Delayed onset of hemidystonia and hemiballismus following head injury: a clinicopathological correlation

2001 ◽  
Vol 94 (2) ◽  
pp. 309-314 ◽  
Author(s):  
Robert B. King ◽  
Christine Fuller ◽  
George H. Collins
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Optic Tract ◽  
Internal Capsule ◽  
Clinical Syndrome ◽  
Motor Disorder ◽  
Posterior Portion ◽  
Content Type ◽  
Medial Segment ◽  
The Brain

✓ The authors report the case of a young man who suffered multiple injuries in a motor vehicle accident, the most significant of which arose in the brain, creating an unusual clinical syndrome. After experiencing an initial coma for several days, the patient was found to have a right-sided homonymous hemianopsia and a right hemiparesis, which was more marked at the shoulder and was accompanied by preservation of finger movement. Dystonic movements appeared 2 months later and progressed, along with increased spasticity on volition, to severe uncontrolled arm movements at 2 years postinjury. This motor disorder continued to worsen during the following 6 years prior to the patient's death. At autopsy, the left side of the brain was observed to have marked atrophy of the optic tract, a partial lesion of the posterior portion of the medial segment of the globus pallidus (GP), and a reduction in the size of the internal capsule at the level of the GP, suggesting impaired circulation to these areas at the time of injury. The isolated lesion of the internal segment of the GP was the presumed cause of the dystonia, acting through an alteration in thalamic inhibition. The atrophic subthalamic nucleus was the probable cause of the hemiballismus. The authors speculate that this and other delayed and progressive features of this case were the result of an active, but disordered, adaptive process that failed to compensate and, instead, caused even greater problems than the original injury.

Intradural extramedullary tuberculoma of the cervical spine

1984 ◽  
Vol 60 (1) ◽  
pp. 200-203 ◽  
Author(s):  
Jeff S. Compton ◽  
Nicholas W. C. Dorsch
Keyword(s):  
Cervical Spine ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Ct Scanning ◽  
Nerve Roots ◽  
Content Type ◽  
Vehicle Accident ◽  
Calcified Lesion ◽  
Intradural Extramedullary ◽  
Fine Print

✓ A case is reported of a 45-year-old man who developed quadriplegia following a trivial motor-vehicle accident. Investigation including computerized tomography (CT) of the cervical spine revealed a large calcified lesion displacing the spinal cord and nerve roots, which proved to be a tuberculoma. The case is unusual in regard to the age of the patient, the size, location, and nature of the lesion, the mode of presentation, and the delineation of the lesion by CT scanning.

Cruciate paralysis

1986 ◽  
Vol 65 (1) ◽  
pp. 108-110 ◽  
Author(s):  
Daniel Dumitru ◽  
James E. Lang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Rare Case ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Cervical Spinal Cord ◽  
Content Type ◽  
Vehicle Accident ◽  
Cord Injury ◽  
Fine Print

✓ A rare case of cruciate paralysis is reported in a 39-year-old man following a motor-vehicle accident. The differentiation of this syndrome from a central cervical spinal cord injury is delineated.

Traumatic carotid—cavernous fistula treated by combined transarterial and transvenous coil embolization and associated cavernous internal carotid artery dissection treated with stent placement

2003 ◽  
Vol 99 (3) ◽  
pp. 584-586 ◽  
Author(s):  
Süleyman Men ◽  
Halil Öztürk ◽  
Baki HekimoğLu ◽  
Zeki Şekerci
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Coil Embolization ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula

✓ The authors report on a case in which a carotid—cavernous fistula and an associated cavernous—carotid dissection developed in a 48-year-old man following a motor vehicle accident. The fistula was treated with coil embolization via a combined transarterial—transvenous approach. The dissected carotid artery segment was treated with a balloon-expandable stent, which restored normal caliber and hemispheric flow. There was no recurrence of the fistula and the postoperative wide patency of the carotid artery indicates that stent placement is an effective method of treating traumatic intracranial artery dissections.

scholarly journals Microsurgical anatomy of the central core of the brain

2018 ◽  
Vol 129 (3) ◽  
pp. 752-769 ◽  
Author(s):  
Eduardo Carvalhal Ribas ◽  
Kaan Yağmurlu ◽  
Evandro de Oliveira ◽  
Guilherme Carvalhal Ribas ◽  
Albert Rhoton
Keyword(s):  
White Matter ◽  
Caudate Nucleus ◽  
Internal Capsule ◽  
Central Core ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Functional Importance ◽  
Posterior Portion ◽  
External Capsule ◽  
The Brain

