Melanotic schwannoma of the sympathetic ganglia: a histologic, immunohistochemical and ultrastructural study.

We describe the case of a 46-year-old male patient who presented with pain in the left thigh, often accompanied by lumbar pain. These symptoms were sustained by a neoplasm, which was located in the sympathetic ganglia, at the level of the 3rd left lumbar spinal root and which was completely excised. Immunohistochemical positivity for S100, HMB45, and NSE antibodies suggested that the lesion was a melanotic schwannoma (MS), with both schwannian and melanocytic differentiations, the latter containing melanosomes at ultrastructural examination. Non-recurrence after 16 months of follow-up further supports our diagnosis of MS.

[Our experience in the treatment of intrathoracic and intraspinal hourglass neurogenic neoplasms]. / Nostra esperienza nel trattamento delle neoplasie neurogene a clessidra, intratoraciche ed intraspinali.

The authors describe their experience in the treatment of dumbbell neurogenic tumours, intrathoracic and intraspinal, with particular reference to clinical presentation, diagnostic for imaging, anatomo-pathological classification and surgical treatment, comparing their clinical cases (9) with the international literature, accurately reviewed. The authors think that the best surgical treatment is the combined approach, in only one stage, of thoracic surgeon and neurosurgeon by hemilaminectomy and extended costotrasversectomy, reserving hemilaminectomy and thoracotomy only for the tumours with big dimension of intrathoracic portion.

[Somatosensory evoked potentials in the evaluation and follow-up of patients with cervical vertebral and spinal cord injuries]. / I potenzali evocati somatosensoriali nella valutazione e follow-up del traumatizzato vertebro midollare cervicale.

Somatosensory evoked potentials have been serially recorded in 21 patients with cervical spinal cord injury. Each patient received the SEP test and a full neurological examination within 1 day after admission, after surgery, and 3-6 weeks following admission. Further SEP test and clinical evaluation were carried out 3-6 months after injury. Neurological status was graded according to the Sunnybrook Scale. In all patients we evaluated latency and amplitude of SEPs obtained from both median and tibial nerve stimulation. Immediately following injury SEPs were absent in 6 patients, abnormal in 10, and normal in 5 patients. No surgery was carried out in patients with normal SEPs where myelography and CT scan could not demonstrate surgical lesions. Four patients had some distal motor improvement but SEPs still absent, one had traceable SEPs following surgery but no motor improvement. Surgery was performed in all 10 patients with abnormal SEPs: 7 patients improved following surgery. In two patients SEPs showed an early postoperative recovery with subsequent late clinical improvement. The SEP technique is well suited to the non invasive study of spinal cord condition and serial recording in patients with spinal cord injury. Although SEPs are of limited clinical value when absent immediately following trauma, the presence of well preserved median and tibial SEP in the postinjury period indicates the best prognosis for motor and sensory functions.

[DDAVP in the treatment of acute neurosurgical diabetes insipidus]. / Il DDAVP nel trattamento del diabete insipido neurochirurgico acuto.

The effects of a synthetic vasopressin analogue, DDAVP (1-deamino-8-d- arginine-vasopressin) were studied in 5 adults and 2 children with acute central diabetes insipidus secondary to neurosurgery. 5 mcg DDAVP was administered intranasally twice a day to the two children, whereas the adults received the drug i.m. (1 mcg twice a day, 3 patients; 1 mcg once a day, 1 patient; 4 mcg twice a day, 1 patient). All subjects displayed an early, prolonged response (12-24 hr). There were no side-effects. The effectiveness of DDAVP, its prolonged action, and virtual freedom from side-effects when given intranasally or parenterally make it the drug of choice in the treatment of acute neurosurgical diabetes insipidus.

[Hemicrania in children: diagnostic and therapeutic problems (author's transl)]. / Problemi diagnostici e terapeutici nel bambino emicranico.

Four children with migraine raised some problems of differential diagnosis (cerebral circulatory disorders; structural brain diseases; or primary psychiatric disorders). Organic lesions were excluded through special investigations (EEG, CAT, Scintigraphy, Angiography etc.). Relationships between migraine and epilepsy in children were considered and the recent literature was reviewed. No agreement was reached on how to evaluate paroxysmal electroencephalograms recorded during migrainous episodes. In a child with personal and family history of migraine suffering from a sudden attack of acute headache accompanied by focal neurological deficits, migraine is the most likely diagnosis. Only if the neurological deficit fails to resolve rapidly (after a few hours), a detailed investigation is necessary (CAT etc.). A paroxysmal electroencephalogram during the attack of migraine does not imply necessarily a diagnosis of epilepsy. Children with history of migraine must be treated with specific anti-migranious drugs even if paroxysmal EEGs are recorded during the migraine attack. It must be remembered that both disorders (i.e. migraine and epilepsy) can exist in the same patient.