RESUMO
Transient neurologic deficits are an unusual presentation of chronic subdural hematoma. Presented herein are three patients with transient aphasia and right-sided sensory-motor abnormalities caused by subdural hematoma. Review of the literature revealed 32 cases similar to ours. Presenting complaints were aphasia (77%), sensory symptoms (57%), headache (48%), hemiparesis (50%), and visual disturbance (3%). Fifteen patients underwent cerebral angiography; only three showed significant carotid atherosclerosis. Electroencephalograms were performed in seven patients; five revealed lateralized slowing, but none showed epileptiform activity. Drainage of the hematoma was uniformly curative, although six patients had transient postoperative symptoms. Patients presenting with transient deficits require imaging to rule out the presence of a chronic subdural hematoma.
Assuntos
Afasia/etiologia , Cefaleia/etiologia , Hematoma Subdural/complicações , Hemiplegia/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Afasia/diagnóstico , Afasia/epidemiologia , Líquido Cefalorraquidiano/química , Doença Crônica , Eletroencefalografia , Feminino , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Hematoma Subdural/diagnóstico , Hematoma Subdural/terapia , Hemiplegia/diagnóstico , Hemiplegia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Tomografia Computadorizada por Raios XRESUMO
This immunocytochemical study was undertaken to clarify the histogenesis of ethylnitrosourea-induced rat brain tumors. The tumors induced in offspring of Sprague-Dawley rats injected with ethylnitrosourea on day 18 of gestation were used in these experiments. Controls consisted of pregnant Sprague-Dawley rats similarly injected with saline alone. Both microtumors (less than 1 mm) and macrotumors were examined immunocytochemically. The cells present in both macro- and microtumors were reactive with anti-Leu 7, an antibody which recognizes oligodendrocytes. Intermixed with, but distinct from the tumor cells were glial fibrillary acidic protein positive cells morphologically identical to astrocytes found in other areas distant to tumors in the treated animals, and in controls. These data suggest that both early and late tumors are oligodendrogliomas, not astrocytomas or mixed gliomas, and that the cell of origin of the tumor is the oligodendrocyte rather than an uncommitted stem cell as previously suggested.
Assuntos
Anticorpos Monoclonais , Antígenos de Diferenciação/análise , Neoplasias Encefálicas/análise , Oligodendroglioma/análise , Animais , Neoplasias Encefálicas/induzido quimicamente , Neoplasias Encefálicas/patologia , Antígenos CD57 , Etilnitrosoureia , Proteína Glial Fibrilar Ácida/análise , Imuno-Histoquímica , Oligodendroglioma/induzido quimicamente , Oligodendroglioma/patologia , Ratos , Ratos EndogâmicosRESUMO
STUDY OBJECTIVE: Concerns exist about the effect of flexible fiberoptic bronchoscopy (FFB) on intracranial pressure (ICP). We studied the effect of FFB on cerebral hemodynamics in patients with severe head injury. DESIGN: Prior to FFB, patients were anesthetized and muscle relaxants were given as necessary to eliminate coughing. Comparisons were made of mean arterial pressure (MAP), ICP, and cerebral perfusion pressure (CPP) prior to, during, and after FFB, as well as comparisons of mean cerebral hemodynamic values in an 8-hour period before and after FFB. Observations were made of changes in neurologic status post-FFB. SETTING: Surgical intensive care unit of Level 1 Trauma Center. PATIENT POPULATION: Fifteen patients with severe head injury in whom ICP was monitored and who required FFB for diagnosis of nosocomial pneumonia or treatment of lobar collapse. RESULTS: Pre-FFB ICP averaged 14.3 mm Hg (range, 6 to 26 mm Hg). During FFB, patients experienced a mean increase in ICP of 13.5 mm Hg above basal values (p = 0.0001). At peak ICP, MAP increased from a baseline of 92.3 mm Hg (SD +/- 16.1) to 111.5 mm Hg (+/- 13.9). Mean CPP was 83.7 mm Hg at peak ICP (range, 52 to 121 mm Hg), a 14.0% increase over baseline. The ICP and MAP returned to basal levels following bronchoscopy. No patient had a clinically significant increase in ICP or demonstrated any deterioration in Glasgow Coma Scale score or neurologic examination findings post-FFB. CONCLUSIONS: Although FFB causes an increase in ICP in patients with severe head injury, MAP also rises, and an adequate CPP is maintained. The ICP returns to basal levels after the procedure. When properly performed, FFB does not adversely affect neurologic status in patients with severe head injury.
