Meningeal melanocytosis in a young patient--an autopsy diagnosis.

Primary diffuse leptomeningeal melanocytosis is a very rare form of brain tumor. We report on a rapidly fatal case in an 18-year-old man presenting with symptoms and imaging features suggestive for subarachnoid hemorrhage or meningitis. The laboratory findings and imaging examination were still confusing and the diagnosis remained unclear during the patient's life. Autopsy was the cornerstone in disclosing the lesion, confirming its usefulness in the assessment of such unusual cases. The complete profile of the tumor was obtained only by histology and immunohistochemistry. Clinicians and pathologists must be aware of diagnosis difficulties in this rare disease which can represent a serious challenge in clinical practice.

Associated pathology with Wallenberg's syndrome. A report of three cases.

Three cases with Wallenberg's syndrome were reported, in which CT-scan revealed silent old right temporal infarction, right recent cerebellar haematoma and left calcified parietal subdural haematoma evidenced after 10 years since trauma due to a traffic accident. Although Wallenberg's syndrome constitutes a fully clinical diagnosis, CT-scan does not seem to be justified by the management logical deductions of the medical act; however, it is better to perform it in order to identify a possible associated pathology.

Acetazolamide therapy evaluation in haemorrhagic stroke.

The influence of acetazolamide in patients with hemorrhagic stroke was assessed in 54 patients in comparison with the influence of other therapies in 68 patients included in a control group. Modified Rankin Scale and mortality rate were evaluated at three different moments: onset, 72 hours and control (3 weeks-one month from the onset). A better outcome was seen when acetazolamide was given. Mortality rate was significantly lower in the group of acetazolamide. This therapy may be safely used in haemorrhagic stroke, especially when hydrocephalus is associated.

Stroke and hypertension. Antihypertensive therapy withdrawal.

The effect of antihypertensive therapy withdrawal in acute ischaemic stroke patients was assessed in order to establish possible correlations between blood pressure values and the modified Rankin Scale (mRS) outcome. One hundred and twelve consecutive patients with acute ischaemic stroke and hypertension were treated with relatively similar regimen. Seventy-two hours following the onset of stroke, systolic blood pressure decreased to < or = 180 mmHg in 110 patients. Antihypertensive therapy was randomly discontinued in 59 patients. Clinical outcome and mortality were compared in patients with and without antihypertensive therapy withdrawal, no statistically significant differences (p > 0.05) between the two groups being found. Statistically significant positive correlations (p < 0.05) between mRS outcome and the decrease of systolic and diastolic blood pressure values were in patients treated with anticoagulant and antihypertensive therapy. Statistically significant negative correlations (p < 0.05) between mRS outcome and low levels of diastolic blood pressure were noted in patients who discontinued antihypertensive therapy. Our findings emphasize the need to associate antihypertensive and anticoagulant therapy in acute ischaemic stroke patients with hypertension. Spontaneous decrease of diastolic blood pressure values showed poor outcome. The management of hypertension associated with acute ischaemic stroke should be reconsidered.

Option for surgical management of cerebral haematoma: case report.

A 48-year-old male patient, a surgeon, displayed a right temporo-occipital cerebral haematoma (5 x 7 cm). He had a history of chronic left occipital migraine-like cephalalgia from the age of 16 and hypertension was diagnosed when he was 42 years old. As therapy, he used ACE inhibitors, nifedipine and clonidine for hypertension and for cephalalgia a combination of aspirin, phenacetin and caffeine. During the last 2-3 months before the detection of cerebral haematoma, injections with piritramide were made when severe headaches were unbearable. The patient was operated on the 7th day since the onset of cerebral haematoma after a "wait and see" period of repeated clinical and CT-scan assessment. The initial option of the patient was surgical. We consider that the patient's profession (medical/surgical profile) may have played a positive motivation for the surgical option.

Outcome in ischaemic stroke: carotid versus vertebro-basilar territory.

Clinical study and laboratory investigations were performed in 166 carotid ischaemic stroke (CIS) patients and 64 vertebro-basilar ischaemic stroke (VBIS) patients. The study revealed some features of VBIS: significant male predominance (p < 0.001), better outcome (for modified Rankin Scale (MRS)) (p < 0.01), significant number of different triggering factors (p < 0.001). Nonsignificant differences in mortality were found in both groups (p > 0.05). Myocardial infarction was an important associated cause of death.