Orbitocerebral injury by a knife: case report.

Orbital penetrating injuries may cause significant harm to the optic nerves and eyeball as well as to the brain and cerebral vessels. Management of orbital foreign bodies should include prompt recognition of the extent of the injury, broad-spectrum parenteral antibiotics, tetanus prophylaxis, anticonvulsant medication and early surgical intervention under direct vision to remove the foreign body and to avoid immediate and long-term complications. We report a penetrating orbital injury caused by a bread knife that extended from the orbit to the tegmental dura mater of the temporal bone. The knife's main trajectory coursed through the temporal lobe. Adjacent cerebral structures were explored before removal of the knife.

Orbitocerebral injury by a knife: case report

Orbital penetrating injuries may cause significantharm to the optic nerves and eyeball as well as to thebrain and cerebral vessels. Management of orbitalforeign bodies should include prompt recognition of theextent of the injury, broad-spectrum parenteral antibiotics,tetanus prophylaxis, anticonvulsant medicationand early surgical intervention under direct vision toremove the foreign body and to avoid immediate andlong-term complications. We report a penetrating orbitalinjury caused by a bread knife that extended fromthe orbit to the tegmental dura mater of the temporalbone. The knife’s main trajectory coursed through thetemporal lobe. Adjacent cerebral structures were exploredbefore removal of the knife (AU)

Los traumatismos perforantes orbitarios suelencausar un daño importante al nervio óptico y globoocular, así como al cerebro y vasos cerebrales. Laórbita permite un acceso fácil hacia la cavidad cranealdebido a que tiene una pared ósea delgada y a la presenciadel agujero óptico. El enfoque terapéutico de lostraumatismos orbitarios por cuerpo extraño dependefundamentalmente del tipo de traumatismo y delcuerpo extraño. El tratamiento de este tipo de lesionesincluirá un rápido diagnostico de la magnitud del dañoocasionado, el empleo por vía parenteral de antibióticosde amplio espectro, profilaxis del tétanos, medicaciónanticonvulsivante y cirugía urgente que permita, bajovisión directa, la extracción del cuerpo extraño, a fin de evitar complicaciones inmediatas o a largo plazo. Presentamosel caso de un traumatismo perforante ocularocasionado por un cuchillo de pan que se extendíadesde la órbita hasta el tegmentum del hueso temporal.El cuchillo seguía una trayectoria directa a través dellóbulo temporal. Se practicó una exploración quirúrgicade las estructuras cerebrales adyacentes para poderextirpar el cuchillo. Se revisan y analizan las opcionesde tratamiento de los traumatismos perforantes de laórbita (AU)

Neuroprotective effect of melatonin on experimental peripheral nerve injury: an electron microscopic and biochemical study.

BACKGROUND AND STUDY AIMS: Melatonin is an important antioxidant agent with a protective role in the prevention of oxidative stress. We designed an experimental study which focused on the potential neuroprotective effect of melatonin on peripheral nerve injury. MATERIALS AND METHODS: Sciatic nerve injury was induced in the mid thigh region of 30 male Wistar rats by clip compression. Melantonin was injected intraperitoneally in 15 of the 30 rats. Electron microscope and biochemical studies were performed to assess the potential beneficial effect of melatonin on peripheral nerve regeneration. Changes to cellular organelles, myelin lamellae and axons were studied. RESULTS: There was a significant difference between the melatonin and nerve injury groups. Rats treated with melatonin demonstrated significant structural protection of the myelin lamellae compared to the nerve injury group. Axonal shrinkage and myelin changes were not prominent histopathologically in melatonin-treated group. Biochemical analysis confirmed the neuroprotective effects of melatonin with significantly lower lipid peroxidation and myeloperoxidase activity measurements in the melatonin-treated group compared to the neural injury group. The results indicate that melatonin can improve neural healing. CONCLUSION: With its neuroprotective effect, as demonstrated in this experimental peripheral nerve injury, melatonin might be used successfully in clinical practice. Further studies on the correct dosage and possible side effects are necessary.

Lumbar epidural abscess caused by brucella species: report of two cases.

Spinal epidural abscess due to Brucella species is usually associated with spondylodiscitis. Urgent surgical decompression should be performed in cases with moderate to severe neurological deficits particularly if progressive. We report clinical features of two cases operated for lumbar epidural abscess caused by Brucella species. Early surgical decompression combined with medical treatment could decrease progression of neurological findings or the severity of complications. Iatrogenic dural tear at the operation should be repaired immediately with fine sutures and fibrin tissue glue to prevent further innoculation into the cerebrospinal axis. These cases should be cautiously followed for any recurrence or neurobrucellosis.

