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2.
Clin Chim Acta ; 505: 43-48, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32088210

RESUMO

BACKGROUND: Intracerebral hemorrhage (ICH) can lead to inflammation. Serum amyloid A (SAA) is an acute phase protein, which might be implicated in acute brain injury. We ascertain relationship between serum SAA and inflammation, severity plus outcome after ICH. METHODS: In this prospective, observational study, serum SAA concentrations were quantified in 159 healthy volunteers and 159 acute primary basal ganglia hemorrhage patients admitted within 24 h after stroke symptom. Prognostic parameters included death and a poor outcome (modified Rankin Scale score > 2) at 90 days after stroke. RESULTS: Serum SAA concentrations were substantially higher in patients than in controls. Among patients, serum SAA concentrations were strongly correlated with serum C-reactive protein concentrations, hematoma volume and National Institutes of Health Stroke Scale scores. Serum SAA appeared to be an independent predictor for 90-day death, overall survival and poor outcome. Under receiver operating characteristic curve, this protein exhibited similar prognostic capability, as compared to hematoma volume and National Institutes of Health Stroke Scale scores. CONCLUSIONS: Rising serum SAA concentrations, in close correlation with inflammation and hemorrhagic severity, are independently related to mortality and poor outcome after ICH, indicating that serum SAA might serve as a potential prognostic biomarker for ICH.


Assuntos
Hemorragia dos Gânglios da Base/sangue , Proteína Amiloide A Sérica/análise , Idoso , Hemorragia dos Gânglios da Base/complicações , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Hematoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Análise de Sobrevida , Resultado do Tratamento
3.
World Neurosurg ; 134: 176-181, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31712110

RESUMO

BACKGROUND: Various radiologic patterns of posterior reversible encephalopathy syndrome (PRES) have been reported. Among them, PRES involving brainstem, thalamus, or deep white matter and lacking parieto-occipital edema is rare. Although PRES in general has a benign course, PRES-related intracranial hemorrhage has been associated with a poor prognosis. We report a case of variant type of PRES associated with deep brain hemorrhage and discuss the characteristics of PRES-related intracranial hemorrhage via a literature review. CASE DESCRIPTION: A woman aged 41 years with a history of untreated hypertension presented to our hospital complaining of severe headache and with an elevated blood pressure of 237/142 mmHg. Computed tomography revealed a hemorrhage in the left thalamus and basal ganglia. Magnetic resonance imaging revealed remarkable hyperintensity in the left cerebellum, pons, bilateral temporal lobes, bilateral basal ganglia, and bilateral cerebral white matter on fluid-attenuated inversion recovery imaging, which represented vasogenic edema. The parieto-occipital regions were unremarkable. Given this clinical presentation, PRES associated with deep brain hemorrhage was suspected. The patient received strict blood pressure control treatment, which resulted in gradual symptom improvement. Magnetic resonance images obtained 1 month after admission demonstrated an almost complete resolution of the edema. CONCLUSIONS: Although hemorrhage in the thalamus, basal ganglia, or brainstem is uncommon in patients with PRES, it may occur in patients with variant type of PRES involving these lesions. It is important to recognize the presence of variant patterns of clinical features and radiologic findings of PRES to allow for early identification and appropriate treatment.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Doenças Talâmicas/diagnóstico por imagem , Adulto , Anti-Hipertensivos/uso terapêutico , Hemorragia dos Gânglios da Base/complicações , Hemorragia dos Gânglios da Base/fisiopatologia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Doenças Talâmicas/complicações , Doenças Talâmicas/fisiopatologia , Tomografia Computadorizada por Raios X
4.
J Craniofac Surg ; 31(1): e27-e30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31449206

