ABSTRACT
A case of metastasis of primary lung-carcinoma to a cerebral artero-venous haemangioma is presented. Although the phenomenon of metastasis to primary brain neoplasm is being recognised with increasing frequency, we've found only two cases into vascular tumours reported. The authors emphasize the rarity of this occurrence and discuss the possible pathogenetic mechanisms, which are at present incompletely understood.
Subject(s)
Brain Neoplasms/secondary , Carcinoma, Small Cell/secondary , Hemangioma, Cavernous/pathology , Hemangioma/pathology , Lung Neoplasms/pathology , Neoplasm Metastasis/physiopathology , Neoplasms, Multiple Primary , Temporal Lobe , Aged , Brain Neoplasms/pathology , Humans , MaleABSTRACT
We have explored the variability of P300 event-related potentials in patients affected by Hakim-Adams syndrome, with raised or intermittent intracranial pressure, treated with surgical cerebrospinal fluid shunting. The clinical utility of P300 is confirmed in the light of the improvement of neurophysiological data after the surgical procedure, parallel with amelioration of neuropsychological performances.
Subject(s)
Arousal/physiology , Attention/physiology , Cerebrospinal Fluid Pressure/physiology , Dementia/physiopathology , Evoked Potentials, Auditory/physiology , Hydrocephalus, Normal Pressure/physiopathology , Hydrocephalus/physiopathology , Pitch Perception/physiology , Aged , Cerebrospinal Fluid Shunts , Dementia/surgery , Female , Humans , Hydrocephalus/surgery , Hydrocephalus, Normal Pressure/surgery , Male , Middle Aged , Neuropsychological Tests , Reaction Time/physiology , Reference Values , SyndromeABSTRACT
Rhabdomyolysis during routine surgery was studied in three groups of patients who had surgery, with limited trauma to muscle, in the lateral and supine positions, and prone on the spinal frame. A range of blood tests was performed (before surgery, and on the first, third and seventh day after operation). These showed that a creatine kinase increase in the 24 hours and the early appearance of myoglobin in the serum were the best indicators. Rhabdomyolysis was associated with the lateral position and long lasting surgery. No blood test before surgery was of any predictive value.
Subject(s)
Posture , Rhabdomyolysis/etiology , Surgical Procedures, Operative , Adult , Aged , Creatine Kinase/blood , Humans , Middle Aged , Myoglobin/blood , Predictive Value of Tests , Rhabdomyolysis/bloodABSTRACT
The authors report a study conducted in three Italian neurosurgical centres on 158 patients admitted after a minor head injury and with CT findings of a hitherto asymptomatic significant extradural haematoma. All patients were examined both prospectively by means of a computerized record containing 18 clinical and radiological parameters, and retrospectively by logistical regression analysis, in order to ascertain which factors influenced most the choice of surgical vs. conservative management. The size of the haematoma, rather than its location, and the degree of midline shift were the factors most influential in deciding in favour of surgical treatment, with a specificity of 0.83 and a sensitivity of 0.92. Conservative management of haematomas having a maximum thickness of less than 10 mm with a midline shift of less than 5 mm appears as safe. Outcome was "good recovery" in both the surgical and the nonsurgical patients, with only one death in the whole series, unrelated to the extradural lesion. This study focuses attention on a group of patients who are seldom examined by CT scan, but who can harbour potentially lethal lesions. Extension of CT scan examination to all adult patients with a minor head injury and a skull fracture can be recommended in order to identify significant haematomas in an asymptomatic phase.
Subject(s)
Brain Injuries/diagnostic imaging , Hematoma, Epidural, Cranial/diagnostic imaging , Skull Fractures/diagnostic imaging , Adolescent , Adult , Brain Injuries/complications , Brain Injuries/surgery , Child , Female , Hematoma, Epidural, Cranial/etiology , Hematoma, Epidural, Cranial/surgery , Hematoma, Subdural/diagnostic imaging , Hematoma, Subdural/etiology , Hematoma, Subdural/surgery , Humans , Male , Middle Aged , Multicenter Studies as Topic , Prospective Studies , Retrospective Studies , Skull Fractures/complications , Skull Fractures/surgery , Tomography, X-Ray ComputedSubject(s)
Brachial Plexus , Electromyography , Nerve Compression Syndromes/diagnosis , Reflex, Abnormal/diagnosis , Adult , Female , HumansSubject(s)
Intervertebral Disc Displacement/physiopathology , Adult , Aged , Electromyography , Female , H-Reflex , Humans , Lumbar Vertebrae , Male , Middle Aged , Nervous System Diseases/diagnosis , Spinal Nerve RootsSubject(s)
Hydrocephalus, Normal Pressure , Hydrocephalus , Amines/metabolism , Brain/metabolism , Cerebrovascular Circulation , Humans , Hydrocephalus/diagnosis , Hydrocephalus/diagnostic imaging , Hydrocephalus/etiology , Hydrocephalus, Normal Pressure/diagnosis , Hydrocephalus, Normal Pressure/diagnostic imaging , Hydrocephalus, Normal Pressure/etiology , Intracranial Pressure , Pneumoencephalography , Serotonin/metabolism , Tomography, X-Ray Computed , Tryptophan/metabolismABSTRACT
Concentrations of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were investigated by lumbar cerebrospinal fluid (CSF) of 21 patients with partial and total spinal subarachnoid block. HVA levels in CSF below a complete block were significantly lower and 5-HIAA levels were signigicantly higher than controls. Below a partial block, HVA levels were normal; 5-HIAA levels were higher than in patients with complete block. Possible explanations for these findings are discussed.
Subject(s)
Brain/metabolism , Homovanillic Acid/cerebrospinal fluid , Hydroxyindoleacetic Acid/cerebrospinal fluid , Phenylacetates/cerebrospinal fluid , Spinal Cord/metabolism , Adolescent , Adult , Aged , Catecholamines/metabolism , Female , Humans , Male , Middle Aged , Serotonin/metabolism , Spinal Nerves/metabolism , Subarachnoid SpaceABSTRACT
21 cases of hypertensive hydrocephalus were investigated for lumbar 5-HIAA before and after operation. Seven groups (posterior fossa tumors) of patients aged between 2 and 12 years were tested after tumor removal; the others (nontumorous hydrocephalus) after ventricular shunting. This last group included 8 patients with noncommunicating hydrocephalus aged between 15 days and 12 years and 6 with communicating hydrocephalus aged between 6 months and 9 years. At the time of the second determination all patients presented an improvement of clinical signs of intracranial hypertension. A correlative analysis of 5-HIAA values before and after operation is made. In tumor cases, preoperative levels were higher than controls, and a significant decrease was found after operation in comparison with preoperative levels. In nontumor cases, a significant decrease was also observed in noncommunicating hydrocephalus, confirming clinical usefulness of the results for controlling the degree of the intracranial hypertension and, in consequence, shunt performance. In communicating cases the results were disappointing, because almost always postoperative levels did not differ from the preoperative ones. Possible interpretations of the data are analyzed.
