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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An unusual case of an iatrogenic dural arteriovenous fistula is reported. The patient presented with a history of progressive generalized headache over a period of 3 to 4 weeks. Computerized tomography demonstrated a chronic subdural hematoma that was successfully evacuated by burr-hole drainage. The patient's postoperative course was complicated by recurrent acute subdural hematomas at the drainage site. Coagulation studies were unremarkable. Selective external carotid angiography demonstrated a small dural arteriovenous fistula adjacent to the burr hole used for the initial operative procedure. Extension of the bone flap and coagulation of the fistula resulted in a good outcome. In the patient with recurrent acute subdural hematoma, the possibility of a vascular malformation must be considered. Selective internal and external carotid angiography is key to the correct diagnosis.
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PMID:Iatrogenic arteriovenous fistula presenting as a recurrent subdural hematoma. Case report. 172 51

A comparison of toluene and ethanol (EtOH) induced changes in central nervous system (CNS) function and symptoms were evaluated in two studies, and when possible the effects of toluene were expressed in EtOH equivalent units. The toluene concentrations were 0, 75, and 150 ppm, bracketing the American Conference of Governmental Industrial Hygienists threshold limit value (ACGIH TLV) of 100 ppm. The socially relevant EtOH doses were 0.00, 0.33, and 0.66 g EtOH/kg body weight, equivalent to two and four 3.5% 12 ounce beers. Forty two paid college students were used in each study. In the first study, subjects were exposed to toluene and an odour masking agent menthol (0.078 ppm) for seven hours over three days. In the second study EtOH or a placebo was administered at 1530 across three days also in the presence of menthol. Verbal and visual short term memory (Sternberg, digit span, Benton, pattern memory), perception (pattern recognition), psychomotor skill (simple reaction time, continuous performance, symbol-digit, hand-eye coordination, finger tapping, and critical tracking), manual dexterity (one hole), mood (profile on mood scales (POMS), fatigue (fatigue checklist), and verbal ability were evaluated at 0800, 1200, and 1600. Voluntary symptoms and observations of sleep were collected daily. A 3 x 3 latin square design evaluated solvent effects simultaneously controlling for learning and dose sequence. An analysis of variance and test for trend were performed on am-pm differences reflecting an eight hour workday and on pm scores for each solvent, in which subjects were their own control Intersubject variation in absorbance was monitored in breath. A 5 to 10% decrement was considered meaningful if consistent with a linear trend at p less than 0.05. At 150 ppm toluene, losses in performance were 6.0% for digit span, 12.1% for pattern recognition (latency), 5% for pattern memory (number correct), 6.5% for one hole, and 3% for critical tracking. The number of headaches and eye irritation also increased in a dose-response manner. The greatest effect was found for an increasing number of observations of sleep. A range of 2 to 7% decrements suggest the ACGIH TLV of 100 ppm toluene may be a good estimate of the biological threshold supporting a re-evaluation of the TLV. At 0.66 g EtOH/kg body weight symptoms and performance decrements were 6.6% for digit span, 9.2% for pattern recognition, 4.0% for continuous performance, 7.9% for symbol-digit, 16.5% for finger tapping, 6.2% for critical tracking, and 5.2% for the one hole test. The EtOH equivalents at 150 ppm toluene for digit span (0.56g EtOH/kg/body weight), the latency for pattern recognition (0.66 g EtOH kg body weight), and the one hole element "move" (0.37 g EtOH kg body weight) show that the first two measures would be affected at or above the 50 mg% blood alcohol concentration. This concentration is recognised as the lowest alcohol concentration associated with increased numbers of automobile accidents. The results suggest that EtOH may be a useful acute standard to compare the effects of various industrial solvents and support investigating an association between exposure to solvents and increased risk to safety in industry.
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PMID:Acute behavioural comparisons of toluene and ethanol in human subjects. 195 53

We used transcranial Doppler ultrasonography to investigate whether a change in hemodynamics in the major arteries of the brain base occurred after diagnostic lumbar puncture. On the day before diagnostic lumbar puncture the flow in the right and left middle cerebral artery was measured in 36 patients using transcranial Doppler ultrasonography. 48 hours after lumbar puncture a second ultrasound examination was performed. We found that only patients with post-lumbar puncture headache (PLPS) showed a significant reduction in the flow of the right middle cerebral artery (p less than or equal to .05). These findings support the puncture-hole-seepage theory as pathogenetic principle of PLPS.
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PMID:[Hemodynamic reactions in the area supplied by the middle cerebral artery in post-puncture headache]. 229 47

