[Serum and cerebrospinal fluid kinetics of ceftazidime]. / Serum- und Liquorkinetik von Ceftazidim.

Ceftazidime serum concentrations and cerebrospinal fluid (CSF) penetration across non-inflamed meninges were evaluated in 10 patients after intravenous application of 2 g ceftazidime over a period of 30 min. After a continuous increase during infusion the highest level of ceftazidime in serum with 172.27 micrograms/ml (+/- 60.43 micrograms/ml) was ascertained at the end of the infusion. The further development demonstrated a continuous decrease of serum concentrations. Concentrations in serum followed a two-compartment open kinetic model. Mean distribution volume was 17.6 l, the total clearance was 142.97 ml/min, half-life was 1.8 h and the determined area under the curve was 139.89 micrograms x min/ml. Penetration of ceftazidime into CSF could only be pointed out in 5 patients. The highest level with 5.11 micrograms/ml (+/- 1.2 micrograms/ml) was observed 32 min after starting the infusion. A steady state with CSF-concentrations over 2 micrograms/ml could be ascertained during the following 4 hours in these patients. Obviously high statistic significance (p less than or equal to 0.01) was present when penetration into CSF was correlated to body surface area (BSA) using the exact Fisher test with Yates correction. Penetration of ceftazidime into CSF across non-inflamed meninges with therapeutic concentrations over a period of 4 hours could only be achieved when BSA was less than 1.95 m2. Further investigations in more patients are necessary to evaluate if BSA is the only parameter which affects distribution of ceftazidime into CSF.

Lesión vestibular periférica secundaria al traumatismo encéfalo craneal / Peripheral vestibular lesion after head trauma

La sintomatología otoneurológica se aprecia frecuentemente en el síndrome postcontusional encefálico, predominando síntomas en forma de vértigo postural, desequilibrio corporal, tinnitus e hipoacusia. La actual experiencia clínica y experimental sugiere una clara relación entre la cuantía del traumatismo encéfalo craneal y el grado de secuela vestíbulo-coclear. El análisis de dos grupos de pacientes con síndrome vestíbulo-craneal post-traumatismo encéfalo craneal diferenciados por su perfil evolutivo temporal entrega indicios de que la persistencia de la lesión laberíntica no compensada a nivel de los núcleos vestibulares centrales participa en la génesis del síndrome post contusional mediante la distorsión de los reflejos vestíbulo-ocular y vestíbulo-espinal. El hallazgo de alteraciones concomitantes en dos reflejos de seguimiento ocular (interacción visual-vestibular-oculomotora) en forma de nistagmus optokinético y seguimiento visual pendular reafirman estos supuestos. Paralelamente se analizan la influencia del cerebelo, interacción visual-vestibular y retículo-espinal en el proceso de la compensación vestibular central

Surgical treatment of lumbar stenosis: long-term results.

Lumbar stenosis is a disease of the elderly which is due, in the majority of cases, to degenerative changes. This disease causes considerable disability which cannot be ameliorated well by conservative treatment. Surgery is usually the treatment of choice, although long-term results have been reported in only a few publications. We attempted a reevaluation of our patients one to seven years after intervention. Overall results indicate that about 80% of our patients benefited from surgery in varying degrees. Only 10% showed post-operative deterioration. One third of operated cases achieved complete working or functional capacity, while in the remaining cases disability persisted. Since long-term results are similar in patients over and under 65 years of age, intervention is recommended even in the older patient if his general condition is good enough to allow surgery.

Sphenopharyngeal encephalocele associated with agenesis of the corpus callosum.

A case of a 38-year-old patient, who had been complaining for some years about impairment in nasal breathing, is presented. Within the last few months the patient presented a rapid deterioration of his visual acuity. Radiological examinations revealed a sphenopharyngeal encephalocele as well as agenesis of corpus callosum. The pathogenesis and therapy of the disease is discussed in the light of the particular case presented as well as those cases reported in the literature.

[Chronic brain disease in old age-a case report contributing to the problem of differential diagnosis (author's transl)]. / Das organische Psychosyndrom im Alter-Ein kasuistischer Beitrag zur Problematik seiner Differentialdiagnose.

This is a report on the case history of a 66-year old female patient whose chronic involutional melancholia was disguised by the signs of a slowly growing clival meningioma with consecutive occlusional hydrocephalus. Despite repeated stays in hospital the deteriorating mental findings were wrongly diagnosed as an organic psychosyndrome of vascular origin until shortly before her death. Typical difficulties in differential diagnosis of the organic psychosyndrome in aged patients are discussed on the basis on the course taken by the disease in this particular case. This case also shows the fundamental possibility of neurosurgical treatment of cerebro-organic disturbances conditioned by disturbances of CSF circulation.