Assuntos
Encéfalo/fisiopatologia , Broncoscopia/efeitos adversos , Traumatismos Craniocerebrais/fisiopatologia , Doença Aguda , Adolescente , Adulto , Idoso , Broncoscópios , Broncoscopia/métodos , Tecnologia de Fibra Óptica , Hemodinâmica , Humanos , Pressão IntracranianaRESUMO
Ubiquitin, a protein important in regulating non-lysosomal proteolysis, has previously been shown to be present in cytoskeletal inclusions of the neurodegenerative diseases. Its role in other pathological processes of the central nervous system, such as neoplastic transformation of cells, is not known. The astrocytoma, a tumor of complex biology derived from the astrocyte, is the most common primary parenchymal human brain tumor in both children and adults. Until recently, ubiquitin was not known to form stable conjugates in cells. We have shown using immunocytochemistry on sections of astrocytomas that both glial fibrillary acidic protein (GFAP) (the major intermediate filament protein present in normal, reactive and neoplastic astrocytes) and ubiquitin are simultaneously present in the cytoplasm and cell processes of tumor cells. The presence of ubiquitin and GFAP was also found in astrocytoma cells in short- and long-term culture, and confirmed by immunostaining of blots of tumor homogenates subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis.
Assuntos
Astrocitoma/metabolismo , Células Tumorais Cultivadas/metabolismo , Ubiquitinas/metabolismo , Citoplasma/metabolismo , Proteína Glial Fibrilar Ácida/metabolismo , Humanos , Imuno-HistoquímicaRESUMO
A cellulitis surrounding a cerebrospinal fluid shunt caused by Branhamella catarrhalis is described. This is the first reported case of a cellulitis caused by this bacterium.
Assuntos
Celulite (Flegmão)/etiologia , Derivações do Líquido Cefalorraquidiano , Neisseriaceae , Celulite (Flegmão)/tratamento farmacológico , Pré-Escolar , Feminino , Humanos , Nafcilina/uso terapêutico , Neisseriaceae/isolamento & purificaçãoRESUMO
We report a case of an ectopic, extraspinal meningioma that appeared as a midline interscapular mass in a 13-year-old girl. The tumor involved the T-2 and T-3 spinous processes, but was dorsal to the lamina and was entirely extrinsic to the spinal canal. Large amounts of tumoral calcification and reactive hyperostosis were present, radiologically mimicking an osteogenic sarcoma.
Assuntos
Coristoma/diagnóstico , Neoplasias Epidurais/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Adolescente , Biópsia , Coristoma/patologia , Coristoma/cirurgia , Diagnóstico Diferencial , Neoplasias Epidurais/patologia , Neoplasias Epidurais/cirurgia , Feminino , Humanos , Laminectomia , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/patologia , Meningioma/cirurgia , Osteossarcoma/diagnóstico , Osteossarcoma/patologia , Osteossarcoma/cirurgia , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgiaRESUMO
Previous reports of computed tomographic scan with contrast myelography in cervical spinal cord injury have shown a rate of disc herniation of less than 5%. We hypothesized that injuries associated with forces adequate to cause bone or ligamentous injury in the region of the disc space could be associated with higher and more significant rates of disc herniation. Thirty-seven consecutive traumatic midcervical fracture subluxations were reviewed. Fracture subluxation was defined by fracture of the facet joints, pedicles, or vertebral bodies or more than 3.5 mm subluxation from C2-C3 to C7-T1. Reduction was achieved in 97% and was not associated with neurological deterioration. On the basis of plain films, tomograms, and plain computed tomographic scans, the injuries were classified as flexion dislocation, flexion compression, compression burst, or extension injuries. Twenty-five computed tomographic scans with contrast myelograms and one magnetic resonance imaging scan were obtained. All patients with partial neurological deficits were studied. A herniated disc was defined as that which deformed the thecal sac and/or nerve roots. Retrospectively, a neuroradiologist reviewed the studies for the presence of herniated disc. Disc herniation was seen at the level of injury in 9 (35%) patients and not seen in other patients. Forty-seven percent of the patients with partial deficits had herniated discs. Herniated disc was seen most frequently in flexion dislocation and flexion compression injuries. Three patients (20%) with partial deficits underwent discectomy. Patients with partial spinal cord injury and discectomy, on average, improved more than other patients with partial spinal cord injury.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Vértebras Cervicais/lesões , Deslocamento do Disco Intervertebral/etiologia , Fraturas da Coluna Vertebral/complicações , Adulto , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Luxações Articulares/complicações , Masculino , Pessoa de Meia-Idade , Mielografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
A variation of an extracranial-intracranial arterial bypass is presented. The subclavian artery is used as the donor vessel and the saphenous vein as the graft; thus, a bypass to a cortical branch of the middle cerebral artery can be accomplished. The advantage of this modification is that the saphenous vein, when tunneled subcutaneously behind the ear, is positioned in a straight line from the donor to the recipient vessel. Since the vein lies in the axis of head rotation, turning of the head causes little displacement of the graft, as opposed to a graft from the common carotid artery to the middle cerebral artery. An additional advantage over the superficial temporal artery to middle cerebral artery bypass is the large flow obtained immediately after anastomosis.
