Multiple gliomas: a case review.

BACKGROUND: Multiple gliomas, although a rare finding, can present with a clinical and radiological picture similar to that of metastatic disease, abscesses, lymphoma and demyelination. CASE REPORT: We report a rare case of multiple gliomas located in the left cerebral hemisphere, with a complex presentation emulating other possible differential diagnoses. CONCLUSION: Multiple gliomas should be taken into consideration as part of the differential diagnosis of multiple parenchymal brain lesions. Certain imaging modalities and findings can be extremely valuable with obtaining a diagnosis, and the subsequent formulation of a therapeutic strategy.

Pattern of head injuries in Malta (EU): a small Mediterranean island.

We have reviewed all acute neurosurgical admissions between December 2007 and December 2009. Hundred and nine (46.6%) of our admissions were head injuries. A subdural haematoma(SDH) was found in 51.4%(56) of the head injuries. Of these, 50/56 presented with a Glasgow Coma Scale(GCS) of 14 to 15, 41.1% (23) of these SDH needed surgery. The commonest mode of injury was falls [67.9%(74) of head injuries]. Risk factors for falls are co-morbidities which are particular to an elderly population, these include osteoarthritis and audio/ visual impairment. Falls are more common in rural areas where elderly are more likely to feel comfortable to walk and sustain trivial falls resulting in chronic subdural heamatomas.

Current surgical treatment of Parkinson`s disease.

There has been a renaissance in the surgical management of Parkinson`s disease. This has been due to long-term effects of levodopa and a better understanding of the basal ganglia and its circuitry. Ablative surgery and neurostimulation are the only realistic surgical options at present. Although surgical treatments, such as ablation and stimulation are effective, they are not useful for stopping the progression or restoring the system. Neural transplantation helps restore the system by using a number of techniques. Targets mostly used are in the thalamus, globus pallidus and subthalamic nucleus. A number of factors must be considered including patient`s age, disability and his wishes. Globus pallidus stimulation might be preferable for patients who suffer from dyskinesia as a major source of disability. Pallidotomy might be appropriate in cases where frequent stimulator adjustments are impractical. Subthalamic nucleus stimulation is more suitable for patients with significant off periods and in younger patients in whom it may be desirable to maintain intact circuitry. Fetal neural transplantation, stem cell transplantation, xenotransplantation, adrenal medullary transplantation and transplantation of genetically engineered cells are at various stages of development and research. Ethical issues surrounding these process are likely to arouse strong emotions and have to be carefully considered.

Current surgical treatment of Parkinson's disease.

There has been a renaissance in the surgical management of Parkinson's disease. This has been due to long-term effects of levodopa and a better understanding of the basal ganglia and its circuitry. Ablative surgery and neurostimulation are the only realistic surgical options at present. Although surgical treatments, such as ablation and stimulation are effective, they are not useful for stopping the progression or restoring the system. Neural transplantation helps restore the system by using a number of techniques. Targets mostly used are in the thalamus, globus pallidus and subthalamic nucleus. A number of factors must be considered including patient's age, disability and his wishes. Globus pallidus stimulation might be preferable for patients who suffer from dyskinesia as a major source of disability. Pallidotomy might be appropriate in cases where frequent stimulator adjustments are impractical. Subthalamic nucleus stimulation is more suitable for patients with significant off periods and in younger patients in whom it may be desirable to maintain intact circuitry. Fetal neural transplantation, stem cell transplantation, xenotransplantation, adrenal medullary transplantation and transplantation of genetically engineered cells are at various stages of development and research. Ethical issues surrounding these process are likely to arouse strong emotions and have to be carefully considered.