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PubMed2000

Location of the traumatic subdural hygroma: role of gravity and cranial morphology.

Traumatic subdural hygroma (TSH) is frequently bilateral and locates on the top of the head in a supine position. It suggests that the gravity and cranial posture act a certain role. The authors tried to test this hypothesis. The computed tomographic (CT) scans or magnetic resonance (MR) images of 86 consecutive patients with TSH were re-evaluated. The symmetry of the cranium, the posture of the head during the radiological examinations, and the location of the lesion were all checked. The cranium was symmetrical in 47 patients and asymmetrical in 39 patients. TSH was more commonly bilateral in patients with symmetrical cranium than those with asymmetrical cranium (77% vs 62%). The asymmetrical cranium tended to turn to the flat side. It was more frequently oblique in MR images, which has a long scanning time, than in CT (29% vs 18%). In 39 asymmetric craniums, TSH was bilateral and it was symmetrical in 14 cases. In the remaining 25 cases, TSH located opposite to the flat side in 18 cases. In seven patients with the same side TSHs, four patients had it on the side of atrophy, two on the opposite side of a mass lesion. The gravity and cranial posture can predict the location of TSH. TSH usually occurs at the least pressure in the cranium as a lesion of ex vacuo.

Adolescent↗
PubMed2003

Pneumocephalus secondary to cerebrospinal fluid leak associated with a lumbar pressure ulcer in a man with paraplegia.

BACKGROUND: Pneumocephalus is a well-known condition following head trauma, but is uncommon in injuries or surgeries of the spine. Even more unusual is its occurrence in association with an eroding pressure ulcer and the subsequent penetration of the intrathecal space. This article reports such a case in a man with spinal cord injury. No previously reported cases of pneumocephalus and subarachnoid-pleural fistula secondary to a pressure ulcer are known. METHODS: Case presentation and literature review. FINDINGS: A 75-year-old man with with paraplegia, T2-level spinal cord injury, impairment score on the American Spinal Injury Association (ASIA) scale of ASIA A, and multiple pressure ulcers developed dural leak via a tract extending from a thoracolumbar ulcer to the T11 -T12 vertebrae. The resultant pneumocephalus was diagnosed based on acute neurologic symptoms and computed tomography scan. He underwent excision of the pressure ulcer and a T10 through L1 laminectomy, during which the dural leak was located and sealed with fibrin glue. CONCLUSION: Deep pressure ulcers overlying the spine should be managed aggressively to avoid life-threatening complications. Signs of meningeal irritation and/or mental status change in a patient with a deep posterior midline pressure ulcer with drainage suggestive of cerebrospinal fluid may indicate invasion of the intramedullary canal. Imaging studies are diagnostic of pneumocephalus and surgical closure of the spinal fluid leak is imperative when meningeal or other adverse neurologic signs are present.

Aged↗
PubMedDate not supplied

Treatment of meningitis and other infections due to ampicillin-resistant Haemophilus influenzae type b in children.

Cefotaxime and other cephalosporins were retrospectively evaluated for the treatment of meningitis and non-central nervous system (CNS) infections due to ampicillin-resistant Haemophilus influenzae type b (Hib). Between January 1985 and February 1989, 45 cases of meningitis and 27 cases of non-CNS infection due to ampicillin-resistant Hib were documented at Texas Children's Hospital in Houston. Of the 45 children with meningitis, 26 (57.8%) were treated with cefotaxime, 11 (24.4%) with chloramphenicol, and three (6.7%) with cefuroxime; five children (11.1%) were initially given chloramphenicol but later received cefotaxime instead. In addition, 14 chloramphenicol-treated patients from a previous study were included in this analysis. There were no significant differences in terms of neurologic sequelae or other complications (except diarrhea) between the cefotaxime and chloramphenicol groups. The efficacy of cefotaxime was equivalent to that of chloramphenicol for the treatment of ampicillin-resistant Hib meningitis. Cefuroxime was as safe and effective as chloramphenicol or cefotaxime for the treatment of non-CNS infections due to ampicillin-resistant Hib.

Ampicillin Resistance↗
PubMed1982

Operative treatment in head injury.