Supplementation of conventional radiographic techniques by computer tomography in cases of subarachnoid haemorrhage (SAH).

124 patients with a spontaneous intracranial haemorrhage were examined. On almost 100% of the cases, the diagnosis could be established computer-tomographically if the study was performed within 5 days following the haemorrhage. As a result of the bleeding pattern it was possible to determine the exact location in 54 (75%) of 71 aneurysms. The clinical course of the patient can be more closely followed without additional risk. Thus with the use of CT, the development of cerebral infarction resulting from arterial vasospasm (6 cases) or of hydrocephalus as a result of CSF resorption disturbances can be easily and quickly determined.

[Secondary blood coagulation disturbances after severe head injuries (author's transl)]. / Sekundäre Störungen der Blutgerinnung bei schweren Schädelhirntraumen.

The release of tissue thromboplastin after a severe brain injury can lead to a consumption coagulopathy. In a group of 83 patients with severe brain injury, platelet count, fibrinogen, prothrombin, partial thromboplastin time and thrombin time were investigated. The pathological laboratory findings in 14 were compatible with a consumption coagulopathy. These alterations were demonstrated during the first hours following trauma and represented an extra handicap for the patients who had to be treated surgically.

Value of computed tomography for the diagnosis of arachnoid cysts and assessment of surgical treatment.

The clinical and radiological findings in 18 patients suffering from arachnoid cysts of the middle fossa (ACMF) are reported. The importance of computed tomography in diagnosis and in the assessment of surgical therapy in 15 cases is emphasized. The indication to operate upon ACMF and criteria of adequate surgical treatment are discussed. We want to point out the superiority of simple shunting procedures over craniotomies and removal of membranes.

[Computerized tomography in head injuries (author's transl)]. / Computer-Tomographie bei Schädel-Hirn-Verletzungen.

Computerized tomography permits the registration of minimal density differences of cerebral tissue. The information obtained by this method is comparable to gross neuropathology. Demonstration of intracranial bleeding and other posttraumatic complications does not present any serious problem. Most of all, it permits for the first time to demonstrate directly parenchymatous lesions of cerebral tissue after a head injury. The treatment nowadays can depend largely on the results gained by computerized tomography. So the care of the patient will be influenced largely by the demonstration of lesions affecting the survival of the patient.

Spontaneous intracerebellar hematoma during childhood caused by spongioblastoma of the IVth ventricle.

Spontaneous intracerebellar hematomas are very rare during childhood and vascular malformations are almost always the cause. We recently had the opportunity to observe and treat two children with this problem. Problems in locating the exact site of the hemorrhage were minimal thanks to the CT studies performed in both cases. The presence of a tumor was proved histologically and the diagnosis of spongioblastoma was made.

[Spontaneous intracerebellar haematoma in childhood (author's transl)]. / Spontane intrazerebelläre Hämatome im Kindesalter

Spontaneous cerebellar haemorrhage accounts for 10% of all intracranial spontaneous haematomas. It is a disease which principally affects patients over middle age, and it is rare in childhood. To twelve cases previously reported we now add a further three. Attention is drawn to the diagnostic difficulties and the values of echoencephalography, angiography, and computerized axial tomography in diagnosis and localisation of the condition. Prognosis can be good even in cases in poor condition of diagnosis and treatment are prompt.

[Intracerebral hematoma with Nishimoto-Takeuchi-Kudo disease (Moyamoya disease): a contribution to the differential diagnosis of intracerebral hematoma (author's transl)]. / Intracerebrale Massenblutung bei Morbus Nishimoto-Takeuchi-Kudo (Moyamoya-Krankheit): Ein Beitrag zur Differentialdiagnose der intracerebralen Blutungen

A 40-year-old female was admitted with the diagnosis of an intracerebral hematoma. A bilateral carotid angiogram showed the typical signs of Nishimoto-Takeuchi-Kudo disease with a left temporal intracerebral expansive process. This disease must consequently be considered as another cause of an intracerebral hematoma. The pathogenetic and arteriographic aspects of this disease are considered.

Carpal tunnel syndrome caused by the persistence of the median artery.

As another cause for a symptomatic carpal tunnel syndrome the persistence of the median artery is postulated. This was observed by the authors in three cases all of whom presented a typical carpal tunnel syndrome. As the only cause in all three cases a persistent median artery was observed. The embryological facts and the possible pathogenetic causes discussed.