bluuebunny/crossref_metadata_2025 huggingface dataset:
Axis Fractures: A Comprehensive Review of Management and Treatment in 107 Cases
Authors: Hadley Mark N. , Browner Carol , Sonntag Volker K.H.
Published: May 2010

The combination of movement, location, and anatomy of the axis predisposes it to multiple and varied fracture/dislocations distinct from other vertebrae. We examine all forms of axis fractures and address the appropriate treatment for each specific fracture type. In a retrospective review of 625 cervical spine fractures during an 8-year period, we found 107 axis fractures. There were 25 hangman's fractures (23%), 59 odontoid fractures (55%), and 23 miscellaneous fractures (22%), Each case was characterized by age, sex, the presence of associated injuries, presenting symptoms and findings, initial treatment, and results of that treatment. Excluding 6 early deaths, 90 of 101 patients were located for a median follow-up of 3.2 years. We found that 17% of cervical fractures involve the axis. Axis fractures have a high association with head and other cervical spine injuries, 40% and 18%, respectively. Few neurological deficits result from a fracture of the 2nd cervical vertebra. Hangman's fractures are effectively treated with external stabilization, preferably with a halo vest. We noted a shorter period of treatment using the halo vest as compared to the SOMI brace. Nonunion occurred in 26% of odontoid Type II fractures, but occurred in 67% of those with dens displacement of 6 mm or greater, regardless of age or direction of dislocation. We recommend early surgical therapy for this subgroup. There is no correlation between age and the rate of nonunion. In patients with odontoid Type II fractures with dens displacement of 0 to 5 mm, fusion occurs with external stabilization alone. Odontoid Type III fractures are one-half as common as Type II fractures, and all heal well with external stabilization. Twenty-two per cent of acute axis fractures are not hangman's or odontoid fractures. Miscellaneous fractures of the axis generally do well with external stabilization and immobilization.
Paranasal Sinusitis: A Common Complication of Nasotracheal Intubation in Neurosurgical Patients
Authors: Deutschman Clifford Scott , Wilton Peter B. , Sinow Jordan , Thienprasit Phudiphorn , Konstantinides Frank N. , Cerra Frank B.
Published: May 2010

Sinusitis secondary to nasotracheal intubation has not been reported to occur in neurosurgical patients. Over a 1-year period, 11 patients admitted to the Intensive Care/Trauma Unit at St. Paul Ramsey Medical Center developed this entity. The mean age of these patients was 36 ± 4 years; 7 were trauma victims, 3 had each had a subarachnoid hemorrhage, and 1 had suffered hypertensive hemorrhage. The patients presented with fever of unknown origin (FUO) and evidence of persistent hypermetabolism without an obvious cause. In 8 cases, the diagnosis was not suspected until mucopurulent nasal discharge was noted. Three additional cases were evaluated for suspected sinusitis before the occurrence of discharge. The mean duration of intubation before the diagnosis of sinusitis was 7.8 ± 1.5 days. The diagnosis was confirmed by sinus films with a Waters view in 7 cases or by computed tomographic scanning in 4 cases and by bacteriological cultures. Two cases involved only the maxillary sinus on the side of intubation; the rest were polysinusites. The organisms involved included gram-positive and gram-negative species; all were polymicrobial with a single organism predominant. Secondary pulmonary involvement was common, and 4 patients revealed a bacteremia consistent with the major sinus organism. One patient developed septic shock. Treatment involved either orotracheal intubation or tracheostomy. This was curative in all cases. It is concluded that neurosurgical patients nasally intubated are at risk for sinusitis, which can have untoward effects such as septicemia or pulmonary infection. A high degree of suspicion will permit early diagnosis and treatment.
High Altitude: An Unusual Cause of Neurological Deterioration in a Patient with an Arteriovenous Malformation
Authors: Tranmer B.I. , Kindt G.W.
Published: May 2010

High altitude associated with neurological deterioration is an unusual presentation for an arteriovenous malformation (AVM). A case report of a man with a left temporal occipital AVM who developed symptoms that were markedly intensified by exposure to high altitude is presented. The AVM was removed surgically, and all symptoms resolved. The pathogenesis of this unusual AVM symptom complex is discussed in this report.
Treatment of Cerebrospinal Fluid and Syringosubarachnoid Shunt Infection with Systemic and Intrathecal Antibiotics
Authors: Tomaszek David E. , Powers Stephen K.
Published: May 2010

We present a case of a patient with two preexisting Silastic syringosubarachnoid shunt catheters who developed Enterobacter meningitis. The infection was treated successfully with systemic and intrathecal antibiotics without removal of the catheters. With careful sequential clinical and laboratory monitoring, even this type of cerebrospinal fluid shunt infection can be eradicated without catheter removal and replacement.
Operative Normalization of Skull Shape in Sagittal Synostosis
Authors: Albright A. Leland
Published: May 2010

The skull shape of most infants with sagittal synostosis can be normalized intraoperatively by combining sagittal strip, occipital circular, and parietal wedge craniectomies. The technique is associated with minimal morbidity.
Ipsilateral Sensory Symptoms Caused by a Temporal Lobe Glioma
Authors: Bucci Michael N. , Farhat Saeed M. , Papadopoulos Stephen M.
Published: May 2010

Sensory symptoms can occasionally occur ipsilateral to lesions of the insula. We report a patient with left-sided sensory symptoms preceding the diagnosis of a left temporal lobe glioma. The anatomical basis for this clinical phenomenon is reviewed. This patient illustrates the complex neuroanatomical pathways and the clinical correlations from lesions in this region.
Myelomeningocele Occurring within a Lumbosacral Teratoma: Case Report
Authors: Reid Steven A. , Mickle Parker J.
Published: May 2010