Improved outcome will result only from improvement in the total care of the head-injured patient. Each aspect of care is dependent on the other: rescue services; aggressive emergency evaluation and resuscitation; monitoring of the patient's physical, chemical, and neurological status; CT scanning; and intensive medical therapy and early rapid surgical decompression. The injured brain is particularly prone to further secondary insults. Intracranial mass lesions must be removed quickly and thoroughly; the brain should be handled in a careful and gentle fashion intraoperatively, and medical complications should be prevented. Dysfunctional cells in a marginal state can only be expected to return to normal with the proper management and environment.

Adolescent↗
PubMed2002

Does hearing loss after spinal anesthesia differ between young and elderly patients?

UNLABELLED: Fifty male patients scheduled for inguinal hernia repair with spinal anesthesia were included in this study. The patients were divided into two groups: 25 patients aged 30 yr or younger (Group Y) and 25 patients aged 60 yr or older (Group E). We performed subarachnoidal injection at the L3-4 interspace by using a 25-gauge Quincke needle with the patient in the sitting position, and 3 mL of 0.5% isobaric bupivacaine was administered. Patients were evaluated by pure tone audiometry (LdB [low frequencies], 125-500 Hz; SdB [speech frequencies], 500-2000 Hz; HdB [high frequencies], 2000-6000 Hz) on the day before and 2 days after spinal anesthesia. Low-frequency hearing loss observed in Group Y was significantly more common than in Group E (P < 0.01). There was no difference between the groups in speech and high frequencies. Mild hearing loss, defined as a hearing loss of 10-20 dB at two or more frequencies, was observed three times more frequently in Group Y than Group E (52% vs 16%; P = 0.014). We conclude that transient hearing loss was more common in young patients after spinal anesthesia, perhaps because the cerebrospinal fluid leakage after dural puncture is less in the elderly than in the young, a finding also associated with the infrequent incidence of postdural puncture headache in the elderly. IMPLICATIONS: Spinal anesthesia is one of the most frequently used regional anesthesia techniques in surgical interventions; however, rarely it may cause some transient or permanent neurological problems. One of these problems is headache, which is more frequent and severe in the young, and hearing loss, especially at low frequencies. Both the pain and the hearing loss are caused by leak of cerebrospinal fluid caused by the puncture in the membrane of the spinal cord during the procedure. We hypothesized that hearing loss might also be more frequent and severe in the young, and to test this hypothesis, we compared the hearing loss developing after spinal anesthesia between the young and the elderly. The implications of this study are as follows: First, spinal anesthesia must be performed carefully, especially in the young. Second, measures must be taken to avoid the leak of cerebrospinal fluid. This study reveals possible problems caused by spinal anesthesia in the young which can be easily overlooked.

Adult↗
PubMed2004

Surgical timing in orbital fracture treatment: experience with 108 consecutive cases.

Orbital fractures can lead to esthetic deformities and functional impairments, and adequate surgical timing is considered important in obtaining good results from surgery. By means of chart review, a retrospective analysis was carried out in 108 consecutive cases of pure orbital fractures to investigate the differences in surgical timing and the correlations with patient age and clinical and radiographic findings. In this analysis, surgical timing of pure orbital fractures was strongly related to the combination of parameters such as anatomical location of the fracture, eventual exposure of the fracture, cerebrospinal fluid (CSF) leakage or penetrating wounds, age of patients, eventual functional impairments or muscle entrapment, and serious conditions of compression or ischemia. As the data confirmed, an urgent approach was considered indispensable in severe orbital apex fractures and in orbital fractures with CSF leakage, penetrating objects, or exposure. Early surgery was necessary within 3 days in children with diplopia (type IIIb) and mainly within 7 days in adults with double vision (type IIIa). Delayed surgery, within 12 days in all cases, was performed orbital wall fractures with no impairments (type II) or in orbital rim fractures (type I). Data from this retrospective analysis confirm the need for an aggressive approach to all orbital fractures. In our experience, surgery was performed within 12 days and most orbital fractures were treated during the first week after trauma, which is earlier than previously reported.

Adolescent↗
PubMed2005

An unusual complication of condylectomy: fracture of the temporal bone and intratemporal facial paralysis.