RESUMO

OBJECTIVE: Basal ganglia hemorrhage can damage the internal capsule and lead to high rates of disability and mortality. The distal transsylvian approach is a validated approach in the treatment of basal ganglia hemorrhage. However, this approach is difficult and prone to complications. The present study was performed to investigate the surgical techniques and prevention of complications of basal ganglia hemorrhage through the distal transsylvian approach. PATIENTS AND METHODS: From January 2015 to January 2018, the authors treated 40 cases of basal ganglia hemorrhage using the distal transsylvian approach. The surgical video recordings and the patients' clinical data were retrospectively analyzed. The authors discussed the surgical techniques and prevention of complications through the distal transsylvian approach. RESULTS: Thirty-eight cases of basal ganglia hemorrhage were successfully treated through the distal transsylvian approach. The other 2 cases were converted to the transcortical transtemporal approach. In the early cases, complications occurred in 3 stages: sylvian fissure dissection, insula lobectomy, and hematoma removal. In the subsequent cases, the authors implemented appropriate surgical techniques to prevent complications. CONCLUSION: Basal ganglia hemorrhage can be treated through the distal transsylvian approach, but not in all patients. The distal transsylvian approach is highly technical and more problematic than the transcortical transtemporal approach. Mastering certain operative skills can reduce the surgical complications.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Feminino , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos
5.
J Neurointerv Surg ; 12(1): 55-61, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31300535

RESUMO

BACKGROUND: The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE: To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS: Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS: For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION: Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/cirurgia , Craniotomia/métodos , Neuroendoscopia/métodos , Paracentese/métodos , Técnicas Estereotáxicas , Adulto , Idoso , Hemorragia dos Gânglios da Base/mortalidade , Estudos de Coortes , Craniotomia/mortalidade , Feminino , Humanos , Imageamento Tridimensional/métodos , Imageamento Tridimensional/mortalidade , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/mortalidade , Paracentese/mortalidade , Estudos Retrospectivos , Técnicas Estereotáxicas/mortalidade , Resultado do Tratamento
6.
World Neurosurg ; 135: 367-374.e1, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31770599

RESUMO

BACKGROUND: Intracerebral hematomas (ICH) is a common disease in the developing countries, and minimally invasive transportal resection of ICH is a widely accepted surgical technique. Many port systems are available, but most are disposable and expensive. We present a safe and cost-effective glove-syringe substitute for endoscopic hematoma evacuation, suitable for developing countries such as China. METHODS: A port substitute of different sizes and lengths was constructed using sterile gloves and syringes, commonly found in a surgical environment. RESULTS: We successfully performed endoscopic hematoma removal in 7 patients including 1 cerebellar hemorrhage case and the remaining 6 supratentorial basal ganglia cases (1 patient taking oral aspirin). Bipolar electrocoagulation was used to control bleeding from the ruptured blood vessels. There were no postsurgical complications. CONCLUSIONS: The glove-syringe port is a convenient, safe, and cost-effective tubular port system for endoscopic surgery of ICH. Such ports can be used as substitutes when commercial sleeves are unavailable, especially in rural areas and developing countries.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Doenças Cerebelares/cirurgia , Luvas Cirúrgicas , Neuroendoscopia/instrumentação , Seringas , Idoso , Hemorragia Cerebral/cirurgia , China , Análise Custo-Benefício , Países em Desenvolvimento , Drenagem , Feminino , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
7.
No Shinkei Geka ; 47(12): 1247-1254, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31874945

RESUMO

OBJECTIVE: We report an unusual case of tentorial dural arteriovenous fistula(DAVF)with bithalamic lesions and bilateral intracranial hemorrhage. CASE PRESENTATION: A 73-year-old man presented with lethargy and progressive cognitive decline. Imaging demonstrated bithalamic edematous lesions and bilateral basal ganglia hemorrhage in the right putamen and left internal capsule. Angiography revealed tentorial DAVF fed by both the internal and external carotid arteries. A shunted pouch was present in the superior petrosal sinus, and retrograde reflux drainage was see in the deep venous system, including the basal vein, vein of Galen, and internal cerebral veins with congestion. Initially, transarterial embolization was palliatively performed, and subsequently, a microsurgery achieved obliteration of the tentorial DAVF. Postoperatively, the bilateral thalamic changes disappeared, although sequela of the intracranial hemorrhage persisted. CONCLUSION: Deep venous congestion due to tentorial DAVF induced unusual bithalamic lesions and bilateral basal ganglia hemorrhage. Tentorial DAVF was treated with combined endovascular and surgical operations. Tentorial AVF is an aggressive vascular disease, and prompt diagnosis and treatment are necessary.


