Faiz A. Jumaa, Samir Z. Al-kaabi, B. Kadhum, Moneer K. Faraj
Objective: We describe newly designed frame holder applied to the head before pin fixation. The already available ear plugs facilitate the straight alignment of the frame by fixing it to the external auditory meatus, but they are quite painful for most of the patients and not prevent the anterior posterior rotation. (2,3) The Leksell frame (Elekta, Sweden) is provided with a clamp that fits only with Mayfield head frame(SM, USA).(1) We performed certain modifications to make the frame fit to the Sugita head clamp (Mizuho, Japan); the only sort of head frame we have in our hospital. Patients & methods: The new modifications were used to fifteen patients in whom the application of the frame was indicated. A new designed net made of sewed ribbons applied to the head before pin fixation. It prevents slipping of the frame especially with the aid of the top plastic cup for its suction ability over a well shaved head. No pain recorded with its use. The other modification was to make few changes with the sugita head clamp middle piece to make it adaptable with that of the leksell which was originally designed for the Mayfield head clamp. Results: The newly designed net caused no pain to all the patients .Slipping was minimal. The time of the application of the frame shortened. With the use of the new adapter with the leksell frame, we were able to perform surgical interventions even as long as 8 hours as in deep brain stimulation operations with no movement noticed between the frame and the operating table. Conclusion: These two technical modifications were useful to help in application of the frame over the patients head with minimal slipping movement and no pain. It permitted us to use the leksell frame with the sugita head frame which is the only sort of head frame we have in our hospital. NOTICE This paper has been designed to resolve certain problems we faced in our work in the neurosciences hospital. We did not receive any financial support from any company mentioned in this paper. INTRODUCTION The Leksell Frame (Elekta, Sweden) is widely used for functional neurosurgical operations. For the proper application of the frame on the patients head; it is provided with ear plugs .these will prevent side way movement but it is quite painful & cannot be tolerated actually with all our patients. Also it will not prevent the foreword backward slipping of the frame. (2, 3) The frame is provided with head clamp compatible with only the Mayfield head holder (SM, USA) (1); making it unadoptable with the head frames like the sugita head frame (Mizuho, Japan); the only sort of head frame we have in our hospital. PATIENTS& METHODS In late 2007 & early 2008 we used these techniques for fifteen patients. Nine had deep brain stimulation (DBS) of the subthalamic nucleus for Parkinson's disease; one patient had DBS of the ventral intermediate nucleus for rubral tremor. One patient had DBS of the Globous pallidus internus nucleus for Dystonia. One patient had stereotact
{"title":"Two Technical Modifications for the Leksell Stereotactic Frame","authors":"Faiz A. Jumaa, Samir Z. Al-kaabi, B. Kadhum, Moneer K. Faraj","doi":"10.5580/1eab","DOIUrl":"https://doi.org/10.5580/1eab","url":null,"abstract":"Objective: We describe newly designed frame holder applied to the head before pin fixation. The already available ear plugs facilitate the straight alignment of the frame by fixing it to the external auditory meatus, but they are quite painful for most of the patients and not prevent the anterior posterior rotation. (2,3) The Leksell frame (Elekta, Sweden) is provided with a clamp that fits only with Mayfield head frame(SM, USA).(1) We performed certain modifications to make the frame fit to the Sugita head clamp (Mizuho, Japan); the only sort of head frame we have in our hospital. Patients & methods: The new modifications were used to fifteen patients in whom the application of the frame was indicated. A new designed net made of sewed ribbons applied to the head before pin fixation. It prevents slipping of the frame especially with the aid of the top plastic cup for its suction ability over a well shaved head. No pain recorded with its use. The other modification was to make few changes with the sugita head clamp middle piece to make it adaptable with that of the leksell which was originally designed for the Mayfield head clamp. Results: The newly designed net caused no pain to all the patients .Slipping was minimal. The time of the application of the frame shortened. With the use of the new adapter with the leksell frame, we were able to perform surgical interventions even as long as 8 hours as in deep brain stimulation operations with no movement