ABSTRACT
Disk herniation can manifest as isolated low back pain, which is usually intermittent and accompanied with stiffness of the lumbar spine. There is almost general agreement that neither neurosurgical treatment nor chemonucleolysis is appropriate in patients with this clinical pattern. We used chemonucleolysis in 19 patients with recurrent episodes of isolated low back pain and one patient with severe permanent isolated low back pain dating back to a conservatively-treated episode of sciatica. All 20 patients had disk herniation documented by imaging studies. A very good or satisfactory outcome was recorded in ten patients after three months, 11 after six months and 12 in March 1993 after a mean follow-up of 72 months. The treatment was well tolerated, even in those patients who were not improved; a single patient developed an episode of acute low back pain that required surgical treatment. In patients with low back pain and disk herniation, there is currently no means of determining whether a causal relationship links these two abnormalities. Nevertheless, we believe that chemonucleolysis can be proposed in severe forms, provided the patients are apprised of current success rates.
Subject(s)
Intervertebral Disc Chemolysis , Intervertebral Disc Displacement/drug therapy , Low Back Pain/etiology , Lumbar Vertebrae , Sacrum , Adult , Female , Follow-Up Studies , Humans , Intervertebral Disc Displacement/complications , Low Back Pain/drug therapy , Male , Middle AgedABSTRACT
The authors report the case of an isolated supratentorial hemangioblastoma occurring in a woman operated on for a cerebellar hemangioblastoma twenty years before. The data furnished by immunohistochemical technics don't seem to be deciding and don't work out the problem of hemangioblastoma histogenesis.
Subject(s)
Hemangiosarcoma/diagnosis , Supratentorial Neoplasms/diagnosis , Carotid Arteries/diagnostic imaging , Cerebellar Neoplasms , Female , Hemangiosarcoma/pathology , Humans , Infratentorial Neoplasms , Middle Aged , Neoplasms, Multiple Primary , Supratentorial Neoplasms/pathology , Tomography, X-Ray ComputedSubject(s)
Brain Diseases/complications , Cerebral Cortex , Adult , Aged , Aged, 80 and over , Brain Diseases/diagnostic imaging , Diagnosis, Differential , Female , Humans , Leg/innervation , Male , Middle Aged , Nervous System Diseases/etiology , Peripheral Nervous System Diseases/diagnosis , RadiographyABSTRACT
The authors report on the case of a young woman, seven months gone, with an history of sudden onset of successive lobar intracerebral hematomas. They revealed a Rendu-Osler-Weber disease. The mechanism is discussed.
Subject(s)
Cerebral Hemorrhage/etiology , Hematoma/etiology , Pregnancy Complications, Cardiovascular , Telangiectasia, Hereditary Hemorrhagic/complications , Adult , Cerebral Hemorrhage/diagnostic imaging , Female , Hematoma/diagnostic imaging , Humans , Pregnancy , Radiography , Recurrence , Time FactorsABSTRACT
The authors report a case of L4-L5 foraminal disc herniation revealed by symptoms of bi-radicular and medullary lesions. Anatomical study allows to understand such association of symptoms.
Subject(s)
Intervertebral Disc Displacement/complications , Ischemia/etiology , Spinal Cord/blood supply , Spinal Nerve Roots/blood supply , Aged , Female , Humans , Lumbar Vertebrae , Sciatica/etiologySubject(s)
Brain Neoplasms/complications , Meningioma/complications , Thrombocytosis/complications , Female , Humans , Middle AgedABSTRACT
Three cases of spinal cord tumor, revealed by hydrocephalus, are reported. Two patients showed symptoms of increased intracranial pressure and the third one presented himself with ataxic gait without intellectual impairment nor incontinence. In two cases ventriculo atrial shunt was initially inserted and the correct diagnosis was made only later on myelogram because lombosciatalgia or syndrome of the cauda equina. Clinical outcome was satisfying after surgical removal of the tumor. The nature of which was a neurinoma of the cauda equina; a lumbar intradural granuloma and an ependymoma of the cauda equina. The mechanism by which spinal cord tumors raised intracranial hypertension is discussed.
