bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decerebrate rigidity in acute head injury
Authors: Bricolo Albino , Turazzi Sergio , Alexandre Alberto , Rizzuto Nicola 
Published: May 2009

✓ A comprehensive study of the motor patterns, usually grouped under the heading “decerebrate rigidity,” was carried out in a series of 800 patients with severe head injuries. The incidence of these manifestations was 39.6%, and when they were present chances of survival were reduced from 79.4% to 28.1%. Clinical and electromyographic investigations revealed heterogeneous and unstable motor manifestations that did not fit into the classical groups of experimental models of decerebrate rigidity. Combinations of extensor and flexor attitudes and/or responses were frequently found in the same patient, but could be separated into homogeneous groups. Each recognized postural pattern had its own distinct neurological signs and prognosis. Age did not significantly affect the outcome; however, intracranial expanding lesions (73.5%), impairment of the brain-stem oculomotor system (49.8%), and deep coma (88.9%) all contributed to an unfavorable course. Surgical treatment was effective when performed for intracranial hematomas and in patients with incomplete extensor rigidity. Good recovery was achieved in 16% of decerebrate patients, while 12.1% survived in prolonged coma or with severe disabilities.
All clinical and neuropathological data suggest that extensor motor abnormalities in the acute phase of cerebral traumatic disease do not always conclusively indicate structural brain-stem damage. A critical analysis of so-called “decerebrate rigidity” (rejecting in some instances its Sherringtonian implications) may allow for a more accurate clinical assessment of the severity of head injury.
Comparison of fascicular, interfascicular, and epineural suture techniques in the repair of simple nerve lacerations
Authors: Levinthal Robert , Jann Brown W. , Rand Robert W. 
Published: May 2009

✓ Simple lacerations of dog anterior tibial nerves were repaired utilizing fascicular, interfascicular, and epineural suture techniques. Two months following repair, the involved regions of the nerves were removed and stained with hematoxylin and eosin, Weil, Bielschowsky, and Masson trichrome stains. An independent, unbiased observer rated proximal and distal myelin, connective tissue responses, and proximal to distal axon counts. The proportion of proximal to distal axons revealed no significant difference between fascicular (77%) and epineural (67%) neurorrhaphy, but showed a significant beneficial effect of fascicular suture to the interfascicular (52%) repair (significance at < 0.02). Masson stain revealed dense connective tissue responses, but the axon counts were adversely affected only when the separate fascicles showed internal disruption by connective tissue. In general, distal myelinization was mildly superior with the fascicular neurorrhaphy technique.
It appears that in simple lacerations in nerves which are repaired via direct end-to-end suture, there is no significant advantage to fascicular over epineural repair; however, there is a definite deleterious effect of interfascicular neurorrhaphy. The theoretical and technical implications of these findings are discussed.
Brain monoamine metabolites and tryptophan in ventricular CSF of patients with spasm after aneurysm surgery
Authors: Vapalahti Matti , Hyyppä Markku T. , Nieminen Vappu , Rinne Urpo K. 
Published: May 2009

✓ Intraventricular pressure was followed continuously after operation for intracranial arterial aneurysm in 20 patients. Ventricular cerebrospinal fluid (CSF), homovanillic acid (HVA), tryptophan, and 5-hydroxyindole acetic acid (5-HIAA) were analyzed daily for 5 days, beginning before the clipping of the aneurysm. Postoperatively, seven patients had spasm, verified clinically and angiographically. Seven other patients with no clinical or angiographic signs of spasm, hydrocephalus, or increased intracranial pressure (ICP) served as controls. Nine of the 20 patients were hydrocephalic.
The mean ± SE values of HVA, tryptophan, and 5-HIAA in the controls were 264 ± 40, 1116 ± 85, and 88 ± 8 ng/ml, respectively, in the controls, and 182 ± 20, 982 ± 89, and 78 ± 3 ng/ml, respectively, in the patients with spasm. The differences are not statistically significant. However, the low values of HVA may have been produced by ischemic changes caused by the spasm. In hydrocephalic patients ventricular CSF tryptophan levels were statistically significantly higher, and 5-HIAA levels lower than in controls. In patients with increased ICP, neither alterations nor intercorrelations of monoamine metabolites and tryptophan were found. The results do not give direct support to prophylactic neuropharmacological treatment of postoperative arterial cerebral spasm. However, ventricular HVA, tryptophan, and 5-HIAA measurements can be used for prognostic purposes during the first few days after the operation.
Acute fractures of the odontoid process
Authors: Apuzzo Michael L. J. , Heiden James S. , Weiss Martin H. , Ackerson Truman T. , Harvey J. Paul , Kurze Theodore 
Published: May 2009

