bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intradural Hemangiopericytoma of the Lumbar Spine: Case Report
Authors: Betchen Simone , Schwartz Amit , Black Candice , Post Kalmon 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Hemangiopericytoma is a rare tumor of the central nervous system, most often found supratentorially. Thirty-nine cases within the spinal column, of which five were intradural, have been reported. To date, no magnetic resonance imaging descriptions of intradural hemangiopericytomas have been published. This article is the first report of an intradural hemangiopericytoma of the lumbar spine and the first magnetic resonance imaging description of such a lesion.

CLINICAL PRESENTATION:
A 31-year-old man presented with progressive bilateral leg paresthesia and increased lower extremity cramping and fatigue during a period of several months. This progressed to urinary urgency, frequency, and sexual dysfunction. A neurological examination revealed no motor or sensory deficits. Gadolinium-enhanced magnetic resonance imaging of the lumbar spine revealed a centrally located intradural mass posterior to the L4 vertebral body.

TECHNIQUE:
The patient underwent a laminectomy of L4 and partial laminectomy of L3 with complete en bloc resection of the tumor. A discrete, intradural, red-appearing lesion was found and resected en bloc. Pathological findings were consistent with hemangiopericytoma.

CONCLUSION:
Intradural hemangiopericytomas, although rare, cannot be differentiated from other, more benign tumors. Spinal hemangiopericytomas ideally should be resected en bloc to reduce operative blood loss and potentially increase disease-free survival time. Despite total surgical resection of these benign-seeming lesions, the high recurrence rate mandates close follow-up and consideration of adjuvant therapy.
There Is No Transmantle Pressure Gradient in Communicating or Noncommunicating Hydrocephalus
Authors: Stephensen Hannes , Tisell Magnus , Wikkelsö Carsten 
Published: July 2004

AbstractOBJECTIVE:To examine whether a transmantle pressure gradient exists in adult patients with communicating and noncommunicating hydrocephalus.METHODS:Ten patients participated in the study. The mean patient age was 57 ± 18 years (range, 20–80 yr); seven patients had communicating hydrocephalus, and three had noncommunicating hydrocephalus. Microsensors were used to measure the intracranial pressure (ICP), for 17 to 24 hours during sleeping and waking periods, in the right lateral ventricle (ICPIV) and in the subarachnoid space (ICPSAS) over the right cerebral convexity simultaneously. Patient activities and body positions were documented. The hydrostatic pressure difference between the two sensors was calculated from cranial x-rays for four basic body positions and compared with the actual body positions of the patients and the measured difference between the two sensors. For three 10-minute periods, the exact transmantle pressure gradient was calculated for each patient as ICPIV − ICPSAS, adjusted for the hydrostatic pressure difference.RESULTS:The measured pressure difference between the two sensors was always within the limits of the maximal possible hydrostatic pressure difference, and it correlated well with the expected difference for the various body positions: mean correlation coefficient, 0.79 ± 0.10 (range, 0.65–0.92). The exact mean transmantle pressure was −0.01 ± 0.24 mm Hg (range, −0.4 to 0.4 mm Hg). ICP waves caused by cardiac pulse, respiration, and B waves were identical in both spaces.CONCLUSION:This study demonstrates no factual support for existence of a transmantle pressure gradient in nonacute communicating or noncommunicating hydrocephalus.
Surgical Resection of Grade II Astrocytomas in the Superior Frontal Gyrus
Authors: Peraud Aurelia , Meschede Magnus , Eisner Wilhelm , Ilmberger Josef , Reulen Hans-Jürgen 
Published: July 2004

