Jens Haase

Clinical Features and Outcome in 48 Patients with Unruptured Intracranial Saccular Aneurysms: A prospective consecutive study

During a 5-year period (1978-1983) the clinical features and operative morbidity/mortality were registered prospectively for all patients in Denmark with an unruptured symptomatic (27 patients) or incidental (21 patients) intracranial saccular aneurysm. A follow-up examination was performed 2 years after diagnosis of the aneurysm. Thirty symptomatic aneurysms in 27 patients most frequently involved the visual pathways or ocular motility (66%). The median diagnostic delay for patients with impaired visual acuity was 7 months but only 14 days for patients with impaired ocular motility. The localisation of the 30 symptomatic and 23 incidental aneurysms were: internal carotid artery (73% approximately 35%), anterior communicating artery (3% approximately 26%) and middle cerebral artery (7% approximately 35%). The diameters of 73% of the symptomatic aneurysms were greater than 10 mm, while the diameter of 74% of the incidental aneurysms were below 10 mm. The total operative morbidity and mortality were 15% and 4%, respectively. The mortality rate in the follow-up period was 10-11% mainly due to fatal bleeding from unoccluded aneurysms. In 21 survivors, a normal mental status was found in 43% and mild dementia was found in another 43%. The impaired visual acuity was unchanged in 67% of patients, while the ocular motility had normalised in 75%. A normal daily functional capacity was enjoyed by 57% while 43% had a moderate reduction, mostly due to visual disturbances.

PROGNOSIS AFTER HEAD INJURY BASED ON EARLY CLINICAL EXAMINATION

Abstract In an attempt to ascertain clinical factors of prognostic significance after traumatic head injury, a prospective study of 201 patients injured in road-traffic accidents was undertaken. Basic clinical signs, determined from the first neurological examination of the patient, the patients age, and post-traumatic blood-pressure were related significantly to functional recovery 2-3 years after injury. In younger patients abnormal motor activity was the most important unfavourable sign, while for older patients it was unconsciousness. Increasing age and post-traumatic hypertension were both related to poor recovery, while major intracranial and extracranial surgical complications were associated with poor functional recovery and increased mortality, respectively. These results indicate that early clinical examination can reveal important prognostic information after head injury.

Intracranial saccular aneurysms results of treatment in 851 patients

SummaryThe series studied comprises all 851 patients with symptom-producing intracranial saccular aneurysms admitted to the departments of neurosurgery in Denmark in the five-year period of 1970–1974. The series was divided into seven clinical stages according to Hunts classification. More than half of the patients were grouped in stages IV and V (Hunt grade 2–3). Of the patients, 76% were found primarily suitable for operation. The mortality within the individual stages was to a great extent independent of the time of operation.A total of 94% of the aneurysms were localized within the region of the carotid artery, with a roughly equal distribution among the internal carotid, anterior communicating, and middle cerebral arteries. Multiple aneurysms were found in 19% of the patients subjected to panangiography.There was a distinct correlation between the severity of the spasms and the clinical condition. The course of operation was complicated in 49% of the patients, the complications being equally distributed within the various clinical stages. The mortality for the patients who underwent operation (total 567) was 32%, and 80% of the deaths were due to direct or indirect consequences of aneurysmal bleeding.At the follow-up performed two to seven years after operation, 52% of the survivors were fully capacitated, 20% were partly capacitated, and 28% were incapacitated. Based on a retrospective analysis, we have started a comprehensive prospective study with registration of available parameters in patients with saccular aneurysms admitted to all departments of neurosurgery in Denmark.

Extradural Cyst of Ligamentum Flavum L4 - A Case

(1972). Extradural Cyst of Ligamentum Flavum L4 - A Case. Acta Orthopaedica Scandinavica: Vol. 43, No. 1, pp. 32-38.

ISOTOPE LIQUORGRAPHY IN THE DEMONSTRATION OF COMMUNICATING OBSTRUCTIVE HYDROCEPHALUS AFTER SEVERE CRANIAL TRAUMA

The incidence of hydrocephalus communicans obstructivus (HCO) complicating severe cranial trauma appears to be significant. In the present material, HCO was demonstrated in 9 out of 28 patients, while in another 5 cases there was some evidence of HCO under development. The diagnosis cannot be established on clinical grounds alone, but must be based on repeated pneumoencephalographic and liquorgraphic examinations. These examinations are indicated in patients with severe cranial trauma, resulting in a period of unconsciousness of long duration, and also in such patients manifesting an arrest in expected clinical improvement. Indications for ventriculoatrial shunting are present when CVR and/or an absence of parasagittal filling are demonstrated on liquorgraphy, and, in addition, progressive HCO is seen on repeated pneumoencephalographic examinations.

A neuropsychological study of 12 patients with transient ischemic attacks before and after EC/IC bypass surgery

ABSTRACT – A neuropsychological study of 12 patients with transient ischemic attacks from the carotid artery territory was carried out about 2 months following their latest attack, about a week before STA/MCA bypass operation, and again 3 months postoperatively. The results suggest that the TIA patients as a group were slightly intellectually impaired preoperatively. After the operation, a minor neuropsychological improvement had taken place although they still were not fully intellectually rehabilitated.

The ulnar-tunnel syndrome.

SummaryThe distal compression neuropathy of the ulnar nerve—the ulnar-tunnel syndrome—is described, and five cases treated by operative decompression via an ulnar incision are presented.

Microsurgery in brachial plexus lesions.

Twenty-two patients with brachial plexus lesions were reviewed 3-6 years after microsurgical repair. Four patients underwent nerve transfer between intercostal nerves and the musculocutaneous nerve. None of these achieved useful elbow flexion. Nerve grafting mainly in the upper part of the plexus was performed in six patients of whom five recovered a useful motor function in at least one important area. Twelve patients underwent neurolysis; useful motor function in at least one important area was achieved in eight. We conclude that microsurgical treatment of brachial plexus lesions is useful in lesions of the upper part of the plexus, distal to the dorsal root ganglion.

Reversible ischemic neurological deficit and minor strokes before and after EC/IC bypass surgery

ABSTRACT Thirty‐three patients with reversible ischemic deficits or completed minor strokes had their cerebral function measured neuropsychologically a few days before and 3 months after extra‐intra cranial bypass surgery. Three months post‐operatively bypass patency was demonstrated by angiography. Ten patients were operated on the right side and 23 on the left side. The right hemisphere patients were found to be neuropsychologically intact or only slightly impaired before, as well as after, the operation whereas the left hemisphere patients pre‐operatively had impaired verbal sequential thinking, reduced capacity for repetition, verbal learning, and mental arithmetic. Post‐operatively they improved significantly on 5 of 15 tests and performed no worse on any test than the control group. Consequently, they, too, had post operatively no or only slight neuropsychological impairment.

The carpal tunnel syndrome and amyloidosis. A clinical and histological study

Twenty-six non-randomized patients with carpal tunnel syndrome are presented. It is documented that three out of four patients may be diagnosed pre-operatively by five or more clinical parameters. All patients were screened for amyloidosis in biopsies from the carpal tunnel. One patient presented amyloid deposits in the transversal carpal ligament. The importance of macro- and microscopic findings in the carpal tunnel inclusive local amyloidosis for the pathogenesis of the carpal tunnel is discussed. It is concluded that provided systemic amyloidosis is not suspected, screening for amyloidosis may have diagnostic interest, however without therapeutic consequences and therefore unnecessary.