Hydrocephalus

1. Any present day definition of hydrocephalus is very loose. The authors would rather adopt the concept that hydrocephalus is an abnormal condition characterized by excessive amount of cerebrospinal fluid with or without enlargement of the head2. The most common cause of hydrocephalus is arachnoiditis followed by congenital anomalies. A neoplasm is a rare cause3. The ideal surgical procedure is the placement of a ventriculoatrial shunt, using either Pudenz or Halter valves. Where these valves cannot be availed of the choice is between a conservative waiting with medical support and ventricular tapping from the older surgical shunting procedures, like ventriculo-peritoneal, chroroidoplexectomy, thecal-fimbia, subarachnoid-ureteral, and others. (Summary)

Trigeminal neuralgia: an evaluation

1. The etiology of trigeminal neuralgia is up to now unknown2. The clinical picture of the malady is characteristic. If there is an abnormal finding during the period of remission, the case is probably not a typical tic douloureux3. The management usually begins with the most conservative medical therapy, but the progressive nature of the disease eventually spells a radical surgical approach very often resulting in actual dissection and/or cutting of the trigeminal nerve4. Thirty four patients have been followed up for a period of 3 months to 5 years. Sodium dilantin almost aborted the disease among 5 patients, whereas 9 patients were more or less relieved by novocaine-alcohol injections. Twenty one patients underwent surgical intervention. All of them were immediately relieved of their facial pains. Three patients had recurrence on the 6th, 18th (peripheral avulsions) and 20th month (sub-temporal neurectomy) after the respective operations. (Summary)

A study of 114 cases of craniocerebral injuries

The number of cases herein presented is not reallly a big one, but there are points in this study which by way of induction are salient enough to constitute as guideposts whenever a case of cranio-cerebral injury is referred for treatment. They are the following: First, after a slight concussion an assurance can be given to the patient that his case will have no complication or sequelaeSecond, serial manometric and fundoscopic studies do not imply the presence of cerebral edema in case of severe concussion under our present laboratory facilitiesThird, for a linear fracture to occur, the symptoms that seemingly could be least expected are those of severe concussion. This is illustrated in this study when, combining the cases of purely linear fractures of the vault and the severed concussions, 19 cases resulted and 7 of these had linear skull fractures. It is always wise, therefore, to request for skull X-rays when there are symptoms manifesting a case more serious than slight cerebral concussionFourth, a serious development could be expected after cerebral contusion. In this study two of the 25 died. This is to be expected because edema always follows a contusion and cerebral edema can never spread beyond the confines of the unyielding calvarium. Beyond this, the edema may either subside by some therapeutic means or it may mean death to the patient. A peculiarity of this group is the attendant difficulty in its diagnosis, so much so that burr holes or a carotid arteriography must have to be made in some cases so that the diagnosis can be establishedFifth, basal fractures when multiple always spell a bad prognosis even under ideal management. The prognosis is worse when such injury is accompanied by other injuries located elsewhere in the bodySixth, an extradural hemorrhage always poses an imminent threat to a patient. This is the type of injury that very often eludes the physicians diagnostic acumen. When in doubt a burr hole must have to be made. A burr hole if performed by the initiated does not result in death. This discipline probably accounts for the comparatively low mortality in this series. The chances of life are approximately better than an 8 to 1 ratio if patients are operated on within the first 24 hours after injury. After the lapse of said period the prognosis will turn from bad to worseSeventh, fractures in the operable group seldom give any difficulty in diagnosis. The admitting house officer is again reminded to palpate the underlying skull if confronted with scalp lacerationEight, a foreign body inside the brain usually stirs one to immediately resort to surgical extraction. This is not superfluous as hematoma, edema and infection are common following this type of injury. (Summary)