Interhemispheric and bilateral chronic subdural hematoma.

Data on bilateral chronic subdural hematomas (CSHs) are scant, including information on the frequency of symptoms, response to various treatments, and postoperative complications, compared with data on unilateral CSH. Bilateral CSHs constitute a fair portion of CSHs, especially in patients older than 75 years and in those with coagulation abnormalities. The presenting symptoms are those of increased intracranial pressure and mass effect. Computed tomography of the head is the best study for the diagnosis and follow-up of bilateral CSHs, although magnetic resonance imaging is a more sensitive modality. Treatment of bilateral CSHs presents its own unique set of problems. New hemorrhage on the contralateral side and shift of midline structures are concerns and can be avoided by simultaneous bilateral decompression. Twist-drill craniostomy, burr-hole washout, and craniotomy are the mainstays of treatment, with subdural-peritoneal shunting reserved for intractable cases.

Intradural convexity chondroma: a case report and review of diagnostic features.

Intradural convexity chondromas are slow-growing tumors of young adults and children. Their symptoms are due to their size and degree of mass effect. They are extra-axial, avascular masses without peritumoral edema. CT and magnetic resonance resonance imaging of the head and cerebral angiography are helpful in diagnosis. Treatment is surgical resection.

FDG-PET in the staging work-up of patients with suspected intracranial metastatic tumors.

OBJECTIVE: To evaluate the role of positron emission tomography with 2-[18F] fluoro-2-deoxy-D-glucose (FDG-PET) in 31 patients with evidence of intracranial metastatic disease. MATERIALS AND METHODS: PET was used to evaluate the intracranial lesions for glucose hypermetabolism to suggest malignancy, mutiplicity of intracranial lesions, and extracranial foci or sources of disease. Patients with proven malignant intracranial lesions subsequently underwent further corroborative radiologic tests and histologic examination to confirm staging and primary location. RESULTS: PET identified focal hypermetabolic abnormalities in 19 of 22 intracranial metastases, 2 hypometabolic lesions, and 1 renal cell tumor embolism that hemorrhaged (hypometabolic lesion). It also identified 82% of extracranial primary tumor sites, of which 55% were found only on PET and not on conventional diagnostic tests. CONCLUSION: FDG-PET may prove valuable in the initial work-up of patients with suspected intracranial metastases.

The soluble granulocyte-macrophage colony-stimulating factor receptor's carboxyl-terminal domain mediates retention of the soluble receptor on the cell surface through interaction with the granulocyte-macrophage colony-stimulating factor receptor beta-subunit.

The hematopoietic cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) mediates its activity through binding to cell-surface receptors. The high-affinity GM-CSF receptor (GMR) consists of two transmembrane-anchored subunits: a ligand-specific, low-affinity subunit (GMRalpha); and a signal-transducing beta-subunit (GMRbeta). The human GMRalpha subunit also exists in a soluble isoform (SOLalpha) which antagonizes GM-CSF activity in vitro. Previous studies by us have shown that coexpression of SOLalpha and a mutated GMRbeta in BHK cells results in retention of SOLalpha on the cell surface and the formation of an intermediate affinity binding complex (Kd approximately 300 pM). This paper investigates the mechanism of the retention of SOLalpha on the cell surface. The data demonstrate that SOLalpha is anchored by a direct, ligand-independent interaction with GMRbeta which also occurs when SOLalpha is coexpressed with wild-type GMRbeta. However, SOLalpha and wild-type GMRbeta form a complex which binds GM-CSF with high affinity (Kd = 39 pM), indistinguishable from the binding characteristics of the TMalpha/GMRbeta complex. The experiments further reveal that the interaction between SOLalpha and GMRbeta is abrogated by removal of the unique 16 amino acid carboxyl-terminal domain of SOLalpha. Specific mutation of cysteine 323 in this carboxyl-domain to alanine also eliminates the cell-surface retention of SOLalpha identifying this residue as being necessary for the formation of the SOLalpha/GMRbeta complex.

Laparoscopic-assisted distal ventriculoperitoneal shunt placement.

