Management of pseudo tumor cerebri by frequent tapping VS lumboperitoneal shunt

Background: The syndrome known as pseudotumor cerebri [PTC] is generally thought of as a condition characterized by increased intracranial pressure [ICP] without evidence of dilated ventricles or a mass lesion by imaging, normal cerebrospinal fluid [CSF] content, and papilledema occurring in most cases in young, obese women without any clear explanation

Aim of the Work: to highlight the early diagnosis, causes of visual deterioration of idiopathic intracranial hypertension, its pathophysiology will be discussed. Special emphasis will be given for trends in management of this disease especially frequent tapping and lumboperitoneal shunt and comparing results of both techniques

Patients and Methods: This prospective and retrospective study was conducted on 20 patients of special criteria confirmed to have pseudotumor cerebri by clinical presentation, radiological findings, fundus and visual field examination

Results: The papilledema of PTC was identical with that in patients with other causes of increased ICP. In most of cases it was bilateral symmetrical, however it was asymmetric in 1% of cases. In the frequent tapping patients group, results showed improvement of all symptoms in about 80% of patients. And in 20% of patients there were persistent complaints especially headache and blurred vision. In the lumboperitoneal shunt group, 65% of Cases showed improvement of all symptoms while 35% of cases showed shunt failure and complications

Conclusion: Concerning the category of patients participated in this study, and particularly with whom medical measures were failing, consideration should be given to investigation of the cranial venous outflow tract with a view to some therapeutic intervention if appropriate

Intracranial fusiform aneurysm, report of 9 cases, a clinico-radiological study

In the present shdy 9 patients with the radiological diagnosis of intracranial fusiform aneurysms are included. All patients were subjected to [1] Full clinical examination [2] Studies for diabetes, lipid profile and serum lipid electrophoresis, ECG [3] CT scan or MRI examination of the brain [4] Conventional 4 vessel angiography or magnetic resonance angiography. All fusiform aneurysms were nicely visualized by CT scan, MRI and angiography. According to the existing parenchymal brain pathology, patients were classified into three main groups as follows. Group [1] patients with ischemic parenchymal changes that are probably not causally related to the existing fusiform aneurysms [33%], group [2] patients with ischemic parenchymal changes that could be causally related to the existing fusiform aneurysms [33%] and group [3] patients without any parenchymal brain changes other than brain stem indentation by the aneuryms. Correlation between the fusiform aneuryms, the clinical picture of the patients and the associated parenchymal brain changes will be presented and discussed. Full description of the radiological picture of these extremely uncommon aneurysms and how they are implicated in pathogenesis and in symptom formation will be made. Also the impact of these aneurysms on patient's management will be discussed

Brain stem gliomas, clinico radiological study: a classification system with "prognostic significance" is suggested

In the present study 21 patients with the clinico-radiological diagnosis of brain stem glioma are included [13 males and 8 females]. Patients were subjected to [1] Full clinical examination [2] MRI and/or CT scan of the brain with and without intravenous contrast enhancement. CT myelography was also done to patients presented with cervicomedullary gliomas. According to the duration of symptomatology before clinical presentation, the anatomical localization of the brain stem gliomas [diffuse versus focal, Cystic versus sold], the pattern of contrast enhancement [non, diffuse, ring or patchy enhancement], the pattern of response to radiotherapy and the overall prognosis during a one year follow up, patients were classified into five groups. Group [1] patients with diffuse brain stem gliomas and with a relatively better prognosis [10 patients, 47.5%], group [2] patients with diffuse brain stem gliomas and with a relatively worse prognosis [4 patients, 19%], group [3] patients with focal pontine or midbrain gliomas [4 patients, 19%], group [4] patients with cervicomedullary gliomas [2 patients, 9.5%] and group [5] a single patient [5%] with probable brain stem metastasis. The clinical and radiological findings in the various groups will presented and discussed. Lines of treatment, clone to each group, and the result of a one year follow up will also be presented and discussed

Role of parents in drug dependence

This study aimed to identify the parental patterns in the social development as perceived by children and its relation to the addictive behavior in a sample of 68 Egyptians [64 males and 4 females aged 17-24 years] with clinically drug abusers or dependents according to DSM IV criteria, frequently visiting four centers of addiction in Cairo and Giza in addition to a control group taken from similar age, sex, level of education, social and economic levels of non-addictive individuals. The study revealed that the families of dependent individuals deviated greatly from the general healthy patterns during the process of social development. It was noticed that the dependents were always relying on their families. The parents' rejection led to a natural reaction of rejection of the child. The father tended to have a more deviated pattern than mothers. Hesitancy is a pattern including the mind more than emotions; the father represents the former, while the mother represents the later. The child usually gets alone with his mother more than his father

Hepatic encephalopathy an approach using brainmapping and the quantitative pharmaco-EEG methology

In the present study 20 patients with stage II or stage III hepatic encephalopathy were examined by brainmapping and the quantitative pharmaco-EEG methodology. The spectral profile demonstrated in all patients was identical to the pharmaco-EEG profile of the Benzodiazepine [BNZ] receptor agonists [diazepam for example]. This spectral profile was instantanously normalised by injection of flumazenil [Anexate], which is a specific BNZ receptor antagonist. These findings indicate that functional increase in the GABA-ergic tone is the aetiopathogenic factor responsible for the clinical and etectrophysiological changes observed in hepatic enphalopthy and they also indicate that these functional increases in the GABA-ergic tone is mediated allosterically through pathological activation of the brain BNZ receptors probably by endogenous substances with diazepam-Like properties. The implication of these results on the management of hepatic encephalopathy will be discussed