Computed tomography and magnetic resonance imaging in traumatic locked-in syndrome.

The first reported case of traumatic locked-in syndrome with computed tomographic and magnetic resonance scan confirmation of the brain stem lesion is presented. The lesion responsible for the patient's condition consisted of a hemorrhage in the ventral pontomedullary junction. The pathophysiology of the production of such lesions is discussed.

Conservative management of thrombosed vein of Galen malformations. Report of two cases and a review of the literature.

Spontaneously thrombosed vein of Galen malformations are rare congenital vascular malformations. Surgical treatment of these lesions based on experience with the management of patent malformations has yielded less than satisfactory results. This report reviews the literature concerning these lesions and details our experience with nonoperative management in 2 patients.

Symptomatic spinal epidural lipomatosis as a complication of steroid immunosuppression in cardiac transplant patients. Report of two cases.

Patients with Cushing's syndrome may develop spinal epidural lipomatosis, an abnormal accumulation of fat in the spinal epidural space. This accumulation of fat may cause compression of the spinal cord or cauda equina with resulting neurological deficit. Two cases of symptomatic spinal lipomatosis are reported in cardiac transplant patients receiving chronic corticosteroid treatment. The literature is reviewed, and diagnostic and therapeutic considerations are discussed.

A prospective analysis of 142 carotid endarterectomies for occlusive vascular disease, 1979-1985.

Carotid endarterectomy may carry a substantial risk of morbidity and mortality from major stroke, thus offsetting any statistical benefit in reduction of future stroke. Because of the disturbing ranges in the incidence of stroke morbidity and mortality reported from the several institutional series studying carotid endarterectomy, the authors undertook a prospective review of 142 consecutive carotid endarterectomies performed for symptomatic atherosclerotic occlusive vascular disease on the neurosurgical service. The University of Alabama Hospital. Preoperative risk assessment was performed in each case according to the Mayo Clinic classification system. The overall mortality rate was 1.4% and the major stroke morbidity rate was 0.7%, for a combined major morbidity and mortality rate of 2.1%. The incidence of minor neurological morbidity was 1.4%. There was no morbidity or mortality in the Grade I and II (low-risk) patient groups. This low combined major morbidity and mortality rate of 2.1% for carotid endarterectomy causes the surgical stroke-free survival curve to intersect the medical stroke-free survival curve at an earlier point in time, and thus demonstrates the greater reduction in risk of stroke which accrues over time for the surgically treated patient.

Intervertebral disc infection after lumbar chemonucleolysis: report of a case.

Intervertebral disc space infection can be a serious and disabling complication of any procedure that affords entry for bacteria into the susceptible disc space. Most disc space infections occur after cervical or lumbar laminectomies. Discitis has been reported after myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. A case of septic discitis occurring after intradiscal therapy with chymopapain is presented. Patients who return for evaluation of recurrent spinal pain after chemonucleolysis, especially those with paravertebral muscle spasm, should be evaluated for the possibility of disc space infection by obtaining an erythrocyte sedimentation rate, peripheral white count, differential cell count, and plain roentgenograms. Radionuclide bone scans, although not specific, may provide further objective evidence leading to the diagnosis of an intervertebral disc space infection.

Glucose-6-phosphate dehydrogenase: a possible clinical indicator for prostatic carcinoma.

Any system of biochemical analysis that can be used to detect chemical differences between normal and malignant cells may add potentially valuable information to complement the histologic data which provide the practical definition of human prostatic carcinoma. A difference (P less than 0.0001) was observed in the levels of glucose-6-phosphate dehydrogenase (G-6-PD) activity in prostatic tissue with benign hyperplasia and prostatic carcinoma. Measured as a function of the amount of protein extracted from whole-tissue homogenates, the values for G-6-PD activity in prostatic carcinoma are almost four times those measured for benign prostatic hyperplasia. The degree of elevation of the activity of this enzyme suggests a correlation between enzymatic activity and clinical prognosticators, ie., histologic differentiation and clinical stage.