Late ophthalmological manifestations in patients with subarachnoid hemorrhage and coiling of cerebral aneurysm

Late ocular manifestations of aneurysmal subarachnoid hemorrhage (SAH) have not been previously investigated except for one study which demonstrated that one half of patients subjected to aneurysm clipping suffer from symptoms of visual pathway impairment. We assessed ophthalmological status of patients after 1–4.5 years from SAH and aneurysm embolization to identify predictors of damage to the visual pathways. Complete ophthalmological examination, static perimetry, and visual evoked potentials (VEPs) were performed in 74 patients (26 men, 48 women, aged 19–76 years), who constituted a consecutive sample of 129 patients treated with aneurysm embolization in the years 2008–2010. The following independent variables: sex, age, time from SAH to embolization, size and site of aneurysm, score in Glasgow Coma Scale, Glasgow Outcome Scale, Hunt-Hess and Fisher scales were subject to univariate and multivariate statistical analyses to study their influence on the ocular outcome. 40 patients (54%) demonstrated visual field defects appearing as multiple peripheral foci and constricted field, affecting both eyes. Among these subjects, 12 patients had severe defects in the visual field, 20 had deterioration in VEPs, and 9 had decreased visual acuity. Older age and high score in Hunt-Hess and Fisher scales were identified as predictors for visual field defects and disturbances in VEPs. More than half of the survivors of SAH and aneurysm embolization suffer from a permanent defect in visual function. Damage of visual pathway correlates with severity of SAH and older age of patients

Endoscopic transconjunctival surgical approach to intraconal space of the orbit: First clinical experience

Background and purpose Recently, a transconjunctival, endoscope-assisted (TEA) approach to the medial intra-orbital space was developed based on cadaver preparations, with an ultimate goal of minimizing disturbances of the anatomic structures of the orbit. However, no report on clinical validation of this promising technique was published thus far. We present our experiences with the TEA approach in two patients. Material and methods In emergency conditions, we approached the lateral retrobulbar space of a 42-year-old male through a 180° incision close to the corneal limbus; a scrap of metal, which had perforated the globe and resided at its posterior wall, was removed endoscopically. Moreover, we used the TEA approach to remove a tumor from the upper intraconal space in a 63-year-old woman. Results In both patients the surgical goal was achieved with no muscle transection and without additional morbidity and complications. Conclusions Our experiences with TEA approach suggest that the procedure is clinically feasible, produces no co-morbidity and yields good functional and cosmetic results. As a result, the whole circumference of the retrobulbar space can be conveniently explored

Przypadek chorego z postacią zlokalizowanią choroby Castlemana: 10-letnia obserwacja

Castleman disease (CD) is a rare atypical lymphoproliferative process of obscure pathogenesis. An intracranial localization of the condition is extremely rare. We present a case of a 29-year-old man, who harbored an intracranial plasma cell variant of CD in the form of a tumor mimicking meningioma and was followed up to 10 years after surgical excision of the lesion. The histopathological examination showed massive infiltration of mononuclear cells, composed mainly of lymphocytes and matured plasmocytes, as well as many small thin-walled vessels surrounded with plasma cells and lymphocytes. This picture was consistent with a plasma cell type of CD. Ten-year follow-up supports a notion that total surgical excision of the solitary intracranial infiltration is curative in plasma cell type of CD.Choroba Castlemana jest rzadkim, atypowym procesem limfoproliferacyjnym o niejasnej etiologii i patogenezie. Postać o lokalizacji wewnątrzczaszkowej rozpoznaje się nadzwyczaj rzadko. W pracy zaprezentowano przypadek 29-letniego mężczyzny, u którego przedoperacyjnie stwierdzono zmianę „oponiakopodobną”, jednak badanie histopatologiczne ujawniło wewnątrzczaszkową postać choroby Castlemana o typie plazmatycznokomórkowym. Chorego obserwowano przez 10 lat po usunięciu guza. W badaniu histopatologicznym stwierdzono naciek zapalny złożony głównie z limfocytów oraz dojrzałych plazmocytów, a także liczne cienkościenne naczynia otoczone komórkami plazmatycznymi i limfocytami. Obraz histopatologiczny jednoznacznie wskazywał na postać plazmatycznokomórkową choroby Castlemana. Dziesięcioletnia obserwacja po usunięciu zmiany wskazuje, że całkowite wycięcie guza może zapewnić trwały efekt leczniczy

Mast cells evaluation in meningioma of various grades

Introduction: Meningioma is a heterogenous group of primary brain tumors. The progression or recurrence is relatively very common; however there is lack of prognostic factors which may indicate those events. The aim of the study was to evaluate the presence of mast cells within the low grade and high grade meningiomas. Material and Methods: The immunohistochemical reaction was done. The tryptase expression was estimated in slides of meningiomas of various grades in 10 random fields under the light microscope. Results: The expression of tryptase was observed in 31,8% low grade meningiomas and in 85,9% high grade meningiomas. The immunostaining was observed next to the blood vessels. Conclusion: The presence of mast cells might be a significant prognostic factor for the recurrence or the worse prognosis of meningiomas

Change in Blood Flow Velocity Pulse Waveform during Plateau Waves of Intracranial Pressure.

