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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Somatosensory evoked potentials (SEP) were used intraoperatively 25 cerebral aneurysm cases during the temporary occlusion of the parent artery of the aneurysm under moderate hypothermia. This technique of vascular occlusion is very useful in facilitating the dissection of difficult aneurysms as well as in reducing the risk of intraoperative rupture. Middle cerebral artery (MCA) cases in Hunt & Hess's grade III, undergoing early surgery, who had shown a transient neurological deficit at the time of subarachnoid haemorrhage or where vasospasm was evident in intraoperatively were prominent among 6 cases where the median nerve SEP was lost within 13 minutes of temporary MCA occlusion at 28.6 degrees C to 31.1 degrees C. A transient neurological deficit was seen in one of these and a permanently increased deficit in the other. In contrast, the SEP was well maintained during occlusion times of upto 52 minutes in 8 cases in the absence of any of the above circumstances. The SEP was lost after 7 minutes in one of 5 cases of internal carotid artery occlusion; this was followed by a paresis of a few hours' duration. The posterior tibial nerve SEP was absent for one minute in one of 5 cases of bilateral A1 segment occlusion; none of these cases showed a postoperative deficit. It is concluded that 1. appropriate SEP monitoring can make a major contribution to patient safety in aneurysm surgery, 2. substantially longer cerebrovascular occlusion times are permissible during hypothermia than at normal temperatures and 3. the employment of additional cerebral protective measures should be considered in cases at high risk from ischaemic damage.
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PMID:Somatosensory evoked potentials in cerebral aneurysm surgery. 339 99

Two cases of cerebral aneurysm combined with polycystic kidneys (PCKs) were presented. Case 1, a 24-year-old hypertensive male, was referred to our clinic owing to sudden onset of severe headache at August 20, 1982. Neurological findings on admission were stuporous, right vitreous hemorrhage (so-called Terson's syndrome), and hypertension. CT scans showed subarachnoid hemorrhage, and right MCA bifurcation aneurysm with marked vasospasms by cerebral angiography was revealed. Intentional delayed operation with V-P shunt was performed. He discharged with mild left upper limb paresis, and visual impairment on the right. Bilateral PCKs were confirmed by postoperative DIP and CT scan. Case 2, a 51-year-old female, who suddenly complained of severe headache, was referred to our department 3 days after subarachnoid hemorrhage. One year previously, she had been pointed out PCKs. Neurological findings on admission at February 29, 1980, were drowsy, left third cranial nerve palsy, and hypertension. Cerebral angiography showed multiple aneurysms (bilateral IC-PC & A-com). Neck clipping (1-IC-PC & A-com) and coating (r-IC-PC) were performed at the next day of admission, and V-P shunt operation was followed about 8 weeks after first operation. About 2 weeks after discharge, she suddenly became loss of consciousness and expired. Autopsy revealed intracerebral hemorrhage in left basal ganglia and thalamus. Both kidneys were PCKs of Potter type 3 and cysts of the liver were also noted. In young hypertensive patients with cerebral aneurysms, it should be in mind whether PCKs may be combined or not, and cerebral angiography in PCKs were reasonable to find out harbored cerebral aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two cases of cerebral aneurysms combined with polycystic kidneys]. 652 33

The goal of this study was to characterize the utility of muscle motor evoked potentials (MMEPs) elicited by direct cortical stimulation as a means of monitoring during unruptured large and giant cerebral aneurysm surgery. This analysis focused on intraoperative changes in MMEPs and their relationship to postoperative motor function. The study population consisted of 50 patients who underwent surgery for large (n = 31) or giant (n = 19) cerebral aneurysms. Intraoperative MMEPs were continuously and successfully obtained in muscles belonging to the vascular territory of interest. There was no postoperative motor paresis in 31 (62%) patients in whom intraoperative MMEPs remained unchanged. Transient MMEP change occurred in 15 (30%) of the 50 patients, but 9 of those patients had no postoperative motor deficits, 5 had transient motor deficits, and 1 suffered permanent motor deficits resulting from postoperative delayed blood flow insufficiency due to arteriosclerosis of the parent artery. Permanent MMEP loss occurred in 4 (8%) of 50 patients, all of whom developed severe and permanent postoperative motor deficits. MMEP is a useful monitoring modality in patients undergoing surgery for large or giant cerebral aneurysms. This strategy can help predict functional prognosis or guide the neurosurgeon intraoperatively in an effort to promote better outcomes.
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PMID:The significance of intraoperative monitoring of muscle motor evoked potentials during unruptured large and giant cerebral aneurysm surgery. 2439 Jan 85