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Sample records for arachnoid

  1. Tuberculous optochiasmatic arachnoiditis

    OpenAIRE

    Anupriya A; Sunithi M; Maya T; Goel M; Alexander M; Aaron S; Mathew V

    2010-01-01

    Arachnoiditis involving optic nerve and the optic chiasm can occur as a complication of tuberculous meningitis (TBM). This study evaluates the clinical features, cerebrospinal fluid (CSF) and laboratory parameters and imaging findings of optochiasmatic arachnoiditis (OCA) and also tried to identify any factors which can predict this complication in patients with TBM. Patients admitted with TBM in the neurology wards of a tertiary care teaching hospital over a period of 6 years formed the mate...

  2. Tuberculous optochiasmatic arachnoiditis.

    Science.gov (United States)

    Anupriya, A; Sunithi, M; Maya, T; Goel, M; Alexander, M; Aaron, S; Mathew, V

    2010-01-01

    Arachnoiditis involving optic nerve and the optic chiasm can occur as a complication of tuberculous meningitis (TBM). This study evaluates the clinical features, cerebrospinal fluid (CSF) and laboratory parameters and imaging findings of optochiasmatic arachnoiditis (OCA) and also tried to identify any factors which can predict this complication in patients with TBM. Patients admitted with TBM in the neurology wards of a tertiary care teaching hospital over a period of 6 years formed the material for this study. Student's "t" test and univariate analysis were done to identify any predictors for this complication and the variables found to be significant were further analyzed by multivariate logistic regression analysis. One hundred sixty-three patients with TBM, admitted over a 6-year period, were studied. Twenty-three (14%) patients developed OCA. Eighteen out of 23 (78%) developed this complication while on antituberculous treatment (ATT) and 5/23 (22%) were newly diagnosed cases of TBM. Of those already on treatment, 12/23 (52%) were receiving only ATT, the remaining 6/23 (26%) had received steroids along with ATT in varying doses and duration. The average period from diagnosis of TBM to visual symptoms was 6.4 months. On the multivariate logistic regression analysis, female sex (P 260 mg% (P < 0.021) were the factors predisposing toward this complication. At 6 months follow-up, on treatment with steroids and ATT, 17% had improvement and no further deterioration was noted in visual acuity in 52%. OCA can develop even while on treatment with ATT. Young women with a high CSF protein content seem to be more prone for this complication.

  3. Tuberculous optochiasmatic arachnoiditis

    Directory of Open Access Journals (Sweden)

    Anupriya A

    2010-12-01

    Full Text Available Arachnoiditis involving optic nerve and the optic chiasm can occur as a complication of tuberculous meningitis (TBM. This study evaluates the clinical features, cerebrospinal fluid (CSF and laboratory parameters and imaging findings of optochiasmatic arachnoiditis (OCA and also tried to identify any factors which can predict this complication in patients with TBM. Patients admitted with TBM in the neurology wards of a tertiary care teaching hospital over a period of 6 years formed the material for this study. Student′s "t" test and univariate analysis were done to identify any predictors for this complication and the variables found to be significant were further analyzed by multivariate logistic regression analysis. One hundred sixty-three patients with TBM, admitted over a 6-year period, were studied. Twenty-three (14% patients developed OCA. Eighteen out of 23 (78% developed this complication while on antituberculous treatment (ATT and 5/23 (22% were newly diagnosed cases of TBM. Of those already on treatment, 12/23 (52% were receiving only ATT, the remaining 6/23 (26% had received steroids along with ATT in varying doses and duration. The average period from diagnosis of TBM to visual symptoms was 6.4 months. On the multivariate logistic regression analysis, female sex (P < 0.037, age less than 27 (P < 0.008 years and protein content in the CSF > 260 mg% (P < 0.021 were the factors predisposing toward this complication. At 6 months follow-up, on treatment with steroids and ATT, 17% had improvement and no further deterioration was noted in visual acuity in 52%. OCA can develop even while on treatment with ATT. Young women with a high CSF protein content seem to be more prone for this complication.

  4. Arachnoid cyst in oculomotor cistern

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Kyun; Choi, Hyun Seok; Jeun, Sin Soo; Jung, So Lyung; Ahn, Kook Jin; Kim, Bum Soo [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2013-10-15

    Oculomotor cistern is normal anatomic structure that is like an arachnoid-lined cerebrospinal fluid-filled sleeve, containing oculomotor nerve. We report a case of arachnoid cyst in oculomotor cistern, manifesting as oculomotor nerve palsy. The oblique sagittal MRI, parallel to the oculomotor nerve, showed well-defined and enlarged subarachnoid spaces along the course of oculomotor nerve. Simple fenestration was done with immediate regression of symptom. When a disease develops in oculomotor cistern, precise evaluation with proper MRI sequence should be performed to rule out tumorous condition and prevent injury of the oculomotor nerve.

  5. Spontaneous hygroma in intracranial arachnoid cyst

    Energy Technology Data Exchange (ETDEWEB)

    Agnoli, A.L.

    1984-06-01

    Anamnesis and treatment of two cases of arachnoid cysts extending into the subarachnoid space are described. No traumatic incident was discovered in the previous history of these two patients. The causal genesis of neurological signs of deficiency in patients with arachnoid and acquired cysts is discussed. However, the cause of the development of a subdural hygroma in arachnoid cysts remains unclarified. CT findings of arachnoid cysts with a hypodense zone between brain surface and the vault of the cranium always require an investigation into the possibility of a spontaneous emptying of the cyst or of a congenital and not only localised extension of the cyst itself.

  6. An interesting case of primary spinal arachnoiditis.

    LENUS (Irish Health Repository)

    Vaughan, Denis

    2012-02-27

    Spinal arachnoiditis describes inflammation of the meninges, subarachnoid space and, in most cases, also involve the pial layer. The vast majority of cases described are secondary and are preceded by a known event, for example,. trauma, infections or irritative substances. Here, we present the case of primary spinal arachnoiditis. A 35-year-old lady was referred to the neurosurgical services in Dublin, Ireland with a 15-month history of progressive, right lower limb weakness. Magnetic resonance imaging revealed cystic distortion of the lumbar spinal canal extending up to the conus. Initially, an L2-L4 laminectomy was performed revealing thickened and adherent arachnoid with a large cyst in the spinal canal. Four months after initial operation, the patient represented with bilateral lower limb weakness and loss of detrusor function. Repeat magnetic resonance imaging was performed, which showed the development of a syrinx in the patient\\'s thoracic spine. We then performed a T9-T10 laminectomy, midline myelotomy and insertion of a syringe-arachnoid shunt. Post-operative imaging showed resolution of the syrinx and a vast improvement in lower limb power. The patient also regained bladder control. In conclusion, spinal arachnoiditis is a clearly defined pathological and radiological entity with a highly variable clinical presentation. It is exceedingly difficult to treat as there is no recognised treatment currently, with most interventions aimed at symptomatic relief.

  7. Sports participation with arachnoid cysts.

    Science.gov (United States)

    Strahle, Jennifer; Selzer, Béla J; Geh, Ndi; Srinivasan, Dushyanth; Strahle, MaryKathryn; Martinez-Sosa, Meleine; Muraszko, Karin M; Garton, Hugh J L; Maher, Cormac O

    2016-04-01

    OBJECT There is currently no consensus on the safety of sports participation for patients with an intracranial arachnoid cyst (AC). The authors' goal was to define the risk of sports participation for children with this imaging finding. METHODS A survey was prospectively administered to 185 patients with ACs during a 46-month period at a single institution. Cyst size and location, treatment, sports participation, and any injuries were recorded. Eighty patients completed at least 1 subsequent survey following their initial entry into the registry, and these patients were included in a prospective registry with a mean prospective follow-up interval of 15.9 ± 8.8 months. RESULTS A total 112 patients with ACs participated in 261 sports for a cumulative duration of 4410 months or 1470 seasons. Of these, 94 patients participated in 190 contact sports for a cumulative duration of 2818 months or 939 seasons. There were no serious or catastrophic neurological injuries. Two patients presented with symptomatic subdural hygromas following minor sports injuries. In the prospective cohort, there were no neurological injuries CONCLUSIONS Permanent or catastrophic neurological injuries are very unusual in AC patients who participate in athletic activities. In most cases, sports participation by these patients is safe.

