Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic hematomas are a common problem during infancy and usually occur as the consequence of trauma. They tend to enlarge and are often managed successfully with repeated subdural taps. In patients with collections that fail to respond to percutaneous drainage, the choice of operative management, including burr hole evacuation, shunting, or craniotomy, remains controversial. A new technique, called endoscopic washout, was successfully used in 7 children under the age of 2 years who presented with irritability, vomiting, seizures, and rapid head growth. Preoperative computerized tomography (CT) scans demonstrated enlarging, bilateral, chronic subdural collections; these failed to respond to repeated percutaneous taps over 10 days. With the patient positioned supine, bilateral linear incisions were made anterior to the coronal suture in the midpupillary lines and burr holes were placed. After the dura and outer membrane were opened and coagulated with bipolar cautery, a 4-mm steerable fiberscope was introduced into the subdural space to visualize the collections, evacuate any residual clot, and continuously irrigate the space with lactated Ringer's solution warmed to physiologic temperature. No bridging vessels or synechiae were violated; nitrous oxide and hyperventilation were discontinued before removing the fiberscope. The subdural space was irrigated again prior to closure. At follow-up (range 18 months to 8 years), CT scans showed reexpansion of the brain and no reaccumulation of the hematomas. We conclude that the endoscopic washout is a safe, uncomplicated treatment for chronic subdural hematomas in infants; is more effective than treatment with conventional burr holes alone, and eliminates the need for shunting or craniotomy.
 ...
PMID:Endoscopic washout: a new technique for treating chronic subdural hematomas in infants. 965 43

Recently, endoscopic procedures have been recommended as the first surgical option for cerebral arachnoid cyst (AC). The author reports seven ACs treated endoscopically and discuss the role of endoscopic fenestration. The age of the patients ranged from two to 62 years. Three ACs were located in the posterior cranial fossa, two in the suprasellar area, one in the middle cranial fossa, and one in the convexity. All cases were examined by cine magnetic resonance (MR) flow study. The patient's symptoms included headache, vomiting, dizziness, problems in balance, visual disturbance, and seizure. The author performed a cysto-cisternostomy or cysto-ventriculostomy via a single burr hole. The follow-up periods ranged from six to 18 months. There was no mortality or morbidity except one case of intracisternal bleeding during endoscopic procedure. Symptoms were relieved in all seven patients. Follow-up imaging studies revealed a decrease in the size or disappearance of the cysts. The results support that the minimal fenestration procedure as possibly as preserving the internal environment is valuable for the management of ACs.
 ...
PMID:The role of endoscopic fenestration procedures for cerebral arachnoid cysts. 1048 26

Nonanastomotic pseudoaneurysms are uncommon complications of prosthetic grafts, which are mostly associated with axillofemoral grafts. The case presented describes a pseudoaneurysm secondary to a previously placed end-to-side aortobifemoral bypass. Back pain developed 3 years after the original bypass and was not relieved with narcotics and muscle relaxants. The patient also complained of a 20-pound weight loss, night sweats, and frequent emesis. Approximately 1 year after the onset of back pain, left leg claudication developed. He eventually underwent magnetic resonance imaging of the lumbosacral spine, which depicted a tumorlike mass eroding the vertebral bodies of L2 and L3. Full oncologic workup was pursued preoperatively. The patient also underwent aortography, computed tomography of the abdomen and pelvis, and an inferior venacavogram to elucidate the relationships between the mass and the major vascular structures. On exploration, no malignancy was present. A hole in the native aorta approximately 2 cm above the level of the end-to-side aortic anastomosis was discovered. This was contiguous with the vertebral bodies and the left psoas muscle. The pseudoaneurysm was repaired by conversion of the proximal anastomosis to an end-to-end aorto right iliac and left femoral bypass. All of the preoperative symptoms resolved after repair of the pseudoaneurysm. Chronic aortic rupture or pseudoaneurysms are difficult to diagnose due to the unusual clinical presentations. Despite complete radiologic evaluation, preoperative diagnosis may be difficult or impossible without a high degree of suspicion. Surgical repair will depend on the cause of the pseudoaneurysm--all but infected aneurysms may be repaired in line by creating a proximal anastomosis above the level of the pseudoaneurysm. Atypical back pain in patients with previous aortic reconstructions should alert the clinician to the possibility of vascular involvement. Patients with aortic pseudoaneurysms should undergo prompt repair to avert the potential risk for rupture when the surrounding structures are no longer able to contain the pulsatile flow.
 ...
PMID:Aortic nonanastomotic pseudoaneurysm eroding lumbar vertebra--a case report. 1145 54

