ABSTRACT
Parkinson's disease affects over one million people in the United States. Although there have been remarkable advances in uncovering the pathogenesis of this disabling disorder, the etiology is speculative. Medical treatment and operative procedures provide symptomatic relief only. Compression of the cerebral peduncle of the midbrain by the posterior cerebral artery in a patient with Parkinson's Disease (Parkinson's Disease) was noted on magnetic resonance imaging (MRI) scan and at operation in a patient with trigeminal neuralgia. Following the vascular decompression of the trigeminal nerve, the midbrain was decompressed by mobilizing and repositioning the posterior cerebral artery The patient's Parkinson's signs disappeared over a 48-hour period. They returned 18 months later with contralateral peduncle compression. A blinded evaluation of MRI scans of Parkinson's patients and controls was performed. MRI scans in 20 Parkinson's patients and 20 age and sex matched controls were evaluated in blinded fashion looking for the presence and degree of arterial compression of the cerebral peduncle. The MRI study showed that 73.7 percent of Parkinson's Disease patients had visible arterial compression of the cerebral peduncle. This was seen in only 10 percent of control patients (two patients, one of whom subsequently developed Parkinson's Disease); thus 5 percent. Vascular compression of the cerebral peduncle by the posterior cerebral artery may be associated with Parkinson's Disease in some patients. Microva-scular decompression of that artery away from the peduncle may be considered for treatment of Parkinson's Disease in some patients.
ABSTRACT
Although the prognosis of acute disseminated encephalitis (ADEM) has generally been reported as favorable, in a small subset of patients, fulminant cerebral edema requiring critical care and surgical management may develop. This article presents a 56-year-old woman who developed ADEM and died of central brain herniation secondary to medically intractable cerebral edema. Following this experience, we encountered a 32-year-old man who also developed central brain herniation despite best medical management. We performed an urgent decompressive hemicraniectomy and frontal lobectomy followed by intensive intracranial pressure management. Few recommendations are available to guide neurologists and neurosurgeons in the management of medically intractable cerebral edema of ADEM. In this report, we present our experience with two severe cases of ADEM, review the pertinent literature, and discuss options for improved management of fulminant cases.
