RESUMO
Delayed post-hypoxic leucoencephalopathy is a demyelinating syndrome characterized by acute onset of neuropsychiatric symptoms including parkinsonism or akinetic mutism that occurs days to weeks after recovery from cerebral hypo-oxygenation. We encountered a patient who presented with an akinetic mute state late after cervical cord injury without a definite hypoxic event.
Assuntos
Afasia Acinética/fisiopatologia , Vértebras Cervicais/lesões , Doenças Desmielinizantes/diagnóstico , Hipóxia/complicações , Traumatismos da Medula Espinal/complicações , Acidentes de Trânsito , Adulto , Afasia Acinética/etiologia , Vértebras Cervicais/cirurgia , Doenças Desmielinizantes/etiologia , Doenças Desmielinizantes/terapia , Eletroencefalografia , Escala de Coma de Glasgow , Humanos , Hipóxia/etiologia , Imageamento por Ressonância Magnética , Masculino , Traumatismos da Medula Espinal/etiologia , Síndrome , Fatores de Tempo , Resultado do TratamentoRESUMO
Combined spinal arteriovenous malformation and lipomyelomeningocele are extremely rare. We present a rare combined case of a lipomyelomeningocele with an intramedullary arteriovenous malformation (AVM) occurred at the L3-L4 level in a 30-year-old man who suffered from low back pain radiating to the lower extremities, dysuria, and frequency for 5 years. The MR studies showed an intradural mass with high-signal intensity on both T1-weighted and T2-weighted images, intermingled with multiple signal-void structures. The mass extended extradurally toward a subcutaneously forming fatty mass on the patient's back. Spinal angiography showed an AVM supplied by the radiculopial branches of the lumbar arteries and drained by tortuous, dilated, perimedullary veins. Endovascular embolization and surgical resection were performed.
Assuntos
Malformações Arteriovenosas/complicações , Lipoma/complicações , Meningomielocele/complicações , Neoplasias da Medula Espinal/complicações , Adulto , Angiografia , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/terapia , Meios de Contraste , Diagnóstico Diferencial , Embolização Terapêutica , Humanos , Lipoma/diagnóstico , Lipoma/terapia , Imageamento por Ressonância Magnética , Masculino , Meningomielocele/diagnóstico , Meningomielocele/terapia , Medula Espinal/irrigação sanguínea , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/terapiaRESUMO
Cerebral arterial vasospasm is a frequent complication after aneurysmal subarachnoid hemorrhage (SAH). Immunological activation may affect the development of vasospasm. This study measured the cytokines released from lipopolysaccharide-stimulated monocytes of SAH patients. We measured cerebral artery diameters before and after surgery for SAH. The activation index of interleukin-1 beta (IL-1 beta), but not tumor necrosis factor-alpha (TNF-alpha), was higher in patients with symptomatic vasospasm (5.6+/-1.7; n=11) than in patients without (1.8+/-0.4; n=11) (P=0.039). Furthermore, the IL-1 beta activation index was correlated with the degree of the postoperative angiographic vasospasm (correlation coefficient=-0.66, P=0.007). Individual variation in systemic immune activation, measured by monocyte-derived IL-1 beta expression levels after stimulation, may be associated with the development of vasospasm after aneurysmal SAH.
Assuntos
Artérias Cerebrais/imunologia , Interleucina-1/metabolismo , Lipopolissacarídeos/farmacologia , Monócitos/metabolismo , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/imunologia , Vasoespasmo Intracraniano/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Artérias Cerebrais/metabolismo , Artérias Cerebrais/fisiopatologia , Feminino , Escala de Resultado de Glasgow , Humanos , Sistema Imunitário/fisiopatologia , Interleucina-1/genética , Masculino , Pessoa de Meia-Idade , Monócitos/efeitos dos fármacos , RNA Mensageiro/metabolismo , Hemorragia Subaracnóidea/fisiopatologia , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo , Vasoespasmo Intracraniano/fisiopatologiaRESUMO
Several molecular and genetic changes have been found in pituitary adenomas. We looked for correlations between these changes and the degree of invasiveness of the tumors. The invasiveness of 11 pituitary adenomas was graded by Hardy classification. We examined the retinoblastoma gene (RB1.20 on chromosome 13q) and the region around the MEN1 locus (chromosome 11q13.1-5) for loss of heterozygosity. Also examined are p53 mutations using single strain conformation polymorphism, p53 protein overexpression using immuno cytochemistry, homozygous deletions of p15 and p16 by polymerase chain reaction, and cellular proliferative activity using MIB-1 antibody. Six tumors (54.5%) had an LOH at either RB1.20 or the MEN1 locus. LOHs were found more frequently in Grade 4 and stage E tumors (72% and 67%) than in Grade 3 and stage D tumors (25% and 40%). However, no mutation or overexpression of p53 was found. No homozygous deletions of p15 or p16 were identified. The cell proliferative index ranged from 0 to 3%. LOH at 11q13 and 13q may be valuable in predicting the invasiveness of pituitary adenomas.
