[Bacterial brain abscess--experiences with 67 patients]. / Der bakterielle Hirnabszess-Erfahrungen bei 67 Patienten.

Sixty-seven patients with brain abscess were managed over 19 years (1975-1993). Our series had a 2.5 to 1 male predominance; the age distribution was from 3 days to 81 years. The underlying conditions of hematogenic brain abscesses (n = 33; 49%) included lung infections (n = 16), heart disease (n = 4), sepsis (n = 10), and other foci (n = 3). Otolaryngologic infections led to the abscess in 10 cases; there were 9 traumatic abscesses. The causes remained unknown in 15 cases. There were 47 solitary abscesses (70%) and 20 multiple abscesses. The most frequent presenting signs and symptoms were neurologic deficits (n = 17), disturbances of consciousness (n = 14), seizures (n = 6), and headaches, meningism and vomiting (n = 13). Causative organisms were isolated in 39 cases (58%) and included staphylococci (n = 6), streptococci (n = 6), enterobacteriae (n = 2), and anaerobic pathogens (n = 9). The most reliable laboratory sign of inflammation was an elevated ESR (52/59 patients). With the advent of computed tomography, burr hole aspiration of the abscess with or without drainage was possible in 30 cases; the mortality in this subgroup was 9%. All 4 patients with surgical excision in the pre CT-era died. The mortality of patients treated with antibiotics only was 62% (18/29). Overall mortality was 37% (25/67), including 5 cases with post mortem-diagnosis of brain abscess. Good recovery was achieved in 29/42 survivors. Predictors of a poor outcome were the patient's age, the level of consciousness, multiple abscesses, polybacterial cultures, and a hematogenic etiology, but not the size of the abscess.

[Intracerebral abscess 48 years after grenade splinter injury]. / Intrazerebraler Abszess 48 Jahre nach Granatsplitterverletzung.

The case report of a 54-year-old patient with a right frontal intracerebral abscess 48 years after a missile injury is presented. Treatment included surgical evacuation and antibiotic therapy. The patient was discharged without neurological deficit.

Outcome of intracerebral hemorrhage: clinical and CT findings in 326 patients.

Clinical symptoms and findings in cranial computed tomography (CT) were evaluated in 326 patients with intracerebral hemorrhage (ICH). Localizations of ICH were the lobes (n = 254), the basal ganglia (n = 46), the pons and brain stem (n = 13) and the cerebellum (n = 8). Multiple hematomas were present in nine patients. An initial coma (n = 225) was most frequent in ICH of the pons (n = 7), cerebellum (n = 6), and the frontal (n = 71) and temporal (n = 66) lobes. Epileptic seizures (n = 70) were most common in hematomas of the frontal (n = 24), temporal (n = 19) and parietal (n = 12) lobes and the basal ganglia (n = 6). A history of hypertension was given in 140 patients; 119 of these had an ICH with a size of ≥3 cm. Mortality (n = 162) was high with ICH in the pons and brain stem (10 out of 13), in the frontal (54 out of 98) and parietal (32 out of 58) lobes and the basal ganglia (n = 23). A size of the ICH of 3 cm or more in cranial CT and an associated ventricular hemorrhage were associated with a bad outcome. An initial disturbance of consciousness was the only reliable clinical predictor of outcome (chi-square, p < 0.001). Katamnestic evaluation of 66 of the 164 survivors after 5.2 years revealed seizures in 20 patients and mild neurological deficits in 41. Another 14 patients were partially, and nine totally dependent Nineteen patients had died in between; there was only one death attributable to another ICH.

Primary intranasal encephalocele: a rare cause of bacterial meningitis.

In four patients with bacterial meningitis a primary intranasal encephalocele was found as portal of entry. In two of the cases the malformation had been misdiagnosed as a nasal polyp and operated upon. In two patients a cerebrospinal fluid fistula developed spontaneously at the age of 54 years. None of the patients had associated symptoms indicating the presence of a cleft. Encephaloceles can be readily visualized by computed tomography particularly in coronal sections. The treatment of choice is transcranial surgical repair.