The authors reported a case of subdural effusion secondary to dural metastasis of prostatic cancer. A 61-year-old man was referred for headache, vomiting and gait disturbance. He had undergone hormonal therapy for prostatic cancer. He showed a mild left hemiparesis and anemia without bleeding. CT-scan disclosed a multilobular crescent shaped low density area in the right hemisphere. Under the diagnosis of chronic subdural hematoma, burr hole irrigation therapy was performed. Xanthochromic fluid was evacuated from the subdural space, in which no tumor cells were shown to exist. CT-scan on the 21st day disclosed a low density area, which was diagnosed as recurrent chronic subdural effusion. Therefore, craniotomy was performed to evacuate the subdural fluid and to explore the dura mater. Removal of the red hemorrhagic tumor at the dura mater and the fluid was performed. The patient died of heart failure in the 16th month despite complete recovery after the second operation. Histopathological examination of the tumor revealed adenocarcinoma at the outer part of the dura mater and the adjacent skull bone, where capillaries were embolized with tumor cells. However, no tumor cells were found in the subdural fluid. The authors could find in the literature 30 cases of subdural hematoma or effusion secondary to dural metastasis of carcinoma. The pathogenesis of the subdural hematoma in this case might be due to circulatory disturbance at the dura mater brought about by the invasion of the tumor or tumor cells emboli in the capillaries.
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PMID:[A case of subdural effusion secondary to dural metastasis of prostatic cancer: case report]. 239 13

Longitudinal insertion of a lumbar puncture needle bevel is less likely to cause post-lumbar puncture headache than is transverse insertion. The reason for this has not been entirely clear. We investigated the direction of dural fibers in posterior L3-4 dura mater obtained from three autopsies and tallied it in three orthogonal planes. Under low-power light microscopy the tissue appeared to be composed of lamellae branching irregularly and directed concentrically to the spinal cord. Electron micrographs (x5000) revealed that the lamellae consisted mainly of bundles of collagen fibers that pursued wavy courses in various directions. The lamellae also contained branching elastic fibers, many of which were directed longitudinally. This arrangement of fibers probably minimizes the tendency of a dural puncture hole to gape under tension if the needle bevel is directed longitudinally.
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PMID:Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture. 258 58

A case of essential thrombocythemia (ET) associated with subdural hematoma and postoperative intracerebral hemorrhage was reported. A 57-year-old man had complained headache in the morning. Six hours later he was found unconsciousness and soon he was brought to our hospital. On admission he was comatose. There was no evidences of head injury and the X-rays were normal. A computed tomography (CT) scan revealed an acute subdural hematoma over the left temporoparietal region. Laboratory data revealed thrombocytosis of 85.7 x 10(4)/mm3 with increased red and white blood cell counts. Emergent right craniotomy was performed and a subdural clot was evacuated. Neither cortical damage nor vascular malformations were seen on the cortical surface. But a spurting cortical artery with a pin-hole could be seen. A postoperative CT scan revealed an intracerebral hemorrhage deep in the right hemisphere. Cerebral angiograms revealed no vascular anomalies. Postoperatively, the platelet count remained high and laboratory data including bone marrow finding, neutrophil alkali-phosphatase score and chromosome analysis were consistent with the diagnosis of essential thrombocythemia. The mechanisms of subdural hematoma formation and postoperative intracerebral hemorrhage associated with essential thrombocythemia were discussed.
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PMID:[Essential thrombocythemia associated with subdural hematoma and postoperative intracerebral hemorrhage--a case report]. 271 68

An acute inhalation chamber study of 42 college students was performed to investigate the relation between exposure to 0, 75, and 150 ppm of toluene and changes in central nervous system function and symptoms. Paid subjects were exposed for seven hours over three days. Verbal and visual short term memory (Sternberg, digit span, Benton, pattern memory); perception (pattern recognition); psychomotor skill (simple reaction time, continuous performance, digit symbol, hand-eye coordination, finger tapping, and critical tracking); manual dexterity (one hole); mood (profile of mood scales (POMS]; fatigue (fatigue checklist); and verbal ability were evaluated at 0800, 1200, and 1600 hours. Voluntary symptoms and observations of sleep were collected daily. An analysis of variance and test for trend was performed on the difference and score for each concentration reflecting an eight hour workday where each subject was their own control. A 3 x 3 Latin square study design evaluated toluene effects simultaneously, controlling for learning across the three days and the solvent order. Intersubject variation in solvent uptake was monitored in breath and urine. A 5-10% decrement in performance was considered significant if it was consistent with a linear trend at p less than 0.05. Adverse performance at 150 ppm toluene was found at 6.0% for digit span, 12.1% for pattern recognition (latency), 5.0% for pattern memory (number correct), 6.5% for one hole, and 3.0% for critical tracking. The number of headaches and eye irritation also increased in a dose response manner. The greatest effect was found for an increasing number of observations of sleep. Overall, no clear pattern of neurobehavioural effects was found consistent with the type 1 central nervous system as classified by the World Health Organisation. Subtle acute effects, however, were found just below and above the ACGIH TLV of 100 ppm toluene, supporting the position that the guideline be lowered since the biological threshold of behavioural effects may be comparable with the TLV.
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PMID:Acute neurobehavioural effects of toluene. 276 22