  8. Treatment options for intracranial arachnoid cysts

    DEFF Research Database (Denmark)

    Holst, Anders Vedel; Danielsen, Patricia L; Juhler, Marianne

    2012-01-01

    The best surgical treatment of cerebral arachnoid cysts is yet to be established. Treatment options are shunting, endoscopic fenestration or microsurgical fenestration through craniotomy.Data from 69 patients with cerebral arachnoid cysts treated in our institution between 1997 and 2007 were...... reviewed.Cysts were located infratentorially in 20% (n = 14) and supratentorially in 80% (n = 55); of these 73% (n = 40) were in the middle cranial fossa. Mean cyst size was 61 mm (range 15-100 mm). The most common symptoms were headache (51%), dizziness (26%), cranial nerve dysfunction (23%), seizure (22......-up was 30 months. In the surgical series 79% (n = 45) had a good outcome.We conclude that the surgical treatment of arachnoid cysts has an overall good outcome. In our institution the best results were obtained with microsurgical decompression through craniotomy....

  9. Giant arachnoid granulation in a patient with benign intracranial hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Kiroglu, Yilmaz; Yaqci, Baki; Cirak, Bayram; Karabulut, Nevzat [Pamukkale University, Department of Radiology, School of Medicine, Denizli (Turkey)

    2008-10-15

    We report magnetic resonance (MR), computed tomography (CT) and angiographic imaging of an unusual giant arachnoid granulation in the superior sagittal sinus in a man with headache and vertigo. Intrasinus pressure measurements revealed a significant pressure gradient across the lesion. MR imaging is useful to identify giant arachnoid granulation and dural sinus thrombosis, whereas dural sinus pressure measurement in certain cases of giant arachnoid granulations can be used to evaluate the lesion as the cause of the patient's symptoms. (orig.)

  10. Global Characteristics of 'Arachnoids' on Venus

    Science.gov (United States)

    Hamilton, V. E.; Stofan, E. R.

    1996-03-01

    The term "arachnoid" has been used colloquially to describe circular to elliptical structures having a set of radiating lineaments distinctly resembling the legs of a spider. However, little is known about the origin of these features and whether or not they are genetically related to each other or to other circular structures on Venus (e.g., coronae, volcanoes, and calderas). We have conducted a global survey of these features in order to more clearly define their characteristics and determine if they are in fact a separate type of feature. In contrast to previous counts, we find a rather small global population of only 36 features that we feel we can confidently call "arachnoids". A detailed examination of these features reveals that they do not display a common set of volcanic or tectonic characteristics indicative of a single process of formation. We also find that these features do not appear to universally represent a particular stage of corona, volcano, or caldera development. _

  11. Teflon sponge shunt for recurrent arachnoid cyst

    OpenAIRE

    Goel Atul; Shah Abhidha; Pareikh Samir

    2007-01-01

    A 50-year-old female presented with complaints of progressive ataxia. Investigations showed a large intradural arachnoid cyst located anterior to the brainstem. Following marsupialization of the cyst she improved remarkably in her symptoms. The symptoms recurred nine months later and investigations revealed recurrence of the cyst. The cyst was evacuated again and two Teflon sponge sheets were placed such that they traversed the length of the cyst cavity and extended into the cisterna magna. A...

  12. Endoscopic treatment of the suprasellar arachnoid cyst

    Directory of Open Access Journals (Sweden)

    Yadav Y

    2010-01-01

    Full Text Available Surgical options for suprasellar arachnoid cyst are cystoperitoneal shunt, craniotomy fenestration and endoscopic fenestration. Endoscopic management has been found to be safe and effective. We report our experience with endoscopic management in 12 (male five, female seven; age range 8 months to 42 years patients with suprasellar arachnoid cyst. The endoscopic procedure included lateral ventricle puncture by precoronal burr hole and superior and inferior wall of the cyst was communicated with the lateral ventricle and the interpeduncular cistern respectively. All patients had hydrocephalus. Four pediatric patients had macrocephaly. All adult patients had visual disturbances. One adult patient presented with psychomotor disturbance along with features of raised intracranial pressure. All cases improved following endoscopic treatment. There were no complications or death. One patient required VP shunt. Postoperative MRI showed significant reduction in cyst volume in 11 patients. Follow-up ranged from 6 months to 6 and a half years. Our study suggests that endoscopic technique is a safe and effective alternative treatment for suprasellar arachnoid cyst. It prevents complications such as subdural effusion and intracranial hematoma, which are not uncommon with craniotomy fenestration.

  13. THE DIAGNOSIS AND TREATMENT OF INTRACRANIAL ARACHNOID CYSTS

    NARCIS (Netherlands)

    GO, KG

    1995-01-01

    Intracranial arachnoid cysts have been found in 0.3% of computed tomography (CT) scans and in 0.1% of brain autopsy specimens, more often in children than in adults. Intracranial arachnoid cysts occur prevalently in males, on the left side, and in the temporal fossa. Their occasional association wit

  14. The presence of progesterone receptors in arachnoid granulations and in the lining of arachnoid cysts : Its relevance to expression of progesterone receptors in meningiomas

    NARCIS (Netherlands)

    Verhagen, Aalt; Go, Kian; Visser, Gerben; BLANKENSTEIN, MA; Vaalburg, Willem

    1995-01-01

    Progesterone receptors (PR) were identified with an enzyme immunoassay in cytosols from human arachnoid granulations and arachnoid cysts. Meningiomas presumably originate from subdural endothelium which is abundantly present in these structures. In the three cases studied, oestrogen receptors were a

  15. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

    Medline Plus

    Full Text Available ... of this developing later on in life into cancer?” And, you know, my understanding is that there ... the encephalocele. Clearly, the arachnoid cyst is not cancer. This is a cyst, a bubble, a lining ...

  16. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

    Medline Plus

    Full Text Available ... an arachnoid cyst. And in listening to Dumanel’s history when we talk with him, it became apparent ... kind of work you see here on the screen, by opening the cyst up, by allowing it ...

  17. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

    Medline Plus

    Full Text Available ... right a very large area of black empty space, which is an arachnoid cyst. And in listening ... again on the slide some arrows indicating the space I’m working on between the eye nerve, ...

  18. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

    Medline Plus

    Full Text Available ... of a frontal encephalocele and an arachnoid cyst. I’m John Meara from the Department of Plastic ... and David Walton from Partners in Health. Ed, I’m going to let you lead off, and ...

  19. Retroperitoneal spinal extradural arachnoid cyst combined with congenital hemivertebrae.

    Science.gov (United States)

    Park, Se-Hwan; Kuh, Sung-Uk; Lim, Beom Jin

    2012-09-01

    Spinal extradural arachnoid cysts usually cause symptoms related to spinal cord or nerve root compression. Here, we report an atypical presentation of a spinal extradural arachnoid cyst combined with congenital hemivertebra which was presented as a retroperitoneal mass that exerted mass effects to the abdominal organs. On image studies, the communication between the cystic pedicle and the spinal arachnoid space was indistinct. Based on our experience and the literature of the pathogenesis, we planned anterior approach for removal of the arachnoid cyst in order to focus on mass removal rather than ligation of the fistulous channel. In our estimation this was feasible considering radiologic findings and also essential for the symptom relief. The cyst was totally removed with the clogged 'thecal sac-side' end of the cystic pedicle. The patient was free of abdominal discomfort by one month after the surgery.