AbstractOBJECTIVE:Surgery in the superior frontal gyrus partially involving the supplementary motor area (SMA) may be followed by contralateral transient weakness and aphasia initially indistinguishable from damage to the primary motor cortex. However, recovery is different, and SMA deficits may resolve completely within days to weeks. No study has assessed the distinct postoperative deficits after tumor resection in the SMA on a homogeneous patient group.METHODS:Twenty-four patients with World Health Organization Grade II astrocytomas in the superior frontal gyrus consecutively treated by surgery were studied. Degree and duration of postoperative deficits were evaluated according to tumor location and boundaries via magnetic resonance imaging scans, intraoperative neuromonitoring results, and extent of tumor resection.RESULTS:Postoperatively, motor deficits were evident in 21 of 24 and speech deficits in 9 of 12 patients. Motor function quickly recovered in 11 and speech function in 3 patients. None of the 12 patients in whom the posterior tumor resection line was at a distance of more than 0.5 cm from the precentral sulcus experienced persistent motor deficits. Eight of these patients developed typical SMA syndrome with transient initiation difficulties. Seven of 12 patients in whom the tumor extended to the precentral sulcus still had motor deficits at the 12-month follow-up assessment.CONCLUSION:Surgery for Grade II gliomas in the superior frontal gyrus is more likely to result in permanent morbidity when the resection is performed at a distance of less than 0.5 cm from the precentral gyrus or positive stimulation points. Therefore, cortical mapping of motor and speech function, in critical cases under local anesthesia with the patient as his or her own monitor, is recommended; resection should be tailored to obtain good functional outcome and maintain quality of life.
Detection of Microemboli by Transcranial Doppler Ultrasonography in Aneurysmal Subarachnoid Hemorrhage
Authors: Romano Jose G. , Forteza Alejandro M. , Concha Mauricio , Koch Sebastian , Heros Roberto C. , Morcos Jacques J. , Babikian Viken L. 
Published: July 2004

Abstract

OBJECTIVE:
To determine the frequency and characteristics of microembolic signals (MES) in subarachnoid hemorrhage (SAH).

METHODS:
Twenty-three patients with aneurysmal SAH were monitored with transcranial Doppler ultrasonography for the presence of MES and vasospasm. Each middle cerebral artery was monitored for 30 minutes three times each week. Patients were excluded if they had traumatic SAH or cardiac or arterial sources of emboli. Monitoring was initiated 6.3 days (1–16 d) after SAH and lasted 6.6 days (1–13 d). Eleven individuals without SAH or other cerebrovascular diseases who were treated in the same unit served as control subjects. Each patient underwent monitoring of both middle cerebral arteries a mean of three times; therefore, 46 vessels were studied (a total of 138 observations). Control subjects underwent assessment of each middle cerebral artery once, for a total of 22 control vessels.

RESULTS:
MES were detected for 16 of 23 patients (70%) and 44 of 138 patient vessels (32%) monitored, compared with 2 of 11 control subjects (18%) and 2 of 22 control vessels (9%) (P &lt; 0.05). MES were observed for 83% of patients with clinical vasospasm and 54% of those without clinical vasospasm. Ultrasonographic vasospasm was observed for 71 of 138 vessels monitored; MES were observed for 28% of vessels with vasospasm and 36% of those without vasospasm. Aneurysms proximal to the monitored artery were identified in 38 of 138 vessels, of which 34% exhibited MES, which is similar to the frequency for vessels without proximal aneurysms (31%). Coiled, clipped, and unsecured aneurysms exhibited similar frequencies of MES.

CONCLUSION:
MES were common in SAH, occurring in 70% of cases of SAH and one-third of all vessels monitored. Although MES were more frequent among patients with clinical vasospasm, this difference did not reach statistical significance. We were unable to demonstrate a relationship between ultrasonographic vasospasm and MES, and the presence of a proximal secured or unsecured aneurysm did not alter the chance of detection of MES. Further studies are required to determine the origin and clinical relevance of MES in SAH.
Fatal Subarachnoid Hemorrhage, with Brainstem and Cerebellar Infarction, Caused by Aspergillus Infection after Cerebral Aneurysm Surgery: Case Report
Authors: Endo Toshiki , Tominaga Teiji , Konno Hidehiko , Yoshimoto Takashi 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Intracranial aspergillosis has been reported to cause subarachnoid hemorrhage (SAH) attributable to ruptured mycotic aneurysms. We describe a case of Aspergillus arteritis that caused SAH without aneurysm formation, followed by successive brainstem and cerebellar infarction.

