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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The infratentorial supracerebellar approach is a popular technique for exposure of lesions of the superior vermis and pineal region. The cerebellomedullary fissure approach is enjoying increasing application as a technique for exposure of the fourth ventricle. Occasionally, a tumor that arises in the quadrigeminal plate or the superior vermis grows to fill the fourth ventricle, and for such a case a combination of the infratentorial supracerebellar approach and the cerebellomedullary fissure approach might be considered. We report a grave hazard of this combination. Two patients with tumors involving the superior vermis and filling the fourth ventricle were managed with a combined infratentorial supracerebellar/cerebellomedullary fissure approach. The first patient, who underwent a bilateral exposure, died on the sixth postoperative day due to massive hemorrhagic venous infarction of the cerebellum. The second patient, who was explored on one side only, suffered a protracted postoperative course characterized by suboccipital pain, torticollis, feeding difficulties and persisting hydrocephalus. Postoperative imaging showed swelling of the inferior vermis and ipsilateral hemisphere of the cerebellum with unilateral tonsillar herniation. Simultaneous compromise of the galenic and tentorial bridging veins and interruption of collateral pathways between these systems and the petrosal bridging veins, as in the combined infratentorial supracerebellar/cerebellomedullary fissure approach, may cause cerebellar venous insufficiency with venous congestion and possible venous infarction.
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PMID:A hazard of combining the infratentorial supracerebellar and the cerebellomedullary fissure approaches: cerebellar venous insufficiency. 1115 60

Von Recklinghausen's disease associated with hydrocephalus due to non-tumoral aqueductal stenosis is rare. Furthermore the formation of subdural hematoma within the spinal canal is also a very rare complication of ventriculoperitoneal shunt. We presented a case of spinal subdural hematoma formation following ventriculoperitoneal shunting for von Recklinghausen's disease associated with aqueductal stenosis. A 10-year-old girl with von Recklinghausen's disease was referred to our hospital for gait disturbance during the previous 8 months. Magnetic resonance imaging (MRI) revealed hydrocephalus due to non-tumoral aqueductal stenosis, and ventriculoperitoneal shunt was instituted. Three months later, the patient developed lumbar pain and paraplegia. MRI revealed subdural hematoma in the lumbosacral spinal canal, and bilateral intracranial subdural hematoma were shown on computerized tomography (CT) scans. Subdural hematoma in the lumbosacral spinal canal was evacuated by laminectomy. Improvement of her neurological deficit was obtained postoperatively, and intracranial subdural hematomas disappeared spontaneously. Spinal subdural hematoma is assumed to be formed by the migratory movement of intracranial subdural hematoma under the influence of gravity. A characteristic finding of MRI is that such a subdural hematoma in the lumbosacral canal is located around the cauda equina.
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PMID:[A case of the spinal subdural hematoma formation following ventriculoperitoneal shunting for von Recklinghausen's disease associated with aqueductal stenosis]. 1121 67

A 37-year-old pregnant woman, gravida 2, para 0, was referred to Ramathibodi Hospital at 31 weeks of gestation with the diagnosis of hydrocephalus and polyhydramnios. Repeated ultrasound scans revealed hydrocephalus with macrocephaly (BPD=10.3 cm), polyhydramnios (AFI=31.5), and a suspected esophageal atresia. After counseling, both parents decided not to pursue the pregnancy and requested vaginal delivery. They decided against transabdominal, ultrasonic-guided cephalocentesis because of its invasiveness, patient's awareness, and pain. Skull decompression with the modified Smellie's perforator was performed after five 400-microg doses of misoprostol were applied to dilate the cervix. The post-partum condition was uneventful. Fetal skull decompression with the modified Smellie's perforator and misoprostol for cervix dilation is a useful, simple, and safe procedure that can be performed with no previous experience.
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PMID:Cephalocentesis with the modified Smellie's perforator. 1181 24

A 69-year-old man presented with progressive nuchal pain and spastic gait 2 years after undergoing ventriculoperitoneal (VP) shunting for a pineal astrocytoma with obstructive hydrocephalus. The neurological manifestations were compatible with radiculomyelopathy caused by an upper cervical lesion. Magnetic resonance imaging showed an enhanced extramedullary mass lesion tightly constricting the upper cervical spinal cord. The pressure of the shunt system was 150 mmH2O, and lumbar puncture revealed normal cerebrospinal fluid (CSF) pressure of 170 mmH2O. After removal of the shunt system, the clinical symptoms and neuroradiological findings markedly improved. This symptomatic spinal mass lesion was thought to be formed secondary to chronic depletion of ventricular CSF through the VP shunt.
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PMID:Symptomatic spinal extramedullary mass lesion secondary to chronic overdrainage of ventricular fluid--case report. 1193 58

The Chiari I malformation is a cerebellar anomaly of uncertain origin, defined in part as tonsillar herniation of at least 3 to 5 mm below the foramen magnum; it is associated with crowding of the craniocervical junction. It is the most frequent of the Chiari malformations and is associated with headaches, syringohydromyelia, and hydrocephalus. The clinical manifestations are related to direct compression of neural tissues and abnormal cerebrospinal fluid dynamics. Common presentation is in adulthood, but there is increasing recognition in childhood. Incidental magnetic resonance imaging discovers Chiari I in one third of patients who do not have clinical symptoms. Headaches in the occipital-suboccipital region or those that are of cough-type suggest symptomatic Chiari I malformation. Suboccipital craniectomy is performed for patients with Chiari I malformation who have neural compression syndromes of the brainstem and spinal cord, select headache types, and other uncommon conditions that are not the topic of this review.
Curr Pain Headache Rep 2002 Aug
PMID:Headache and Chiari I malformation: clinical presentation, diagnosis, and controversies in management. 1209 70

