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At least 271 records · Page 15Linked to original sources
PubMed1978

[Amyotrophy caused by herpes zoster. Description of 5 cases].

Radicular paralysis is the most frequent, though usually less serious, complication of Herpes Zoster, being observed in rather less than 5% of patients. The site affected--leaving aside exceptional cases--it that of the gangliar and radicular district where the eruption occurs. A clinical and neurophysiological study was made of 5 patients with loss of strength and trophism on the part of muscles in the eruption site within 2 to 5 weeks after the onset of Herpes. Routine blood chemistry tests were run, together with spinal puncture in three cases. The EMG data pointed to variously severe neurogenic distress referable to myeloradicular involvement. Subsequent clinical and EMG controls demonstrated gradual, though slow improvement. This finding is in line with the literature data.

Adult↗
PubMed1981

Delayed complication of Matson operation for hydrocephalus: case report.

A 26-year-old woman had had a lumbar subarachnoid-ureteral shunt established at the age of 10 weeks for hydrocephalus. She developed normally and had no trouble until meningitis developed because of reflux from a urinary tract infection. The meningitis responded to antibiotic treatment, and the shunt was removed from the subarachnoid space. Subsequently, the patient deteriorated clinically, with ictal episodes of altered consciousness, headache, and signs of midbrain dysfunction. Despite normal size ventricles on serial computed tomographic scans, her intracranial pressure was markedly elevated, which was shown by spinal puncture pressure. A diversionary lumboperitoneal shunt was inserted. An immediate, sustained recovery followed. The recognition of increased intracranial pressure in the absence of ventriculomegaly led to management that averted a disastrous outcome.

Adult↗
PubMed1980

Subependymal hematoma in "Moyamoya" disease.

A 27-year-old woman in the ninth month of her pregnancy suddently developed nausea and motor weakness of her right lower extremity while shopping. Subsequently a disturbance of consciousness and right-sided hemiparesis developed. Spinal puncture yielded clear CSF but CT scan demonstrated a left subependymal hematoma. Angiographical examination led to a diagnosis of "Moyamoya" disease. The source of the intracranial hemorrhage could not be identified. The hematoma could not have been diagnosed accurately without the CT scan.

Adult↗
PubMed1994

A prospective comparison of iotrolan and iohexol in lumbar myelography.

In a double-blind study 238 patients were examined with lumbar myelography using iotrolan or iohexol in randomized sequence in order to evaluate the image quality, the safety and tolerance of iotrolan by monitoring the adverse effects with special attention to late reactions. There were no serious complications. On the first day 28 patients (24%) had headache after iotrolan and 41 (34%) after iohexol. This difference was not significant, and these frequencies are similar to those found after spinal puncture alone. The second most frequent side effect was neck pain; the duration of neck pain were significantly longer after myelography with iohexol than with iotrolan. There was a significantly higher frequency of adverse effects in females the first 24 hours, but during examination and on days 2 to 4 there were no differences between males and females. Anamnestic information or myelographic diagnosis could not predict which patients would have side effects. The image quality was excellent or good in all examinations but one. It is concluded that iotrolan is a safe contrast medium well suited for lumbar myelography.

Adult↗
PubMed1996

[Locoregional anesthesia for injuries of the lower limbs].

Isolated lower limb injuries are very common; difficulties for emergency anaesthesia may come from full stomach and drug interferences. The outcome of geriatric-fractured hip is influenced neither by a preoperative delay shorter than 48 hours, nor by the choice of anaesthetic technique; Nevertheless the use of acrylic cement is associated with an increased early mortality rate in hemiarthroplasties. Regional anaesthesia is the best choice for stable patients with a limited peripheral injury; The technique must be adapted to the pain induced by fracture; sitting position is useful for puncture. Spinal anaesthesia using 0.5% plain bupivacaine produces a block quickly achieved, not influenced by posture, allowing surgical installation and procedures. Postoperative analgesia using local anaesthetics may obscure symptoms of compartment syndrome which occasionally complicate tibial and femoral nailing.

Age Factors↗
PubMed1996

[Spontaneous intracranial hypotension syndrome].