We report 3 cases of posterior fossa subdural effusion resulting from head trauma, and we review 20 previously reported cases. All patients with the acute type presented with progressive deterioration of consciousness associated with stiff neck, seizure, and dyspnea (apnea). By contrast, in the subacute or chronic type, persistent headache, multiple cranial nerve pareses, and ataxia were characteristic. Occipital bone fracture was common in the acute type, and supratentorial subdural effusion was more frequently associated with the subacute or chronic type. Evacuation of the subdural fluid collection through a burr hole is the most common and effective treatment, but subdural-peritoneal shunting or closed drainage of the subdural fluid collection may be necessary. The prognosis of posterior fossa subdural effusion after head trauma is relatively good.
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PMID:Posterior fossa subdural effusion due to head trauma. 317 66

A 15 year old female began to suffer from a headache 12 hours prior to admission to a hospital in Broken Hill, N.S.W., Australia. Several hours after the onset of the headache, she had a generalized tonic-clonic seizure. Upon arrival at the hospital, she was lethargic, but did respond to commands. Her speech was slurred and the right side of her body was paralyzed. She had no fever and blood pressure was normal. Despite attempts to treat her with intravenous dexamethasone, she slipped into an unconscious state. A CT scan uncovered a left parietal hypodense lesion. Her pupils quickly dilated the next day. The right pupil did respond slightly to light, however. Physicians made a burr hole in the parietal area of her skull which exposed underlying necrotic tissue. After the operation, her brain stem failed to function. She died the following day, 3 days after the symptoms began. Other than a febrile convulsion at 10 months, she had been in good health. She had been taking a combined oral contraceptive (COC) made of 125mcg levonorgestrel and 50mcg ethinyl estradiol for 2 weeks. Pathologists found an area of necrosis in the left temporo-parietal region of the brain and an occlusive thrombosis near the left middle cerebral artery. Further, a pronounced segmental necrotizing vasculitis of the left middle cerebral and right posterior cerebral arteries existed. Based on other documented cases and this case, the physicians point to evidence that vessel size in vasculitis has an effect on the severity of the disease. Vasculitis in small vessels has a tendency to cause a gradual progression of the disease, while this disease in medium and large vessels may cause a rapid progression of the disease, as in this case. The researchers suspect that the COC may have precipitated the disease.
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PMID:Isolated angiitis of the brain in a young female on the contraceptive pill. 345 Dec 35

In proportion to a rapid increase of dialysis patient, death caused by neurological complications is increasing annually among long-term hemodialyzed patients. A case of chronic subdural hematoma during long-term hemodialysis is presented. A 35-year-old male had undergone hemodialysis three times weekly for four years. He had marked changes in body-weight and blood pressure between hemodialysis. In March 1983, he had a headache, vomiting, and left hemiparesis. The CT scan showed a right subdural hematoma. He was admitted to our hospital 10 days later because of progressive hemiparesis and speech disturbance. The neurological examination showed left hemiparesis with sensory deficit and dysarthria. The CT scan showed an increase in the size of the subdural hematoma. Bleeding time was over 10 minutes. A right-sided burr hole was made and altered blood was removed and irrigated. After operation, headache and weakness rapidly subsided, but the next morning, attacks of convulsion occurred. The CT scan showed the rebleeding in the subdural space. After correcting the level of serum potassium by hemodialysis, a right parietal craniotomy was performed. Hematoma of about 100 g was removed and the capsule of the hematoma showed organized tissue histologically. Postoperatively, although attacks of convulsion occurred temporarily, he gradually improved. The levels of serum potassium and BUN were controlled by several treatments of hemodialysis. He was discharged with only mild hemiparesis. Subdural hematoma caused by hemodialysis is a very important complication. Chronic subdural hematoma is sometimes very difficult to differentiate from dysequilibrium syndrome or dialysis dementia. The CT scan is a very valuable examination to rule out subdural hematoma.
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PMID:[A case of chronic subdural hematoma in a hemodialyzed patient]. 372 77


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