bluuebunny/crossref_metadata_2025 huggingface dataset:
Progressive ventricular dilatation following pneumoencephalography
Authors: Rovit Richard L. , Schechter Mannie M. , Ortega Benbienizi , Brinker Ray A.
Published: May 2009

✓ Eight patients with “normal pressure hydrocephalus” are presented who demonstrated radiographic and occasional clinical evidence of progressive dilatation of the ventricles following pneumoencephalography. The characteristic pneumographic signs of tentorial obstruction to the flow of cerebrospinal fluid (CSF) had been documented in the original air contrast study. The authors postulate that pneumoencephalography in patients with normal pressure hydrocephalus may result in a sudden displacement of CSF from the ventricles into the already compromised basal cisterns, leading to further obstruction of CSF outflow and progressive ventricular dilatation. Other mechanisms such as reduction in the potential resorptive capacity of the ventricular ependyma by air replacing ventricular fluid may play a part. The value of repeat radiological studies 24 and 48 hours after the original pneumogram is emphasized both as an aid in the radiological diagnosis of normal pressure hydrocephalus and as an additional parameter for studying problems in CSF flow and absorption.
Experimental evaluation of a tissue adhesive as an agent for the treatment of aneurysms and arteriovenous anomalies
Authors: Zanetti Paul H. , Sherman Frank E.
Published: May 2009

✓ Studies were performed on adult mongrel dogs to evaluate the possibility of occluding saccular aneurysms and arteriovenous (AV) anomalies with an intravascular injection of the tissue adhesive isobutyl-2-cyanoacrylate (IBC). Twelve normal canine renal arteries, four surgically constructed AV fistulas, and six surgically constructed vein pouch aneurysms were occluded by the injection of IBC through a fluoroscopically positioned intra-arterial catheter. The IBC was also directly injected into 25 surgically constructed vein pouch aneurysms. Angiography performed immediately after injection and up to 3 months following treatment revealed persistent occlusion of the renal arteries, arteriovenous fistulas, and aneurysms. Tissue reaction to the IBC was mild and confined to the intima in these experiments. Further investigation of this procedure for the treatment of aneurysms and arteriovenous anomalies by either a stereotaxic or selective catheterization technique is suggested.
Sensory responses elicited by subcortical high frequency electrical stimulation in man
Authors: Alberts W. Watson , Wright E. W. , Feinstein B. , Gleason C. A.
Published: May 2009

✓ A radiofrequency current of 100 kHz sine wave was applied to therapeutic targets in the human brain and produced unpleasant sensory responses. Increasing the applied frequency to 250 kHz eliminated all these responses.
Thoracic cord compression due to chondrosarcoma in two cousins with hereditary multiple exostoses
Authors: Crowell Robert M. , Wepsic James G.
Published: May 2009

✓ Two teen-age male cousins with hereditary multiple exostoses developed cord compression secondary to chondrosarcoma. The clinical presentation, diagnostic work-up, surgical treatment, pathological findings, and postoperative course are described in each patient.
Multiple primary tumors of the brain and bowel
Authors: Sorenson Bruce F.
Published: May 2009

✓ A 69-year-old man had two different primary neoplasms of the central nervous system and a third primary malignant neoplasm of the large bowel. Similarities and differences between this case and cases previously reported are discussed.
Radioisotope encephalo-cisternography and encephalo-ventriculography
Authors: Chiro Giovanni Di , Ashburn William L. , Zeiger Louis S. , Schall Gerald L.
Published: May 2009

✓ The techniques of radioisotope encephalo-cisternography (REC) and encephalo-ventriculography (REV) permit integrated and essentially simultaneous dual color visualization of the conventional brain scan and cerebrospinal fluid (CSF) scan. Sequential scintiphotos of the brain and CSF distribution of two radiopharmaceuticals were obtained with the use of a pulse height analyzer by taking advantage of the difference in their photopeaks. The patient was kept in the same position during the two sequential procedures. The two scintiphotos were then superimposed and integrated by one of two simple photographic color conversion methods. Valuable information is obtained by these two techniques, particularly for the evaluation of the relative size of the CSF cavities and the brain substance, and for the differentiation of extra- from intracerebral endocranial lesions.
Brain scanning in the diagnosis of acoustic neuromas
Authors: Baum Sheldon , Rothballer Alan B. , Shiffman Felix , Girolamo Rita F.
Published: May 2009

✓ Of 22 patients found to have acoustic neuromas at surgery, 99mTc-sodium pertechnetate brain scans correctly identified these tumors in 18. This successful imaging is due largely to two factors: the improved visualization of the posterior cranial fossa with technetium 99m and the use of delayed scans. With the latter, it was found that the optimum time for scanning acoustic neuromas was 2½ hours following radionuclide administration; scans performed before that time failed to visualize the tumor in five patients whose studies were positive on delayed scans. The authors feel that for acoustic neuromas 2 cm or more in diameter, 99mTc scanning is the diagnostic procedure of choice and is especially useful in detecting tumor recurrence.
Brain scans of the posterior fossa
Authors: Moody Robert A. , Olsen John O. , Gottschalk Alexander , Hoffer Paul B.
Published: May 2009

✓ The results of posterior fossa brain scanning in 37 patients with proven posterior fossa tumors were reviewed. Pertechnetate-99m was used as the scanning agent, and attention was paid to careful positioning of the patient. Perchlorate was used to block the parotid gland. The overall detection rate was 78%, particularly good results being obtained with meningiomas, ependymomas, juvenile astrocytomas, metastases, and acoustic neuromas, in that order.
The radiographic diagnosis of trigeminal neurinomas
Authors: Palacios Enrique , Macgee Edwin E.
Published: May 2009

