Intramedullary pyogenic abscess in the conus medullaris.

Primary pyogenic abscess in the conus medullaris in a healthy adult has never been reported. An urgent MRI scan with contrast and prompt surgical evacuation may lead to good neurological recovery.

Intraosseous schwannoma of the cervical spine.

The authors report a rare case of a cervical intraosseous schwannoma, which was diagnosed following an incidental history of trauma. This is the first case of an intraosseous schwannoma of the cervical vertebra that was diagnosed using magnetic resonance imaging. The authors discuss the radiological imaging, surgical procedure and review the relevant literature.

Primary and secondary control over age-related changes in physical appearance.

Beliefs about appearance-related changes due to aging were used to test the effects of perceived control and secondary control (acceptance) in a sample of 412 young, early-middle-age, and late-middle-age college-educated adults. Mean difference in aging-related appearance control and hypotheses regarding the adaptiveness of primary and secondary control were examined. Primary control over aging-related appearance was lower in older adults and secondary control was higher. In addition, the results indicated support for the Primacy/Back-Up Model that primary perceived control is important at all levels of actual control. Those with stronger beliefs in their primary control were less distressed. Secondary control served a back-up function in that it was related to less distress only for those who had medium or lower beliefs in primary control. The implications of these findings, that primary control may be advantageous even in low-control circumstances, are discussed.

A clinical evaluation of the Camino subdural screw and ventricular monitoring kits.

The aim of this study was to compare readings of intracranial pressure from a ventricular catheter with those obtained from a Camino catheter-tipped transducer. The Camino transducer was evaluated in two ways: firstly, when it was inserted by a subdural screw, and secondly, when it was inserted into a ventricular catheter using a ventricular monitoring kit. Data were recorded for 376 hours for the subdural screw method and for 486 hours for the ventricular monitoring kit. Average pressure readings were calculated every 5 minutes (10 half-minute values), and regression analysis was performed. For the subdural screw method, the correlation coefficient was 0.945 (gradient, 1.04; intercept, -5.51. The results from the ventricular monitoring kit showed that the correlation coefficient was 0.901 (gradient, 0.93; intercept, -0.92. The correlation between recordings of ventricular fluid pressure and the Camino recordings obtained from both subdural screw insertions and ventricular monitoring kits was good, with the subdural screw method proving more accurate and reliable in clinical use.

Experimental intracerebral hemorrhage: progression of hemodynamic changes after production of a spontaneous mass lesion.

The aim of the study was to determine whether the extent of ischemia produced by an experimental space-occupying lesion changed between 5 minutes and 4 hours after the production of a lesion. In two groups of rats, a 50-microliter balloon was inflated in the right caudate nucleus. Cerebral blood flow (CBF) was determined by 14C-iodoantipyrine quantitative autoradiography, in Group 1 (n = 6) 5 minutes after inflation and in Group 2 (n = 6) 4 hours later. After 5 minutes of inflation, the mean blood flow in the caudate nucleus was reduced to 65% of the contralateral value and 11.5% of the ipsilateral caudate nucleus had a blood flow of below 25 ml/100 g/minute. After 4 hours of inflation, there was a greater fall in the mean CBF of the ipsilateral caudate nucleus to 30% of the contralateral value, and 38.9% of the ipsilateral caudate nucleus had a CBF of less than 25 ml/100 g/minute. The differences between the two groups were significant (mean CBF, P less than 0.01; CBF less than 25 ml/100 g/minute, P less than 0.02). The results show that the initial ischemic lesion produced by a spontaneous intracerebral space-occupying lesion does not remain static, but progresses with time and is significantly greater after 4 hours than after 5 minutes. Interventions that reduce the progression of ischemia may be beneficial in reducing the ultimate amount of ischemic brain damage.

Experimental intracerebral haemorrhage: the effect of nimodipine pretreatment.

The effect of pretreatment with the calcium antagonist nimodipine on the pathophysiological events which follow an intracerebral haemorrhage in rats was compared with a similar control group. Cerebral blood flow was higher and the amount of pathologically determined ischaemic damage measured by light microscopy was less in the nimodipine pretreated group. Bloodbrain barrier permeability was increased in the nimodipine group, but there was no evidence of cerebral oedema. Nimodipine appeared to have no effect on the intracranial pressure.

Experimental intracerebral hemorrhage: effects of a temporary mass lesion.

Late pathophysiological events after the production and subsequent removal of an intracerebral mass were investigated using a mechanical microballoon model to simulate intracerebral hemorrhage. Immediately following balloon inflation in the caudate nucleus of rats, there was a significant increase in intracranial pressure to 14 +/- 1 mm Hg (mean +/- standard error of the mean), accompanied by a reduction in cerebral blood flow (CBF) in the ipsilateral frontal cortex, as measured by the hydrogen-clearance technique. Carbon-14-iodoantipyrine autoradiography revealed a significant reduction in the CBF of the ipsilateral caudate nucleus 4 hours after balloon inflation: 31% of the caudate nucleus had a CBF of less than 20 ml X 100 gm-1 X min-1 compared to only 1% in the sham-treated control group (balloon insertion without inflation). The rats with an intracerebral mass exhibited a significant increase in the volume of ischemic damage in the ipsilateral caudate nucleus (17.1% of total volume) compared to only 1.7% in the sham-treated group; however, there was no evidence of cerebral edema. Ischemic damage and reduced CBF persisted for 4 hours after transient inflation of a microballoon in the caudate nucleus. This suggests that ischemic damage occurs at the time of formation of the lesion and is not prevented by its early removal.

Distant extradural haematoma complicating removal of frontal tumours.

The authors report two patients who developed occipito-parietal extradural haematomas following removal of large frontal meningiomas. In both, CT scanning aided diagnosis and subsequent management. Although rare, this complication should be considered when patients deteriorate or fail to improve after removal of frontally situated tumours or inexplicable brain swelling is encountered at the time of original surgery.