[Multiple emboli from a cardiac metastasis of a renal-cell carcinoma]. / Multipele embolieën veroorzaakt door een cardiale metastase van een niercelcarcinoom.

A 68-year-old man was hospitalised with a vascular occlusion in the left leg. After treatment with urokinase he developed multiple intracerebral haemorrhages. The occlusion and the intracerebral haemorrhages evoked by urokinase were caused by embolisation originating from a cardiac metastasis of a renal-cell carcinoma. Cardiac surgery was performed, but complete removal of the tumour was not possible. The process of embolisation continued and the patient died a few weeks after diagnosis. Cardiac metastasis is seen in 10% of all cancer patients. Most of these metastases remain without symptoms. Left ventricular metastasis of renal-cell carcinoma without involvement of the inferior V. cava is very rare. If embolic occlusion of one or more vascular areas is present, transthoracic echography of the heart should be performed. Early detection and surgical treatment prevent further embolisation which may result in a better prognosis.

Type I cerebral dural arteriovenous fistulas of the lateral sinus: clinical features in 24 patients.

To review the clinical and diagnostic characteristics of type I cerebral dural arteriovenous fistulas (CDAVF) of the lateral sinus medical records of 24 patients with Type I CDAVF were retrospectively reviewed. All patients were interviewed aiming at presenting symptoms, impact on daily functioning, diagnostic delay, relevant medical history and post-treatment status. Nineteen of 24 patients (79%) were women. The median age at the time of diagnosis was 56 years (range 32-69). Unilateral pulsatile tinnitus was the presenting symptom in all patients. A bruit could be heard at auscultation on the retroauricular skull in all patients. The median diagnostic delay was 17.9 months (range 1-120). Standardized magnetic resonance imaging (MRI) of the brain was normal in all patients. The diagnosis of CDAVF was confirmed on cerebral angiography. In conclusion, CDAVF type I of the lateral sinus occurs predominantly in middle aged women and presents with unilateral pulsatile tinnitus, which resulted in impairment of social and occupational functioning in the vast majority of patients. An audible bruit at retroauricular auscultation confirms the clinical diagnosis of a cerebral dural fistula. MRI is not helpful in the diagnosis and cerebral angiography is indicated to classify the dural fistula.

Resection of the lesion in patients with hypothalamic hamartomas and catastrophic epilepsy.

BACKGROUND: Patients with hypothalamic hamartomas (HH) often have severe refractory epilepsy, incapacitating behavioral abnormalities, and cognitive decline. Attempts to control the seizure disorder by resection of apparently epileptogenic mesial temporal or other cortical structures have failed consistently. OBJECTIVE: To report a series of 13 patients in whom the hamartoma itself was resected. METHODS: All patients underwent preoperative evaluation between ages 2 and 33 years and had subtotal or complete resection of the hamartoma. Follow-up ranged from 1 to 5.5 years (mean: 2.8 y). RESULTS: Preoperatively, all patients had variable combinations of gelastic, complex partial, and generalized seizures. Eight had drop attacks. In addition, all had marked behavior abnormalities and cognitive impairment. Postoperatively, two patients are completely seizure-free and 11 are either seizure-free or have achieved a greater than 90% reduction of drop attacks and generalized tonic-clonic seizures. However, minor gelastic, complex partial, and atypical absence seizures have persisted in 11 patients, although at significantly reduced rates. In addition, there has been a dramatic improvement in behavior and cognition. Three patients had an anterior thalamic and one a capsular infarct, which left only minimal long-term deficits. Exact location of the lesion in relation to the interpeduncular fossa and the walls of the third ventricle correlated with extent of excision, seizure control, and complication rate. CONCLUSION: Resection can alleviate both the seizures and the behavioral and cognitive abnormalities of hypothalamic hamartomas, but complications are frequent.

Encephalocraniocutaneous lipomatosis with otolaryngologic manifestations: a rare neurocutaneous syndrome.