Assuntos
Adenoma/genética , Adenoma/patologia , Genes do Retinoblastoma , Proteínas de Neoplasias/genética , Neoplasias Hipofisárias/genética , Neoplasias Hipofisárias/patologia , Proteínas Proto-Oncogênicas , Proteínas Supressoras de Tumor , Adenoma/diagnóstico por imagem , Adenoma/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Ciclo Celular/genética , Transformação Celular Neoplásica , Cromossomos Humanos Par 11 , Cromossomos Humanos Par 13 , Inibidor de Quinase Dependente de Ciclina p15 , Inibidor p16 de Quinase Dependente de Ciclina/genética , Feminino , Genes Supressores de Tumor , Genes p53 , Humanos , Perda de Heterozigosidade , Masculino , Pessoa de Meia-Idade , Mutação , Invasividade Neoplásica , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/fisiopatologia , Polimorfismo Conformacional de Fita Simples , Radiografia , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismoRESUMO
Intermittent administrations of dopaminergic agents in hemiparkinsonian rat enhances the behavioral response to subsequent administration of the drugs. This phenomenon is known as "priming" and thought as comparable to drug-induced dyskinesia in patients with Parkinson's disease. We investigated the behavioral and electrophysiological changes in 6-hydroxydopamine (6-OHDA)-lesioned hemiparkinsonian rats after repeated administrations of apomorphine. Administration of apomorphine (0.32 mg/kg, intraperitoneal, i.p.) twice daily for 6 days enhanced the rotation induced by apomorphine from 341 turns/hour at the beginning to 755 turns/hr at the end. At the same time, the response to selective D2 agonist quinpirole (0.26 mg/kg, i.p.) was also enhanced from 203 to 555 turns/hr. Extracellular single unit recording revealed no significant difference in the basal firing rates of substantia nigra pars reticulata (SNr) neurons between the ipsilateral and contralateral side of the 6-OHDA lesion regardless of the repeated administrations of apomorphine. In SNr of the lesion side, the units with burst firing pattern were found more frequently after repeated administrations of apomorphine and the suppressive effect of quinpirole on the firing rate was enhanced. These findings suggest that the increased percentage of the burst units is the important electrophysiological change in the development of enhanced response to selective D2 agonist.
Assuntos
Apomorfina/farmacologia , Agonistas de Dopamina/farmacologia , Transtornos Parkinsonianos/fisiopatologia , Receptores de Dopamina D2/efeitos dos fármacos , Substância Negra/efeitos dos fármacos , Animais , Intoxicação por MPTP/fisiopatologia , Masculino , Oxidopamina/toxicidade , Quimpirol/farmacologia , Ratos , Ratos Sprague-Dawley , Substância Negra/fisiologiaRESUMO
Seven patients with schwannomas of the jugular foramen were included our study in Samsung Medical Center between 1995 and 1999. Patients with neurofibromatosis were excluded. The records of the seven patients (six surgical case and one nonsurgical case) were retrospectively reviewed. There were six women and one man (mean age, 47 years) with a symptom duration ranging from 3 months to 14 years (mean, 47 months). The predominant symptoms were hearing difficulty, hemifacial spasm and hoarseness. Preoperative audiologic evaluation, computerised tomography (CT), magnetic resonance (MR) imaging, and angiography were performed in most patients. We classified tumours into four types using Kaye and Pellet classification on the basis of radiological and surgical findings. The tumours were: Type A (at cerebellopontine angle) in one; Type B (foraminal) in two; Type C (extracranial and/or foraminal) in two; and Type D (intra- and extracranial) in two cases. We used various surgical approaches such as retrosigmoid suboccipital craniectomy for Type A tumours, infratemporal fossa type A approach (ITFA) for Type C tumours, petro-occipital transsigmoid approach or modified transcochear approach for Type D tumours and ITFA with partial labyrinthectomy for Type B. In the selection of surgical approaches, we took consideration of tumour extension, tumour size, and preoperative hearing function. Facial nerve transposition was not used only in one case of ITFA because of small tumour size (1.5cm). Gross total removal was achieved in five cases, and subtotal removal in one case (Type D tumour) with a single-stage operation. Stereotactic radiosurgery was performed on residual mass in the subtotally removed case. Follow-up period ranged from 13 to 49 months (mean, 27.5 months). There was neither postoperative mortality nor recurrence on follow-up MR imaging. There were two cases of temporary facial nerve palsy and one aggravation of pre-existing low cranial palsy. Two case of sustained vocal cord palsy underwent thyroplasty, but there was no aspiration pneumonia. Persistent cerebrospinal fluid collection was improved with lumboperitoneal shunt. The surgical approaches of each case should be tailored according to their shape and the clinical manifestation. We obtain acceptable outcomes from one-stage operation.