OBJECTIVEThe purpose of this study was to describe in detail the cortical and subcortical anatomy of the central core of the brain, defining its limits, with particular attention to the topography and relationships of the thalamus, basal ganglia, and related white matter pathways and vessels.METHODSThe authors studied 19 cerebral hemispheres. The vascular systems of all of the specimens were injected with colored silicone, and the specimens were then frozen for at least 1 month to facilitate identification of individual fiber tracts. The dissections were performed in a stepwise manner, locating each gray matter nucleus and white matter pathway at different depths inside the central core. The course of fiber pathways was also noted in relation to the insular limiting sulci.RESULTSThe insular surface is the most superficial aspect of the central core and is divided by a central sulcus into an anterior portion, usually containing 3 short gyri, and a posterior portion, with 2 long gyri. It is bounded by the anterior limiting sulcus, the superior limiting sulcus, and the inferior limiting sulcus. The extreme capsule is directly underneath the insular surface and is composed of short association fibers that extend toward all the opercula. The claustrum lies deep to the extreme capsule, and the external capsule is found medial to it. Three fiber pathways contribute to form both the extreme and external capsules, and they lie in a sequential anteroposterior disposition: the uncinate fascicle, the inferior fronto-occipital fascicle, and claustrocortical fibers. The putamen and the globus pallidus are between the external capsule, laterally, and the internal capsule, medially. The internal capsule is present medial to almost all insular limiting sulci and most of the insular surface, but not to their most anteroinferior portions. This anteroinferior portion of the central core has a more complex anatomy and is distinguished in this paper as the “anterior perforated substance region.” The caudate nucleus and thalamus lie medial to the internal capsule, as the most medial structures of the central core. While the anterior half of the central core is related to the head of the caudate nucleus, the posterior half is related to the thalamus, and hence to each associated portion of the internal capsule between these structures and the insular surface. The central core stands on top of the brainstem. The brainstem and central core are connected by several white matter pathways and are not separated from each other by any natural division. The authors propose a subdivision of the central core into quadrants and describe each in detail. The functional importance of each structure is highlighted, and surgical approaches are suggested for each quadrant of the central core.CONCLUSIONSAs a general rule, the internal capsule and its vascularization should be seen as a parasagittal barrier with great functional importance. This is of particular importance in choosing surgical approaches within this region.

Methods for microelectrode-guided posteroventral pallidotomy

1996 ◽  
Vol 84 (2) ◽  
pp. 194-202 ◽  
Author(s):  
Andres Lozano ◽  
William Hutchison ◽  
Zelma Kiss ◽  
Ronald Tasker ◽  
Karen Davis ◽  
...  
Keyword(s):  
Single Unit ◽  
Optic Tract ◽  
Internal Capsule ◽  
Cell Types ◽  
Precise Determination ◽  
Single Unit Activity ◽  
Content Type ◽  
Posteroventral Pallidotomy ◽  
Sensory Responses

✓ Methods for localizing the posteroventral globus pallidus internus are described. The authors' techniques include the use of microelectrodes to record single-unit activity and to microstimulate in human pallidum and its surrounding structures. This technique allows a precise determination of the locations of characteristic cell types in sequential trajectories through the external and internal segments of the pallidum. The location of the optic tract can be determined from microstimulation-evoked visual sensations and recordings of flash-evoked potentials. In addition, microstimulation-evoked motor and sensory responses allow the internal capsule to be identified. The data collected using this technique are an important adjunct to selecting optimum sites to place electrocoagulation lesions for stereotactic posteroventral pallidotomy for refractory Parkinson's disease.

Germinoma causing wallerian degeneration

1998 ◽  
Vol 88 (1) ◽  
pp. 126-128 ◽  
Author(s):  
Kiyoshi Nagata ◽  
Yuji Nikaido ◽  
Takashi Yuasa ◽  
Kenta Fujimoto ◽  
Yong Jin Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Basal Ganglia ◽  
Cerebral Hemisphere ◽  
Wallerian Degeneration ◽  
Pathological Change ◽  
Internal Capsule ◽  
Resonance Imaging ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ Germinomas occurring in the thalamus and basal ganglia sometimes cause atrophy of the cerebral hemisphere on the affected side. The authors present the case of a 12-year-old girl with a germinoma that developed in the basal frontal lobe and cerebral basal ganglia. Magnetic resonance imaging showed atrophy not only of the cerebrum but also of the brainstem. A T2-weighted image revealed an area of high intensity that proved to be wallerian degeneration extending from the corona radiata and internal capsule to the brainstem. The authors suggest that this pathological change may be involved in the development of the symptoms and hemiatrophy associated with germinomas in this region of the brain.