Spontaneous intracranial hypotension is a rare but well known entity first described by the German neurosurgeon Schaltenbrand. We report the clinical and radiological findings of four patients (2 males, 2 females, mean age 55 years) presenting with this clinical entity and peculiar constant MRI findings. Intense postural headache was present in all patients together with a very low CSF pressure at lumbar tap although none of the patients had any history of recent lumbar puncture, spinal or cerebral surgery or cranio-cervical trauma. MRI revealed in all patients an intense meningeal enhancement and thickening which was most prominent on the dural side of the subdural space. The ventricular system was thin, presenting almost like slit ventricules. A downward shift of the cerebellar tonsils and hemorrhagic subdural collections were also observed in two patients. Biopsy of meninges performed in two patients showed fibrosis of the leptomeninges together with signs of old hemorrhage in one case. We postulate that histologic and radiologic changes are due to chronic subdural bleeding in relation with abnormal displacement of the nervous structures due to intracranial hypotension. The underlying cause of spontaneous intracranial hypotension is rarely established and the course of the disease is benign. Some authors have advocated to perform isotopic cysternography in search for a CSF leak, particularly in the spine, that could be surgically corrected. No such investigation has been conducted yet in our patients because the spontaneous evolution has been mostly favorable.

Cerebrovascular Disorders↗
PubMed1997

[Outbreak of meningitis caused by echovirus type 30].

OBJECTIVES: In the cold months of 1994-1995, we detected in our hospital an epidemic outbreak of acute enteroviral meningitis caused by echovirus type 30 (Echo 30). Until now, these outbreaks of viral epidemics had not been detected in Spain. PATIENTS AND METHODS: We reviewed retrospectively 46 clinical histories of patients who were admitted to our hospital between September 1994 and January 1995 with the diagnosis of acute lymphocytic meningitis, analyzing the clinical outbreak, epidemiological and laboratory characteristics, and how the outbreak spread. RESULTS: Regarding the patients, there was a prevalence in males, with an average age of 6 years and a range of 2 to 13 years of age. The most constant symptom was severe frontal headache, with signs of meningitis in only 50% of the cases. In the CSF, we found a predominance of PMN in the differential cell count in 63% of the cases, with the time of evolution before spinal puncture less than 24 hours in the majority of the patients. Viral cultures were performed on CSF, stool and throat scrapings in 16 patients with Echo 30 being isolated in 15 cases, which suggests 32.6% of the total cases. CONCLUSIONS: We detected in our environment an epidemic outbreak of viral meningitis caused by an agent not found previously in Spain, which presented epidemiological, clinical and laboratory characteristics similar to those reported in the literature. Its appearance during the cold months contrasts to what normally occurs.

Adolescent↗
PubMed1976

[Intracranial aneurysm in a child--a case report and some considerations on etiology (author's transl)].

An operative case of 12-year-old boy with a saccular aneurysm at the anterior communicating artery was reported. He had episodes of occasional headache during one year before admission. He was attacked by a severe headache associated with nausea and vomiting, and was admitted to Ooita Pref. Hospital under the diagnosis of subarachnoid hemorrhage four days later. On admission physical examinations revealed almost normal findings except for moderate dehydration and a blood pressure of 130/70 mmHg. Routine examinations (blood, serum including total cholesterol, urine, ECG and plain chest X-film) were normal. Neurologically there were lethalgic state, moderate nuchal rigidity and bilateral abducens paresis. Slightly hemorrhagic and xanthochromic CSF was demonstrated by a spinal puncture. An aneurysm was found at the anterior communicating artery on the right carotid arteriogram. The left carotid and the left vertebral arteriograms showed no pathologic findings. Operation via right fronto-temporal approach disclosed a berry aneurysm about 4 mm in diameter arising from the bifurcation of the right anterior cerebral and the anterior communicating artery. There was a plaque presumably an atherosclerotic change at the neck of the aneurysm. Clipping of the aneurysmal neck was done. The aneurysm was not visualized on the postoperative arteriogram, and the patient was discharged in good condition two weeks after the operation. It is true that this patient had a lesion which seemed to be an atherosclerotic plaque at the neck of the aneurysm macroscopically, but he did not have any evidence of generalized atherosclerosis or other metabolic disturbance. This plaque may be of special significance in etiological respect. In general, however, degenerative lesions like atherosclerosis occur predominantly in larger arteries than smaller arteries of the brain. Also the location of this aneurysm was at the anterior communicating artery which is reported to be implicated in anomalous vascularity on occasion. From these facts the authors considered combined congenital and acquired factors in the development of this aneurysm.

Age Factors↗
PubMed1998

[The beginning of anesthesia].

On October 16, 1846, the first public demonstration of etherization, at the Massachusetts General Hospital, Boston, illustrated the rise of Inhalational Anaesthesia. Pioneers were: Hickman, Wells, Morton, Davy and Long. Anaesthesia was considered an American invention. Thereafter, the development of new molecules (cocaine, hexobarbital) which can be administered by others ways (spinal puncture, intravenous injections) allowed new methods of anaesthesia to be achieved. Thus, three successive periods have illustrated the Story of Anaesthesia: Inhalational Anaesthesia (1844), Local Anaesthesia (1860), Intravenous Anaesthesia (1932).

