Extradural meningioma in the left fronto-temporo-parietal region.

A case of a 47-year-old male patient who presented with a history of complaints of headache, vertigo and an expanding painful swelling on the left side of the head over the last year is reported. The lump was 15 x 15 cm and protruded 1-3 centimeters. Neurological examination revealed the presence of a mild right hemiparesis with right central facial palsy. Plain skull X-ray film demonstrates a heterogeneous bone thickening in the left fronto-temporo-parietal region with a small osteolytic focus and spotted shadows. Computed tomography scan of the skull showed that a major part of the squamas of the frontal and temporal bones were transformed into spiculoform structures turned outwards and inwards. Thus the bone appeared thickened overall. There were no alterations in the cerebral structures. The tumour was completely removed. It was located extradurally and through the bones extended to the soft tissues under the skin. The histological findings showed a meningioma with hemorrhages and necroses and the presence of lipids containing xanthochromic cells. After a surgical extirpation of the tumour a reduction of the neurological symptomatology and subjective complaints was observed.

Traumatic intracerebral hematomas--diagnostic and therapeutic problem.

A retrospective analysis was performed of 79 patients with hematomas treated surgically or conservatively. The surgical modality was most often opted for in the following cases: patients with hematomas exceeding 4 cm in diameter; patients with hematomas causing a pronounced dislocation of cerebral structures; patients with multiple hematomas that can be accessed through a bone flap. Hematomas smaller than 4 cm in diameter as well as those located in several brain regions were found to tend easily to resorption at the control computer tomography due to which we preferred treating them using conservative therapeutic methods. This therapeutic approach to the patients with hematomas is supported by the statistical analysis. Comparison of the groups of survivors and nonsurvivors shows that the former predominated in cases of hematomas located in the frontal lobe; the latter are predominant when the hematomas are located in the temporal lobe of the brain. There was no difference between the groups of surgically and conservatively treated patients with respect to the outcome of the disease if it is improvement or death. In the group of patients who underwent conservative treatment there was a predominance of those patients that showed no improvement of the initial state. The following conclusions can be made: 1. Surgical treatment is most often administered to patients with hematomas greater than 4 cm in diameter and hematomas causing dislocation of the cerebral structures. 2. The patients at highest risk for adverse outcome are those with temporal location of the hematoma.

A neurofibroma affecting the first right cervical sympathetic ganglion and entering the jugular foramen of the skull base.

The case of a 27 year old male patient is presented. He had been complaining for three months prior to his initial medical examination of severe pulsating headache in the right occipital region, propagating toward the right parietal and temporal regions, occasionally extending along the neck to the right shoulder. The pain subsequently spread over the right tonsil, the voice became hoarse and the patient experienced difficulties in swallowing. On admission to our Department we found: persistent attacks of headache, dysphonia, dysphagia, the palatine arch was slow during phonation. The right pharyngeal reflex was absent, there was pain on palpation over the right occipital bone and the antero-lateral region of the neck, as well as hypotrophy of the right sternocleidomastoid muscle. Selective right carotid arteriogram was performed--the A/P view revealed lateral displacement of the right internal carotid artery 3 cm above the bifurcation, while on lateral view the artery was pushed forward. Computed tomography of the neck with bolus contrast enhancement showed a space-occupying lesion which caused asymmetry of right pharyngeal valleculae. During surgery the tumor was found to have a spindleform shape, to emerge from the jugular foramen and to involve within its capsule the first cervical sympathetic ganglion. After enlarging the jugular foramen we achieved total extirpation of the tumor along with the first right sympathetic ganglion. The histological characteristics of the specimen defined it as neurofibroma and neural ganglion. The headache subsided in the postoperative period, recovery of the voice without dysphonia was also noted. A month later the fibrillar contractions of the tongue disappeared.

Application of one-dimensional echoencephalography to diagnosis of brain death.

Three groups of patients were studied by echoencephalography using a one-dimensional encephalograph Eho 12. The first group consisted of 100 patients with a mild craniocerebral traumas. Good pulsations of the elements of the echoencephalogram were found during the study. The second group involved 14 people who had died as a result of craniocerebral trauma. The investigation performed postmortem revealed fixed echoencephalogram without any pulsations of its elements. The third group included 11 patients with severe craniocerebral trauma in a state of deep coma. These patients were on mechanical ventilation, their brainstem reflexes were absent, but the cardiac activity remained preserved. The echoencephalographic study in these patients showed a fixed screen curve, without pulsations of its elements. We conclude that absence of pulsations of the elements of echoencephalogram produced by one-dimensional echoencephalograph indicates brain death of the investigated patients. This investigation should be included as a component of the established diagnostic tests.