noticed between the frame and the operating table. Conclusion: These two technical modifications were useful to help in application of the frame over the patients head with minimal slipping movement and no pain. It permitted us to use the leksell frame with the sugita head frame which is the only sort of head frame we have in our hospital. NOTICE This paper has been designed to resolve certain problems we faced in our work in the neurosciences hospital. We did not receive any financial support from any company mentioned in this paper. INTRODUCTION The Leksell Frame (Elekta, Sweden) is widely used for functional neurosurgical operations. For the proper application of the frame on the patients head; it is provided with ear plugs .these will prevent side way movement but it is quite painful & cannot be tolerated actually with all our patients. Also it will not prevent the foreword backward slipping of the frame. (2, 3) The frame is provided with head clamp compatible with only the Mayfield head holder (SM, USA) (1); making it unadoptable with the head frames like the sugita head frame (Mizuho, Japan); the only sort of head frame we have in our hospital. PATIENTS& METHODS In late 2007 & early 2008 we used these techniques for fifteen patients. Nine had deep brain stimulation (DBS) of the subthalamic nucleus for Parkinson's disease; one patient had DBS of the ventral intermediate nucleus for rubral tremor. One patient had DBS of the Globous pallidus internus nucleus for Dystonia. One patient had stereotact","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122835429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Multicentric gliomas are aggressive and uncommon lesions of the central nervous system(CNS) . Multicentric high grade gliomas often have a distinct neuroimaging pattern with poor prognosis. These multicentric gliomas may be either metachronous or synchronous.We present a case of synchronous high grade multicentric gliomas involving the temporal lobes in a young patient who presented with mild symptoms and had no neurological deficits .He was operated for both the lesions and underwent radiotherapy for the same. Although it is difficult to diagnose and treat multicentric gliomas the aim of the surgeon must be to remove the largest and /or the nearest and most accessible lesion without causing additional neurological deficits. Further management, either radiotherapy or chemotherapy is based on the histopathological diagnosis.
{"title":"Bitemporal Multicentric High Grade Gliomas: A Case Report","authors":"V. Velho, A. Jaiswal, D. Palande","doi":"10.5580/12a7","DOIUrl":"https://doi.org/10.5580/12a7","url":null,"abstract":"Multicentric gliomas are aggressive and uncommon lesions of the central nervous system(CNS) . Multicentric high grade gliomas often have a distinct neuroimaging pattern with poor prognosis. These multicentric gliomas may be either metachronous or synchronous.We present a case of synchronous high grade multicentric gliomas involving the temporal lobes in a young patient who presented with mild symptoms and had no neurological deficits .He was operated for both the lesions and underwent radiotherapy for the same. Although it is difficult to diagnose and treat multicentric gliomas the aim of the surgeon must be to remove the largest and /or the nearest and most accessible lesion without causing additional neurological deficits. Further management, either radiotherapy or chemotherapy is based on the histopathological diagnosis.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115593082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Schwarz, F. Kaltenböck, W. Nemetz, A. Schöpfer, R. Hoyer, G. Litscher
Background: Transcranial regional cerebral oxygen saturation (rSO2) is based on specific algorithms of near infrared spectroscopy (NIRS). In an animal model we measured the reactivity of rSO2 trends under basal total intravenous anesthesia (TIVA) with propofol and remifentanil during different experimental interventions. These maneuvers included the additional application of desflurane and halothane as well as hypoand hyperventilation in two pigs.Results: Induced hypercapnia during administration of desflurane and halothane led to increased rSO2 values. Administration of thiopental (5mg/kg bolus followed by 3mg/kg/h continuously) under normocapnia also led to increased rSO2 values. In contrast, thiopental administration during hypocapnia led to moderately decreased rSO2 readings.Conclusion: Monitoring of cerebral oxygenation metabolism seems to be a control tool in an interventional setting using the combination of thiopental and hyperventilation. Further studies in this context using NIRS monitoring and cerebral tissue oxygenation appear warranted.
