Tumours of the central nervous system: analysis of 476 cases observed at the University Hospital of the West Indies

A statistical survey of the incidence, age and sex distribution, and preferential sites of occurrence of tumours of the central nervous system observed at the University Hospital of the West Indies during a 15-year period is presented. Four hundred and seventy-six histologically confirmed neoplasms were recorded. Intracranial tumours were 7 times as common as those of the spinal cord. Of 416 intracranial neoplasms, there were 40 percent neuropithelial tumours, 21 percent meningiomas, 15 percent pituitary adenomas, 9 percent metastatic lesions, 6 percent congenital tumours, 5 percent vasoformative tumours, 3 percent nerve sheath tumours and 1 percent unclassified neoplasms. Men and women were equally affected. Meningiomas and pituitary adenomas were more frequent than in other reported series. Metastases were relatively more frequent in the spinal than in the intracranial group. Of the primary spinal tumours, those of nerve sheath origin were nearly three times as common as the meningiomas (AU)

Intramedullary schwannoma of the spinal cord

A rare case of solitary, dorsally located, intramedullary schwannoma of the thoracic spinal cord is reported in a 54-year-old man. The pathogenesis of the tumour in the location is discussed (AU)

Intradural extramedullary tuberculoma

A case of intradural, extramedullary tuberculoma presenting 5 years after the initial infection is described. The rarity of this discrete form of the disease is indicated and the excellent result which can result from a combination of surgery and chemotherapy is emphasized (AU)

Ulnar nerve abscess in hansen's disease

A case of abscess formation in a large peripheral nerve in a patient with leprosy is presented. The pathogenesis of such lesions is discussed and the rarity in the local community is emphasized (AU)

Delayed presentation of brain abscess following penetrating cranial wound

Two cases of brain abscess occurring several years after trivial head injury by a wooden object are presented. Attention is drawn to the high risk of late abscess formation in such cases, and the value of plain radiographs in detacting cases with penetration of the skull which are likely to develop neurological complications is emphasised (AU)

Spontaneous spinal epidural haematoma

A case of the rare syndrome of spontaneous spinal epidural haematoma is reported. In this patient, the initiating factor appeared to be the vasopressor responses associated with orgasm. A plea is made for greater awareness of this condition in patients with acute transverse myelitis with no obvious cause (AU)

Cryptococcosis in the West Indies

Crptococcosis with meningitis is reported in seven patients, six from Jamaica and one from Belize. All seven had headache, six had fever and five had confusion/coma. Despite biochemical findings of meningitis in the cerebrospinal fluid of five patients, Cryptococcosis was diagnosed antemortem in only three. Two patients treated with oral flucytosine survived. Awareness that Cryptococcosis occurs in the West Indies may assist in early diagnosis which is crucial to successful treatment (AU)

Spinal cord compression in thalassaemia

Two cases of spinal cord compression resulting from extramedullary haemopoesis in patients with thalassemia of intermediate clinical severity are reported. The association between mild thalassemia with long survival and the risk of spinal cord compression from extramedullary haemopoetic deposits is emphasised. (AU)

Supratentorial haemangioblastoma with polycythaemia

A case is reported of a 21 year old man with polycythaemia and a vascular frontal lobe tumour that was histologically compatible with the diagnosis of haemangioblastoma. On review of the English literature no case could be found of polycythaemia associated with supratentorial haemangioblastoma (AU)

Influence of pregnancy and oral contraception on the incidence of strokes in women of childbearing age

Ischaemic strokes are not uncommon in women aged 15-45. Over 500 carotid strokes were fully investigated between 1956 and 1965; 146 (29.2 percent) of the patients were aged 15-45 and 44.5 percent of these were women. Since oral contraceptives became available the proportion of non-pregnant women among the cases investigated in this age group has not increased; 40 of the 42 non-pregnant women with strokes are known not to have been taking oral contraceptives. There is no obvious difference between strokes reported in association with oral contraceptives and those occuring in other women in this age-group; thus there is no evidence from this study that oral contraceptives are responsible for producing or precipitating cerebral arterial occulusion in young women. Of the 65 women with strokes, in this age-group a third were pregnant of puerperal; these pregnant patients had a considerably higher mortality than men or non-pregnant women women with strokes. Full investigation of cases of non-haemorrhagic hemiplegia in pregnancy shows that two-thirds are due to major arterial occlusion, and that cerebral venous thrombosis is not the usual cause, as is commonly stated. (AU)