bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Management of Intracranial Hemorrhage in Patients Receiving Thrombolytic Therapy: Case Reports
Authors: Eleff Scott M. , Borel Cecil , Bell William R. , Long Donlin M. 
Published: April 2011

Abstract
Intracranial hemorrhage is an uncommon complication of antithrombotic therapy. We present two patients who suffered life-threatening intracranial bleeding as a complication of thrombolytic/anticoagulant treatment. Early diagnosis and treatment appear to be crucial factors for survival. We suggest an approach to perioperative management for intracranial hemorrhage resulting from antithrombotic therapy.
Morphometric Analysis of Reticular and Elastin Fibers in the Cerebral Arteries of Patients with Intracranial Aneurysms
Authors: Chyatte Douglas , Reilly Jeffrey , Tilson David M. 
Published: April 2011

Abstract
Elastin and reticular fibers were identified using standard histological stains in middle cerebral arteries taken from patients who had died from aneurysmal subarachnoid hemorrhage and control patients who did not have cerebral aneurysms, Examination of cerebral arteries from normal individuals revealed a dense network of fine reticular fibers in the arterial media that were uniformly distributed. Computerized morphometric analysis indicated that reticular fibers in the arterial media of cerebral arteries were significantly decreased in patients with aneurysms. In addition, these fibers were irregularly distributed and shortened when compared to those seen in control arteries. In both patients with aneurysms and control patients, elastin fibers were limited almost exclusively to the internal elastin lamina. No differences were observed in the appearance or content of elastin fibers in control patients and patients with aneurysm. Although other explanations cannot be excluded, these observations are consistent with the hypothesis that “intrinsic“ abnormalities in the walls of cerebral arteries lead to conditions that favor the formation and rupture of cerebral aneurysms.
An Unusual Cause for Trigeminal Neuralgia: Contralateral Meningioma of the Posterior Fossa
Authors: Haddad Fuad S. , Taha Jamal M. 
Published: April 2011

Abstract
Twenty cases of facial neuralgia associated with tumors of the contralateral posterior fossa were collected from the world literature. Only four of these conform to the description of typical trigeminal neuralgia. We report on a fifth such case with a critical review of the literature. Subtotal excision of the tumor improves the pain and may convert a carbamazepine-resistant neuralgia into a responsive one. Total excision is often followed by a cure. Faced with such a case, the tumor should always be excised first, as this usually cures the neuralgia. Surgical treatment of the neuralgia in the presence of the tumor may be followed by disastrous results. An alternative hypothesis to the pathogenesis of the contralateral neuralgia is presented.
Multiple Meningiomas of the Fourth Ventricle in Infancy: Case Report
Authors: Díaz Pedro , Maillo Angel , Morales Francisco , Gómez-Moreta Juan A. , Hernández Javier 
Published: April 2011

Abstract
Meningiomas are uncommon tumors in infancy. Intraventricular meningiomas do occur more frequently in infancy than in adulthood, although the establishment and growth of such tumors in the fourth ventricle is exceptional in children. The occurrence of multiple meningiomas is currently estimated to be less than 8%. We present the case of a girl who displayed two meningiomas in the fourth ventricle. Five years later, the child had four more meningiomas detected and extirpated from the same site. Eighteen months later, a new tumor appeared in the lower third of the clivus; after resection this was found to be another meningioma. The presence in a child of the repeated occurrence of multiple meningiomas, both in the fourth ventricle and in other areas of the posterior fossa, have led the authors to consider that the case is both curious and rare. Twelve similar cases of meningiomas developing exclusively in the fourth ventricle have been published; of these, only 3 occurred during infancy. A discussion is offered concerning the etiology and pathogenesis of these tumors, in which the possibility of unknown neuro-oncogenic factors that might induce meningiomas is postulated.
Evaluation of Posttraumatic Cerebral Blood Flow Velocities by Transcranial Doppler Ultrasonography
Authors: Weber Marcel , Grolimund Peter , Seiler Rolf W. 
Published: April 2011