{"title":"Transcranial Monitoring of Cerebral Oxygen Saturation under Different Anesthetic Drugs and Ventilation Patterns: Observations in an Animal Model","authors":"G. Schwarz, F. Kaltenböck, W. Nemetz, A. Schöpfer, R. Hoyer, G. Litscher","doi":"10.5580/21d5","DOIUrl":"https://doi.org/10.5580/21d5","url":null,"abstract":"Background: Transcranial regional cerebral oxygen saturation (rSO2) is based on specific algorithms of near infrared spectroscopy (NIRS). In an animal model we measured the reactivity of rSO2 trends under basal total intravenous anesthesia (TIVA) with propofol and remifentanil during different experimental interventions. These maneuvers included the additional application of desflurane and halothane as well as hypoand hyperventilation in two pigs.Results: Induced hypercapnia during administration of desflurane and halothane led to increased rSO2 values. Administration of thiopental (5mg/kg bolus followed by 3mg/kg/h continuously) under normocapnia also led to increased rSO2 values. In contrast, thiopental administration during hypocapnia led to moderately decreased rSO2 readings.Conclusion: Monitoring of cerebral oxygenation metabolism seems to be a control tool in an interventional setting using the combination of thiopental and hyperventilation. Further studies in this context using NIRS monitoring and cerebral tissue oxygenation appear warranted.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132136325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Tailor, George Samandouras, P. Pretorius, R. Kerr
Recurrent parenchymal brain haemorrhages that are angiographically occult, are problematic due to the uncertainty of the underlying diagnosis. We describe a rare case of high-grade glioma in the thalamus that presented with multiple thalamic haemorrhages, before features of the underlying mass lesion evolved, and discuss the challenges faced in the early diagnosis and management of tumour related haemorrhages.
{"title":"Angiographically occult recurrent thalamic haemorrhage: a management dilemma","authors":"J. Tailor, George Samandouras, P. Pretorius, R. Kerr","doi":"10.5580/136b","DOIUrl":"https://doi.org/10.5580/136b","url":null,"abstract":"Recurrent parenchymal brain haemorrhages that are angiographically occult, are problematic due to the uncertainty of the underlying diagnosis. We describe a rare case of high-grade glioma in the thalamus that presented with multiple thalamic haemorrhages, before features of the underlying mass lesion evolved, and discuss the challenges faced in the early diagnosis and management of tumour related haemorrhages.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116084359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Baysal, E. Avcı, F. Torun, M. Cengiz, Ali Çigdem, Turhan Togrul, Halil Nacar, A. Çakir
Desflurane has been known as a weak triggering anesthetic of malignant hyperthermia (MH). It may produce a delayed onset of symptoms. In addition the use of succinylcholine may aggravate occurrence of MH. The prolonged interval after exposure may occur more than 3 h after the induction of anesthesia. Although, the treatment of MH with Dantrolene is gold standard, it is not available in most countries. Because, MH has been rarely reported all over the world. So we present the first MH suspected case in our hospital.
{"title":"Malignant Hyperthermia during Desflurane - Succinylcholine Anesthesia for Neurosurgery: A case report","authors":"Z. Baysal, E. Avcı, F. Torun, M. Cengiz, Ali Çigdem, Turhan Togrul, Halil Nacar, A. Çakir","doi":"10.5580/283","DOIUrl":"https://doi.org/10.5580/283","url":null,"abstract":"Desflurane has been known as a weak triggering anesthetic of malignant hyperthermia (MH). It may produce a delayed onset of symptoms. In addition the use of succinylcholine may aggravate occurrence of MH. The prolonged interval after exposure may occur more than 3 h after the induction of anesthesia. Although, the treatment of MH with Dantrolene is gold standard, it is not available in most countries. Because, MH has been rarely reported all over the world. So we present the first MH suspected case in our hospital.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114861807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Described here is an unusual complication after diagnostic biopsy for brain metastasis. We admitted a 39-year-old male patient with history of recent onset seizure. MRI revealed multiple lesion . Workup to diagnosis of metastasis was negative. He underwent a lesionectomy. Histological examination identified metastatic adenocarcinoma. After the surgery hemorrhage in corpus callosum deteriorated his neurological status. Brain metastases represent a significant source of morbidity and mortality in patients with systemic cancer. Among adults, the highest incidence is observed in the fifth to seventh decades of life[1]. The most common sources of brain metastases in this patient group are cancers of the lung, breast, and skin, in descending order[2]. As many as 10% to 15% of patients with a clinical diagnosis of metastasis may, in fact, have nonmetastatic lesions such as abscesses or primary tumors[3]. So in patients without known primary site of tumor, sampling can provide tissue for confirming the diagnosis of metastasis. In other hands post operative hemorrhage has been known as a complication of surgery.
