ABSTRACT
Surgical therapy for Parkinson's disease has a long history beginning in the 1930s with empirical exploration of different brain targets, such as resection of the primary motor cortex or extirpation of the caudate. Recently, there has been a renaissance of functional neurosurgery for the treatment of advanced Parkinson's disease, particularly deep brain stimulation (DBS). To date, DBS of the globus pallidus interna and subthalamic nucleus has been reported to relieve motor symptoms and levodopa-induced dyskinesia in patients with advanced Parkinson's disease. DBS also has different advantages over pallidotomy and subthalamotomy, including reversibility, decreased risk of reoperation and decreased morbidity. In addition to well-experienced neurologists and neurosurgeons, a multidisciplinary team approach is fundamental and critical to ensure success in the DBS procedure in individual patients. With the advances in neuroimaging, neurophysiology and localization techniques, it is increasingly likely that there will be more surgical targets in the future that can also improve cardinal features of Parkinson's disease, or even nonmotor manifestations of this condition.
Subject(s)
Deep Brain Stimulation , Parkinson Disease/therapy , Deep Brain Stimulation/instrumentation , Deep Brain Stimulation/methods , Deep Brain Stimulation/standards , Dystonia/therapy , Globus Pallidus , Humans , Interprofessional Relations , Parkinson Disease/etiology , Patient Selection , Practice Guidelines as Topic , Subthalamic Nucleus , Treatment OutcomeABSTRACT
A report is made of a unique combination of occurrences of primary intraspinal epidural and subdural meningiomas and primary subcutaneous meningioma in the cervical region of a 15-year-old boy. The subcutaneous meningioma was detected at birth. Review of 92 recorded cases of primary dermal meningiomas revealed that they tended to occur in young patients, with an average age of 34 years for both sexes. The female-to-male ratio was 4:5. Most cutaneous meningiomas occurred in the head and neck, and the scalp was the most common site.
Subject(s)
Meningioma/pathology , Skin Neoplasms/pathology , Spinal Neoplasms/pathology , Adolescent , Humans , Male , Meningioma/diagnostic imaging , Meningioma/surgery , Radiography , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/surgery , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/surgeryABSTRACT
A 32-year-old homosexual man presented with headache and progressive right hemiparesis. CT scan revealed a heterogeneous ring-enhancing mass in the left parietooccipital lobe which proved to be astrocytoma. Clinicians should be aware of this new and unusual association of a cerebral glioma and acquired immune deficiency syndrome. Tissue examination is essential for proper diagnosis.
Subject(s)
Acquired Immunodeficiency Syndrome/pathology , Brain Neoplasms/pathology , Occipital Lobe/pathology , Parietal Lobe/pathology , Adult , Astrocytes/pathology , Biopsy , Glial Fibrillary Acidic Protein/analysis , Humans , Male , Tomography, X-Ray ComputedABSTRACT
The case of an astrocytoma of the cervical cord associated with signs and symptoms of increased intracranial pressure in a 14-year-old girl is reported. Several possible etiological factors responsible for producing this syndrome are presented. The impairment of CSF absorption at the convexity proven by CSF dynamic study is the main factor for the increased intracranial pressure and the neoplastic inflammatory reaction appears to be the causative mechanism for poor CSF absorption in this patient.
Subject(s)
Astrocytoma/physiopathology , Intracranial Pressure , Spinal Cord Neoplasms/physiopathology , Adolescent , Astrocytoma/cerebrospinal fluid , Astrocytoma/diagnostic imaging , Female , Humans , Radiography , Spinal Cord Neoplasms/cerebrospinal fluid , Spinal Cord Neoplasms/diagnostic imagingABSTRACT
A 22-year-old woman with neurocutaneous melanosis is reported in whom an intraspinal melanotic congenital arachnoid cyst and melanotic lipoma occurred at the same thoracic location. Such combined occurrence of lesions of the central nervous system, producing compression of the spinal cord, has not been noted in any previously reported case of neurocutaneous melanosis. The pathogenesis of these two unusual melanotic lesions is discussed in relation to the ectomesenchymal properties of the neural crest. The concurrent melanotic arachnoid cyst and lipoma, in juxtaposition, were demonstrated by a computed tomography scan in which the preoperative diagnosis of lipoma was possible through the density of the lesion.
Subject(s)
Arachnoid , Cysts/complications , Lipoma/complications , Melanosis/complications , Spinal Cord Neoplasms/complications , Adult , Cysts/diagnostic imaging , Cysts/pathology , Female , Humans , Laminectomy , Lipoma/pathology , Melanosis/pathology , Myelography , Nervous System Diseases/complications , Nervous System Diseases/pathology , Skin Diseases/complications , Skin Diseases/pathology , Spinal Cord Diseases/complications , Spinal Cord Diseases/diagnostic imaging , Spinal Cord Diseases/pathology , Spinal Cord Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Lymphocyte proliferation tests to rabies antigen and myelin basic protein were performed on peripheral blood lymphocytes from nine patients with the encephalitic form and on seven with the paralytic form of human rabies. Six of the nine patients with encephalitis had proliferative responses to rabies antigen, whereas all of the patients with paralysis had no response. Two patients in each group also had a proliferative response to myelin basic protein. The myelin basic protein-reactive patients had a more rapidly fatal disease than the non-reactive patients. This preliminary study suggests that host immune responses may influence the clinical manifestations and course in human rabies.