Abstract
Thirty-five patients were admitted to the hospital with Glasgow coma scale scores of 4 to 7 after severe, blunt head injury. Blood flow velocities of the middle cerebral artery (MCA) and the ipsilateral internal carotid artery (ICA), high in the neck, were recorded noninvasively by Doppler ultrasonography. Serial examinations were begun within 48 hours of trauma and continued until the patient either died or was discharged. Spasm of the MCA was assumed if the ratio of the velocity of blood flow in the MCA (VMCA) to the velocity of blood flow in the ICA (VICA) exceeded 3 (normal value, 1.7 ± 0.4). In cases of severe MCA spasm, this ratio is higher because of increased flow velocity in the MCA and reduced flow in the ICA due to increased cerebrovascular resistance. Higher MCA velocities with VMCA/VICAabove 3, consistent with MCA spasm, were found in 14 of the 35 patients (40%). The increase began as early as 48 hours after injury, reached a maximum between Days 5 and 7, and lasted until 2 weeks after injury. There was a significant correlation between the occurrence of vasospasm and the quantity of cisternal or intracerebral blood seen on a computed tomographic scan. No correlation was found with the age of the patients, the Glasgow coma scale score at admission, the intracranial pressure, or the functional outcome 6 months after injury. The occurrence of a secondary infarction in a patient with severe MCA spasm suggests that, at least in some cases, spasm may influence the prognosis.
Epidural Peg Electrodes for the Presurgical Evaluation of Intractable Epilepsy
Authors: Barnett Gene H. , Burgess Richard C. , Award Issam A. , Skipper George J. , Edwards Christopher R. , Luders Hans 
Published: April 2011

Abstract
A new electrode design for the extradural recording of electrical brain activity is described. Epidural peg electrodes are implantable mushroom-shaped composites of Silastic clastomer and a stainless steel or platinum disc. These electrodes are useful for the preoperative mapping of seizure foci in some patients who have cranial defects or severe muscle artifacts on scalp recordings. They are also used for canvassing wide areas of cortex to determine whether a seizure is focal in origin, arises diffusely from a hemisphere, or has a bilateral origin. Advantages of epidural peg electrodes over screw and other types of epidural electrodes include low risk of infection or hemorrhage and improved patient comfort.
Subacute Pituitary Apoplexy: Clinical and Magnetic Resonance Imaging Characteristics
Authors: Glick Roberta P. , Tiesi James A. 
Published: April 2011

Abstract
Between 1987 and 1988, we utilized magnetic resonance imaging (MRI) in the diagnosis of seven cases of “subacute” pituitary apoplexy. that is, intra-adenomatous pituitary hemorrhage associated with clinical symptoms atypical of acute pituitary apoplexy. These symptoms lasted longer than 24 hours and included visual changes in four patients, headache in five, and seizures, endocrine dysfunction, and oculomotor palsy in one each. Estimates of the ages of the hemorrhages were also possible based on characteristics on the MRI scan and ranged from 48 hours to more than 14 days. Four of our seven patients underwent transsphenoidal decompression at which time the presence of intratumoral hemorrhage was confirmed. The remaining three patients have been followed as outpatients with serial MRI examinations and have shown improvement in clinical symptoms and stabilization of the radiological picture. From our series of patients, it is now apparent that the MRI scan is an invaluable tool in identifying this subacute form of intra-adenomatous pituitary hemorrhage and has proven especially useful as a means of therapeutic planning and follow-up care in patients presenting with symptoms not typical of classic pituitary apoplexy.
Radiofrequency Cingulotomy for Intractable Cancer Pain Using Stereotaxis Guided by Magnetic Resonance Imaging
Authors: Hassenbusch Samuel J. , Pillay Prem K. , Barnett Gene H. 
Published: April 2011