CLINICAL PRESENTATION:
A 50-year-old woman experienced a sudden onset of headache. Computed tomography demonstrated SAH. After angiography revealed an aneurysm of the anterior communicating artery, a complete neck-clipping operation was performed, without neurological deterioration. However, the patient experienced another episode of SAH on the 26th postoperative day.

INTERVENTION:
We repeated the craniotomy and confirmed that the clip was still intact. A second angiographic evaluation did not reveal an aneurysm or any other cause of hemorrhage. On the 30th postoperative day, magnetic resonance imaging demonstrated cerebellar infarction in the territory of the anteroinferior cerebellar artery. The patient died on the 40th postoperative day, after another episode of SAH and progressive cerebellar and brainstem infarction. The postmortem examination revealed destruction of the basilar artery and occlusion of the basilar and vertebral arteries attributable to Aspergillus arteritis.

CONCLUSION:
When a patient presents with SAH of unknown origin followed by cerebral infarction, Aspergillus arteritis should be included in the differential diagnosis. Earlier recognition of this fungal infection improves the prognosis.
Endothelial Cell Activation after Subarachnoid Hemorrhage
Authors: Frijns Catharina J.M. , Rinkel Gabriël J.E. , Castigliego Domenico , van Gijn Jan , Sixma Jan J. , Fijnheer Rob 
Published: July 2004

Abstract

OBJECTIVE
Evidence from animal experiments suggests that endothelial cell activation plays a pathogenetic role in the development of cerebral ischemia after subarachnoid hemorrhage (SAH). We measured plasma concentrations of two markers of endothelial cell activation, i.e., ED1-fibronectin (ED1-fn) and von Willebrand factor (vWf), among patients with aneurysmal SAH. We analyzed the relationships of concentrations to initial clinical conditions, treatment modalities, and the occurrence of delayed cerebral ischemia.

METHODS
We collected 123 blood samples from 27 patients with aneurysmal SAH. Aneurysms were treated surgically in 19 cases, were treated endovascularly in 7 cases, and remained untreated in 1 case. Twelve patients developed symptomatic delayed cerebral ischemia.

RESULTS
Initial concentrations of ED1-fn (4.3 ± 3.7 μg/ml) and vWf (17.8 ± 8.2 μg/ml) were higher than the reference values (ED1-fn, 1.7 ± 0.9 μg/ml, P &lt; 0.001; vWf, 11.5 ± 5.2 μg/ml, P = 0.003). Concentrations were higher among patients in poor clinical condition at admission, compared with patients in good clinical condition (mean difference, ED1-fn, 5.7 μg/ml, P = 0.04; vWf, 10.4 μg/ml, P = 0.02). Levels of both markers increased significantly after surgery (mean increase, ED1-fn, 7.5 μg/ml, P = 0.01; vWf, 13.2 μg/ml, P = 0.05) and after ischemic episodes (mean increase, ED1-fn, 8.3 μg/ml, P = 0.02; vWf, 5.0 μg/ml, P = 0.04).

CONCLUSION
Plasma concentrations of markers of endothelial cell activation were increased early after SAH and were significantly associated with the clinical condition at admission. We also observed a significant increase in concentrations after surgery and after ischemic episodes. Whether endothelial cell activation is a causal or indirectly related factor in the pathogenesis of delayed cerebral ischemia after SAH is still uncertain.
The Diagonal Ventricular Dimension: A Method for Predicting Shunt Malfunction on the Basis of Changes in Ventricular Size
Authors: Mesiwala Ali H. , Avellino Anthony M. , Ellenbogen Richard G. 
Published: July 2004

