Multiple intracranial cavernomas with focal amyloid deposition - diagnostic pitfalls.

We report a case of a patient with multiple, intracranial superficial calcified tumorous lesions with focal amyloid deposition. On the basis of the first neuronavigated needle biopsy, the tumors were originally assessed as amyloidomas. Additional data was obtained from a second biopsy and supplementary neuroimaging information and the tumors were diagnosed as of vascular origin, probably cavernomas. The report exemplifies how only one diagnostic tool may sometimes be misleading in establishing a final diagnosis. The additional imaging may thoroughly enhance, supplement and improve the diagnostic process.

Evaluation of functional response of cerebral arteries by a new morphometric technique.

The contractile response of the rabbit basilar artery under four conditions was determined: (1) response in a resting condition without exclusion of the sympathetic nervous system (control group I); (2) response in a resting condition with alpha-adrenoceptor blockade (group II); (3) response to subarachnoid haemorrhage (SAH) (group III); and (4) response to SAH with alpha-adrenoceptor blockade (group IV). It was also ascertained whether it was possible to measure contractile response using a new morphometric method. Vessels were prepared by intracardial perfusion fixation, stained by haematoxylin and eosin, and the length of the intimal corrugations were measured by computer image analysis. Two procedures were followed in order to express the intensity of intimal corrugation, indicating the contractibility of the basilar arteries: (1) the corrugation coefficient (CC) of the basilar artery intima was estimated by dividing the precisely measured length of the intimal corrugations by the length of the measured vessel wall section of the vessel cross-sections (obtained histologically); (2) the lumen reduction coefficient (LRC) of the basilar artery was determined by dividing the "ideal" luminal area (calculated from the total length of the intimal circumference) by the real luminal cross-section area. The results of CC measurements revealed the smoothest intima (mean CC = 1.146, P = 0.00) and the least reduction of lumen (mean LRC = 0.26, P = 0.000) in group II (rabbits without SAH but with alpha-blocker phenoxybenzamine), and in group IV (SAH group of rabbits with alpha-blocker phenoxybenzamine) where the mean CC was 1.141 (P = 0.001) and the mean LRC was 0.33 (P = 0.002) in comparison with the SAH-only group III, pointing out the effectiveness of alpha-blockade even against SAH vasospastic stimuli. Control group I (without SAH and without treatment) showed a greater degree of corrugation in the intima and an increased reduction in the lumina than in groups II and IV, but still significantly less than in group III (mean CC = 1.197, P = 0.001, and mean LRC = 0.40, P = 0.028), thus demonstrating a certain resting tone of the basilar arteries (in an ideal situation, without any tone at all, the CC and LRC would be equal one). The highest degree of intimal corrugation and the greatest lumina reduction were discovered in the SAH-only group III (mean CC = 1.374 and mean LRC = 0.60). The differences among groups I, II and IV were insignificant. The results of this study suggest four conclusions: (i) the possibility of evaluating the functional response of rabbit cerebral arteries using this new morphometric technique; (ii) the adrenergic influence on resting tone of these arteries; (iii) the likely preventive role of an alpha-blockade on post-SAH vasospasm of basilar arteries in rabbits; and (iv) good comparability of the results of CC and LRC measurements with the angiographically estimated vessel diameters of other similar studies.

Helical high-resolution volume-rendered 3-dimensional computer tomography angiography in the detection of intracranial aneurysms.

BACKGROUND AND PURPOSE: This study was carried out to determine whether high-resolution 3-dimensional prospective-volume-rendered computed tomographic (CT) angiography can replace conventional intra-arterial digital subtractional angiography in the diagnostic evaluation of patients with an acute subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm. METHODS: Both techniques were performed in 30 consecutive patients within 2 to 12 hours after their admission to the hospital. RESULTS: In this group of 30 patients, CT angiography with 3-dimensional volume-rendered reconstruction detected 31 aneurysms in 25 patients. Two aneurysms were missed on CT angiography. Conventional angiography detected 33 aneurysms in 27 patients. The authors considered angiograms in 3 patients presenting with SAH as normal. In all cases where an aneurysm was detected on CT angiography, the finding was confirmed by conventional angiography. CONCLUSIONS: CT angiography with 3-dimensional post-processing is a sensitive, noninvasive method that provides a 3-dimensional view of intracranial vessels and the aneurysm. It is also very useful in planning either surgical or endovascular treatment.

Presentation of a previously asymptomatic Chiari I malformation by a flexion injury to the neck.

Flexion injury and/or whiplash injury to the neck in car accidents are usually trivial injuries with no serious neurological deficits. Our intention was to point out the importance to proceed with diagnostic procedures if neurological deficits do occur in order to reveal the true cause of the deficit. The paper presents the case of a 35-year-old woman who sustained a flexion injury to the neck. A relatively trivial injury to the neck promoted a progressive neurological deterioration. The standard diagnostic procedures (x-ray, computed tomography scan) were normal. Further diagnostics with magnetic resonance imaging was required to reveal an underlying Chiari I malformation. Finally, the operative decompression of the craniocervical junction was performed. Following the surgical treatment, the patient's clinical symptoms regressed. One year after her discharge, she remains in good physical condition. To our knowledge, this case is the first report of the manifestation of Chiari I malformation in the adult as a result of a flexion or whiplash injury of the neck. This unusual case suggests that in a trivial flexion injury to the neck sustained in a car accident, which presents with serious neurological dysfunction, and where the standard diagnostic procedures are normal, the possibility of underlying congenital abnormality, such as Chiari I malformation should be considered.

