NMC Case Report Journal
Online ISSN : 2188-4226
ISSN-L : 2188-4226
Volume 2, Issue 3
Displaying 1-10 of 10 articles from this issue
Case Reports
  • Cıkla Ulaş, Philip F. Giampietro, Alireza Sadighi, Mustafa K. Başkaya
    2014 Volume 2 Issue 3 Pages 85-87
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: February 20, 2015
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    A 44-year-old male with Aarskog syndrome (AS) presented with subarachnoid hemorrhage secondary to ruptured posterior communicating artery aneurysm. AS, also known as faciogenital dysplasia, is an X-linked, autosomal dominant or autosomal recessive congenital developmental disorder. This syndrome is characterized by short stature in association with a variety of multiple anomalies in musculoskeletal, neurological, and urogenital systems. Cerebrovascular abnormalities such as anomalous cerebral venous drainage, dysplastic internal carotid artery, and basilar artery malformation have been reported to be associated with AS. To our knowledge this represents the first case of a ruptured intracranial aneurysm in a patient with AS.
  • Jun Watanabe, Jun Maruya, Keiichi Nishimaki
    2014 Volume 2 Issue 3 Pages 88-92
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: June 26, 2015
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    A 69-year-old man consulted our department regarding further examination because abnormal venous ectasia of the basal vein of Rosenthal (BVR) was accidentally found on magnetic resonance imaging. Angiography revealed a dural arteriovenous fistula (DAVF) in the left sphenoid wing; the fistula was supplied by the ophthalmic artery and the middle meningeal artery. Venous drainage from the fistula consisted of a large collector vein located in the temporal tip, which drained into the BVR. We selected open surgery because this lesion may be difficult to access and is associated with significant risks through an endovascular approach. After temporal clip ligation of the drainer, the superficial middle cerebral vein became the main drainage route directly in connection with the fistula. Therefore, both were ligated, after coagulation of feeding arterial networks on the dura around the sphenoid wing. The patient experienced no complications from the surgical procedure, and postoperative angiography demonstrated obliteration of the fistula. DAVF in the sphenoid wing with deep drainage is believed to carry a high risk of hemorrhage or venous infarction because of the presence of Galenic drainage, varix, and cortical venous reflux. Treatment is strongly recommended even if the symptoms are minimal. Open surgery appears to be safe and often the best therapeutic option.
  • Kiyoshi Tsuji, Norihito Fukawa, Nobuhiro Nakagawa, Tomonari Yabuuchi, ...
    2014 Volume 2 Issue 3 Pages 93-96
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: June 26, 2015
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    Extracranial carotid artery aneurysms (ECAAs) are rare, and their treatment is very difficult and challenging. The case of a 59-year-old woman who presented with a pulsatile mass on the left side of her neck, was diagnosed with a left-sided giant thrombosed common carotid artery aneurysm, and underwent definitive treatment by overlapped stenting, is presented. Overlapped stenting is a safe and an effective treatment procedure for ECAA. A covered stent would theoretically be reasonable and immediately effective, but its long-term patency remains unknown. Therefore, in patients lacking ischemic tolerance and those not requiring urgent intervention, overlapped stenting using uncovered stents is preferable.
  • Hideki Nakajima, Tomoya Ishiguro, Masaki Komiyama
    2014 Volume 2 Issue 3 Pages 97-100
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: June 26, 2015
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    Basilar artery dissection (BAD) presenting with subarachnoid hemorrhage (SAH) is life-threatening, but its treatment has not been established yet. We treated two patients with ruptured BAD. They were 40-year-old and 41-year-old women. Both of them were treated conservatively during the acute stage. In one patient, radiological abnormality of BAD improved spontaneously. In another patient, reconstructive endovascular treatment (stent with coiling) was required in the chronic stage because the lesion deteriorated morphologically. Neither of them suffered from rebleeding and both had favorable outcome. We reported two patients with ruptured BAD treated conservatively during the acute stage and their outcomes were favorable. We reviewed the literature of BAD presenting with SAH and discussed the management for these lesions.
  • Kazuhito Takeuchi, Tetsuya Nagatani, Tadashi Watanabe, Eriko Okumura, ...
    2014 Volume 2 Issue 3 Pages 101-105
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: June 26, 2015
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    A combined transsphenoidal-transcranial approach for the resection of pituitary adenomas has previously been reported. While this approach is useful for specific types of pituitary adenomas, it is an invasive technique. To reduce the invasiveness of this approach, we adopted the keyhole concept for pituitary adenoma resection. A 23-year-old man presented at a local hospital with a 6-month history of bilateral hemianopia. Magnetic resonance imaging revealed a large pituitary adenoma extending from the sella turcica toward the right frontal lobe. Endoscopic transsphenoidal surgery was planned at a local hospital; however, the operation was abandoned at the start of the resection because of the firm and fibrous nature of the tumor. The patient was subsequently referred to our hospital for additional surgery. The tumor was removed purely endoscopically via a transsphenoidal and transcranial route. Keyhole craniotomy, 3 cm in diameter, was performed, and a tubular retractor was used to achieve a wider surgical corridor; this enabled better visualization and dissection from the surrounding brain and provided enough room for the use of surgical instruments under endoscopic view. The tumor was successfully removed without complication. This is the first case report to describe the resection of a giant pituitary adenoma using a purely endoscopic and simultaneous transsphenoidal and transcranial keyhole approach.
