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At least 451 records · Page 25Linked to original sources
PubMed1996

[Acute epidural hematoma of posterior fossa: comparative analysis between 20 cases in adults and 10 cases in children].

A comparative study of the clinical features was made among 30 patients, 10 children (less than 14) and 20 adults (older than 15) with traumatic acute epidural hematoma of the posterior fossa (PFEDH). The characteristic findings in both groups were as follows: 1) PFEDH accounted for 15% of 200 epidural hematoma cases. Incidence of PFEDH was 23.3% (10/43) in children and 12.7% (20/157) in adults. Thus, PFEDH is more common in children than in adults. 2) In seven out of 10 children, PFEDH was confined to the posterior fossa but in the other three children, PFEDH extended to the supratentorial area. On the other hand, in all the adult cases PFEDH extended over the supratentorial space. 3) Hematoma density was high in 5 out of 10 children and 18 in out of 20 adults. Mixed (including low) density occurred at a higher rate in children (50%) than in adults (10%). 4) Brain contusion associated with PFEDH was found by CT scan in 12 adult cases and one child case. Subarachnoid hemorrhage was found by CT scan in 4 adult cases. Subdural effusion was found by CT scan in 1 adult case. Thus, intracranial complications associated with PFEDH occurred in a significantly higher number in adults than in children. 5) 20 cases (4 children, 16 adults) of 30 underwent surgery, and 10 cases (6 adults, 4 children) were given conservative treatment. Results (GOS); GR was observed in 22 cases (in all 10 children and in 12 adults), and MD in 8 cases. There were no SD, VS or cases ending in death.

Acute Disease↗
PubMed1996

[Preventive effect of intracisternal methylprednisolone on symptomatic vasospasm after aneurysmal subarachnoid hemorrhage].

A series of 103 patients with ruptured cerebral aneurysms were treated by intracranial irrigation, after aneurysmal clipping, with pH 8.0 Hartmann solution containing 1 mg/ml of methylprednisolone sodium succinate, during operation. Postoperatively, 5 ml/day of the solution was also injected until day 14, percutaneously through an Ommaya reservoir into the cisterns around the clipped aneurysm. Six (5.7%) of the 103 patients suffered symptomatic vasospasm postoperatively. The Glasgow Outcome Scale at discharge of all patients indicated good recovery, Moderately disabled, Severely disabled and Vegetative state in 74 (72%), 18 (17%), 9 (9%) and 2 (2%) patients respectively. As a complication, subdural effusion was noticed in 17 (17%) patients, without any influence on outcome at all.

Female↗
PubMed1997

[Factors associated with the prognosis of bacterial meningitis in children].

Treatment of bacterial meningitis depends on its severity. The signs, symptoms, and laboratory values of 51 patients with bacterial meningitis admitting to the Department of Pediatrics at Sendai City Hospital from January 1985 to December 1994 were analyzed in order to evaluate their prognostic value. The overall mortality rate was 3.9%. The incidence of neurological deficit on discharge was 31.4%. According to their prognoses, patients were divided into two groups: those who recovered with no detectable disabilities (good prognosis) and those who died or were left with neurological deficits (poor prognosis). An analysis of these groups using Fisher's exact probability test revealed that the following risk factors were associated with poor prognosis: 1) duration of fever (including the periods of relapse) for more than 10 days ; 2) abnormal findings on brain imaging, such as cerebral infarction, cerebral hemorrhage, cerebral abscess and subdural effusion: 3 initial serum CRP value above 16 mg/dl; 4) initial CSF glucose value below 12 mg/dl; and 5) initial CSF LDH value above 220 IU/l. Streptococcus pneumoniae infection carried the worst prognosis: the causal organism of both the two fetal cases was S. pneumoniae. The incidence of poor prognosis was also high in S. pneumoniae meningitis (60.0%), compared to those by Hemophilus influenzae (46.7%) and group B streptococcus (25.0%). In the cases in which causal agents were not detected, this incidence was as low as 10 percent, showing significant difference from cases in which causal agents were identified. In order to improve the prognosis of bacterial meningitis, factors associated with poor prognosis should be recognized at early stages of the illness.

Adolescent↗
PubMed1997

Ultrasonographic study of children suspected of hydrocephalus at the Queen Elizabeth Central Hospital in Blantyre, Malawi.