AbstractOBJECTIVESerial computed tomographic and magnetic resonance imaging studies are critical in the evaluation of patients who present with symptoms and signs of recurrent hydrocephalus or possible ventricular shunt malfunction. Subtle changes in ventricular volume or complex variations in ventricular anatomy often make subjective assessment of changes in ventricular size difficult, and no previously described method relates these changes to intracranial pressure or shunt system function. The purpose of this study was to develop an objective, reproducible, simple linear method of detecting changes in ventricular size that provides an accurate reflection of shunt function on the basis of serial imaging studies.METHODSWe developed a simple, linear estimate of ventricular volume—the diagonal ventricular dimension—to objectively assess changes in ventricular size on serial computed tomographic scans and magnetic resonance imaging scans. Serial imaging studies for 14 patients ages 1.6 to 71 years who underwent evaluation for shunt malfunction were used in this study. The sensitivity and specificity of this method in predicting shunt malfunction was compared with other well-established linear estimates of ventricular size as well as with a radiologist's interpretation of the same studies. The “gold standard” for measuring the status of ventricular shunt system function in this study was the measurement of intracranial pressure via shunt tap or surgical exploration results.RESULTSThe sensitivity (100%) and specificity (100%) of the diagonal ventricular dimension in detecting changes in ventricular size consistent with shunt malfunction was superior to that of any other linear estimate and to a radiologist's interpretation of the same films.CONCLUSIONThe diagonal ventricular dimension provides an objective, simple linear method of assessing changes in ventricular size that correlates well with shunt system function in the context of a collaborative examination.
Schwannoma Arising from the Tentorium at an Unusual Location: Case Report
Authors: Oikawa Akihiro , Takeda Naoto , Aoki Nobuhiko , Takizawa Touichiro , Sakoma Takaaki 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
We present a case of schwannoma attached to the tentorium.

CLINICAL PRESENTATION
A 41-year-old woman without evidence of neurofibromatosis presented with a 3-month history of headache, positional vertigo, and truncal ataxia. Magnetic resonance imaging revealed an extra-axial cystic mass lesion in the left anteromedial cerebellar region with a dural tail sign.

INTERVENTION
The tumor was removed completely by retrosigmoid craniotomy. Dense adhesion of the tumor to the inferior surface of the tentorium was confirmed during surgery. On light microscopic study, this neoplasm was composed of spindle cells and showed palisaded structures. Immunohistochemically, the tumor cells stained positive for S-100 protein and vimentin. Reticulin staining revealed a pericellular pattern of distribution of reticulin fibers. Electron microscopy confirmed the presence of a basement membrane encompassing the tumor cells. From these findings, the tumor was diagnosed as a schwannoma arising from the tentorium.

CONCLUSION
To our knowledge, this case report is the first to describe a schwannoma arising from the tentorium. Our case report indicates that schwannoma is a possible pathology in the differential diagnosis of dura-based tumors.
Acromegaly Caused by a Growth Hormone-releasing Hormone-secreting Carcinoid Tumor: Case Report
Authors: Altstadt Thomas J. , Azzarelli Biagio , Bevering Carl , Edmondson James , Nelson Paul B. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
We describe a patient with acromegaly and pituitary hyperplasia secondary to a growth hormone-releasing hormone-secreting gastrointestinal carcinoid tumor. This case report illustrates the importance of including this rare clinical syndrome in the differential diagnosis of acromegaly for patients with suspected or known neuroendocrine tumors.

CLINICAL PRESENTATION
A 19-year-old, Asian-American, male patient with a 2-year history of a nonresectable, metastatic, intestinal carcinoid tumor presented with complaints of headaches, arthralgias, sweats, and changing features. The examination revealed a young subject with acromegalic features, without visual field deficits. Magnetic resonance imaging revealed a diffuse sellar mass that extended suprasellarly to compress the optic chiasm. Endocrinological studies demonstrated a growth hormone level of more than 100 ng/ml and an inappropriately elevated growth hormone-releasing hormone level.

INTERVENTION
The patient underwent transsphenoidal resection of the pituitary mass for diagnostic and decompressive purposes. The pathological examination revealed pituitary hyperplasia, without evidence of an adenoma. Therapy with long-acting repeatable octreotide (Sandostatin LAR; Novartis AG, Basel, Switzerland) was initiated postoperatively, to further control the acromegaly and carcinoid tumor. The soft-tissue swelling resolved, and the patient remained free of headaches, arthralgias, and sweats at the 6-month follow-up examination.

