Effects of clotrimazole on experimental spinal cord ischemia/reperfusion injury in rats.

OBJECTIVE: The effect of clotrimazole was examined using a spinal cord ischemia/reperfusion model. METHODS: Twenty albino Wistar rats weighing 234 +/- 12.3 g were used in this study. Rats were anesthetized intraperitoneally with 50 mg/kg ketamine HCl. All animals underwent laparotomy under aseptic conditions. Abdominal aortas of the animals in all but the sham group were exposed. After opening the retroperitoneum, the infrarenal abdominal aorta was clipped for 45 minutes to produce ischemia/reperfusion injury. Polyethylene glycol (PEG, 1 mL) was administrated to the vehicle group. PEG (1 mL) and clotrimazole (30 mg/kg) were administered intraperitoneally in the clotrimazole group. Total laminectomy of T8-T12 was performed on all rats under a microscope. Spinal cords were excised for a length of 2-cm rostrally and 1-cm caudally to the injury site and deep frozen at -76 degrees C for biochemical studies. The levels of malondialdehyde, glutathione-peroxidase, superoxide dismutase, and catalase were measured as an indicator of ischemia level. The most cranial part of the specimens was evaluated morphologically. RESULTS: Treatment with clotrimazole significantly decreased malondialdehyde, glutathione-peroxidase, superoxide dismutase, and catalase levels in comparison with other groups (P = 0.008). Morphologic evaluation revealed that clotrimazole protected the axons and their myelin sheaths from ischemic damage. CONCLUSION: This study showed the neuroprotective effects of clotrimazole on spinal cord ischemia/reperfusion injury.

Massive congenital intracranial immature teratoma of the lateral ventricle with retro-orbital extension: a case report and review of the literature.

Germ cell tumors comprise 0.4-3.1% of all intracranial tumors, and teratoma constitutes 9-30% of them. Congenital intracranial tumors are very rare and only account for 0.5-1.5% of all childhood brain tumors. The most common type of these tumors present at birth is teratomas, which represent 0.5% of all intracranial tumors. Most teratomas are midline tumors located predominantly in the sellar and pineal regions. In this study, we report a neonatal intracranial immature teratoma at the lateral ventricle because of its rare location. A 5-day-old female neonate presented with a history of irritability and left eye protrusion since birth. A head computed tomographic (CT) scan and magnetic resonance imaging (MRI) disclosed a large tumor filling the left lateral ventricle and extending into the ipsilateral retro-orbital space. With left frontotemporoparietal craniotomy, a large grayish-white lobulated vascular mass was encountered, and total removal of tumor was performed. Histological examination revealed the diagnosis of immature teratoma. The prognosis of congenital intracranial immature teratoma is usually poor because the lesions are extensive when they are identified. Prenatal ultrasonography is necessary for the prenatal diagnosis. Fetal MRI should be made for the evaluation of intracranial tumor. If the tumor is detected before the 24th week of gestation, termination of the pregnancy should be considered.

Effects of clotrimazole on experimental spinal cord injury.

BACKGROUND: We examined a possible neuroprotective effect of clotrimazole on spinal cord clip compression injury. METHODS: Rivlin and Tator's acute extradural clip compression injury (CCI) model was used for producing SCI on 24 albino Wistar rats weighing 180-250 g. All rats were anesthetized with 30 mg/kg ketamine HCl intraperitoneally and were breathing spontaneously without tracheal intubation. Total laminectomy of T8-T12 was performed on all rats under operation microscope, and CCI was performed on all rats (expect those in group 1) with a 50-g closing force aneurysm clip for 1 min. Three hours later, all of the rats were killed with sodium pentobarbital. Spinal cords were excised for a length of 2 cm; 1 cm rostrally and caudally to the injury site and deep frozen at -76 degrees C for biochemical studies. RESULTS: Treatment with clotrimazole decreased MDA levels in rats with SCI with a statistically significant difference. CONCLUSIONS: To our knowledge, this the first study that shows the effects of clotrimazole on spinal cord clip compression injury. Clotrimazole was found to be effective on spinal cord clip compression injury, but further investigations are mandatory.

Ruptured chronic encapsulated intracerebral hematoma in infancy: review of the literature with a case report.

