Intracerebral hemorrhage complicating cervical “hourglass” schwannoma removal

2001 ◽  
Vol 94 (1) ◽  
pp. 150-153 ◽  
Author(s):  
Xavier Morandi ◽  
Laurent Riffaud ◽  
Beatrice Carsin-Nicol ◽  
Yvon Guegan
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Procedure ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Neurosurgical Procedure ◽  
Content Type ◽  
Postoperative Course ◽  
First Case ◽  
Fine Print

✓ The authors report a case of infra- and supratentorial intracerebral hemorrhage complicating the postoperative course of a patient who had undergone surgical removal of a cervical schwannoma with an hourglass configuration. To their knowledge, this is the first case in which this neurosurgical procedure was followed by such a complication. Possible mechanisms are discussed; however, pathological events leading to this complication are unclear. The development of new neurological deficits not attributable to the surgical procedure should suggest this possibility.

Successful long-term deep brain stimulation for hemichorea—hemiballism in a patient with diabetes

2005 ◽  
Vol 102 (6) ◽  
pp. 1137-1141 ◽  
Author(s):  
Naoki Nakano ◽  
Takuya Uchiyama ◽  
Takeshi Okuda ◽  
Masahiko Kitano ◽  
Mamoru Taneda
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Diabetic Coma ◽  
Mr Images ◽  
Content Type ◽  
First Case ◽  
Fine Print ◽  
Deep Brain

✓ The authors report a case of hemichorea—hemiballism (HC-HB) that was successfully treated using deep brain stimulation (DBS). A 65-year-old right-handed man exhibited a sudden onset of right HC-HB without a diabetic coma. At admission T1-weighted magnetic resonance (MR) images revealed a high-intensity signal in the left striatum, contralateral to the patient's involuntary movements. The HC-HB continued for 5 months after onset of the condition despite medical treatment and a decreased intensity of the signal on T1-weighted MR images. The patient underwent placement of a quadripolar DBS electrode in the left thalamus, including the left ventral oralis (VO) anterior and posterior nuclei (the VO complex). Postoperatively, the right-sided HC-HB disappeared rapidly during electrical stimulation and there were no neurological deficits. The authors demonstrate that DBS can be an effective treatment for medically refractory HC-HB. This is the first case of HC-HB that has been successfully treated with DBS.

Spinal cord arteriovenous malformations with significant intramedullary components

1983 ◽  
Vol 59 (3) ◽  
pp. 471-478 ◽  
Author(s):  
Philip Cogen ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
The Other ◽  
Neurological Deficits ◽  
Content Type ◽  
Postoperative Course ◽  
Microsurgical Techniques ◽  
Spinal Arteriovenous Malformations ◽  
High Degree ◽  
Fine Print

✓ Few neurosurgeons have stressed the occurrence, manifestations, and resectability of intramedullary spinal arteriovenous malformations (AVM's). In six of 17 patients in the authors' series of operable spinal AVM's, the lesions had major intramedullary components. Three of these six patients presented with subarachnoid hemorrhage, and all had catastrophic neurological deficits which gradually improved. The hemorrhages appeared to originate from large venous varices lying adjacent to the intramedullary portion of the AVM. The mechanism explaining the sudden neurological deficit in the other three patients was presumed to be thrombosis within the venous varices associated with their AVM's. The reliability of the various radiographic procedures in identifying the intramedullary components of these AVM's is discussed. These malformations may be removed totally with a high degree of safety using microsurgical techniques. The postoperative course in this series of patients was gratifying in terms of improvement of neurological deficits. Postoperative angiography was not performed on all of these patients. However, the follow-up period averaged 5 years.

Amusia following resection of a Heschl gyrus glioma

2003 ◽  
Vol 98 (5) ◽  
pp. 1109-1112 ◽  
Author(s):  
Stephen M. Russell ◽  
John G. Golfinos
Keyword(s):  
Clinical Presentation ◽  
Right Hemisphere ◽  
Preliminary Evidence ◽  
Neurological Deficits ◽  
Content Type ◽  
Postoperative Course ◽  
Music Production ◽  
Fine Print ◽  
Heschl Gyrus

✓ The incidence and character of neurological deficits following resection of glial neoplasms localized to the Heschl gyrus are currently unknown. In this series, the authors report the clinical presentation, management, and postoperative course of three patients with right hemisphere Heschl gyrus gliomas, one of whom developed difficulty with music production and comprehension postoperatively. Resection of right hemisphere Heschl gyrus gliomas can result in deficits involving music comprehension. Preliminary evidence suggests that when these deficits occur, they may be transient in nature.

