Some sources of stress found in mothers of spina bifida children.
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The scores on a malaise inventory for 51 mothers of spina bifida children born between 1956 and 1962 in South Wales revealed significantly higher scores when the child was incontinent, had a severe locomotor disability, had an IQ less than 80, and was attending a special school rather than a normal school. No difference in scores was found between the sexes or for size of family, and only a slight difference occurred between the malaise scores of mothers of mildly and moderately handicapped children. (+info)
We report the case of a 4-year-old boy who presented with a congenital mass on the bridge of his nose. A magnetic resonance study failed to rule out a communication of the tumor with the cranial cavity. The lesion was totally removed. Histopathological study of the excised mass showed a peripheral zone of fibrous-connective tissue with a core of glial and neuronal elements. We discuss the origin of these masses and their relation to nasal cephaloceles. We suggest that this type of lesions should be included within the broader spectrum of atretic cephaloceles. (+info)
Pilot dose-escalation study of caffeine plus ethanol (caffeinol) in acute ischemic stroke.
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BACKGROUND AND PURPOSE: In animal models, the combination of caffeine and ethanol (caffeinol) provides robust neuroprotection at blood levels that should be easily and safely achieved in humans. This study was designed to determine the safety and tolerability of ascending doses of this combination in stroke patients. METHODS: This Food and Drug Administration-approved open-label, single-arm, dose-escalation study had 3 original dose groups: group 1, caffeine 6 mg/kg plus ethanol 0.2 g/kg; groups 2 and 3, incremental increases of caffeine and ethanol by 2 mg/kg and 0.2 g/kg, respectively. Intravenous thrombolysis was encouraged if patients qualified. Drug was started within 6 hours of stroke onset, and blood levels of caffeine and ethanol were drawn at baseline and end of infusion. The target blood caffeine and ethanol ranges were 8 to 10 microg/mL and 30 to 50 mg/dL, respectively. Clinical outcome measurements included the National Institutes of Health Stroke Scale at the end of infusion, at 24 hours, and at discharge. Potential complications from caffeine and ethanol were recorded. Cases were reviewed by an independent stroke neurologist for safety. RESULTS: A total of 23 patients were recruited. Target blood caffeine and ethanol levels were reached in 0 of the 4 patients in the first group. The second dose group (caffeine 8 mg/kg plus ethanol 0.4 g/kg) included 8 patients. The median end-of-infusion caffeine and ethanol levels were within the desired target ranges. Two days after infusion, 1 patient in this group with preexisting cardiac disease and end-of-infusion caffeine and ethanol levels of 10.7 microg/mL and 69 mg/dL developed reversible congestive heart failure and required transfer to an intensive care unit. The original third dose group was canceled given achievement of target blood caffeine and ethanol levels in group 2. However, 3 new dose groups were created in an attempt to minimize the dose of ethanol. Although blood levels were proportional to dose, none of these new dose groups provided optimal blood levels. Congestive heart failure occurred in 1 other patient with previously asymptomatic cardiomyopathy. No other side effects were noted. Concomitant thrombolytic therapy was given in 8 patients, 1 of whom died of intracerebral hemorrhage. CONCLUSIONS: Caffeinol alone or combined with intravenous tissue plasminogen activator can be administered safely. Caffeine 8 mg/kg plus ethanol 0.4 g/kg produces target caffeine and ethanol levels of 8 to 10 microg/mL and 30 to 50 mg/dL, respectively. A randomized, placebo-controlled trial is needed to determine the neuroprotective effect of this combination. (+info)
Rapid spontaneous resolution of signs of intracranial herniation due to subdural hematoma--case report.
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An 83-year-old female presented with signs of intracranial herniation due to subdural hematoma (SDH) which resolved rapidly and spontaneously. This patient showed bilateral decerebrate postures due to left SDH on admission. Since she had serious neurological symptoms and critical systemic conditions caused by an asthma attack, conservative treatment including osmotherapy and mechanical ventilation was performed instead of surgical intervention. Her signs of intracranial herniation resolved only 6 hours after admission. Although the SDH did not diminish rapidly, she showed excellent neurological improvement even with conservative treatment only. Characteristic serial changes on computed tomography corresponding to the neurological improvements were seen. She was discharged with slight right hemiparesis and slight dementia that were present prior to this admission. The rapid resolution of signs of intracranial herniation was attributable to the spontaneous diminution of SDH. The diminution or disappearance of hematomas probably depended on the redistribution of cerebrospinal fluid into the hematoma in the present case. (+info)
Two-stage management of mega occipito-encephalocele.
