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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report an autopsy case of methamphetamine-related intracranial hemorrhage and vasculitis. The possible relationship between drug usage and the occurrence of intracranial bleeding and cerebral vasculitis in such patients is discussed. A 22-year-old woman died after an intravenous injection of unknown dose of methamphetamine. A computed tomography head scan demonstrated massive subarachnoid hemorrhage and hematoma in corpus callosum. Cerebral angiography revealed nonfilling of bilateral intracranial carotid arteries and extravasation of contrast medium from right pericallosal artery which was visualized retrogradely via vertebral artery. Postmortem studies showed cerebral edema, subarachnoid and intracerebral hemorrhage, and intracranial vasculitis in the absence of aneurysm, arteriovenous malformation or chronic hypertension. Histological findings of necrosis of blood vessel walls with destruction of the elastica and smooth muscle layer, and without leukocytotic infiltration of the blood vessel walls were observed in order of anterior cerebral, middle cerebral, vertebral, posterior cerebral and basilar arteries. These angiographic and histological evidence suggests that such hemorrhage results from the development of fibrinonecrosis in the large intracerebral vessels, in addition to a sudden rise in blood pressure.
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PMID:[An autopsy case of subarachnoid and intracerebral hemorrhage and necrotizing angitis associated with methamphetamine abuse]. 321 43

Renal autotransplantation was performed in five patients and extracorporeal vascular reconstruction was required in two of these cases. One had a carcinoma of the mid-ureter with a solitary kidney. Two patients had ureteral injury. One was iatrogenic from a prior operation, and the other had intrinsic ureteral disease secondary to schistosomiasis. The fourth patient had renovascular hypertension with disease extension into the interlobar renal arteries and a single kidney. The final patient had a large, renal arteriovenous malformation and polycystic kidneys. All have functioning grafts at follow-up ranging from 10 to 36 months. There is no evidence of tumor recurrence after 30 months in the patient with ureteral malignancy. The patient with renovascular hypertension has adequate blood pressure control with medication 12 months after surgery. His creatinine which had risen in the post-operative period to 4.2 mg/dl, has returned to its pre-operative valve of 1.8 mg/dl. None of the other four patients had any post-operative decline in renal function. These cases illustrate that the technique of nephrectomy, extracorporeal surgery, and renal autotransplantation can be applied to a variety of benign and malignant diseases of the kidney and ureter not amenable to conventional in-situ correction, thus allowing maximal preservation of renal parenchyma. We also have demonstrated that the procedure can be successfully performed in the presence of significant infectious risk (Case 2: indwelling nephrostomy), and retroperitoneal infection (Case 3: schistosomiasis). We feel that this procedure is currently underutilized.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal autotransplantation and extracorporeal reconstruction for complicated benign and malignant diseases of the urinary tract. 329 82

A case of allergic granulomatous angiitis showing various symptoms of the central nervous system is reported. A 29-year-old female was admitted to our hospital because of severe headache and urinary incontinence. Consciousness was drowsy, and right IIIrd cranial nerve palsy was observed. CT scan revealed subarachnoid hemorrhage, hydrocephalus and arachnoid cyst. Since no aneurysm or arteriovenous malformation was detected by angiography, continuous ventricular drainage was performed. Marked hypertension due to renal vascular origin was suggested by means of laboratory data about serum renin etc., so renal as well as cerebral angiography was carried out by Seldinger's method. There revealed aneurysms of the left renal artery and a branch of the left anterior cerebral artery. Then, ventriculo-peritoneal shunt and resection of left frontal aneurysm were done. Microscopic finding of the excised aneurysm was necrotizing angiitis with infiltration of eosinophil. Six days after the operation, CT scan showed asymptomatic subcortical hematoma at the right occipital lobe. The patient was in good condition and had no cerebral or other complication following steroid therapy. The present case was considered as a very rare one because no case with subarachnoid hemorrhage and cerebral aneurysm due to allergic granulomatous angiitis was reported in the previous literature.
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PMID:[Allergic granulomatous angiitis with subarachnoid hemorrhage--a case report]. 339 97

We report a case of a right renal arteriovenous malformation with high output cardiac failure and hypertension which was cured by nephrectomy. Hemodynamic findings pre- and post-operatively are presented. Plasma renin activity (PRA), both from peripheral venous and renal vein samples, was assessed. The fall in PRA associated with nephrectomy lends support to the suggestion that the renin-angiotensin system plays a role in the hypertension in these patients.
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PMID:Hemodynamic and plasma renin responses to treatment of a renal arteriovenous malformation. 351 86

We report a case of FIRDA associated with a pial-dural arteriovenous malformation (AVM). The patient presented with headaches, papilledema and partial oculomotor nerve palsy. CT scan had failed to discover the AVM. After partial embolization of the AVM, the patient's symptoms and signs resolved, and the FIRDA disappeared. FIRDA has been thought to be caused by frontal lobe ischemia or periventricular edema. It has not been reported in benign intracranial hypertension (BIH). We postulate that the FIRDA in this case was due to the circulatory "steal" effect of the AVM, and not to the intracranial hypertension. Five percent of patients with dural AVM's present with a picture consistent with BIH. We recommend a diligent search for additional pathology if FIRDA is seen in association with presumed BIH.
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PMID:Frontal intermittent rhythmic delta activity (FIRDA) in pial-dural arteriovenous malformation. 366 10