Assuntos
Hemorragia dos Gânglios da Base , Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Seios Transversos , Idoso , Angiografia Cerebral , Dura-Máter , Humanos , Masculino
9.
World Neurosurg ; 131: e562-e569, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400527

RESUMO

BACKGROUND: Minimally invasive surgical techniques may have beneficial effects on spontaneous intracerebral hemorrhage. Accurate localization of the hematoma and real-time guided puncture are more important in minimally invasive surgical procedures than in traditional craniotomy. Here, we introduce a novel simple puncture positioning and guidance system for intracerebral hematoma and demonstrate its utility for hematoma puncture surgery in a simulation experiment and series of patients. METHODS: We describe the device and use of the technique for hematoma puncture surgery in basal ganglia hematomas and report on the precision of the simulation experiments compared to that of freehand puncture, as well as its clinical application in 16 cases. RESULTS: The accuracy of this technique was superior to that of freehand puncture. All 16 patients underwent successful puncturing of the hematoma cavity or ventricles only once without any related complications. CONCLUSIONS: We demonstrate a novel simple puncture positioning and guidance system that has the advantages of simplicity, low-cost, device availability, and individual real-time guidance. We believe this system may be useful in resource-limited centers where navigation is not available.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Hemorragia Cerebral Intraventricular/cirurgia , Drenagem/métodos , Hematoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Punções/métodos , Adulto , Idoso , Hemorragia Cerebral/cirurgia , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Cirurgia Assistida por Computador
10.
World Neurosurg ; 131: e402-e407, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376559

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage (SICH) is of high mortality and morbidity. SICH in the basal ganglia is usually attributed to chronic hypertension. Postoperative rehemorrhage is a severe complication, and it is relative to surgical techniques. METHODS: A retrospective survey was conducted on 123 patients with basal ganglia SICH who received surgery from January 2015 to January 2019. Postoperative rehemorrhage within 24 hours was recorded. Preoperative clinical parameters, surgeon experience (<10 and >20 years), operation time, surgical approach, and hemostasis technique were recorded and analyzed. RESULTS: The total postoperative rehemorrhage rate was 12.2% (15/123). The univariable analysis showed general surgeons had a higher postoperative rehemorrhage rate than experienced surgeons (30.4% vs. 8.6%, respectively; P = 0.068). The operation time (minutes) in experienced surgeons was significantly longer (164.9 ± 53.5 vs. 137.7 ± 30.8, P = 0.016), but they had a higher chance to locate the responsible vessel (74.2% vs. 40.0%, P = 0.001), respectively. Logistic analysis indicated that experienced surgeons significantly reduced the risk of rehemorrhage (odds ratio [OR], 0.242; P = 0.021). Transsylvian approach was a protective factor for postoperative rehemorrhage (OR, 0.291; P = 0.045). CONCLUSIONS: Surgeons' experience plays the most important role in postoperative rehemorrhage. Surgeons with rich experience were willing to spend more time to achieve definitive hemostasis in operation. The use of a transsylvian approach can significantly reduce the rehemorrhage rate. Packing hemostasis with gelatin sponge may increase complications.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Hemostasia Cirúrgica/métodos , Neurocirurgiões/estatística & dados numéricos , Procedimentos Neurocirúrgicos/métodos , Hemorragia Pós-Operatória/epidemiologia , Adulto , Craniectomia Descompressiva/métodos , Feminino , Esponja de Gelatina Absorvível , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Recidiva , Estudos Retrospectivos
11.
J Integr Neurosci ; 18(2): 193-196, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31321961