✓ Trigeminal neurinomas are rare, benign tumors, amenable to surgery. The characteristic features of these lesions are discussed and illustrated with two cases. The importance of the use of the various radiographic techniques for evaluation of these tumors is stressed.
Graded cryohypophysectomy in the rhesus monkey
Authors: Saglam Suleyman , Kragt Clifford L. , Wilson Charles B. , Kaplan Selna L. , Barker Marvin
Published: May 2009

✓ Histopathology and endocrine function of the pituitary gland of rhesus monkeys subjected to graded cryohypophysectomy were compared with the histopathology and endocrine function in hypophysectomized and sham-operated monkeys. Freezing at −50°, −100°, and −150°C destroyed 72.3%, 78.3%, and 93.1% of the pituitary respectively. The posterior lobe was more resistant to the damaging effects of cold. A nearly complete (96.3%) histological hypophysectomy was accomplished at −190°C; nearly all remaining viable tissue was in the posterior lobe. Freezing at −150°C appears to result in a complete functional hypophysectomy. Of the adenohypophyseal cells, the gonadotropin-secreting cells were the most susceptible to cold, with the growth-hormone-producing cells next in susceptibility. Adrenocorticotropin-secreting cells were more resistant. Cells producing thyroid-stimulating hormones were not susceptible, and the pituitary stalk was quite resistant to the damaging effects of freezing at these temperatures. Thus, a predictable partial hypophysectomy by means of cryosurgery seems feasible, and, with a predetermined time, it is evident that the degree of cold is critical in achieving a complete cryohypophysectomy.
The uptake of hydrocortisone in mouse brain and ependymoblastoma
Authors: Schwartz Michael L. , Tator Charles H. , Hoffman Harold J.
Published: May 2009

✓ At 2, 10, and 60 min after intravenous injection of tritiated hydrocortisone into tumor-bearing mice, samples of brain and tumor were taken for autoradiography. Within 2 min of injection, large amounts of the steroid had left the bloodstream and had penetrated normal brain. By 60 min virtually all the drug had left the brain. The most radioactive structure was the choroid plexus. Within the normal and edematous brain, hydrocortisone was not found in cells alone but was spread randomly throughout the tissue. Edematous brain adjacent to implanted tumor contained much more steroid than normal brain. This difference was maximal at 10 min after injection. Edematous white matter adjacent to tumor was usually as radioactive as tumor. In the ependymoblastoma at 2 min after injection, neoplastic cells and interstitial tissue adjacent to blood vessels contained much hydrocortisone. At 10 min the drug was uniformly spread through the tumor tissue and by 60 min was largely gone. The uptake of the drug by the edematous brain suggests a direct local action. The high choroid plexus concentration may indicate a direct action there, perhaps to reduce cerebrospinal fluid production.
The role of the arachnoid villus in the removal of red blood cells from the subarachnoid space
Authors: Alksne John F. , Lovings Ethel T.
Published: May 2009

✓ The electron microscope examination of arachnoid villi from dogs after the subarachnoid injection of blood reveals that erythrocytes accumulate and degenerate in the villi. A continuous layer of endothelium separates the villus from the lumen of the sagittal sinus. No evidence for pores through the endothelium or for the passage of intact erythrocytes from CSF to blood through arachnoid villi has been found.
Bifrontal craniotomy for anterior communicating artery aneurysms
Authors: Pool J. Lawrence
Published: May 2009

✓ The results in 60 cases of ruptured aneurysm of the anterior communicating artery are analyzed.
Anspergillosis presenting as spinal cord compression
Authors: Seres Joel L. , Ono Hirohisa , Benner Ernest J.
Published: May 2009

✓ A case of pulmonary aspergillosis resembling bronchogenic carcinoma with extension to the thoracic vertebrae is presented. Therapy is discussed and the need for awareness of this potentially fatal infection stressed.
Radiographic identification and surgical removal of a teratoid tumor of the roof of the third ventricle
Authors: Ferry Darwin J. , Mylander Kenneth , Hardman John
Published: May 2009

✓ A case of teratoid tumor of the roof of the third ventricle is presented. The tumor was associated with absence of the falx cerebri and the corpus callosum. Diagnostic studies showed an avascular mass in the midline supratentorial position with a strongly positive brain scan.
Intramedullary enterogenous cyst
Authors: Silvernail William I. , Brown Richard B.
Published: May 2009

✓ A congenital enterogenous cyst lying within the spinal cord in the cervicothoracic region was investigated in a patient when it began to produce radicular symptoms. Its origin, associated anomalies, and surgical management are discussed.
Radioactive tissue changes induced to control experimental hydrocephalus
Authors: Weiss Martin H. , Roessmann Uros
Published: May 2009

✓ Hydrocephalic animals were given an intraventricular infusion of radioactive colloidal gold and then sacrificed up to 7 weeks after infusion. Histological evaluation revealed progression from a marked hemorrhagic necrosis of choroid plexus vessels and stroma to eventual replacement by fibrous connective tissue, sclerosis, and fibrinous degeneration of stromal vessels. Particulate colloid was found engulfed in perivascular spaces in the subependymal periventricular tissues, but there was no evidence of vascular damage, gliosis, or demyelination. These findings may play a role in decreasing cerebrospinal fluid production.
Selective radionecrosis of the choroid plexus for control of experimental hydrocephalus
Authors: Weiss Martin H. , Nulsen Frank E. , Kaufman Benjamin
Published: May 2009