✓ Between 1969 and 1974, 45 cases of acute odontoid fracture were diagnosed and treated at this institution. The group consisted of 35 men and 10 women; 24 were between 19 and 40 years of age, and 21 were over 40 years old. Detectable myelopathy was appreciated in eight cases (18%). Diagnosis was established within 72 hours of the traumatic event. Initial evaluation disclosed displacement of the fracture in 17 cases (38%). Following reduction, the initial treatment was posterior fusion in three cases, and external immobilization in 42 cases. Excluding two deaths within the first week of treatment, 40 cases were available for follow-up analysis. Bone union failed to occur following periods of immobilization ranging from 4 to 6 months in 13 cases (33%). Fibrous union with no evidence of instability was apparent in two cases. Nonunion in displaced fractures was seen in 60%, with a rate of 88% in those displaced more than 4 mm. The rate of nonunion in undisplaced fractures was 16%. The rates of incidence of displacement (53% vs 26%) and nonunion (78% vs 33%) in those displaced were higher in individuals over 40 years of age than in those under 40 years. The incidence of nonunion in individuals aged under 40 with nondisplaced fractures was 12%; it was 25% for individuals over 40 years old. A total of 13 patients underwent posterior fusion. All eventually manifested stability at the C1–2 level. However, 69% failed to show bone union at the fracture site in a 6- to 18-month follow-up period.
This review indicates that in consideration of the fracture, external immobilization is the initial treatment of choice in all nondisplaced fractures. Displaced fractures occurring in patients over 40 years old, and those displaced more than 4 mm are candidates for internal stabilization and fusion as a primary mode of treatment.
Mannitol dose requirements in brain-injured patients
Authors: Marshall Lawrence F. , Smith Randall W. , Rauscher L. Andrew , Shapiro Harvey M. 
Published: May 2009

✓ There is little information as to the optimal use of mannitol. To determine the dose-response relationship, the osmotic gradient required, and the time course of intracranial pressure (ICP) reduction produced by mannitol, eight patients with acute head injury were studied in whom ICP was monitored with a ventriculostomy and found to be elevated. Ventilation was controlled to a pCO2 of 25 ± 3 mm Hg and all were paralyzed with Pavulon. None had received barbiturates. Before mannitol administration the intracranial volume-pressure response was determined. Mannitol was administered as a bolus of 0.25 gm/kg, 0.5 gm/kg, and in six patients, 1 gm/kg, separated by at least 8 hours.
In all patients the ICP reduction with 0.25 gm/kg (41.3 ± 10.2 mm Hg→16.4 ± 5.6, p < 0.01) was equivalent to that achieved with the larger doses. Serum osmolality rises of 10 mOsm or more were associated with a reduction in ICP. Much smaller doses than those previously recommended were effective in reducing the ICP acutely, although at 5 hours there was a trend toward persistent reduction when the larger dose is used. This trend was small and indicates that smaller and more frequent doses are as effective in reducing the ICP while avoiding the risk of osmotic disequilibrium and severe dehydration.
Experimental neurogenic pulmonary edema in cats
Authors: Hoff Julian T. , Nishimura Merry 
Published: May 2009

