Transcranial Doppler and cerebral tomodensitometry scan in the predictivity of intracranial hypertension

To compare transcranial Doppler ultrasonography [TCD] and cerebral tomodensitometry [CT], in the predictivity of intracranial hypertension [ICH]. Sixteen patients, with a median age of 47 years, under continuous monitoring of intracranial pressure [ICP] were included in a double blinded prospective study. Each time a CT was performed the left and right middle cerebral arteries were insonated. With TCD, ICH is noted if the worst mean blood flow diastolic velocity was less than 25 cm/s, associated with a pulsatility index value larger than 1.2. Cerebral tomodensitometry was analysed and the ICH noted if one or more of the following radiographic signs was present [disappearance of sulci, effacement of ventricles, reduction of the white-grey matter differentiation, basal cistern compression, hydrocephalus and midline shift higher to 5 mm]. The median initial Glasgow Coma Score was 8 +/- 3. Intracranial pressure monitoring was undertaken in the following situations: 10 severe head injury, 4 strokes and 2 cerebral tumours. A total of 30 CT were carried out. Fourteen patients presented at least one episode of ICH. During episodes of ICH, TCD correlated with ICP in 64% of the cases, whereas CT correlated with ICP in 68% of the cases. In the absence of ICH the correlation of TCD and ICP decreased to 37.5%. In 4 cases of ICH, data of CT were not in favour of ICH while TCD correlated with ICP. Associating TCD and CT allows to detect ICH in 86% of cases vs. 68% only with CT [p=0.15] and vs. 64% only with TCD [p=0.08]. Transcranial Doppler ultrasonogrpahy is equivalent to CT in the predictivity of an ICH. This predictability is better in cases of ICH [ICP > 20 mmHg]. Associating TCD to CT allows to recover the majority of the cases of ICH not detected by CT alone

Surgical management of symptomatic suprasellar arachnoid cysts

The true incidence of intracranial arachnoid cysts is unknown because many may be asymptomatic throughout life. However, with the advent of CT and MRI the frequency of the diagnosis of arachnoid cyst has significantly increased. In adults they represent 9% of all the arachnoid cysts while in paediatric population this percentage reaches 15%.The various surgical options for treating suprasellar arachnoid cysts [SSAC] include craniotomy with fenestration or marsupialization of the cyst, cystoperitoneal shunt and percutaneous ventriculocysto-cisternostomy. Ten patients with SSAC were operated on in our institution since 1992. The aim of our work consists of describing the clinical manifestations, the radiological features and the different surgical methods to treat SSAC. The patients ranged in age from one month to 33 years [mean age = 8 yrs]. The signs and symptoms are referable to the size of the cyst. All patients with SSAC underwent preoperative CT, cisternography or MRI. In 7 patients, marsupialization of the cyst was performed; in 5 patients, a cystoperitoneal shunt was placed and ventricuhocysto-cisternostomy performed in only 2 patients. Five patients were operated more than one time undergoing two different methods of surgery

Hypothalamic hamartoma causing precocious puberty treated by surgery

Hypothalamic hamartomas are benign turnouts that are often associated with central precocious puberty. Resection of hypothalamic hamartoma has been recommended as a treatment option for selected cases of pedenculated lesions, especially in young children. We report a case of a four-year-old boy whose onset of puberty began at approximately 10-months of age when his parents noticed incipient pubic hair and a husky voice. Magnetic resonance imaging demonstrated a pedenculated isodense mass below the tuber cinereum associated with a pituitary microadenoma. The hamartoma was totally removed microsurgically. Postoperatively, the signs and symptoms of precocious puberty began to disappear. Clinical presentation, mechanism and treatment of precocious puberty caused by hypothalamic hamartoma are fully discussed

Acute traumatic central cord syndrome

Central cord syndrome [CCS] is a frequently incomplete cervical spinal cord injury. It is characterised by a disproportionately greater motor deficit of the upper than lower extremities, with varying degrees of sensory loss below the level of the lesion and bladder dysfunction. The purpose of this paper is to describe in detail the clinical and radiological characteristics, evaluate prognosis of patients with CCS after follow-up and discuss the most probable pathophysiological mechanisms. The authors evaluated five patients [mean age 62.8 years] who sustained CCS after cervical spinal trauma. Falls were the most common aetiology followed by motor vehicle accidents. Mean total ASIA motor score on admission was 68.4 +/- 13.93, mean admission upper and lower motor score were 26.8 k 10.85 and 41.6 +/- 7.08 respectively. The admission total motor score was significantly different from 3 months [p < 0.05] and 2 years [p 0.001] follow-up total motor scores. There was an improvement of motor and bladder function at 3 months after the injury. All patients had spondylosis and cervical canal stenosis with obliteration of the anterior subarachnoid space over multiple levels identified on magnetic resonance imaging [MRI]. TI-weighted MRI showed no areas of high signal corresponding to subacute haemorrhage. Instead, high signal was seen in all patients on T2-weighted MRI that was interpreted as focal oedema. Lamirgxtorny, generally from C3-C6 without facetectomy and fixation, was performed in three patients. The general outcome of patients was good, despite the fact that complications such as chronic pain and hyperpathia are common

Arachnoid cyst mimicking intramedullary spinal cord tumour

Arachnoid cysts are intra-arachnoid collections of cerebrospinal fluid [CSF] that produce neurologic symptoms either by compressing adjacent neural tissue or by obstructing CSF flow. This is a case of symptomatic arachnoid cyst at C5-C6 level in a 20-year-old man with intradural tumours suspected as neuroenteric cyst, epidermoid cyst or low grade glioma. The past medical history of this patient was non-contributory. There was no cervical spine trauma and no causative factors of arachnoiditis. The cyst was widely fenestrated and postoperatively the patient experienced progressive improvement of weakness, numbness and sensory deficits. The authors report this case and discuss the rarity of such a lesion, the mechanism of formation, clinical significance and radiological features

[Orbital eosinophil granuloma. case report and review of the literature]

Eosinophyl granuloma is a rare tumor affecting mainly children, involving the vault more frequently than the skull base. Treatment is mainly surgical, adjuvant therapies can be used only in special cases. The report is about a case of a 8-year-old girl presented with a right frontal mass and a non-significant exophthalmia; neuroradilogicaI investigations showed a non-painful front lateral mass with bone erosion in regard. Surgery revealed an invasive tumor for the temporal bone and muscles. Histological, epidemiological and radiological features are discussed in the study