The ciliospinal reflex in pentobarbital coma

1999 ◽  
Vol 90 (4) ◽  
pp. 644-646 ◽  
Author(s):  
John C. Andrefsky ◽  
Jeffrey I. Frank ◽  
Douglas Chyatte
Keyword(s):  
Pupil Size ◽  
Pupillary Dilation ◽  
Content Type ◽  
Medical Interventions ◽  
Neurointensive Care Unit ◽  
Pathological Conditions ◽  
Direct Light ◽  
The Face ◽  
Life Threatening ◽  
Fine Print

Object. This study was conducted to delineate the ciliospinal reflex (CSR), which is defined as pupillary dilation caused by a noxious stimulus to the face or head. The authors anecdotally observed that patients in a pentobarbital coma have a CSR that can mimic pathological conditions. A pentobarbital coma obscures the results of the neurological examination in patients with potentially life-threatening cerebral edema; pupil size and reactivity are the only readily monitored signs. Any condition that incorrectly suggests evolving intracranial pathological processes can lead to unnecessary clinical actions.Methods. The authors evaluated six consecutive patients in the neurointensive care unit in whom a pentobarbital coma had been induced, documenting the presence and duration of the CSR. The CSR was always bilateral and symmetrical, manifesting as enlarged (6–8 mm), seemingly nonreactive pupils continuing from 1 to 6 minutes and was usually seen after routine nursing maneuvers. The pupils appeared nonreactive to short flashes of direct light but did react if longer flashes were used.Conclusions. Recognition of the CSR can potentially lead to reduction of unnecessary transportation and complicating medical interventions in critically neurologically ill patients in whom a pentobarbital coma has been induced.

Associated change in plantar temperature and sweating after transthoracic endoscopic T2–3 sympathectomy for palmar hyperhidrosis

2001 ◽  
Vol 95 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Han-Jung Chen ◽  
Cheng-Loong Liang ◽  
Kang Lu
Keyword(s):  
Skin Temperature ◽  
Temperature Change ◽  
The Body ◽  
Palmar Hyperhidrosis ◽  
Compensatory Sweating ◽  
Content Type ◽  
Postoperative Changes ◽  
The Face ◽  
The Difference ◽  
Fine Print

Object. Transthoracic endoscopic T2–3 sympathectomy is currently the treatment of choice for palmar hyperhidrosis. Compensatory sweating of the face, trunk, thigh, and sole of the foot was found in more than 50% of patients who underwent this procedure. The authors conducted this study to investigate the associated intraoperative changes in plantar skin temperature and postoperative plantar sweating. Methods. One hundred patients with palmar hyperhidrosis underwent bilateral transthoracic endoscopic T2–3 sympathectomy. There were 60 female and 40 male patients who ranged in age from 13 to 40 years (mean age 21.6 years). Characteristics studied included changes in palmar and plantar skin temperature measured intraoperatively, as well as pre- and postoperative changes in plantar sweating and sympathetic skin responses (SSRs). In 59 patients (59%) elevation of plantar temperature was demonstrated at the end of the surgical procedure. In this group, plantar sweating was found to be exacerbated in three patients (5%); plantar sweating was improved in 52 patients (88.1%); and no change was demonstrated in four patients (6.8%). In the other group of patients in whom no temperature change occurred, increased plantar sweating was demonstrated in three patients (7.3%); plantar sweating was improved in 20 patients (48.8%); and no change was shown in 18 patients (43.9%). The difference between temperature and sweating change was significant (p = 0.001). Compared with the presympathectomy rate, the rate of absent SSR also significantly increased after sympathectomy: from 20 to 76% after electrical stimulation and 36 to 64% after deep inspiration stimulation, respectively (p < 0.05). Conclusions. In contrast to compensatory sweating in other parts of the body after T2–3 sympathetomy, improvement in plantar sweating was shown in 72% and worsened symptoms in 6% of patients. The intraoperative plantar skin temperature change and perioperative SSR demonstrated a correlation between these changes.