A 60-year-old male presented with normal pressure hydrocephalus following subarachnoid hemorrhage and underwent a shunt operation. However, a shunt effective range was so narrow that he repeated a sign of overdrainage and underdrainage of CSF. At the result, reflex sympathetic dystrophy (RSD) as a complication of overdrainage was demonstrated. We could prescribe appropriate shunt flow rate by using siphon control system instead of antisiphon device (ASD) and then avoid shunt malfunction. In addition, medication of Neurotropin for pain control of RSD was so effective. We report a case of RDS as a complication of shunt malfunction.
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PMID:[Reflex sympathetic dystrophy induced by shunt malfunction: a case report]. 1235 84

Several neuropeptide FF (NPFF)-related peptides, known as modulators of the opioid system, have been previously characterized in bovine and rodent brain. Reverse-phase high pressure liquid chromatography (HPLC) fractions of a human with normal pressure hydrocephalus cerebrospinal fluid (CSF), co-migrating with NPFF-related synthetic peptides, were characterized by capillary HPLC coupled on-line to nanospray ion trap tandem mass spectrometry. Two peptides present in the pro-NPFF(A) precursor, NPAF (AGEGLNSQFWSLAAPQRF-NH2) and NPSF (SLAAPQRF-NH2), were identified. The monitoring of NPFF-related peptides in human CSF can be helpful to understand their roles in pain sensitivity.
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PMID:Identification of neuropeptide FF-related peptides in human cerebrospinal fluid by mass spectrometry. 1248 85

A 48-year-old man underwent ventriculoperitoneal shunting for hydrocephalus secondary to subarachnoid hemorrhage due to left vertebral artery dissection, which had been successfully treated by trapping. The peritoneal catheter was correctly positioned via a right upper abdominal incision, and symptoms related to the hydrocephalus disappeared. One month later, the patient began to complain of pain on the right side of the neck. Chest radiography revealed that the peritoneal end of the catheter had migrated into the right pulmonary artery. The catheter route was explored through a small neck incision, and was found to enter the external jugular vein. The catheter was extracted and repositioned into the peritoneum. This type of shunt migration is quite unusual, but could be lethal by causing pulmonary infarction or arrhythmia. The catheter had probably entered the external jugular vein through a perforation caused by the shunt guide during the ventriculoperitoneal shunt operation. Follow-up radiography should be scheduled to detect such a complication.
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PMID:Peritoneal shunt migration into the pulmonary artery--case report. 1251 32

Tonsillar ectopia, encompassing slight descent of the cerebellar tonsils and Chiari I malformations, are disorders observed routinely in older children and adults and are believed to be an acquired form of the Chiari malformations. This entity is different from the other Chiari malformations in that hydrocephalus plays no role in its evolution. More likely it is a disorder of para-axial mesoderm, characterized by posterior fossa hypoplasia and content overcrowding, and not an embryologic anomaly of neuroectoderm. The prevalence of tonsillar ectopia to my knowledge has not been studied. The incidence of Chiari I malformations ranges from less than 1%to 3% at various tertiary centers. The occipital and exertional headache associated with this malformation can be observed in subjects who have new-onset tonsillar ectopia resulting from repeated lumbar puncture,idiopathic intracranial hypotension, lumboperitoneal shunting, or spontaneous development [34-36]. This new-onset headache can remit with return to normal tonsil positioning. These findings support the proposal that pressure dissociation gradients and perhaps traction of pain-sensitive tissues play a role in generation of the headache observed in this malformation. In accordance with this idea, the extent of tonsillar descent is irrelevant alone,and the degree of posterior fossa hypoplasia and decrement of CSF flow velocity are better defining factors for determining the clinical significance of tonsillar ectopia.
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PMID:Tonsillar ectopia and headaches. 1506 36

The aim of this study was to examine the prevalence of secondary impairments in young adults with spina bifida and to relate the prevalence to the type of spina bifida and the level of lesion. This cross-sectional study is part of the ASPINE (Adolescents with Spina Bifida in the Netherlands) study. Data were collected on medical history, hydrocephalus (shunt: yes/no), neurological level of lesion (International Standards for Neurological and Functional Classification of Spinal Cord Injury), visual acuity (Landolt rings), spasticity (Modified Ashworth Scale), contractures (range of motion), scoliosis (deviation from perpendicular), ambulation (Hoffer criteria), pressure sores and blood pressure (physical examination), epilepsy, pain, incontinence and sexuality (questionnaire), and cognitive functioning (Raven Standard Progressive Matrices). In total, 179 patients with spina bifida participated (41% male, age range 16 to 25 years, mean 20 years 9 months, SD 2 years 11 months). These were 37 patients with spina bifida occulta, 119 patients with spina bifida aperta and hydrocephalus (AHC+) and 23 patients with spina bifida aperta without hydrocephalus (AHC-). Of our patient group, 73 had a high-level lesion (L2 and above), 68 a mid-level lesion (L3 to L5), and 38 a low-level lesion (S1 and below). Both subdivisions were strongly related with patients with higher lesions more often having hydrocephalus. Most secondary impairments were found for patients with AHC+, and patients with AHC- were mostly comparable to patients with spina bifida occulta. According to level of lesion, most medical problems were found in the high-level lesion group. However, all subgroups suffered from health problems.
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PMID:Secondary impairments in young adults with spina bifida. 1517 35


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