Apparent paradoxical vault changes with middle cranial fossa arachnoid cysts--implication for aetiology.

Three cases of middle cranial fossa arachnoid cyst with paradoxical bone changes in the adjacent vault are described, namely, a small middle cranial fossa and pneumosinus dilatans. This association is unusual and unique. The existing literature is reviewed and the probable aetiological factors discussed.

Direct cervical vertebro-venous fistula with radiculopathy and MRI changes resolving after successful endovascular embolisation: a report of two cases.

We report two cases of rare direct cervical vertebro-venous fistula (VVF) presenting with chronic radiculopathy as part of the symptom complex. We describe the MRI and intra-arterial angiography findings before and after successful embolisation. These demonstrate occlusion of the fistula with collapse and thrombosis of the draining extradural venous plexus and, in one case, resolution of MRI signal abnormality in the cervical spinal cord.

Characterization of primary intracranial lymphoma by computed tomography: an analysis of 36 cases and a review of the literature with particular reference to calcification haemorrhage and cyst formation.

Previous published series describing the appearances of primary central nervous system lymphoma (PCNSL) state that calcification, haemorrhage and cyst formation are rare, but generally fail to quantify or expand on this statement. We present the pre-treatment computed tomography (CT) findings of 36 patients with biopsy proven PCNSL. In this series, calcification was present in only one very atypical lesion and evidence of haemorrhage was not seen. Small intralesional cysts were present in four of the total of 50 lesions. PCNSL usually appeared as one or more well defined focal lesions, iso- or hyperdense to grey matter, with homogeneous enhancement following IV contrast injection. Less commonly the contrast enhancement was inhomogeneous, only one lesion failed to enhance. Disproportionately little oedema and mass effect compared with lesion size was noted on approximately half the CTs. Lesions usually touch either the ependymal lining of the ventricles or the leptomeningeal surface.

Case report: symptomatic metastasis from a sacrococcygeal chordoma.

Chordoma is generally thought to be a locally invasive tumour of low metastatic potential. Review of the literature suggests that metastatic spread from chordoma is not an uncommon occurrence, but that the metastases are usually clinically silent. We present an unusual case where a metastasis from a sacrococcygeal chordoma produced a syndrome of lumbar root compression after resection of the primary lesion.

Case report: multiple intra-cranial metastases from a prolactin-secreting pituitary tumour.

Only seven cases of metastatic prolactin-secreting pituitary tumour have been reported in world literature. The metastases were intra-cranial in five cases and extra-cranial in two cases. We report a further case with multiple intra-cranial metastases in the supra-tentorial compartment. Histologically, both primary and metastatic tumours were benign with strongly positive immuno-histochemical staining for prolactin. Our case exemplifies the inconsistent correlation between the histopathological appearance and biological behaviour of malignant pituitary tumours.

CT cisternography in the investigation of cerebrospinal fluid rhinorrhoea.

Eighteen consecutive patients with cerebrospinal fluid (CSF) rhinorrhoea investigated by computed tomographic cisternography (CTC) are reported and the literature is reviewed. Twenty-one CTC studies were performed without complications on nine patients presenting with spontaneous CSF rhinorrhoea, six with head injury and three who had undergone craniotomy. Two meningoceles and two encephaloceles were found in patients with spontaneous rhinorrhoea. The site of the CSF leak was identified in 17 examinations (81%) and verified at operation in 14 patients--no surgery was performed following two examinations--and in one the site of leakage was not identified at operation. No defect was identified in three (14.3%) examinations and in one the result was equivocal (4.7%). CTC is an accurate, well-tolerated procedure and should be regarded as the method of choice for investigation of this condition.

Temozolomide: a new oral cytotoxic chemotherapeutic agent with promising activity against primary brain tumours.

Temozolomide, a new oral cytotoxic agent, has been given to 28 patients with primary brain tumours. Treatment was given at a dose of 150 mg/m2/day for 5 days (i.e. total dose 750 mg/m2) escalating, if no significant myelosuppression was noted on day 22, to 200 mg/m2/day for 5 days (i.e. total dose 1000 mg/m2) for subsequent courses at 4 week intervals. A major improvement in computer tomography (CT) scan was noted in 5/10 patients with astrocytomas recurrent after radiotherapy, with a major clinical improvement but minor improvement on CT scan in one further patient. Reduction in the size of the CT lesion was also observed in 4/7 patients with newly diagnosed high grade astrocytomas given 2-3 courses of temozolomide prior to irradiation. 1 patient with recurrent medulloblastoma had a clinical response in bone metastases. Temozolomide was well tolerated with little subjective toxicity and usually predictable myelosuppression and is a promising new drug in the treatment of primary brain tumours.

Pseudoaneurysm of the internal carotid artery: a forgotten complication of tonsillitis?

Pseudoaneurysm of the internal carotid artery is an uncommon but potentially lethal complication of tonsillar or peritonsillar sepsis, which appears to have occurred more frequently prior to the introduction of penicillin. Management of such a case is discussed, and a literature review presented.

The significance of haematomas of the basal ganglia in closed head injury.

In a large series of patients with severe closed head injury, 26 (3.2%) had haematomas of the basal ganglia. It is suggested that such haematomas indicate primary brain damage, being part of the spectrum of lesions that may be seen in diffuse axonal injury. Clinical outcome was found to depend on the pattern of brain damage, notably on the additional presence of contusions or of other computed tomographic (CT) evidence of diffuse axonal injury.

The prognostic significance of the third ventricle and basal cisterns in severe closed head injury.

A retrospective study is presented of all the patients seen in a regional neurosurgical unit during 1985 and 1986 who suffered primary brain injury following severe closed head trauma. Clinical outcome is correlated with the type and extent of the primary brain injury, the appearances of the third ventricle and basal cisterns on computed tomography, and the intracranial pressure, where available. Compression and obliteration of the third ventricle and basal cisterns is shown to have a close correlation with raised intracranial pressure and with a poor prognosis.

An analysis of referrals for primary diagnostic abdominal ultrasound to a general X-ray department.

Abnormalities were found in 30% of examinations. Comparison of outpatient and family practitioner referrals in cases of suspected gallstones (24%:27%) indicated the value of GP access. There was also evidence, in the absence of a dilated common bile duct, that there was little value in extending the examination of the gallbladder. In post-cholecystectomy syndrome, endoscopic retrograde cholangiography is shown to be the investigation of choice. Abnormalities revealed in lower abdomen examinations were related only to pelvic organs and in this group examination should therefore be confined to this area. Pick-up rates of 15% were found in patients with left upper quadrant pain and a number of miscellaneous conditions. There is a marked increase in positive findings in the presence of a palpable mass.