The authors describe their experience with four cases of dural arteriovenous malformation (AVM) which led them to analyze the clinical aspects of these lesions in an attempt to understand their pathophysiology. An additional 191 previously reported cases of dural AVM's were reviewed with special attention to the mechanism of intradural, central, and peripheral nervous system manifestations. Apart from the peripheral cranial nerve symptoms, which are most likely due to arterial steal, the central nervous system (CNS) symptoms appear to be related to passive venous hypertension and/or congestion. Generalized CNS symptoms can be related to cerebrospinal fluid malabsorption due either to increased pressure in the superior sagittal sinus, to venous sinus thrombosis, or to meningeal reaction resulting from minimal subarachnoid hemorrhages. These phenomena are not related to the anatomical type of venous drainage. On the other hand, focal CNS symptoms are specifically indicative of cortical venous drainage. Seizures, transient ischemic attacks, motor weakness, and brain-stem and cerebellar symptoms can be encountered depending on the territory of the draining vein or veins. Therefore, the localizing value of focal CNS symptomatology relates to the venous territory and not to the nidus or to the arterial supply characteristics of dural AVM's. Furthermore, the venous patterns of various dural AVM's at the base of the skull are expressed by differences in their clinical presentation. Dural AVM's of the floor of the anterior cranial fossa and of the tentorium are almost always drained by the cortical veins and, therefore, have a high risk of intradural bleeding. The remarkable similarities in the manifestations of dural and brain AVM's and the differences in the manifestations of dural and spinal dural AMV's are pointed out. High-quality angiograms and a multidisciplinary approach to the study of dural AVM's will provide the best understanding of their symptoms and, therefore, the most appropriate treatment strategy.
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PMID:Neurological manifestations of intracranial dural arteriovenous malformations. 370 21

Thirteen patients with caudate hemorrhage are described. All the hemorrhages were in the head of the caudate nucleus, and all the hemorrhages but one ruptured in the anterior horn of the lateral ventricle. In 9 patients, the hemorrhage was related to hypertension and the patients were older. In the other 4 patients, the hemorrhage resulted from rupture of an arteriovenous malformation (AVM) and the patients were under 40 years old. Clinical manifestations were nearly the same in both groups, suggestive of subarachnoid hemorrhage and including hemiparesis in most patients. In patients with hypertension, good recovery was obtained by conservative treatment and in those with ruptured AVMs, resection of AVMs through an anterior transcallosal approach may be safe and recommended.
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PMID:Caudate hemorrhage. 370 14

In a review of 16 cases, the authors emphasize that small brainstem haemorrhages, diagnosed by CT-scan, can have a good outcome, most often spontaneously. Twelve hematomas were in the pons, four in the mesencephalon. Several clinical features were remarkable: consciousness was not or moderately impaired, focal symptoms and signs predominantly neuro-ophthalmologic were present. Involvement of the cranial nerves and long tracts occurred rarely in isolation. Arterial hypertension was the usual cause (50 p. cent); one normotensive patient with neurological disorders prior to the bleeding had an arteriovenous malformation, demonstrated angiographically. In two cases an obstructive hydrocephalus was surgically treated. Expected advances from CT-scan and magnetic resonance imaging (M.R.I.) are discussed.
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PMID:[Clinical and developmental aspects of small brain stem hematomas. Contribution of x-ray computed tomography]. 370 28

The authors report on factors influencing the outcome after hemorrhagic strokes in infants, children, and adolescents over a period of 14 years. Their series comprised primary hemorrhage in 24 cases (46.2%), including 5 cases of vitamin K deficiency; arteriovenous malformation in 20 cases (38.5%); intracranial aneurysm and moya-moya disease in 3 cases (5.7%) each; and spinal angioma in 2 cases (3.9%). Ten of 52 patients with juvenile hemorrhagic strokes died despite surgical treatment. These fatal cases involved an intraparenchymal hematoma with ventricular casts, and unilateral hydrocephalus suggesting acute, uncontrollable intracranial hypertension. The "child's biologic plasticity" plays an important role in the favorable prognosis in infants, children, and adolescents with hemorrhagic strokes. On the contrary, cases with intraventricular hemorrhage due to any pathologic condition have an unfavorable prognosis.
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PMID:Hemorrhagic stroke in infancy, childhood, and adolescence. 376 53

We review 139 consecutive cases of primary non-traumatic intracranial hemorrhage observed at the Neurosurgical Division of Pellegrini Hospitals, Naples. We excluded 20 similar cases which were not thoroughly studied. In the region Campania, which has almost five and a half million inhabitants, there are four emergency centres for neurosurgical patients one of which is at the Pellegrini Hospitals in Naples. In our series of 139 patients, 68 (48.92%) had an intracerebral hematoma (CH); while 71 (51.07%) patients had a subarachnoid hemorrhage (SAH). Thirteen cases out of 68 were added to the 71 cases with SAH because they had an arterial aneurysm or an arteriovenous malformation (AVM) which had ruptured both in the subarachnoid space and in the brain. The most frequent cause of CH was arterial hypertension. Out of 84 patients with SAH, 57 (67.85%) had a vascular malformation. Age, sex, presence of vasospasm, gravity of hemorrhage and interval between hemorrhage and neurosurgical observation were studied. Out of 139 cases, 68 (48.92%) were surgically treated. In conclusion, out of 68 operated patients, 48 (70.58%) survived and 20 died; while, out of 71 non-operated patients, 24 (23.80%) survived and 47 died. The survival rate of patients with aneurysms operated on after 14 days from the hemorrhage is 90.47%. The survival rate in patients with CH operated on after the fifth day is 89.47%.
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PMID:Primary non traumatic intracranial hemorrhage: 139 consecutive cases treated at an emergency regional hospital. 618 84


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