Pneumocephalus secondary to a neck stab wound without neurologic injury in a 13-year-old girl.

Pneumocephalus is usually caused by injury that damages the brain meninges and thus allows air to enter the intracranial cavity. Our intention was to establish the importance of considering a stab wound in the neck as a possible cause of traumatic pneumocephalus. The paper presents the case of a 13-year-old girl who was accidentally stabbed in the neck with a kitchen knife by her brother. She had no neurological deficit but had developed headaches. An examination showed cerebrospinal fluid leaking from the neck wound and a CT scan revealed the pneumocephalus. Following surgical treatment, the patient's clinical symptoms regressed. To our knowledge, this case is the first report of the manifestation of pneumocephalus as the result of a neck stab wound in a child; overall, there are only three reported cases of pneumocephalus caused by a neck stab wound.

Long-term survival following treatment of multiple supra- and infratentorial aspergillus brain abscesses.

Aspergillus brain abscess is a rare but frequently fatal disease. Despite the scarcity of reported survivors, a combination of medication and surgical treatment might be effective. We report a 37-year-old man who developed multiple aspergillus brain abscesses after severe bacterial pneumonia. The following strategy was used to treat the patient: diagnostic puncture of one of the abscesses, long-term treatment with medication, excision of chronic granuloma in the occipital lobe and fourth ventricle, surgical treatment of the hydrocephalus. Following various surgical and antifungal treatments, the patient survived. Nearly three years after discharge, he still is in good physical condition and has a moderate neurologic deficit. Only 36 patients have been reported to have survived longer than three months after receiving treatment for brain aspergillosis. A course of medication in combination with various surgical procedures was required to achieve a successful outcome in this otherwise fatal disease.

Sympathetic nervous system exclusion following experimental subarachnoid haemorrhage prevents vasospasm in rabbits.

BACKGROUND: The objective of this study was to establish whether the exclusion of the effect of the sympathetic nervous system prevents vasospasm of cerebral arteries after experimental subarachnoid haemorrhage in rabbits. METHODS: The effect of sympathetic exclusion on vasospasm was studied in 29 New Zealand rabbits under conditions similar to human subarachnoid haemorrhage: 1. The activity of the sympathetic nervous system was excluded only after subarachnoid haemorrhage. 2. The effect of this exclusion was evaluated on the eighth day after subarachnoid haemorrhage. 3. The single haemorrhage model of experimental subarachnoid haemorrhage was chosen. Four groups of rabbits were investigated. The control group A comprised rabbits without subarachnoid haemorrhage; group B consisted of those with subarachnoid haemorrhage (1 ml autologous blood/kg BW suboccipitally into the cisterna magna); group C included those with subarachnoid haemorrhage and pharmacological sympathetic exclusion by the alpha blocker phenoxybenzamine, and group D was composed of those with subarachnoid haemorrhage and operative sympathetic exclusion by cervical gangliectomy. Changes in the basilar arteries of rabbits were evaluated by computer image analysis, using histologic specimens of vessel walls. A new measuring procedure was developed to assess the intensity of vasospasm; the method has a corrugation coefficient that expresses changes in intimal corrugation. RESULTS: Comparison of control group A and group B in regard of vessel intima corrugation showed significantly less corrugated intima in group A (P = 0.0042). In comparison with group B, corrugation of the vessel intima in group C was less intense after sympathetic exclusion by phenoxybenzamine following subarachnoid haemorrhage (P = 0.00012). In comparison with group B, a reduced corrugation was also found in group D after sympathetic exclusion by upper cervical gangliectomy following subarachnoid haemorrhage (P = 0.0026). CONCLUSIONS: The results of the study suggest that exclusion of sympathetic nervous system activity in rabbits prevents vasospasm in circumstances similar to subarachnoid haemorrhage in man. Thus, the sympathetic nervous system could play a critical role in the development of vasospasm in subarachnoid haemorrhage.

[Organization of experimental microsurgery research at the General Hospital in Maribor--principles and personal experience]. / Organizacija eksperimentalne mikrokirurske djelatnosti u Opcoj bolnici Maribor--principi i nasa iskustva.

In this report, the authors discuss the organization of experimental microsurgical activities from the standpoint of their own experience. Their opinion is that elementary microsurgical technique and routine could be obtained only in the experimental laboratory. Each institution dealing with microsurgery should organize such a functional unit. The importance of an experimental laboratory is not only for education, but also for basic microsurgical research. To attain adequate results, specially in nonclinical institutions, it is necessary to follow consequently clearly defined principles of organization and provide adequate conditions. The competence of such a concept is illustrated with the results of the authors' own researches during 1987. They completed 44 microvascular anastomoses in rats, on vessels of approximately 1 mm in diameter and obtained initial and early patency rates of 88.6 and 93.2% respectively. These patency rates could be sufficient for the safe clinical application of the microvascular technique.