Abstract
This study presents a new and simplified method of creating cingulate gyrus lesions by using stereotaxis guided by magnetic resonance imaging (MRI). Previous methods have utilized ventriculogram-guided stereotaxis requiring indirect cingulate gyrus localization and general anesthesia. With the present technique a BRW stereotactic frame was applied with the patient under local anesthesia. An MRI scan was performed using a T1 signal (TR, 600 ms; TE, 30 ms) in the coronal plane with 5-mm thick sections spaced every 6 mm. The coronal slice 24 mm posterior to the anterior tip of lateral ventricle was identified. The center of each (right and left) cingulate gyrus was identified as a target area, and appropriate coordinates were determined. Approach parameters were calculated for the right and left gyri using an azimuth of 45° and 315°, respectively, and a declination of 45°. A radiofrequency electrode was stereotactically placed so that the electrode tip was at a target point which was the center of the cingulate gyrus. A radiofrequency lesion (75°, 60 seconds) was made in each hemisphere's cingulate gyrus. Four patients with intractable terminal cancer pain have been initially treated in this manner. The lesions were well-localized on postoperative MRI scans. There have been no complications except for perilesional edema for 10 days in 1 patient (treated with longer radiofrequency settings that have subsequently been modified). Short-term pain relief in cancer patients was dramatic: morphine (intravenous 14 to 40 mg/h or oral 60 mg every 4 hours) preprocedure to oral oxycodone (1 to 2 tablets q4-6h) or oral morphine (4 to 8 mg every 4 to 6 hours) postprocedure. The use of MRI-guided stereotaxis to make cingulate gyrus lesions is an improvement that potentially allows the routine creation of these lesions as a standard cancer pain treatment. The technique is simple, uses local anesthesia, and appears to be effective and safe.
Chondromatosis of the Choroid Plexus: Case Report
Authors: Valdueza Jose Manuel , Freckmann Niels , Herrmann Hans-Dietrich 
Published: April 2011

Abstract
We report the case of a patient with successful total removal of a previously undescribed intracranial tumor arising in the right lateral ventricle (probably of metaplastic origin). The histopathological examination revealed benign chondromatosis of the choroid plexus. The pathogenesis of this lesion, with special reference to synovial chondromatosis and to the differential diagnosis of solid neoplastic chondromas, their clinical features, and computed tomographic and magnetic resonance imaging findings, is presented and discussed.
Isolated Growth Hormone Deficiency Associated with a Giant Arteriovenous Varix
Authors: Martin Neil A. , Macagba-Crain Carol Lynn , Geffner Mitchell , Peacock Warwick 
Published: April 2011

Abstract
A 6.5-year-old girl with short stature (height age, 3 years; bone age, 1.75 years) had isolated growth hormone deficiency. Preoperative computed tomography and magnetic resonance imaging demonstrated a large, well-demarcated, homogeneous mass above the dorsum sellae with a density consistent with flowing blood. Vertebral angiography showed a giant intracranial varix caused by an arteriovenous fistula that originated at the apex of the basilar artery. At operation, an aneurysm clip was placed at the origin of the fistula, and occlusion of the fistula was confirmed by intraoperative digital subtraction angiography. There were no permanent neurological sequelae. Despite shrinkage of the varix, demonstrated by follow-up computed tomography, growth hormone deficiency persisted postoperatively. Biosynthetic growth hormone therapy was initiated 6.5 months after surgery and resulted in a height increment of 8.2 cm after 9 months of treatment.
Posterior Interosseous Nerve Palsies
Authors: Cravens George , Kline David G. 
Published: April 2011

Abstract
One hundred seventy patients with radial nerve disorders were reviewed at the Louisiana State University Medical Center over a 15-year period. Of these, 32 had involvement of the posterior interosseous nerve exclusively. Findings included weak wrist extension with a radial drift, inability to extend the fingers, paralysis of thumb extension, and weak thumb abduction. Causes included entrapment at the arcade of Froshe (14 patients), laceration (6 patients), fracture (6 patients), compression or contusion (3 patients), and loss associated with tumor (3 patients). The ratio of men to women was 2:1, and the right arm was involved twice as often as the left. Preoperative evaluation included physical examination, electrophysiological testing (electromyogram/nerve conduction velocity), and roentgenograms of the elbow and forearm. Of the 30 patients (2 patients had bilateral lesions), 26 underwent operation. In the operative series, all 28 nerves had a function of Grade 3 or more of a possible 5 after 4 years of follow-up. Seventeen had achieved Grade 4/5, and 7 had obtained Grade 5/5. At operation, 23 nerves were found to be in continuity. Fourteen lesions of nerves in continuity were associated with entrapment and. not unexpectedly, transmitted a nerve action potential with slowed conduction and low amplitude across the lesion. Four nerves in continuity that had lesions caused by injury had nerve action potentials and were treated by neurolysis, and another 4 had no nerve action potentials and were treated by graft or suture repair. Five injured nerves were not in continuity. Two could be repaired by end-to-end suture, and 3 required graft repair. A large ganglion cyst involving the posterior interosseous nerve was also resected.
Repair of Isolated Axillary Nerve Lesions after Infraclavicular Brachial Plexus Injuries: Case Reports
Authors: Friedman Allan H. , Nunley James A. , Urbaniak James R. , Goldner Richard D. 
Published: April 2011