BACKGROUND: Intraperitoneal adhesions, obesity, and distorted abdominal anatomy in shunt-dependent hydrocephalic patients are patient characteristics that increase distal ventriculoperitoneal (VP) shunt failure rates. The use of laparoscopic-aided placement of the distal VP catheter as a technique to decrease the failure rate is evaluated in these patients. METHOD: Thirteen hydrocephalus patients considered to either have intra-abdominal adhesions, be obese, or have distorted abdominal anatomy underwent laparoscopic-aided distal VP catheter placement or revision. Two had shunts placed for the first time and eleven had revisions. Eight patients had revisions performed by both the standard minilaparotomy and laparoscopic methods, but at different times. The average surgical times for both techniques were looked at for these eight patients. Case illustrations are presented. RESULTS: In patients who had both types of abdominal approaches, the average surgical time was 81 min for the laparoscopic-aided technique versus 116 min for the minilaparotomy procedure. The only complication related directly to the laparoscopic procedure was one wound infection. CONCLUSION: In patients with intra-abdominal adhesions, obesity, or distorted abdominal anatomy, laparoscopic-aided distal shunt insertion increases the success rate by its direct visual capability and the ability to lyse abdominal adhesions and position the distal end of the catheter in a desired place.

On the nature of Wisconsin Card Sorting Test performance in schizophrenia.

Performance on the Wisconsin Card Sorting Test (WCST) is widely reported to be impaired in patients with schizophrenia. It has been hypothesized that the performance deficit on the WCST in schizophrenia is related to a dysfunction of the frontal lobe, specifically the dorsolateral prefrontal cortex. This hypothesis was tested by comparing a group of patients with schizophrenia to patients with low grade right or left frontal lobe tumors and a group of patients with non-frontal high grade tumors. The results demonstrated a remarkable similarity in performance on the WCST between patients with schizophrenia and patients with right frontal lobe tumors. Patients with left frontal lobe tumors, non-frontal tumors, and normal control subjects did not show the same pattern of performance. This study provides support for frontal lobe dysfunction in the symptomatology of schizophrenia.

Glioma-stimulated chemoattraction of endothelial cells and fibroblasts in vitro: a model for the study of glioma-induced angiogenesis.

Induction of angiogenesis is essential for the continued growth of solid tumors, and one critical component of tumor-induced angiogenesis involves the stimulation of microvascular cells to migrate into the growing mass. We have developed a convenient model system utilizing dual co-culture chambers to study cellular chemotaxis induced by glioma cells in vitro. In this system, rat C6 glioma cells induced migration of fibroblasts and brain capillary endothelial cells. The migratory response was directly related to the number of C6 cells serving as stimulus in the lower chamber. Similar migratory responses were induced by C6 cell conditioned medium in a concentration dependent fashion. Medium conditioned by cultured human anaplastic astrocytoma cells was also found to contain potent chemotactic factor(s). This system may ultimately be employed in the identification of particular glioma cell population(s) and secreted factor(s) responsible for the chemoattraction of microvascular cells.

Treatment of high-dose intrathecal morphine overdose. Case report.

The case is reported of a 45-year-old woman who was being treated for chronic back and right leg pain with intrathecal morphine administered via a subcutaneous continuous-infusion device. She received an accidental 450-mg bolus injection of morphine intrathecally and developed hypertension, status epilepticus, intracerebral hemorrhage, and respiratory failure. Treatment with continuous intravenous naloxone infusion, lumbar catheter drainage of cerebrospinal fluid, and control of hypertension and status epilepticus resulted in an excellent outcome with return to neurological baseline. Care providers who refill pump reservoirs with morphine must be knowledgeable about these devices and the life-threatening consequences associated with errors in refilling them. This case describes the complications and successful treatment of high-dose intrathecal morphine overdose.

Localized hypertrophic mononeuropathy involving spinal roots and associated with sacral meningocele. Case report.

Hypertrophic nerve lesions displaying onion-bulb cellular formations are quite rare in the absence of a generalized hypertrophic neuropathy. The isolated peripheral nerve lesion has been termed "localized hypertrophic mononeuropathy" (LHN), and fewer than 30 cases of this condition have been reported. Very little is known regarding the etiology and the natural course of this rare disorder. A unique case of LHN afflicting spinal roots in association with a sacral meningocele is reported with a brief review of the relevant literature. The unique features of this case not only reveal a variable clinical presentation of the disease but also support the theory that LHN may be a localized reaction to nerve trauma or entrapment.

Delayed cerebral vasospasm after uncomplicated operation on an unruptured aneurysm: case report.

We present the case of a patient who developed significant vasospasm on the 9th postoperative day after the uneventful clipping of an unruptured asymptomatic berry aneurysm. We discuss the literature and potential mechanisms for vasospasm in the absence of subarachnoid hemorrhage.