{"title":"Unusual Intracerebral Hemorrhage as a Postoperative Complication of A Metastatic Tumor","authors":"S. Karamouzian","doi":"10.5580/38","DOIUrl":"https://doi.org/10.5580/38","url":null,"abstract":"Described here is an unusual complication after diagnostic biopsy for brain metastasis. We admitted a 39-year-old male patient with history of recent onset seizure. MRI revealed multiple lesion . Workup to diagnosis of metastasis was negative. He underwent a lesionectomy. Histological examination identified metastatic adenocarcinoma. After the surgery hemorrhage in corpus callosum deteriorated his neurological status. Brain metastases represent a significant source of morbidity and mortality in patients with systemic cancer. Among adults, the highest incidence is observed in the fifth to seventh decades of life[1]. The most common sources of brain metastases in this patient group are cancers of the lung, breast, and skin, in descending order[2]. As many as 10% to 15% of patients with a clinical diagnosis of metastasis may, in fact, have nonmetastatic lesions such as abscesses or primary tumors[3]. So in patients without known primary site of tumor, sampling can provide tissue for confirming the diagnosis of metastasis. In other hands post operative hemorrhage has been known as a complication of surgery.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122096200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Daya, P. Webb, B. Tapper, S. Graham, C. Greenough, S. Papastefanou
Objective: Somatosensory evoked potentials (SSEPs) are now routinely used to monitor the integrity of the sensory pathways of the spinal cord during major corrective spinal deformities surgery. We have reviewed retrospectively the outcomes and course of action for a 137 electrophysiologically monitored procedures over a five year period.Methods: Responses were recorded via a bipolar epidural electrode positioned in the epidural space at levels T1/T3 prior to surgery. An initial baseline SSEP waveform was recorded early in the surgical procedure and subsequent recordings were compared with those. A decrease of 50% in amplitude or an increase of 10% in latency of the SSEP waveform was used as a threshold for intervention.Results: Our findings demonstrate that a drop in amplitude greater than 50% occurred in 46 monitored procedures and whilst the traces of 22 patients remained below the acceptable levels for the subsequent duration of the surgery, there was no evidence of any clinically detectable neurological impairment. Of the 32 interventions by the surgical team to restore the SSEP waveform, only 18 were successfully restored to above the 50% level. None of the SSEP waveforms that were not restored to acceptable levels exceeded a 75% drop in amplitude. Conclusion: There were no reports of postoperative neurological deficit and it is probable that the true boundaries at which the critical levels for intervention resides is probably between 50 % and 75%.
{"title":"Intervention mechanisms and outcomes in somatosensory evoked potential monitoring during scoliosis surgery","authors":"A. Daya, P. Webb, B. Tapper, S. Graham, C. Greenough, S. Papastefanou","doi":"10.5580/202e","DOIUrl":"https://doi.org/10.5580/202e","url":null,"abstract":"Objective: Somatosensory evoked potentials (SSEPs) are now routinely used to monitor the integrity of the sensory pathways of the spinal cord during major corrective spinal deformities surgery. We have reviewed retrospectively the outcomes and course of action for a 137 electrophysiologically monitored procedures over a five year period.Methods: Responses were recorded via a bipolar epidural electrode positioned in the epidural space at levels T1/T3 prior to surgery. An initial baseline SSEP waveform was recorded early in the surgical procedure and subsequent recordings were compared with those. A decrease of 50% in amplitude or an increase of 10% in latency of the SSEP waveform was used as a threshold for intervention.Results: Our findings demonstrate that a drop in amplitude greater than 50% occurred in 46 monitored procedures and whilst the traces of 22 patients remained below the acceptable levels for the subsequent duration of the surgery, there was no evidence of any clinically detectable neurological impairment. Of the 32 interventions by the surgical team to restore the SSEP waveform, only 18 were successfully restored to above the 50% level. None of the SSEP waveforms that were not restored to acceptable levels exceeded a 75% drop in amplitude. Conclusion: There were no reports of postoperative neurological deficit and it is probable that the true boundaries at which the critical levels for intervention resides is probably between 50 % and 75%.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116511385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rajeev Kumar, A. Kakani, C. Deopujari, Rajan M. Shah
A 26 years old male presented with complaints of dysphagia and hoarseness of voice with poor gag reflex. Magnetic resonance imaging (MRI) of the spine and brain showed medium sized, ovoid shaped, intensely enhancing intramedullary lesion at D5-7 associated with extensive syringomyelia from cervicomedullry junction to D11 and syringobulbia. He underwent D5-8 laminectomy with near total excision of the lesion. The histopathology revealed astrocytoma (WHO Grade-1). The patient improved completely after surgery with resolution of syrinx. In the present case, the unusual clinical presentation, diagnostic challenges, and treatment dilemmas have been discussed.