Choroid plexus cysts (CPCs) are the most common neuroepithelial cysts, occurring in more than 50% of some autopsy series. They are typically small and asymptomatic and are discovered incidentally in older patients, usually in the trigone of the lateral ventricle. Symptomatic CPCs (usually exceptionally large, 2-8 cm) are rare. The authors report a case of large symptomatic choroid plexus cyst, located in the trigone of the right lateral ventricle in a 26-yr-old man who presented with headache and vomiting. The patient underwent endoscopic removal through a burr hole placed 3 cm from the midline and just behind the hair line. The histological examination of the cyst wall was consistent with choroid epithelium. Despite of postoperative intraventricular hemorrhage and catheter infection, he discharged home without neurologic deficits. The endoscopic fenestration rather than excision should be considered as the first surgical procedure because the goal of treatment is shrinkage of the cyst until normal cerebrospinal fluid flow is restored.
 ...
PMID:Neuroendoscopic removal of large choroid plexus cyst: a case report. 1583 13

Recent findings have focused on the possible role of linezolid as a suitable candidate for the treatment of central nervous system infections. The linezolid treatment for meningitis was sporadically reported in adults but there was no report in children. Here, we present a 6-month-old boy with meningitis and subdural empyema which was unresponsive to more conventional agents but successfully treated with linezolid therapy. A previously healthy 6-month-old boy was referred to our clinic for deteriorating general condition with fever, vomiting and seizures. He had fever and tense-bulging anterior fontanelle. Based on his first cerebrospinal fluid (CSF) results, empirical antibiotic therapy for bacterial meningitis consisting of vancomycin and ceftriaxone was started. However, CSF culture yielded no micro-organisms but blood culture showed coagulase-negative Staphylococci. On the 7th day, he still had high fever and the erythrocyte sedimentation rate (ESR) and serum CRP levels had risen by 105 mm/h and 36.2 mg/dl, respectively. On 10th day, computerized cranial tomography showed bilateral frontoparietal subdural empyema. Purulent material was evacuated by burr hole, and gram stains of the material showed polymorphonuclear leukocytes and no microorganisms. Clinical and CSF findings of our case were, unresponsiveness to vancomycin, ceftriaxone and consecutive meropenem treatment while we still observed subdural empyema during these treatments. For this reason we started linezolid 10 mg/kg twice daily. Clinical signs improved dramatically, with both completely normal neurological findings and normalization of CSF and radiological findings. To the of our best knowledge, linezolid treatment of meningitis in children has not been reported previously. Clinical and CSF findings of our case were improved completely with linezolid treatment. Also, control cranial computerized tomography showed the total recovery of subdural empyema. Here we present the youngest case with meningitis which was successfully treated with linezolid treatment.
 ...
PMID:Successful treatment with linezolid of meningitis complicated with subdural empyema in a 6-month-old boy. 1759 89

The objective of this study was to investigate the outcome of neurosurgical treated children with suppurative intracranial complications (SIC) of sinusitis over the past 28 years in our hospital. We reviewed the cases notes of a series of 11 consecutive paediatric patients, who were subjected to surgery for sinusitis-induced SIC, retrospectively. Eleven children (10 males and only one female) were underwent neurosurgical procedure in our hospital between 1978 and 2006. Their age at the time of diagnosis ranging from 13 to 17 years (mean 15.27 years, SD 1.737). The commonest presenting symptoms were headaches (81.8%) followed by vomiting (45.5%) and swelling of the forehead (45.5%). The most often involved sinus was the frontal sinus (63.6%) and sinus surgery was performed in eight (72.72%) of 11 cases. The neurosurgical procedures carried out included burr hole drainage or aspiration of abscess in five cases, craniotomy and evacuation of empyema in seven cases and craniectomy in two cases. Four (36.4%) of 11 patients had more than one neurosurgical operation due to re-accumulation of pus and worsening of their clinical status. Most common pathogen was Streptococcus species (81.9%), and anaerobes were isolated in three (27.3%) cases. Postoperative antibiotic treatment lasted from 26 to 70 days (mean 45.45 days, SD 15.280). Epilepsy was diagnosed in two patients, postoperatively. During the follow-up period, persistent focal neurological deficits were present in five (45.5%) of 11 patients. Interestingly, five (45.45%) cases occurred over the last 2 years (2005-2006) and the other six over the previous 16 years (1978-2006). Prompt and aggressive medical and neurosurgical intervention is required, aiming to minimize the morbidity and mortality and also to maximize the favourable outcome of those children.
 ...
PMID:Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. 1807 89

