Meningoencephalic herniation into the middle ear.

Meningoencephalic herniation into the middle ear (MHME) is a rare condition. It can result from ear surgery, infection, head trauma or can be spontaneous. Diagnosis requires a high degree of clinical suspicion. The presentation may suggest the condition, but sometimes the intraoperative discovery of an occult meningoencephalic herniation may be a frightening situation. Treatment planning must avoid intra-cranial complications. Transmastoid (TM) and middle cranial fossa (MCF) are alternative or complementary approaches, determined by several factors, including the size and the site of the bony defect and the presence or absence of middle ear infection. Three case reports are presented and a review of the literature is performed, to explain some aspects related to MHME, including aetiopathogenesis, clinical presentation, histopathology, diagnosis and treatment.

Cavernous haemangioma of the facial nerve.

Facial nerve haemangiomas are probably the most frequent benign tumours involving the facial nerve in its intratemporal portion. Usually facial nerve dysfunction is present when these tumours are of extremely small size, the average tumour being less than 10 mm. We present a case of a 15 mm diameter cavernous haemangioma of the geniculate region, with histological findings of nerve infiltration, without facial nerve symptoms. The atypical clinical presentation justifies the report and subsequent literature review.

Olfactory mucosa response in guinea pigs following intranasal instillation with Cryptococcus neoformans. A histological and immunocytochemical study.

A central nervous system isolate from an acquired immunodeficiency syndrome (AIDS) patient of 10(3) Cryptococcus neoformans cells was instilled intranasally into guinea pigs. These were killed to evaluate the fate of the organisms and the response of the olfactory mucosa. Olfactory epithelium prevented the penetration of Cryptococcus neoformans and showed focal hyperplastic responses. The organisms, which manifested an affinity for the olfactory portion of the nasal cavities, were cleared from the olfactory space with no intervention from the immune system cells. By the end of the fifth week almost no organisms could be found and there was no histological evidence of dissemination. In contrast, destruction of the olfactory epithelium with zinc sulfate allowed the invasion of the subepithelial tissues, demonstrating the role of the olfactory mucosa in preventing infection with Cryptococcus neoformans through the nasal route. The results and the model described in this report may be useful in clarifying the pathogenic mechanisms of cryptococcosis and the non immune mediated host responses to Cryptococcus neoformans.

Olfactory pathways in three patients with cryptococcal meningitis and acquired immune deficiency syndrome.

The olfactory mucosa, bulbs and tracts were examined for the presence of Cryptococcus neoformans in 3 patients with the acquired immune deficiency syndrome (AIDS) and cryptococcal meningitis. Two of them had antibodies against HIV-1 and one had positive serology for HIV-2. Cryptococci were seen in the subarachnoid space around olfactory tracts and bulbs and in the submucosal olfactory nerve fascicles. In one case, olfactory nerve fascicles from the lamina propria were also affected. Olfactory epithelium and respiratory mucosa were not involved. We suggest that Cryptococcus reached the olfactory nerve fascicles through the olfactory pathways for cerebrospinal fluid drainage which might serve as a source of latent cryptococcal infection.

[Cervical discectomies by the anterior approach]. / Discectomias cervicais por via anterior.

A retrospective study was made of sixty patients who underwent anterior cervical surgery, between January, 1980 and May, 1989. The standard anterior approach devised by Cloward (DEC) was used for 28 patients, and discectomy alone (DS), without bone graft, for the other 32. The postoperative stay was 2.4 times longer after DEC than after DS. Surgical complications had an incidence of 11.6%, 14.3% with DEC and 9.3% with DS. There was no mortality. A total of 57 patients were available for transversal clinical evaluation, 26 of the DEC group and 31 of the DS group. There was no difference in the success rate between the two groups. Considering the over-all results, 77.2% had good or excellent results, 10.5% had fair results and 12.3% had poor results. Patients with radicular symptoms alone had better results. Evolution of the spine stability at the level of the intervention was of no major difference between the two groups. The authors conclude that there are identical results, whatever the technique used. Still, morbidity and postoperative hospitalization are higher with Cloward's approach, which seems a good reason to restrict its use to cervical instability situations, namely traumatic cervical pathology.

[The early diagnosis of an acoustic neuroma]. / O diagnóstico precoce do neurinoma do acústico.

A revision is made of the initial symptoms in acoustic neuroma. The authors propose a study protocol to achieve an early diagnosis of this tumor.

Intracranial hypertension: an unusual case due to sinus obstruction by fibrosarcoma.

A case of a skull fibrosarcoma compressing the right lateral sinus is presented as a rare cause of intracranial hypertension.

Neuronal ceroid-lipofuscinosis: ultrastructural study of lymphocytic dense bodies.

We studied the ultrastructural alterations of the dense bodies of peripheral blood lymphocytes in one case of neuronal ceroid-lipofuscinosis. These cytoplasmic vesicles were characterized by vacuolar transformation and "fingerprint" content. When we tilted the specimens, the "fingerprint" arrangement was shown to be the same as the arrangement of the crystalloid inclusions found in the same cells. Both vacuoles and periodic cytoplasmic inclusions could be due to a disorder of secondary lysosomes--the lymphocytic dense bodies.