Subject(s)
Hydrocephalus/etiology , Pseudotumor Cerebri/etiology , Spinal Cord Neoplasms/complications , Adolescent , Adult , Cauda Equina , Ependymoma/complications , Female , Granuloma/complications , Humans , Male , Middle Aged , Neurilemmoma/complications , Spinal Cord Diseases/complicationsABSTRACT
A case of a surgically verified neurinoma of the oculomotor nerve is presented. The diagnostic difficulties due to the parasellar localisation are discussed. Computed tomography scan data rarely allow to distinguish the nature of the tumor and in all cases are insufficient to distinguish a trigeminal nerve neurinoma of the oculomotor nerves.
Subject(s)
Neurilemmoma/diagnostic imaging , Oculomotor Nerve , Cerebral Angiography , Female , Humans , Middle Aged , Neurilemmoma/surgery , Tomography, X-Ray ComputedABSTRACT
Dysphagia due to a traumatic lesion of the foramen lacerum posterior is relatively rare. Two cases are described in which swallowing troubles were perceived when the post-traumatic coma improved; these were ascribed to a traumatic lesion of the foramen lacerum posterior injuring the cranial nerves. Treatment involves preventing inhalation and nasogastric feeding whilst starting active and early rehabilitation of swallowing. Recovery is possible in most cases without surgery.
Subject(s)
Deglutition Disorders/etiology , Occipital Bone/injuries , Skull Fractures/complications , Adolescent , Child, Preschool , Coma , Cranial Nerve Injuries , Humans , Intubation, Gastrointestinal , Laryngoscopy , Male , Radiography , Skull Fractures/diagnostic imagingABSTRACT
A 31-year old primigravida was admitted at 31 week gestation for subarachnoid haemorrhage. Cerebral angiography revealed an aneurysm on the left middle cerebral artery. Eleven days later, the aneurysm was clipped off. General anaesthesia was induced with thiopentone, pancuronium and fentanyl, and maintained with fentanyl (40 micrograms.kg-1) and isoflurane in air/O2 with a non-rebreathing circuit. The patient was mechanically ventilated to maintain mild hypocapnia. Arterial hypotension was induced by increasing the inspired isoflurane concentration from 1 to 3 vol%. The response was immediate and a mean arterial pressure of 60 mmHg was maintained for 80 min with an inspired isoflurane concentration of 2.5 vol%. Foetal heart rate was monitored before, during and after general anaesthesia. Loss of beat to beat variation was observed after induction, and foetal heart rate slowly decreased from 150 to 115 b.min-1 at the end of the operation. Postoperative state was good, except for transitory aphasia. At 35 week gestation, the patient went into premature labour, with hypothermia of 39.5 degrees C; an emergency caesarean section was performed. The 2,340 g female infant had a 10 min Apgar score of 8. One month later, clinical examination of the mother and daughter was quite normal. The precautions and anaesthetic management of patients suffering from ruptured cerebral aneurysm during the end of pregnancy are reviewed. Hypotensive agents are discussed.
Subject(s)
Hypotension, Controlled , Intracranial Aneurysm/surgery , Isoflurane , Pregnancy Complications/surgery , Adult , Cesarean Section , Female , Fetal Monitoring , Humans , Intracranial Aneurysm/complications , Pregnancy , Pregnancy Trimester, Third , Subarachnoid Hemorrhage/etiologyABSTRACT
A 22 year old woman had a seizure, and the skull X-ray showed an intracranial arched calcification. CT scan permitted diagnosis of dermoid cyst. Rupture of the cyst was testified by low density areas disseminated on the cortical surface and intra-ventricular fat level. Surgical removal confirmed dermoid cyst with rupture and fat fluid inside. Authors underline infrequency of such intra-ventricular fat level. CT scan, with low density of lipidic origin promote considerably such diagnosis both of the real nature of the cyst and of its rupture.