Abstract
Stretch injuries of the infraclavicular brachial plexus have a much better prognosis for spontaneous recovery than do their supraclavicular counterparts. We present three patients with stretch injuries of the infraclavicular brachial plexus who had spontaneous restoration of function in all muscles except the deltoid. Decreased shoulder abduction was a serious handicap to these individuals. At surgical exploration, each patient had an isolated, complete axillary nerve disruption at the quadrilateral space. Deltoid muscle function was restored in all three patients by repair of the axillary nerve with sural nerve grafts across the quadrilateral space.
Xenon-enhanced Computed Tomographic Measurement of Cerebral Blood Flow in Patients with Chronic Subdural Hematomas
Authors: Tanaka Akira , Yoshinaga Shinya , Kimura Masato 
Published: April 2011

Abstract
We compared clinical symptoms with extent of brain shift on computed tomographic (CT) scans and quantitative and three-dimensional measurements of cerebral blood flow (CBF) on xenon-enhanced CT scans in 10 patients with chronic subdural hematomas. Five patients had only headache and minimal or no brain shift on a CT scan. The other five had hemiparesis and/or mental disturbance in addition to headache and moderate or severe brain shift on a CT scan. The mean hemispheric CBF decreased about 7% in patients with headache and about 35% in patients with hemiparesis and/or mental disturbance. It decreased also on the side without the hematoma. The CBF reduction was always more pronounced in the putamen and thalamus than in the cortex. On the contrary, the cortex CBF was mostly preserved or even elevated in both groups of patients. We speculate that CBF reduction in patients with a chronic subdural hematoma occurs initially in central cerebral areas like the basal ganglia and thalamus, and then extends to the entire hemisphere including the cortex as brain compression and displacement progress. Central cerebral area involvement might be more responsible for clinical symptoms than the cortex.
Shunt for Bypass Graft of the Cavernous Carotid Artery: An Anatomical and Technical Study
Authors: Al-Mefty Ossama , Khalil Nabil , Elwany Mohammed Nagy , Smith Robert R. 
Published: April 2011

Abstract
During direct surgery of neoplastic and vascular lesions of the cavernous sinus, the intracavernous carotid artery may be injured beyond repair, or its total isolation may be necessary for surgical management of these lesions. The newly developed procedure of a saphenous vein graft bypass of the cavernous carotid artery allows re-establishment of carotid circulation. Patients with poor collateral circulation are at high risk for ischemic complications induced by the prolonged temporary occlusion required to perform the bypass graft. Optimal management of these patients is to perform the venous bypass graft for permanent vascularization while maintaining carotid cerebral circulation through an intraoperative shunt. We studied this procedure in cadavers, and three shunt types were evaluated: the external intrapetrous-supraclinoid shunt (Type A), the internal intrapetrous-supraclinoid shunt (Type B), and the neck internal carotid-supraclinoid shunt (Type C). Anatomical landmarks, techniques, distances, caliber, and materials used are presented. The rationale and candidates for such a procedure are discussed. The specifications of an optimal balloon shunt are presented, and the three procedures are compared.
Entrapment Neuropathy of the Meidan Nerve at the Level of the Ligament of Struthers
Authors: Bilge Turgay , Yalaman Okan , Bilge Semra , Çokneşeli Baki , Barut Şeref 
Published: April 2011

Abstract
The presence of a supracondylar process and Struthers' ligament is a rare congenital anomaly that may cause compression of either the median nerve, the brachial artery, or both. The authors present a case in which the supracondylar process and Struthers' ligament compressed both the median nerve and the brachial artery. This case is unusual, in that the symptoms of compression of the brachial artery increased—namely, the pulse intensity decreased and the pain increased with elbow flexion.
Pretreatment Neuropsychological Status and Associated Factors in Children with Primary Brain Tumors
Authors: Brookshire Bonnie , Copeland Donna R. , Moore Bartlett D. , Ater Joann 
Published: April 2011