  20. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

    Medline Plus

    Full Text Available ... frontal encephalocele and an arachnoid cyst. I’m John Meara from the Department of Plastic Surgery, and ... initially when Dumanel came to our attention. Actually, John Meara, who is here with us on our ...

  1. Opto-chiasmatic arachnoiditis in the young.

    Science.gov (United States)

    Iraci, G; Gerosa, M A; Tomazzoli, L; Pardatscher, K; Fiore, D L; Secchi, A G; Tormene, A P; Javicoli, R; Giordano, R; Olivi, A

    1983-01-01

    14 young patients, operated upon for opto-chiasmatic arachnoiditis by craniotomy are presented. 2 main etiopathogenetic forms (and their respective clinical equivalents) of the disease could be recognized. Only 1 postoperative death occurred, in a patient with a dominant clinical picture of intracranial hypertension. Results of surgery (craniotomy and lysis of adhesions) could be distinguished as positive (functional improvement) in 5 cases, indifferent or negative in the others, with a follow-up duration of up to 23 years. The role of the diagnostic value of the pneumoencephalogram as a basis for surgical indication is discussed: it is felt that this examination, when reported as negative, is not of sufficient value to rule out the diagnosis, which must essentially rely upon clinical data.

  2. [Cerebral arachnoiditis in patients with chronic rhinosinusitis].

    Science.gov (United States)

    Gushchin, A N

    1994-01-01

    The examination and treatment of 66 patients with rhinosinusogenic cerebral arachnoiditis (RCA) were performed using otorhinolaryngological and neurological tests with special emphasis on pneumoencephalography to provide objective assessment of the brain layers and ventricles. It is shown that RCA occurs most frequently in subjects suffering from chronic purulent axillary sinusitis or recurrent polysinusitis. RCA manifestations depend on the duration of rhinosinusitis and its recurrence rate. RCA onset is usually not acute and takes place at the time of rhinosinusitis exacerbation. There are also mild frontal headaches, pathological changes in the coats of the anterior cranial fossa. The above abnormalities were most pronounced at the side of rhinosinusitis or most affected sinus. The treatment should be first of all oriented on elimination of maxillary infection in line with pathogenetic treatment of RCA. An individual approach to treatment policy is advocated.

  3. [Changes in several hemodynamic indices in cerebral arachnoiditis[].

    Science.gov (United States)

    Avizhonene, I P

    1976-01-01

    The author examined 195 patients from 17 to 60 years with cerebral arachnoiditis. The following haemodynamical factors were analyzed: rheoencephalograms, synchronous rigistration of the REG and EEG, peripheral and retinal pressures. The studies showed tow tendencies of the haemodynamic changes: regional hypertonicity and hypotonicity. The specificity of the haemodynamic factors depends on the phase of the hypertensive syndrome and the duration of the disease.

  4. The Specific Sagittal Magnetic Resonance Imaging of Intradural Extra-Arachnoid Lumbar Disc Herniation

    OpenAIRE

    Tatsuro Sasaji; Kiyoshi Horaguchi; Noboru Yamada; Kazuo Iwai

    2012-01-01

    Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral du...

  5. Severe optochiasmatic arachnoiditis after rupture of an internal carotid artery aneurysm

    Directory of Open Access Journals (Sweden)

    Ricardo Ramina

    1989-06-01

    Full Text Available The case of a 24-year-old man with progressive visual loss due to optochiasmatic arachnoiditis is presented. The cause of the arachnoiditis was subarachnoidal bleeding due to rupture of an internal carotid artery aneurysm. The aneurysm was clipped 5 years after the first episode of bleeding. The diagnosis of optochiasmatic arachnoiditis was confirmed during the operation. This case, is presented in order to discuss the causes, the symptoms and the therapeutical possibilities of this rare condition.

  6. Spinal arachnoiditis as a consequence of aneurysm-related subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    Only a few case reports currently exist regarding symptomatic spinal arachnoiditis following aneurysm-related subarachnoid haemorrhage. We present three patients who developed symptomatic spinal arachnoiditis following spontaneous aneurysm rupture. Following initial aneurysm and subarachnoid haemorrhage management (including ventriculo-peritoneal shunt placement), all three patients developed gradually worsening neurological abnormalities, and subsequent imaging demonstrated spinal arachnoiditis. Despite spinal decompression, all three patients experienced progressively worsening neurological decline.

  7. Recent advances in diagnostic approaches for sub-arachnoid hemorrhage

    OpenAIRE

    Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, ODA; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi

    2011-01-01

    Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digit...

  8. Acute respiratory failure as a manifestation of an arachnoid cyst

    OpenAIRE

    Pillai Lalitha; Achari Gopal; Desai Sanjay; Patil Vinayak

    2008-01-01

    Arachnoid cysts are the most common congenital cystic lesions in the brain occurring in the middle fossa, suprasellar region and occasionally in the posterior fossa. Conventionally all cysts are considered as benign and symptoms are attributed to expansion of cysts causing compression of adjacent neurological structures, bleeds within the cyst or due to the development of acute hydrocephalus. We are reporting this case of a 15-year-old female patient with non-progressive weakness in the limbs...

  9. Arachnoid nodules in the lungs of high altitude Indians.

    OpenAIRE

    Heath, D.; Williams, D

    1993-01-01

    BACKGROUND--Nodules of cells showing a striking histological similarity to those of arachnoid villi have previously been found closely adjacent to pulmonary venules in several diseases associated with alveolar hypoxia or pulmonary oedema including mitral stenosis, plexogenic pulmonary arteriopathy, pulmonary thromboembolism, and chronic obstructive pulmonary disease. METHODS--Histological sections of the lungs of seven adult native highlanders from La Paz (3600 m) were examined. RESULTS--Arac...

  10. Suprasellar arachnoid cyst presenting with bobble-head doll movements: A report of 3 cases

    Directory of Open Access Journals (Sweden)

    Desai K

    2003-07-01

    Full Text Available We report a series of three patients with suprasellar arachnoid cysts who presented with a rare 'bobble-head doll' syndrome. The abnormal head movements improved after surgical evacuation of the cysts in all the three cases. Various pathophysiological mechanisms involved in the bobble-head doll syndrome are discussed. The literature on suprasellar arachnoid cysts is briefly reviewed.

  11. Neurotrophic arthropathy of the shoulder secondary to tuberculous arachnoiditis: a case report.

    Science.gov (United States)

    Nissenbaum, M

    1976-01-01

    A rapidly progressive neurotrophic arthropathy of the shoulder was noted in a 44-year-old man with tuberculous adhesive arachnoiditis. Difficulty in making the diagnosis of adhesive arachnoiditis was encountered because of the variable and confusing neurologic manifestations until a cisternal myelogram was performed and this previously unreported relationship established.

  12. Twelfth nerve paresis induced by an unusual posterior fossa arachnoid cyst: case report and literature review.

    Science.gov (United States)

    Tarantino, Roberto; Marruzzo, Daniele; Colistra, Davide; Mancarella, Cristina; Delfini, Roberto

    2014-08-01

    There are only three cases of arachnoid cysts inducing twelfth nerve paresis described in English medical literature. We herein report one more instance. Six weeks after surgery, the patient has almost fully recovered. This case underlines the importance of considering the arachnoid cyst as a possible cause of twelfth nerve paresis.

  13. The Specific Sagittal Magnetic Resonance Imaging of Intradural Extra-Arachnoid Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Tatsuro Sasaji

    2012-01-01

    Full Text Available Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral dural line on T2-weighted sagittal images is a characteristic finding of intradural extra-arachnoid lumbar disc herniation. The division of ventral dural line seemed to be a “Y,” and, thus, we called it the “Y sign.” The “Y sign” may be useful for diagnosing intradural extra-arachnoid lumbar disc herniation.

  14. [Suprasellar arachnoid cyst--report of a case (author's transl)].