The occurrence of a myelomeningocele completely embodied within a lumbosacral teratoma is extremely rare. We report on the clinical presentation, radiological appearance, surgical treatment, and histological make up of such a lesion.
Lateral Atlantooccipital Dislocation: Case Report
Authors: Watridge Clarence B. , Orrison William W. , Arnold Hendrick , Woods Gregory A.
Published: May 2010

A case of lateral atlantooccipital dislocation is presented, and its successful management is outlined, demonstrating the importance of the physical examination and the utilization of computed tomography. Open reduction and stabilization with direct visualization of the spinal axis is the preferred method of treatment.
Ventriculitis after Metrizamide Lumbar Myelography
Authors: Budny James L. , Hopkins L. N.
Published: May 2010

A 62-year-old man underwent lumbar metrizamide myelography complicated initially by a bout of aseptic chemical meningitis. Afterward, he suffered persistent headache, nausea, and blurred vision and, 12 weeks after his myelography, computed tomographic scans showed abnormalities consistent with a chronic ventriculitis. The case is presented; its pathological substrate and clinical implications are discussed.
Spinal Intradural Ependymal Cyst: A Case Report and Review of the Literature
Authors: Findler Gideon , Hadani Moshe , Tadmor Rina , Bubis Jose J. , Shaked Itzhack , Sahar Abraham
Published: May 2010

Spinal intradural ependymal cysts are extremely rare. The case presented is the sixth reported in the literature. The symptoms are consistent clinically and radiologically with a spinal intradural space-occupying lesion. The cyst wall is lined with both ciliated and nonciliated cells, resting directly on connective tissue. The exact embryonal origin of these cysts is obscure.
Primary Intracranial Chondrosarcoma: A Report of Two Cases
Authors: Adegbite Andrew B. O. , McQueen Donald J. , Paine Kenneth W. E. , Rozdilsky Bohdan
Published: May 2010

Two cases of primary intracranial chondrosarcoma are presented. The cases were similar in that they both arose from the temporal bone, contained both myxomatous tissue and material of cartilaginous consistency, and were avascular. Histological studies excluded the diagnosis of chondroid chordoma. A brief review of the subject is presented.
Unruptured Fusiform Aneurysms of the Posterior Circulation with Thalamic Infarction
Authors: Graff-Radford Neill R. , Adams Harold P. , Smoker Wendy R. K. , Biller José , Boarini David J.
Published: May 2010

Three patients with unruptured fusiform aneurysms of the posterior circulation presented with nonhemorrhagic thalamic infarctions. All of the aneurysms were seen on enhanced computed tomographic (CT) scans preangiographically. Although unruptured fusiform aneurysms are probably a rare cause of nonhemorrhagic thalamic infarction, their importance lies in the therapeutic implications of this diagnosis. In patients with nonhemorrhagic thalamic infarction, we suggest careful scrutiny of the blood vessels on enhanced CT scans.
Concurrent Pineoblastoma and Unilateral Retinoblastoma: A Forme Fruste of Trilateral Retinoblastoma?
Authors: Whittle Ian R. , McClellan Katherine , Martin Frank J. , Johnston Ian H.
Published: May 2010

A 10-month-old boy who presented with strabismus and symptoms of intracranial hypertension was found to have a pineoblastoma and a unilateral ocular retinoblastoma. Despite enucleation of the eye, subtotal removal of the pineoblastoma, and craniospinal axis irradiation, the patient died 6 months later from disseminated intracranial neoplasm. As there was no clinical evidence of bilateral retinoblastoma, this case may represent a forme fruste of the trilateral retinoblastoma complex. The clinicopathological features of this unusual syndrome are reviewed.
Traumatic Intracavernous Carotid Aneurysm with Massive Epistaxis
Authors: Liu Ming-Ying , Shih Chun-Jen , Wang Yeou-Chih , Tsai Shin-Han
Published: May 2010

Five cases of traumatic intracavernous carotid aneurysm are presented. All of the patients were young men with a history of severe head injury. The clinical manifestations were massive epistaxis and an ipsilateral cavernous sinus syndrome. The diagnosis was made correctly by carotid angiography. All of the patients developed another episode of massive epistaxis after admission. Emergency trapping of the internal carotid artery was performed. An urgent rescue method was used in one of our patients to prevent exsanguination before definitive surgical treatment. One patient died of exsanguination in spite of emergency ligation of the internal carotid artery. In the other four patients, no epistaxis was experienced after the operation.
Expanded Role of the Cerebrospinal Fluid Reservoir in Neurooncology: Indications, Causes of Revision, and Complications
Authors: Machado Miguel , Salcman Michael , Kaplan Richard S. , Montgomery Elizabeth
Published: May 2010