Encephalocraniocutaneous lipomatosis (ECCL) is a rare congenital disorder and was first described in 1970. The main clinical features of the syndrome include convulsions beginning in infancy, mental retardation, and unilateral cutaneous and ophthalmologic lesions with ipsilateral cerebral manifestations. A 14-year-old caucasian boy with ECCL associated with otolaryngologic manifestations is reported. To our knowledge, this is the first case of ECCL with otolaryngologic manifestation in the English literature.

The amino-terminus of the amyloid-beta protein is critical for the cellular binding and consequent activation of the respiratory burst of human macrophages.

Here, we show that amyloid-beta (Abeta) is capable to prime and activate the respiratory burst of human macrophages. Previously, the N-terminus of Abeta(1-42) has been shown to contain a cell binding domain that is implicated in eliciting neuropathogenic microglia in vitro. To evaluate the role of this domain in the Abeta(1-42)-induced respiratory burst activity, the effect of Abeta subfragments on the Abeta(1-42)-induced superoxide release were studied. On the basis of the antagonistic properties of Abeta(1-16), it is concluded that the N-terminal region of Abeta is critical for the cellular binding and consequent activation of the respiratory burst of human phagocytes.

Electrographic evidence suggests that human dysplastic cortex is intrinsically epileptogenic

Lesöes displásicas corticais (LDC) estäo frequentemente associadas a epilepsias de difícil controle. Nós descrevemos os correlatos eletrográficos deste alto grau de epileptogenicidade, caracterizado por descargas epileptógenas rítmicas, contínuas ou quase-contínuas, registradas diretamente das LDC durante eletrocorticografia trans-operatória. Esta atividade ictal ou descargas epileptogênicas contínuas (AI/DEC) manifestava-se por um de três padröes: (a) crises eletrográficas repetidas; (b) surtos de polipontas recorrentes; ou (c) espículas rítmicas contínuas ou quase-contínuas. Um ou mais destes padröes estava presente em 23 de 34 pacientes (67 por cento ) com epilepsia partial de difícil controle associada a LDC. Esta AI/DEC era geralmente mais localizada, assim contrastando com a atividade interictal ao eletrocorticograma, que era mais difusa. Nós concluimos que LDC säo altamente e intrinsicamente epileptogênicas e discutimos mecanismos possivelmente relacionados a esta epileptogenicidade intrínsica

Cerebral metastasis from choriocarcinoma and oncotic aneurysms. Case report.

Cerebral metastasis occur in 10 to 20% of patients with choriocarcinoma. We describe the twelfth patient with oncotic aneurysms from choriocarcinoma verified by cerebral angiography. The importance to consider this disease in a woman of childbearing age who develop an intracerebral hemorrhage or a lesion with mass effect is emphasized, as well as laboratial and radiological characteristics. Therapeutic approaches with chemotherapic agents, surgery and irradiation are discussed.

Cerebral metastasis from choriocarcinoma and oncotic aneurysms

Cerebral metastasis occur in 10 to 20% of patients with choriocarcinoma. We describe the twelfth patient with oncotic aneurysms from choriocarcinoma verified by cerebral angiography. The importance to consider this disease in a woman of childbearing age who develop an intracerebral hemorrhage or a lesion with mass effect is emphasized, as well as laboratial and radiological characteristics. Therapeutic approaches with chemotherapic agents, surgery and irradiation are discussed

Anatomoradiological correlation of the intersection of the carotid siphon with the dura mater.

In order to obtain frames of reference to determine the place of intersection of the carotid siphon with the dura mater in conventional arteriograms, a debated topic lacking general agreement in the literature, 34 cadaveric sphenoids were prepared with the injection of radiopaque medium in both internal carotid arteries. After having marked the dura mater with steel wire, the pieces were radiographed in lateral view. The points of intersection of the clinoclinoid line and the sphenoidal line with the internal carotid artery as well as the emergence of the ophthalmic artery and its posterior projection were marked on the radiographs obtained. The distances between the various points were measured and submitted to statistical treatment. The results showed multiple regressions with a strong correlation coefficient in two equations. A table was built in which, knowing the distances between the points of the clinoclinoid and the sphenoidal plane lines and those of the ophthalmic artery and its projection, the position of the dura mater which covers the cavernous sinus may be estimated in arteriograms.