RESUMO

The two most common surgical interventions for spontaneous intracerebral hemorrhage in the basal ganglia of patients more than 65 years old are either minimally invasive puncture and drainage or craniotomy. This study aimed to compare the curative effects of these two procedures in such patients. A retrospective study of patients older than years with spontaneous intracerebral hemorrhage was conducted between January 2012 and December 2015. Of the 86 patients, 47 received minimally invasive puncture and drainage and 39 underwent craniotomy. One year after surgery no statistically significant difference was observed between the two groups with respect to: evacuation rate of the hematoma five days after the operation, volume of residual hematoma, occurrence of rebleeding, development of infectious meningitis, length of hospitalization, fatality, or Glasgow Outcome Scale and Barthel Index scores. However, the amount of blood loss during the procedure (P < 0.001), total cost of hospitalization (P = 0.004), and incidence of epilepsy (P = 0.045) were significantly higher for the craniotomy group than the minimally invasive puncture and drainage group. It was found that, in patients older than 65 years with basal ganglia hemorrhage, minimally invasive puncture and drainage is less invasive, more cost efficient and induces less bleeding during surgery than craniotomy.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Craniotomia/métodos , Paracentese/métodos , Idoso , Idoso de 80 Anos ou mais , Craniotomia/normas , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Paracentese/normas , Estudos Retrospectivos , Resultado do Tratamento
12.
J Craniofac Surg ; 30(8): e768-e771, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31348204

RESUMO

To evaluate the edema area around basal ganglia hemorrhage by the application of computerized tomography (CT)-based radiomics as a prognostic factor and improve the diagnosis efficacy, a total of 120 patients with basal ganglia hemorrhage were analyzed retrospectively. The texture analysis software Mazda 3.3 was used to preprocess the CT images and manually sketch the region of interest to extract the texture features. The extracted texture features were selected by Fisher coefficient, POE+ACC and mutual information. The texture discriminant analysis uses the B11 module in the Mazda 3.3 software. The data were randomly divided into a training dataset (67%) and test dataset (33%). To further study the texture features, the training dataset can be divided into groups according to the median of GCS score, NIHSS score, and maximum diameter of hematoma. Random forest model, support vector machine model, and neural network model were built. AUC of the receiver operating characteristics curve was used to assess the performance of models with test dataset. Among all texture post-processing methods, the lowest error rate was 2.22% for the POE+ACC/nonlinear discriminant. For the maximum diameter of hematoma, GCS score, and NIHSS score group, the lowest error rate were 26.66%, 23.33%, and 30.00%, respectively. The values of AUCs were 0.87, 0.81, and 0.76, for random forest model, support vector machine model, and neural network model in the test dataset, respectively. Radiomic method with proper model may have a potential role in predicting the edema area around basal ganglia hemorrhage. It can be used as a secondary group in the diagnosis of edema area around basal ganglia hemorrhage.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Edema/diagnóstico por imagem , Idoso , Hemorragia dos Gânglios da Base/complicações , Edema/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
13.
J Craniofac Surg ; 30(4): e306-e308, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166274

RESUMO

Basal ganglionic germinoma (BGG) with syncytiotrophoblastic giant cells (STGC) is a rare type of ectopic germ cell tumors with mild elevation of human chorionic gonadotropin level. Intratumoral hemorrhage is not uncommon for BGG, but presenting with repeated hemorrhage is very rare. Herein, we described an extremely rare case of BGG with STGC mimicking a growing hematoma. Furthermore, the characteristics, treatment, and prognosis of BGG with STGC were investigated and reviewed.