Advances in chemotherapy have increased the indications for insertion of cerebrospinal fluid (CSF) reservoirs in the treatment of both primary and secondary central nervous system neoplasia. There have been no recent evaluations of the current indications and complications of this procedure in a general neurooncology practice. We undertook a retrospective review of our total experience of 60 patients who were implanted with CSF reservoirs between November 1977 and October 1983. The mean age of those implanted was 38 years (range, 22 months to 79 years). The reasons for insertion were: drug instillation, 35 cases (58.3%); drug level monitoring, 15 cases (25.0%); intermittent tumor cyst drainage, 6 cases (15.0%); and syrinx drainage, 1 case (1.6%). Drug level monitoring was most often done in conjunction with specific experimental chemotherapy protocols. There were no complications after primary insertion. but 9 of 60 reservoirs (15%) required revision for technical failure. Revision was much more likely to occur in the presence of an intracranial mass lesion (7 of 34. or 20.5%). The revision rate in cases of meningeal carcinomatosis was only 7.6% (2 of 26). Patients requiring revision included 5 with glioblastoma, 2 with metastatic tumors. and 2 with meningeal carcinomatosis. Four of the 9 patients requiring revisions developed complications (44%). There were three infections with positive CSF cultures and one subdural hematoma. Infected patients included those with multiple craniotomies. prior cranial irradiation. or some form of chemotherapy. We conclude that primary insertion of a CSF reservoir in a patient with neoplastic involvement of the central nervous system is extremely safe, that technical failure tends to occur in the presence of mass lesions, and that the complication rate of repeated insertion is quite high.
Topographic Electroencephalographic Study with Power Ratio Index Mapping in Patients with Malignant Brain Tumors
Authors: Nagata Ken , Gross Cordell E. , Kindt Glenn W. , Geier J. Michael , Adey Geoffrey R.
Published: May 2010

A variant of electroencephalogram (EEG) power spectral mapping called power ratio index (PRI) mapping was used to monitor 15 patients with malignant brain tumors. This index is generated by dividing the low frequency (delta, theta) power by the high frequency (alpha, beta) power. Because the nonparoxysmal effect of a brain tumor on the EEG is reflected as a relative loss of high frequency power and a gain in low frequency power, utilization of the PRI has the effect of placing the epicenter of the “power dysfunction” coincident with the epicenter of the tumor.
Subarachnoid Hemorrhage from a Peripheral Intracranial Aneurysm Associated with Malignant Glioma: Report of a Case
Authors: Andrews Brian T. , Raffel Corey , Rosegay Harold
Published: May 2010

The case of a patient who initially presented with a subarachnoid hemorrhage from an aneurysm of the distal left middle cerebral artery is reported. The aneurysm was later found to have occurred within a malignant glioma. Histological analysis showed tumor infiltrating the wall of the aneurysm. A causal relationship between growth of the tumor and development and rupture of the aneurysm is postulated.
Traumatic Subarachnoid-Pleural Fistula
Authors: Lovaas M. Edward , Castillo Reynaldo G. , Deutschman Clifford S.
Published: May 2010

Subarachnoid-pleural fistula is a rare condition; only 18 cases have been reported. The 19th case of subarachnoid-pleural fistula. which followed a small caliber gunshot wound, is reported. Diagnosis was made via radionuclide scan, and primary operative repair was necessitated by the failure of conservative management. A review of the literature reveals several means of diagnosing this disorder, as well as a number of management alternatives.
Subacute Diencephalic Necrosis and Dural Arteriovenous Malformation
Authors: Nakada Tsutomu , Kwee Ingrid L. , Ellis William G. , St. John James N.
Published: May 2010

We report a case of congestive venous necrosis involving the diencephalon symmetrically, presumably precipitated by a dural arteriovenous malformation (AVM). The patient presented with a 1-month history of intermittent confusion and gait ataxia. The initial radiological work-up revealed a dural AVM. The patient's subsequent deterioration was accompanied by computed tomographic findings of diencephalic congestion. Pathological examination showed subacute necrosis of the diencephalon. We discuss the pathogenesis of this case of subacute diencephalic necorsis and its possible relationship to the entity of subacute diencephalic angioencephalopathy.
The Cerebral Venous System
Authors: Schmidek Henry H. , Auer Ludwig M. , Kapp John P.
Published: May 2010

The authors discuss the gross and microscopic anatomy and the physiology of the cerebral venous system. Cerebral veins under pathological circumstances (hypercapnia, arterial hypertension, and increased intracranial pressure), pharmacological observations, the venous blood-brain barrier, and traumatic involvement are reviewed. Neoplastic involvement and radiological aspects are included. Surgical reconstruction of venous sinuses (including the Donaghy technique), tumor removal, sinus thrombectomy, and extraanatomical bypass of the transverse sinus are discussed.
Cranial Chordomas: Clinical Presentation and Results of Operative and Radiation Therapy in Twenty-six Patients
Authors: Raffel Corey , Wright Donald C. , Gutin Philip H. , Wilson Charles B.
Published: May 2010

The clinical presentation and the results of operative and radiation therapy in a series of 26 patients with cranial chordomas seen at the University of California, San Francisco, between 1940 and 1984 are reviewed. There were 14 men and 12 women, with a mean age of 39.6 years. Six patients had chondroid chordomas. The most common presenting symptoms were headache and diplopia, and the most common presenting sign was extraocular palsy. Fifty-three operations directed at removal of the tumor were performed. Twenty-three patients received various forms of radiation therapy postoperatively, including conventional external beam therapy, heavy charged particles, and interstitial implants. The average length of follow-up is 5.6 years. Eleven of 26 patients have died; the mean duration of survival in this group, excluding 1 perioperative death, was 4 years and 2 months. Although the average survival time of 6 years and 4 months was the same in patients with typical chordomas (excluding the perioperative death and 1 patient lost to follow-up) and in those with the chondroid variant, all of the latter are still alive, whereas more than half of the patients with typical chordoma have died.
Psychological Factors and Outcome of Electrode Implantation for Chronic Pain
Authors: Daniel Michael S. , Long Charles , Hutcherson W. L. , Hunter Samuel
Published: May 2010