General dysplasia of the cerebral arteries with persistent primitive acoustic artery and giant aneurysm.

A case of cerebrovascular systemic dysplasia is presented. The anomalies were: persistent primitive acoustic artery, giant aneurysm of the left internal carotid artery, aneurysm of the basilar artery, and an arteriovenous fistula. A review of the literature shows that the association of multiple malformations of cerebral vessels with a persistent primitive acoustic artery has not previously been described. Impairment of embryonic development is suggested as the origin of the malformations.

CT findings in subarachnoidal haemorrhage (SAH). A retrospective study of 138 patients.

In a retrospective study the CT scans of 138 patients with the clinical diagnosis of SAH were reviewed. CT was highly sensitive in detecting blood in the CSF spaces during the 3 days following SAH, with decreasing accuracy correlated to the time interval between SAH and CT examination. Clinical state on admission and CT findings were closely related, as were the localisation of detectable blood and the site of source of bleeding. Whereas blood clots in the basal cisterns, above the convexities, and intracerebrally, as well as the finding of a brain oedema, were significantly correlated to the time of survival, hydrocephalus and ventricular haemorrhage had no bearing on the survival time.

[Differential diagnosis of superior orbital fissure syndrome]. / Zur Differentialdiagnose des Fissura-orbitalis-superior-Syndroms.

Paresis of cranial nerves III, IV, VI and the ophthalmic nerve is termed fissura-orbitalis-superior syndrome. It is caused by affections of the surrounding bones, vascular lesions in the region of the cavernous sinus, tumours of sella and sphenoid bones and diseases of the orbital cavity. Cranial computed tomography (with and without contrast enhancement) is a reliable diagnostic method which may be supported by angiography of NMR in individual cases.

[Gunshot injuries of the skull. Computerized tomography findings and clinical course]. / Schussverletzungen des Schädels. Computertomographischer Befund und klinischer Verlauf.

The clinical and computed tomographic findings in 22 civilian cases of craniocerebral gunshot injury are reported. Fifteen out of the 19 male cases were suicidal attempts; the 3 women were shot by their husbands. In 2 cases the injuries resulted from use of a slaughterer's gun. The level of consciousness is a valuable predictor of outcome from the clinical point of view. CT findings such as bihemispheric injury and detection of intraventricular blood or air were associated with a poor outcome. Surgical intervention appears to be justified only in patients with extensive subdural or epidural hematoma. The mortality rate in this study was 45%.

Neurological and neuropathological findings in familial erythrophagocytic lymphohistiocytosis.

An infant case of erythrophagocytic lymphohistiocytosis is reported. The disease began at the age of two months with hepatosplenomegaly and intractable fever, and later developed pancytopenia. Splenectomy had to be performed at the age of six months and led to the final diagnosis. After the age of nine months the patient developed progressive neurological signs (loss of visual function convulsions, opisthotonus and CSF pleocytosis). The changes in the CT-scan of the brain were explained by the neuropathologic findings after the death of the patient at the age of 13 months. The markedly atrophic brain showed diffuse and mainly perivascular infiltration of brain and meninges with lympho- and histiocytes and extensive microscopic calcification.

[Spontaneous carotid cavernous fistula in a case of hereditary hemorrhagic telangiectasia (Osler-Rendu) (author's transl)]. / Spontane Carotis-cavernosus-Fistel bei Morbus Osler-Rendu (Teleangiektasia hereditaria)

A 37-year-old woman suffered from headaches, right facial pain, double vision and occasional tinnitus. On examination there was only a slightly dilated right pupil, weakened corneal reflex and capillary bleeding from telangiectasia of both hands. Similar bleedings occured in her mother (mouth and hands) and son (nose). The arteriography of the right carotid artery showed a cavernous sinus fistula with a small shunt. Steady compression of the carotid artery by hand caused a marked improvement in the subjective symptomatology.