New treatment of lumbar disc herniation involving 5-hydroxytryptamine2A receptor inhibitor: a randomized controlled trial

2005 ◽  
Vol 2 (4) ◽  
pp. 441-446 ◽  
Author(s):  
Masahiro Kanayama ◽  
Tomoyuki Hashimoto ◽  
Keiichi Shigenobu ◽  
Fumihiro Oha ◽  
Shigeru Yamane
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Low Back ◽  
Content Type ◽  
Medical Interventions ◽  
Randomized Controlled ◽  
Nsaid Group ◽  
Fine Print

Object. Serotonin or 5-hydroxytryptamine (5-HT) is a chemical mediator associated with nucleus pulposus—induced radiculopathy. Inhibition of 5-HT receptors may potentially alleviate symptoms in patients with lumbar disc herniation. This prospective randomized controlled study was performed to evaluate the efficacy of the 5-HT2A receptor inhibitor in the treatment of symptomatic lumbar disc herniation. Methods. Forty patients with sciatica due to L4–5 or L5—S1 disc herniation were randomly allocated to treatment with the 5-HT2A inhibitor (sarpogrelate 300 mg/day) or nonsteroidal antiinflammatory drugs (NSAIDs; diclofenac 75 mg/day). Low-back pain, leg pain, and numbness were evaluated using a visual analog scale (VAS) before and after a 2-week course of treatment. The patients received only allocated medicine during the 2-week regimen and were thereafter allowed to choose any treatment options depending on their residual symptoms. One-year clinical outcomes were assessed based on the rates of additional medical interventions. The mean VAS score improvements in the 5-HT2A and NSAID groups were 33 and 46% for low-back pain, 32 and 32% for leg pain, and 35 and 22% for leg numbness, respectively. After the 2-week regimen, no additional medical interventions were required in 50% of 5-HT2A—treated patients and 15% of those receiving NSAIDs. Epidural or nerve root block procedures were performed in 35% of the 5-HT2A group and 45% of the NSAID group. Surgery was required in 20% of the 5-HT2A group and 30% of the NSAID group patients. Conclusions. The current study provided evidence that the efficacy of the 5-HT2A inhibitor was comparable with that of NSAID therapy for lumbar disc herniation. The 5-HT2A inhibitor has the potential to alleviate symptoms in patients with lumbar disc herniation.

Diagnosis and treatment of Ogilvie's syndrome after lumbar spinal surgery

1992 ◽  
Vol 76 (6) ◽  
pp. 1012-1016 ◽  
Author(s):  
Robert A. Feldman ◽  
Richard C. Karl
Keyword(s):  
Spinal Surgery ◽  
Mechanical Obstruction ◽  
Ogilvie's Syndrome ◽  
Ogilvie’S Syndrome ◽  
Content Type ◽  
Cecal Perforation ◽  
Life Threatening ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal ◽  
Fine Print

✓ Three patients who developed Ogilvie's syndrome following lumbar spinal surgery are described. Ogilvie's syndrome, also known as pseudo-obstruction of the colon, is characterized by massive cecal distention without mechanical obstruction. If this condition is not recognized and not promptly treated, it may be complicated by cecal perforation, a life-threatening hazard. The etiology, diagnosis, management, and potential relationship between lumbar spinal surgery and Ogilvie's syndrome are discussed.

New pain following cordotomy: clinical features, mechanisms, and clinical importance

2001 ◽  
Vol 95 (3) ◽  
pp. 425-431 ◽  
Author(s):  
Takumi Nagaro ◽  
Naoto Adachi ◽  
Etsuo Tabo ◽  
Shigeo Kimura ◽  
Tatsuru Arai ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Importance ◽  
Mirror Image ◽  
Referred Pain ◽  
Spontaneous Pain ◽  
Contributing Factors ◽  
Content Type ◽  
Pathological Conditions ◽  
Painful Area ◽  
Fine Print

Object. The clinical features, possible causes, and contributing factors associated with novel spontaneous pain following unilateral cordotomy were investigated to clarify the mechanism and clinical importance of this pain. Methods. Forty-five patients who underwent cordotomy for severe unilateral cancer pain were included in this study. New pain occurred in 33 (73.3%) of 45 patients. Pathological conditions of tissue demonstrated on imaging corresponded to new pain in eight patients, referred pain in five, and neither of these in 15 patients. New pain was centered opposite the site of the original pain in a mirror-image location in 28 patients and rostral to the original pain in five patients. It was temporary in seven patients, weaker than the original pain in 25, and as severe as the original pain in one patient. The incidence of moderate or severe pain was significantly higher in patients with confirmed tissue disease (six of eight patients) than in those without (six of 20 patients). An important contributing factor to the occurrence of new pain was the achievement of analgesia by performing the cordotomy. Conclusions. The present results indicate that new pain occurs frequently after unilateral cordotomy. Nonetheless, cordotomy may still be indicated for unilateral uncontrollable pain because new pain, when present, was weaker and more easily controlled than the original pain in nearly all cases. The authors speculate that new pain may represent a type of referred pain from the original painful area or may arise from sensitization of contralateral spinal nociceptive circuits due to metastasis or tumor infiltration, and that new pain is potentiated by the interruption of descending inhibitory pathways.

