Marchiafava Bignami Disease Potentially Complicating Normal Pressure Hydrocephalus

Marchiafava-Bignami disease (MBD) is a rare disorder of demyelination or necrosis of the corpus callosum. Mainly, MBD is associated with alcohol and malnutrition. We report a 60-year-old woman with no history of alcohol consumption or malnutrition who had MBD as a possible complication of normal pressure hydrocephalus (NPH). The patient presented with a 2-month history of progressive gait unsteadiness, urinary incontinence, and forgetfulness, for which the patient underwent ventriculoperitoneal shunt surgery with remarkable improvement. Magnetic resonance imaging (MRI) demonstrated hyperintensity in the body and splenium of corpus callosum when she was brought to the hospital again with rapid deterioration of her mental ststus. It might be postulated that cerebrospinal fluid (CSF) tumor necrosis factor-alpha (TNF-alpha) might have contributed to the development of MBD although not measured in this patient, given that TNF-alpha, as a proinflammatory cytokine mediating demyelinating process have been found in be increased in the CSF of NPH.

Medullary Hemorrhage after Ischemic Wallenberg's Syndrome in a Patient with Cavernous Angioma

BACKGROUND: The main complication of cerebral cavernous angioma is hemorrhage. Ischemic stroke as a complication of cerebral cavernous angioma has rarely been described, and hemorrhage after ischemic Wallenberg's syndrome has not been reported before. CASE REPORT: A 45-year-old woman presented with perioral numbness, hoarseness, dysphagia, and worsening of her previous sensory symptoms. The patient had been taking aspirin for 3 years after suffering from ischemic Wallenberg's syndrome with left paresthesia as a residual symptom. Brain computed tomography revealed an acute medullary hematoma in the previously infarcted area. Follow-up magnetic resonance imaging revealed a cavernous angioma in the right medulla. CONCLUSIONS: We presume that cerebral cavernous angioma was responsible for both the ischemia and the hemorrhage, and we also cautiously speculate that the aspirin contributed to the development of hemorrhage in the previously infarcted area.

Intraventricular Pefloxacine Therapy for a Cerebral Ventriculitis by Enterobacter Aerogenes: Case Report

No abstract available.

Expansile Suraplasty for Posttraumatic Syringiomyelia

No abstract available.

The Effect of Gamma Knife Surgery on Uveal Melanoma

The optimal management of uveal melanoma is still a matter of controversy. To determine the effect of Gamma Knife surgery on patients with uveal melanoma, the authors reviewed the outcome of five operations performed between September 1993 and August 1996. The mean age of the patients was 60.7(range 42 to 76) years; the median follow-up period was 10 months, and four patients were followed up for more than 6 months. The mean tumor volume was 3442mm3(mean diameter 15.3mm) and all patients were irradiated with a mean maximum dose of 74Gy (range 60-80Gy), using a 50% isodose on the tumor margin. In one patient, the tumor disappeared completely 32 months after Gamma Knife surgery; because the tumor did not regress, one patient subsequently required enucleation, and two remained stable. During a mean follow-up period of 10 months, vision was preserved in two patients, but one went blind; in one, enucleation was performed because the tumor did not regress. These results suggest that in cases of uveal melanoma Gamma Knife surgery can effectively control local tumors, can spare the eyeball, and may prevent loss of vision.