The utility of using psychological assessments as a basis for predicting pain relief after electrode implantation is examined. Two raters independently reviewed the functional pain protocols of chronic pain patients who were candidates for deep brain (n = 13) or spinal cord (n = 17) electrode implants and predicted whether each would have a good or poor treatment response. At follow-up, five deep brain (39%) and four spinal cord (24%) patients were classified as having good responses to treatment. Predictions of outcome based on psychological data were accurate for 80% of the patients. These results suggest that functional pain assessment is useful as a part of preimplantation screening and emphasize the importance of psychological factors in the outcome of treatment for chronic pain.
Malignant Carcinoid Causing Spinal Cord Compression
Authors: Gowitt Gerald T. , Mirra Suzanne S.
Published: May 2010

Neurological complications of malignant carcinoid are infrequent, Only 11 cases of central nervous system metastasis are documented, and neurological symptoms may be the initial or only manifestation of this tumor. We describe the case of a 60-year-old man with no known primary tumor who presented with spinal cord compression by a thoracic epidural tumor. After laminectomy, the diagnosis of carcinoid was made by light and electron microscopic demonstration of neurosecretory granules in tumor cells. Urine 5-hydroxyindole acetic acid and plasma serotonin levels were subsequently found to be elevated. Carcinoid tumors should be considered in the differential diagnosis of lesions metastatic to the spinal cord and brain.
Combined Occipital Transtentorial and Infratentorial Supracerebellar Approach in the Concorde Position for the Treatment of an Arteriovenous Malformation in the Upper Vermis: Case Report
Authors: Aoki Nobuhiko
Published: May 2010

With a patient in the concorde position, lying prone with the head flexed and tilted laterally, higher than the heart, it is possible to use both the occipital transtentorial and infratentorial supracerebellar approaches without changing the patient's position. We report the successful treatment with this combined approach of an arteriovenous malformation in the upper vermis supplied by the superior cerebellar artery.
Bilateral Internuclear Ophthalmoplegia Due to Hydrocephalus: A Case Report
Authors: Nishizaki Tomoyuki , Tamaki Norihiko , Nishida Yoshimitsu , Matsumoto Satoshi
Published: May 2010

We report a case of bilateral internuclear ophthalmoplegia due to hydrocephalus associated with Arnold-Chiari malformation. The bilateral internuclear ophthalmoplegia in this case was probably caused by brain stem displacement due to hydrocephalus. This patient was considered to have “arrested” hydrocephalus on the basis of the clinical and computed tomographic findings and the results of the continuous intraventricular pressure monitoring. However, the bilateral internuclear ophthalmoplegia gradually improved after ventriculoperitoneal shunting.
Late Epilepsy after Aneurysm Operations
Authors: Keränen Tapani , Tapaninaho Antti , Hernesniemi Juha , Vapalahti Matti
Published: May 2010

The risk of late epilepsy was analyzed in a consecutive series of 177 patients operated on for supratentorial aneurysms. Late seizures occurred in 25 patients (14%); the seizures were recurrent in 21 patients (12%). Most seizures were partial, secondary generalized, or generalized tonic-clonic (72%). The mean latency between the operation and seizures was 8.4 months (range, 1 to 24 months), and in only 2 patients was the interval more than 12 months. The most important risk factors were preoperative and postoperative complications. Only 2.5% of the 81 Grade I patients developed epilepsy, compared to 33% of the 42 Grade III-IV patients. Other risk factors were location of the aneurysm in the middle cerebral artery, the presence of a large intracerebral hematoma, postoperative spasm with late ischemic infarction, and shunt-dependent hydrocephalus. The timing of operation or intraventricular intracranial pressure monitoring did not change the risk of late epilepsy. The fact that only 2 patients had early epilepsy may have been due to routine treatment with prophylactic anticonvulsants. The value of prophylaxis in late epilepsy is unproven, but prophylactic treatment could be useful in patients with a high risk of epileptic seizures.
Prevention of Rebleeding after Operation for Subarachnoid Hemorrhage of Unknown Cause
Authors: Sakai Noboru , Yamada Hiromu , Ando Takashi , Nishimura Yasuaki
Published: May 2010

This study is presented to promote prophylactic operation to prevent rebleeding after subarachnoid hemorrhage (SAH) of unknown cause. Twenty-two cases of nontraumatic SAH of unknown cause of a total of 254 cases of SAH treated during a 5-year period (1980-1984) were available for this study. A follow-up study (4 to 61 months after treatment; median, 43 months) revealed a 4.5% mortality rate. Four patients chosen from among the 22 SAH cases underwent prophylactic operation. The decision to operate was based on repeated angiography showing regional cerebral vasospasm corresponding to a limited hyperdense area on the computed tomographic scan at the time of the onset of SAH. Microsurgery revealed a minute protrusion (less than 2 mm in diameter) or thinning of the arterial wall with old hematoma of the surrounding brain in all 4 cases, and treatment required only coating of the abnormal site. All 4 patients are now fully recovered. Frequently, abnormal changes of such cerebral arteries as the anterior communicating artery, the internal carotid artery (C-1 and C-2), and the middle cerebral artery (M-1) may occur. Therefore, the authors emphasize the necessity of surgical treatment for specific cases of SAH with an unknown cause.
Sudden Loss of Pain Control with Morphine Pump Due to Catheter Migration
Authors: Hirsh Leonard F. , Thanki Ashokkumar , Nowak Thomas
Published: May 2010