  • Manoj Bohara, Yukoh Ohara, Junichi Mizuno, Hidenori Matsuoka, Natsuki ...
    2014 Volume 2 Issue 3 Pages 106-108
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: June 26, 2015
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    Thoracic vertebral fractures are very unusual complications of cardiopulmonary resuscitation (CPR). A 78-year-old man developed cardiac arrest after aspirating and conventional CPR was performed. After recovery, the patient had complete paraplegia (Frankel grade A). Magnetic resonance image of spine showed a dislocation fracture with hematoma at T6 thoracic level. Computed tomography scan of chest revealed the fracture of sternum. After the patient’s condition became stable with subsequent medical treatment, posterior decompression and pedicle screw fixation was performed. The patient had uneventful postoperative course with continued rehabilitation. Thus, this report emphasizes that care should be taken especially in elderly patients with fragile bone to recognize such rare complication of chest compression; however, adequate compressions to ensure circulation should be maintained.
  • Taigo Kawaoka, Junya Hanakita, Toshiyuki Takahashi, Mizuki Watanabe
    2014 Volume 2 Issue 3 Pages 109-113
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: June 26, 2015
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    Although intervertebral implants have been advocated for cervical fixation surgery, classic Cloward’s method or Smith-Robinson’s methods using autologous iliac bone has been performed in our clinic for about 30 years. In most cases, the postoperative clinical course is uneventful with satisfactory result. However, the authors experienced three cases of donor site iliac bone fracture in the patients who performed anterior cervical fixation surgery. All three patients were female, elderly, short, and lean with low bone mineral density. Iliac bone fractures manifested with sudden pain in the vicinity of donor site. For the iliac bone fracture, two patients received invasive plate fixation surgery and the other was managed conservatively. As to the mechanism of donor site iliac bone fracture, the share stress during bone donation is speculated to cause iliac crest fragile. After beginning of walking after surgery, tractive force of the muscles attaching to the iliac crest play an important role in promoting the fracture cleft. Several clinical factors were analyzed to investigate the cause and prevention of this troublesome complication of cervical anterior fixation surgery. Age, female gender, lean, and small structure were risk factors for such iliac donor site fracture.
  • Manuel Moser, Gerhard Hildebrandt
    2014 Volume 2 Issue 3 Pages 114-117
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: June 26, 2015
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    Remote cerebellar hemorrhage (RCH) after burr-hole evacuation for chronic subdural hematoma (cSDH) is a rare and uncommon complication of minor supratentorial surgery with very few reports in the literature and an uncertain etiology. We present the case of a 62-year-old male who underwent single burr-hole trepanation for unilateral cSDH, revealing incidental RCH on routine postoperative computed tomography (CT) scan most likely resulting from overdrainage of cerebrospinal fluid (CSF) within the postoperative period. The patient recovered well without further neurosurgical intervention. Intra- and postoperative drainage of large volumes of CSF and the venous origin of the bleeding are accepted factors in the controversial concept of its pathophysiology. Alterations in transtentorial pressure and stretching of superficial cerebellar veins with consequent rupture seem to constitute a useful concept, although details on mechanical or hemodynamic changes still remain unknown. A multifactorial etiology with CSF-overdrainage as the major main factor seems reasonable. Neurosurgeons should be aware of the possibility of RCH even in minor supratentorial procedures such as simple burr-hole trepanation. There is a tendency towards more benign courses, but higher patient age and severity of RCH correlate with a poor outcome. Early diagnosis of RCH and close monitoring reduce unnecessary diagnostic and therapeutic interventions in these patients, probably affecting morbidity and mortality.
  • Hajime Takase, Junya Tatezuki, Naoki Ikegaya, Daisuke Yamamoto, Mizuki ...
    2014 Volume 2 Issue 3 Pages 118-122
    Published: 2014
    Released on J-STAGE: July 01, 2015
    Advance online publication: June 26, 2015
    JOURNAL FREE ACCESS FULL-TEXT HTML
    A 66-year-old woman who was previously diagnosed with idiopathic thrombocytopenic purpura (ITP) presented with mild right-sided hemiparesis and drowsiness. Head computed tomography (CT) imaging demonstrated a massive left chronic subdural hematoma (CSDH) with a midline shift. Because initial laboratory data showed a significantly decreased blood platelet count (0.3 × 104/mm3), medical treatments such as platelet transfusion, intravenous immunoglobulin (IVIG), and high-dose corticosteroid therapy, were initiated. She clinically and radiologically responded well to these treatments without any surgical intervention. In addition to presenting our case, we searched the PubMed and Ichushi Web databases to comprehensively illustrate clinical characteristics and treatment outcomes of similar cases. Including the present case, we found 19 reports and 23 cases of CSDH associated with ITP in the literature, and assessed 17 reports and 21 cases that were written in English and Japanese. None or mild neurological symptom were seen in 13 cases, and severe, such as coma and hemiparesis, were described in the younger 8 cases with significant difference. All except one were first treated with medical therapies. Most cases of the former group responded well to conservative therapy. On the other hand, most in the latter eventually needed surgical treatment in addition except recent two cases including the present case. CSDH associated with ITP is rarely described, and its management remains controversial. However, this report highlights multiple continuous medical treatments under strict observation and general care might be a useful alternative to avoid surgery in cases presenting with severe neurological deficits and extremely low platelet counts.
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