Assuntos
Nervo Acessório/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Craniotomia/métodos , Nervo Glossofaríngeo/cirurgia , Neurilemoma/cirurgia , Osso Occipital/cirurgia , Osso Temporal/cirurgia , Adulto , Doenças dos Nervos Cranianos/etiologia , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Drenagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Osso Occipital/diagnóstico por imagem , Radiografia , Osso Temporal/diagnóstico por imagem , Resultado do TratamentoRESUMO
OBJECT: Surgical treatment of cortical dysplasia (CD) together with intractable seizures is challenging because both visualization and localization of the lesion are difficult, correlation with seizure foci requires comprehensive study, and the surgical outcomes reported thus far are unsatisfactory. The authors report their experience in the surgical treatment of CD classified according to a surgical point of view. METHODS: The definition of CD used in this study was a dysplastic lesion visible on magnetic resonance (MR) images or a lesion that, although not visible on MR images, was diagnosed as moderate-to-severe dysplasia by using pathological analysis. During the last 4.5 years, the authors treated 36 patients with intractable epilepsy accompanied by CD. They divided the 36 cases of CD into four characteristic groups: Group A, diffuse bilateral hemispheric dysplasia; Group B, diffuse lobar dysplasia; Group C, focal dysplasia; and Group D, a moderate to severe degree of CD with a normal appearance on MR images. All but one patient in Group C were monitored in the epilepsy monitoring unit by using subdural electrodes for seizure localization and functional mapping. The incidence of CD among a cohort of 291 patients who had undergone epilepsy surgery at the authors' center during the study period was 12.4%. The mean age of the 36 patients was 21.3 years and the mean age at seizure onset was 8.5 years. The mean follow-up period was 26 months. Twenty-six patients (72.2%) belonged to Engel Class I or II (20 and six, respectively). There were five cases in Group A, nine in Group B, nine in Group C, and 13 in Group D. Patients in Groups A and B were significantly younger at seizure onset and had significantly poorer surgical outcomes compared with patients in Groups C and D (p < 0.05). If outcome is compared on the basis of the extent of removal of CD, patients in whom CD was completely removed had significantly better outcomes than those in whom CD was only partially removed (p < 0.001). CONCLUSIONS: The authors conclude that intractable epilepsy accompanied by CD can be treated surgically using comprehensive preoperative approaches. Deliberate resective procedures aimed at complete removal of dysplastic tissue ensure excellent seizure control without permanent neurological deficit.
Assuntos
Córtex Cerebral/anormalidades , Córtex Cerebral/cirurgia , Epilepsias Parciais/epidemiologia , Epilepsias Parciais/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Eletrodos Implantados , Eletroencefalografia , Epilepsias Parciais/patologia , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espaço Subdural , Resultado do TratamentoAssuntos
Neoplasias dos Nervos Cranianos/patologia , Doenças do Nervo Oculomotor/patologia , Rabdomiossarcoma/patologia , Adolescente , Hemorragia Cerebral , Neoplasias dos Nervos Cranianos/cirurgia , Evolução Fatal , Gadolínio , Humanos , Imageamento por Ressonância Magnética , Masculino , Doenças do Nervo Oculomotor/cirurgia , Complicações Pós-Operatórias , Rabdomiossarcoma/cirurgiaRESUMO
Vascular endothelial growth factor (VEGF) is an endothelial cell-specific antigen and angiogenic factor that plays a role in angiogenesis. We analyzed the expression of four VEGF mRNA isoforms in meningiomas. Among 35 meningiomas, 11 came from patients who underwent complete (n=4) or partial (n=7206=189 in all samples. However, the VEGF121 and 165 isoforms were significantly upregulated in samples from patients who underwent partial preoperative embolization. The diffusible VEGF121 isoform may be important for vascularity and edema formation in meningiomas.
Assuntos
Fatores de Crescimento Endotelial/genética , Endotélio Vascular/metabolismo , Linfocinas/genética , Neoplasias Meníngeas/genética , Meningioma/genética , Adolescente , Adulto , Idoso , Permeabilidade Capilar/fisiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Neoplasias Meníngeas/fisiopatologia , Meningioma/fisiopatologia , Pessoa de Meia-Idade , Estresse Oxidativo/fisiologia , Isoformas de Proteínas/metabolismo , RNA Mensageiro/metabolismo , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio VascularRESUMO
A 15-year-old boy developed back pain and sciatica after a minor trauma. Magnetic resonance imaging revealed lumbar spinal subdural hematoma. After repeated lumbar spinal puncture and drainage of hemorrhagic fluid, spinal subdural hematoma was resolved completely. The benefits of conservative treatment by lumbar spinal puncture are discussed.