Assuntos
Hemorragia dos Gânglios da Base/patologia , Gânglios da Base/patologia , Neoplasias Encefálicas/patologia , Germinoma/patologia , Hematoma/patologia , Diagnóstico Diferencial , Feminino , Células Gigantes/patologia , Humanos , Masculino , Paresia/etiologia , Prognóstico , Recidiva , Trofoblastos/patologia
14.
World Neurosurg ; 129: e494-e501, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150853

RESUMO

OBJECTIVE: Hemorrhage in the basal ganglia is a common type of intracerebral hemorrhage and has high mortality and poor prognosis. In our study, we aimed to evaluate surgical outcomes and functional recovery after evacuation of hematoma using either craniotomy or endoscopy. METHODS: We analyzed retrospective data from 58 patients with basal ganglia hemorrhage who were treated with hematoma evacuation using either craniotomy or endoscopy. Magnetic resonance imaging and a navigation system were used for calculating hematoma volume and for navigation during surgery. Clinical information and surgical outcomes were recorded. At 6-month follow-up, the recovery of neurologic function and the results of the Aphasia Battery of Chinese test were assessed. RESULTS: The endoscopy group showed lower intraoperative blood loss (75.36 ± 45.56 vs. 462.67 ± 120.08 mL, P < 0.001), shorter operation time (1.59 ± 0.30 vs. 4.17 ± 0.86 hours, P < 0.001), and a higher hematoma clearance rate (0.93% ± 0.05% vs. 0.88% ± 0.13%, P = 0.04) than the craniotomy group, respectively. No significant differences in mortality were identified, but a trend toward lower mortality in the endoscopy group was apparent (7.14% in the endoscopy group vs. 16.67% in the craniotomy group, P = 0.43). Assessment of neurologic recovery indicated significant differences in the modified Rankin Scale grades between the 2 groups (χ2 = 4.381, P = 0.036). Listening comprehension and speaking ability were also better in the endoscopy group than the craniotomy group (χ2 = 4.693, P = 0.03). CONCLUSIONS: Evacuation by endoscopy had better surgical outcomes, recovery of neurologic function, and aphasia recovery than evacuation by craniotomy. It appears that endoscopy is the surgical treatment of choice for middle-aged and elderly patients with a basal ganglia hemorrhage volume of >35 mL.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Gânglios da Base/cirurgia , Craniotomia/métodos , Neuroendoscopia/métodos , Recuperação de Função Fisiológica/fisiologia , Idoso , Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
J Neurol Surg A Cent Eur Neurosurg ; 80(6): 498-502, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31075809

RESUMO

BACKGROUND: Cranioplasty is a common procedure in neurosurgery. It is usually performed following decompressive craniectomy (DC). However, complications may occur after the operation, such as massive brain swelling. Up to now, far too little attention has been given to this severe complication. We report one case of fatal cerebral swelling after cranioplasty and analyze the possible mechanism of this complication. CASE DESCRIPTION: The patient was a 40-year-old man who had a severe right basal ganglia cerebral hemorrhage and underwent DC ∼ 2 months before. One day before scheduled cranioplasty, a lumbar cerebrospinal fluid drainage was placed. The cranioplasty itself was uneventful. However, he gradually fell into a coma, and his right pupil was moderately dilated 20 hours after the surgery. A brain computed tomography (CT) scan indicated massive right cerebral edema with compressed right midbrain. The patient did not regain consciousness, and he remained quadriplegic. CONCLUSION: It is necessary to increase awareness of complications of cranioplasty in high-risk patients. The lessons learned from this case include avoiding excessive drainage of cerebrospinal fluid. Patients with low-density lesions in the brain need to be treated with caution. Once the CT scan shows massive cerebral swelling, the patient has a poor prognosis.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Edema Encefálico/etiologia , Craniectomia Descompressiva/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Edema Encefálico/diagnóstico por imagem , Drenagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
16.
World Neurosurg ; 127: 8-10, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30928593