A reliable method for non-invasive detection of dangerous intracranial pressure (ICP) elevations is still unavailable. In this preliminary study, we investigate quantitatively our observation that superimposing waveforms of transcranial Doppler blood flow velocity (FV) and arterial blood pressure (ABP) may help in non-invasive identification of ICP plateau waves. Recordings of FV, ABP and ICP in 160 patients with severe head injury (treated in the Neurocritical Care Unit at Addenbrookes Hospital, Cambridge, UK) were reviewed retrospectively. From that cohort, we identified 18 plateau waves registered in eight patients. A "measure of dissimilarity" (Dissimilarity/Difference Index, DI) between ABP and FV waveforms was calculated in three following steps: 1. fragmentation of ABP and FV signal according to cardiac cycle; 2. obtaining the normalised representative ABP and FV cycles; and finally; 3. assessing their difference, represented by the area between both curves. DI appeared to discriminate ICP plateau waves from baseline episodes slightly better than conventional pulsatility index did: area under ROC curve 0.92 vs. 0.90, sensitivity 0.81 vs. 0.69, accuracy 0.88 vs. 0.84, respectively. The concept of DI, if further tested and improved, might be used for non-invasive detection of ICP plateau waves

Endoscopic drainage of orbital abscesses aided with intraoperative sonography

Background and purpose Accurate localization and adequate visualization of the superiorly or inferiorly located subperiosteal orbital abscesses or intraorbital abscess is difficult with transnasal endoscopic approach. Sonography is a well-known and effective tool for evaluation of orbital pathologies but no paper documenting intraoperative application of this method in orbital abscess surgery has been published to date. Material and methods We present a series of 12 patients in whom orbital abscesses were drained endoscopically with an aid of neuronavigation and intraoperative ultrasonography. The abscesses were localized subperiosteally in the medial (n=6), superior (n=2) or inferior (n=1) part of the orbit whereas in 3 patients the abscess was localized in the intraconal space. Results According to intraoperative sonographic imaging complete drainage of the abscess was achieved in 11 out of 12 patients and no complications occurred. Intraoperative sonography helped to limit opening of the orbital wall in the medial subperiosteal abscesses, enabled check-up for completeness of drainage of the far extending pouches in the superior and inferior subperiosteal abscesses and enabled visualization of the tip of surgical instrument when reaching deeply located intraorbital abscesses. Conclusions Intraoperative ultrasonography facilitates the endoscopic management of orbital abscesses, especially those which are difficult to reach due to subperiosteal location in the superior and inferior parts of the orbit, or abscesses localized intraorbitally

Early outcomes and perioperative complications of endovascular embolization in patients with aneurysmal SAH

Background We still lack reliable data on the outcomes of endovascular coiling for ruptured cerebral aneurysms. As this is still an evolving technique, the outcomes of the procedures performed in the past and more recently cannot be directly compared. We present the early outcomes of endovascular coiling in a relatively large group of patients with ruptured intracranial aneurysms. Method The study included 190 consecutive patients (a total of 216 aneurysms) subjected to endovascular coiling in 2006–2013 (127 women aged 56±13 years and 63 men aged 50± 15 years). Up to 87.5% of the aneurysms were located within anterior circulation. Most patients presented with “mild to moderate” subarachnoid hemorrhages (85% of Hunt &Hess scores 1–3, and 72% of Fisher scores 1–3). Results Embolization was feasible in 176 (92.6%) patients. In 14 cases, the embolization was not attainable due to unfavorable anatomy of the aneurysm, intraoperative vasospasm and/or aneurysm rupture, or prolapse of a coil. Early complications related to the procedure were recorded in 23 (13.1%) patients. The most common perioperative complication was aneurysm rupture. All fatal complications occurred in patients with aneurysms located at the anterior circle of Willis. At the time of discharge, 126 patients scored 4 or 5 on the Glasgow Outcome Scale. Conclusions Endovascular embolization is an effective and relatively safe method for treatment of ruptured cerebral aneurysms. Complications related to the procedure are significantly less frequent in the case of vertebral-basilar complex aneurysms