Subject(s)
Brain Neoplasms/diagnostic imaging , Dermoid Cyst/diagnostic imaging , Adult , Female , Humans , Radiography , Rupture, SpontaneousABSTRACT
The stability of anaesthesia and the quality of recovery obtained with low doses of enflurane were studied. Two groups of 20 patients operated for lumbar slipped disc were compared. The mean age and weight distribution of the two groups were not statistically different. Induction was the same in the two groups (diazepam, fentanyl, pancuronium and nitrous oxide). In one group, enflurane (0.4%) was added with controlled ventilation. Thiopentone was added if some spontaneous movements were observed, if arterial pressure and heart rate increased, and if the digital plethysmograph curve decreased. The quality of recovery was assessed by number-connection tests 1 and 2 h after the end of anaesthesia. Thiopentone was required five times in the group without enflurane, whilst it was never used in the group with enflurane. This difference was statistically significant (p less than 0.01) and showed a more important stability of anaesthesia when enflurane (0.4%) was used. No statistically significant difference was found in the recovery scores between the two groups 1 and 2 h after the end of anaesthesia. It was proposed that low doses of enflurane were sufficient to increase the effects of the other anaesthetic drugs without any residual effect on recovery. Low doses of enflurane could be used during anaesthesia induced with fentanyl and diazepam, giving better stability during anaesthesia without any pernicious effects on recovery.
Subject(s)
Anesthesia, General/methods , Enflurane/administration & dosage , Adult , Anesthesia Recovery Period , Drug Synergism , Female , Humans , Intraoperative Period , Male , Middle Aged , Thiopental/administration & dosageSubject(s)
Athletic Injuries , Sports , Tennis , Vertebral Artery/injuries , Adolescent , Humans , MaleABSTRACT
Infection of six cerebro-spinal fluid shunts in six patients were treated with daily intrashunt injections of antibiotics plus combination of intravenous or oral systemic antibiotic therapy. Three organisms were involved in the shunt infection: staphylococcus epidermidis in five, staphylococcus capitis and micrococcus varians. One patient had mixed shunt infection with micrococcus varians and staphylococcus épidermidis. All six patients received daily intrashunt injections of vancomycin and oral rifampin with a combination of trimethoprim/sulfamethoxazole (three patients), or intravenous fosfomycin (two patients), or intravenous vancomycin (one patient). Four of six cases were considered cured of their infection without shunt surgery. Their hydrocephalus will be well controlled during antibiotic therapy. Surgery was necessary for two patients with associated shunt malfunction, one of them was considered a treatment failure of antibiotic therapy.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Cerebrospinal Fluid Shunts/adverse effects , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Bacterial Infections/etiology , Child , Drug Therapy, Combination , Female , Humans , Infant , Male , Micrococcus , Middle Aged , Staphylococcal Infections/drug therapy , Staphylococcus epidermidisSubject(s)
Anticoagulants/adverse effects , Cerebral Hemorrhage/chemically induced , Hemorrhage/chemically induced , Spinal Diseases/chemically induced , Aged , Cerebral Hemorrhage/drug therapy , Cerebral Hemorrhage/surgery , Emergencies , Female , Hematoma, Epidural, Cranial/chemically induced , Hematoma, Epidural, Cranial/drug therapy , Hematoma, Subdural/chemically induced , Hematoma, Subdural/drug therapy , Hemorrhage/drug therapy , Heparin/adverse effects , Humans , Male , Middle Aged , Protamines/therapeutic use , Spinal Diseases/drug therapy , Vitamin K/antagonists & inhibitorsABSTRACT
The case is reported of an 18 year old patient who developed a peripheral neuropathy after being given 1.5 g ornidazole daily for 6 days and 2 g daily for 16 days (total dose: 41 g). Bilateral radial paralysis was noted clinically, whilst electrical investigations showed diffuse motor and sensitive anomalies. Three months after the drug had been stopped, all symptoms and signs had disappeared. The pathogenesis of this complication is discussed. The part played by ornidazole is suggested but cannot be proved because of the multiple disorders presented by the patient.