Biomedical subjects

Harald Barth

Publications and source records attributed to Harald Barth.

5 recordsLinked to original sources

PubMed2004

Intracranial and spinal melanotic schwannoma in the same patient.

Melanotic schwannoma is a nerve sheath tumor composed of melanin - producing cells with ultrastructural features of Schwann cells, which is very rare. These tumors can appear intracranially and less common in the spinal canal. The prognosis is usually good although cases with metastases and death are described in the literature. We present the unusual and rare case of a young man with a spinal melanotic schwannoma at L5/S1 who presented 30 months later with an intracranial melanotic schwannoma.

Adult↗

PubMed2003

Accidental intrathecal mercury application.

The authors present a case of accidental intrathecal mercury application. A 69-year-old white woman was admitted to our department with suspected meningitis following surgery for spinal stenosis at another hospital. Postoperatively, she had developed a cerebro-spinal fluid (CSF) fistula with a subcutaneous cavity. Local wound irritation had been suspected and, unfortunately, mercury-containing disinfectant was injected into the cavity. Within 24 h the patient demonstrated acute neurological deterioration due to meningitis and encephalitis and was admitted to our clinic with suspected meningitis due to postoperative CSF fistula. Lumbar puncture revealed desinfectant-stained, non-bloody CSF, while lumbar MRI demonstrated the large lumbar subcutaneous cavity. Additionally, CSF fistula was visualized on MRI. Laboratory examination revealed extremely high mercury levels in CSF, blood and urine. Treatment consisted in insertion of a lumbar drainage to wash out the mercury. The patient underwent medical detoxication using chelating agents (DMPS: RS-2,3-dimercapto-1-propansulfonacid, DMSA: meso-2,3-dimercaptosuccinatacid). Surgery was performed in order to close the cavity and the fistula. Postoperatively, the patient was admitted to the intensive care unit and remained intubated for 3 days. Within 4 weeks after surgery, she demonstrated good recovery. Eighteen months after intoxication, polyneuropathy and slight neuropsychological deficiencies were detectable.

Aged↗

PubMed2003

Cerebral edema leading to decompressive craniectomy: an assessment of the preceding clinical and neuromonitoring trends.

The aim of this study was to examine the pre-operative clinical and neuromonitoring courses in patients with a decompressive craniectomy to assess and to compare clinical and neuromonitoring signs indicating extensive cerebral edema. We conducted a retrospective analysis of the clinical signs and courses of simultaneous monitoring of intracranial pressure (ICP) and cerebral oxygenation (PtiO2) in 26 consecutive patients who were sedated and treated with a decompressive craniectomy due to extensive cerebral edema after aneurysmal subarachnoid hemorrhage (SAH) (n = 20) or severe head injury (SHI) (n = 6). Pathological monitoring trends always preceded clinical deterioration. In 18 of 26 patients extensive cerebral edema was indicated solely by increasing ICP > 20 mmHg or decreasing PtiO2 < 10 mmHg or both. Anisocoria occurred in only 8 of 26 patients. As opposed to SHI patients, 9 of 20 SAH patients showed decreasing PtiO2 as first warning sign clearly before neurological deterioration or ICP increase. This series shows the utility of combined ICP and PtiO2 monitoring in patients who develop extensive cerebral edema. Pathological monitoring trends indicate deterioration prior to clinical signs which offers a wider therapeutical window. PtiO2 monitoring appears to be particularly valuable after aneurysmal SAH as adjunct to ICP monitoring and CT imaging.

Adolescent↗

PubMed2003

Risk of recurrent intracerebral hemorrhages.

Intracerebral hemorrhage (ICH) occurs in about 10%-15% of all strokes, and hypertension and cerebral amyloid angiopathy (CAA) are the main underlying causes. There is often controversy regarding surgical evacuation especially in elderly patients. Follow-up of these patients and regulation of hypertension is important to prevent re-bleeding. The number of recurrent hematomas will increase with time of follow-up. We reviewed 968 patients with an ICH treated in our Department and 48 patients with recurrent hemorrhages (4.9%). The mean interval between the first and the second hemorrhage was three years (one month to 10 years). Clinical outcome after a second hemorrhage was severe and only 50% of patients were operated on the second hemorrhage compared to 77% (37/48) of patients who were operated on the first hemorrhage.

Adolescent↗

PubMed2003

Barotrauma as a possible cause of aneurysmal subarachnoid hemorrhage. Case report.

The authors report the case of a 47-year-old man who suffered a diving accident. After regaining consciousness he experienced severe headache. He was initially treated for barotrauma, but the persistent headache led to diagnostic imaging that revealed an aneurysmal subarachnoid hemorrhage. To the authors' knowledge, this is the first report of a ruptured brain aneurysm associated with barotrauma.

Barotrauma↗