Increased levels of lipid peroxides measured in the CSF during the acute stage of SAH were predictive of both symptomatic vasospasm and poor outcome. Measurements of lipid peroxides in the CSF may be useful prognostically for patient outcomes as well as for predicting symptomatic vasospasm.
A 78-year-old female presented with a nontraumatic acute subdural hematoma (ASDH) caused by hemorrhage from a cavernous angioma located on the convexity dura mater. The hematoma and angioma were removed successfully. Neuroimaging performed 2 years previously had not revealed cavernous angioma. The angioma most likely grew rapidly over the 2 year period, during which she had received oral antiplatelet medication. Nontraumatic ASDH may originate from a cavernous angioma which grows rapidly.
A 70-year-old female presented with symptoms of right-sided trigeminal neuralgia. Computed tomography showed a high-density mass in the prepontine cistern without enhancement. Magnetic resonance (MR) imaging showed the mass as heterogeneous with variable but largely high-signal intensity on T1-weighted images and low-signal intensity on T2-weighted images. At surgery, the lesion was found to be an epidermoid cyst filled with old blood and lipid debris. The high-signal intensity on the T1-weighted images may reflect lipid or methemoglobin with the low intensity on T2-weighted images representing hemosiderin. Most intracranial epidermoid cysts appear as low-intensity lesions on T1-weighted images and high-signal intensity on T2-weighted images. Typical MR imaging findings are neither specific for nor constant with epidermoid cysts, requiring critical differential diagnosis.
Cold sensation and numbness have been reported as post-stroke sensory sequelae attributable to distal axonopathy, which is caused by chronic ischemia of diseased limbs resulting from dysfunction of vasomotor regulatory systems. Keishibukuryogan is a traditional herbal medicine used to treat symptoms of peripheral ischemia such as cold extremities. This study investigated clinical improvement and skin temperature in peripheral ischemia patients to determine the efficacy of keishibukuryogan in alleviating post-stroke cold sensation and numbness. Twenty-two stroke patients with cold sensation and/or numbness were enrolled in this study. Subjective cold sensation and numbness, evaluated using the visual analogue scale, were found in 21 and 31 limbs, respectively. The skin temperature of diseased and healthy limbs was recorded. We observed all patients for 4 weeks and 17 patients for 8 weeks after administration of keishibukuryogan. The skin temperature of diseased limbs was significantly higher than baseline at 4 weeks and 8 weeks, whereas that of healthy limbs did not change significantly. Cold sensation and numbness were significantly improved at 4 weeks and 8 weeks compared to baseline. Keishibukuryogan administration resulted in warming of diseased limbs and improved cold sensation and numbness, probably by increasing peripheral blood flow.
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