    Science.gov (United States)

    Takahashi, T; Kawai, S; Kaminoh, T; Hiramatsu, K; Maekawa, M; Yuasa, T; Miyamoto, N; Hattori, Y

    1982-04-01

    A 4-year-old boy with suprasellar arachnoid cyst was reported. At the age of 30-month-old his aunt was aware of his squint. During the observation by ophthalmologists from the age of 1y. to 3y., enlargement of the head and impairment of the visual acuity were manifested. Cranial CT scan revealed the enlargement of the ventricular system and a round low density area located superior to the sella. Absorption coefficient of the lesion was similar to that of the cerebrospinal fluid. No abnormal contrast enhancement was seen. Examination revealed the head circumference of 53.3 cm larger than doubled standard deviation, the right external strabismus, impaired vision (R:0.03, L:0.3) and optic atrophy but no other neurological signs. Cerebral angiography showed suprasellar mass lesion. After the ventriculography with water-soluble contrast medium, V-P shunt operation was performed and then the patient was transferred to the CT room. CSF enhanced CT scan showed no communication between the ventricles and the cyst. By frontotemporal approach, microsurgical removal of the cystwall was performed and the histological diagnosis was arachnoid membrane. Several days after the operation, bilateral subdural effusion was seen on CT scan and was treated with bilateral S-P shunt and the removal of V-P shunt. Follow up CT scan disclosed the disappearance of the subdural effusion and the suprasellar cyst. The visual acuity was improved well and the endocrinological study was normal. Analysis of the 45 reported cases of suprasellar arachnoid cyst suggested that direct removal of the cyst wall is better than the V-P shunt operation and the cyst shunting is advisable for repeat recurrence of the cyst. Removal of the ventricular shunting system may be effective for the prevention of the subdural effusion as a complication after direct operation. PMID:7099383

  15. Symptomatic ecchordosis physaliphora mimicking as an intracranial arachnoid cyst.

    Science.gov (United States)

    Filis, Andreas; Kalakoti, Piyush; Nanda, Anil

    2016-06-01

    Ecchordosis physaliphora (EP) is a rare, benign tumor derived from the notochordal remnants. Usually slow growing with an indolent course, most cases are incidental findings on autopsy. Limited data exists on symptomatic patients with EP. Diagnosis mainly relies on correlating histopathologic findings confirming the notochordal elements with MRI. We herein present a middle aged woman with symptomatic EP in the pre-pontine cistern that mimicked an arachnoid cyst on preoperative scans. Additionally, we emphasize the pathological and radiological characteristics of EP that could aid in prompt diagnosis of the lesion with emphasis on considering EP as a differential for mass lesions localized in the pre-pontine cistern.

  16. Arachnoid granulations may control heat exchange between intracranial dural sinuses and cerebrospinal fluid

    Directory of Open Access Journals (Sweden)

    Abdullah Kaya

    2013-02-01

    Full Text Available Selective brain cooling is a system in a human that protects the brain from hyperthermia. Cool venous blood from head skin and upper respiratory tract drains into intracranial dural sinuses. In that region, cool blood in the dural sinuses decreases the temperature of the cerebrospinal fluid. Cerebrospinal fluid provides brain cooling. All cortical arteries to the brain pass the cerebrospinal fluid compartment. Also cerebrospinal fluid washes cortical nervous tissue. To provide optimal temperature for the brain cortex, heat exchange between cerebrospinal fluid and venous blood in dural sinuses should be well controlled. Head skin is in direct contact with the outside, and significant heat exchanges may occur within dural sinuses. A barrier made of dura mater and arachnoid mater has been proposed to transmit heat from dural sinuses to the cerebrospinal fluid. However, this barrier is a mechanical barrier and can’t optimize the temperature of cerebrospinal fluid. Also it has two laminas (dura mater and arachnoid mater and dura mater has a high vascularization. Therefore, this barrier may obstruct heat exchange. In this hypothetical paper, I offer arachnoid granulations as a functional barrier for heat exchange between blood in dural sinuses and cerebrospinal fluid. Arachnoid granulations are invaginations of arachnoid mater to the dural sinuses. Cerebrospinal fluid passes to the dural sinuses via arachnoid granulations. An arachnoid granulation provides a very thin wall between two compartments and may transmit heat effectively. Also arachnoid granulations may control cerebrospinal fluid flow to the dural sinuses according to temperature differences between two compartments. It is worth researching whether there are any functional or histological differences of the arachnoid granulations between people living in cold and hot places. There may also be an association between pathologies such as migraine and pseudotumor cerebri and this possible

  17. [Arachnoid cyst associated with pyloric stenosis in a young boy].

    Science.gov (United States)

    Diaconescu, Smaranda; Păduraru, Gabriela; Bărbuţă, O; Vâscu, B; Lupu, V V; Burlea, M; Aprodu, G

    2010-01-01

    An unusual association between an arachnoid cyst and a decompensated pyloric stenosis in a three years-old boy is presented. The little patient was admitted into hospital with haematemesis, melena, influenced generally condition and acute posthemorrhagic anaemia following aspirin intake for hypertermia. Specific intensive care was successful and the little patient was discharged but without an upper digestive endoscopy(parents refusal, technical reasons). After one week he returned with progressive worsening vomitings and an intracranial hypertension was suspected. CT documented an arachnoid cyst in the right middle cranial fossa and the patient is directed to the Neurosurgical Clinic where a cyst fenestration was done. Subsequent to operation the vomitings reinstaled with severe dehydration and an upper GI series showed a decompensated pyloric stenosis. He was operated on underwenting an antrectomy. Finally the child recovered with good short and long-term evolution. The coincidental presence of an intracranial congenital mass and a complicated aspirin-induced peptic ulcer in this young patient, misleaded us and in the lack of an early endoscopy an intempestive neurosurgical operation was initially done. PMID:21500459

  18. Giant Spiders of Venus - Redefinition, Revised Population, and Implications of Formational Processes of Arachnoids

    Science.gov (United States)

    Kostama, V.-P.; Törmänen, T.

    2007-03-01

    The large population of volcano-tectonic structures is characteristical to the surface of Venus. In addition to the well studied coronae, there are other smaller groups of features, such as the arachnoids.

  19. Large intradural craniospinal arachnoid cyst: A case report and review of literature

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    Souvagya Panigrahi

    2012-01-01

    Full Text Available Presence of an arachnoid cyst at craniospinal junction is not very common. This is a very rare anatomic site, with only seven other cases reported in the literature. We report a case of large intradural craniospinal arachnoid cyst presenting with obstructive hydrocephalus and cranial nerve palsy. A 39-year-old male presented with 8-month history of neck pain, headache, vomiting, visual disturbances, diminished taste sensation, and numbness of face. He had bilateral papilledema on ophthalmoscopy. Magnetic resonance imaging (MRI revealed a posterior fossa arachnoid cyst extending down to the lower border of C5 vertebra. Posterior decompression was done through C5 laminectomy. He made a full recovery and was asymptomatic at 6-month follow-up examination. The clinical features, diagnosis, and management of these rare craniospinal arachnoid cysts are discussed.

  20. Chronic subdural hematoma associated with arachnoid cyst: report of two cases

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hong; ZHANG Jian-ming; CHEN Gao

    2007-01-01

    @@ Intracranial arachnoid cysts,which often occur in children(75%),account for 1% of intracranial masses.1 The cyst is most commonly located at the middle cranial fossa and more frequently on the left side.

  1. Acute Onset of Psychosis in a Patient with a Left Temporal Lobe Arachnoid Cyst

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    Alexander Mironov

    2014-01-01

    Full Text Available Arachnoid cysts are considered a rare neurological tumor, few of which exhibit any symptomatology. A 38-year-old Haitian American female with no past psychiatric history presented with rapid onset of psychosis. Workup for medical etiology proved to be within normal limits, with the exception of a left temporal lobe arachnoid cyst. The purpose of this paper is to add to a number of existing case reports that suggest a relationship between such lesions and psychiatric illness.

