ABSTRACT
Spontaneous intracranial hematoma is not rare, but with bad prognosis, complication in patients on maintenance hemodialysis (HD). Diagnostic difficulties result from a fact that symptoms of acute hematoma such as headaches,, nausea, vomitis, apathy, sleepiness, parestesia and seizures may also suggest dysequilibrium syndrome, dialytic dementia as well as hypertensive encephalopathy. We describe a case of female patient with 20-year interview data of hypertension on HD since 1981 because of end-stage renal failure in a course of chronic glomerulonephritis, who developed spontaneous epi- and subdural hematoma four year ago in 47 age of life. Performed CT examination confirmed diagnosis and on the same day the patient underwent right frontoparietotemporal craniotomy and the hematoma was removed. During postoperative period, HD sessions were performed without heparin. After surgery the patient developed transcient hypertonia, epileptic sizures and left-sided paresis. Currently, 48 months after craniotomy the patient is fully rehabilitated, with normal blood pressure, without epileptic sizures or palsy. Gradually we discontinued anticonvulsans and antihypertensives.
Subject(s)
Hematoma, Epidural, Cranial/surgery , Hematoma, Subdural/surgery , Kidney Failure, Chronic/complications , Craniotomy/adverse effects , Female , Hematoma, Epidural, Cranial/diagnostic imaging , Hematoma, Epidural, Cranial/etiology , Hematoma, Subdural/diagnostic imaging , Hematoma, Subdural/etiology , Humans , Hypertension/etiology , Kidney Failure, Chronic/therapy , Middle Aged , Paraparesis/etiology , Paraparesis/rehabilitation , Radiography , Renal Dialysis , Seizures/etiology , Seizures/prevention & control , Treatment OutcomeABSTRACT
Even with the advent of the present diagnostic possibilities, polytraumas are still a serious problem with a large mortality. Owing to the complexity of the clinical picture, severe craniocerebral injury masks other extracerebral signs and creates a risk of unnoticeable injury of another organ. We describe a case of a 63 year-old patient, who suffered a polytrauma in road accident. A typical treatment of traumatic subarachnoid haemorrhage was administered and patient's state of consciousness improved. On 5-th day after the trauma the patient's state deteriorated. The neurological examination didn't reveal intracranial hypertension signs. Increasing anaemia was detected and an extracerebral reason of deterioration was sought. The following x-ray picture of chest was taken revealing elevation of the diaphragm without any other posttraumatic lesions. The patient was selected for thoracosurgical operation because pericordial sac disruption and diaphragm contusion were found. The pericardial sac was sutured. During further treatment the patient's state improved. He was discharged walking and independent.
Subject(s)
Multiple Trauma/diagnosis , Diagnosis, Differential , Diaphragm/injuries , Hemothorax/diagnostic imaging , Humans , Intracranial Pressure/physiology , Male , Middle Aged , Multiple Trauma/complications , Radiography, Thoracic , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/etiology , Temporal Lobe/diagnostic imaging , Temporal Lobe/injuries , Tomography, X-Ray ComputedABSTRACT
Piracetam (Nootropil) is a cytoprotective to brain tissue and improving cerebral blood flow medicine. In the Department of Neurotraumatology we investigated results of piracetam treatment in a group of 100 succeeding patients admitted between 1995-96 due to craniocerebral injury. High doses (24-30 g per day) of this medicine have a positive effect on final result of treatment, when treatment is initiated immediately after the injury and described conditions are abided. We also showed usefulness of piracetam treatment in posthospital management.
Subject(s)
Brain Injuries/drug therapy , Neuroprotective Agents/therapeutic use , Piracetam/therapeutic use , Cerebrovascular Circulation/drug effects , Glasgow Coma Scale , Humans , Treatment OutcomeABSTRACT
Deep phlebothrombosis is a one of the postoperative complications in neurosurgery in 90% localized in lower extremities. The brain contains the highest concentration of tissue thromboplastin compared with the other organs. That fact plays an important roll in pathophysiology of thrombo-embolic process in neurosurgery. The most frequent places of thrombogenesis are venous sinus of soleus muscle and gastrocnemius muscle, next: deep veins of crus, femoral veins and iliac veins. We describe the case of the efficient treatment of femoral vein and iliac vein thrombosis using filter placed under control of monitor in the inferior caval vein higher than the thrombus.