RESUMO

BACKGROUND: Stereotactic ventro-oral thalamotomy has been performed in cases of focal task-specific dystonia, including writer's cramp, with excellent outcomes. However, no reports have revealed the outcome of ventro-oral thalamotomy in a patient with a contralateral cerebral lesion. We describe a patient with left-hand writer's cramp with an old lesion in the left hemisphere and transient gait disturbance after right ventro-oral thalamotomy. CASE DESCRIPTION: A 43-year-old man had a hemorrhage in the left basal ganglia due to cerebral arteriovenous malformation at 22 years of age, and right hemiparesis remained as a sequela. He developed left-handed writing ability; however, he became aware of the stiffness of his left hand and difficulty in writing. Writer's cramp was diagnosed. Medical treatments were not effective, and right ventro-oral thalamotomy was performed. Although his writing ability improved, he could not walk. After performing rehabilitation, his walking completely improved, reaching the level before surgery, after 3 months, and his writer's cramp was completely cured. CONCLUSIONS: In patients with basal nucleus lesions, gait disturbance may appear transiently after contralateral thalamotomy. It is crucial to fully explain the potential complications, particularly in relation to temporal gait disturbances, and obtain informed consent.


Assuntos
Distúrbios Distônicos/cirurgia , Transtornos Neurológicos da Marcha/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Tálamo/cirurgia , Adulto , Hemorragia dos Gânglios da Base/complicações , Humanos , Masculino , Complicações Pós-Operatórias , Resultado do Tratamento
17.
World Neurosurg ; 127: e835-e842, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954736

RESUMO

OBJECTIVE: Hypertensive cerebral hemorrhage leads to greater mortality and worse functional outcomes at high altitudes. Experimental studies have suggested that hemoglobin can lead to increased perihemorrhagic edema after intracerebral hemorrhage. METHODS: Patients were divided into a high-hemoglobin (H-H) group (>180 g/L) and a low-hemoglobin (L-H) group (≤180 g/L). The distance from the cortex to the midline was used to indicate the degree of edema. At 1, 7, 14, and 21 days, the patients' status was scored using the Glasgow coma scale, and survival was plotted using Kaplan-Meier survival curves. Pearson correlation analysis showed that the difference between the postoperative and preoperative Glasgow coma scale score correlated with the hemoglobin concentration. The Glasgow outcome scale was used to assess neurological recovery after 6 months. RESULTS: On days 7, 14, and 21, the edema of the H-H group was significantly greater than that of the L-H group (P < 0.01 and P < 0.001, respectively). The edema of the H-H group peaked at 14 and 21 days, but that of the L-H group peaked at 7 days. The hemoglobin concentration and postoperative neurological recovery had a linear relationship in the H-H group. The L-H group had greater survival compared with the H-H group (P < 0.05). The L-H group had higher Glasgow outcome scale scores compared with the H-H group (P < 0.05). CONCLUSION: The hemoglobin concentration affects the mortality and morbidity from hypertensive cerebral hemorrhage in high-altitude regions, and a linear relationship exists between hemoglobin concentration and neurological recovery in the H-H group.


Assuntos
Altitude , Hemorragia dos Gânglios da Base/sangue , Hemoglobinas/biossíntese , Hipertensão/etiologia , Hemorragia Intracraniana Hipertensiva/sangue , Idoso , Hemorragia dos Gânglios da Base/cirurgia , Hemorragia Cerebral/cirurgia , Humanos , Hemorragia Intracraniana Hipertensiva/cirurgia , Masculino , Pessoa de Meia-Idade
18.
Neurol Med Chir (Tokyo) ; 59(5): 191-195, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30996152

RESUMO

Post-traumatic striatocapsular infarction is extremely rare and has been described only within the vascular territory of the perforating arteries originating from the middle cerebral artery (MCA). We recently encountered a patient presenting with unilateral multifocal striatocapsular hemorrhagic infarctions following mild head injury. This 25-year-old female was admitted to our trauma center after a motorcycle accident. Initial brain computed tomography and magnetic resonance (MR) imaging showed multifocal acute hemorrhagic infarctions with a clustering in the right caudate head, anterior limb of internal capsule, and globus pallidus. MR angiography and digital subtraction angiography showed suspicious luminal irregularities of the lenticulostriate arteries of the right MCA. Vessel wall MR images (VWI) did neither indicate intramural hematoma nor wall enhancement in the right MCA, suggesting dissection. However, VWI showed the passages of each lenticulostriate artery supplying each infarction site. Therefore, based on both conventional images and VWI, we postulate that this patient's post-traumatic multifocal striatocapsular hemorrhagic infarctions were caused by damage to multiple lenticulostriate arteries.