Rosai-Dorfman disease (RDD) is a rare idiopathic histiocytic disorder that only occasionally involves the central nervous system (CNS). Previous cases of RDD involving the CNS were generally seen in adults. Pediatric cases of RDD are rare, and the disease in these cases typically has an indolent clinical course. In this report, the authors describe a pediatric case of intracranial RDD with rapid clinical and radiological progression. A previously healthy 13-year-old girl presented with a 15-day history of progressive left-sided headaches, vomiting, and fever. On examination she was pyrexial but otherwise normal. Neuroimaging results demonstrated an extraaxial left frontal lesion with peripheral enhancement. A bur hole was drilled over the lesion to obtain a tissue sample and de-bulk the lesion. The initial histological results showed a nonspecific inflammatory lesion. Postoperatively, the patient was asymptomatic, and neuroimaging results confirmed a significant reduction in the size of the lesion. Repeated neuroimaging 3 months later, however, revealed a large recurrence of the lesion, which was removed macroscopically by a craniotomy. Histological analysis of the tissue confirmed the RDD diagnosis. At the latest follow-up (12 months) the patient had remained asymptomatic with no evidence of recurrence on neuroimaging. This is the first reported case of intracranial RDD with an aggressive clinical course.
 ...
PMID:Cerebral localization of Rosai-Dorfman disease in a child. Case report. 1845 87

Atresia of the foramina of Magendie and Luschka is a rare cause of obstructive hydrocephalus. Although this condition has been classically treated by CSF shunting, recent treatments have also included endoscopic third ventriculostomy. In the present study, the authors present the case of a patient with hydrocephalus in whom an alternative method was used following a CSF shunt malfunction. A young female patient in whom a shunt was placed during the patient's 1st year of life was faring well until she was 8 years old. She was admitted to the emergency department 5 times with signs of CSF shunt malfunction. Each time, the CT scan showed a slight dilation of the lateral and third ventricles and a large increase in the size of the fourth ventricle. In comparison, ventricles were smaller in a previous imaging study obtained when the patient was asymptomatic. Magnetic resonance imaging showed the same slight dilation of all the ventricles and a significant increase in the fourth ventricle. There was no aqueductal stenosis. An important enlargement of both lateral recesses of the fourth ventricle suggested the possibility of an atresia of the foramina. The foramen of Monro and the width of the third ventricle would not allow the passage of an endoscope. The decision was made to open those foramina endoscopically through the fourth ventricle. After induction of general anesthesia, with the patient in the prone position, a bur hole was made in the left paramedian and suboccipital region. The endoscope was introduced underneath the cerebellar hemisphere. The authors were then able to distinguish the floor of the fourth ventricle and other anatomical landmarks. Navigation through the lateral recesses allowed them to see the fine membranes closing the foramina. These membranes were opened with a monopolar cautery as a blunt instrument. The orifice was then enlarged with a 3 Fr Fogarty catheter. The authors also opened a bulging thin membrane located at the foramen of Magendie. During the postoperative period, the authors observed a marked improvement in the state of the patient's alertness as well as a disappearance of her headaches and cessation of vomiting. In addition, the patient's gait ataxia improved slowly. Six-month postoperative MR imaging demonstrated an unequivocal reduction in the size of the fourth ventricle. The patient was still doing well 36 months after the surgery. Endoscopic fourth ventriculostomy, the opening of the 3 foramina of the fourth ventricle, may be an alternative treatment in cases in which these structures are congenitally closed.
 ...
PMID:Fourth ventriculostomy: an alternative treatment for hydrocephalus due to atresia of the Magendie and Luschka foramina. 2128 60

A 76-year-old woman with a 20-year history of chronic hepatitis C was referred to our hospital for worsening exertional dyspnea. She had been given a diagnosis of interstitial pneumonia based on chest computed tomography findings 5 years previously. Contrast-enhanced echocardiography confirmed an intrapulmonary right-to-left shunt, and therefore we diagnosed hepatopulmonary syndrome comorbid with interstitial pneumonia. In July 2009 she was admitted to our hospital with a low grade fever, headache, and vomiting. We diagnosed a left cerebellar brain abscess caused by Streptococcus intermedius. She underwent stereotactic burr-hole drainage and received vancomycin, piperacillin and cefotaxime. Cases of brain abscess secondary to hepatopulmonary syndrome are rare. Nevertheless, we should be aware of this complication of hepatopulmonary syndrome.
 ...
PMID:[A brain abscess as a complication of hepatopulmonary syndrome coexisting with interstitial pneumonia]. 2184 92

A complication of otitis media is defined as a spread of infection beyond the pneumatized area of the temporal bone and the associated mucosa. Complications can be classified as intra temporal or intra cranial, which includes extradural abscess, brain abscess, subdural abscess, sigmoid sinus thrombophlebitis, otic hydrocephalus, and meningitis. Since the introduction of antibiotics, intra cranial complications in otitis media are less common, however, the occurrence should not be underestimated due to their associated morbidity and mortality. Herein, we report a case of chronic suppurative otitis media (CSOM) with intra cranial complication (brain abscess) in a 25-year-old male patient with ear discharge, severe headache, and vomiting. Computerized tomography scan confirmed the diagnosis. The patient was managed by a combined neurosurgical and otologic approach. Surgery of the abscess includes aspiration through a bur hole or craniotomy and by radical mastoidectomy for CSOM.
 ...
PMID:Chronic suppurative otitis media with intracranial complication. 2226 47


<< Previous 1 2 3 Next >>