Anesthesia↗
PubMed1998

[Otogenic meningitis].

We present three patients with otogenic meningitis, whose illness varied in extent and clinical course. Meningitis and otitis media are associated in 19-22% of all meningitis-patients. Streptococcus pneumoniae is the predominant microorganism with hemophilus influenzae being the second most important. We discuss the importance and problems of spinal puncture, early CT-scan as well as further, more extensive and sophisticated examinations to exclude late complications or predisposing factors. We emphasize an early start of antibiotic treatment, which should not be delayed for diagnostic reasons. With the appearance of highly penicillin-resistant pneumococci antibiotic therapy may become more difficult in the future, but for the moment pneumococcal infections in Switzerland can initially still be treated with cephalosporins or high dose penicillin. The use of steroids, although of unproven efficacy, may be considered in some cases. An otolaryngologist should initially be consulted for diagnostic reasons as well as for possibly indicated early surgery.

Adult↗
PubMed1998

[Headache, general malaise and left-side ptosis].

A 82-year-old female was admitted to hospital because of deteriorated general condition, severe diffuse headache and complete left-sided ptosis. A computed tomography scan of the head revealed no subarachnoid haemorrhage. Based on the hypothesis that the symptoms resulted from an infarction in the brain stem, the previous medication with Aspirin was continued. After repeated vomitus hypotensive dehydration developed and was adequately treated. Because of confusion, elevated white blood counts and signs of meningism, a spinal puncture was performed. Only the serology for Borrelia-IgG was positive, therefore the patient received Rocephin. During treatment only the ptosis persisted, therefore the substitution with sodium and the medication with Prednisone were stopped. Afterwards the symptoms reappeared and the laboratory results showed insufficiency of the pituitary. A magnetic resonance scan showed a microadenoma of the pituitary with local bleeding. Nine months after pituitary apoplexy, with hormonal substitution only a divergent strabism on the left side persisted. Clinical findings, course and therapy of pituitary apoplexy are discussed.

Aged↗
PubMed1994

Postdural puncture headache and spinal needle design. Metaanalyses.

BACKGROUND: Attempts have been made to reduce the incidence of postdural puncture headache (PDPH) after spinal anesthesia by changing the size and design of the needle. We wished to determine whether these strategies are effective in reducing PDPH and whether they affect the incidence of back pain and the failure rate of spinal anesthesia. METHODS: The literature was searched for trials comparing noncutting spinal needles with cutting needles and larger spinal needles with smaller needles. Trials were included if they were randomized or blinded and if outcomes included PDPH, backache, or failure of the method. The pooled odds ratio for each side effect was computed, and the results were considered statistically significant if the 95% confidence interval excluded 1. RESULTS: Four hundred fifty articles were identified by title using computerized search strategies. Thirty-one abstracts, 25 correspondences, 44 original articles, and 12 reviews were assessed. There was a reduction in the incidence of PDPH when noncutting spinal needles rather than cutting needles were used (P < 0.05), unless the discrepancy in needle size was very large. There also was a reduction in PDPH when a small spinal needle was used compared with a large needle of the same type (P < 0.05). There was no difference in the incidence of failure of spinal anesthesia or the incidence of back pain. CONCLUSIONS: We conclude that a noncutting needle should be used for patients at high risk for PDPH, and the smallest gauge needle available should be used for all patients.

Anesthesia, Spinal↗
PubMed1996

[A case of spinal epidermoid caused by lumbar punctures].

A case of spinal epidermoid caused by lumbar punctures is reported. The 50-year-old man, who had been diagnosed as having poliomyelitis and who had been treated with lumbar puncture 24 times when he was 1 year old, came to our clinic complaining of gradual worsening of atrophy and weakness in his right leg during the last 10 years. Neuroradiologically, intraspinal tumor with calcification was detected in the lumbar region and partial removal of the tumor was performed. Pathological diagnosis was that it was epidermoid. During frequent lumbar puncture at the age of 1, some small skin grafts had been implanted intrathecally and we concluded that, changing its original nature, it had grown slowly to become epidermoid. We want to emphasize especially here that, when we performe lumbar puncture, we should, as far as possible, use a small needle with stilette so as not to induce future spinal epidermoid.

Epidermal Cyst↗