Assuntos
Hemorragia dos Gânglios da Base/diagnóstico por imagem , Gânglios da Base/irrigação sanguínea , Gânglios da Base/diagnóstico por imagem , Hemorragia Cerebral Traumática/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Adulto , Hemorragia dos Gânglios da Base/etiologia , Hemorragia Cerebral Traumática/complicações , Infarto Cerebral/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética
19.
J Clin Neurosci ; 64: 54-56, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30852075

RESUMO

We aimed to study the potential relationship of Guillain-Barré syndrome (GBS) and intracranial haemorrhage (ICH). We present a case of a 70-year-old hypertensive woman who developed global weakness, eventually becoming quadriplegic, during an inpatient stay for treatment of a basal ganglia haemorrhagic stroke. Guillain-Barré syndrome was confirmed and treatment initiated. She responded well to intravenous immunoglobulin treatment and then subsequently continued with rehabilitation. There have been a few case reports of GBS as a complication of spontaneous intracranial haemorrhage (ICH) or traumatic brain injury. It may not be a coincidence that our patient developed GBS shortly after presentation. There may be an immunological explanation with immune activation following neuronal injury after ICH with associated blood-brain barrier breakdown. GBS following ICH adds further complexity to treating patients who are already critically ill. If patients develop new weakness after ICH, there should be a high index of suspicion for GBS. It should be distinguished from critical illness neuropathy/myopathy and other causes of weakness in critical care patients because the treatment is very different. Immune activation and sensitization to myelin-associated proteins may be the underlying pathophysiological basis.


Assuntos
Hemorragia dos Gânglios da Base/complicações , Síndrome de Guillain-Barré/etiologia , Idoso , Feminino , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico
20.
World Neurosurg ; 125: 228-233, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30738934

RESUMO

BACKGROUND: Contralateral C7 nerve transfer is widely applied for the treatment of brachial plexus injuries or central paralysis of the upper extremities. The surgical approach has evolved from the precervical subcutaneous route to the prespinal route, which is currently the most commonly used one. We report a patient with central paralysis of the right upper extremity treated with contralateral C7 nerve transfer via the posterior spinal route. CASE DESCRIPTION: A 59-year-old female patient was admitted on 3 July, 2018 with right hemiplegia. The muscle strength of the right lower and upper extremities was grade 4 and 0, respectively. On the basis of magnetic resonance imaging, she was diagnosed with central paralysis of the right upper extremity. Considering the short length of the patient's healthy C7 nerve, contralateral C7 nerve transfer via the posterior spinal route was performed. No intraoperative complication was encountered. The patient reported slight numbness of the volar side of the left thumb, middle finger, and index finger after surgery. The patient showed a right shrug movement 1.5 months after surgery. CONCLUSION: We propose carrying out contralateral C7 nerve transfer via the posterior spinal route because of the shorter distance, no need for nerve transplantation, and low occurrence of the complications encountered with the prespinal route (such as vertebral artery injuries, esophageal fistula, and upper extremity pain when swallowing).


Assuntos
Hemiplegia/cirurgia , Transferência de Nervo/métodos , Raízes Nervosas Espinhais/cirurgia , Hemorragia dos Gânglios da Base/complicações , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/cirurgia , Vértebras Cervicais , Feminino , Humanos , Pessoa de Meia-Idade , Extremidade Superior
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