Eighty Malawian children aged below 15 months who presented with rapidly enlarging head and were suspected of having hydrocephalus were investigated with anterior fontanelle ultrasonography at the Queen Elizabeth Central Hospital (QECH), Blantyre. Of the 68 (85%) who were found to have hydrocephalus, 35 (51.5%) were post infective, 14 (20.6%) were associated with lumbosacral myelomeningocele, 13(19.1%) were post haemorrhagic and the rest probably congenital or idiopathic. The remaining 12 patients with macrocephaly but without hydrocephalus comprised six children with hydranencephaly, five with subdural effusion and one with achondroplasia. Ultrasonography of the head is thus a simple, quick, non-invasive, economical diagnostic tool in the management of macrocephaly and to a limited sense as effective as CT scan. Its increased use in the investigation of infantile hydrocephalus is therefore recommended in developing countries with limited resources and without sophisticated imaging techniques.

Diagnosis, Differential↗
PubMed1985

Gammasubdurography in the diagnosis of chronic subdural bilateral and communicating effusion in infants.

The results obtained by means of Gammasubdurography (G.S.G.) in 37 infants having chronic subdural bilateral effusions, are presented. The use of this procedure, which consists of unilateral injection of Radioiodinated Human Sero Albumin (RIHSA-I 131), into the subdural effusion, is suggested for the determination of a communication between the two cavities. At the same time it is possible to get valuable information about their exact localization and extension. Once the communication is diagnosed, the treatment proposed is internal or external unilateral drainage. The method is safe and is performed in a short time which permits its use in the screening of these patients, especially in conjunction with Gammaencephalography (G.E.G.) and Computer Tomography (CT), patients to it. The test (G.S.G.) has been used by us since 1979. All our cases are included in this series. All of them had been diagnosed by subdural puncture, transillumination, G.E.G. and or CT Scan, as having bilateral subdural collections. All the patients received a saturated iodine solution, 24 hours in advance and for 10 days, as a thyroid blocking agent, which was administered in the usual oral dosage. The radiopharmaceutical administration was performed through a unilateral subdural puncture in a dose of 50 to 80 microcurie of RIHSA-I 131 with a high specific activity. Immediately after this, sequential analog images were obtained with the patient supine and in anterior and lateral head projections. This was accomplished by using a PICKER DYNA 4 Gammacamera equipped with a medium energy parallel hole collimator. The interval between the images was determined during the test in agreement with the findings.

Cerebrospinal Fluid Shunts↗
PubMed1998

Quantitative kinetic analysis of blood vessels in the outer membranes of chronic subdural hematomas.

Dynamic biologic modeling was used to calculate the transfer rate constant for gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) and capillary permeability in the outer membrane of chronic subdural hematomas and effusions. Following intravenous Gd-DTPA injection, Gd concentrations in the subdural fluid and in timed arterial blood samples were measured by ion-coupled plasma emission spectrometry in 53 chronic subdural hematomas and 18 chronic subdural effusions. The capillary surface area in outer membrane was assessed morphometrically. Transfer rate constants for subdural hematomas and subdural effusions were 12.4 +/- 1.0 and 20.6 +/- 1.7 (x 10(-4)min-1, respectively. Capillary permeabilities for subdural hematomas and subdural effusions were 16 +/- 1.2 and 19 +/- 3.7 ml.min-1(mm2/mm3)-1, respectively. The capillary surface areas for subdural hematomas and subdural effusions were 48 +/- 3 and 77 +/- 10 mm2/mm3, respectively. The high degree of infiltration of Gd into subdural effusions reflects the high capillary surface area in the outer membrane rather than greater permeability of individual capillaries. The value of transfer rate constant was correlated inversely with the duration of the chronic subdural fluid collection. Immature outer membrane has a high transfer rate constant which allows extravasation of plasma components into the subdural space, resulting in increasing volume of the subdural effusion. Delayed magnetic resonance imaging following Gd administration may be clinically useful for estimating the age of chronic subdural fluid accumulations.

Aged↗
PubMed1980

Subdural cysts and diencephalic tumor.

Four children with diencephalic emaciation, three of whom had subdural cysts (effusions), are described. In two of these cases the initial diagnosis was subdural effusion, which delayed the correct diagnosis. Three of the four patients with emaciation of diencephalic origin had large tumors in which the involved part of the diencephalon accounted for only a small part of the total tumor bulk. The fourth patient had a large glioma of the optic chiasm.

Brain Diseases↗