{"title":"A dorsal intramedullary astrocytoma presenting as syringobulbia: A case report.","authors":"Rajeev Kumar, A. Kakani, C. Deopujari, Rajan M. Shah","doi":"10.5580/682","DOIUrl":"https://doi.org/10.5580/682","url":null,"abstract":"A 26 years old male presented with complaints of dysphagia and hoarseness of voice with poor gag reflex. Magnetic resonance imaging (MRI) of the spine and brain showed medium sized, ovoid shaped, intensely enhancing intramedullary lesion at D5-7 associated with extensive syringomyelia from cervicomedullry junction to D11 and syringobulbia. He underwent D5-8 laminectomy with near total excision of the lesion. The histopathology revealed astrocytoma (WHO Grade-1). The patient improved completely after surgery with resolution of syrinx. In the present case, the unusual clinical presentation, diagnostic challenges, and treatment dilemmas have been discussed.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132047072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a rare case report of a patient with chronic subdural haematoma presenting with sudden onset blindness secondary to severe acute bilateral papilloedema. Following prompt surgical evacuation, the patient’s visual acuity returned back to almost normal. Previous reported cases in the literature of blindness following subdural haematomas were related to bilateral homonymous hemianopia due to compression of the posterior cerebral artery following tentorial herniation. These patients were either left blind or developed significant visual deficit despite surgical evacuation. Our case is the first in the literature where the blindness was reversible and due to severe acute papilloedema. There was also no evidence of posterior cerebral artery territory ischaemia. We discuss the importance of visual symptoms in subdural haematoma and emphasize the importance of prompt early intervention. CLINICAL PRESENTATION A 21 years old man was transferred as an emergency from the regional district general hospital after he presented with sudden onset of complete blindness in both eyes in the early hours of the day of transfer. Prior to this, he has been complaining of severe progressive headache with episodic visual blurring over the previous seven weeks. There was nothing of note in previous background history. On examination, he was alert, confused and obeying commands. He was eye opening spontaneously and there were no lateralizing signs. He was completely blind in both eyes and there was evidence of gross papilloedema bilaterally. CT (computerized axial tomography) scan showed a significant left sided acute on chronic subdural haematoma with 1 cm midline shift and also a left middle fossa arachnoid cyst. These findings were confirmed on MR (magnetic resonance) imaging (Fig 1) with MRA (magnetic resonance angiography) ruling out an underlying vascular abnormality. Figure 1 Fig 1: MRI scan showing chronic subdural haematoma causing midline shift. There is also a left temporal arachnoid cyst Considering the papilloedema and scan appearances, he underwent emergency burrhole drainage of subdural haematoma on the evening of transfer. He had significant recovery of his vision within 24 hours of his surgery. Visual acuity has been recorded as 6/9 right eye, 6/12 left eye with good fields in Goldman perimetry but with enlarged blind spots bilaterally. He was subsequently discharged home and at the time of discharge, he was self caring, alert, oriented and had not suffered any deficits a result of the surgery. On review in the outpatient clinic in 6 weeks time, his visual acuity in the right eye was 6/6+2 and left eye 6/9+1. Repeat CT scan (Fig 2) showed that the Sudden onset blindness as a presenting feature of chronic subdural haematoma: case report 2 of 4 subdural haematoma had resolved and the arachnoid cyst was unchanged.
