RESUMEN
Fractures of the mandibular condylar process are common and account for up to 40% of all mandibular fractures. Penetration of the condylar head into the middle cranial fossa is, however, rare. We have found reports of only 43 cases since 1834. The diagnosis of intracranial condylar dislocation is difficult, there are usually no particular symptoms or neurological signs. As a result, detailed radiological studies are necessary. In the absence of clear radiographic images of the condylar structures, computed tomography (CT) is essential to locate the fragments and to investigate and monitor intracranial lesions. This paper describes the diagnostic and surgical procedures used in two cases of condylar dislocation and discusses them with reference to previous cases. The use of a titanium screw, which was positioned intracranially in the first case, has not, to our knowledge, been described previously.
Asunto(s)
Luxaciones Articulares/diagnóstico por imagen , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico por imagen , Placas Óseas , Trasplante Óseo , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Base del Cráneo/diagnóstico por imagen , Férulas (Fijadores) , Hueso Temporal/lesiones , Articulación Temporomandibular/lesiones , Disco de la Articulación Temporomandibular/lesiones , Tomografía Computarizada por Rayos XRESUMEN
The benefit of decompressive craniectomy for the treatment of uncontrolled post-traumatic intracranial hypertension seems to be encouraging if medical management fails. We present our experience in 22 cases of cerebral edema due to head trauma. The edema alone was rarely the direct consequence of head trauma. Frequently it was associated with an acute subdural or extradural hematoma and contusion (with or without mass effect). First of all we treated the mass effect of the hematoma and contusion when the diameter was more than 3 cm. Intracranial pressure was monitored in the majority of patients. Bone decompression was performed in the operating theatre depending on the values of intracranial pressure. In our series 41% of patients had a good recovery, 18% a severe disability, 23% a vegetative state and 18% died. The findings showed that the bony decompression must be performed early before the situation becomes irreversible. We suggest that if intracranial pressure values remain greater than 30 mmHg with cerebral perfusion pressure below 70 mmHg, despite vigorous anti-edema therapy, decompressive craniectomy should be considered.
Asunto(s)
Edema Encefálico/cirugía , Lesiones Encefálicas/cirugía , Craneotomía , Descompresión Quirúrgica , Hipertensión Intracraneal/cirugía , Adolescente , Adulto , Daño Encefálico Crónico/etiología , Daño Encefálico Crónico/mortalidad , Edema Encefálico/mortalidad , Lesiones Encefálicas/mortalidad , Niño , Femenino , Hematoma Subdural/mortalidad , Hematoma Subdural/cirugía , Humanos , Hipertensión Intracraneal/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Tasa de SupervivenciaRESUMEN
We present the clinical and neuroradiological features of a ruptured aneurysm at the beginning of the left PICA suffering from subarachnoid hemorrhage (SAH). The young patient refused surgery, endovascular treatment and also follow-up. After 4 and 5 years she repeated the left vertebral angiography that showed a spontaneous thrombosis of the aneurysm. After 8 years MR angiogram images confirmed the total obliteration of the aneurysm.
Asunto(s)
Cerebelo/irrigación sanguínea , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/terapia , Adulto , Angiografía Cerebral , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Hemorragia Subaracnoidea/etiología , VasoconstricciónRESUMEN
A patient suffering for an ischemic "locked-in" syndrome following a subarachnoid hemorrhage, was evaluated with brain stem acoustic evoked potentials (BAEPs), short latency somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs). Neuroradiological findings failed to reveal any lesion in the brain stem, while a transcranial Doppler showed increased flow velocity upon the basilar artery, suggesting vascular spasm. BAEPs were normal and SEPs showed to be slightly impaired while MEPs upon magnetic cortical stimulation were heavily deranged. Neurophysiological investigations appeared remarkable for the early diagnosis of the disease, when neuro-radiological findings were still negative.
Asunto(s)
Tronco Encefálico/fisiopatología , Potenciales Evocados , Actividad Motora/fisiología , Cuadriplejía/fisiopatología , Adulto , Aneurisma Roto/complicaciones , Arteria Basilar , Potenciales Evocados Auditivos del Tronco Encefálico , Potenciales Evocados Somatosensoriales , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/fisiopatología , Cuadriplejía/diagnóstico , Cuadriplejía/diagnóstico por imagen , Cuadriplejía/etiología , Rotura Espontánea , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/fisiopatología , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler TranscranealRESUMEN
During cerebral aneurysms surgery, brain tissue may suffer for global or local ischemia due to deliberate hypotension and surgical manoeuvres. Somatosensory evoked potentials (SEPs) can detect functional derangements consequent to hypoxia, before a permanent brain damage is produced. Forty two patients, undergoing cerebral aneurysms surgery for treatment of SAH, were evaluated intraoperatively with SEP recordings. It has been stressed that no permanent neurological damage is to be expected if the absolute value of Central Conduction Time (CCT) does not exceed 9.5 ms for 10 min at least and the cortical waves are visible throughout the whole procedure. SEP changes are strictly related with MAP decrease and surgical handlings.
Asunto(s)
Potenciales Evocados Somatosensoriales , Aneurisma Intracraneal/cirugía , Monitoreo Intraoperatorio/métodos , Adulto , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Circulación Cerebrovascular , Femenino , Humanos , Hipotensión Controlada/efectos adversos , Masculino , Persona de Mediana EdadRESUMEN
The transcranial doppler (T.C.D.) is a non-invasive technique useful for the evaluation of vasospasm and intracranial hypertension in patients with subarachnoid hemorrhage (S.A.H.). Eighteen patients with recent S.A.H. were studied by means of T.C.D. device: in 14 patients the source of bleeding was a ruptured aneurysm of the circle of Willis, while the remaining 4 presented a negative four-vessels angiography. All the patients were studied 5 and 10 days after the bleeding. Our data showed that the ultrasonographic demonstration of vasospasm and/or I.C.H. is clearly related to the clinical status of the patients. No significant T.C.D. difference was noticed between the "sine materia" S.A.H. patients and the ones with ruptured aneurysm.