[Favorable outcome of hyperacute epidural hematoma in an octogenarian].

Acute epidural hematoma is very rare in the elderly after head injury. It is usually associated with extremely high mortality or severe disability. In an 87-year-old woman a large, hyperacute, epidural hematoma was diagnosed. She was treated promptly and enjoyed an uneventful, complete recovery. This exceptional case should encourage an intensive approach even in seemingly minor head trauma in the elderly.

Neurobehavioral consequences of closed head injury in the elderly.

The assessment of neurobehavioural outcome after head injury in older patients (> 60 year old) has met with difficultives, due to the obstacles in finding subjects who would constitute an appropriate control group. In the present study, survivors of closed head injury (CHI) of this age group were compared to two control groups: (1) orthopaedic patients (OP) who were injured in similar circumstances but did not sustain head injury and (2) healthy, age-matched volunteers (HC). Compared with HC, CHI and OP were impaired on word fluency, memory and reasoning. No differences were found between CHI and the OP. These results may indicate that, rather than resulting only from the head injury brought about by falling, the cognitive decline may predate the injury and increase the risk of accidents in old age.

[An achondroplastic dwarf with paraplegia].

A 30-year-old female achondroplastic dwarf developed a progressive gait disturbance erroneously attributed to her hydrocephalus and deformities of both legs. Her condition deteriorated into flaccid paraplegia with anal and urinary incontinence. CT revealed extreme spinal stenosis typical in achondroplasia (shallow vertebral body, short pedicles, and hypertrophy of intervertebral joints) together with disc protrusions. Wide laminectomy of the lumbar vertebrae resulted in complete amelioration of all the neurological deficits. Progressive paraplegia is a rare complication of achondroplasia; its early recognition and surgical treatment is very rewarding.

Gradual resolution of an arachnoid cyst after spontaneous rupture into the subdural space. Case report.

The authors present the case of a young patient in whom the spontaneous rupture of a known, long-standing middle fossa arachnoid cyst into the subdural space was documented. This spontaneous rupture was followed by gradual diminution of the cyst to near-complete resolution.

[Microvascular decompression of the trigeminal nerve: electrophysiological changes].

In a 67-year-old woman with trigeminal neuralgia, pressure on the trigeminal nerve of vascular bundle and arachnoidal adhesions was relieved by microsurgery. Short-latency, brainstem, trigeminal evoked-potentials were continuously recorded throughout the operation. The initial response was characterized by prolonged latency, low amplitude and distorted shape. Immediately after decompression the response attained normal latency, amplitude and shape. Pain disappeared within less than 24 hours. Power spectrum analysis showed wide frequency range in the initial evoked potentials, consistent with desynchronization of the afferent impulses. The range of frequencies was reduced to normal as soon as the trigeminal nerve was decompressed.

[Head injury in the elderly].

We report 281 consecutive admissions of head-injured patients over 65 years of age. 2/3 were males, as in younger age groups, despite the decreased activity and increased proportion of females among the elderly. The main causes of injury were falls (71.8%; mostly at home) and pedestrian accidents (20.6%). There was a high incidence of cardiovascular disease among the men. The unique set of causes and types of head injuries in this age group (1/3 chronic subdural hematomas, 1/3 cerebral contusions and 1/5 acute subdural hematomas), as well as the grim outcome, justify regarding head injury in the elderly as a special clinical entity. Its special medical, surgical, organizational and ethical aspects should be considered.

Head injuries in the elderly.

Two hundred and sixty-three consecutive head-injured patients aged over 65 years, admitted to a neurosurgical service, are reported. In contrast to younger age group the main cause was falls concomitant with a high rate of cardiovascular pre-existing disorders. The distribution of causes and grim results justify, in our opinion, regarding head injury in the elderly as a distinct entity requiring special surgical, medical, organizational and ethical considerations.

[Practical significance of middle molecules of the blood in assessing the severity of the status of neurosurgical patients]. / Prikladnoe znachenie srednikh molekul krovi dlia otsenki tiazhesti sostonianiia neirokhirugicheskikh bol'nykh.