{"title":"Sudden onset blindness as a presenting feature of chronic subdural haematoma: case report","authors":"S. Kabir, A. A. Kamat, T. Carroll","doi":"10.5580/2918","DOIUrl":"https://doi.org/10.5580/2918","url":null,"abstract":"We present a rare case report of a patient with chronic subdural haematoma presenting with sudden onset blindness secondary to severe acute bilateral papilloedema. Following prompt surgical evacuation, the patient’s visual acuity returned back to almost normal. Previous reported cases in the literature of blindness following subdural haematomas were related to bilateral homonymous hemianopia due to compression of the posterior cerebral artery following tentorial herniation. These patients were either left blind or developed significant visual deficit despite surgical evacuation. Our case is the first in the literature where the blindness was reversible and due to severe acute papilloedema. There was also no evidence of posterior cerebral artery territory ischaemia. We discuss the importance of visual symptoms in subdural haematoma and emphasize the importance of prompt early intervention. CLINICAL PRESENTATION A 21 years old man was transferred as an emergency from the regional district general hospital after he presented with sudden onset of complete blindness in both eyes in the early hours of the day of transfer. Prior to this, he has been complaining of severe progressive headache with episodic visual blurring over the previous seven weeks. There was nothing of note in previous background history. On examination, he was alert, confused and obeying commands. He was eye opening spontaneously and there were no lateralizing signs. He was completely blind in both eyes and there was evidence of gross papilloedema bilaterally. CT (computerized axial tomography) scan showed a significant left sided acute on chronic subdural haematoma with 1 cm midline shift and also a left middle fossa arachnoid cyst. These findings were confirmed on MR (magnetic resonance) imaging (Fig 1) with MRA (magnetic resonance angiography) ruling out an underlying vascular abnormality. Figure 1 Fig 1: MRI scan showing chronic subdural haematoma causing midline shift. There is also a left temporal arachnoid cyst Considering the papilloedema and scan appearances, he underwent emergency burrhole drainage of subdural haematoma on the evening of transfer. He had significant recovery of his vision within 24 hours of his surgery. Visual acuity has been recorded as 6/9 right eye, 6/12 left eye with good fields in Goldman perimetry but with enlarged blind spots bilaterally. He was subsequently discharged home and at the time of discharge, he was self caring, alert, oriented and had not suffered any deficits a result of the surgery. On review in the outpatient clinic in 6 weeks time, his visual acuity in the right eye was 6/6+2 and left eye 6/9+1. Repeat CT scan (Fig 2) showed that the Sudden onset blindness as a presenting feature of chronic subdural haematoma: case report 2 of 4 subdural haematoma had resolved and the arachnoid cyst was unchanged.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129149771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intramedullary capillary heamangioma is a rare tumour, Capillary heamangionas are benign vascular lesion commonly encountered in the cutaneous tissue. They are rare in the nervous system. Capillary heamangiomas have been well documented as occuring in the dura and spinal nerve roots (1, 2). Only eight cases are known to have been described as occuring in the spinal cord (3).These lesions are histologically characterized by a lobular architecture. In early lesions lobules are highly cellular and composed of mitotically active plump endothelial cells(4). The lobules are surrounded by a pseudocapsule and consist of small vessels lined by single endothelical layer.The clinico-pathological features revealing extramedullary heamatopoiesis and syringomyelia is highlighted.The objective of this paper is to review the capillary heamangioma and its differential diagnosis and add to the few numbers that have been published
{"title":"Intra Medullary Capillary Heamangioma","authors":"O. Labeodan","doi":"10.5580/1a89","DOIUrl":"https://doi.org/10.5580/1a89","url":null,"abstract":"Intramedullary capillary heamangioma is a rare tumour, Capillary heamangionas are benign vascular lesion commonly encountered in the cutaneous tissue. They are rare in the nervous system. Capillary heamangiomas have been well documented as occuring in the dura and spinal nerve roots (1, 2). Only eight cases are known to have been described as occuring in the spinal cord (3).These lesions are histologically characterized by a lobular architecture. In early lesions lobules are highly cellular and composed of mitotically active plump endothelial cells(4). The lobules are surrounded by a pseudocapsule and consist of small vessels lined by single endothelical layer.The clinico-pathological features revealing extramedullary heamatopoiesis and syringomyelia is highlighted.The objective of this paper is to review the capillary heamangioma and its differential diagnosis and add to the few numbers that have been published","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123284661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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