Metabolic changes during successful medical therapy for brain hydatid cyst: case report.

BACKGROUND: Medical therapy for hydatid disease of the brain has been reported with encouraging results especially in small or medium-sized cysts. To date, no other case correlating the metabolite levels of the cyst with albendazole treatment has been reported. CASE DESCRIPTION: A 52-year-old woman presented with left hemiparesis and seizure. Cranial magnetic resonance revealed a right frontal cystic mass lesion. A diagnosis of hydatid cyst was made, and she was put on medical therapy with albendazole. An MRS before the medical therapy was begun revealed the typical findings of a hydatid cyst with resonance of alanine, acetate, and succinate that were specific for hydatid disease, and additional nonspecific lactate peaks with an additional small peak of choline. Comparison between the multiple MRS examinations was made by comparing the metabolite ratios specific for hydatid disease to choline, which seemed stable from the beginning. Two sequential MRS imaging revealed a prominent decrease of the succinate and acetate resonance, accompanied by a smaller decline of the alanine resonance progressively, correlated with the conventional MRI findings of the cyst, which had a smaller size with blurred margins in the meantime. After 5 months of medical treatment, the cyst had completely disappeared. The patient has been monitored for 5 years and remains well without recurrence. CONCLUSIONS: This case provides additional proof that the brain hydatid cyst is a medically treatable disease in appropriate cases. Furthermore, the changes in the metabolic profile of the cyst, especially those regarding succinate and acetate may represent the efficacy of the medical treatment.

Intracarotid L-arginine reverses motor evoked potential changes in experimental cerebral vasospasm.

OBJECTIVE: To investigate motor evoked potentials during short term L-arginine infusion in cerebral vasospasm after experimental subarachnoid hemorrhage. METHODS: Three groups were designated for this study: control group, subarachnoid hemorrhage-saline infusion group, and subarachnoid hemorrhage-L-arginine infusion group. A subarachnoid hemorrhage was created by intracisternal injection of autologous blood in New Zealand rabbits. At the fourth day of subarachnoid hemorrhage, latency and amplitude of motor evoked potentials were recorded during intracarotid saline and L-arginine infusion, and compared with motor evoked potential parameters of the control group. RESULTS: Motor evoked potential latencies were increased, and amplitudes were decreased in all animals before saline and L-arginine infusion on the fourth day of subarachnoid hemorrhage. A decrease in latencies as well as an increase in motor evoked potential amplitudes was observed with short-term intracarotid L-arginine infusion. CONCLUSION: Intracarotid short term L-arginine infusion significantly improves motor evoked potential parameters after experimental subarachnoid hemorrhage.

Cervical compression myelopathy: is fusion the main prognostic indicator?

OBJECT: A variety of factors may affect the neurological improvement in patients with cervical compression myelopathy (CCM) after surgery. The aim of this study was to report and discuss the prognostic factors in a group of patients with insufficient decompression of the spinal canal. METHODS: A prospective follow up and analysis of 20 consecutive patients with CCM treated between 2000 and 2002 was performed. All patients were surgically treated via an anterior approach, either by anterior cervical discectomy and fusion with instrumentation or by cervical corpectomy and fusion with instrumentation. The surgical results were examined using the modified Japanese Orthopaedic Asssociation disability scale, with reference to the findings of magnetic resonance imaging, computed tomography, and radiography. Seventeen patients (85%) experienced a 50% or more recovery rate as calculated using the Hirabayashi formula during the follow-up period (mean 32.5 months), despite a persistently narrow spinal canal and permanent or increased intramedullary high-intensity signal after surgery. CONCLUSIONS: Results of the study showed that patients with CCM benefited from anterior cervical discectomy and fusion with instrumentation or cervical corpectomy and fusion with instrumentation procedures despite insufficient decompression of the spinal canal. Fusion of the affected level(s) might be the reason for the acquired high recovery rates. The authors also conclude that the neurological improvement is not correlated with the reversal of or decrease in the intramedullary high-intensity signal change after surgery.

A safe and effective method for treatment of chronic subdural haematoma.

OBJECTIVE: Burr-hole irrigation and burr-hole drainage without irrigation are the most popular methods for treatment of chronic subdural haematoma. It is not well known if irrigation is necessary or which method has a higher recurrence rate. We compared the recurrence rates of those two methods. MATERIALS AND METHODS: Forty-two patients were treated by burr-hole irrigation (irrigation group), whereas 38 patients were treated by burr-hole drainage (drainage group). Recurrence rate and its relation with sex, age, haematoma localization and aetiology were investigated in both groups. RESULTS: There was no significant difference between recurrence rates of the two groups. There was also no correlation between recurrence rate and age, sex, haematoma localization, or aetiology. CONCLUSIONS: There was no significant difference between recurrence rates of the two groups. Since the burr-hole drainage method is simpler to carry out, its use may be preferable.

Chronic subdural hematoma in patients with idiopathic thrombocytopenic purpura: A case report and review of the literature.

BACKGROUND: cSDH is a rare form of bleeding in patients with ITP. Intracerebral hematoma or subarachnoid hemorrhage is more frequently reported in these patients. Spontaneous resolution of cSDH in patients with idiopathic subdural hematoma is uncommon. CASE DESCRIPTION: We report a case of spontaneous cSDH in a patient with ITP, and we review the related cases in the literature. In our patient, the hematoma resolved spontaneously despite very low platelet levels. There also was an incidental left parietal convexity meningioma. A review of the literature is presented, and the management of the patients is discussed. CONCLUSION: In patients with ITP, cSDHs may resolve spontaneously or with medical treatment, and surgery might be deferred except in emergency conditions or in patients with normal neurological findings. Close neurological and radiological observation along with the medical treatment may be appropriate in the management of patients with normal neurological findings.