scholarly journals P.090 A case of delayed uncal herniation secondary to external hydrocephalus post intraventricular surgery

2019 ◽  
Vol 46 (s1) ◽  
pp. S37
Author(s):  
Y Ellenbogen ◽  
K Yang ◽  
J Lu ◽  
K Reddy
Keyword(s):  
Stable Condition ◽  
Neurological Deficits ◽  
Tumour Resection ◽  
Clinical Progression ◽  
Subdural Hygroma ◽  
Intraventricular Tumour ◽  
External Hydrocephalus ◽  
Level Of Consciousness ◽  
Subdural Drain ◽  
Radiologic Evidence

Background: Central neurocytoma’s are typically located in the lateral ventricles and are optimally treated with surgical resection. Surgical entry into the ventricles are associated with a number of complications, including subdural hygroma and shunt-dependent hydrocephalus. Methods: We report a patient who developed acute bilateral uncal herniation from progessively enlarging subdural hygromas following intraventricular tumour resection. Results: A 60-year-old female underwent minimally invasive transcortical transventricular resection of an intraventricular CN. The patient’s postoperative course was complicated by repeated presentations to the emergency department due to persistent and intractable nausea and headaches, without focal neurological deficits. Imaging demonstrated small bilateral subdural hygromas. The patient eventually presented with acute deterioration in her level of consciousness with clinical and radiologic evidence of bilateral uncal herniation, requiring urgent insertion of a subdural drain to treat elevated intracranial pressure (ICP). After insertion of a ventriculoperitoneal shunt, the patient was discharged in stable condition and is currently followed by the multi-disciplinary neuro-oncology team. Conclusions: Bilateral subdural hygroma could mask underlying external hydrocephalus post transventricular surgeries. Patients who are symptomatic from bilateral subdural hygromas after transventricular resection of tumors should be carefully monitored for radiographic or clinical progression, in order to avoid acute deterioration caused by elevated ICP.

scholarly journals Pyogenic Ventriculitis Associated with Urosepsis: A Rare Case Report

2020 ◽  
Author(s):  
Joana Correia Lopes ◽  
Andreia Sofia Basílio ◽  
Mário Amaro
Keyword(s):  
Neurological Deficits ◽  
Resonance Imaging ◽  
Cerebral Ventricles ◽  
E Coli ◽  
Clinical Challenge ◽  
Level Of Consciousness ◽  
Rare Case Report ◽  
History Of ◽  
G 12

Pyogenic ventriculitis is an infection of the cerebral ventricles usually associated with neurosurgery or head trauma. There are less than 10 reported cases of community-acquired pyogenic ventriculitis in adults. We present the case of a 71-year-old man with a medical history of type 2 diabetes mellitus, hospitalized due to urosepsis caused by E. coli. Because he had a fluctuant level of consciousness, he underwent magnetic resonance imaging that diagnosed pyogenic ventriculitis. He was treated with ceftriaxone 2 g 12/12h for a total of 6 weeks and recovered without neurological deficits. Pyogenic ventriculitis is a clinical challenge due to its rarity, atypical presentation and variety of aetiological microorganisms.

scholarly journals Ruptured giant aneurysm of a cortical middle cerebral artery: A case report

2021 ◽  
Vol 12 ◽  
pp. 95
Author(s):  
Samer S. Hoz ◽  
Zaid Aljuboori ◽  
Sajaa A. Albanaa ◽  
Zahraa F. Al-Sharshahi ◽  
Mohammed A. Alrawi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Giant Aneurysm ◽  
Neurological Deficits ◽  
Intracerebral Hematoma ◽  
Microsurgical Clipping ◽  
Level Of Consciousness ◽  
History Of ◽  
Posterior Parietal ◽  
Mca Aneurysm

Background: Aneurysms of the cortical branches of the middle cerebral artery (MCA) are rare. They usually are secondary to traumatic or infectious etiologies and are rarely idiopathic. The specific characteristics of idiopathic aneurysms in such location are not well defined in the literature. The authors report a rare case of a ruptured giant idiopathic cortical MCA aneurysm with review of the available literature on this clinical entity. Case Description: A 24-year-old female presented with headache, disturbed level of consciousness, and right-sided weakness. Imaging studies showed a left frontoparietal intracerebral hematoma and a giant saccular aneurysm in the posterior parietal cortical branch of the MCA. The patient had no history of head trauma or active infection; therefore, the aneurysm was considered idiopathic. A microsurgical clipping of the aneurysm with evacuation of the hematoma was performed. There were no surgical complications, and the patient achieved a good outcome modified Rankin Scale of 1 with no neurological deficits. Conclusion: Idiopathic aneurysms of the cortical branches of the MCA are rare, and usually present with intraparenchymal hemorrhage due to rupture. There is no clear consensus regarding the optimal management strategy. This case shows that timely management can lead to good outcomes.