Assuntos
Artérias Cerebrais/cirurgia , Revascularização Cerebral/métodos , Veia Safena/transplante , Artéria Subclávia/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Transplante AutólogoRESUMO
The microsurgical preparation and high level performance with extracorporeal recipient perfusion of a stable, totally isolated rat brain model is presented. Emphasis has been placed on the use of the operating microscope, bipolar cautery and mechanical fixation units to affect a complete ablation of all non-osseous cephalic and vertebral tissues with minimal physiological disturbance of the animal as a whole. The simplified technique of recipient support circulation of the isolated brain organ achieves at least 5 h of tissue viability and function as measured by electrocortical activity, A-Vo2 differences and morphological appearance. To date, no other isolated rodent brain model has been described which is truly anatomically separated from all cephalic tissues. Additionally, other surgical attempts at isolation have required the use of abnormal physiological states, including deep hypothermia and circulatory arrest.
Assuntos
Encéfalo/fisiologia , Circulação Extracorpórea , Microcirurgia/métodos , Animais , Encéfalo/irrigação sanguínea , Encéfalo/cirurgia , Eletroencefalografia , Masculino , Perfusão , Ratos , Ratos EndogâmicosRESUMO
The effects of changes of perfusion pressure and hypothermia on the cerebral blood flow of a new isolated rat brain preparation have been studied in 7 animals. The cerebral blood flow was extremely sensitive to the mean arterial pressure of perfusion, showing little evidence of autoregulation at low pressure, and only slight evidence in hypertension. The cerebral blood flow was lower in hypothermia. The preparation maintained good electroencephalographic activity throughout, and arteriovenous differences persisted up to 1 h after it became isoelectric.
Assuntos
Encéfalo/irrigação sanguínea , Circulação Cerebrovascular , Hipotermia Induzida , Animais , Encéfalo/fisiologia , Eletroencefalografia , Circulação Extracorpórea , Masculino , Perfusão , Pressão , Ratos , Ratos EndogâmicosRESUMO
Changes of tropomyosin isoforms have previously been found accompanying morphologic alterations such as those associated with neoplastic transformations in mammalian cells. To determine whether an isoform change is associated with the malignancy of brain tumors, we employed both polyclonal antibodies specific to high and low molecular weight tropomyosin isoforms. We found, by using immunocytochemistry and immunoblotting, that an alteration of tropomyosin isoforms is associated with human astrocytomas. Differential staining patterns were seen for normal, reactive, and neoplastic astrocytes. Characterization of the antibodies revealed an increase in the higher molecular weight tropomyosin in more anaplastic astrocytomas than in those that were well differentiated. We also observed that the different isoforms have specific subcellular localizations. These findings suggest that neoplastic transformation is associated with alteration of tropomyosin isoforms in astrocytomas. We speculate that this change may be related to morphologic transformation in which microfilament functions, such as cell shape, interaction, and recognition are altered.
Assuntos
Astrócitos/análise , Astrocitoma/análise , Neoplasias Encefálicas/análise , Glioblastoma/análise , Tropomiosina/análise , Adolescente , Adulto , Idoso , Astrócitos/citologia , Astrocitoma/patologia , Neoplasias Encefálicas/patologia , Criança , Eletroforese em Gel de Poliacrilamida , Epitopos/análise , Feminino , Glioblastoma/patologia , Humanos , Immunoblotting , Masculino , Pessoa de Meia-Idade , Peso Molecular , Tropomiosina/imunologiaRESUMO
Cervical spine fractures are a serious complication of maxillofacial trauma because of the high potential for mortality and neurologic morbidity. This study reviewed 563 patients with facial fractures treated by the Division of Oral and Maxillofacial Surgery at a level I trauma center and identified 11 concomitant cervical spine fractures (2.0%). These patients were almost exclusively male (91%), white (100%), between 20 and 35 years of age (64%), involved in a motor vehicle accident (91%), with a concomitant mandibular fracture (91%). The examination, diagnosis, and management of patients with cervical spine injuries are discussed.
