Fourth ventricle neurocysticercosis: Rigid endoscopic management. Description of direct transcerebellar approach.

BACKGROUND: Endoscopy has gained a crucial role in high specialty neurosurgery during the last decades. At present, there are well-defined flexible neuroendoscopic procedures to treat ventricular and subarachnoid space pathologies. Neurocysticercosis is recognized as a common cause of neurologic disease in developing countries and the United States. Surgical intervention, especially cerebrospinal fluid diversion, is the key for management of hydrocephalus. In 2002, a consensus suggested that ventricular forms should be treated with endoscopy as the first option. CASE DESCRIPTION: Here, we present the case of a 51-year-old right-handed male, from Estado de México. Two days before admission he experienced holocraneal headache 7/10 on the visual analogue scale which was intermittent, with no response to any medication, sudden worsening of pain to 10/10, nausea, and vomit. On physical examination, he presented with 14 points in the Glasgow coma scale (M6, O4, V4), pupils were 3 mm, there was adequate light-reflex response, and bilateral papilledema. The cranial nerves did not have other pathological responses, extremities had adequate strength of 5/5, and normal reflexes (++/++) were noted. Neuroimaging studies showed dilatation of the four ventricles as well as a cystic lesion in the fourth ventricle. Surgical position was Concorde, and the approach through a suboccipital burr hole was planned preoperatively with craneometric points. A rigid Karl Storz Hopkins II® endoscope was inserted directly through the cerebellum and the cystic lesion was extracted entirely. CONCLUSION: This article presents a useful technique with low morbidity and mortality. Further investigation is needed, especially in our Mexico, where neuroendoscopical techniques are still in the development phase.

Esclerodermia lineal en coup de sabre. Manifestaciones neurológicas, imágenes y revisión / Linear scleroderma en coup de sabre. Neurological symptoms images and review

Introducción. La esclerodermia lineal en ‘golpe de sable’, mejor conocida como esclerodermia lineal en coup de sabre (ELCS), es una enfermedad rara de causa incierta, caracterizada por atrofia focal progresiva craneofacial y, en parte, es diferente al síndrome de Parry-Romberg (SPR). Casos clínicos. Comunicamos tres pacientes con ELCS (2 mujeres y 1 hombre, con un promedio de edad de 40 años). Las manifestaciones neurológicas principales fueron cefalea y crisis convulsivas. Los alteraciones radiológicas, aunque diversas, fueron todas ipsilaterales al ‘golpe de sable’. En una paciente sometida a biopsia se obtuvo evidencia histopatológica de gliosis e infiltrado inflamatorio mixto perivascular. Destacamos en otro paciente la afectación cerebrovascular, dado el hallazgo de un infarto cerebeloso antiguo subclínico y oclusión de la arteria cerebelosa superior en ausencia de otra posible causa. Conclusiones. La ELCS, cuando afecta al sistema nervioso central es heterogénea en su presentación clínica y radiológica. Los estudios de imagen durante el control clínico y los hallazgos histopatológicos apoyan un proceso inflamatorio focal que puede ser progresivo. La afectación arterial se debe probablemente a una vasculopatía inflamatoria no ateroesclerosa, oclusiva y crónica (AU)

Introduction. ‘Sword stroke’ linear scleroderma, which is better known as linear scleroderma en coup de sabre (LSCS), is a rare disease with an uncertain causation that is characterised by progressive craniofacial focal atrophy and is, at least in part, different from Parry-Romberg syndrome (PRS). Case reports. Here, we report on the cases of 3 patients with LSCS (2 females and 1 male, with a mean age of 40 years). The main neurological symptoms were headache and seizures. Although different alterations were observed in the X-ray images, they were all ipsilateral to the coup de sabre. Histopathological evidence for gliosis and mixed perivascular inflammatory infiltrate was found in the study of a biopsy specimen taken from one female. Cerebrovascular involvement was seen in another patient, as highlighted by the observation of an earlier subclinical cerebellar infarct and occlusion of the superior cerebellar artery in the absence of any other possible causation. Conclusions. When it affects the central nervous system, the clinical and radiological presentation of LSCS is heterogeneous. Both the imaging studies carried out during the clinical control and the histopathological findings suggest a focal inflammatory process that can be progressive. The arterial involvement is probably due to a non-atherosclerotic, occlusive and chronic inflammatory disease of the peripheral vessels (AU)

[Linear scleroderma en coup de sabre: neurological symptoms, images and review]. / Esclerodermia lineal en coup de sabre. Manifestaciones neurologicas, imagenes y revision

