Complications of lumbar drainage after thoracoabdominal aortic aneurysm repair.
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OBJECTIVES: Paraplegia remains a frequent complication of thoracoabdominal aortic aneurysm (TAAA) repair. Many adjunct therapies have been developed to address this complication. Lumbar drainage is frequently used in an attempt to decrease intrathecal pressure and improve intramedullary perfusion pressure. The effectiveness of this therapy is unclear, and the complications of lumbar drainage used for this indication are unknown. We present a case of intraspinal hematoma with significant neurologic deficit after TAAA repair and review the associated complications of lumbar drains placed for TAAA. METHODS: The charts of all patients undergoing operations for TAAA repair were reviewed. Patients who underwent perioperative placement of a lumbar drain were included regardless of aneurysm type or etiology. Demographics, Crawford grade, and perioperative parameters and complications were reviewed. RESULTS: Sixty-five patients underwent TAAA repair with 62 (95%) receiving a preoperative lumbar drain. There were two (3.2%) intraspinal hemorrhagic complications, including one patient with a poor neurologic outcome. No infections or other complications directly related to drainage were identified. Multivariate logistic regression analysis failed to demonstrate a significant association between lumbar drain complications and perioperative and intraoperative parameters such as blood loss or hypotension, level of drain placement, and Crawford grade. CONCLUSIONS: Lumbar drainage is a frequent adjunct to TAAA repair. However, placement of the drain itself can be associated with significant complications whose aggravating factors may be unidentifiable. Complications resulting from lumbar drainage should be considered in any patient who has postoperative lower extremity neurologic deficits. (+info)
Nuclide angiography in Paget's disease of the skull: Case report.
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Early-appearing and persistent uptake on nuclear angiography in a patient with early Paget's disease of the skull is described. The diagnosis of subdural hematoma may be ruled out at the time of brain scanning. (+info)
MR imaging of shaken baby syndrome manifested as chronic subdural hematoma.
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Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanced MRI revealed diffuse dural enhancement. (+info)
Organizing posterior fossa hematomas simulating developmental cysts on prenatal imaging: report of 3 cases.
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OBJECTIVE: We encountered 3 organizing tentorial hematomas simulating posterior fossa lesions such as Dandy-Walker, dermoid, or arachnoid cysts. We sought to correlate the clinical and pathologic features that allow distinction of developmental cysts from hematomas in the posterior fossa on imaging. METHODS. Prenatal sonograms in all fetuses and fetal magnetic resonance scans in 2 of the 3 were reviewed. One case proceeding to term had serial imaging up to age 11 months. Two cases had complete neuropathologic evaluation after termination. Maternal records were reviewed. RESULTS: In each case, the ultrasonographic findings were reminiscent of a developmental cyst but with echogenic debris, a rim, or both. Magnetic resonance imaging suggested tentorial hemorrhage in 2, 1 also with falcine hemorrhage. Serial prenatal and postnatal imaging showed resolution in the surviving case. Pathologically, 2 fetuses had organizing tentorial hematomas causing brain displacement. Calcifications, white matter damage, germinal matrix hemorrhage, and brain stem necrosis were also present. One mother had von Willebrand disease. CONCLUSIONS: Tentorial hematomas, with or without maternal coagulopathy, should be considered in the prenatal ultrasonographic diagnosis of cystlike posterior fossa abnormalities containing echogenic material. Fetal magnetic resonance imaging can suggest blood products. Hypoxic-ischemic brain damage may be concurrent; however, resolution of the hematoma, with no apparent neurologic sequelae, can occur. (+info)
Improved brain scan specificity utilizing 99mTc-pertechnetate and 99mTc(Sn)-diphosphonate.
