ABSTRACT
A 41-year-old woman was seen in no acute distress with an infected ventriculoperitoneal shunt. She underwent several revisions of the shunt but was readmitted to the hospital with nausea, vomiting, and neurologic sequelae. Results of spinal fluid analysis were white blood cells 68/mm3 (25% neutrophils), glucose less than 20 mg/dl, and protein 513 mg/dl. Cerebrospinal fluid, aerobic and anaerobic, and blood cultures were negative. Three weeks later the patient suffered a seizure and was prescribed antitubercular agents for a presumed diagnosis of tubercular meningitis. One week later, chest wound culture from her first visit suggested Mycobacterium tuberculosis, which was confirmed by DNA probe; cerebrospinal fluid culture eventually grew the organism. The patient fared well once she received antituberculosis agents. The time between first contact and treatment in the hospital delayed therapy.
Subject(s)
Phenytoin/therapeutic use , Seizures/drug therapy , Seizures/etiology , Tuberculosis, Meningeal/complications , Tuberculosis, Meningeal/drug therapy , Vancomycin/therapeutic use , Adult , Aminoglycosides , Anti-Bacterial Agents/therapeutic use , Anticonvulsants/therapeutic use , Female , Humans , Mycobacterium tuberculosis/physiology , Tuberculosis, Meningeal/diagnosisABSTRACT
PET has a promising role in neuroradiology for accurate diagnosis and prognostication of malignant tumors as well as differential diagnosis of radiation necrosis and recurrent tumors. Particularly, PET has proven its ability to accurately differentiate radiation necrosis from recurrent brain tumor. Active tumors have accelerated glycolysis, and a remarkable accumulation of FDG radiotracer in high grade brain tumors is evident on PET images. Tumor metabolism also proportionally increases with increasing pathologic grades of brain tumor, and accelerated tumor metabolism indicates a poor prognosis for the tumor.
Subject(s)
Brain Neoplasms/diagnostic imaging , Frontal Lobe/diagnostic imaging , Glioblastoma/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Postoperative Complications/diagnostic imaging , Temporal Lobe/diagnostic imaging , Tomography, Emission-Computed/methods , Adult , Female , Humans , MaleABSTRACT
The treatment of head-injured patients has over the past 15 years become significantly more complex and involved. The rising interest in the treatment of these patients has been driven in large part by the growing body of evidence showing that there is a definite association between elevated ICP and increased mortality and long-term morbidity. The effective treatment of intracranial hypertension with hyperventilation, osmotic agents, and barbiturate therapy has been aided by the regular use of ICP monitoring in most neurosurgical centers. A continuing and ongoing record of ICP allows for the judicial and appropriate use of modern treatment modalities.
Subject(s)
Brain Injuries/diagnosis , Intracranial Pressure , Monitoring, Physiologic , Adolescent , Adult , Aged , Brain Injuries/physiopathology , Brain Injuries/surgery , Child , Humans , Middle AgedABSTRACT
This study reports the technical application of stereotactic interstitial brachytherapy for malignant gliomas in two groups of patients. Group I consisted of 2 patients who had undergone previous debulking brain surgery; group II were 3 patients who were not candidates for craniotomy because their tumors were surgically inaccessible. The stereotactic implantation technique in group I was somewhat complicated due to the irregular shape of the residual tumor masses. Sophisticated pre-implantation planning was necessary for adequate coverage of the entire tumor volume. In this series, inoperable tumors were also successfully implanted with excellent results.
Subject(s)
Brachytherapy , Brain Neoplasms/radiotherapy , Glioblastoma/radiotherapy , Stereotaxic Techniques , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Combined Modality Therapy , Follow-Up Studies , Glioblastoma/pathology , Glioblastoma/surgery , Humans , Magnetic Resonance Imaging , Prostheses and Implants , Tomography, X-Ray ComputedSubject(s)
Brain Neoplasms/radiotherapy , Brain/radiation effects , Glioma/radiotherapy , Aged , Brain/pathology , Brain Neoplasms/diagnosis , Dose-Response Relationship, Radiation , Electrodes, Implanted , Female , Glioma/diagnosis , Humans , Male , Middle Aged , Prognosis , Stereotaxic Techniques , Tomography, X-Ray ComputedABSTRACT
This review of 406 patients with head injury examines the role of emergency cervical radiography in head trauma and the frequency of associated cervical spine injury. Of 293 patients who had emergency cervical radiography (72 percent), 8 showed some abnormality, but only 5 (1.2 percent) were significant for cervical spine injury. All eight patients were, however, clinically suspected to have associated cervical spine injury before emergency cervical radiography. One hundred thirteen patients (28 percent) did not undergo emergency cervical radiography based on clinical evaluation, and none was subsequently found to have a missed cervical spine injury. There was no correlation between severity of head injury and the presence of associated cervical spine injury (p greater than 0.16). Head trauma is infrequently associated with cervical spine injury and when present is usually not clinically occult. Emergency cervical radiography is not efficacious and should not be routine in the emergency room management of head trauma. When associated cervical spine injury is clinically suspected, adequate cervical immobilization should be maintained and cervical radiography performed on a low priority basis. Head injury due to automobile and pedestrian or motorcycle and automobile accident may be more likely to be associated with cervical spine injury.