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We report three cases of large occipito-encephaloceles that were managed in the Neurosciences Unit, Hospital Universiti Sains Malaysia over the last 5 years. All patients had pre-operative MRI (magnetic resonance imaging) evolution and mapping of the sagittal sinus tract. The cerebrospinal fluid (CSF) of all three patients were initially diverted by means of ventricular shunt two weeks prior to shunt removal. The slow drainage of CSF prevented electrolyte and volume disturbances due to sudden decompression during their definitive occipital encephalocele operations. After 3 years follow-up, all these patients are progressing well. (+info)
Monitoring of increased intracranial pressure resulting from cerebral edema with transcranial Doppler sonography in patients with middle cerebral artery infarction.
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OBJECTIVE: Cerebral herniation resulting from postischemic brain edema is the most common cause of death in patients with large cerebral infarctions. Early monitoring of intracranial pressure and application of necessary treatment procedures may have life-saving value. In this study, the data obtained by transcranial Doppler sonography were compared with clinical examination and the neuroradiologic findings. METHODS: Eighteen patients with first-ever strokes and large middle cerebral artery infarction who were admitted within the first 12 hours after stroke onset were included. Clinical findings were evaluated according to the daily Glasgow Coma Scale and Rankin disability scores on the 10th day. Initial cerebral computed tomography was performed at admission to the hospital. Midline shift and ventricular displacement were evaluated on the third day. Follow-up tomographic scans of some patients were performed on subsequent days if necessary. Systolic, diastolic, and mean blood flow velocities and pulsatility indices of all patients were measured by transcranial Doppler sonography daily for 10 days. RESULTS: The pulsatility indices were higher on the third hospital day than on the first day. The increases in the pulsatility indices were correlated with the midline shift measured on the third day. The prognoses of the patients whose maximal pulsatility indices during the first 10 days were higher than 1.5 were poorer than those of the patients whose maximal pulsatility indices were lower than 1.5. CONCLUSIONS: Transcranial Doppler sonography enables noninvasive monitoring of raised intracranial pressure in patients with large infarctions. It also provides information for detecting cerebral herniation and deciding on the medical or surgical therapy. (+info)
Temporal lobe encephalocoele presenting with seizures and hearing loss.
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A case of a bilateral temporal lobe encephalocoele that presented as seizures and hearing loss for many years. Diagnosis was confirmed on CT and MR imaging, which showed deficiencies in the temporal bone. The patient subsequently underwent surgical repair and recovered from his presenting symptoms. (+info)
Poststroke neurological improvement within 7 days is associated with subsequent deterioration.
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BACKGROUND AND PURPOSE: Improvement in the National Institutes of Health Stroke Scale (NIHSS) 24 hours after stroke has been associated with subsequent neurological deterioration. We hypothesized that a similar association would be apparent for events occurring after 7 days, when acute changes from edema and herniation are less common. We evaluated the degree of NIHSS improvement at 7 days (recovery) as a predictor of subsequent neurological deterioration from day 7 to day 90. METHODS: We studied all patients of the Glycine Antagonist (gavestinel) In Neuroprotection (GAIN) International Trial with ischemic stroke alive at day 7, excluding patients with hemorrhagic events and deaths from nonstroke-related causes. The GAIN International Trial was a randomized, double-blind, placebo-controlled, and parallel-group trial; because the study drug had no effect on stroke outcome, treatment groups were combined for this analysis. Neurological deterioration was assessed by the combined measure, including: (1) stroke-related events recorded as "serious adverse events," (2) recurrent stroke recorded on a separate case report form, and (3) any NIHSS worsening. RESULTS: Among 1187 patients included, 25% had >65% recovery. Deterioration was more prevalent in the group with >65% early recovery (15.5% versus 10.3%; P=0.01). Logistic regression modeling indicated that recovery was associated with subsequent neurological deterioration (odds ratio, 1.2; 95% CI, 1.1 to 1.3, per 10% recovery) after adjusting for age, NIHSS at 7 days, and stroke subtype. CONCLUSIONS: Substantial neurological recovery at 7 days is associated with subsequent neurological deterioration. (+info)