✓ Hydrocephalic dogs treated with intraventricular radioactive colloidal gold showed a sustained decrease in cerebrospinal fluid flow and intraventricular pressure associated with a reversal of progressive hydrocephalus. Gamma scanning and isotopic sampling, however, indicated a more diffuse distribution of the isotope than previously thought, although pathological changes up to 7 weeks post-instillation of the radioactive colloid appeared confined to the choroid plexus.
Extraventricular origin of the cerebrospinal fluid: formation rate quantitatively measured in the spinal subarachnoid space of dogs
Authors: Sato Osamu , Asai Takahiko , Amano Yoshiyuki , Hara Makoto , Tsugane Ryuichi , Yagi Michiyuki
Published: May 2009

✓ The spinal subarachnoid space of the dog was perfused with an artificial cerebrospinal fluid containing inulin as a tracer. The experimental procedures were based upon the concept that the decrease in inulin concentration occurring during the perfusion was exclusively a function of the volume of newly formed cerebrospinal fluid in the system.
Choroidal arteries in the diagnosis of thalamic tumors
Authors: Margolis M. Theodore , Hoffman Harry B. , Newton Thomas H.
Published: May 2009

✓ Arteriograms of 12 patients with space-occupying lesions involving the thalamus were compared with 100 vertebral and carotid arteriograms reported as normal. It was found that masses that involve the thalamus primarily or secondarily affect the choroidal arteries in a characteristic manner. The most commonly involved vessel is the lateral posterior choroidal artery. The medial posterior choroidal artery may also be affected because of its contribution to the dorsal medial nucleus of the thalamus and its occasional course around the pulvinar. Because the anterior choroidal artery is reciprocal in size to the lateral posterior choroidal artery, the lesion will often be demonstrated on carotid angiography.
Craniopharyngiomas in children and adults
Authors: Hoff Julian T. , Patterson Russel H.
Published: May 2009

✓ The records of 51 patients with craniopharyngiomas were reviewed to compare the clinical features of the tumor in children and adults, to weigh the results of radical removal of the neoplasm, and to evaluate the benefit of postoperative radiation therapy. Signs and symptoms in the two age groups differed modestly. Endocrine abnormalities and visual field deficits were recognized more often in adults, whereas skull films were more likely to be abnormal in children. Six patients underwent radical removal of tumor. All have returned to normal life and remain free of recurrence. When tumor removal was incomplete, recurrence was common, appearing earlier in the younger patients. The administration of postoperative radiotherapy following partial removal of tumor appeared to delay recurrence in both age groups.
Cerebral anaerobism during experimental incremental oligemic hypotension
Authors: Yashon David , Locke George E. , Hunt William E.
Published: May 2009

✓ Thirty-seven dogs were studied to establish the level of mean arterial pressure (MAP) causing cerebral tissue lactate (CTL) accumulation as a result of anaerobic metabolism and to assess the extent of preservation of aerobic metabolism afforded by autoregulation during oligemia. Specimens were removed prior to oligemia and at 5, 30, and 60 min following hypotension created by blood withdrawal. In four control animals, CTL averaged 4.83 (range 3.26 to 7.07) mMol/kg. At 60 min after induction of oligemic hypotension, 13 animals with a MAP of 30 and 40 mm Hg showed concentrations of CTL between 16.56 and 20.89. At a MAP of 50 mm Hg six animals showed a CTL concentration between 4.39 and 15.88; at a MAP of 60 mm Hg eight animals showed a CTL between 3.76 and 14.93; and at a MAP of 70 mm Hg six animals had a CTL between 2.43 and 4.27. At 5 min, at all mean arterial pressures the cerebral tissue lactate varied between 2.07 and 5.50. By 30 min the elevations were similar to those at 60 min. CTL elevation was independent of pre-oligemic MAP. In the canine brain there is a uniform incremental elevation of CTL between a MAP of 30 to 50 mm Hg directly related to the time of hypotension; there is variable intolerance to MAP in the range of 50 to 70 when related to a time longer than 5 min.
Intracranial arterial narrowing and spasm in acute head injury
Authors: Suwanwela Charas , Suwanwela Nitaya
Published: May 2009

✓ Arteriography in 350 patients with a moderate to severe head injury, including repeated studies in 40 patients, revealed narrowing of one or more of the intracranial arteries in 65 patients (18.6%). Narrowing of the intracranial portion of the internal carotid artery and the first part of the anterior and middle cerebral arteries was found in 18 patients and was believed to be responsible for the clinical symptoms in some. Narrowing of the branches of the cerebral arteries at the site of the cerebral contusion was seen in 33 patients and diffuse narrowing of the intracranial arteries in 12. In two additional patients with gunshot wounds of the brain, there was narrowing of the cerebral artery adjoining a torn vessel. The evidence suggests that vascular spasm is responsible for the narrowing in some patients, while contusion and hemorrhage in the arterial wall is the cause in others. Whatever the mechanism, the occurrence and significance of cerebral arterial narrowing in association with acute head injury needs to be emphasized.
Infection after depressed fracture of skull
Authors: Jennett Bryan , Miller J. Douglas
Published: May 2009