INTRODUCTION: 'Sword stroke' linear scleroderma, which is better known as linear scleroderma en coup de sabre (LSCS), is a rare disease with an uncertain causation that is characterised by progressive craniofacial focal atrophy and is, at least in part, different from Parry-Romberg syndrome (PRS). CASE REPORTS: Here, we report on the cases of 3 patients with LSCS (2 females and 1 male, with a mean age of 40 years). The main neurological symptoms were headache and seizures. Although different alterations were observed in the X-ray images, they were all ipsilateral to the coup de sabre. Histopathological evidence for gliosis and mixed perivascular inflammatory infiltrate was found in the study of a biopsy specimen taken from one female. Cerebrovascular involvement was seen in another patient, as highlighted by the observation of an earlier subclinical cerebellar infarct and occlusion of the superior cerebellar artery in the absence of any other possible causation. CONCLUSIONS: When it affects the central nervous system, the clinical and radiological presentation of LSCS is heterogeneous. Both the imaging studies carried out during the clinical control and the histopathological findings suggest a focal inflammatory process that can be progressive. The arterial involvement is probably due to a non-atherosclerotic, occlusive and chronic inflammatory disease of the peripheral vessels.

Serum testosterone:dihydrotestosterone ratio and CA 19-9 in the diagnosis of pancreatic cancer.

The testosterone:dihydrotestosterone ratio (T:DHT) and the antigenic marker CA 19-9 were studied in the serum of 21 male patients with pancreatic cancer and 62 controls with other gastrointestinal malignancies or benign pancreatobiliary disease. Specificity of the T:DHT ratio was 98%, significantly better than the specificity of CA 19-9 at both a 37 U/ml cutoff level (61%) and at 100 U/ml (79%). Sensitivity of the T:DHT ratio was 67%, and that of CA 19-9, 71% and 90% at the upper and lower cutoff levels, respectively. False-negative results of the T:DHT ratio were found predominantly in cases of advanced pancreatic cancer, whereas all four stage I patients had an abnormal (less than 5) T:DHT ratio. These results suggest that the T:DHT ratio is a useful marker for pancreatic cancer in males. It can be used alone or in combination with CA 19-9, and should be further evaluated in the differential diagnosis of patients with the early stages of this disease.

[Diagnostic usefulness of Ca 19-9 antigen in cancer of the pancreas and neoplasms of the pancreato-biliary intersection]. / Utilidad diagnóstica del antígeno CA 19-9 en cáncer de páncreas y neoplasias de la encrucijada pancreatobiliar.

Antigen CA 19-9 was measured in the serum of a group of 16 patients with pancreatic cancer, in 19 patients with non-pancreatic gastrointestinal malignancies, and in 19 others with benign pancreatobiliary disease. The test showed a high sensitivity with a low specificity and a positive predictive value for diagnosis of pancreatic cancer when confronted with a group of controls that included both benign and malignant gastrointestinal disease. The low specificity was due to high CA 19-9 values in other gastrointestinal cancers, especially in carcinoma of the ampulla and the biliary tract. When the latter were added to the group of patients with pancreatic cancer, and the diagnostic accuracy of the test was re-evaluated, sensitivity, specificity and both positive and negative predictive values increased. Values of CA 19-9 over 100 U/ml are highly predictive of malignancy in patients with pancreato-biliary disease.

Long-term hemodynamic effects of ketanserin, a 5-hydroxytryptamine blocker, in portal hypertensive patients.

Ketanserin, a 5-hydroxytryptamine-2 receptor blocker, has been shown to decrease portal pressure in recent acute hemodynamic studies that have been performed both in experimental animals and portal hypertensive patients. The present study was designed to investigate the effects of chronic oral administration of ketanserin in portal hypertensive patients with cirrhosis. The mean baseline hepatic venous pressure gradient in the 13 patients with alcoholic cirrhosis who completed the study was 15.7 +/- 2.7 mmHg. It decreased significantly to 13.3 +/- 2.0 mmHg (p less than 0.001) after ketanserin was administered at a mean dose of 51 mg per day for a mean period of 32 days. This 14.6% reduction in hepatic venous pressure gradient resulted mainly from a decrease in mean wedged hepatic venous pressure (from 22.2 +/- 4.0 to 20.1 +/- 3.6 mmHg) and was accompanied by significant decreases in cardiac index (18.8%) and in mean arterial pressure (8.1%). However, changes in cardiac index or in mean arterial pressure were not predictive of modifications in the hepatic venous pressure gradient. Eight of 16 patients entered in the study developed side effects, the most significant being a reversible portosystemic encephalopathy, which occurred in three patients who had poor liver function. This study confirms evidence in favor of a role for 5-hydroxytryptamine in portal hypertension and adds a new group of agents for the chronic treatment of portal hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)