Assuntos
Vértebras Cervicais/lesões , Traumatismos Maxilofaciais/complicações , Fraturas da Coluna Vertebral/complicações , Acidentes de Trânsito , Adulto , Criança , Feminino , Humanos , Masculino , Fraturas Mandibulares/complicações , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/terapia , Fraturas Maxilares/complicações , Fraturas Maxilares/diagnóstico por imagem , Fraturas Maxilares/terapia , Pessoa de Meia-Idade , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapiaRESUMO
Posttraumatic chronic atlantoaxial rotatory subluxation and congenital absence of the posterior arch of the atlas are rare upper cervical spine abnormalities. The present case is that of a 4-year-old girl who had these two spinal disorders as well as spastic cerebral palsy. The interrelationship, if any, between these three conditions is unclear but presented an unusual diagnostic triad. A posterior spinal fusion between the occiput and third cervical vertebra was performed because of concern for upper cervical spine instability. The patient was immobilized in a halo vest, and a solid fusion occurred within 3 months. Preoperatively the child had never walked independently, but postoperatively, while wearing the halo vest, she was able to walk without external support, thus raising the suspicion of previous spinal instability. Fifteen months postoperatively she remains spastic but has a stable, orthotic-free, independent gait.
Assuntos
Articulação Atlantoaxial/lesões , Paralisia Cerebral/patologia , Atlas Cervical/anormalidades , Luxações Articulares/patologia , Acidentes de Trânsito , Articulação Atlantoaxial/diagnóstico por imagem , Paralisia Cerebral/complicações , Paralisia Cerebral/diagnóstico por imagem , Atlas Cervical/diagnóstico por imagem , Pré-Escolar , Doença Crônica , Pé Torto Equinovaro/patologia , Feminino , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Radiografia , Fusão Vertebral , Síndrome , Torcicolo/diagnóstico por imagem , Torcicolo/etiologia , Torcicolo/cirurgiaRESUMO
A 100-month retrospective review was undertaken to identify the population characteristics of patients with both facial and cranial fractures and to establish the relationships between them. A 4.4% incidence of cranial fractures was found in the 882 patients with facial fractures. These patients tended to be males (85%) between the ages of 16 and 30 years (54%) who were involved in motor vehicle accidents (64%). Patients with midfacial fractures predominated (70%), and these injuries were most frequently associated with fractures of the frontal (38%), sphenoid (24%), or temporal (22%) bones. No relationship was noted between mandibular fractures and cranial fractures. Midfacial fractures were related to individual cranial bone fractures by sutural attachment. The presence of cranial fractures did not play a role in the development of complications associated with facial fractures.
Assuntos
Ossos Faciais/lesões , Fraturas Cranianas/epidemiologia , Acidentes de Trânsito , Adolescente , Adulto , Fatores Etários , Lesões Encefálicas/classificação , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/etiologia , Criança , Comorbidade , Feminino , Fraturas não Consolidadas/epidemiologia , Osso Frontal/lesões , Escala de Coma de Glasgow , Humanos , Masculino , Fraturas Mandibulares/epidemiologia , Fraturas Maxilares/epidemiologia , Ohio/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Fraturas Cranianas/classificação , Fraturas Cranianas/etiologia , Osso Esfenoide/lesões , Osso Temporal/lesões , Fraturas Zigomáticas/epidemiologiaRESUMO
One hundred closed head injuries associated with facial fractures treated over a 78-month period at a level I trauma center in Northeast Ohio were reviewed. The incidence of closed head injury in patients with facial fractures was 17.5%. Males suffered closed head injuries four times more often than females, and sustained severe intracranial injuries eight times as often. The 16- to 30-year age group predominated (59%). Although motor vehicle accidents were the most frequent cause of injury (61%), motorcycle accidents were associated with the most severe head injury. The mandible/midface fracture ratio (1.3:1) was almost half that of the non-head-injured population (2.1:1). Facial fracture complications were found to have a similar incidence (14%) as in the non-head-injured population, but were associated with more severe intracranial injuries.