✓ The authors analyze and discuss the 10% infection rate among 359 civilians with compound skull fractures. Infection results from incomplete debridement, for which antibiotics are no substitute. Inadequate treatment usually derives from missing the diagnosis of depressed fracture completely, but sometimes from underestimating the seriousness of the individual injury. Many patients with this injury never lose consciousness, do not have immediate x-ray studies, and are not admitted to hospital; infection is a serious risk in this group. Complete removal of all bone fragments, as recommended for missile injuries, is not necessary. If bone is replaced, the incidence of infection (and of epilepsy) is not greater, and the need for cranioplasty avoided; bone can be safely replaced even when surgery is delayed for 24 hours and when the dura is torn.
Compartmentation of the jugular foramen
Authors: Shapiro Robert
Published: May 2009

✓ The radiographic anatomy of the jugular foramen is described. Normal variations in size and configuration are discussed and principal pathological configurations listed. The radiographic features of complete separation of the jugular foramen into separate neural and vascular components are presented.
Malignant melanoma of the choroid plexus epithelium
Authors: Beatty Robert A.
Published: May 2009

✓ A patient with a malignant melanoma of the choroid plexus epithelium is described. The embryological implications of the epithelial rather than stromal location are emphasized. This case appears to be unique in the literature.
Abscess formation in a Rathke's cleft cyst
Authors: Obenchain Theodore G. , Becker Donald P.
Published: May 2009

✓ An abscessed Rathke's cleft cyst was removed in a 50-year-old woman who had had headaches and episodic fever for 3 years and had been on intermittent methotrexate therapy for psoriasis for 4 years. There was clinical and laboratory evidence of panhypopituitarism. Erosion of the sella turcica was present. The patient has remained asymptomatic on replacement therapy. A brief review of abscess formation in the region of the pituitary gland is presented.
Acrylic fixation of atlanto-axial dislocations
Authors: Kelly David L. , Alexander Eben , Davis Courtland H. , Smith Jack M.
Published: May 2009

✓ An operative technique using methyl methacrylate (acrylic) and wiring for the treatment of atlanto-axial dislocations is described. Long-term evaluation of a series of patients indicates that this is a safe and effective method of obtaining cervical fixation.
Federal programs for the care and study of spinal cord injuries
Authors: Heyl Henry L.
Published: May 2009

✓ This report summarizes in one document the four federal programs devoted specifically to the care and study of spinal cord injuries. The accompanying editorial emphasizes the need for coordination between these agencies in the optimal use of specific capabilities and separate federal budgets, particularly in the planning for regional spinal cord injury centers.
Altered norepinephrine metabolism following experimental spinal cord injury
Authors: Osterholm Jewell L. , Mathews George J.
Published: May 2009

✓ Experimentally injured spinal cord tissues were chemically examined for changes in norepinephrine (NE), serotonin, and dopamine; remarkable NE metabolic alterations were found. The amine doubled in 30 minutes, quadrupled in 1 hour, and thereafter slowly declined to approach control values at 4 hours. Comparisons between injured tissue NE content and the presence of central gray hemorrhages and necrosis were consistently found, and profound increases in NE were universally associated with massive central hemorrhages. Within 2 hours of injection of minute quantities of pure NE into the spinal gray matter, large central hemorrhages appeared that closely resembled the lesions associated with severe spinal cord injury. We have hypothesized that toxic quantities of tissue NE induce intense vasospasm which impedes or arrests cord perfusion and causes the neuronal necrosis, vascular rupture, and parenchymal self-destruction manifest as central hemorrhagic necrosis. Thus, excess NE liberated within traumatized tissue may act to depress or halt electrical activity of adjacent fibers and neurons, producing the neuronal response of transient weakness or paralysis. Permanent loss of function ensues as the electrically depressed spinal cord tissue also undergoes hemorrhagic autodestruction.
Altered norepinephrine metabolism following experimental spinal cord injury
Authors: Osterholm Jewell L. , Mathews George J.
Published: May 2009

✓ Alpha methyl tyrosine (AMT) immediately blocks tyrosine hydroxylase and therefore norepinephrine (NE) synthesis. In cats, AMT administered 15 minutes after spinal cord injury exerted a strong protective effect against hemorrhagic necrosis and lowered post-traumatic NE accumulation. Seventy percent of the spinal cords from animals so treated were normal or had only minor gray matter changes; all untreated animals developed severely destructive lesions. Three of four severely injured and AMT-treated animals walked normally. These experiments strongly support the NE hypothesis of spinal cord injury; when NE hypersynthesis was prevented, the characteristic hemorrhagic necrotic lesions of the central gray did not occur.
Effects of hyperbaric oxygenation and tissue oxygen studies in experimental paraplegia
Authors: Kelly David L. , Lassiter Kenneth R. L. , Vongsvivut Arbha , Smith Jack M.
Published: May 2009

✓ This study demonstrates that the tissue pO2 of the normal spinal cord of dogs can be modified by ventilating the animals with oxygen and carbogen. Following trauma to the cord, the tissue pO2 responded only to hyperbaric oxygen. A series of animals rendered paraplegic and treated with hyperbaric oxygen recovered to a greater degree than those in an untreated control group.
A myelographic variant in lumbar arachnoiditis
Authors: Smith Randall W. , Loeser John D.
Published: May 2009