  2. Acute Onset of Psychosis in a Patient with a Left Temporal Lobe Arachnoid Cyst

    OpenAIRE

    Alexander Mironov; Sabu John; Jonathan Auerbach; Ghassan Jamaleddine

    2014-01-01

    Arachnoid cysts are considered a rare neurological tumor, few of which exhibit any symptomatology. A 38-year-old Haitian American female with no past psychiatric history presented with rapid onset of psychosis. Workup for medical etiology proved to be within normal limits, with the exception of a left temporal lobe arachnoid cyst. The purpose of this paper is to add to a number of existing case reports that suggest a relationship between such lesions and psychiatric illness.

  3. A rare case of suprasellar arachnoid cyst with giant perimesencephalic and mesial temporal extension - physiopathological mechanisms

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    Turliuc Dana Mihaela

    2016-03-01

    Full Text Available The arachnoid cyst is a lesion commonly encountered in neurosurgery, especially in pediatric pathology. We are presenting the case of an adult patient with a suprasellar arachnoid cyst with giant perimesencephalic and mesial temporal extension discovered incidentally, where there is a discrepancy between the spectacular neuroimaging and the non-specific symptomatology. Some of the physiopathological mechanisms which led to the evolution of the cyst will also be presented.

  4. Anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbe: an angiographic study

    Energy Technology Data Exchange (ETDEWEB)

    Gailloud, P. [Johns Hopkins Hospital, Baltimore, MD (United States). Dept. of Radiology and Radiological Sciences; Dept. of Radiology, Geneva University Hospital, Geneva (Switzerland); Muster, M.; Khaw, N.; Martin, J.B.; Murphy, K.J.; Ruefenacht, D.A. [Dept. of Radiology, Geneva University Hospital, Geneva (Switzerland); Fasel, J.H.D. [Dept. of Morphology, University of Geneva (Switzerland)

    2001-02-01

    We studied the anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbe in 57 consecutive angiograms. Patients with pathology in intracranial venous structures or with inadequate image quality of the venous system were excluded. Arachnoid granulations were found in 12 of the 57 patients (21.1 %), always at the junction of the vein of Labbe and the transverse sinus; the vein of Labbe was present in 55 patients (96.5 %), most often without associated arachnoid granulations; the latter, however, were not observed in the absence of a vein of Labbe. This study confirms the close, constant anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbe. This observation may help to differentiate arachnoid granulations from pathologic conditions involving the transverse sinus such as dural sinus thrombosis. The constant character of this relationship suggests a developmental role of afferent veins in the formation of arachnoid granulations. (orig.)

  5. Magnetic resonance imaging and computed tomography characteristics of intracranial intra-arachnoid cysts in 6 dogs

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) and computed tomographic imaging (CT) characteristics of intracranial intra-arachnoid cysts in six dogs are described. Of the six dogs, three were less than one year of age and 4 were males. Five of the six dogs weighed less than 11 kg. Five cysts were located in the quadrigeminal cistern. On CT images, the intracranial intra-arachnoid cysts had sharply defined margins, contained fluid isodense to CSF and did not enhance following i.v. administration of contrast. On MRI images, the intracranial intra-arachnoid cysts were extra-axial, contained fluid isointense with CSF and did not enhance following i.v. contrast. While spinal arachnoid cysts of dogs have been reported in the literature, other than the six dogs contained in this report, intracranial intra-arachnoid cysts have not to our knowledge been described in animals. These six dogs have a similar age, sex, history, clinical signs, CT and MRI findings to those reported in people with intracranial intra-arachnoid cysts

  6. Syringomyelia secondary to "occult" dorsal arachnoid webs: Report of two cases with review of literature

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    Parag P Sayal

    2016-01-01

    Full Text Available In a certain group of patients with syringomyelia, even with the advent of sophisticated magnetic resonance imaging (MRI, no associated abnormality or cerebrospinal fluid (CSF block is easily identified. This type of syringomyelia is often termed idiopathic. Current literature has less than 10 reports of arachnoid webs to be the causative factor. We present our experience in the management of two cases of syringomyelia secondary to arachnoid webs. Both our patients presented with progressive neurological deterioration with MRI scans demonstrating cervical/thoracic syrinx without Chiari malformation or low-lying cord. There was no history of previous meningitis or trauma. Both patients underwent myelography that demonstrated dorsal flow block implying CSF obstruction. Cord displacement/change in caliber was also noted and this was not evident on MRI scans. Both patients underwent thoracic laminectomy. After opening the dura, thickened/abnormal arachnoid tissue was found that was resected thus widely communicating the dorsal subarachnoid space. Postoperatively at 6 months, both patients had significant symptomatic improvement with follow-up MRI scans demonstrating significant resolution of the syrinx. In patients with presumed idiopathic syringomyelia, imaging studies should be closely inspected for the presence of a transverse arachnoid web. We believe that all patients with idiopathic symptomatic syringomyelia should have MRI CSF flow studies and/or computed tomography (CT myelography to identify such arachnoid abnormalities that are often underdiagnosed. Subsequent surgery should be directed at the establishment of normal CSF flow by laminectomy and excision of the offending arachnoid tissue.

  7. [Proliferative granulomatous arachnoiditis: an infrequent form of tuberculous myeloradioculopathy].

    Science.gov (United States)

    Amorín Díaz, M; Calleja Puerta, S; Jiménez-Blanco, L; Astudillo, A; Fernández, J M; Lahoz, C H

    2001-01-01

    Proliferative granulomatous arachnoiditis is an infrequent manifestation of central nervous system tuberculosis. The mortality rate is 30%, and there are functional sequels in almost all patients. We present the case of a 22-year-old woman, immunocompetent that suffered form tuberculous radiculo-myelopathy with fatal evolution, which allowed us to confront neuroimaging and neuropathological findings. Although serial MR imaging illustrated evolution of lesions, autopsy revealed more extensive lesions that those observed in neuroimaging studies. The characteristic pathological lesion was an intradural inflammatory exudate with a global medullar necrosis. Even through duration of medical treatment is still discussed, early diagnosis, complete antituberculous drug regimen and prolonged corticosteroid therapy are essential to avoid fatal evolution as occurred in this case.

  8. Individual surgical treatment of intracranial arachnoid cyst in pediatric patients

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    Chao Wang

    2013-01-01

    Full Text Available Background and Aim: Intracranial arachnoid cysts (IAC are benign congenital cystic lesions filled with cerebrospinal fluid (CSF. This study evaluated microsurgical craniotomy and endoscopy in the surgical treatment of IAC. Materials and Methods: Eight-one consecutive pediatric patients with IAC were surgically treated between January 2004 and January 2011. The surgical procedures included microsurgical craniotomy and endoscopy. Symptoms at presentation, location of IAC, surgical treatment options, and effectiveness were evaluated. Results: There were 43 males and 38 females and the mean age was 8.7 years (range between 1 month and 14 years at the time of surgery. The cyst location was supratentorial in 72 patients and infratentorial in 9 patients, arachnoid cyst were identified. Follow-up period ranged between 2 and 8 years. Of the 49 patients with headache 83.67% of patients had cure and 10.2% had significant improvement. Of the eight patients with hydrocephalus and gait disturbances, six (75% had complete total relief of symptoms and two (25% patients had significant improvement. Four of the six patients with cognitive decline and weakness showed improvement. Of the 18 patients with epilepsy seizure freedom was: Engle class I grade I in 14 (77.78% patients; class II in 2 (11.11% patients; and class III in 2 (11.11% patients. Follow-up studies from 2 to 8 years showed that headache was cured in 41 of the 49 cases (83.67%, significantly improved in 5 cases (10.20%, and showed no variation in 3 cases (6.12%. Hydrocephalus and gait disturbances were controlled in six of the eight cases (75.00% and significantly improved in two cases (25.00%. Cognitive decline and weakness were obviously improved in four of the six cases (66.67% and exhibited no variation in two cases (33.33%. According to the Engle standard, the following results were obtained from 18 patients with epilepsy: Grade I in 14 cases (77.78%; grade II in 2 cases (11.11%; and grade III

  9. [A case of suprasellar arachnoid cyst followed up for a long time].