scholarly journals Sudden ‘Stroke-Like’ Onset of Hemiparesis Due to Herpetic Encephalitis

1995 ◽  
Vol 22 (4) ◽  
pp. 320-321 ◽  
Author(s):  
Mohammad AbdulJabbar ◽  
Ibrahim Ghozi ◽  
Anwar Haq ◽  
Hanz Korner
Keyword(s):  
Herpes Simplex ◽  
Young Patients ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Type I ◽  
Focal Neurological Deficit ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Herpetic Encephalitis ◽  
Magnetic Resonance Imaging Mri

AbstractBackground/ObjectiveHerpes simplex encephalitis usually has a progressive cause. Sudden neurological deficits are unusual.MethodCase study.ResultsA 17-year-old girl presented with an acute onset focal neurological deficit followed one week later by the more classical feature of altered level of consciousness, fever and focal seizures. The diagnosis of hepetic encephalitis was made by magnetic resonance imaging (MRI) and by the significant increase in cerebrospinal fluid titres of antibodies against herpes simplex type I.ConclusionHerpetic encephalitis should be considered in the differential diagnosis of acute stroke in young patients even in the absence of encephalitic features, if common etiological factors such as embolization and intracerebral bleed are excluded.

Thiamine-deficient lactic acidosis with brain tumor treatment

1998 ◽  
Vol 89 (6) ◽  
pp. 1025-1028 ◽  
Author(s):  
Hiroshi Kuba ◽  
Takanori Inamura ◽  
Kiyonobu Ikezaki ◽  
Masatou Kawashima ◽  
Masashi Fukui
Keyword(s):  
Brain Tumor ◽  
Lactic Acidosis ◽  
Brain Tumors ◽  
Neurological Deficits ◽  
High Dose ◽  
Content Type ◽  
Malignant Brain Tumors ◽  
Level Of Consciousness ◽  
Lactic Acidemia ◽  
Fine Print

✓ Lactic acidosis due to thiamine deficiency is known to complicate chemotherapy and radiotherapy treatment of malignant extracranial tumors, but to the authors' knowledge, this complication has not been reported in patients treated for malignant brain tumors. They report three such cases, demonstrating that this complication can occur during treatment of brain tumors. In all patients, consciousness levels deteriorated within 1 to 2 days. Serum lactic acid levels increased to concentrations between 62 and 96.7 mg/dl, resulting in severe metabolic acidosis. A low blood thiamine level (9 ng/ml) was demonstrated at the onset in one case, and high-dose thiamine infusions dramatically improved lactic acidemia as well as impairment of consciousness in two cases. In the other case, hydrocephalus was suspected initially, resulting in a delay in thiamine supplementation. Clinical differentiation of this form of lactic acidosis from hydrocephalus or tumor progression can be very difficult in a patient undergoing treatment for a malignant brain tumor. Demand for thiamine is thought to be increased in patients with malignant brain tumors, and supplemental thiamine during treatment is necessary to prevent lactic acidosis. When this complication occurs, immediate treatment with sufficient thiamine is essential, together with normalization of pH by using sodium bicarbonate. With timely intervention, the level of consciousness can recover to the preacidotic state with no new neurological deficits.

scholarly journals Pediatric Air Gunshot Penetrating Head Injury with Good Outcome: A Case Report

2020 ◽  
Vol 16 (2) ◽  
pp. 119
Author(s):  
Yusriandi Ramadhan ◽  
Zainal Abidin ◽  
Ardik Lahdimawan Lahdimawan
Keyword(s):  
Case Report ◽  
Head Injury ◽  
Lateral Ventricle ◽  
Stable Condition ◽  
Neurological Deficits ◽  
Left Lateral Ventricle ◽  
Air Gun ◽  
Perifocal Edema ◽  
Gun Shot ◽  
The Brain