✓ A variant of lumbar arachnoiditis is described in patients undergoing rhizotomy for intractable radicular pain following multiple lumbar epidural operative procedures. The peculiar adhesions of the arachnoid, nerve roots, and dura are described and pictured. The slight myelographic abnormality seen in the presence of this kind of arachnoiditis, namely, lack of root sleeve visualization, is correlated with the gross operative findings and contrasted with the commonly recognized myelographic picture of lumbar arachnoiditis. Diagnostic and therapeutic implications are discussed.
Consequence of ligation of the vertebral artery
Authors: Shintani Akira , Zervas Nicholas T.
Published: May 2009

✓ A case requiring ligation of the vertebral artery to treat an aneurysm of that vessel is reported. Review of the literature reveals that vertebral artery ligation is far less hazardous than ligation of the carotid artery as long as the opposite vertebral artery is functioning.
Cerebral metabolism in patients with intracranial tumors
Authors: Zupping Rein
Published: May 2009

✓ In a series of 64 patients with various intracranial tumors the cerebrospinal fluid (CSF), arterial and jugular venous acid-base, gas, and electrolyte values were measured before surgery and during the first 8 postoperative days. Before operation, patients without clinical signs of increased intracranial pressure had almost normal CSF acid-base status and cerebral gas exchange. The patients with signs of intracranial hypertension had CSF metabolic acidosis, arterial and jugular venous respiratory alkalosis, and mild arterial and jugular hypoxemia. Following surgery a remarkable increase in CSF metabolic acidosis, arterial and jugular hypocapnia, and hypoxemia occurred. A slight decrease of CSF potassium concentration was also revealed but the CSF sodium concentration was found to be elevated only in fatal cases or in patients with impaired consciousness. A close relationship was found between the severity of brain damage and the degree of CSF metabolic acidosis and arterial hypocapnia. Cerebral venous hypoxemia was not related to the severity of the brain lesion. It is suggested that cerebral acidosis may contribute to the development of brain edema and pulmonary hyperventilation in patients with intracranial tumors.
Compartmental abnormalities of regional cerebral blood flow in children with head trauma
Authors: Kasoff Samuel S. , Zingesser Lawrence H. , Shulman Kenneth
Published: May 2009

✓ Regional cerebral blood flow (CBFr) and compartmental analysis in a series of children with closed head injuries have demonstrated abnormalities of both rate and distribution of blood flow. The most frequent derangement was a triphasic flow pattern overlying one or more regions of traumatized brain. The rate of flow in this third compartment is two to five times the rate of normal gray matter flow; while the relative weight of the compartment varies between 3.5% and 15%. The pathophysiology of this third, rapid compartment of flow is discussed, and the argument put forth that such flow does not represent hyperperfusion but rather an ischemia of the gray matter because such blood flow is not available to the tissue for nutrition. If this is so, it may well be a cause of permanent sequelae in the pediatric age group.
Seizures associated with the use of meglumine iothalamate 60% in ventriculography
Authors: Picaza Jorge A. , Hunter Sam E. , Lee Ling
Published: May 2009

✓ Meglumine iothalamate 60% (Conray) is a water-soluble substance being developed for the roentgenographic visualization of the cerebral ventricular system. Although it offer definite advantages compared to other contrast media, a recognized disadvantage is the possible development of seizures. This complication seems to be relatively rare and largely preventable, but once present may seriously endanger the patient's life. It appears to be a neurotoxic phenomenon, resistant to the usual anticonvulsant medications, and requires the availability of sophisticated personnel and emergency procedures to prevent death.
The relationship of Arnold-Chiari and Dandy-Walker malformations
Authors: Gardner W. James , Smith J. Lawton , Padget Dorcas H.
Published: May 2009

✓ The posterior fossa is abnormally small in cases of Arnold-Chiari malformation because the tentorium is too low, whereas it is abnormally large in the Dandy-Walker malformation because the tentorium is too high.
Intradural spinal ossifying schwannoma
Authors: Graham David I. , Bond Michael R.
Published: May 2009

✓ A case of solitary intradural spinal ossifying schwannoma is presented in a patient whose symptoms and signs indicated a lesion at the level of the cauda equina.
Spinal cord sarcoidosis
Authors: Banerjee Timir , Hunt William E.
Published: May 2009

✓ A case of spinal cord sarcoidosis simulating an intramedullary tumor is presented. Surgical intervention increased the neurological deficit which was subsequently decreased by steroid therapy. The common complications are discussed and the need for extensive physical therapy emphasized.
Spinal cord involvement with Schistosoma mansoni
Authors: Herskowitz Allan
Published: May 2009

✓ A case of Schistosoma mansoni involving the spinal cord is reported and the pertinent literature reviewed. The epidemiology, pathology, clinical signs and symptoms, and laboratory data that frequently occur in this disease are presented. Low back or leg pain associated with sphincter disturbance and eosinophilia in a patient from an endemic area should alert the physician to the diagnosis. Early institution of specific therapy and decompressive surgery are the major determinants for a favorable prognosis in this potentially curable neurological disease.
Acute necrotizing encephalitis complicating bifrontal craniotomy and pituitary curettage
Authors: Fearnside Michael R. , Grant John M. F.
Published: May 2009

✓ An acute necrotizing encephalitis due to herpes simplex virus may complicate craniotomy and cause death. Two such cases are reported and the subject reviewed. Early diagnosis is essential so that idoxuridine can be given and external surgical decompression contemplated.
False aneurysm secondary to penetration of the brain through orbitofacial wounds
Authors: Ferry Darwin J. , Kempe Ludwig G.
Published: May 2009