Abstract
We report on the neuropsychological status of 31 children with primary brain tumors who underwent assessment before receiving therapy. Overall, the children performed within normal limits in all test areas. The exception was the group with anterior hemispheric tumors who demonstrated deficits in executive cognitive functions. Also, when compared according to tumor type, children with midline tumors and hydrocephalus performed more poorly than others on measures of intelligence, executive abilities, visual-motor skills, and fine-motor functions. Although one-half to two-thirds of the children with supratentorial midline and infratentorial tumors had cranial nerve, oculomotor, or cerebellar deficits, only the latter were associated with specific neuropsychological deficits (poorer performance on fine-motor and visual-motor tests). Age did not appear to be a factor in these children's neuropsychological test performances.
Endovascular Coil Embolization of Unusual Posterior Inferior Cerebellar Artery Aneurysms
Authors: Dowd Christopher F. , Halbach Van V. , Higashida Randall T. , Barnwell Stanley L. , Hieshima Grant B. 
Published: April 2011

Abstract
Three patients underwent transarterial platinum coil embolization of unusual posterior inferior cerebellar artery aneurysms. In one case, a giant, bilobed, partially thrombosed aneurysm exhibited marked mass effect on the adjacent medulla. In the second case, diffuse severe cerebral vasospasm, 3 days after subarachnoid hemorrhage, rendered transvascular treatment of the aneurysm difficult. Increasing vertigo and nausea caused by mass effect from an aneurysm previously coated with methyl methacrylate warranted treatment in the third case. Indications for transvascular coil treatment included relative surgical inaccessibility to the aneurysm, and, in our case, inability to perform transarterial detachable balloon therapy. The aneurysms were obliterated by endovascular coil embolization in each case. In the patient with vasospasm, aneurysm treatment followed angioplasty of the major affected cerebral vessels, resulting in significant neurological improvement within 24 hours. Two patients were neurologically intact at the time of discharge, and the third displayed persistent cerebellar signs despite a marked decrease in vertigo and nausea. Reports of transvascular coil embolization of intracranial aneurysms are very rare. Our experience with these patients demonstrates that this technique can be successfully utilized in selected cases.
Observations on the Pathophysiology of Nelson's Syndrome: A Report of Three Cases
Authors: Buchfelder Michael , Fahlbusch Rudolf , Thierauf Paul , Muüller Otto A. 
Published: April 2011

Abstract
Nelson's syndrome is generally regarded as an unusual sequela of primary bilateral adrenalectomy when performed for Cushing's disease. It is classically defined by cutaneous hyperpigmentation, considerably elevated adrenocorticotropic hormone (ACTH) levels, and an enlarged sella turcica. In this report, we present three cases initially treated by transsphenoidal sellar exploration for Cushing's disease. In two of these cases, remission of hypercortisolism did not occur after the initial pituitary exploration. A microadenomectomy was performed in one case and, in the other, no microadenoma was found. In both, Nelson's syndrome occurred after adrenalectomy. A second transsphenoidal operation and radiotherapy were required to control tumor growth. In another case, transsphenoidal adenomectomy of an ACTH-secreting tumor initially led to a remission of hypercortisolism for 4 years, but recurrent Cushing's disease necessitated adrenalectomy, and again Nelson's syndrome occurred. The documentation of a pre-existing ACTH-secreting basophilic pituitary microadenoma before adrenalectomy, as seen in two of our cases, has not been previously reported, and these observations of “non-classical” courses have major implications for the pathophysiology of Nelson's syndrome.
Juvenile Intervertebral Disc Calcification: Recognition, Management, and Pathogenesis
Authors: Dias Mark S. , Pang Dachling 
Published: April 2011

Abstract
Juvenile intervertebral disc calcification is an uncommon disorder of childhood, characterized by calcification of the nucleus pulposus of one or more intervertebral discs. Calcification may remain dormant or subsequently become symptomatic. The symptoms include fever, malaise, and neck pain and are associated with an elevated erythrocyte sedimentation rate and, occasionally, leukocytosis. Although disc protrusion occurs in 38% of patients, neurological signs are distinctly uncommon. We report the case of a patient with a herniated T2-T3 calcified intervertebral disc and compressive myelopathy. Juvenile intervertebral disc calcification is generally a self-limiting disease that seldom requires an operation. The symptoms are transient, and resorption of the disc calcification is the rule once symptoms occur. Neither the cause of the disc calcification nor the trigger for the onset of symptoms is known. An inflammatory response within the disc appears to give rise to clinical symptoms and is associated with eventual resorption of the disc calcification.