✓ Hemorrhagic pulmonary edema was produced consistently in 19 of 20 anesthetized, paralyzed, ventilated cats when intracranial pressure (ICP) was raised for 30 minutes by intraventricular infusion of mock CSF to 150 mm Hg in 14, or 200 mm Hg in six. However, under identical conditions, except that ICP was raised to only 100 mm Hg, three of seven animals did not develop hemorrhagic edema of the lungs and the remaining four had spotty hemorrhage. Thirteen control animals with normal ICP had normal lungs. Gravimetric lung water analysis by Pearce's method confirmed gross and microscopic appearance of hemorrhagic pulmonary edema. Extravascular lung water (p < 0.05) and lung blood (p < 0.05) were significantly greater than control values when ICP was raised to or exceeded 150 mm Hg. Despite hemorrhagic edema, pulmonary gas exchange (O2, CO2) remained unaffected.
This animal model allows quantitative measurement of neurogenically-mediated hemorrhagic edema of the lungs before gas exchange is impaired. The model may facilitate clarification of the pathogenesis of neurogenic pulmonary edema and, consequently, refine evaluation of therapy.
Detachable balloon catheter
Authors: DiTullio Michael V. , Rand Robert W. , Frisch Eldon 
Published: May 2009

✓ Recent Russian reports have described the use of balloon occlusion in both the diagnosis and treatment of various pathological processes affecting intracranial vessels. This intraluminal approach has demonstrated successful results in vascular problems such as carotid-cavernous fistulae, arteriovenous malformations, and large inoperable aneurysms. Despite widespread interest in the neurosurgical community, the application of a similar technique in the Western hemisphere has been hindered by lack of an adequate, functional, inflatable apparatus.
The authors describe their experience with the prototype of a safe, reliable, detachable balloon. Because of a unique development, the apparatus may be filled with liquid and detached from its parent catheter without subsequent leakage. In order to satisfy variable requirements, balloons are available in several sizes ranging from 0.5 to 4.0 mm in diameter. When fully inflated these devices will hold from 1 to 3 cc of fluid. The authors' study involved 18 dogs with artificially created carotid-jugular fistulae that were visualized by angiography. Under fluoroscopic control, detachment of inflated balloons on the venous side of the defect not only successfully occluded the fistulae but also preserved the arterial vasculature. X-ray films taken several weeks later failed to show any change either in size or position of theinflated devices.
Pulsatile cerebral echo in diagnosis of brain death
Authors: Uematsu Sumio , Smith Thomas D. , Walker A. Earl 
Published: May 2009

✓ Conclusive diagnosis of brain death can be made by the demonstration of prolonged cessation of cerebral blood flow. This report describes a simple method to determine the presence or absence of the blood flow in the brain by recording the pulsatile midline echo on one channel of the electroencephalogram (EEG) or on any four-channel monitoring system in the intensive care unit. A firm transducer holder has been developed to eliminate artifacts caused by transducer motion. The pulsations of the midline echo are assumed to be the result of displacement of the midline structures by the arterial injection of each cardiac systole. Thus, the absence of these midline pulsatile echoes correlates with the absence of cerebral blood flow and, if the absence persists over 30 minutes in the presence of normal blood pressure, then the result is brain death.
Twenty-eight cases of clinical brain death with electrocerebral silence of EEG and 18 obtunded patients with various types of cerebral pathology were examined by the echo-pulsation technique. Twenty-six of the 28 cases showed no pulsation of the midline echo. The validity of the technique was documented in four cases by four-vessel cerebral angiogram.
Death following external carotid artery embolization for a functioning glomus jugulare chemodectoma
Authors: Pandya Sunil K. , Nagpal Ranjit D. , Desai Anand P. , Purohit Anil V. 
Published: May 2009

✓ A 24-year-old man with left sixth through twelfth cranial nerve palsies and severe, fluctuating, systemic arterial hypertension was found to have a large, vascular, catecholamine-forming glomus jugulare chemodectoma. After his electrolyte imbalance was corrected, left external carotid embolization (using Gelfoam) was carried out. The systemic blood pressure stabilized at around 160/100 mm Hg over the next 12 hours. Ten hours later the hitherto conscious patient developed acute arterial hypotension, lapsed into coma, and died. Autopsy showed tumor infarction, swelling, cerebellar tonsillar herniation, and medullary compression.
An unusual complication of glomus tumor embolization is highlighted. The roles of preliminary decompressive surgery and urgent resuscitation by vasopressors are discussed.
Cerebral arterial responses to induced hypertension following subarachnoid hemorrhage in the monkey
Authors: Boisvert Donald P. , Overton Thomas R. , Weir Bryce , Grace Michael G. 
Published: May 2009