    Science.gov (United States)

    Kaisho, Y; Miyazaki, S; Shimo-oku, M; Hayashi, T; Tani, E

    1995-01-01

    We followed a case of suprasellar arachnoid cyst for 12 years. The patient was a sixteen-year-old girl without particular problems in her general condition. She showed optic atrophy in both eyes and optic nerve hypoplasia with an inferotemporal quandranopsia in the left eye. A suprasellar arachnoid cyst communicating with the tubarachnoid space was found to extend into the sella turcica as an empty sella. A cyst wall was resected and a cyst-peritoneal shunt performed. After 12 years from the operation, sensitivity was slightly depressed in the visual field where it had already been disturbed. Although there are few reports in the literature on involvement of the optic nerves and chiasma by suprasellar arachnoid cysts, papilledema and optic atrophy are often found in children, and infero-temporal quandranopsia or homonymous hemianopsia have been reported. Visual field defects were most likely caused by compression of the optic nerve by cyst or prolonged papilledema. We also suspect that some kind of disturbance to the optic nerve occurred during extension of the arachnoid cyst as an empty sella, or during formation of arachnoid cyst in the fetus stage. PMID:7887322

  10. [Cisto-peritoneal shunt in the surgical treatment of intracranial arachnoid cysts: an analysis of 49 cases].

    Science.gov (United States)

    Gelabert-González, Miguel

    2011-08-01

    Arachnoid cysts are benign space-occupying lesions formed by an arachnoid membrane containing cerebrospinal fluid. Controversy continues regarding the optimal surgical management. There is ongoing debate regarding whether to fenestrate or to perform shunting of the cyst. We present a single-institution experience on surgical treatment of arachnoid cyst using cistoperitoneal shunt. This serie includes 49 children (31 males/18 females) with a diagnosis of intracranial arachnoid cyst and average age of 4-9 years (range 1-16). The predominant symptom was intracranial hypertension in 26 patients (53%). There were 12 complications in 10 patients. We conclude that arachnoid cyst are located predominantly in the temporal fossa. Cisto-peritoneal shunt is a good option in the younger children and have improved clinical symptoms.

  11. Acute respiratory failure as a manifestation of an arachnoid cyst

    Directory of Open Access Journals (Sweden)

    Pillai Lalitha

    2008-01-01

    Full Text Available Arachnoid cysts are the most common congenital cystic lesions in the brain occurring in the middle fossa, suprasellar region and occasionally in the posterior fossa. Conventionally all cysts are considered as benign and symptoms are attributed to expansion of cysts causing compression of adjacent neurological structures, bleeds within the cyst or due to the development of acute hydrocephalus. We are reporting this case of a 15-year-old female patient with non-progressive weakness in the limbs since the age of seven years who presented with acute onset syncopal attacks and respiratory failure. She was intubated and ventilated. An magnetic resonance imaging scan showed large posterior fossa cyst extending up to mid second cervical vertebra causing compression of the medulla and pons, with mild hydrocephalus. After a failed attempt to wean her from the ventilator a cysto peritoneal shunt surgery was performed following which she was weaned from the ventilator successfully. Weakness in the upper and lower limbs, which had increased in the preceding month, also improved following the surgery.

  12. Endoscopic management of large multicompartmental intraventricular arachnoid cyst extending from foramen magnum to foramen of Monro

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    Yadav Y

    2010-01-01

    Full Text Available The treatment options for symptomatic arachnoid cysts are shunting, open craniotomy, and endoscopic fenestration. Endoscopic fenestration of large arachnoid cyst is safe and effective. Postoperative subdural hematoma and intraparenchymal hemorrhage can be avoided by endoscopic fenestration. This technique has the additional advantage of identifying and treating ventricular abnormalities, such as foramen of Monro stenosis and cerebral aqueduct occlusion. This report describes endoscopic dual fenestration in a child with large multicompartmental intraventricular arachnoid cyst extending from foramen magnum to foramen of Monro. The child presented with difficulty to hold the neck in upright position, irritability, vomiting, and large head. Follow-up postoperative magnetic resonance imaging at 3 months showed a significant reduction in size of the cyst. Clinically, the patient showed a gradual improvement at 10 months follow-up. Probably this is the first report of this nature.

  13. Acute hydrocephalus in a child with a third ventricle arachnoid cyst and coincidental enteroviral meningitis.

    Science.gov (United States)

    Jeltema, Hanne-Rinck; Kuijlen, Jos M A; Hoving, Eelco W

    2014-06-01

    We present a 2.5-year-old child suffering from acute hydrocephalus. First, the child was diagnosed with aseptic viral meningitis. The PCR of the cerebrospinal fluid (CSF) was positive for enterovirus. Subsequently, MRI revealed that the hydrocephalus was caused by a cyst in the third ventricle. During ventriculoscopy, the cyst had all aspects of an arachnoid cyst. An endoscopic fenestration and partial removal of the cyst was performed, combined with a ventriculocisternostomy. The coincidental finding of viral meningitis and a third ventricle arachnoid cyst in a patient with acute hydrocephalus has, to our knowledge, not been described in literature before. If there is a relation between the enteroviral meningitis, the arachnoid cyst (possibly causing a pre-existing subclinical hydrocephalus) and the rapidly evolving neurological deterioration, remains speculative. Proposed mechanisms, by which the viral meningitis could accelerate the disease process, are slight brain swelling or increased CSF production. This rare combination of diagnoses could also be coincidental.

  14. Cauda equina syndrome after spinal anaesthesia in a patient with asymptomatic tubercular arachnoiditis

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    Divya Sethi

    2011-01-01

    Full Text Available A 14-year-old boy underwent emergency debridement surgery of right foot under spinal anaesthesia. Four hours after the surgery, the patient developed symptoms of cauda equina syndrome (CES. Postoperative magnetic resonance imaging of the patient′s spine suggested underlying tubercular arachnoiditis. The boy was started on intravenous methylprednisolone and antitubercular therapy. He responded to the therapy and recovered completely in 2 weeks without any residual neurological deficits. We suggest that underlying pathological changes in the subarachnoid space due to tubercular arachnoiditis contributed to maldistribution of the local anaesthetic drug leading to CES.

  15. Intramedullary cyst formation after removal of multiple intradural spinal arachnoid cysts: A case report

    Science.gov (United States)

    Zekaj, Edvin; Saleh, Christian; Servello, Domenico

    2016-01-01

    Background: A rare cause of spinal cord compression is spinal arachnoid cysts. Symptoms are caused by spinal cord compression, however, asymptomatic patients have been also reported. Treatment options depend upon symptom severity and clinical course. Case Description: We report the case of a 47-year-old patient who developed an intramedullary arachnoid cyst after removal of an intradural extramedullary cyst. Conclusion: Surgery should be considered early in a symptomatic disease course. Longstanding medullary compression may reduce the possibility of neurological recovery as well as secondary complications such as intramedullary cyst formation. PMID:27512608

  16. Recent advances in diagnostic approaches for sub-arachnoid hemorrhage.

    Science.gov (United States)

    Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, Oda; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi

    2011-07-01

    Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digital subtraction angiography (DSA) including three dimensional DSA as the mainstay diagnostic techniques. The non-invasive angiography in the form of CTA and MRA has evolved in the last decade as rapid, easily available, and economical means of diagnosing the cause of SAH. The role of three dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional "gold standard" DSA. The most recent addition has been the introduction of the fourth dimension to the established 3D-CT angiography (4D-CTA). At many centers, DSA is still treated as the first choice of investigation. Although, CT angiography still has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. We study the recent advances in the diagnostic approaches to SAH with special emphasis on 3D-CTA and 4D-CTA as the upcoming technologies. PMID:22347331

  17. Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature.