Abstract: Ball bearing (BB) and pellet guns are non-power guns but their related injuries have been reported worldwide. They represent a significant cause of injury especially among children and teenagers. Their potentially harmful and lethal effects have been well documented in the medical literature since the early 1980s. Fatality rate is closely related to the damaged part of the brain and the level of the damage. In this Case Report we documented a 6-years-old girl was getting shot at the head by herself, who initially want to play around, using her neighbour’s Air gun rifle. The pellet trajectory passed through the left frontal lobe, left temporal lobe, left posterior putamen, posteriorly left crus posterior of internal capsule, left occipital horn of lateral ventricle, left occipital lobe, and ended at left cerebral falx between both medial surfaces of occipital lobes. Directional slope of the pellet was medially upward, with its tracking left Intracerebral Hemorrhage (ICH) with perifocal edema and Intraventricular Hemorrhage (IVH) dominant in the left lateral ventricle. After 8 days management, the patient was discharged from our hospital with stable condition, GCS 15 without any significant neurological deficits. Intracranial intracerebral pellet due to air gun shot injury, may have fatal and lethal manifestation if the pellet damage the eloquent area and/or deep area of the brain (hypothalamus, thalamus and brain stem). If accessible the foreign body or pellet should be removed immediately for better outcome. Keywords: Head Injury, Air Gun Shot, Intracerebral Haemorrhage

Diagnostic method for differentiating external hydrocephalus from simple subdural hygroma

2006 ◽  
Vol 105 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Pil-Woo Huh ◽  
Do-Sung Yoo ◽  
Kyung-Suok Cho ◽  
Chun-Kun Park ◽  
Seok-Gu Kang ◽  
...  
Keyword(s):  
Head Trauma ◽  
Diagnostic Method ◽  
Obstructive Hydrocephalus ◽  
Fluid Collection ◽  
Subdural Effusion ◽  
Subdural Fluid Collection ◽  
Subdural Hygroma ◽  
Subdural Collection ◽  
External Hydrocephalus ◽  
Frontal Horn

Object The various terms used to describe subdural fluid collection—“external hydrocephalus,” “subdural hygroma,” “subdural effusion,” “benign subdural collection,” and “extraventricular obstructive hydrocephalus”—reflect the confusion surrounding the diagnoses of these diseases. Differentiating external hydrocephalus from simple subdural hygroma may be difficult, but the former appears to be a distinct clinical entity separate from the latter. In this report, the authors present a diagnostic method for differentiating external hydrocephalus from simple subdural hygroma, based on their clinical experience in treating subdural fluid collection after mild head trauma. Methods Twenty patients with subdural fluid collection after mild head trauma were included in this study. Ventricle size was measured using a modified frontal horn index (mFHI); that is, the largest width of the frontal horns divided by the bicortical distance in the same plane, instead of the inner table distance. Bur hole trephination was performed on the appearance of a subdural fluid collection thicker than 15 mm on computed tomography (CT), persistent (longer than 4 weeks) or increasing in size, and accompanied by neurological symptoms (confusion or memory impairment). During the procedure, subdural pressure was measured using a manometer before opening the dura mater. Subdural pressure varied among the patients, ranging from 3 to 27.5 cm H2O. Four patients with a subdural pressure greater than 15 cm H2O had hydrocephalus after surgery (p < 0.05). Hydrocephalus developed in a pediatric patient (2 years old) with a subdural pressure of 12 cm H2O. All of the patients in whom hydrocephalus developed after bur hole trephination had had enlarged ventricles (mFHI > 33%) on preoperative CT scans. Conclusions Monitoring subdural pressure may be a valuable tool for differentiating subdural hygroma from external hydrocephalus in patients with mild head trauma. Additionally, the mFHI reflects the nature of the subdural collection more accurately than the standard frontal horn index.

scholarly journals Simultaneous Cranioplasty and Subdural-Peritoneal Shunting for Contralateral Symptomatic Subdural Hygroma following Decompressive Craniectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Muh-Shi Lin ◽  
Tzu-Hsuan Chen ◽  
Woon-Man Kung ◽  
Shuo-Tsung Chen
Keyword(s):  
Decompressive Craniectomy ◽  
Surgical Intervention ◽  
Muscle Power ◽  
Neurological Deficits ◽  
Fluid Circulation ◽  
Subdural Hygroma ◽  
Cerebrospinal Fluid Circulation ◽  
Excellent Outcome ◽  
Cerebral Herniation ◽  
Computed Tomography Scans

Background.Contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits.Material and Methods.Nine patients who underwent one-stage, simultaneous cranioplasty and contralateral subdural-peritoneal shunting were included in this study. Clinical outcome was assessed by Glasgow Outcome Scale as well as Glasgow Coma Scale, muscle power scoring system, and complications.Results.Postoperative computed tomography scans demonstrated completely resolved subdural hygroma and reversed midline shifts, indicating excellent outcome. Among these 9 patients, 4 patients (44%) had improved GOS following the proposed surgery. Four out of 4 patients with lethargy became alert and orientated following surgical intervention. Muscle strength improved significantly 5 months after surgery in 7 out of 7 patients with weakness. Two out of 9 patients presented with drowsiness due to hydrocephalus at an average time of 65 days after surgery. Double gradient shunting is useful to eliminate the respective hydrocephalus and contralateral subdural hygroma.Conclusion.The described surgical technique is effective in treating symptomatic contralateral subdural hygroma following decompressive craniectomy and is associated with an excellent structural and functional outcome. However, subdural-peritoneal shunting plus cranioplasty thoroughly resolves the subdural hygroma collection, which might deteriorate the cerebrospinal fluid circulation, leading to hydrocephalus.