Intrapontomesencephalic colloid cyst: an unusual location

2001 ◽  
Vol 94 (1) ◽  
pp. 118-121 ◽  
Author(s):  
Servet Inci ◽  
Nidal Al-Rousan ◽  
Figen Söylemezoglu ◽  
Özdemir Gurçay
Keyword(s):  
Histopathological Examination ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Cystic Mass ◽  
Surgical Removal ◽  
Content Type ◽  
Transsylvian Approach ◽  
First Case ◽  
Nerve Paresis ◽  
Fine Print

✓ Colloid cysts appear most commonly in the third ventricle; the occurrence of a colloid cyst in the brainstem is very unusual. The authors report on a patient with an intrapontomesencephalic colloid cyst. This 15-year-old girl complained of a headache associated with diplopia. Her neurological examination revealed right-sided sixth nerve paresis and a mild left hemiparesis. Radiological investigations revealed an intraparenchymal pontomesencephalic cystic mass. Surgical removal of the lesion was achieved via the pterional transsylvian approach and the patient experienced an excellent recovery. Histopathological examination revealed that the lesion was a typical colloid cyst. To the best of the authors' knowledge, this is the first case in which an intraparenchymal upper brainstem colloid cyst was surgically excised totally. In addition to describing this case, the authors also review other brainstem neuroepithelial cysts described in the literature and briefly discuss the concept of their origin.

Intention-to-treat analysis of Spetzler—Martin Grades IV and V arteriovenous malformations: natural history and treatment paradigm

2003 ◽  
Vol 98 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Patrick P. Han ◽  
Francisco A. Ponce ◽  
Robert F. Spetzler
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Content Type ◽  
Intention To Treat ◽  
Complete Treatment ◽  
Risk Of Hemorrhage ◽  
Treat Analysis ◽  
Fine Print

Object. In this study the authors quantified a subgroup of patients with Spetzler—Martin Grades IV and V arteriovenous malformations (AVMs) recommended for complete, partial, or no treatment, and calculated the retrospective hemorrhage rate for these lesions. Methods. Between July 1997 and May 2000, 73 consecutive patients with Grades IV and V AVMs were evaluated prospectively by the cerebrovascular team at Barrow Neurological Institute. Treatment recommendations given to the patients or referring physicians were classified as complete treatment, partial treatment, and no treatment. Retrospectively, the hemorrhage rates associated with these treatment groups were also calculated. In the prospective portion of the study (the intention-to-treat analysis), no treatment of the AVM, was recommended for 55 patients (75%) and partial treatment was recommended for seven patients (10%). Aneurysms associated with an AVM were obliterated by surgical or endovascular treatment in seven patients (10%), and complete surgical removal was recommended for four patients (5%). The overall hemorrhage rate for Grades IV and V AVMs was 1.5% per year. The annual risk of hemorrhage was 10.4% among patients who previously had received incomplete treatment, compared with patients without previous treatment. Conclusions. The hemorrhage risk of 1.5% per year, which was associated with Grades IV and V AVMs appears to be lower than that reported for Grades I through III AVMs. The authors recommend that no treatment be given for most Grades IV and V AVMs. No evidence indicates that partial treatment of an AVM reduces a patient's risk of hemorrhage. In fact, partial treatment may worsen the natural history of an AVM. The authors do not support palliative treatment of AVMs, except in the specific circumstances of arterial or intranidal aneurysms or progressive neurological deficits related to vascular steal. Complete treatment is warranted for patients with progressive neurological deficits caused by hemorrhage of the AVM. This selection process plays a significant role in the relatively low combined morbidity and mortality rates for Grade IV and Grade V AVMs (17 and 22%, respectively) reported by the cerebrovascular group in both retrospective and prospective studies.

Management of intracerebral hemorrhage in idiopathic thrombocytopenic purpura

1976 ◽  
Vol 45 (6) ◽  
pp. 700-704 ◽  
Author(s):  
Robin P. Humphreys ◽  
Anthony D. Hockley ◽  
Melvin H. Freedman ◽  
E. Fred. Saunders
Keyword(s):  
Intracerebral Hemorrhage ◽  
Idiopathic Thrombocytopenic Purpura ◽  
General Anesthetic ◽  
Radiological Investigation ◽  
Thrombocytopenic Purpura ◽  
Neurological Sequelae ◽  
Neurosurgical Procedure ◽  
Content Type ◽  
Specific Management ◽  
Fine Print

✓ There has been little comment on the specific management of intracerebral bleeding occurring in patients suffering idiopathic thrombocytopenic purpura. The authors present the cases of four children with intracerebral hemorrhage due to this coagulation disturbance. A plan of management is described based on this experience; it includes immediate control of cerebral edema, emergency splenectomy, supportive care with platelet transfusions and corticosteroids, cerebral angiography, and a definitive neurosurgical procedure. If necessary, the radiological investigation and surgical therapy can be performed with a single general anesthetic. Three of the patients have survived without major neurological sequelae.

