[Pharmacoresistant epilepsy after craniocerebral injury]. / Farmakorezistentní epilepsie po kraniocerebrálním poranení.

INTRODUCTION: Posttraumatic epilepsy is one of the possible serious consequencies of both closed and open head injury with clinical manifestation months or years after surgery. In pharmacoresistant patients, surgical therapy should be considered. MATERIAL AND METHODS: The study summarises the results of surgical treatment of pharmacoresistant posttraumatic epilepsy in a group of 13 patients (11 males and 2 females). Average age at the time of injury was 9.6 years in males and 8.8 years in females. The average number of seizures was 10.7-17 seizures/month preoperatively. Invasive EEG monitoring was required in 5 patients in whom non invasive or semiinvasive investigations failed to localize the epileptogenic zone adequately. Temporal lobe resections were performed in 4 patients, 4 patients underwent extratemporal resections and vagus nerve stimulation system was implanted in 5 patients. RESULTS: Three patients (75%) after temporal resections became seizure free (Engel I) and in the remaining patient significant reduction of seizures was achieved (Engel III). There were 2 seizure free patients after extratemporal resections (50%) and significant reduction of seizure rates was achieved (Engel III) in the remaining two. One patient after vagus nerve stimulation met the criteria for > 90% response and there was a 50-90% seizure rate reduction in the remaining 4 patients (vagus nerve stimulation responder). CONCLUSIONS: Although in limited group of patients the study confirms good results of surgical treatment of selected posttraumatic epilepsy patients--mainly temporal epilepsy patients and patients after vagus nerve stimulation. Meticulous presurgical evaluation including invasive encephalography in indicated patients is a precondition for surgical success.

Castleman's disease: a study of a rare lymphoproliferative disorder in a university hospital.

Castleman's disease (CD) is a group of rare lymphoproliferative disorders sharing characteristic clinical and histological features, and usually accompanied by a marked systemic inflammatory response. Two histological patterns of lymph nodes were described: the hyaline-vascular and plasma-cell types. The former is more common (80-90%) and tends to be localized. The plasma cell type is more aggressive and usually multicentric. It is interesting that the inflammatory manifestations seem to be related to a lymph node lesion, because the systemic symptoms and inflammatory activity can return to normal after surgical excision or successful medical treatment of the disease. We report here our 15-year experience with this rare disease in King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, focusing on the clinical features, therapy, and patients'outcome.

[Primary brain tumor as a rare cause of acute subdural hematoma]. / Primární tumor mozku jako vzácná prícina akutního subdurálního hematomu.

The aim of the study is to present a case report describing patient, admitted for subdural haematoma located on temporal lobe base and brain convexity with intracerebral haematoma located in the depth of temporal lobe. Both haematomas were evacuated from burr holes. Histological analysis of tissue obtained during intracerebral haematoma aspiration has proven tumorous tissue consistent with anaplastic astrocytoma. Contrast enhanced MRI has confirmed the diagnosis and patient underwent tumor surgery. The study brings additional data to differential diagnosis of subdural haematoma, especially of non traumatic origin. When compared with meningiomas and metastatic tumors primary brain glioma is an exceptional cause of subdural haematoma of non traumatic origin.