The use of implantable morphine pumps for the treatment of cancer pain is increasing. A sudden loss of previously adequate pain control should suggest pump malfunction. Pump revision should be considered, rather than automatically increasing oral analgesics. This case report details a rapid loss of pain control due to intraspinal catheter migration into the abdominal subcutaneous space
Completely Thrombosed Giant Aneurysm of the Basilar Artery Trunk: A Case Report
Authors: Spincemaille G. H. J. J. , Slooff J. L. , Hogenhuis L. A. H. , Lodder J.
Published: May 2010

A patient with a completely thrombosed giant aneurysm arising from the trunk of the basilar artery is described. Although it is difficult to differentiate this anomaly from a posterior fossa tumor, negative angiographic findings combined with certain computed tomographic (CT) signs may point to the correct diagnosis. Our case demonstrates that one of these CT signs (viz. ringlike contrast enhancement) can be explained by the presence of vasa vasorum in the aneurysm wall
External Pneumatic Calf Compression Reduces Deep Venous Thrombosis in Patients with Ruptured Intracranial Aneurysms
Authors: Black Peter McL. , Crowell Robert M. , Abbott William M.
Published: May 2010

We evaluated the ability of intermittent external pneumatic calf compression to prevent deep venous thrombosis after subarachnoid hemorrhage from ruptured intracranical aneurysms. Fifty-six subarachnoid hemorrhage patients not given external pneumatic calf compression were compared with 90 patients who had calf compression after their subarachnoid hemorrhages. Both groups of patients were on strict bedrest for 7 to 21 days after aneurysm rupture, and both received e-aminocaproic acid, 30 to 36 g/day intravenously, until operation. The risk factors in the two groups were similar, and the nursing and medical care did not seem to differ. Of patients without external pneumatic compression, 18% had venographically proven deep venous thrombi, which contrasts with 6% of patients receiving calf compression. This was a significant difference (p < 0.05; x2). These retrospective data suggest that external pneumatic calf compression helps to prevent deep venous thrombosis in patients with subarachnoid hemorrhage when delayed operation, bedrest, and antifibrinolytic agents are used.
Brain Necrosis after Radiotherapy for Primary Intracerebral Tumor
Authors: Hohwieler Marcia L. , Lo Theodore C. M. , Silverman Mark L. , Freidberg Stephen R.
Published: May 2010

Radiotherapy is a standard postoperative treatment for cerebral glioma. We have observed the onset of symptoms related to brain necrosis, as opposed to recurrent tumor, in surviving patients. This has been manifest as dementia with a computed tomographic pattern of low density in the frontal lobe uninvolved with tumor, but within the field of radiotherapy. Two patients presented with mass lesions also unrelated to recurrent tumor. We question the necessity of full brain irradiation and suggest that radiotherapy techniques be altered to target the tumor and not encompass the entire brain.
Reversal of Visual Impairment after Interstitial Irradiation of Pituitary Tumor
Authors: Kumar P. P. , Good R. R. , Cox T. A. , Leibrock L. G. , Skultety F. M.
Published: May 2010

Bilateral blindness secondary to a recurrent hemangiopericytoma of the pituitary fossa in a 22-year-old man was corrected by the transsphenoidal implantation of a single high activity iodine-125 seed.
Dysphagia and Dysphonia Secondary to Anterior Cervical Osteophytes
Authors: Brandenberg Greg , Leibrock Lyal G.
Published: May 2010

A 77-year-old man presented with a 4-year history of progressive dysphagia to the point that he could no longer swallow solid foods. During the past several months, he had developed dysphonia. Cervical spine x-ray films demonstrated massive anterior degenerative osteophytic spurs between C-3 and C-7. Evaluation with barium swallow and cervical computed tomography demonstrated esophageal and laryngeal compression. Resection of the anterior osteophytes resolved the dysphagia and dysphonia.
Expanding Intracerebellar Hematoma: A Possible Clinicopathological Entity
Authors: Aoki Nobuhiko , Mizuguchi Kunio
Published: May 2010

An adult case of intracerebellar hematoma with a definite capsule is presented. The hematoma is thought to have been enlarged by repeated hemorrhages inside the capsule, with consequent progressive neurological symptoms. Intracerebellar hematoma does not always disappear by absorption. On the contrary, it may expand, and symptoms and signs similar to those of cerebellar tumor may subsequently develop. The authors propose that the expanding intracerebellar hematoma is a possible clinicopathological entity with a definite capsule comparable to that of chronic subdural hematoma.
Spontaneous Migration of a Bullet in the Spinal Subarachnoid Space Causing Delayed Radicular Symptoms
Authors: Karim Najmaldin O. , Nabors Michael W. , Golocovsky Mario , Cooney Donald F.
Published: May 2010

The authors report a case of a gunshot wound to the left lower quadrant of the abdomen in a patient who initially was neurologically intact. The bullet had lodged at the T-11, T-12 level in the spinal canal. After an exploratory laparotomy, the patient developed severe low back pain radiating to his left lower extremity and an incomplete footdrop. Repeat x-ray films and a myelogram showed that the bullet had migrated to the L-4, L-5 level on the left. Bullet emboli and delayed sequelae of gunshot wounds to the spine are discussed.
Use of the Philadelphia Collar as an Alternative to the Halo Vest in Patients with C-2, C-3 Fractures
Authors: Sean M. Grady , Matthew A. Howard , John A. Jane , John A. Persing
Published: May 2010