Effect of Radiosurgery on Symptomatic Epilepsy

It has been suggested that focused radiation generated and delivered by several means can reduce seizure frequency in idiopathic and lesional epilepsy. Stereotactic radiosurgery has become one of the most acceptable means of treating intracranial arteriovenous malformations or tumors, and has been found to have an effect on seizures serendipitously while being used for other indications. Between 1988 and 1996, 595 lesions of 490 patients with AVM or brain tumors were treated with radiosurgery(55 by Linear accelerator, 545 by Gamma Knife). Lesional epilepsy was accompanied in 73 patients before treatment. Among them, 24 cases had chronic repeated seizure(more than 4 times per 1 year over 1 year) and were on anticonvulsants before treatment, and were followed longer than 1 year. The lesion volume was 2.9-27.9cc(mean, 16.2+/-15.1cc). The estimated dose was 10-26.4Gy(mean, 15.9+/-4Gy) at the margin. Mean follow-up is 20 months(from 12 to 42.3). Epilepsy worsened transiently in 2 cases due to radiation induced imaging changes that were improved with steroid medication. Four cases were seizure-free after treatment. Six patients presented a reduction of seizure frequencies by more than 50%. Reduction of the lesion volume did not correlate with the reduction of seizures. However, the mean volume of preoperative lesions in improved cases(19.3+/-2.8cc) was larger than in unimproved cases(13.1(8.2cc) and it was the only statistically significant variable. It seems that radiosurgery employing a standard neuro-oncological dose can improve seizures and this effect is not related to the lesion volume reduction.

Gamma Knife Radisurgery of Lateral Ventricular Neoplasm

Surgical access to the lateral ventricle is always gained through sectioning the corpus callosum or cerebral cortex. Besides the destruction of normal tissue, total removal of a tumor is often difficult and potential complications may occur due to a narrow and deep surgical field. However, stereotactic radiosurgery has a number of advantages in treating lateral ventricular tumors. Thre are less critical structures around the lateral ventricle. The large proportion of the tumors is surrounded by CSF instead of normal brain tissue. Tumors in this location often are benign and well demarcated on MRI. Among 382 intracranial tumors which have undergone Gamma Knife radiosurgery between May 192 and April 1996, 13 tumors were in the lateral ventricle(neurocytoma 2, oligodendroglioma 1, giant cell astrocytoma 2, pilocytic astrocytoma 1, glioblastoma multiforme 1, meningioma 3, ependymoma 1, immature teratoma 1, undetermined 1). The marginal dose to the tumor ranged from 6.5 to 18 Gy, most often to the 50% isodose line . Eleven cases were followed-up for 3-42 months with imaging studies. Six tumors almost disappeared with remaining small vestiges 4.3-42 months after radiosurgery. Two had markedly shrunk. Three tumors including 2 meningiomas with short follow-up period(5.8, 5.9 months) had no changes in size. These results suggest that lateral ventricular tumors respond very well to radiosurgery while risky surgical procedures can be avoided.

Percutaneous radiofrequency Thermal Rhizotomy for Trigeminal Neuralgia

This study was performed to analyze the long-term results of percutaneous radiofrequency thermal rhizotomy for trigeminal neuralgia. The authors analyzed 193 cases with trigeminal neuralgia which underwent percutaneous radiofrequency thermal rhizotomy documented from March, 1973 to December, 1992. The patients(122 cases) were followed-up for average 6.1 years. Initial pain relief was obtained in 97.4% of the patients with percutaneous thermal rhizotomy. Recurrence of trigeminal pain after surgery was observed in 47 cases(38.5%) during the follow-up period. Surgical complications were as follows; masseter weakness in 7 patients, oculomotor palsy in 1 patient, weakness of the corneal reflex in 10 patients(1 of them requested ocular management) for keratitis, and anesthesia dorosa in 2 patients. These results suggest that percutoneous radiofrequency thermal rhizotomy is a useful therapeutic tool to relieve pain immediately an safely in trigeminal neuralgia.

MR Angiography in Hydranencephaly: Case Report

Hydranencephaly is a rare condition in which the cerebral hemispheres are replaced by membranous sacs containing cerebrospinal fluid. Major causes of hydranencephaly include occlusive diseases of the supraclinoid part of internal carotid artery. Magnetic resonance(MR) imaging and MR angiography are the most reliable diagnostic tools for examining the major cerebral arteries in hydranencephaly. We present the MRI and MRA findings in a case of hydranencephaly with a review of the literature.