✓ Two cases of intracranial false aneurysm following penetrating orbitofacial wounds are reported. These were the only false aneurysms identified in a series of 2187 penetrating wounds of the brain from Vietnam. Three similar false aneurysms have been reported previously, and these also were associated with orbitofacial penetration. The unusual incidence of this type of arterial injury secondary to penetrating orbitofacial wounds suggests the value of early arteriographic evaluation.
Melanotic neuroectodermal tumor involving the cranium in infancy
Authors: Gilmor Richard L. , Mealey John
Published: May 2009

✓ A case of the cranial form of a melanotic neuroectodermal tumor is reported in an infant, and similar cases reviewed in seven other patients. The predilection of this tumor for the anterior fontanel region, its rapid invasion of adjacent bone, and its predominance to date in Negro males are documented. The prognosis appears to be excellent after simple excision and electrocautery of the dural extension. The probable origin and pathological features are discussed.
Intravascular repositioning of a ventriculoatrial shunt
Authors: McSweeney William J.
Published: May 2009

✓ Intravascular repositioning of a misdirected ventriculoatrial shunt from the left innominate vein into the right atrium was accomplished using a Muller guidewire deflector system. The guidewire and its surrounding small polyethylene catheter were inserted into a left superficial saphenous vein and advanced through the right side of the heart into the superior vena cava. The deflector system was activated and easily hooked the misplaced ventriculoatrial catheter. With gentle traction it was repositioned in the right atrium. The simplicity and safety of this approach make it recommended for use in infants and children.
Retraction of tumor capsule with Hemoclips
Authors: DeLong W. Bradford
Published: May 2009

✓ Tantalum clips with attached sutures are a useful aid in the retraction of a tumor capsule, cyst wall, and other similar structures. The method is especially useful when space for dissection is limited.
Preoperative management of patients with ruptured intracranial aneurysms
Authors: Ransohoff Joseph , Goodgold Albert , Benjamin M. Vallo
Published: May 2009

✓ The authors report their experience with the use of an antifibrinolytic agent and hypotensive drugs in the prevention of rebleeding from recently ruptured intracranial aneurysms and conclude that both measures are of suggestive value. With further refinement in these techniques an additional reduction of early rebleeding may be expected. Secondary cerebral vasospasm remains the major obstacle to early recovery and definitive surgery for ruptured intracranial aneurysms.
Traumatic aneurysms of the cerebral vessels
Authors: Acosta Carlos , Williams Phillip E. , Clark Kemp
Published: May 2009

✓ Four cases of traumatic intracranial aneurysms are presented and the pathology and pathophysiology discussed. Two were successfully treated by direct surgical attack. The diagnosis of traumatic aneurysm should be suspected when a patient has an episode of intracranial hemorrhage after a head injury. The outcome of bleeding episodes is fatal in a significant number of cases. Surgery to obliterate the aneurysm is the treatment of choice.
Intracranial pressure in patients with ruptured saccular aneurysm
Authors: Nornes Helge , Magnæes Björn
Published: May 2009

✓ Intracranial pressure was recorded in 21 patients with subarachnoid hemorrhage due to rupture of a saccular aneurysm. Two different pressure patterns were found in nine patients who had verified recurrent hemorrhages while awaiting clinical improvement. One was associated with massive hematoma while the other occurred with edema but only minimal hematoma; the terms “hemorrhagic-compressive lesion” and “ischemic-edematous lesion” have been used for these two conditions. Four patients showed transient deterioration concomitant with marked pressure peaks in the continuous record. Although there was no evidence of fresh hemorrhage, three of these episodes were followed by a verified hemorrhage within 24 hours. Since no such “warning episode” was seen after the aneurysm had been clipped, the authors consider this pressure peak and concomitant clinical deterioration to be related to the mechanism of aneurysm rupture and possibly a forerunner of a life-threatening hemorrhage. These three pressure patterns showed the whole range from full spatial compensation to total decompensation. The determining factors are considered to be the volume of extravasated blood, the vasomoter reaction, and the intracranial spatial buffering capacity.
Aneurysm-induced third nerve palsy
Authors: Raja Iftikhar A.
Published: May 2009

✓ Forty-two patients with aneurysm-induced third nerve palsy are described. After carotid ligation, 58% showed satisfactory and 42% unsatisfactory functional recovery. In some patients the deficit continued to increase even after carotid ligation. Early ligation provided a better chance of recovery of third nerve function. Patients in whom third nerve palsy began after subarachnoid hemorrhage had a poor prognosis. No relationship was noted between the size of the aneurysm and the recovery of third nerve function.
Intracranial mycotic aneurysms of extravascular origin
Authors: Suwanwela Charas , Suwanwela Nitaya , Charuchinda Srisakul , Hongsaprabhas Chaturaporn
Published: May 2009

✓ Six patients with intracranial mycotic aneurysms of extravascular origin are reported. Four had aneurysms of the intracavernous portion of the internal carotid artery associated with thrombophlebitis of the cavernous sinus, and two had aneurysms of the cerebral arteries associated with meningitis. An aneurysm of this type may rupture, producing subarachnoid hemorrhage, or it may become thrombosed and decrease in size or spontaneously disappear. In some patients it may persist and develop calcification in the wall.
Differential blockade of cat dorsal root C fibers by various chloride solutions
Authors: King J. Stovall , Jewett Don L. , Sundberg Howard R.
Published: May 2009