We analyzed retrospectively 27 individuals with C-2, C-3 fractures, 8 of whom were treated with a Philadelphia collar rather than the more commonly used halo vest. Successful fusion without neurological deficit occurred in all cases whether treatment was by Philadelphia collar (n = 8), halo apparatus (n = 16), or prolonged bed rest (n = 3). There was an increase in subluxation in 3 patients in both the Philadelphia collar group and the halo apparatus group. However, 1 of the 3 in the collar group was uncooperative and discarded his collar during treatment. If he is excluded, the subluxation rate in the Philadelphia collar group is 27%: the rate in the halo group is 19%. The Philadelphia collar seems to be an acceptable means of stabilizing the neck in C-2, C-3 fractures, but one must consider the degree of cervical movement in the collar (as detected by dynamic x-ray films), patient reliability, and patient age. The presence of subluxation did not preclude successful fusion in either the Philadelphia collar or the halo vest groups.
Chronic Vermal Herniation in a Case of Osteosarcoma of the Occipital Bone
Authors: Challa Venkata R. , Crone Kerry R. , Ferree Carolyn R. , Moody Dixon M. , Kelly David L.
Published: May 2010

Upward projection of the cerebellar vermis through the tentorial hiatus is called upward vermal herniation (UVH). UVH is less common in clinical practice than uncal herniation. Even more uncommon is chronic vermal herniation and impaction in the tentorial hiatus. To illustrate this phenomenon, we present the clinical, radiological, and morphological features of vermal impaction in a patient with a postradiation osteosarcoma of the occipital bone. In spite of nearly total excision of the tumor pushing the cerebellum upward, his postoperative course was complicated by respiratory problems and an altered level of consciousness, finally resulting in death. His clinical status paralleled the computed tomographic (CT) demonstration of persistent obliteration of the supramesencephalic cistern. CT makes more reliable the detection and management of UVH, but a high index of suspicion is necessary for prevention of this complication.
Pure Word Deafness: A Possible Explanation of Transient Deteriorations after Extracranial-Intracranial Bypass Grafting
Authors: Kanter Steven L. , Day Arthur L. , Heilman Kenneth M. , Gonzalez-Rothi Leslie J.
Published: May 2010

Pure word deafness is a rare behavioral disorder in which the comprehension of spoken language is grossly disturbed. but the abilities to speak, read, write, and process nonverbal auditory stimuli remain intact. This disorder is caused by superior temporal gyrus lesions in the dominant hemisphere that isolate Wernicke's area from incoming auditory information. This involved area is supplied by cortical middle and posterior temporal end-artery branches of the middle cerebral artery. Among approximately 100 extracranial-intracranial bypass procedures performed at our institution in the past 5 years, three patients developed the syndrome of pure word deafness. A cortical or posterior temporal branch of the middle cerebral artery was utilized as the recipient artery in each instance. In all cases, the deficit was transient, delayed (i.e. the patient did not awaken from anesthesia with the deficit), and unrelated to the preoperative deficit. The syndrome of pure word deafness may be more common after bypass than is currently recognized. Localized arterial spasm, dysautoregulation secondary to operative manipulation, or focal brain swelling may be operative mechanisms in the development of this and other delayed, reversible deficits related to bypass surgery.
Forme Fruste of von Recklinghausen's Disease: Unilateral Association of an Orbital Neurofibroma, a Trigeminal Neurinoma, and an Acoustic Neurinoma
Authors: Kasuya Hidetoshi , Kadowaki Hirotaka , Yato Seiji , Kubo Osami , Kagawa Mizuo , Kitamura Koichi
Published: May 2010

A patient who presented with a tumor of the left ambient cistern, a left cerebellopontine angle tumor, and a left orbital tumor causing left hearing loss and left exophthalmos without café au lait spots or cutaneous neurofibromas is described. There was no family history of von Recklinghausen's disease. A cerebellopontine angle tumor removed by a suboccipital craniectomy was an acoustic neurinoma. An ambient cistern tumor was approached through a subtemporal route. A tumor arising from the trigeminal nerve was also a neurinoma. An orbital neurofibroma was excised by a frontal craniotomy with removal of the orbital roof. This rare unilateral association of neurinomas and a neurofibroma on the left side was thought to be a forme fruste of von Recklinghausen's disease, and it could be considered a presentation of a mosaic of von Recklinghausen's disease.
Neuroradiological and Electroencephalographic Features in a Case of Temporal Lobe Status Epilepticus
Authors: Stone James L. , Hughes John R. , Barr Arlene , Tan Walter , Russell Eric , Crowell Robert M.
Published: May 2010

A patient with medically intractable status epilepticus of temporal lobe origin is presented. A computed tomogram showed a low density area adjacent to the midbrain, possibly related to atrophy of the medial temporal lobe. Cerebral angiography revealed early filling veins and an anterior temporal blush. Magnetic resonance (MR) scanning (T2 weighted images) showed increased signal intensity in the region of the amygdala and anterolateral left temporal lobe. Ictal activity was recorded from scalp electrodes over the left temporal area, and many paroxysms were recorded from cortical surface electrodes. An anterior temporal lobectomy revealed only gliosis. The cerebral blood flow changes accompanying status epilepticus of focal origin are reviewed, and a possible relation of electroencephalographic, angiographic, and MR findings is discussed.
Intrathecal Morphine during Lumbar Spine Operation for Postoperative Pain Control
Authors: Blacklock J. Bob , Rea Gary L. , Maxwell Robert E.
Published: May 2010