A viable residual spinal hydatid cyst cured with albendazole

2000 ◽  
Vol 93 (1) ◽  
pp. 142-144 ◽  
Author(s):  
M. Kemali Baykaner ◽  
Fikret Doğulu ◽  
Gülyüz Öztürk ◽  
Naci Edali ◽  
Turgut Tali
Keyword(s):  
Hydatid Disease ◽  
Single Case ◽  
Cord Compression ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Lower Extremity Weakness ◽  
Content Type ◽  
One Year ◽  
Fine Print

✓ Spinal hydatid disease is a rare entity that frequently yields to severe, acute-onset neurological deficits. Although the gold standard treatment is total surgical removal of the cysts without inducing any spillage, it may not be possible to perform this in patients with multiple and fragile cysts. In such cases, the neural structures should be adequately decompressed and albendazole should be administered promptly. The authors describe the case of a 13-year-old girl who was admitted with a history of back pain and acute-onset lower-extremity weakness. Magnetic resonance imaging scans demonstrated severe spinal cord compression caused by multiple cysts involving T-4 and the mediastinum. The patient underwent surgery, and the cysts were removed, except for one cyst that was hardly exposed. Following histopathological confirmation of spinal hydatid disease, she was treated with albendazole for 1 year. One year postoperatively, the residual cyst had gradually shrunk and had almost disappeared. Although a single case is not sufficiently promising, we believe that administration of albendazole is efficient to prevent recurrences in cases in which it is not possible to obtain total removal of the cysts without inducing spillage.

Surgical removal of arteriovenous malformations from the brain stem and cerebellopontine angle

1975 ◽  
Vol 43 (6) ◽  
pp. 661-670 ◽  
Author(s):  
Charles G. Drake
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Surgical Experience ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The author reports his surgical experience with five cases of arteriovenous malformation of the brain stem and cerebellopontine angle causing multiple hemorrhages and severe neurological deficits. Surgical removal of the lesions had good results in four cases; there was one death.

Conservative management of a mesencephalic tuberculoma

1981 ◽  
Vol 55 (2) ◽  
pp. 287-288 ◽  
Author(s):  
Gonzalo Bravo ◽  
Jesús Vaquero ◽  
Roberto Martínez ◽  
José Cabezudo
Keyword(s):  
Brain Stem ◽  
Conservative Management ◽  
Surgical Procedure ◽  
Specific Treatment ◽  
Surgical Removal ◽  
Content Type ◽  
Intraoperative Diagnosis ◽  
Fine Print ◽  
Tuberculostatic Agents

✓ A case of clinically unsuspected mesencephalic tuberculoma that was diagnosed at operation is presented. After intraoperative diagnosis, the surgical procedure was interrupted and specific treatment with tuberculostatic agents was started. The symptoms remitted totally in a few months. This conservative management is preferable to surgical removal when the diagnosis of brain-stem tuberculoma has been established.

Deferoxamine-induced attenuation of brain edema and neurological deficits in a rat model of intracerebral hemorrhage

2004 ◽  
Vol 100 (4) ◽  
pp. 672-678 ◽  
Author(s):  
Takehiro Nakamura ◽  
Richard F. Keep ◽  
Ya Hua ◽  
Timothy Schallert ◽  
Julian T. Hoff ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Brain Injury ◽  
Intracerebral Hemorrhage ◽  
Brain Edema ◽  
Oxidative Dna Damage ◽  
Iron Accumulation ◽  
Neurological Deficits ◽  
Content Type ◽  
Autologous Whole Blood ◽  
Fine Print

Object. Previous studies undertaken by the authors have indicated that iron accumulation and oxidative stress in the brain contribute to secondary brain damage after intracerebral hemorrhage (ICH). In the present study the authors investigate whether deferoxamine, an iron chelator, can reduce ICH-induced brain injury. Methods. Male Sprague—Dawley rats each received an infusion of 100 µl of autologous whole blood into the right basal ganglia and were killed 1, 3, or 7 days later. Iron distribution was examined histochemically (enhanced Perls reaction). The effects of deferoxamine on ICH-induced brain injury were examined by measuring brain edema and neurological deficits. Immunohistochemical analysis was performed to investigate 8-hydroxyl-2′-deoxyguanosine (8-OHdG), a marker of oxidative DNA damage, and Western blot analysis was performed to measure the amount of apurinic/apyrimidinic endonuclease/redox effector factor—1 (APE/Ref-1), a repair mechanism for DNA oxidative damage. Iron accumulation was observed in the perihematomal zone from 1 day after ICH. Deferoxamine attenuated brain edema, neurological deficits, and ICH-induced changes in 8-OHdG and APE/Ref-1. Conclusions. Deferoxamine and other iron chelators may be potential therapeutic agents for ICH. They may act by reducing the oxidative stress caused by the release of iron from the hematoma.

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