OBJECTIVES: We report a case of a 2-month-old boy with chronic encapsulated intracerebral hematoma (EICH) and discuss clinical, radiological and pathological features of the case. CONCLUSIONS: Chronic EICH in infants is extremely rare in the literature. Only two cases have been previously reported. One of the cases reported in the literature was supratentorial and the other was infratentorial.

Effects of citicoline on experimental spinal cord injury.

OBJECTIVE: To investigate the effects of citicoline on experimental spinal cord injury (SCI). BACKGROUND: Citicoline has been successfully used in clinical studies of head injury and cerebral infarction, but there is limited literature regarding its use in experimental SCI. STUDY DESIGN: Twenty adult Wistar rats were divided into four groups: sham, trauma, vehicle, and citicoline-treated. SCI was produced using a weight drop technique. Citicoline 300 mg/kg was given intraperitoneally, 5 minutes after the induction of trauma. The animals were sacrificed and 1 cm long samples of injured spinal cord were obtained at 48 hours post-SCI. Lipid peroxidation was estimated by the thiobarbituric acid test. Neurological examinations were performed using a previously described grading scale. RESULTS: Measures of lipid peroxidation and motor scores of the citicoline-treated group were significantly lower than those in the other injury groups. CONCLUSIONS: Citicoline attenuated lipid peroxidation after SCI and improved the motor scores. Further investigations will be required to determine the long-term effects of this drug on spinal cord injury.

Effects of early versus delayed nutrition on intestinal mucosal apoptosis and atrophy after traumatic brain injury.

PURPOSE: To determine the optimal time to start nutritional support after traumatic brain injury (TBI). METHODS: Rats were divided into six groups of seven. All but one of these groups were subjected to moderate closed head trauma under general anesthesia. Groups Ia and Ib were commenced on immunonutrition and standard enteral nutrition, respectively, 8 h later; groups IIa and IIb were commenced on immunonutrition and standard enteral nutrition, respectively, 72 h later; and group III was commenced on a parenteral saline infusion 8 h later. Group IV was a control group fed a laboratory diet and not subjected to trauma. The rats were killed 7 days later, and ileal segments were examined using light and electron microscopy. We used the deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) technique to detect intestinal mucosal apoptosis. RESULTS: Group III had a lower body weight than the other groups (P < 0.005). The mean villous height was highest in groups Ia and IV and lowest in group III. The villi count was lower in groups Ib, IIa, IIb, and III than in group IV (P < 0.005). The apoptotic index counts were higher in groups IIa, IIb, and III than in group IV (P < 0.005). CONCLUSIONS: The addition of enriching immunonutrients to early enteral feeding helps preserve an almost normal gut mucosa.

Conservative management of spontaneous posterior fossa subdural hematoma in a neonate.

Symptomatic intracranial hemorrhage in term neonates is uncommon, and is usually secondary to trauma, coagulation disorders and/or hypoxia. Posterior fossa hemorrhage in the neonate is a rare neurosurgical emergency and is usually associated with the same etiological factors. Diagnosis is with computed tomography and magnetic resonance imaging. We present a spontaneous posterior fossa subdural hematoma in a term neonate and discuss conservative management.

Giant cranial extradural primary fibroxanthoma: a case report.

Primary fibroxanthoma of the cranium is an extremely rare condition. Xanthomatous tumors of the central nervous system are occasionally associated with diseases such as Hand-Schuler-Christian disease, malignant fibrous histiocytoma, hyperlipidemia, and a complication of metabolic or storage disorders. However, until 2003, only a few cases of primary fibroxanthoma have been reported. We report a giant fibroxanthoma destroying the lateral skull base unaccompanied by a systemic or metabolic disease.

Clinical course of spontaneous spinal epidural haematoma mimicking Guillain-Barré syndrome in a child: a case report and literature review.

We describe a 9-year-old female with thoracic epidural haematoma. The clinical course simulated Guillain-Barré syndrome (GBS) so intravenous immunoglobulin therapy was started at the paediatric clinic. Magnetic resonance imaging (MRI) 3 days after admission showed thoracic epidural haematoma between T2 and T8. An emergency laminectomy was performed and the patient's neurological symptoms began to improve immediately after surgery and she made a full recovery during the 2 weeks of follow-up. Time is a very important factor in achieving reversibility of symptoms of compressive cord lesions, such as spinal epidural haematoma, and MRI is mandatory for patients with progressive paraplegia, even though the signs and symptoms might suggest GBS.