✓ Regional cerebral blood flow (rCBF), angiographic cerebral arterial caliber, and cerebrospinal fluid (CSF) pressure were measured in rhesus monkeys to determine the effect of experimentally induced subarachnoid hemorrhage (SAH) on cerebral arterial responses to graded increases in blood pressure. These measurements were also performed in a control group of monkeys subjected to a mock SAH by injection of artificial CSF into the cerebral space.
Before subarachnoid injection of blood or artificial CSF, graded increases in mean arterial blood pressure (MABP) to a level 40% to 50% above baseline values had no effect on rCBF. The major cerebral arteries constricted and CSF pressure remained unchanged. Similar responses were observed after injection of artificial CSF. When MABP was increased in animals that had been subjected to subarachnoid injection of blood, rCBF increased and was associated with dilatation of the major cerebral arteries and moderate increases in CSF pressure. These results demonstrate that cerebral arterial responses to increases in blood pressure may be abnormal in the presence of subarachnoid blood. The manner in which abnormal cerebral arterial reactivity, changes in blood pressure, and vasospasm combine to determine the level of cerebral perfusion following SAH is postulated.
Pituitary adenomas in childhood and adolescence
Authors: Richmond Isabelle L. , Wilson Charles B. 
Published: May 2009

✓ This report describes a group of 25 children and adolescents with biopsy-proven pituitary adenomas. They were found in 33% of patients encountered in our recent study of 74 parasellar tumors detected in patients under 20 years old. Earlier detection accounts for this apparent increase in frequency. This interpretation is supported by the rarity of signs of intracranial hypertension at presentation, as well as decreased incidence and severity of visual failure. More than 70% of patients have evidence of pituitary hypersecretion at presentation. Increased awareness of these endocrinological signs as well as improved hormonal assays facilitate both diagnosis and management. Hypopituitarism is rare; the important exception is suppression of gonadotrophic function that is known to occur early in the natural history of intrasellar pituitary adenomas.
The low incidence of suprasellar and extrasellar extension is documented by both radiographic and operative findings. Transsphenoidal resection was employed in 92% of patients, with an estimated total resection in 73% of cases. Follow-up studies show a high quality of survival; no patient has severe neurological deficit and less than half of them require replacement therapy. The recurrence rate is 8%. Our findings do not support a previous report that pituitary adenomas in this age group are frequently extrasellar and invasive.
Chemotherapy of recurrent medulloblastoma with combined procarbazine, CCNU, and vincristine
Authors: Crafts David C. , Levin Victor A. , Edwards Michael S. , Pischer Tana L. , Wilson Charles B. 
Published: May 2009

✓ Seventeen patients with recurrent medulloblastoma were treated with a combination of three drugs: procarbazine, CCNU, and vincristine (PCV). Tumor recurrence was documented at varying periods following surgery and radiotherapy. Among 16 evaluable patients, ten showed a response to PCV on the basis of subjective neurological improvement and a decrease in tumor size by radiological criteria. Five patients were designated as having stable disease on the basis of no change in neurological status and tumor size. One patient showed uninterrupted progression of disease. The median time to progression for all patients was 45 weeks.
Significant myelotoxicity, exacerbated by prior spinal irradiation, compromised therapy. After an initial response, it was often necessary to reduce the higher doses of CCNU and procarbazine that caused concomitant bone-marrow toxicity; as a consequence of the lowered doses, tumor progression was then frequently observed. The authors conclude that PCV is an effective form of palliative therapy for recurrent medulloblastoma.
Neurovascular relationships of the sphenoid sinus
Authors: Fujii Kiyotaka , Chambers Steven M. , Rhoton Albert L. 
Published: May 2009