Associated arteriovenous malformation of the orbit and brain: a case of Wyburn-Mason syndrome without retinal involvement

2001 ◽  
Vol 95 (2) ◽  
pp. 346-349 ◽  
Author(s):  
Francisco A. Ponce ◽  
Patrick P. Han ◽  
Robert F. Spetzler ◽  
Alexa Canady ◽  
Iman Feiz-Erfan
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Rare Condition ◽  
Cerebral Arteriovenous Malformations ◽  
Cutaneous Lesions ◽  
Content Type ◽  
Gestational Period ◽  
Fourth Case ◽  
The Face ◽  
Fine Print

✓ Wyburn-Mason syndrome is a rare condition associated with multiple cerebral arteriovenous malformations. The disease, also called retinoencephalofacial angiomatosis, includes lesions of the retina, brain, and skin. This disorder stems from a vascular dysgenesis of the embryological anterior plexus early in the gestational period when the primitive vascular mesoderm is shared by the involved structures. The timing of the insult to the embryonic tissue determines which structures are affected. Extensions of the lesions vary widely but cutaneous lesions are unusual. Among reports in the literature, only three cases appear to have manifested without retinal involvement. The authors report the fourth case of Wyburn-Mason syndrome in which there was no retinal involvement and the first to involve neither the retina nor the face.

The suboccipital cavernous sinus

1997 ◽  
Vol 86 (2) ◽  
pp. 252-262 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty ◽  
T. Glenn Pait ◽  
Ali F. Krisht ◽  
Muhammad M. Husain
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Microsurgical Anatomy ◽  
Transverse Foramen ◽  
Cross Sectional ◽  
Anatomical Structures ◽  
Content Type ◽  
Arterial Walls ◽  
Pathological Conditions ◽  
Fine Print

✓ The authors studied the microsurgical anatomy of the suboccipital region, concentrating on the third segment (V3) of the vertebral artery (VA), which extends from the transverse foramen of the axis to the dural penetration of the VA, paying particular attention to its loops, branches, supporting fibrous rings, adjacent nerves, and surrounding venous structures. Ten cadaver heads (20 sides) were fixed in formalin, their blood vessels were perfused with colored silicone rubber, and they were dissected under magnification. The authors subdivided the V3 into two parts, the horizontal (V3h) and the vertical (V3v), and studied the anatomical structures topographically, from the superficial to the deep tissues. In two additional specimens, serial histological sections were acquired through the V3 and its encircling elements to elucidate their cross-sectional anatomy. Measurements of surgically and clinically important features were obtained with the aid of an operating microscope. This study reveals an astonishing anatomical resemblance between the suboccipital complex and the cavernous sinus, as follows: venous cushioning; anatomical properties of the V3 and those of the petrous—cavernous internal carotid artery (ICA), namely their loops, branches, supporting fibrous rings, and periarterial autonomic neural plexus; adjacent nerves; and skull base locations. Likewise, a review of the literature showed a related embryological development and functional and pathological features, as well as similar transitional patterns in the arterial walls of the V3 and the petrous-cavernous ICA. Hence, due to its similarity to the cavernous sinus, this suboccipital complex is here named the “suboccipital cavernous sinus.” Its role in physiological and pathological conditions as they pertain to various clinical and surgical implications is also discussed.

Hemangiopericytoma of the brain

1973 ◽  
Vol 39 (5) ◽  
pp. 636-641 ◽  
Author(s):  
Ivanka Lolova ◽  
Margarita Kamenova
Keyword(s):  
Tumor Cells ◽  
Content Type ◽  
Pathological Conditions ◽  
Undifferentiated Cells ◽  
The Brain ◽  
Histochemical Examination ◽  
Fine Print

✓ The authors report the histological and histochemical examination of four cases of hemangiopericytoma. The tumors showed mature, differentiated, and undifferentiated cells with frequent mitoses, and an abundance of anaplastic cells. The histochemical characteristics of the tumor cells are summarized and compared to those of pericytes under normal or pathological conditions.