Study of the content of medium-size molecules (MM), residual nitrogen, creatinine, and urea in the blood of 80 neurosurgical patients with various diseases showed correlation between the severity of the patient's general condition and the MM level. No correlation was noted between the content of MM, creatinine, and urea. The MM level in the blood correlated with that of residual nitrogen in 20% of cases. The MM dynamics may serve as a prognostic sign of the course and outcome of the disease. The MM content corresponds to the severity of the patient's general condition and is not dependent on the etiological and pathogenetic factors.

[Elastic properties of the cerebrospinal system and cerebrospinal fluid dynamics in intracranial hypertension and normotensive hydrocephalus in adults]. / Elasticheskie svoistva tserebrospinal'noi sistemy i likvorodinamika pri vnutricherepnoi gipertenzii i normotenzivnoi gidrotsefalii u vzroslykh.

Time course of changes of the CSF and the elastic properties of the cerebrospinal system were studied in 25 patients with normotensive hydrocephalus and in 26 patients suffering from benign intracranial hypertension. In 66% of cases with the normotensive hydrocephalus syndrome and in 60% of those with benign intracranial hypertension CSF resorption resistance and the elasticity gradient increased. Shunting operations proved effective in such cases.

[Tryptophan loading and its plasma concentration in neurosurgical patients]. / Nagruzka triptofanom i ego soderzhanie v plazme krovi u neirokhirurgicheskikh bol'nykh.

Tests for blood plasma tryptophan in patients with various diseases of the nervous system showed a statistically significant increase of its content in tumors of the astrocytic series in patients with meningiomas and oligodendrogliomas. The character of the tryptophan excretion curve after a load in neurooncological patients was different from that in healthy individuals and patients with thrombosis of the sinus and arachnoencephalitis. Hydrocortisone injection normalized the tryptophan curve in patients and, consequently, also the tryptophanpyrrolase reaction which is evidently disturbed in neurooncological patients.

[Diagnosis of hypertensive syndromes of unclear origin (according to the results of radionuclide cisternography)]. / Diagnostika gipertenzionnogo sindroma neiasnogo geneza (po dannym radionuklidnoi tsisternografii).

Analysis of the findings of radionuclide cisternography in 34 patients with a hypertension syndrome of unclear genesis allowed 3 variants of an aggregate of radiological signs to be distinguished. The 1st and 2nd variants indicate diminution of the drainage function of the cerebral submeningeal space, which does not exclude the presence of a pathological process, one of tumorous genesis among others. The third variant which reveals open internal hydrocephalus (ventricular hydrocephalus) with diminished drainage activity of the submeningeal space of the brain excludes the existence of a three-dimensional pathological process, that of tumorous origin also. In hypertension syndrome of unclear genesis disturbed circulation of cerebrospinal fluid was always attended by its impaired resorption; not only a diminished reaction (function) but an accelerated reaction of drainage of the cerebrospinal fluid from its passages may occur when the maintaining drainage function of the submeningeal space of the spinal cord is manifested.

[Assessment of reinnervation of the muscles of facial expression following plastic repair of the facial nerve with the descending branch of the hypoglossal nerve (according to electromyographic findings)]. / Otsenka reinnervatsii mimicheskikh myshts posle plastiki litsevogo nerva niskhodiashchei vetv'iu pod''iazychnogo nerva (po dannym élektromiografii)

The data of electromyographic studies of the bioelectrical activity of the facial muscles following plastic repair of the facial nerve with the aid of the descending branch of the hypoglossal nerve permit to interpret the succession and quality of the reinnervation of the muscles. Myoelectrogenesis, as shown by the examinations of 13 patients, develops earlier and with greater completeness in the muscles around the mouth than in the orbicular eye muscle and the frontal muscle, which corresponds to the clinical observations. In the process of reinnervation the activity of the zygomaticus muscle favoured the formation of joint and voluntary movements of the orbicular muscle of the eye and of the frontal muscle.