Subject(s)
Craniocerebral Trauma/diagnostic imaging , Emergencies , Accidents, Traffic , Adolescent , Adult , Aged , Child , Child, Preschool , Craniocerebral Trauma/classification , Craniocerebral Trauma/complications , Craniocerebral Trauma/etiology , Female , Humans , Infant , Male , Middle Aged , Radiography , Spinal Injuries/complications , Spinal Injuries/diagnostic imagingABSTRACT
Indirect calorimetry was performed on 15 nonsteroid-treated, head-injured patients over 16 postinjury days. A search was made for a clinical marker that could be used to predict the caloric requirement in individual head-injured patients. Of all parameters reviewed, only motor activity correlated with the caloric needs of the patients (P less than 0.0001). Flaccid patients had a mean caloric expenditure of 108% of expected values, whereas patients with abnormal motor activity had a mean caloric expenditure of 191% of expected values.
Subject(s)
Craniocerebral Trauma/metabolism , Energy Intake , Energy Metabolism , Craniocerebral Trauma/classification , Humans , Intracranial Pressure/drug effects , Pentobarbital/therapeutic use , Rest , Severity of Illness IndexABSTRACT
A case of interhemispheric subdural hematoma ( ISH ) is presented and discussed. This disorder is a rare form of intracranial hemorrhage, which classically presents as an isolated paresis of one leg or a hemiparesis worse in the leg than the arm. The majority of cases are due to occipital trauma because of the anatomy of the bridging veins. Chronic interhemispheric hematomas are rare since the natural history of these lesions is to spread out over the cerebral convexity. Conservative treatment for ISH may be beneficial unless neurological deterioration necessitates early operative intervention.
Subject(s)
Hematoma, Subdural/diagnostic imaging , Craniocerebral Trauma/complications , Hematoma, Subdural/drug therapy , Hematoma, Subdural/etiology , Humans , Intracranial Pressure/drug effects , Male , Mannitol/therapeutic use , Middle Aged , Radiography , Wounds, NonpenetratingSubject(s)
Cerebral Ventricle Neoplasms/surgery , Choroid Plexus , Ependymoma/surgery , Adult , Humans , MaleABSTRACT
A unique case of a shotgun wound producing a lateral medullary syndrome is reported. Evidence indicating direct brainstem injury and not vascular injury is presented. The long-term complications of this type of injury are stressed.
Subject(s)
Brain Injuries/complications , Brain Stem/injuries , Lateral Medullary Syndrome/etiology , Wounds, Gunshot/complications , Adolescent , Female , HumansABSTRACT
Oligodendrogliomas occur primarily in the cerebral hemispheres of adults. A rare case of an oligodendroglioma in the cerebellum of a child is presented. The tendency for oligodendroglioma to metastasize through the cerebrospinal fluid (CSF) is reviewed and emphasized. A recommendation for CSF cytology and possible spinal axis irradiation in the treatment of oligodendrogliomas is made.
Subject(s)
Cerebellar Neoplasms/surgery , Oligodendroglioma/surgery , Age Factors , Cerebellar Neoplasms/cerebrospinal fluid , Cerebellar Neoplasms/radiotherapy , Cerebellum/pathology , Child, Preschool , Humans , Male , Oligodendroglioma/cerebrospinal fluid , Radiotherapy Dosage , Sex Factors , Tomography, X-Ray ComputedSubject(s)
Hematoma, Subdural , Aged , Animals , Brain/diagnostic imaging , Brain/surgery , Cerebral Angiography , Chronic Disease , Disease Models, Animal , Dogs , Electroencephalography , Hematoma, Subdural/diagnosis , Hematoma, Subdural/etiology , Hematoma, Subdural/therapy , Humans , Intracranial Pressure , Mental Disorders/complications , Middle Aged , Neurologic Manifestations , Radionuclide Imaging , Spinal Puncture , Tomography, X-Ray ComputedABSTRACT
A case of traumatic atlantooccipital dislocation is presented and the literature reviewed. This type of traumatic dislocation is probably produced by violent hyperextension of the upper cervical spine. Cranial nerve injuries and spinal cord injuries are common. Early fusion is recommended.
