Lhermitte duclos disease and Cowden disease: clinical, pathological and neuroimaging study of a case.

The authors report the case of a 26-year-old female patient affected by Lhermitte Duclos disease and Cowden disease. Preoperative MRI allowed a correct diagnosis which was confirmed by pathological examination. The authors stress the possibility that Lhermitte Duclos and Cowden disease be a single phakomatosis; for this reason all the patients affected by Lhermitte-Duclos should be screened for the presence of multiple hamartomas or malignant neoplastic lesions typical of Cowden disease.

Cervical spinal epidural abscesses. A report on five cases.

The authors report a series of five cases of non tuberculous cervical spinal epidural abscesses. There were neither patients suffering from immunodeficiency syndromes nor drug addicts; all the patients were in their seventh decade; two patients were affected by diabetes mellitus refractory to medical treatment. Retropharyngeal abscess was the main etiological risk factor (two cases); Staphylococcus aureus was cultured in two cases. Gadolinium MRI was necessary for a preoperative diagnosis, planning surgical approach and postoperative prognosis. Surgical debridement was performed via an anterior approach in those cases where the collection was located lower than C4 and did not span more than three vertebral segments; posterior approach, via a laminectomy, was performed in a case of C1-C2 location of the lesion and in a case of involvement of the whole cervical spine. Surgical results were poor in those patients affected by diabetes mellitus, a lesion involving the high cervical segments (higher than C4) or a lesion spanning more than three levels. Medical treatment with MRI follow-up was not undertaken in any of the patients and we opted for surgical drainage in all the cases due to the possibility of a sudden neurological deterioration, caused both by spinal cord mechanical compression and vascular compromission.

Spinal malignant melanotic schwannoma. Case report.

The authors report a rare case of spinal cord compression syndrome due to a malignant melanotic schwannoma. Pathogenesis, diagnostic difficulty and therapeutical problems are discussed. The authors conclude that such tumours should be surgically treated due to the possibility of a benign clinical behaviour even in those cases showing malignant histological features.

Infected cerebral hemorrhage by ruptured infectious anterior communicating artery giant aneurysm in a patient with T cell acute lymphoblastic leukemia. Case report.

Although the majority of infectious (bacterial) intracranial aneurysms occur in patients with subacute bacterial endocarditis, septic cerebral embolization and infectious intracranial aneurysm formation can also occur in immunocompromised patients. We report the case of ruptured bacterial aneurysm occurring in a 19 years old man immunocompromised by vigorously treated acute lymphoblastic leukemia. This case confirms very poor prognosis for infectious aneurysms in immunocompromised patient reported in literature, suggesting that a high index of suspicion needs for early diagnosis and that a conservative approach (high dose antibiotic therapy with possible delayed surgery) should be preferred unless intracerebral hemorrhage or abscess with significant mass effect provides a clear indication for operative intervention.

Idiopathic middle cerebral artery occlusion in children: report on three cases.

Three cases of middle cerebral artery occlusion in children are reported. The origin of M1 was the site of occlusion in two cases, while occlusion 1 cm after the origin of M1 was found in the third. The possible etiological diagnosis was infectious arteritis in the first two cases, cranial trauma in the third. In no case were serious contralateral motor deficits detected in follow-up examinations. Follow-up digital subtraction angiography showed complete regression of arterial lesions in the second case. The authors conclude that middle cerebral artery occlusion may have a benign clinical course in children; surgical revascularization is indicated only in highly selected cases.

Cauda equina compression syndrome in a patient affected by thalassemia intermedia: complete regression with blood transfusion therapy.

Surgical excision followed by radiotherapy has been reported to be successful in the treatment of spinal cord compressions due to extramedullary hematopoiesis in patients affected by thalassemia. The authors report a case of cauda equina compression in such a patient successfully treated with repeated blood transfusions.

Neurocysticercosis treated with praziquantel. Long-term follow-up of a case.

The Authors report a case of neurocysticercosis treated with praziquantel and ventriculoperitoneal shunt. The patient presented, at CAT, multiple intracranial calcifications and cysts located in the cerebral parenchyma, ventricular system and subarachnoid cisterns. Praziquantel was orally administered at a daily dosage of 50 mg/kg. Two 15 day cycles of therapy were administered with an interval of one month between them. No significant side effects were observed during the treatment. Serial follow-up CAT scans demonstrated a gradual decrease in size and, finally, total disappearance of the cystic lesions. No neurological disfunction was observed at the last follow-up examination 4 years after treatment.

A case of thrombosed aneurysm of the vein of Galen associated with superior sagittal sinus thrombosis.