Biomechanical evaluation of single- and multi-level anterior cervical discectomy and fusion with polyetheretherketone cages: radiological and clinical outcomes

Objective. The aim of this study was to analyse the outcomes of single- and multi-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages, with particular emphasis on the risk of secondary adjacent segment disease. Materials and methods. This retrospective study included 30 patients with single- or multi-level cervical disc herniation. Before the ACDF, and one year thereafter, the patients underwent clinical and radiological evaluation including determination of cervical pain severity with a numerical rating scale (NRS), and a survey with a Polish adaptation of the neck disability index questionnaire (NDI-PL). Biomechanical parameters of the cervical spine were determined using the Cobb method. Results. One year after ACDF, all patients had achieved complete fusions, and 97% showed a significant reduction of pain severity. Also, a significant decrease in all NDI-PL indices was observed. A significant decrease in overall cervical spine mobility coexisted with a significant increase in the mobility of the segment above the one operated upon and a non-significant decrease in the mobility of the segment below. No statistically significant change was found in the intervertebral disc space height (IVH) above and below the operated segment, and no evidence of degeneration within the segments adjacent to the operated one was documented. Conclusion. One- and two-level ACDF with standalone PEEK cages provided high fusion rates. Surgical spondylosis contributed to a reduction of spinal mobility despite the hypermobility in adjacent spinal segments. No degeneration in adjacent spinal segments was documented within a year of ACDF, and the treatment seemed to improve patients’ quality of life

Median nerve conduction impairment in patients with diabetes and its impact on patients’ perception of health condition: a quantitative study

INTRODUCTION: Impaired mobility and compromised manual dexterity leading to difficulties with the activities of daily living (ADL) are an inherent part of the clinical picture in diabetes. Hand function in diabetes is influenced by a variety of pathologies: the median nerve, the most important nerve of the hand, can suffer from metabolic disturbances, ischemia and/or entrapment neuropathies. The resulting deterioration in functional capacity is likely to have significant consequences for the ability to perform ADL, influencing adjustment to diabetes and affecting quality of life. The aim of the present study was to examine the influence of hand function as measured by median motor nerve conduction on quality of life, taking into account various aspects of functioning in patients with diabetes, including activities of daily living, psychological status and acceptance of illness. PATIENTS AND METHODS: Seventy one hospital patients with diabetes participated in the study. Electrophysiological recordings of conductance in the median nerve were obtained for both hands and the relationship between hand function and functional status (BI), depression and anxiety (HADS), adjustment to illness (AIS) and their effect on quality of life (SF-36v2 and QLI) was studied. RESULTS: Damage to the median nerve of the left hand was associated with significant differences in functioning in the physical, but not the mental component of the SF-36v2, p = 0.03 and in functional status (p = 0.006). QOL was associated with depression, patient age, acceptance of illness, functional ability and to a small, but significant extent with median nerve damage to the right hand on the measure of conduction velocities (R2 =0.726). CONCLUSIONS: Nerve conductance studies demonstrated a small, but significant effect of hand function on quality of life. Impairment of the median nerve in the left hand was associated with functional difficulties in the activities of daily living and a diminished quality of life in the area of physical functioning. No dependencies of this kind were found for the right hand, which may reflect the greater compensatory capacity of the right hand resulting from improved efficiency due to practice

Skurcz tętnic mózgowych u chorych z krwotokiem śródmózgowym : doniesienie wstępne

Background: Spasm of the intracranial arteries is a frequent and dangerous complication after subarachnoid hemorrhage. However, only a few cases of cerebral vasospasm in intracerebral hemorrhage (ICH) have been reported. Therefore, we decided to analyze the results of angiographic examinations in ICH patients retrospectively and evaluate the occurrence of vasospasm. Material/Methods: 46 patients with ICH, aged 20-72 (15 women and 31 men), routinely referred for cerebral angiography, were included in this study. Spasm was graded as mild (up to 25% of vessel narrowing), moderate (26-50% of vessel narrowing) and severe (more than 50% of vessel narrowing). Results: We observed middle cerebral artery (MCA) spasm on the side of ICH in 11 patients. In 3 cases the spasm occurred also in the anterior cerebral artery (ACA). We found evidence of MCA narrowing on the side opposite to ICH in only 1 patient. MCA spasm was graded as severe, moderate and mild in 2, 5 and 5 patients respectively. ACA spasm was found to be mild. Conclusions: Initial results indicate that the cerebral vasospasm may be a frequent complication in ICH patients. Further studies should be carried out to determine the occurrence of vasospasm in a larger group of such patients in various clinical states as well as to develop noninvasive ways of diagnosing the spasm