✓ A possible mechanism by which intrathecal infusion of partially frozen saline might relieve patients of chronic pain has been studied by applying hypertonic saline to the dorsal rootlets of cats in vitro. The supernatant of partially thawed normal saline was found to be hypertonic. Persistent block of C fibers, detected by a collision method, occurred after the rootlets had been exposed to saline from 500 to 2500 mOsm/L for 15 min followed by 15 min of isotonic saline. Few of the A fibers were blocked by this procedure, but both A and C fibers were blocked when solutions of 3500 mOsm/L were used. Differential blockage of C fibers could also be produced with hypotonic saline and with distilled water. Localized cooling, to 2°C for 25 min, had no persistent effect on C fiber conduction, and when cooling was combined with hypertonic saline there was no potentiation of the differential blockade caused by the saline. Hypertonic solutions of sucrose or sodium nitrate produced no persistent differential block; most A and C fibers recovered. However, choline chloride was as effective as sodium chloride in giving a differential blockade. It seems that chloride ion plays a major role in establishing the persistent C fiber blockade observed when dorsal rootlets are exposed to hypertonic saline.
Sciatica caused by nerve root entrapment in the lateral recess: the superior facet syndrome
Authors: Epstein Joseph A. , Epstein Bernard S. , Rosenthal Alan D. , Carras Robert , Lavine Leroy S.
Published: May 2009

✓ Fifteen patients with intense sciatic pain in whom surgical exploration disclosed no evidence of a herniated disc were found to have an entrapped L-5 or S-1 nerve root in a stenotic lateral recess beneath the superior articular facet of the inferior vertebra. Neurological abnormalities were infrequent. A conspicuously positive Lasègue sign was the most definite and consistent finding. Roentgenograms of the spine were not helpful, and myelography was negative or showed minimal changes because of the normal ventrodorsal diameter of the spinal canal and the lack of filling of the narrow lateral recesses. Electromyography was positive in the five patients studied. Surgical unroofing of the lateral recess with removal of the overhanging horizontal portion of the superior facet decompressed the incarcerated nerve root and relieved symptoms.
Dorsal column stimulation for control of pain
Authors: Nashold Blaine S. , Friedman Harry
Published: May 2009

✓ Thirty patients with chronic intractable pain have had dorsal column implants and a trial of subsequent electrical self-stimulation to relieve the pain. Burning pain originating from damage to the CNS was most often relieved, while chronic bone, joint, and disc pain responded less well. Patients with severe psychiatric factors should be excluded, but preoperative selection is still difficult because of the lack of objective clinical tests. The long-term effect of the implant on the tissues of the dorsal column is still unknown and requires further evaluation. Although relief of pain has been reported for as long as 3 years, much longer follow-ups are necessary to evaluate the efficiency of this system in patients with chronic pain. Direct stimulation of the spinal cord raises a number of interesting questions in regard to perception and sensory phenomena in man but, as yet, there are no answers as to how dorsal column stimulation effects its relief of pain.
Zenker's solution in the surgical treatment of craniosynostosis
Authors: Pawl Ronald P. , Sugar Oscar
Published: May 2009

✓ Tissue fixative (Zenker's solution) was applied to the outer layer of the cranial dura mater in 34 patients to delay regrowth of bone after craniectomy for craniosynostosis, and the results evaluated. Seizures, heretofore unrecorded as a complication, were noted postoperatively in two of 12 patients in whom the Zenker's solution was mixed with acetic acid. A time limit of 3 min for application of the solution to the dura mater and omission of acetic acid appeared to prevent permanent seizures in subsequent patients. Reoperation to maintain opened sutures has been necessary when the fixative was applied only to the bone edges and adjacent dura, indicating that the entire exposed dural surface must be covered. Cranioplasty to close large defects often became necessary at a later age when the solution containing acetic acid was applied longer than 3 min. With the modifications noted, the authors feel the technique is safe for use in cosmetic procedures.
Effect of experimental brain injury on blood pressure, cerebral sinus pressure, cerebral venous oxygen tension, respiration, and acid-base balance
Authors: Kaste Markku , Troupp Henry
Published: May 2009

✓ Changes in the blood pressure, cerebral sinus pressure, cerebral venous oxygen tension, acid-base balance, respiratory frequency, and respiratory minute volume were studied in the rabbit after a lethal cold injury to the brain. About half of the animals responded to the injury with a quick rise in cerebral sinus pressure and in its relation to blood pressure (CSP/BP); in the other half, cerebral sinus pressure and the CSP/BP ratio rose more slowly. Changes in the CSP/BP ratio correlated well with criteria for changes in respiratory performance. The changes in cerebral venous oxygen tension were reasonably uniform: a dip during freezing, an overshoot to a mean of 1.6 times the original level (about 30 mm Hg) immediately after injury, a gradual return to the pretraumatic level, and then a drop to lower levels. The brain injury led to a respiratory alkalosis that became more pronounced the longer the animals lived. Considered with CSP/BP ratio, respiratory reaction to the brain injury may provide an early and accurate prognosis. The fact that at the time of death the cerebral perfusion pressure was still within a range believed safe for the brain shows that an actual brain injury, in addition to raised intracranial pressure, is important in such experiments and emphasizes the inappropriateness of comparing levels of intracranial pressure raised by a variety of methods.
Intrasellar aneurysm with subarachnoid hemorrhage and hypopituitarism
Authors: Cartlidge Neill E. F. , Shaw David A.
Published: May 2009

✓ A patient is described who initially presented with subarachnoid hemorrhage and later with acute hypopituitarism. She had an aneurysm situated entirely within the pituitary fossa. The usual clinical features of parasellar aneurysms are described, and the endocrine assessment of the case is discussed.
Ganglioneuroma-paraganglioma of the intradural filum terminale
Authors: Lerman Robert I. , Kaplan Edward S. , Daman Lauren
Published: May 2009