Lumbar epidural abscess caused by brucella species: report of two cases

Spinal epidural abscess due to Brucella species isusually associated with spondylodiscitis. Urgent surgicaldecompression should be performed in cases withmoderate to severe neurological deficits particularlyif progressive. We report clinical features of two casesoperated for lumbar epidural abscess caused by Brucellaspecies. Early surgical decompression combinedwith medical treatment could decrease progression ofneurological findings or the severity of complications.Iatrogenic dural tear at the operation should be repairedimmediately with fine sutures and fibrin tissue glueto prevent further innoculation into the cerebrospinalaxis. These cases should be cautiously followed for anyrecurrence or neurobrucellosis (AU)

Los abscesos epidurales espinales debidos a Brucellase asocian habitualmente a espondilodiscitis. Ladescompresión quirúrgica urgente debe ser realizadaen casos con déficit neurológico moderado o graveparticularmente si este es progresivo. Describimos losaspectos clínicos de dos casos operados por abscesosepidurales causados por Brucella. El tratamiento quirúrgicotemprano asociado con tratamiento médicopuede disminuir la progresión de la sintomatologíaneurológica y la gravedad de las complicaciones. Laaparición de desgarros durales durante la cirugía debeser reparada de forma inmediata con sutura o pegamentosde fibrina para prevenir la inoculación dentrodel neuroeje. Estos casos deben ser seguidos de formacuidadosa para evitar la recurrencia de la neurobrucelosis (AU)

Rare intracranial manifestations of frontal osteomas.

Osteomas of the paranasal sinuses are usually asymptomatic. When enlarged, they could give rise to intracranial manifestations and serious complications. Osteomas most commonly affect the fronto-ethmoid sinuses. They rarely show intra-orbital extension or cause intracranial complications such as CSF rhinorrhea, pneumocephalus and intracranial infection. We report two unusual cases of frontal osteomas complicated by rare manifestations such as intracranial mucocele, CSF leak, pneumocephalus and bacterial meningitis. We demonstrate the importance of these intracranial manifestations when these lesions are accompanied by neurological symptoms and signs with special emphasis on the importance of early treatment.

Craniocervical neurenteric cyst without associated abnormalities.

Spinal neurenteric (NE) cyst is an uncommon congenital cyst and frequently found in the cervical region. The clinical symptoms associated with this entity depend on the site of the lesion and are not typical for all such cysts. A definitive diagnosis can only be made by biopsy and histological examination. MRI can confirm these cystic masses and is the method of choice for their imaging investigation. They are often connected by a fibrous tract, fistula or cleft to structures derived from the primitive gut in the thoracic or abdominal cavities and are commonly associated with anterior spina bifida or other vertebral anomalies. We report a case of craniocervical NE cyst without associated abnormalities and discuss the implications for clinical diagnosis and management by a thorough review of the literature.

Surgical management of syringomyelia-Chiari complex.

Great variety exists in the indications and techniques recommended for the surgical treatment of syringomyelia-Chiari complex. More recently, magnetic resonance (MR) imaging has increased the frequency of diagnosis of this pathology and offered a unique opportunity to visualize cavities inside the spinal cord as well as their relationship to the cranio-cervical junction. This report presents 18 consecutive adult symptomatic syringomyelia patients with Chiari malformation who underwent foramen magnum decompression and syringosubarachnoid shunting. The principal indication for the surgery was significant progressive neurological deterioration. All patients underwent preoperative and postoperative MRI scans and were studied clinically and radiologically to assess the changes in the syrinx and their neurological picture after surgical intervention. All patients have been followed up for at least 36 months. No operative mortality was encountered; 88.9% of the patients showed improvement of neurological deficits together with radiological improvement and 11.1% of them revealed collapse of the syrinx cavity but no change in neurological status. None of the patients showed further deterioration of neurological function. The experience obtained from this study demonstrates that foramen magnum decompression to free the cerebro-spinal fluid (CSF) pathways combined with a syringosubarachnoid shunt performed at the same operation succeeds in effectively decompressing the syrinx cavity, and follow-up MR images reveal that this collapse is maintained. In view of these facts, we strongly recommend this technique, which seems to be the most rational surgical procedure in the treatment of syringomyelia-Chiari complex.

Orbital hydatid cysts: report of four cases.

Hydatid cysts of central nervous system are rare and comprise only 2% to 3% of all hydatid cysts reported. Orbital localization is very uncommon and has been reported less than 1% of all hydatid diseases. The primary treatment of hydatid disease is surgical. The most important complication of the surgical treatment is secondary hydatidosis due to spillage of the cyst contents. Because of the difficulties of the orbital localization, total extirpation of the cysts without rupture is almost impossible. Preventing spontaneous rupture of the cysts during surgery and postoperative antihelmintic treatment should be taken into consideration in these cases. This study includes four cases who underwent surgery for orbital hydatid cysts. Radiological characteristics, operative technique and postoperative medical therapy are discussed.