CONCLUSION
Ectopic acromegaly is a rare syndrome that must be recognized by neurosurgeons because its treatment differs from that of classic pituitary acromegaly. We describe a patient for whom this syndrome was documented with magnetic resonance imaging, endocrinological testing, and pathological examinations.
Fourth Ventricle Central Neurocytoma: Case Report
Authors: Hsu Peng-Wei , Hsieh Tsung-Che , Chang Chen-Nen , Lin Tzu-Kang 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Central neurocytomas (CNs) are typically located in the lateral ventricle. Primary origins in the fourth ventricle are very rare. We discuss the clinical symptoms, imaging findings, and microscopic features of these rare tumors.

CLINICAL PRESENTATION
We report a case of a fourth ventricle CN in a 35-year-old male patient with the initial symptoms of progressive headaches and blurred vision for more than 2 months. Computed tomography and magnetic resonance imaging of the brain revealed a slightly enhanced tumor in the fourth ventricle, with obstructive hydrocephalus.

INTERVENTION
Total surgical removal of the tumor was performed. The tumor was initially diagnosed as an oligodendroglioma. The final definitive diagnosis as a CN was made after special immunohistochemical studies.

CONCLUSION
CNs located in the fourth ventricle are extremely rare. Immunohistochemical stains and transmission electron microscopy can provide useful diagnostic information. Total tumor excision is associated with favorable prognoses. Postoperative radiotherapy may be considered for cases of subtotal excision, anaplastic histological variants, or recurrent tumors.
A Craniocerebral Infectious Disease: Case Report on the Traces of Hippocrates
Authors: Viale Giuseppe L. , Deseri Sergio , Gennaro Sergio , Sehrbundt Elke 
Published: July 2004

Abstract
A MODERN CASE of complicated sinusitis, with osteitis of the cranium and intraorbital-intracranial empyema, closely corresponds to descriptions reported in the Hippocratic treatise Diseases II. The therapeutic measures suggested in that work can be regarded as suitable according to modern practice. An ancient physician who followed the Hippocratic doctrine probably would have been able to recognize this complicated disease and possibly save the patient.
Antiepileptic Effect of High-frequency Stimulation of the Subthalamic Nucleus (Corpus Luysi) in a Case of Medically Intractable Epilepsy Caused by Focal Dysplasia: A 30-month Follow-up: Technical Case Report
Authors: Benabid Alim Louis , Minotti Lorella , Koudsié Adnan , de Saint Martin Anne , Hirsch Edouard 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Currently, some forms of epilepsy are resistant to both pharmacological and surgical interventions. As a result, there is a need for new therapeutic strategies. Because the nigral system modulates neuronal excitability in animal models of epilepsy, we considered therapeutic high-frequency stimulation of the subthalamic nucleus (STN). We were encouraged by the known relationship between the STN and the nigral system, as well as by our experience with high-frequency stimulation of the STN in Parkinsonian patients.

CLINICAL PRESENTATION
A 5-year-old girl with pharmacologically resistant, inoperable epilepsy caused by focal centroparietal dysplasia underwent implantation with a permanent electrode in the left STN and was chronically stimulated. To date, we have followed up this patient for 30 months postoperatively.

TECHNIQUE
High-frequency stimulation of the STN induced a significant voltage-dependent reduction (by 80%) in the number and severity of seizures. In addition, consistent improvement in both motor and cognitive functions was noted as a result of reduced postictal states. The effect was more prominent for seizures occurring in clusters (89% reduction) and during the day (88% reduction) than for those that occurred during sleep (53% reduction).

CONCLUSION
This is the first report of epilepsy control using chronic high-frequency stimulation of the STN. Preliminary observations in three other operated patients (at 2, 12, and 18 mo) confirm these data. We think that high-frequency stimulation of the STN may hold significant future potential as a treatment for epilepsy, similar to its established role in the treatment of Parkinson's disease. This finding opens completely new experimental and therapeutic avenues for the treatment of surgically and medically intractable epilepsy.