Intracavernous carotid artery aneurysms.

Six patients with intracavernous carotid artery aneurysms (ICCAAns) were seen at our department from 1998 to 2002. All patients had only one intracranial aneurysm and their ages at diagnosis ranged from 36 to 72 years (median 56). Five were women and four had a history of hypertension. One patient was pregnant. All of the ICCAAns were symptomatic at diagnosis. Duration of symptoms was 2-30 days. On admission to our department, initial symptom was headache in four patients, visual loss in two, eye pain in one, third nerve paresis in two and subarachnoid hemorrhage (SAH) in one. Spontaneous thrombosis was present in two patients. All of the ICCAAns were saccular. Computed tomography (CT) was superior when compared with magnetic resonance imaging (MRI) for diagnosis of ICCAAns on admission. Angiography remains the gold standard for diagnosis and determination of specific anatomical details, which are necessary to plan treatment.

Meningitis and Pneumocephalus. A rare complication of external dacryocystorhinostomy.

Meningitis due to fracture of the fovea ethmoidalis during external dacryocystorhinostomy is a rare complication. We report a case of pneumocephalus and meningitis in a 51-year-old female who underwent an external dacryocystorhinostomy (DCR). Although extracranial complications during or after external DCR have been well-described, only one case of meningitis has been reported in the literature. Physical examination, computerised tomography, lumbar puncture, and bacteriologic cultures were used to make the diagnosis. The patient responded well to antibiotic therapy. Her symptoms resolved immediately and she was discharged on the 21st post-operative day. This complication emphasises the importance of careful surgical technique and a thorough knowledge of regional anatomy, during DCR and similar procedures.

Intratumoral haemorrhage: a clinical study.

Although the incidence of spontaneous intracranial haemorrhage associated with meningioma is 1.3%, the incidence of intratumoral haemorrhage could not be determined. The authors report on 11 patients, six men and five women, with meningiomas that presented as spontaneous intratumoral haemorrhage, among 126 meningioma cases which were evaluated radiologically and histopathologically. The average age of patients was 58.9 years (range 45-72 years). Two (1.5%) cases showed radiological, and nine cases (7.9%) showed microscopic bleeding. Most of these cases also showed microcysts (9.7%) and necrosis (6.3%). The location, histopathological types, sex, age, blood dyscrasia, hypertension do not influence the occurrence of intratumoral haemorrhages in meningiomas. We concluded that microcysts and necrosis are important in the occurrence of intratumoral haemorrhage in meningiomas.

Giant cystic primary cerebral neuroblastoma in a child and solid primary cerebral neuroblastoma in an adult: two case reports.

Primary cerebral neuroblastoma is a rare entity in neurosurgical practice. They occur primarily in young children and are extremely rare in adults. Primary cerebral neuroblastoma is one of a group of highly malignant undifferentiated primitive neuroectodermal tumours arising from germinal matrix cells of the embryonic neural tube. They are difficult to diagnose preoperatively and pathologically. We present two cases of primary cerebral neuroblastoma.

Shunt dysfunction due to calcification of a ventriculo-peritoneal shunt: a case report.

Calcification and related dysfunction of ventriculo-peritoneal shunts are rare events in neurosurgical practice. Shunt calcification causes shunt dysfunction in two ways, namely disconnection and obstruction. We present a 16-year-old girl with shunt malfunction due to disconnection secondary to calcification. The shunt tubing fractured during attempted removal and some of the remaining components, including the ventricular catheter, had to be left in situ. The shunt was revised and the patients symptoms resolved. Replacement of the calcified and perished shunt components with a new shunt is essential. Aggressive surgical manipulation for removal of the remaining shunt components is not advisable as this may increase morbidity and mortality.

The effects of tyrphostine Ag 556 on experimental spinal cord ischemia reperfusion injury.