Transcranial resection of tumors of the paranasal sinuses and nasal cavity

1989 ◽  
Vol 71 (1) ◽  
pp. 10-15 ◽  
Author(s):  
J. Bob Blacklock ◽  
Randal S. Weber ◽  
Ya-Yen Lee ◽  
Helmuth Goepfert
Keyword(s):  
Nasal Cavity ◽  
Paranasal Sinuses ◽  
Free Tissue Transfer ◽  
Complication Rates ◽  
Effective Technique ◽  
Content Type ◽  
The Face ◽  
Variable Success ◽  
Fine Print

✓ Combined cranial and facial procedures for resection of malignancies of the paranasal sinuses and nasal cavity have been used with variable success and complication rates in the last 25 years. A series of nine patients undergoing 10 exclusively transcranial procedures for these tumors is presented, and an effective technique for reconstruction without free tissue transfer is described. The patients in this series suffered no major complications, and all have remained free of disease during the short follow-up period. The technique described in this report offers the advantage of wide exposure, symmetrical approach to the superstructures of the face and orbits, the potential for resection of a large portion of the anterior cranial floor, and substantial reconstruction which is a major factor in avoiding complications.

Migration of detachable mini-balloon from the ICA causing occlusion of the MCA

1983 ◽  
Vol 58 (3) ◽  
pp. 430-434 ◽  
Author(s):  
Keith H. Langford ◽  
Jiri J. Vitek ◽  
Evan Zeiger
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Middle Cerebral Artery Territory ◽  
Detachable Balloon ◽  
Content Type ◽  
Severe Hemorrhage ◽  
Life Threatening ◽  
Threatening Situation ◽  
Fine Print

✓ This patient had an aneurysm on the internal carotid artery that was responsible for episodes of severe hemorrhage through the nose. During occlusion of the aneurysm by a detachable balloon, the balloon became dislodged and migrated, obstructing the middle cerebral artery territory and causing a life-threatening situation. This was treated promptly and successfully by removal of the balloon and repair of the artery. Attention is drawn to the risk of such migration occurring, and the possible causes.

Tremor cells in the human thalamus: differences among neurological disorders

2004 ◽  
Vol 101 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Jason A. Brodkey ◽  
Ronald R. Tasker ◽  
Clement Hamani ◽  
Mary Pat McAndrews ◽  
Jonathan O. Dostrovsky ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Critical Role ◽  
Thalamic Nuclei ◽  
Related Activity ◽  
Content Type ◽  
Pathological Conditions ◽  
Human Thalamus ◽  
Patient Groups ◽  
Cerebellar Disorders ◽  
Fine Print

Object. Thalamic neurons firing at frequencies synchronous with tremor are thought to play a critical role in the generation and maintenance of tremor. The authors studied the incidence and locations of neurons with tremor-related activity (TRA) in the thalamus of patients with varied pathological conditions—including Parkinson disease (PD), essential tremor (ET), multiple sclerosis (MS), and cerebellar disorders—to determine whether known differences in the effectiveness of thalamic stereotactic procedures for these tremors could be correlated to differences in the incidence or locations of TRA cells. Methods. Seventy-five operations were performed in 61 patients during which 686 TRA cells were recorded from 440 microelectrode trajectories in the thalamus. The locations of the TRA cells in relation to electrophysiologically defined thalamic nuclei and the commissural coordinates were compared among patient groups. The authors found that TRA cells are present in patients with each of these disorders and that these cells populate several nuclei in the ventral lateral tier of the thalamus. There were no large differences in the locations of TRA cells among the different diagnostic classes, although there was a difference in the incidence of TRA cells in patients with PD, who had greater than 3.8 times more cells per thalamic trajectory than patients with ET and approximately five times more cells than patients with MS or cerebellar disorders. Conclusions. There was an increased incidence of TRA in the thalamus of patients with PD. The location of thalamic TRA cells in patients with basal ganglia and other tremor disorders was similar.

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