【资讯翻译】两篇神经外科病例，求助战友翻译
发布于 2013-09-08 · 浏览 959 · IP 吉林吉林
这个帖子发布于 11 年零 239 天前，其中的信息可能已发生改变或有所发展。
Case 91: Saccular aneurysms of the internal carotid artery
A 44-year-old male dentist suffered a short spell of sudden unconsciousness and right oculomotor palsy on July 25, 1973. the clinical examination performed after his admission to our service was negative aside from the oculomotor palsy and revealed a systolic blood pressure of 140mmHg. A spinal tap showed bloody cerebrospinal fluid. A right carotid angiogram demonstrated a saccular aneurysm of the siphon. The left carotid angiogram was normal; in particular, no vascular malformation was present at the level of the internal carotid artery. On August 4,1973, the patient underwent ligation of the right internal carotid artery,which was followed by a transitory left hemiparesis.
The patient was able to resume his normal activity , and latter follow-up examinations showed that the hemiparesis cleared completely, the 3rd nerve palsy improved greatly and the blood pressure remained constant at 140 mmHg.
Nine years later(December 19.1982), the patient presented with a new episode of unconsciousness of short duration with severe headache. On clinical examination, the blood pressure was normal, and a 3rd nerve palsy was evident on the left side. A spinal tap showed bloody cerebrospinal fluid. A left carotid angiogram demonstrated an aneurysm of the internal carotid artery in the supracavernous segment, which had not been present on the previous angiogram.
On December 31, 1982, the patient underwent an intracranial operation for clipping of the aneurysm. The postoperative couse was complicated by right hemiparesis and dysphasia, which improved during the following monthes. Follow-up examination showed complete normalization of the hemiparesis and the 3rd nerve palsy, but some mental deterioration.
Case 68: Arachnoid cyst of the lateral ventricle
This 25-year-old man was seen in May 1992, because of a 2-month history of headache, nausea, and vomiting; a Jacksonian seizure in the left arm and leg had occurred 2 days before the admission.
Neurologic examination showed slight weakness of the left limbs. The eye fundus was normal.
The patient was initially evaluted bycontrast-enhanced CT, which showed a large round area of cerebrospinal fluid density within the trigone and occipital horn of the right lateral ventricle. Magnetic resonance imaging confirmed the presence of an intraventricular mass with well defined margins and signal intensity similar to that of CSF; the wall of the cyst was clearly visible on both T1-weighted and T2-weighted images.
On May 20th the patient was operated on by a right parietooccipital craniotomy. The occipital horn was approached by opening a cortical sulcus; a cyst with a whitish and thick capsule occupying the occipital horn and ventricular trigone was seen. It was opened and a discrete amout of clear fluid was evacuated. The cyst wall was weakly attached to the choroid plexus but not adherent to the ventricular ependyma. It was easily separated from the ventricular wall and removed after coagulation and transection of its attachment.
Histologically, the cyst wall was composed of arachnoid cells and connective tissue. Postoperatively, the left hemiparesis slowly improved, after a transient immediate worsening. In June 1995, 3 years after the operation, slight weakness of the left arm was noticed. Ct scan showed normal findings with no recurrence of the cyst.
A 44-year-old male dentist suffered a short spell of sudden unconsciousness and right oculomotor palsy on July 25, 1973. the clinical examination performed after his admission to our service was negative aside from the oculomotor palsy and revealed a systolic blood pressure of 140mmHg. A spinal tap showed bloody cerebrospinal fluid. A right carotid angiogram demonstrated a saccular aneurysm of the siphon. The left carotid angiogram was normal; in particular, no vascular malformation was present at the level of the internal carotid artery. On August 4,1973, the patient underwent ligation of the right internal carotid artery,which was followed by a transitory left hemiparesis.
The patient was able to resume his normal activity , and latter follow-up examinations showed that the hemiparesis cleared completely, the 3rd nerve palsy improved greatly and the blood pressure remained constant at 140 mmHg.
Nine years later(December 19.1982), the patient presented with a new episode of unconsciousness of short duration with severe headache. On clinical examination, the blood pressure was normal, and a 3rd nerve palsy was evident on the left side. A spinal tap showed bloody cerebrospinal fluid. A left carotid angiogram demonstrated an aneurysm of the internal carotid artery in the supracavernous segment, which had not been present on the previous angiogram.
On December 31, 1982, the patient underwent an intracranial operation for clipping of the aneurysm. The postoperative couse was complicated by right hemiparesis and dysphasia, which improved during the following monthes. Follow-up examination showed complete normalization of the hemiparesis and the 3rd nerve palsy, but some mental deterioration.
Case 68: Arachnoid cyst of the lateral ventricle
This 25-year-old man was seen in May 1992, because of a 2-month history of headache, nausea, and vomiting; a Jacksonian seizure in the left arm and leg had occurred 2 days before the admission.
Neurologic examination showed slight weakness of the left limbs. The eye fundus was normal.
The patient was initially evaluted bycontrast-enhanced CT, which showed a large round area of cerebrospinal fluid density within the trigone and occipital horn of the right lateral ventricle. Magnetic resonance imaging confirmed the presence of an intraventricular mass with well defined margins and signal intensity similar to that of CSF; the wall of the cyst was clearly visible on both T1-weighted and T2-weighted images.
On May 20th the patient was operated on by a right parietooccipital craniotomy. The occipital horn was approached by opening a cortical sulcus; a cyst with a whitish and thick capsule occupying the occipital horn and ventricular trigone was seen. It was opened and a discrete amout of clear fluid was evacuated. The cyst wall was weakly attached to the choroid plexus but not adherent to the ventricular ependyma. It was easily separated from the ventricular wall and removed after coagulation and transection of its attachment.
Histologically, the cyst wall was composed of arachnoid cells and connective tissue. Postoperatively, the left hemiparesis slowly improved, after a transient immediate worsening. In June 1995, 3 years after the operation, slight weakness of the left arm was noticed. Ct scan showed normal findings with no recurrence of the cyst.
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