Subject(s)
Hemofiltration/methods , Iliac Vein/surgery , Postoperative Complications/surgery , Thrombophlebitis/surgery , Vena Cava, Inferior/surgery , Female , Humans , Meningioma/diagnosis , Meningioma/surgery , Middle Aged , Neoplasm Recurrence, Local , Postoperative Complications/diagnosis , Radiography , Skull Neoplasms/diagnosis , Skull Neoplasms/surgery , Sphenoid Bone/diagnostic imaging , Sphenoid Bone/surgery , Thrombophlebitis/diagnosisABSTRACT
We report a case of Sneddon syndrome in a 39-year-old woman who developed recurrent cerebral ischaemic events associated with livedo racemosa. We describe clinical and radiological features of this rare vasculopathy and laboratory findings essential for differential diagnosis.
Subject(s)
Sneddon Syndrome/diagnosis , Adult , Biopsy , Female , Humans , Ischemic Attack, Transient/diagnosis , Skin/pathology , Tomography, X-Ray ComputedABSTRACT
A group of 100 patients treated immediately following a cranio-cerebral injury was analyzed. The patients, administered piracetam either in an intravenous infusion (GCS 3-8) or orally (GCS above 9), were divided into groups depending on the dose and clinical status. Piracetam participates in the activity of the majority of neurotransmitters, increases glucose and oxygen consumption in the ischaemic nervous tissue and increases blood flow through cerebral terminal vessels. In cranio-cerebral injuries, piracetam is employed to achieve cytoprotection and improve cerebral blood flow. In patients with neurological deterioration following the administration of 6-10 mg/day, no good results were obtained. A dose of 24-30 mg/day had a significant positive effect on therapeutic results providing certain conditions were met, such as ensuring proper partial oxygen pressure (oxygen therapy) and proper blood glucose levels. The use of piracetam is justified immediately after an injury; after the discharge oral piracetam therapy is recommended.
Subject(s)
Brain Injuries/drug therapy , Neuroprotective Agents/therapeutic use , Piracetam/therapeutic use , Dose-Response Relationship, Drug , Humans , Injections, Intravenous , Retrospective Studies , Treatment OutcomeABSTRACT
Posttraumatic posterior cranial fossa haematoma is a rare occurrence. In our material it accounted for 1.5% of all intracranial haematomas. Due to its infrequency and diagnostic difficulties these patients are referred with delay to neurosurgeons and often die with signs of brain stem lesion. The reported case was a 25-year-old man with this haematoma and considerable diagnostic difficulties were encountered despite the application of modern imaging techniques. These difficulties hamper the qualification of the patient for operation which is the method of choice in these cases.
Subject(s)
Brain Stem/pathology , Cranial Fossa, Posterior/diagnostic imaging , Hematoma, Epidural, Cranial/pathology , Adult , Brain Stem/surgery , Cranial Fossa, Posterior/injuries , Cranial Fossa, Posterior/surgery , Diagnosis, Differential , Hematoma, Epidural, Cranial/surgery , Humans , Male , Tomography, X-Ray ComputedABSTRACT
Nine cases of posttraumatic primary brain stem haematoma are described. All cases presented ocular and vegetative symptoms. Hyperextension was regarded as the most likely mechanism of injury. All patients were treated conservatively; half of them with a good outcome.
Subject(s)
Brain Stem/injuries , Cerebral Hemorrhage/therapy , Head Injuries, Closed/therapy , Hematoma/therapy , Adolescent , Adult , Aged , Brain Stem/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Child, Preschool , Female , Glasgow Coma Scale , Head Injuries, Closed/diagnostic imaging , Hematoma/diagnostic imaging , Humans , Male , Middle Aged , Pons/diagnostic imaging , Pons/injuries , Tomography, X-Ray Computed , Treatment Outcome , Whiplash Injuries/diagnostic imaging , Whiplash Injuries/therapyABSTRACT
Posttraumatic vasospasms occur according to various authors in 5-10% of cases, and in our material they were demonstrated in 6% of the patients, that is about 8 times less frequently than in cases of bleeding from a vascular malformation. Computed tomography of the head showing posttraumatic vasospasm complicating "normal" clinical course is ever less frequent which does not mean that this disturbance is not occurring, but rather it shows that CT is insufficient for its demonstration. It was shown that in every case of unclear aetiology in which the clinical condition is not correlating with CT pattern of the head angiography of brain vessels should be performed or cerebral blood flow should be determined by other making possible early institution of adequate (targeted) treatment.