    Science.gov (United States)

    Slavin, K V; Nixon, R R; Nesbit, G M; Burchiel, K J

    1999-10-01

    The authors present the case of progressive thoracic myelopathy caused by the extensive ossification of the arachnoid membrane and associated intramedullary syrinx. Based on their findings and results of the literature search, they describe a pathological basis for this rare condition, discuss its incidence and symptomatology, and suggest a simple classification for various types of the arachnoid ossification. They also discuss the magnetic resonance imaging features of arachnoid ossification and associated spinal cord changes. The particular value of plain computerized tomography, which is highly sensitive in revealing intraspinal calcifications and ossifications, in the diagnostic evaluation of patients with a clinical picture of progressive myelopathy is emphasized. PMID:10505510

  18. Differential diagnosis of arachnoid cyst from subarachnoid space enlargement by phase-contrast cine MRI

    Institute of Scientific and Technical Information of China (English)

    于群; 孔祥泉; 刘定西

    2003-01-01

    Objectives To reveal the relationship of brain motion and cerebrospinal fluid (CSF) flow by phase-contrast cine MRI, and to evaluate this technique in differentiating between arachnoid cysts and subarachnoid space enlargement. Methods Using a phase-contrast cine MRI pulse sequence, we measured brain motion and CSF flow during the cardiac cycle in 10 healthy volunteers and 10 patients with MRI-suspected arachnoid cyst or subarachnoid space enlargement. CSF stroke volume curve was illustrated according to flow quantification, and time-signal intensity curve was traced. The two curves were compared. Results This study showed that brain motion was due to the volume difference between arterial and venous blood flow during a cardiac cycle, and thus drives CSF pulsation. Arachnoid cysts and subarachnoid space enlargement carried different curve patterns, demonstrating that phase-contrast MRI and flow quantification can be a useful and reliable technique for non-invasive evaluation of brain motion and CSF flow. Conclusion Arachnoid cysts can be successfully differentiated using phase-contrast cine MRI from subarachnoid space enlargement.

  19. Guidelines for the management of obstructive hydrocephalus from suprasellar-prepontine arachnoid cysts using endoscopic third ventriculocystocisternostomy.

    Science.gov (United States)

    Mattox, Austin; Choi, Jonathan D; Leith-Gray, Linda; Grant, Gerald A; Adamson, D Cory

    2010-09-01

    Intracranial endoscopy has emerged as an innovative surgical tool for various intracranial procedures, but its use remains limited to neurosurgeons trained in this minimally invasive technique. Complex, skull base arachnoid cysts represent one entity that is challenging to treat because of adjacent critical neurovascular structures; however, the advent of intracranial endoscopic techniques has revolutionized treatment. Arachnoid cysts located in the suprasellar-prepontine skull base region can cause obstructive hydrocephalus or symptomatic mass effect and require urgent decompression. These patients may present with nonfocal symptoms that can quickly lead to a life-threatening condition if not accurately diagnosed and treated. The authors present a summary of the world literature of suprasellar-prepontine arachnoid cysts (SPACs) to ascertain clinical presentations and provide class III evidentiary treatment guidelines for this uniquely challenging type of arachnoid cyst. Urgent endoscopic third ventriculostomy results in normalization of intracranial pressure, return of normal CSF flow, and relief of symptoms.

  20. Development of intracranial hypertension after surgical management of intracranial arachnoid cyst: report of three cases and review of the literature.

    LENUS (Irish Health Repository)

    Kaliaperumal, Chandrasekaran

    2013-11-12

    To describe three cases of delayed development of intracranial hypertension (IH) after surgical treatment of intracranial arachnoid cyst, including the pathogenesis of IH and a review of the literature.

  1. Parasellar arachnoid cyst presenting with a nonpupil sparing third nerve palsy mimicking a posterior communicating artery aneurysm in an adult

    OpenAIRE

    Tempel, Zachary J.; Johnson, Stephen A.; Richard, Paul S.; Friedlander, Robert M.; Rothfus, William E.; Hamilton, Ronald L.

    2013-01-01

    Background: Arachnoid cysts are congenital lesions that contain fluid identical to cerebrospinal fluid (CSF). They usually do not communicate with CSF spaces. The vast majority of arachnoid cysts are congenital asymptomatic lesions that are discovered incidentally. Those lesions that do become symptomatic typically present in childhood with signs and symptoms of intracranial hypertension, seizures, and focal neurologic deficits specific to cyst location. Case Description: A rare case of a par...

  2. Population study of Pyxis arachnoides brygooi (Vuillemin & Domergue, 1972 in the area surrounding the Village des Tortues, Ifaty-Mangily, southwest Madagascar

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    Tantelinirina Rakotondriamanga

    2011-06-01

    Full Text Available The Madagascar spider tortoise (Pyxis arachnoides spp. is faced with the threat of habitat destruction as well as the international pet trade. Habitat requirements and population structure of this species are largely unknown. Detailed studies have so far concentrated on the subspecies Pyxis arachnoides arachnoides. The present study surveyed a population of the western subspecies Pyxis arachnoides brygooi during the wet season from February to April 2008. The survey was carried out in the forest of Ifaty - Mangily, 20 km north of Toliara, and supported by a local tortoise centre, the Village des Tortues. Population densities were estimated from transect counts and plot surveys; they range from 0.33 to 1.72 animals per hectare. Both sexes were evenly represented in the field during the research period. Three individuals of the subspecies Pyxis arachnoides arachnoides were detected during this field survey. Their presence might be due to a transitional zone of both subspecies in the area of research.

  3. Perineural arachnoidal gliomatosis: case report Gliomatose aracnoidal perineural: relato de caso

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    Luciano Sousa Pereira

    2008-08-01

    Full Text Available Gliomas are the most common infiltrative neoplasms of the optic nerve and can present as two distinct growth patterns: intraneural glial proliferation and perineural arachnoidal gliomatosis (PAG. It has been suggested that perineural arachnoidal gliomatosis is seen almost exclusively in the setting of neurofibromatosis type 1 (NF1. We describe a child with perineural arachnoidal gliomatosis occurring without neurofibromatosis type 1, supported by both radiographic and histological findings. A 4-year-old female without neurofibromatosis type 1 presented with rapidly progressive right-sided proptosis. Magnetic resonance imaging (MRI revealed an enhancing fusiform intraconal lesion, which was hypointense on T1 and hyperintense on T2-weighted images: characteristic of perineural arachnoidal gliomatosis, the optic nerve was visualized coursing the tumor. Histopathologic study was consistent with perineural arachnoidal gliomatosis. Perineural arachnoidal gliomatosis can develop independent of neurofibromatosis type 1, as demonstrated by this case.Gliomas são as neoplasias infiltrativas mais freqüentes do nervo óptico e podem se apresentar através de dois padrões distintos de crescimento: proliferação glial intraneural e gliomatose aracnoidal perineural. Existem evidências de que a gliomatose aracnoidal perineural é vista quase exclusivamente em pacientes com neurofibromatose tipo 1. Descrevemos um caso de gliomatose aracnoidal perineural ocorrendo em criança sem neurofibromatose tipo 1, comprovado tanto por achados radiológicos quanto histológicos. Uma criança de quatro anos de idade, do sexo feminino, sem evidências de neurofibromatose tipo 1, apresentou quadro de proptose à direita rapidamente progressiva. Ressonância magnética revelou lesão intraconal fusiforme hipointensa em T1 e hiperintensa em T2 - característico de gliomatose aracnoidal perineural, o nervo óptico pôde ser observado atravessando o tumor. O estudo histol

  4. Characterization of cytoskeletal and junctional proteins expressed by cells cultured from human arachnoid granulation tissue