The incidence of temporomandibular joint (TMJ) ankylosis appears to be decreasing with the increased socioeconomic status of society. The intraoperative complications were reported to be few, the most dangerous of which are facial nerve injury during the extended preauricular incision and maxillary artery injury during condylectomy. The authors report a case of fracture of the temporal bone tearing the intratemporal portion of the facial nerve, resulting in a total facial nerve paralysis.

Ankylosis↗
PubMed1981

Imaging the intracranial complications of Hemophilus influenzae meningitis.

Computed tomography (CT) and radionuclide imaging of the central nervous system (CNS) are important modalities in both the diagnosis and management of CNS complications from Hemophilus influenzae meningitis. Both examinations are sensitive indicators of CNS abnormalities associated with bacterial meningeal infections and are important determinants of the therapy and ultimate prognosis of such complications. Representative findings from CT and radionuclide imaging of children with complications from H. influenzae infection of the meninges are presented.

Brain↗
PubMed2002

Migration of Tc-99m DTPA from the cerebral ventricle to the subarachnoid space.

A 70-year-old woman was examined because of increasing problems with cognition. She had a history of a cerebral shunt placed surgically 10 years previously. Introduction of Tc-99m DTPA directly into the ventricular cavity revealed good ventricular distribution, followed by progression downward, as though into a previous ventriculoperitoneal shunt. However, a chest radiograph revealed what appeared to be a shunt tube in the right atrium. Delayed lateral images showed activity in proximity to the vertebral column, indicating migration of tracer and cerebrospinal fluid into the dorsal and lumbar subarachnoid space.

Aged↗
PubMed1983

Artifact simulating chronic extracerebral fluid collections on computed tomography of the head.

Accurate analysis in computed tomography of the brain requires recognition of artifacts that may lead to an erroneous diagnosis or at least confuse the examination. An artifact that mimics chronic extracerebral fluid collections is described; it can occur with the Picker 600 scanner. One should be aware that an artifact can be machine specific, depending on the reconstruction and design differences of the scanner.

Child, Preschool↗
PubMedDate not supplied

The role of computerized tomography-myelography in a patient with spontaneous intracranial hypotension from multiple cerebrospinal fluid leaks.

OBJECTIVES: To describe a patient with spontaneous intracranial hypotension (SIH) secondary to multiple sites of cerebrospinal fluid (CSF) leaks, a rarely described phenomenon. To compare computerized tomography-myelography with radionuclide cisternography as confirmatory diagnostic aids in SIH. METHODS: A patient with SIH had transient or no response to 2 thoracic epidural blood patches. A computerized tomography-myelography showed bilateral CSF leaks at T11-T12 and T12-L1 levels and on the left side of T10-T11. RESULTS: A left paramedian epidural blood patch was performed at T12-L1 under fluoroscopy guidance. Injection of 1 mL dye showed confinement of the dye at the left T11-L1 epidural space. The patient had 90% to 95% relief of her headache and complete relief at 4 months. She was asymptomatic 1 year after the last epidural blood patch. CONCLUSIONS: In a patient with SIH, a computerized tomography-myelography should be performed if an initial epidural blood patch is ineffective. This is to show the vertebral level and site(s) of CSF leak and to guide the physician to the ideal vertebral level for the epidural blood patch.

Adult↗
PubMed2003

En bloc vertebrectomy and dural resection for chordoma: a case report.

STUDY DESIGN: Case report. OBJECTIVES: Report a surgical technique for dural reconstruction after vertebrectomy. SUMMARY OF BACKGROUND DATA: None available. METHODS: Clinical case analysis: chordoma from T12 to L2 with infiltration of the dura. RESULTS: Forty-six months after vertebral resection and reconstruction, the patient is disease free. CONCLUSIONS: Wide en bloc resection is required for local control in chordoma. When the tumor permeates the dura, resection not including the dura is intralesional with high risk of local recurrence. Therefore, a proper wide resection consists in vertebrectomy removing the dura infiltrated by the tumor. The two-stage dural reconstruction had strongly limited the leakage of liquor during surgery, and the dural patch provided extra strength anteriorly, where the dural suture is more difficult.

Back Pain↗