scholarly journals Leptomeningeal Carcinomatosis Secondary to Gastroesophageal Adenocarcinoma: A Case Report and Review of the Literature

2002 ◽  
Vol 16 (11) ◽  
pp. 807-811 ◽  
Author(s):  
Ayman A Abdo ◽  
Sylvain Coderre ◽  
Ronald J Bridges
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
English Literature ◽  
Gastroesophageal Junction ◽  
Leptomeningeal Carcinomatosis ◽  
Neurological Deficits ◽  
Solid Organ ◽  
Meningeal Enhancement ◽  
Altered Level ◽  
Level Of Consciousness

BACKGROUND: Leptomeningeal carcinomatosis (LC) is a rare metastatic complication of solid tumours. It has been mainly described in association with breast cancer, lung cancer and melanoma.CASE PRESENTATION: A patient presenting with progressive solid food dysphagia with documented adenocarcinoma of the lower esophagus and gastroesophageal junction is reported. One month after the initial diagnosis, the patient developed gradual onset of increasing headache and progressive decrease in the level of consciousness. Computed tomography of the head showed evidence of meningeal enhancement, and cerebrospinal fluid examination showed the presence of adenocarcinoma cells, making the diagnosis of LC. The patient died one month after LC was diagnosed.DISCUSSION: LC is a poor prognostic sign in solid organ malignancies. It usually presents with headache, altered level of consciousness and focal neurological deficits. Diagnosis is established by finding malignant cells in the cerebrospinal fluid and supported by marked meningeal enhancement on computed tomography of the brain. A review of the English literature found only three reported cases of LC secondary to esophageal malignancy.CONCLUSION: A case of LC complicating esophageal and gastroesophageal junction malignancy is described. A high index of suspicion and early diagnosis may influence the poor outcome of these patients.

Factors Affecting Survival of Children with Malignant Gliomas

Neurosurgery ◽  
1987 ◽  
Vol 20 (3) ◽  
pp. 416-420 ◽  
Author(s):  
Ossama Al-Mefty ◽  
Nayef R. F. Al-Rodhan ◽  
Robert L. Phillips ◽  
Mohammed El-Senossi ◽  
John L. Fox
Keyword(s):  
Brain Stem ◽  
Cerebral Hemisphere ◽  
Survival Curve ◽  
Malignant Gliomas ◽  
Neurological Deficits ◽  
Survival Times ◽  
Factors Affecting ◽  
Computed Tomographic ◽  
Level Of Consciousness

Abstract Forty-four patients (23 male and 21 female, aged 2 to 20 years (mean, 9.6)), harboring pathologically proven malignant glioma (Grades III and IV) were treated between 1976 and 1985. Tumor sites included the cerebral hemisphere (26 patients), thalamus (6 cases), brain stem (7 cases), and the cerebellum (5 cases). All patients underwent operation and initial treatment with steroids. Irradiation was given in 35 patients; 3 had adjuvant chemotherapy. At the time of study, 22 were deceased. The longest period of follow-up was 65 months. Survival curves were calculated from the date of the first visit to the date of the last evaluation or death. The mean survival times were 30 months for all patients, 14 months for cerebellar cases, 17 months for brain stem cases, 26 months for thalamic cases, and 33 months for cerebral hemisphere cases. However, the differences between mean survival times were not statistically significant. The patient's age was the single most significant factor, with those 5 to 10 years old having the worst survival curve (P= 0.0036). Irradiation was associated with an improved mean survival time (34 vs. 19 months); however, this was not statistically significant (P= 0.15). Girls had shorter mean survival times than boys (16.5 vs. 37 months, P= 0.0511). Otherwise, there was no clinical or radiological factor that indicated a better prognosis. This was also confirmed by x2analyses comparing 72 factors between patients with more than 24 months of survival and those with less than 24 months of survival. In particular, tumor size (greater or less than 5 cm), the presence of neurological deficits, the level of consciousness, increased intracranial pressure, hydrocephalus, calcium or cyst on a computed tomographic scan, and histological grading (III or IV) showed no significant correlations.

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