✓ A rare ganglioneuroma-paraganglioma of the filum terminale is reported, and the histological, histochemical, and ultrastructural characteristics of the lesion described. Classification was resolved by the ultrastructure.
Status epilepticus as a complication of intrathecal fluorescein
Authors: Wallace Jan D. , Weintraub Michael I. , Mattson Richard H. , Rosnagle Robert
Published: May 2009

✓ This report describes a case of chemical meningitis with status epilepticus following intrathecal injection of fluorescein to delineate cerebrospinal fluid rhinorrhea. The patient was treated with parenteral steroids and anticonvulsants and recovered without sequelae. The wisdom of using minimal practical dosages of fluorescein is emphasized.
Effects of experimental ischemia on electrolytes of cortical cerebrospinal fluid and on brain water
Authors: West Charles R. , Matsen Frederick A.
Published: May 2009

✓ A procedure for perfusion over the cortical surfaces of the cerebral hemispheres of monkeys (Macaca mulatta) was used in combination with a procedure for producing sudden, temporary circulatory arrest in one hemisphere while the carotid circulation to the other hemisphere remained intact. The underlying disturbance in brain metabolism subsequent to circulatory arrest for 60 minutes was reflected in part by a decrease in the concentration of sodium and an elevation in the concentration of potassium in the cortical cerebrospinal fluid (CSF) on the ischemic side. The changes occurred at or within 30 minutes of the onset of circulatory arrest. The concentration of chloride in the cortical CSF on the ischemic side did not show significant differences from the control values. The ischemic brain exhibited as much as 18% swelling of cortical gray matter and 16% swelling of subcortical white matter at 5 hours after reestablishment of the carotid circulation. Vascular injury pursuant to ischemia was reflected in a significantly increased permeability to 131I-albumin entering the cortical CSF from the cerebral blood vessels. It is suggested that the CSF and vascular water are the sources of increased brain water.
Experimental augmentation of cerebral blood flow by intermittent aortic occlusion
Authors: Simeone Frederick A. , Laurent John P. , Trepper Peter J. , Brown Daniel J. , Cotter John
Published: May 2009

✓ Intermittent occlusion of the descending aorta just below the origin of the brachiocephalic vessels by a preformed balloon passed via the femoral artery is capable of significantly increasing the pressure and flow in the common carotid artery. Regional cerebral blood flow determination by the krypton-85 washout technique measured maximum increases of over 40% of the controls, which could easily be achieved and maintained. This technique apparently takes advantage of the finite delay in autoregulatory response to the increased arterial pressure before the onset of maximal autoregulation. Dogs were “pumped” in this way for up to 18 hours and survived in good health. Principal problems with this technique were the development of cerebral edema in the presence of diffuse established cerebral anoxia, and a shock-like cardiovascular response if the intermittent aortic occlusion was discontinued too abruptly. The clinical application of this technique to cerebral ischemia secondary to postoperative vasospasm may not require the extremes of hyperperfusion used in these experiments.
Intracranial pressure responses to alterations in arterial carbon dioxide pressure in patients with head injuries
Authors: Paul Ronald L. , Polanco Octavio , Turney Stephen Z. , McAslan T. Crawford , Cowley R. Adams
Published: May 2009

✓ Cerebral vasomotor responses to alterations in arterial carbon dioxide (PaCO2), as manifested by intraventricular pressure changes, were studied in a group of patients with head injuries. These patients could be classified into three types based on various degrees of responsiveness thought to reflect the integrity of their cerebral vasomotor reactivity.
Hemodynamic and metabolic concomitants of brain swelling and cerebral edema due to experimental cerebral infarction
Authors: Teraura Tetsuaki , Meyer John Stirling , Sakamoto Keizo , Hashi Kazuo , Marx Peter , Sterman-Marinchesu Cornelia , Shinmaru Seiji
Published: May 2009

✓ Severe cerebral ischemia was produced in 25 baboons by clamping the carotid and vertebral arteries bilaterally for 10 minutes. Cerebral hemodynamics and metabolism were monitored throughout. Cerebral anoxia was less severe in animals in which a marked pressor response occurred due to ischemia of the vasomotor center, and a reversible type of brain swelling was usual. In those with more severe ischemic anoxia, progressive cerebral edema was a pathological entity. Evidence is presented that cerebral edema was caused by loss of autoregulation of cerebral blood flow (CBF) concomitant with hyperemia and an increase of water and chloride content of brain tissue. Cerebral edema began when CBF was reduced during occlusion and progressed for several hours after termination of occlusion. Evidence is adduced that uncoupling of oxidative phosphorylation may be an important concomitant of cerebral edema.
Dorsal rhizotomy for the relief of chronic pain
Authors: Loeser John D.
Published: May 2009

✓ A retrospective study of 45 patients who had dorsal rhizotomies for relief of chronic pain is reported. The overall long-term success rate was 28% although initial results were much more favorable. The long-term results were correlated with a variety of preoperative and operative factors. Sex, age, history of narcotic use, compensation, number of roots cut, duration of pain, level of roots cut, effect of nerve blocks, or prior surgery for pain did not seem to influence the long-term results. The presence of arachnoiditis or pain subsequent to disc disease was associated with poorer results. Pain secondary to a malignancy responded better to this operation. The potential causes of operative failure are discussed.