Endoscopic transpedicular thoracic discectomy

1999 ◽  
Vol 91 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Hae-Dong Jho
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Skin Incision ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Transpedicular Approach ◽  
Thoracic Discectomy ◽  
Fine Print

Object. To minimize the invasiveness and maximize the adequacy of the decompressive procedure in thoracic discectomy, a 70° endoscope was adapted to perform transpedicular thoracic discectomy. Methods. A posterior transpedicular approach was performed via a 2-cm transverse skin incision, aided by an operating microscope or a 0° lens endoscope. Using a 70° lens endoscope, discectomy was performed after obtaining direct visualization of the ventral aspect of the spinal cord dura mater. This surgical technique has been used in 25 patients. There were 12 men and 13 women whose ages ranged from 29 to 74 years (median 46 years). Thirteen patients experienced myelopathy, with or without radiculopathy, 10 presented with radiculopathy, and two patients suffered from segmental pain. The follow-up period ranged from 4 to 60 months (median 27 months). In 12 of 13 patients with myelopathy, excellent improvement was shown postoperatively. In the remaining patient, symptoms recurred after she was injured in a motor vehicle accident 3 months postsurgery. In nine of 10 patients with radiculopathy, pain resolved completely. In the one patient with right-sided hypochondral pain and in the two patients with segmental pain, no relief was obtained despite excellent discectomy results demonstrated on postoperative magnetic resonance images. The average length of hospital stay was overnight. Conclusions. The use of a 70° lens endoscope through a transpedicular route has made thoracic discectomy comparable with cervical or lumbar discectomy in terms of minimal surgical invasiveness, recovery time, and complexity of the procedure.

Atlantooccipital transarticular screw fixation for the treatment of traumatic occipitoatlantal dislocation

2005 ◽  
Vol 2 (3) ◽  
pp. 381-385 ◽  
Author(s):  
Iman Feiz-Erfan ◽  
L. Fernando Gonzalez ◽  
Curtis A. Dickman
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Screw Fixation ◽  
Full Range ◽  
Neurological Injury ◽  
Content Type ◽  
Vehicle Accident ◽  
A New Technique ◽  
Atlantooccipital Dislocation

✓ The authors describe a new technique of internal atlantooccipital screw fixation involving posterior wiring and fusion for the treatment of traumatic atlantooccipital dislocation, which was performed in a 17-year-old male patient involved in a motor vehicle accident and who suffered from atlantooccipital dislocation without neurological injury. At the 6-month follow-up examination, the patient was neurologically intact with a solid occipitocervical fusion and full range of motion of the neck.

Preliminary experience with the DOC dynamic cervical implant for the treatment of multilevel cervical spondylosis

2002 ◽  
Vol 97 (3) ◽  
pp. 330-336 ◽  
Author(s):  
Michael P. Steinmetz ◽  
Ann Warbel ◽  
Melvin Whitfield ◽  
William Bingaman
Keyword(s):  
Cervical Spondylosis ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Fusion Rate ◽  
Content Type ◽  
Dynamic Cervical Implant ◽  
Vehicle Accident ◽  
The Mean ◽  
Fine Print

Object. Despite the wide use of anterior cervical instrumentation in the management of multilevel cervical spondylosis, the incidences of pseudarthrosis and instrument-related failure remain high. The use of a dynamic implant may aid in the prevention of these complications. The purpose of this study was to evaluate the DOC dynamic cervical implant in the treatment of multilevel cervical spondylosis. Methods. The authors evaluated 34 cases in which anterior multilevel cervical decompression and fusion were performed using the DOC Ventral Cervical Stabilization System. Postoperatively, and at each follow-up visit, the sagittal angle and the degree of subsidence that developed were measured. Fusion rates and clinical outcomes were also evaluated. The mean postoperative sagittal angle was 14° of lordosis. The mean change in the sagittal angle during the follow-up period was 0.4° of lordosis. By 6 months postoperatively some subsidence had occurred in most patients, with no subsidence occurring in only 15%. By 3 months greater than or equal to 2 mm of subsidence was demonstrated in 61% of cases. The overall fusion rate was 91%. In the majority of patients (79%) symptoms were judged to be improved or resolved. Conclusions. The DOC dynamic cervical implant permitted controlled subsidence and prevented progression of kyphotic deformity. There was one construct failure (related to a motor vehicle accident) and an overall fusion rate of 91%. The DOC implant is a safe and effective cervical construct for multilevel spondylotic disease.

Posttraumatic cerebrospinal fluid cyst of the orbit

1985 ◽  
Vol 62 (6) ◽  
pp. 922-924 ◽  
Author(s):  
Patrick A. Sibony ◽  
Azad K. Anand ◽  
P. Arjen Keuskamp ◽  
Allen G. Zippen
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Dural Tear ◽  
Pertinent Literature ◽  
Direct Communication ◽  
Content Type ◽  
Specific Diagnosis ◽  
Orbital Roof ◽  
Vehicle Accident ◽  
Metrizamide Cisternography

✓ A 27-year-old man sustained a fracture of the orbital roof and a basofrontal dural tear in a motor-vehicle accident. One week later, he developed an orbitocranial dural fistula manifested by an orbital cyst, pulsatile proptosis, and serous drainage from the eye. Specific diagnosis was established only after computerized tomography metrizamide cisternography demonstrated direct communication of the orbital cyst with the subarachnoid space. The pertinent literature is reviewed.

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