Isolated accessory nerve palsy of unusual cause.

We report the case of a 23 year old male patient who presented for an isolated left accessory nerve palsy which had appeared one year before. Neuroradiological investigations showed that the causative pathology was a giant saccular aneurysm of the intracranial left vertebral artery. Three months after diagnosis, signs of bulbar palsy rapidly developed. An emergency intra-arterial embolization was then attempted, which led to complete recovery except for the accessory nerve palsy which remained unchanged. We conclude that, in cases of apparently isolated accessory nerve palsy, neuroradiological investigations should include the posterior fossa.

[Traumatic lesions of the brachial plexus. Evaluation of 144 cases studied using direct cervical myelography and non-ionic contrast media]. / Le lesioni traumatiche del plesso brachiale. Valutazione di 144 casi studiati con mielografia cervicale diretta e mezzo di contrasto non ionico.

The authors report their experience in 144 patients with traumatic brachial plexus injury who underwent Direct Cervical Myelography (DCM). Sometimes the diagnostic investigation was completed by CT. Various myelographic patterns are described: pseudomeningocele, missing sheet of the root, scarring lesions. In 9 cases only, myelography was not sufficient to provide a complete diagnosis. The examination showed all plexus roots lacerated in 14 patients, a monoradicular lesion in 75 cases, and no lesion in 26 cases. Twenty-one out of the 26 negative cases were confirmed during surgery, while in 2 patients an intraspinal injury was found, which had not been detected due to the presence of scars. Scars often compress healthy roots, and may mask intraspinal injuries. In such cases, and when the spinal cord stretches towards the side of the lesion, Myelo-CT can be useful. DCM proved to be an extremely sensitive and specific method, which can be used as a first-choice radiological procedure in the study of traumatic injuries of the brachial plexus.

Lower cranial nerve palsy produced by internal carotid artery dilatation. Report of two cases.

We report two cases of lower cranial nerve palsies (XII in case 1, IX-X-XII in case 2) associated with abnormalities of the internal carotid artery at the base of the skull. In case 1 a limited dissection of the carotid wall produced both paresis of the hypoglossal nerve and Horners syndrome by compression of the nerve trunk against the base of the skull and stretching of the periarterial sympathetic fibres respectively. In case 2 we speculate that a narrow angled kinking of the internal carotid artery may have damaged cranial nerves IX, X and XII by interfering with the blood supply to the nerve trunks. In both cases the outcome was favorable with almost complete regression of the initial symptoms. We conclude that the association between lower cranial nerve disturbances and internal carotid artery abnormalities is probably more common than was thought. We suggest that the pathogenesis of the damage to the cranial nerves may differ from one case to the next.

[Comparative study between cerebral seizure and the climatic trend in the province of Brescia]. / Studio comparativo fra ictus cerebrale ed andamento climatico nella provincia di Brescia.

This study seeks to identify which of the various climatic parameters is the most significant causative factor for the onset of cerebral ictus or TIA in subjects clinically "at risk". The research was conducted in the province of Brescia, where it was discovered that the most stressful climatic factor was a warm, dry south-westerly wind (SW). It was postulated that such climatic conditions may favour platelet aggregation by means of an increase in the charge of positive ions in the air.