BACKGROUND: To investigate the effects of Tyrphostin Ag 556 on spinal cord ischemia reperfusion injury. METHODS: The inhibition of tyrosine kinase may represent a novel approach in the treatment of spinal cord ischemia reperfusion injury. Recently, a family of tyrosine kinase inhibitors, the tyrphostins, has been successfully used in models of endotoxemia, peritonitis, and hypovolemic shock. MATERIALS AND METHODS: Twenty-four Wistar rats were used in the study. Rats were divided into 4 groups of 6 animals. The groups were named as sham operated group, injury group, vehicle group, and treatment group. Clamping of the abdominal aorta was performed for 45 minutes with all of the groups except sham-operated group. All of the rats were sacrificed 24 hours after the operation for biochemical and ultrastructural studies. RESULTS: Tyrphostin Ag 556 treatment was found effective on experimental spinal cord ischemia reperfusion injury. The Malondialdehyde (MDA) values of the treatment group were statistically significant lower then the other reperfusion injury groups. The histologic examination showed better cellular structure in the treatment group than the other reperfusion injury groups. The neurologic scores of the treatment group also improved after treatment. CONCLUSIONS: Tyrphostin Ag 556 alters spinal cord ischemia reperfusion injury by inhibiting protein kinases. Further investigations will be required to determine the long-term effects of this drug.

Ligamentum flavum cyst.

INTRODUCTION: Although magnetic resonance imaging (MRI) of ligamentum flavum and other spinal cysts have been well described, the role of contrast enhancement in this diagnosis has been neglected. We describe such a case and correlate the MRI findings with the histopathology. CASE REPORT: A 71-years-old woman was admitted with of neurogenic lumbar claudication. X-rays of the lumbar spine showed degenerative changes with scoliosis. Lumbar magnetic resonance imaging demonstrated a L3/4 extradural cystic mass. An L3 laminectomy was performed and the mass excised. The histopathological diagnosis was consistent with a ligamentum flavum cyst. Postoperatively, the patient's symptoms resolved completely. CONCLUSION: The possibility of a ligamentum flavum cyst should be considered whenever a hyperintense extradural mass with a peripheral hypointense rim on T2 weighted and slightly contrast enhanced peripheral rim on T1 weighted MRI is identified in a patient with degenerative changes of the lumbar spine.

Pilocytic astrocytoma of neurohypophysis.

A case of pilocytic astrocytoma of neurohypophysis is presented. The clinical, pathological and MRI features of a rare tumor of the neurohypophysis are described. A 5-year-old girl presented with a 3 month history of lethargy, imbalance and visual disturbances. A MRI revealed a large suprasellar mass. Histopathological examination demonstrated a pilocytic astrocytoma. Its astrocytic nature was confirmed by positive immunostaining for GFAP and the findings of an electron microscopy.

Effects of immunonutrition on intestinal mucosal apoptosis, mucosal atrophy, and bacterial translocation in head injured rats.

BACKGROUND: Immunonutrition has been demonstrated to modulate gut function, reduce infectious complications, hospital stay, and ventilator days in the critical patients. AIM OF THE STUDY: We assessed the effect of immunonutrition for the prevention of intestinal mucosal atrophy, apoptosis, and bacterial translocation in head injured rats. METHODS: Thirty five rats were randomised into 5 groups. Following moderate closed head injury, in Group 1; Standard Enteral Nutrition, Group 2; Immunonutrition, Group 3; TPN, Group 4; pe. saline were applied. Group 5 was control group (chow-fed). The rats were sacrificed and segments of the ileum were removed for histologic examination, and samples of tissues taken for microbiologic evaluation. RESULTS: Both intestinal apoptosis and mucosal atrophy were significantly lower in Group 2 and Group 5 (p<0.008). Bacterial translocation was significantly lower in Group 2 than Group 1 (p<0.008). CONCLUSION: The enteral immunonutrition prevents intestinal barrier function in brain injured rats.

Clear cell meningioma: case report and literature review.

The clear cell meningioma is rare and a recently described histologic variant of meningioma. The most interesting aspect of clear cell meningioma is the high recurrence rate and agressiveness. Until now 17 intracranial clear cell meningioma cases had been reported in the English language literature. We present 2 new cases of clear cell meningioma which is discussed with the relevant literature.

Solitary plasmacytoma with intracranial intraorbital and, paranasal sinus extension.

Intracranial solitary plasmacytomas (ICSPs) are extremely rare tumours in neurosurgical practice, and are often misdiagnosed preoperatively. Here we present a solitary intracranial plasmacytoma with orbital, nasal and paranasal sinus extension. A subtotal excision of the tumour was performed and the complete response was seen after postoperative radio-chemotherapy. The neuroradiological and neurosurgical features of the case are discussed with the pertinent literature.