The analgesic requirements and bladder function of 5 patients who received 1 mg of intrathecal morphine during lumbar spine operation are compared to those of 10 control patients. No analgesics were used by the treatment group for the first 24 hours postoperatively. The test group subsequently required twice the amount of analgesics during the 2nd through 5th days after operation compared to controls. All 5 patients who received intrathecal morphine developed urinary retention for 24 to 36 hours. The brief duration of analgesia, the increased narcotic use after the effects of the morphine dissipated, and urinary retention after a single intraoperative dose of intrathecal morphine suggest caution in using this technique.
Myiatic Scalp and Skull Infection with Diptera Sarcophaga: Case Report
Authors: Arbit Ehud , Varon Rose E. , Brem Steven S.
Published: May 2010

The authors describe an unusual infestation of an ulcerative squamous cell carcinoma of the scalp and skull with Diptera Sarcophaga larvae. Human myiasis is rare in temperate zones and presents a rather unique neurosurgical challenge. The clinical presentation and treatment of human myiasis are briefly discussed.
Acute Middle Cerebral Artery Occlusion: Experience with Volume Expansion Therapy
Authors: Tranmer Bruce I. , Gross Cordell E. , Keller Ted S. , Kindt Glenn W.
Published: May 2010

Five consecutive patients with acute neurological deficits after middle cerebral artery (MCA) occlusion were given emergency treatment with colloidal volume expansion. In each case, the diagnosis was confirmed promptly by computed tomography and cerebral angiography. Aggressive volume expansion therapy was started 2 to 18 hours (mean, 11 hr) after the onset of the neurological deficit. The mean colloidal volume used was 920 ml/day for an average of 4 days. During volume expansion, the mean cardiac output increased 57% from 4.6 + 0.6 to 7.2 + 1.9 litres/min (P < 0.05). The mean hematocrit decreased 19% from 46 + 3% to 37 + 4% (P < 0.01). The mean arterial blood pressure remained stable, and the pulmonary artery wedge pressure was maintained at < 15 mm Hg. Three patients improved dramatically with volume expansion therapy and have returned to their previous life-styles. Two patients made partial recoveries and manage at home with nursing care. The three patients who improved dramatically were young (aged <34) and, when compared to the older patients, they had greater increases in cardiac output (67% vs. 19%). No major complications or deaths were attributed to the volume expansion therapy. We propose that intravascular volume expansion and its concomitant augmentation of the cardiovascular dynamics may be effective in the treatment of acute neurological deficits after acute MCA occlusion.
Neurocysticercosis: Surgical and Medical Management with Praziquantel
Authors: Leblanc Richard , Knowles Kathleen F. , Melanson Denis , MacLean John Dick , Rouleau Guy , Farmer Jean-Pierre
Published: May 2010

Eight cases of neurocysticercosis were encountered at the two major neurological centers affiliated with McGill University in Montreal in 4 years. All patients were immigrants who had been in Canada for a period of 1 to 18 years and came from South America (three cases), Haiti (three cases), and Greece (two cases). Five patients had parenchymal cysts and presented with epilepsy; three had the racemose form and presented with hydrocephalus. Four patients with parenchymal cysts were treated by removal of the cysticercus and did well. One patient with numerous cysts was treated with praziquantel with good clinical and radiological results. Two patients with the racemose form were treated by cyst aspiration, cerebrospinal fluid (CSF) diversion, and praziquantel and did well. Another patient with the racemose form, seen before the advent of praziquantel, died of cysticercosis infection. Neurocysticercosis is not uncommon in the immigrant population of large North American cities. Single symptomatic cysts can be evacuated surgically with good results; multiple parenchymatous cysts can be treated with praziquantel. Patients with the racemose form who are treated with CSF diversion and praziquantel do well, although those who are only treated surgically die of their disease.
Long Term Survival of a Patient with an Intracranial Ependymoma: Case Report
Authors: Grady Sean M. , Vandenberg Scott R. , Jane John A.
Published: May 2010

A patient with a posterior fossa ependymoma who has survived for over 49 years is presented. Inspection of the original specimen from 1936 and comparison to subsequent biopsies show no change in the benign morphology of the tumor. This case is unique not only in the patient's length of survival, but also in the sequential histological examination of the tumor.
Carotid Occlusion in a 27-Year-Old Man: A Case Report
Authors: Osgood Carroll P. , Karunaratne Esiri R. , Sandler Richard , Vandevander Dennis J.
Published: May 2010

A 27-year-old man developed premature carotid atherosclerosis some 15 years after mantle radiation to the head and neck for nasopharyngeal lymphoepithelioma.
Isolated C-2 Osteomyelitis of Hematogenous Origin: Case Report and Literature Review
Authors: Venger Benjamin H. , Musher Daniel M. , Brown Eugene W. , Baskin David S.
Published: May 2010

A case of hematogenous Staphylococcus aureus osteomyelitis isolated to the 2nd cervical vertebra is presented. To our knowledge, this is the second case to be reported of hematogenous infection involving only the body and odontoid process of the axis. The first report was published prior to the advent of computed tomography, bone scans, and halo orthosis. The pathophysiology of blood-borne atlantoaxial infection is described, as well as methods of diagnostic evaluation and therapeutic recommendations. The use of computed tomography to define the extent of the lesion is illustrated.
Cerebral Salt Wasting after Pituitary Exploration and Biopsy: Case Report
Authors: Andrews Brian T. , Fitzgerald Paul A. , Tyrell Blake J. , Wilson Charles B.
Published: May 2010

