ABSTRACT
Forty six patients who had normal pressure hydrocephalus (NPH) and who presented 2 or more of the 5 following preoperative signs: dementia with gait disturbances and urinary incontinence, gait disturbance as first sign, known etiology, positive lumbar puncture withdrawal test, presence of periventricular hypodensity on CT and absence of visible cerebral sulci, were treated by lumboperitoneal shunt. Postoperative results were evaluated at 1 month, 6 months and 1 year with 60.6 p. 100 of good results. Complications of LP shunts (26 p. 100) were mild and did not compromise the outcome. We emphasize the necessity of clinical selecting criteria before surgery and the value of LP shunt in the treatment of NPH.
Subject(s)
Cerebrospinal Fluid Shunts , Hydrocephalus, Normal Pressure/surgery , Hydrocephalus/surgery , Aged , Aged, 80 and over , Female , Humans , Lumbosacral Region , Male , Peritoneum , Retrospective StudiesABSTRACT
Syringomyelic cavitation of various origins (excluding tumour) has been treated by syringo-peritoneal shunting (SPS) in 10 patients. The main clinical and radiological symptoms are reviewed and postoperative results evaluated; among the symptoms, pain is the most likely to improve after surgery. But the global outcome in the majority of cases remains unchanged, some patients showing neurological deterioration. Although MRI is of fundamental importance in diagnosis, the significance of the postoperative appearances on MRI has still to be elucidated. Other studies are certainly necessary to define the exact place of SPS in the treatment of syringomyelia.
Subject(s)
Cerebrospinal Fluid Shunts , Syringomyelia/surgery , Adult , Aged , Female , Humans , Leg , Male , Middle Aged , Movement Disorders/etiology , Movement Disorders/physiopathology , Pain , Peritoneal Cavity , Postoperative Period , Syringomyelia/complications , Syringomyelia/physiopathologyABSTRACT
A 14 year-old boy presented, at a 3 month interval, with 2 episodes of hemiplegia of rapid onset. The first time, CT scan revealed a large parietal "tumor", shown to be pseudocystic at surgery, and histologically proven as a demyelinating disease. During the second attack, CT scan showed a similar but contralateral lesion, regressing completely under steroid treatment. 40 months after the onset of the disease, the child's life and intelligence are normal.
Subject(s)
Brain Neoplasms/diagnosis , Demyelinating Diseases/diagnosis , Acute Disease , Adolescent , Adrenal Cortex Hormones/therapeutic use , Brain Neoplasms/diagnostic imaging , Diagnosis, Differential , Hemiplegia/etiology , Humans , Male , Recurrence , Tomography, X-Ray ComputedABSTRACT
Spontaneous cerebellar hemorrhages are more easily recognized since the large use of CT scanner. In this series of 28 cases, they represent 9% of all spontaneous intra-cranial hemorrhages. Three main categories may be described. Small hematomas (less than 3 cm) are located in the postero-medial part of the cerebellum (9 cases): they are difficult to recognize, due to their limited clinical signs; their evolution is spontaneously favorable. Larger hematomas (more than 3 cm) represent two thirds of our clinical cases. When situated near the midline (7 cases) stupor or coma are quite constant, as neurovegetative signs; differentiating this type of case from brain-stem hemorrhages is difficult; prognosis is severe as even with surgery; there is a high mortality rate. When located more laterally (12 cases), their evolution is less acute: consciousness disturbances do not generally occur at the onset, whereas cerebellar disfunction is quite obvious; contrary to midline cases, these, when operated upon at an early stage, show a high success rate. If operation is delayed, the prognosis is much more serious due to the mass effect of this lesion in the posterior fossa. This is clearly demonstrated by CT scan which consistently shows displacement of the 4th ventricle with hydrocephalus of the lateral ventricles.
Subject(s)
Cerebellar Diseases/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Cerebellar Diseases/diagnosis , Cerebellar Diseases/therapy , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/therapy , Follow-Up Studies , Humans , Middle Aged , PrognosisABSTRACT
Biometry was performed on the computed tomographical cross-sections of one human cervical spine. The entire spine was removed with the head and neck from a fresh cadaver of an adult man. Horizontal cross-sections were performed with a C.T. scan from the base of the skull to the thoracic level. The measurements concerned the diameters of the vertebrae, spinal canal and spinal cord: the density of the posterior and anterior walls, and of the para-vertebral muscles. Clinical and fundamental applications are underlined.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Tomography, X-Ray Computed , Aged , Anthropometry/methods , Cervical Vertebrae/anatomy & histology , Humans , MaleABSTRACT
The results of thermo-coagulation have been evaluated in a series of 50 patients followed up from two to six years (average three years). Neuralgia disappeared in nearly 80 p. 100 of the cases (however this was obtained with a second operation in nine cases). The frequency of recurrences increase with time: 20 p. 100 during the first two years reaching 40 p. 100 after three years. They were more likely to occur if the post-operative sensory deficit is moderate. Complications directly related to the surgical technique were rare: some faded away relatively quickly (oculo-motor palsies less than 1 p. 100, masseter weakness 20 p. 100 in the first weeks). The only residual problems were related to sensory deficits: in general they were limited to a small cutaneous area and total anesthesia was never been observed. Although paresthesias were noted in 12 p. 100 of the cases, these usually were not really troublesome. Our conclusion, therefore, is that differential thermocoagulation appears to be the best surgical treatment for trigeminal neuralgia.
