Type 2 herpes simplex reactivation after craniocervical decompression for hind brain hernia and associated syrinx.

Herpes virus reactivation is a well-known phenomenon rarely described in neurosurgery. We report a case of type 2 herpes simplex virus reactivation following neurosurgery of the posterior fossa. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis of over 200 x 10(6)/l. Viral reactivation should be considered in patients with fever, meningism and extended hospital admission following neurosurgical procedures.

Does a paresthesia during spinal needle insertion indicate intrathecal needle placement?

BACKGROUND AND OBJECTIVES: Paresthesias are relatively common during spinal needle insertion, however, the clinical significance of the paresthesia is unknown. A paresthesia may result from needle-to-nerve contact with a spinal nerve in the epidural space, or, with far lateral needle placement, may result from contact with a spinal nerve within the intervertebral foramen. However, it is also possible and perhaps more likely, that paresthesias occur when the spinal needle contacts a spinal nerve root within the subarachnoid space. This study was designed to test this latter hypothesis. METHODS: Patients (n = 104) scheduled for surgery under spinal anesthesia were observed during spinal needle insertion. If a paresthesia occurred, the needle was fixed in place and the stylet removed to observe whether cerebrospinal fluid (CSF) flowed from the hub. The presence of CSF was considered proof that the needle had entered the subarachnoid space. RESULTS: Paresthesias occurred in 14/103 (13.6%) of patients; 1 patient experienced a paresthesia twice. All paresthesias were transient. Following a paresthesia, CSF was observed in the needle hub 86.7% (13/15) of the time. CONCLUSIONS: Our data suggest that the majority of transient paresthesias occur when the spinal needle enters the subarachnoid space and contacts a spinal nerve root. Therefore, when transient paresthesias occur during spinal needle placement it is appropriate to stop and assess for the presence of CSF in the needle hub, rather than withdraw and redirect the spinal needle away from the side of the paresthesia as some authors have suggested.

[Headache with transient neurologic deficits and lymphocytosis in the cerebrospinal fluid]. / Hodepine med forbigående nevrologiske utfall og lymfocytose i spinalvaesken.

BACKGROUND: Patients with episodes of headache associated with transient neurologic deficits and lymphocytes in the cerebrospinal fluid have been reported over the last two decades. MATERIAL AND METHODS: We present five patients without a prior history of migraine who experienced a limited series of 1-10 episodes of headache associated with transient neurologic deficits and lymphocytosis ranging from 85 to 500 x 10(6)/l in the cerebrospinal fluid. RESULTS: Some patients had elevated protein levels in the cerebrospinal fluid and focal EEG pathology. Analysis of cerebrospinal fluid, blood tests and imagining investigations did not give plausible aetiological explanations. INTERPRETATION: The prognosis of this syndrome is good. Its aetiology is unknown. It is reasonable to search for neurotropic viruses in future cases.

Self-limited recurrent multifocal neurological symptoms, headache, and cerebrospinal fluid lymphocytic pleocytosis: a benign syndrome with a predilection for young adult men.

Two young men, aged 34 and 30 years, developed transient recurrent multifocal neurological symptoms with associated severe headache over a 2-week period. Both had a lymphocytic pleocytosis in their cerebrospinal fluid. Cranial imaging studies were normal. All symptoms resolved without recurrence. Although the cause and pathogenesis are undefined, this self-limited benign neurological syndrome may be more common than previously recognized and has a predilection for young adult men.

Vascular trauma associated with routine spinal anaesthesia.

Samples of cerebrospinal fluid obtained from 130 patients undergoing spinal anaesthesia were examined microscopically. Subarachnoid puncture was performed using either a 25G Whitacre or 25G Quincke spinal needle. Two samples were collected from each patient and the red blood cell count of the second sample collected was taken as a measure of the vascular trauma associated with the procedure. Red blood cells were seen in 50 (38%) of these samples, of which 18 (14%) contained > 100 red blood cells.mm-3. Paraesthesia was felt by 11 (8.5%) patients and the occurrence of paraesthesia was associated with significantly raised red blood cell counts (p < 0.0001). There was also a correlation between the number of needle passes made at lumbar puncture and the red blood cell count in the sample (p < 0. 0001). Neither spinal needle type nor antiplatelet drug therapy influenced red blood cell counts (p = 0.66 and 0.37, respectively). These findings suggest that routine spinal anaesthesia is often complicated by minor degrees of vascular trauma, especially when paraesthesiae or technical difficulty occur at subarachnoid puncture.

[Clinical course and treatment of acute inflammatory demyelinating polyradiculoneuropathy (Landry-Guillain-Barré syndrome)]. / Klinika i lechenie ostroi vospalitel'noi demieliniziruiushchei poliradikuloneiropatii (sindroma Landri-Giiena-Barre).

Motor, sensitive and vegetative disorders were subjected to a clinical analysis in 40 adult patients with Landry-Guillain-Barre syndrome in the acute disease stage and during rehabilitation. Investigation of the cerebrospinal fluid and of the rate of the nervous impulses conduction in the peripheral nerves has demonstrated that in the majority of the patients, the clinical findings did not correlate with the laboratory ones. Early diagnosis and rational therapy with plasmapheresis and glucocorticoids ensured a favourable prognosis.

Monosymptomatic sensory symptoms and cerebrospinal fluid immunoglobulin levels in relation to multiple sclerosis.

Of 53 patients with monosymptomatic paresthesiae, 55% had oligoclonal bands and 28% an elevated cerebrospinal fluid (CSF) IgG index. Over a mean observation period of 64 months, nine patients developed clinically definite multiple sclerosis (MS); all of these patients had IgG bands, illustrating the prognostic importance of this CSF aberration. Two lumbar punctures more than one year apart were performed in 31 of the patients, of whom 20 had oligoclonal bands. This abnormality was constant between the time of punctures in all subjects except one, thus behaving as in MS. Similarly, the CSF findings in the 11 patients without oligoclonal bands remained normal over the observation period. The majority of patients with oligoclonal bands had cells in their CSF producing immunoglobulin of one or more of the three main classes, while none of those without oligoclonal bands displayed immunoglobulin-producing cells in CSF. Occurrence of oligoclonal bands in CSF is common in patients with paresthesiae and increases the risk for future development of MS.

Multiple mononeuritis and radiculitis with erythema, pain, elevated CSF protein and pleocytosis (Bannwarth's syndrome).

Four patients with Bannwarth's syndrome were examined. One to three weeks weeks after the appearance of a large erythematous skin lesion they developed pain of variable localisation. Four days to four weeks later uni- or bilateral facial palsies and other nerve lesions developed. CSF showed elevated protein and mononuclear pleocytosis. There was a defect of the blood-brain barrier and increased intrathecal production of IgG. Facial nerve latencies were increased 4 to 7 times in three cases and normal in one case examined 15 months after onset. Conduction velocity along other nerves was normal apart from slight slowing in one diabetic patient. Recovery was incomplete in three patients 8 to 15 months after onset of disease and complete in one patient after 15 months.