We report a case of hyponatremia associated with volume depletion after pituitary exploration and biopsy. The presence of clinical dehydration precluded diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone. The absence of a hypoadrenal state and the patient's response to volume reexpansion were consistent with a diagnosis of primary cerebral salt wasting.
Management of Bilateral Locked Facets of the Cervical Spine
Authors: Maiman Dennis J. , Barolat Giancarlo , Larson Sanford J.
Published: May 2010

A total of 28 cases of cervical spine dislocation with bilateral locking of facets treated between 1976 and 1984 were analyzed to determine whether treatment modality had any effect on outcome based on cord or root function. Motor vehicle accidents were responsible for 19 cases; the most common levels of dislocation were C-5, C-6 and C-6, C-7, with 10 each. Twenty patients were admitted with complete myelopathies. Ten patients whose dislocations were successfully reduced with traction had no neurological changes, but 1 reduced elsewhere deteriorated from a C-5 to C-2 level. Eleven of these patients underwent posterior cervical fusions after delays of 1 to 17 days (mean = 6.3); 2 died, and 1 patient achieved slight root return. Seven underwent anterior decompression and fusion or combined anterior and posterior approaches after delays of 9 to 120 days. One patient died in the postoperative period, 1 had substantial recovery of cord function, and 5 had recovery of root function. There was no operation or improvement in 2 patients. Eight patients had incomplete myelopathies; 4 were initially reduced, with 2 improving slightly as a result. Three patients underwent posterior fusions with foraminotomies with minimal improvement. Five had anterior or combined approaches; these patients improved at least one neurological grade each, including 3 who became newly ambulatory. All 24 surviving patients achieved spinal stability, although it occurred slightly earlier in the anterior fusion groups. Surgical approaches designed to provide spinal stability and restore the normal anatomy of the spinal canal and neural foramina may be of functional benefit in the management of these dislocations.
Laser Resection of Fifty Spinal Lipomas
Authors: McLone David G. , Naidich Thomas P.
Published: May 2010

The value of laser resection was assessed in the last 50 of 128 consecutive cases of pediatric spinal lipoma. In this series, there was no mortality. No patient suffered increase in neurological or urological deficit. Postoperatively, 8 of 20 patients with prior motor deficit (40%) had substantially improved motor function. Two of 17 previously incontinent patients became continent of urine (12%). Use of the CO2 laser reduced the length of operation, the intraoperative blood loss, and the degree of manipulation of the spinal cord and nerve roots. Most of the fat could be removed successfully from the liponeural junction, permitting more nearly anatomical removal of the intramedullary component of the lesion and greater ease in replacing the cord into a reconstructed arachnoid-dural canal. In the authors' opinions, proper management of the patient with spinal lipoma now requires early prophylactic resection of the lipoma and untethering of the spinal cord.
Isolated Central Nervous System Metastasis from Transitional Cell Carcinoma of the Bladder: Report of a Case and Review of the Literature
Authors: Davis Raphael P. , Spigelman Melvin K. , Zappulla Rosario A. , Sacher Michael , Strauchen James A.
Published: May 2010

Although systemic metastases from transitional cell carcinoma of the bladder occur frequently, involvement of the central nervous system is uncommon. We describe a patient with an isolated cerebral metastasis who had previously undergone resection of a Grade III, Stage B2 carcinoma of the bladder. We have been able to find only one previous case report of a solitary intracerebral metastasis from transitional cell carcinoma of the bladder without evidence of primary recurrence or additional sites of spread. Central nervous system metastasis from bladder carcinoma must be considered in the differential diagnosis of solitary intracerebral lesions.
Vancomycin Penetration of a Brain Abscess: Case Report and Review of the Literature
Authors: Levy Robert M. , Gutin Philip H. , Baskin David S. , Pons Vincent G.
Published: May 2010

A 56-year-old man developed an abscess within a right parietal cystic anaplastic astrocytoma 3 days after removal of iodine-125 sources placed 9 days earlier for interstitial radiation therapy. After treatment with cephalosporin antibioties proved unsuccessful, the patient was treated with intravenous vancomycin and intermittent percutaneous drainage of the abscess. Vancomycin levels obtained from the brain abscess fluid, both before and during later operative removal of the abscess, were 15 and 18 μg/ml, respectively; the serum vancomycin level was 21 μg/ml. This is the first report of the excellent penetration of vancomycin into brain abscess fluid.
Fenestration of Intraventricular Cysts Using a Flexible, Steerable Endoscope and the Argon Laser
Authors: Powers Stephen K.
Published: May 2010

Two infants with hydrocephalus and compartmentalization of the lateral ventricles due to cerebrospinal fluid infection were treated by fenestration of the ventricular cysts using the argon laser through a steerable flexible endoscope. Both children had undergone failed multiple shunting procedures that attempted to drain the lateral ventricular cysts. One child had chronic granulomatous disease and persistent Candida ventriculitis and meningitis. His infection resolved after removal of multiple shunt systems was made possible by endoscopic laser fenestration to convert a multilocular to a unilocular hydrocephalus. Postoperative computed tomographic scans and head circumference measurements showed arrested hydrocephalus in both cases, and both children remain symptom-free 6 months after operation. The argon laser was used to coagulate and incise the ventricular septae in both cases. The steerable flexible endoscope enabled excellent visualization of the ventricular system without manipulation of the endoscope at the corticotomy site. Necessary improvements in the design of the flexible endoscope and the delivery system for the argon laser are discussed.