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Query: UMLS:C0004134 (ataxia)
 15,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Optimal techniques for the preoperative assessment and intraoperative management of the petrous carotid artery remain undefined. While purposeful "avoidance" of this structure may result in partial tumor removal, limited exposure of the petrous carotid artery may lead to inadvertent injury with life-threatening neurovascular sequelae. Twenty-five cases are reported in which surgical manipulation of the petrous carotid artery was necessary to accomplish total tumor removal or gain operative exposure to the skull base. A standard diagnostic radiographic assessment consisted of high-resolution computed tomography, magnetic resonance imaging, and a 4-vessel angiography. Preoperative balloon occlusion of the involved internal carotid artery was performed in four patients. Surgical approaches used in this series were broadly classified as: infratemporal-anterolateral (14), pterional-infratemporal (6), or pterional-anterolateral (5). Intraoperative management of the carotid artery consisted of total decompression in 19 cases, decompression with mobilization in four patients, and resection in two instances. Major neurovascular complications included one stroke and death caused by arterial occlusion, one stroke and death caused by arterial spasm, one stroke caused by brain edema, and one death related to a postoperative carotid hemorrhage. Other nonvascular complications included brain swelling, cranial nerve palsies, dysphagia, ataxia, cerebrospinal fluid fistulae, flap necrosis with wound infection, and pneumocephalus. Invasive and noninvasive methods are outlined for the preoperative assessment of the petrous carotid in cases of advanced skull base disease and intraoperative management options are detailed.
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PMID:The perioperative management of the petrous carotid artery in contemporary surgery of the skull base. 211 30

A 54-year-old woman with a past medical history of asthma and depression presented with right side hearing loss and ataxia. She was scheduled for a sitting craniotomy for cerebellopontine angle tumor resection. Somatosensory evoked potential, brainstem auditory evoked response, and facial nerve EMG were monitored intraoperatively. Approximately 30 minutes into the case, there was an episode of air embolism, which resolved after the source was identified and treated. Near the conclusion of the case, there was an abrupt loss of the right cortical somatosensory evoked potential signal, which never returned to baseline. A postoperative CT scan showed a substantial amount of subarachnoid air and intraventricular air in the frontal and temporal regions. The patient awakened in the ICU with no new neurologic deficit besides preoperative hearing loss on the right side. Despite the high specificity of somatosensory evoked potential change associated with postoperative neurodeficit when the change never returns to the baseline, there was no postoperative neurologic deficit in this patient. This case indicates the false-positive somatosensory evoked potentials caused by pneumocephalus in the sitting position.
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PMID:Loss of SSEP during sitting craniotomy. 1450 75

We report a case of atraumatic pneumocephalus associated with prolonged use of nasal continuous positive airway pressure. Initial symptoms included headache, ataxia, vertigo, and a "gurgling" sensation in the head; and a CT image showed small air bubbles along the falx of cerebrum and adjacent to the temporal epidural spaces bilaterally. Although no evidence of cerebrospinal fluid (CSF) leak was either reported by the patient or found at initial clinical examination, subsequent nasal discharge tested positive for beta2-transferrin, a finding consistent with CSF leak in the paranasal sinus region or through the cribriform plate. To try to prevent infection from an open communication between the paranasal sinuses and intracranial structures, an attempt should be made to localize the anatomic defect.
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PMID:Atypical headache after prolonged treatment with nasal continuous positive airway pressure. 1595 84

Endolymphatic sac tumors (ELSTs) are rare neuroectodermal neoplasms arising within the posterior petrous bone. We present a case of a 21-year-old man who presented with a 6-month history of intermittent morning headaches, fatigue, diplopia, and gait ataxia. Imaging and surgical pathology identified an adenocarcinoma of the endolymphatic sac compressing the cerebellum and brain stem. The tumor and multiple metastases were treated with surgery, radiation, and radiosurgery. Following insertion of a ventriculoperitoneal shunt for hydrocephalus, he developed symptomatic tension pneumocephalus secondary to radionecrosis of his petrous bone, requiring flap reconstruction and use of a programmable shunt valve complemented by hyperbaric oxygen (HBO) therapy. We document here a young patient with a rare adenocarcinoma of the endolymphatic sac. This case is unique for its initial presentation without any vestibuloauditory symptoms. Metastatic spread of ELSTs is also rare. While osteoradionecrosis (ORN) of the temporal bone has been reported previously in patients with nasopharyngeal carcinoma, this is the first time it has been presented in the context of an ELST. Tension pneumocephalus is a rare complication of skull base ORN. This is the first reported use of a programmable shunt valve and HBO therapy in the management of tension pneumocephalus.
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PMID:Flap reconstruction and hyperbaric oxygen therapy in the management of temporal bone osteoradionecrosis in an endolymphatic sac tumor: case report. 2398 14

Pneumocephalus is a clinical condition caused by dysbarism, trauma, and iatrogenic causes. The most common iatrogenic causes of pneumocephalus are major interventions as a neurosurgery and cardiovascular operations, endoscopy, and minor interventions as a peripheral and central venous access. Especially during insertion of central venous line and intravenous drug and fluid infusion, the venous air embolism may occur in emergency department. In these patients, retrograde pneumocephalus occurs as a result of the air entering the right atrium to the brain. Clinical effects of the air delivery rates are known to be more specific than the total amount of air. In general, intravenous administration of 300 to 500 mL air in the speed of 100 mL/min is considered to be lethal. Large amounts of air embolism can cause hypotension and acute circulatory collapse with intracardiac obstruction. The most common symptoms of venous air embolism are anxiety, dyspnea, chest pain, cyanosis, tachycardia, tachypnea, headache, confusion, agitation, syncope, slurred speech, blurred vision, seizures, and ataxia. The mortality of pneumocephalus caused by central venous catheters in patients presented with symptoms of focal neurologic was 8%, whereas the mortality of pneumocephalus in patients presented with encephalopathy was 36%. In our report, a case of pneumocephalus secondary to disconnection of catheter cap in chronic renal failure patient who has hemodialysis via catheter has been presented.
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PMID:Retrograde cerebral air embolism. 2499 85

Pneumocephalus in patients receiving positive airway pressure ventilation commonly occurs in the setting of trauma or surgery. We report a case of atraumatic pneumocephalus in a patient with a ventriculoperitoneal (VP) shunt on nasal continuous positive airway pressure (CPAP) for obstructive sleep apnoea. The patient presented with a 1-week history of "gurgling" sensation in his head and ataxia, with CT scan findings of a significant pneumocephalus. As extensive work up did not reveal any cause for his pneumocephalus, the nasal CPAP was thought to be the source. The CPAP was discontinued with improvement of the pneumocephalus, and resolution of his symptoms. He subsequently represented with recurrence of his symptoms, and increasing pneumocephalus on imaging. This was successfully managed by increasing his shunt pressure.
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PMID:Spontaneous pneumocephalus from nasal continuous positive airway pressure in a patient with ventriculo-peritoneal shunt. 2754 38