Brain Computerized Tomographic Findings in Various Epilepic Children

Epilepsy is, in some occassions, manifested as one of the symptoms complex of central nervous system diseases, as well as systemic diseases such as metabolic disorders. In 1976, Bachman reported that 33% of epileptic patients manifested abnormal lesions in their computerized tomographic findings. 1005 epileptic children with various types of seizures have been investigated to detect the possible causes of epilepsies. 32% of the patients had abnormal brain C-T findings, of these patients, infantile spasm was the most frequently manifested abnormal C-T finding, rating 52.9%; simple partial seizure, 37.7%; complex partial seizure, 36.1% and generalized seizure, 27.1%, in order of frequency. Curable lesions, such as tumor, granuloma and arachnoid cyst were detected by brain C-T scan, and a brain tumor was detected in 2% of the patients. The brain C-T scan is one of the most effective diagnostic tools to evaluate the underlying lesions of the central nervous system of epileptic children.

The Pre-operative Assesment for Shunt Surgery in Normal Pressure Hydrocephalus

Normal pressure hydrocephalus(NPH) is defined as a combination of dementia, gait disturbance and/or urinary incontinence, hydrocephalus on C-T scan, with a normal intracranial pressure. The clinical effect of CSF shunting in patients with this syndrome is sometimes striking but generally only 50-60% of the shunted patients benefit from the treatment. So many pre-operative investigations are performed including clinical examination, computed tomography, R-I cistrnography, T1/2 calculated from ventricular volume pressure curve and lumbar drainage. Among the pre-operative investigations, the effect of preoperative lumbar drainage was the most reliable indicator of NPH. The possible mechanisms of improved case are proposed. The differential diagnosis of primary brain atrophy and NPH can be made by the effect of pre-operative lumbar drainage.

Clinical Analysis of Surgical Treatment of Postmeningitic Hydrocephalus

To evaluate the surgical results, the author made a clinical analysis on 70 patients of postmeningitic hydrocephalus who had been treated surgically. And the results were summarized as follows. 1) The tuberculous meningitis was the most common type causing the postmeningitic hydrocephalus(72.9%). 2) Among 70 patients, 51 were male and 19 were female. About 40% of cases were under 5 years old. 3) The most common clinical symptom was vomiting(67%). Headache, fever and generalized seizure were symptoms in order of frequency. Neurological sings represented neck stiffness, cranial nerve palsy and motor weakness. 4) The most common clinical condition on admission was stage 3 (advanced cases with unconciousness and severe neurological deficits). 5) The spinal fluid analysis showed more abnormal findings comparing to the ventricular fluid. But ventricular pressure was higher than spinal fluid pressure. 6) Plain skull x-rays, carotid angiograms were useful diagnostic methods but CT brain scan was though to be the most accurate, noninvasive method which showed size of ventricle and effectiveness of shunting procedures with Evans'ratio. In enhanced CT brain scans, the basal cistern enhancement was the most common finding beside ventricular enlargement (64.1%). 7) Ventriculoperitoneal shunting was the most common procedure in this series. 8) The initial revision rate was 12/70(19%) and the most of the revision was performed within 6 months after the initial shunting. 9) The revision rate in relation to shunting system and cerebrospinal fluid finding was not statistically significant. 10) The most common cause of the shunt malfuntion was obstruction of the ventricular catheter. 11) Forty one patients(58.6%) showed favorable outcome. The motality rate was 14/70(20%) and they were all belong to the stage 3. About half of the patients in stage 2 and stage 3 showed dramatic improvement after early shunting procedures. So the timing of operation was the most important factor influencing their outcome.

Intracranial Cysticercosis: A Report of 6 Cases

Cysticercosis infestation is a cosmopolitan disease. Recently we experienced six cases of intracranial cysticercosis in childhood, three of them were male and their age distributed from 2 to 15 years. Their main clinical manifestations were symptoms of increased intracranial pressure signs and other neurological sings as well, In diagnostic procedures, brain C-T scan was performed in all cases and Conray ventriculography was very helpful in cases of intra-ventricular location of cysticerci. By surgical exploration, single cysticerci were removed from 4 th ventricle in five cases, and cysticercus racemosus was found in subdural space in one cases. Five cases were successfully cured and one case was died of persistent brain swelling after surgical manipulation.