whose natural history is poorly defined. In this report, the authors review the clinical presentation, radiological appearance, operative findings, and histological features in two cases of meningeal melanocytoma: one cranial and one spinal. Two women, aged 21 and 30 years, were admitted to the hospital 60 years apart: the first because of progressive paraplegia and the second because of slowly progressive hearing loss. The first patient had an extradural tumor that was treated by laminectomy, subtotal resection, and postoperative radiotherapy in 1936. Her symptoms recurred 16 years later and she underwent reoperation of the residual tumor, which was found to have an intradural component. The authors' patient, who presented 60 years later, underwent plain and enhanced computerized tomography and magnetic resonance imaging that demonstrated a large posterior fossa lesion indicative of either an acoustic neuroma or a meningioma. She underwent posterior fossa decompression but only partial excision of the tumor could be accomplished because vigorous bleeding limited the extent of the resection. Surgery was followed by radiotherapy. The residual tumor enlarged despite these measures and required repeated resection 6 months later. At the second operation the tumor was much less vascular, perhaps reflecting the effects of radiotherapy, and was removed almost entirely. The patient died 6 months later from an anticoagulant-related cerebellar hemorrhage. In both cases the lesions were jet black, and histological examination revealed melanin-containing hypercellular tumors with rare mitotic figures. Meningeal melanocytomas are being diagnosed with increased frequency in parallel with improvements in neuroimaging and clarification of histological features. Clinical presentation of patients with these tumors typically occurs in their fifth decade and women are affected twice as often as men. The posterior fossa lesions can mimic acoustic neuromas and meningiomas in location and radiological appearance; however, the internal auditory canal is normal. In the spine, meningeal melanocytomas present with the clinical features of myeloradiculopathy. Diagnosis is made intraoperatively from the gross, jet-black appearance of the tumor and from histological examination. Vascularity, size, and location may render complete resection unfeasible. Because of the tumor's propensity to recur, radiotherapy has been recommended but its role remains to be elucidated.

scholarly journals Seven-Digit Creatine Kinase in Acute Rhabdomyolysis in a Child

2017 ◽  
Vol 4 ◽  
pp. 2329048X1668439 ◽  
Author(s):  
Nuha Basheer ◽  
Sirin Mneimneh ◽  
Mariam Rajab
Keyword(s):  
Renal Failure ◽  
Creatine Kinase ◽  
Acute Renal Failure ◽  
Creatine Kinase Level ◽  
Peak Plasma ◽  
Renal Dialysis ◽  
Acute Rhabdomyolysis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Plasma Creatine Kinase

Rhabdomyolysis is an acute life-threatening condition that can occur in childhood secondary to many causes. The authors report the case of a 3-year-old male child who presented with acute rhabdomyolysis. The peak plasma creatine kinase level was extremely high. The 2 main causes of rhabdomyolysis in childhood are viral myositis and trauma, which can sometimes lead to acute renal failure. The highest creatine kinase levels reported in the literature so far was a 6-digit level in 2014 case report. In this study, the authors report the case of a 7-digit creatine kinase level in a child secondary to viral myositis who did not require renal dialysis.

Lead encephalopathy presenting as a posterior fossa mass

1986 ◽  
Vol 65 (5) ◽  
pp. 713-715 ◽  
Author(s):  
J. Frederick Harrington ◽  
Timothy B. Mapstone ◽  
Warren R. Selman ◽  
Pamela Galloway ◽  
Carl Bundschuh
Keyword(s):  
Computerized Tomography ◽  
Posterior Fossa ◽  
Content Type ◽  
Lead Encephalopathy ◽  
Fine Print

✓ A case of lead encephalopathy with clinical and computerized tomography evidence of a midline posterior fossa mass is presented. The pathophysiology and the predilection for posterior fossa involvement are discussed.

Diagnostic value of 201Tl—single-photon emission computerized tomography studies in cases of posterior fossa hemangioblastomas

2001 ◽  
Vol 95 (2) ◽  
pp. 292-297 ◽  
Author(s):  
Takeo Kondo ◽  
Toshihiro Kumabe ◽  
Shin Maruoka ◽  
Takashi Yoshimoto
Keyword(s):  
Computerized Tomography ◽  
Posterior Fossa ◽  
Single Photon ◽  
Photon Emission ◽  
Magnetic Resonance Images ◽  
Thallium 201 ◽  
Homologous Region ◽  
Single Photon Emission ◽  
Content Type ◽  
Fine Print

Object. The 201Tl uptake index was evaluated for its usefulness in formulating a diagnosis of hemangioblastoma. Thallium-201—single-photon emission computerized tomography (SPECT) studies were performed in nine patients harboring hemangioblastomas in the posterior fossa and in five patients (six lesions) with gliomas in the posterior fossa. Methods. The 201Tl uptake index was defined as the ratio of mean counts of isotope per pixel in the tumor to mean counts of isotope per pixel in the homologous region of the healthy brain. The 201Tl uptake indices of the early image (TlE) and that of the delayed image (TlD) were calculated. The isotope retention index (RI) was calculated as (TlE − TlD)/TlE. The TlE was 2.7 ± 0.7 in hemangioblastomas and 2.9 ± 1.7 in gliomas (mean ± standard deviation). The TlD was 1.5 ± 0.4 in hemangioblastomas and 2.4 ± 1.6 in gliomas. There were no significant differences between hemangioblastomas and gliomas when TlEs and TlDs were compared. The isotope RI was 0.43 ± 0.07 in hemangioblastomas and 0.15 ± 0.1 in gliomas, showing a significantly higher RI in hemangioblastomas compared with gliomas (p < 0.01). Conclusions. Thallium-201 washout is significantly faster in hemangioblastomas. Hemangioblastoma is biologically benign, but contains a rich capillary network that forms a hypervascular tumor bed. Variations in its appearance on magnetic resonance images may cause difficulties in the differential diagnosis of hemangioblastoma. Thallium-201 SPECT studies can be used to distinguish hemangioblastomas from gliomas in the posterior fossa.

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