✓ The increasing use of the transsphenoidal approach to sellar tumors has created a need for more detailed information about the neurovascular relationships of the sphenoid sinus. To better define this anatomy, 25 sphenoid sinuses were examined in cadavers, with attention to the neural and vascular structures in the lateral wall of the sinus. Three structures produced prominent bulges into the lateral wall of the sinus; they were 1) the optic nerves, 2) the carotid arteries, and 3) the maxillary branches of the trigeminal nerve. Over half of these structures had a bone thickness of less than 0.5 mm separating them from the sphenoid sinus, and in a few cases, they were separated by only sinus mucosa and dura.
1) The optic canals protruded into the superolateral part of the sphenoid sinus in all except one side of one specimen. In 4% of the optic nerves, only the optic sheath and sinus mucosa separated the nerves from the sinus, and in 78%, less than a 0.5-mm thickness of bone separated them. 2) The carotid arteries produced a prominent bulge into the sphenoid sinus in all but one side of one specimen. In 8% of the carotid arteries there were areas where no bone separated the artery and the sinus. 3) The maxillary branches of trigeminal nerves bulged into the inferolateral part of the sphenoid sinus in all except one side of two specimens. One side of one specimen had no bone, and 70% had less than a 0.5-mm thickness of bone separating the nerve from the sinus. The importance of these findings in transsphenoidal surgery is reviewed.
Cerebrovascular responses to subarachnoid blood and serotonin in the monkey
Authors: Boisvert Donald P. J. , Weir Bryce K. A. , Overton Thomas R. , Reiffenstein Rhoderick J. , Grace Michael G. A. 
Published: May 2009

✓ Preliminary in vitro experiments were performed to determine the serum concentration of serotonin in the monkey, and the ability of cyproheptadine to block serotonin and serum-induced contractions in monkey cerebral arteries. Thirty-four cynomolgus monkeys were subsequently used to study changes in regional cerebral blood flow (CBF) obtained by the intracarotid 133Xe technique, and in the angiographic cerebral arterial caliber resulting from subarachnoid injection of artificial cerebrospinal fluid (CSF), blood, and serotonin. Five animals in each injection group were given 1.0 mg/kg intravenous cyproheptadine (a serotonin-blocking agent) during the post-injection period.
Subarachnoid injection of artificial CSF produced no change in CBF or arterial caliber. Post-injection administration of cyproheptadine also had no effect on these parameters. A subarachnoid injection of fresh autogenous blood produced a significant but transient (less than 1 hour) decrease in CBF and moderate vasospasm, which lasted at least 3 hours. This vasospasm was essentially unaffected by intravenous cyproheptadine. The CBF and arterial caliber were unchanged following a subarachnoid injection of serotonin at concentrations (5 × 10−6M) present in normal monkey serum. In contrast, 5 × 10−6 M serotonin invariably produced near maximal contractions in the in vitro cerebral artery preparations. Higher (× 10) serotonin concentrations caused a transient CBF response similar to that obtained with blood. However, the cerebral vasospasm induced was of shorter duration than that obtained with blood.
These results do not support a major role for serotonin in the production of post-subarachnoid hemorrhage vasospasm. Moreover, our data indicate that in vitro experiments do not reflect the ability of serotonin to constrict cerebral arteries in the intact animal.
Intracranial pressure and conductance to outflow of cerebrospinal fluid in normal-pressure hydrocephalus
Authors: Børgesen Svend Erik , Gjerris Flemming , Sørensen Søren Claus 
Published: May 2009

✓ Forty patients with clinical evidence of normal-pressure hydrocephalus were studied by monitoring intraventricular pressure during a 24-hour period, and by a lumboventricular perfusion test for measurement of the conductance to outflow of cerebrospinal fluid (CSF). The purpose of the study was to investigate whether there is a relationship between intraventricular pressure and conductance to outflow of CSF, and whether it is possible to use the results from pressure monitoring in the selection of patients who may be expected to benefit from shunting therapy. The conductance to outflow was used as an evaluation factor in the selection of patients to be treated by a shunt.
The conductance to CSF outflow differed by twelvefold between the lowest and highest values. The level of resting intraventricular pressure was within normal limits in all patients. Accordingly, there was no evidence of a relationship between conductance to outflow and intraventricular pressure. So-called B-waves were seen more frequently in patients with decreased conductance to outflow, but were also present in patients with high conductance to outflow. Therefore, the presence of B-waves does not imply a low conductance to outflow of CSF.