A case of thrombosed aneurysm of the vein of Galen associated with superior sagittal sinus thrombosis is reported. Clinical course was characterized by multiple intraparenchimatous hemorrhages and hydrocephalus. NMR showed dural sinuses thrombosis better than CT even though cerebral angiography was more effective for the diagnosis. Intracranial hypertension due to hydrocephalus was relieved with a ventriculoperitoneal shunt. The authors suggest that the abnormal hemodynamic patterns due to the drainage of the malformation into the vein of Galen and dural sinuses led to venous occlusion and multiple intracranial hemorrhages.

Craniocerebral gunshot wounds in civilians. Report on 40 cases.

The Authors report an analysis on 40 cases of craniocerebral gunshot wounds treated in a civil hospital over a 8-year period. The important role of CT for a correct diagnosis and treatment planning is stressed even though patients with a G.C.S. lower than 4 die regardless of their CT findings; subdural and intracerebral hematomas are not a serious complication unless patient's neurological status is poor; timing of surgical treatment plays a major role in order to avoid infection of the wound.

Rhizopus arrhizus in Italy as the causative agent of primary cerebral zygomycosis in a drug addict.

A rare case of primary cerebral zygomycosis in an Italian drug addict is described. The diagnosis was based on the histologic detection of broad, aseptate, hyaline mycelium in fluid aspirated from a brain mass detected by computerized axial tomography. The zygomycete isolated from the clinical specimen was identified as Rhizopus arrhizus var arrhizus. The patient had no known predisposing condition that would have suppressed his immunological defenses. Once the diagnosis was established, treatment with amphotericin B was initiated, but the patient died during the first day of treatment.

Computed axial tomography versus NMR for the diagnosis of neurocysticercosis.

A case of generalised neurocysticercosis in a 45-year-old woman is presented with CT and NMR findings. The great additional value of NMR for the diagnosis of this disease is stressed.

Malignant ventricular arrhythmia in the Wolff-Parkinson-White syndrome during amiodarone treatment.

The ventricular rate during rapid atrial rhythms is related in Wolff-Parkinson-White (WPW) syndrome to antegrade effective refractory period of the accessory pathways. Among the many antiarrhythmic drugs available, amiodarone is most commonly used for its large therapeutic window and very long half-life. We report a case of cardiac pre-excitation syndrome in a young male patient in whom amiodarone therapy (3000 mg/weekly) was instituted to modify the dangerous ventricular response during atrial fibrillation (shortest R-R interval 190 ms, ventricular rate 210 beats/min). Four months later, starting pharmacological treatment, a new electrophysiological study documented a malignant ventricular arrhythmia: during atrial fibrillation the minimum R-R interval was 160 ms and the ventricular rate 280 beats/min. Finally, the possible mechanism of paradoxical effect observed in our patient is hypothesized. Amiodarone could favor conduction over the accessory pathways by slowing or blocking conduction into the atrioventricular node and decreasing concealed retrograde conduction into the accessory bypass tract by normally conducted beats.

Primary spinal epidural lymphomas. Report of ten cases.

The Authors report their results on the treatment of 10 cases of primary spinal epidural lymphoma. All patients underwent surgery followed by radiotherapy and 60% of them improved after treatment. The Authors stress the importance the preoperative neurological status and early diagnosis play on the prognosis. They conclude that only further studies on a large series can determine the influence of the histological type of the neoplasm on prognosis.

Intracerebral mass lesions in patients affected by AIDS.

"Toxoplasma gondii" cerebral abscess is a common opportunistic infection in patients affected by AIDS. Making a reliable diagnosis of acute cerebral toxoplasmosis is difficult in AIDS patients because of the lack of specificity of serological data and neuroradiological findings. Brain biopsy is the only procedure which enables a reliable diagnosis to be made a trial of specific medical therapy for toxoplasmosis in patients affected by AIDS and intracranial mass lesion can be advisable before performing brain biopsy. The authors report the cases of three patients affected by AIDS and cerebral toxoplasmosis. Tissue diagnosis was made in the first patient from autopsy material while a presumptive diagnosis was made in the other two cases since specific medical therapy resulted in a dramatic improvement of the neurological status. Despite the good possibilities in the treatment of this complication AIDS, however, carries a poor prognosis.

Cystic meningiomas. Report of seven cases.

Seven patients with cystic meningioma are reported. The computerized tomography appearance of these meningiomas may mimic that of a glial or metastatic tumor with cystic or necrotic changes, and lead to an incorrect presumptive diagnosis. Radiological evaluation and recognition are important for the surgical removal of these potentially curable neoplasms.

Variations in the 5-hydroxy-indoleacetic acid concentration in the cerebrospinal fluid during the sleep-wake cycle in man.

A variation in the ventricular fluid 5-HIAA concentration has been observed during the phases of the sleep-wake cycle in man. This variation affects the NREM phase, during which 5-HIAA increases markedly, rather than the waking state and the REM phase. The results are discussed in relation to the possible relevance of serotonin to the sleep mechanism.