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Each of 36 patients was studied with two separate brain scans performed sequentially after the injection of 20 mCi of 99mTc-pertechnetate or 20 mCi of 99mTc(Sn)-diphosphonate. The resulting scans were qualitatively compared, and lesion-to-nonlesion ratios of activity determined. Diagnoses were established by clinical criteria and were supported in the majority of cases by computerized axial tomography or roentgen angiography or both. Histologic confirmation was available in five cases of tumor and in the single cases of subdural hematoma and cerebral abscess. Of 22 cerebral infarctions, 15 were better demonstrated with 99mTc-(Sn)-diphosphonate than with 99mTc-pertechnetate. Of the seven remaining cases, three were visualized equally well with each agent, and three were better demonstrated with 99mTc-pertechnetate. One was not seen with either agent. Of the 12 tumors, 11 were visualized better with 99mTc-pertechnetate than with 99mTc-(Sn)-diphosphonate while in one case the lesion was seen equally as well with both agents. In no case was a lesion definitely seen with one radiopharmaceutical and not with the other. These results indicate that this dual method is helpful in differentiating gliomas and metastases from cerebral infarctions. (+info)
Investigating subdural haemorrhage in infants.
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When an infant or young child presents with subdural haemorrhage, the diagnostic priority is to exclude physical child abuse. A team approach should be adopted for the clinical child protection investigation. The diagnostic process is inevitably one of detective work; appropriate radiological, ophthalmological, haematological, biochemical, and postmortem investigations are discussed. (+info)
Prenatal diagnosis of an infratentorial subdural hemorrhage: case report.
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We report a case of a prenatally diagnosed infratentorial subdural hemorrhage. The hematoma located in the posterior cerebral fossa was detected by conventional ultrasound at 24 weeks of gestation. Intrauterine magnetic resonance imaging confirmed the diagnosis. Autopsy of the fetus revealed a well-circumscribed subdural hematoma. The prenatal findings of intracranial bleeding located in the posterior fossa and the prognosis of such cases are discussed. (+info)
Characterization of the diarylether sulfonylester (-)-(R)-3-(2-hydroxymethylindanyl-4-oxy)phenyl-4,4,4-trifluoro-1-sulfonate (BAY 38-7271) as a potent cannabinoid receptor agonist with neuroprotective properties.
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(-)-(R)-3-(2-Hydroxymethylindanyl-4-oxy)phenyl-4,4,4-trifluoro-1-sulfonate (BAY 38-7271) is a new high-affinity cannabinoid receptor subtype 1 (CB1 receptor) ligand (K(i) = 0.46-1.85 nM; rat brain, human cortex, or recombinant human CB1 receptor), structurally unrelated to any cannabinoid receptor ligand known so far. BAY 38-7271 was characterized as a CB1 receptor agonist in 5-[gamma(35)S]-thiophosphate triethylammonium salt binding assays using rat or human CB1 receptors. In the rat hypothermia assay, BAY 38-7271 induced a dose-dependent reduction in body temperature (minimal effective dose = 6 microg/kg, i.v.); whereas in rats trained to discriminate the CB1/CB2 receptor agonist (-)-cis-3-[2-hydroxy-4(1,1-dimethyl-heptyl)phenyl]-trans-4-(3-hydroxypropyl) cyclohexanol (CP 55,940; 0.03 mg/kg, i.p.) from vehicle, BAY 38-7271 induced complete generalization (3 microg/kg, i.v.). In both in vivo models, a specific CB1 receptor-mediated mechanism was confirmed by demonstrating that the effects of CP 55,940 and BAY 38-7271 were blocked by pretreatment with the selective CB1 receptor antagonist N-(piperidin-1-yl)-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole -3-carboxamidehydrochloride. In the rat traumatic brain injury model, BAY 38-7271 demonstrated highly potent and efficient neuroprotective properties when administered as a 4-h infusion immediately after induction of subdural hematoma (70% infarct volume reduction at 100 ng/kg/h). Even when applied with a 3-h delay, a significant neuroprotective efficacy could be observed (59% infarct volume reduction at 300 ng/kg/h). The neuroprotective potential of BAY 38-7271 was confirmed in a rat model of focal cerebral ischemia induced by permanent occlusion of the middle cerebral artery. It is concluded that the CB1/CB2 receptor agonist BAY 38-7271 shows pronounced neuroprotective properties that do not result from drug-induced hypothermia and that occur in a dose range devoid of typical cannabinoid-like side effects. (+info)