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    Mehta Bhavya C

    2005-10-01

    Full Text Available Abstract Background The arachnoid granulations (AGs are projections of the arachnoid membrane into the dural venous sinuses. They function, along with the extracranial lymphatics, to circulate the cerebrospinal fluid (CSF to the systemic venous circulation. Disruption of normal CSF dynamics may result in increased intracranial pressures causing many problems including headaches and visual loss, as in idiopathic intracranial hypertension and hydrocephalus. To study the role of AGs in CSF egress, we have grown cells from human AG tissue in vitro and have characterized their expression of those cytoskeletal and junctional proteins that may function in the regulation of CSF outflow. Methods Human AG tissue was obtained at autopsy, and explanted to cell culture dishes coated with fibronectin. Typically, cells migrated from the explanted tissue after 7–10 days in vitro. Second or third passage cells were seeded onto fibronectin-coated coverslips at confluent densities and grown to confluency for 7–10 days. Arachnoidal cells were tested using immunocytochemical methods for the expression of several common cytoskeletal and junctional proteins. Second and third passage cultures were also labeled with the common endothelial markers CD-31 or VE-cadherin (CD144 and their expression was quantified using flow cytometry analysis. Results Confluent cultures of arachnoidal cells expressed the intermediate filament protein vimentin. Cytokeratin intermediate filaments were expressed variably in a subpopulation of cells. The cultures also expressed the junctional proteins connexin43, desmoplakin 1 and 2, E-cadherin, and zonula occludens-1. Flow cytometry analysis indicated that second and third passage cultures failed to express the endothelial cell markers CD31 or VE-cadherin in significant quantities, thereby showing that these cultures did not consist of endothelial cells from the venous sinus wall. Conclusion To our knowledge, this is the first report of

  5. Goel′s Teflon sponge internal shunt for anterior spinal arachnoid cyst

    OpenAIRE

    Raghvendra Ramdasi; Abhidha Shah

    2014-01-01

    We report a case of a 6-year-old boy who presented with progressive quadriparesis and bowel-bladder incontinence. Magnetic resonance imaging (MRI) of the spine showed anteriorly located arachnoid cyst in the cervicodorsal region. Following marsupialization of the cyst, an internal Teflon sponge shunt (Goel's shunt) was done that extended from the cyst cavity to the subarchnoid space. The patient improved dramatically in his symptoms. The physical nature of the teflon sponge and its usefulness...

  6. Ultrastrucmturaiml munogold labelling of vimentin filaments on postembedding ultrathin sections of arachnoid villi and meningiomas

    OpenAIRE

    Yamashima, Tetsumori; Tachibana, Osamu; Nitta, Hisashi; Yamaguchi, Narihito; Yamashita, Junkoh

    1989-01-01

    An immunoelectron microscopic technique for the labelling of vimentin intermediate filaments on postembedding ultrathin sections is reported. Arachnoid villi obtained at autopsy and meningiomas at surgery were fixed in 1% paraformaldehyde for 30 minutes, embedded without postfixation in Epon-Araldite mixture and polymerized at 37OC for 3 weeks. Ultrathin sections were etched in 2% KOH for 3 minutes and incubated with anti-vimentin monoclonal antibodies whic...

  7. Micro-fabricated shunt to mimic arachnoid granulations for the treatment of communicating hydrocephalus.

    Science.gov (United States)

    Kralick, Francis; Oh, Jonghyun; Medina, Tim; Noh, Hongseok Moses

    2012-01-01

    Hydrocephalus is the abnormal accumulation of cerebrospinal fluid (CSF) within the confines of the skull that if left untreated results in significant morbidity and mortality. The treatment for hydrocephalus has remained essentially unchanged for over 50 years. It was a technological advance in materials that allowed John Holter, in conjunction with neurosurgeons Spitzer and Nulsen, to devise a valve and shunt system that diverted excess CSF from the ventricular space to the peritoneum. This ventriculo-peritoneal (VP) shunt is far from ideal, with problems associated with under/over shunting, mechanical mismatch, infection, high failure rates, disconnection and erosion. With the advances in the field of micro-fabrication and micro-machines we propose an innovative shunt system that would mimic the function of arachnoid granulations. This micro-fabricated shunting device, or micro-mechanical arachnoid granulation (MAG), consists of a multiplicity of micro-valves each 210 μm in diameter that each adhere to individual micro-needles. This work demonstrates the design and initial test results of the micro-valve with parameters for low cracking pressure, optimal flow rate, and reflux that would mimic the function of the native arachnoid granulations.

  8. Spastic Paraparesis Due to a Spinal Arachnoid Cyst Associated with Herniation of Cerebellar Tonsils After a Ventriculoperitoneal Shunt

    Directory of Open Access Journals (Sweden)

    Nargess Afzali

    2009-01-01

    Full Text Available  Secondary intradural arachnoid cysts involving the spine are uncommon and can be due to trauma, surgery, lumbar puncture, intrathecal injection and arachnoiditis (TB meningitis, chemical meningitis. Caudal dislocation of the cerebellar tonsils may be associated with known clinical conditions such as intracranial mass lesions or Chiari I and II malformations. It may also be acquired after repeated lumbar punctures or lumboperitoneostomy and traumatic CSF leaks. In rare cases it is reported after supratentorial shunting. "nHere a 16 year old boy is presented with progressive spastic paraparesis 18months after a ventriculoperitoneal shunt. Brain MRI revealed acquired post surgical cerebellar herniation and the spinal MRI showed a large intradural arachnoid cyst. TB laboratory tests were negative. Laminectomy, cyst drainage and suboccipsital craniectomy were performed. Despite the surgery, the disease progression continued to severe paraparesis. 

  9. Arachnoid adhesion caused by SURGICEL after operation for ventral spinal schwannoma

    Institute of Scientific and Technical Information of China (English)

    CHEN Sheng-li; ZHANG Gang-li; ZHANG Han-wei; LEI Ting; HU Chang-chen

    2010-01-01

    @@ To the editor: Ventral spinal schwannoma is not a frequently encountered disease and its surgical treatment is difficult.1,2 It has not been reported that the arachnoid adhesions caused by SURGICEL after operation for ventral spinal schwannoma.A 45-year-old man was admitted to our clinic with complaints of intermittent lumbar pain for 12 months. Physical examination: The patient's lower extremity muscle strength was Ⅲ-Ⅳ grade, the bilateral knee tendon reflexes was hyperactive, the bilateral Babinski sign was positive, the sensory dysfunction level was at T11, the anal reflex was positive, the bilateral cremasteric reflex was positive.

  10. Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review.

    Science.gov (United States)

    Killeen, T; Kamat, A; Walsh, D; Parker, A; Aliashkevich, A

    2012-12-01

    A 27-year-old woman developed severe adhesive arachnoiditis after an obstetric spinal anaesthetic with bupivacaine and fentanyl, complicated by back pain and headache. No other precipitating cause could be identified. She presented one week postpartum with communicating hydrocephalus and syringomyelia and underwent ventriculoperitoneal shunting and foramen magnum decompression. Two months later, she developed rapid, progressive paraplegia and sphincter dysfunction. Attempted treatments included exploratory laminectomy, external drainage of the syrinx and intravenous steroids, but these were unsuccessful and the patient remains significantly disabled 21 months later. We discuss the pathophysiology of adhesive arachnoiditis following central neuraxial anaesthesia and possible causative factors, including contamination of the injectate, intrathecal blood and local anaesthetic neurotoxicity, with reference to other published cases. In the absence of more conclusive data, practitioners of central neuraxial anaesthesia can only continue to ensure meticulous, aseptic, atraumatic technique and avoid all potential sources of contamination. It seems appropriate to discuss with patients the possibility of delayed, permanent neurological deficit while taking informed consent. PMID:23061983

  11. Digital subtraction cystography for detection of communicating holes of spinal extradural arachnoid cysts

    Energy Technology Data Exchange (ETDEWEB)

    Gu, Kyo Won; Kwon, Jong Won; Kim, Eun Sang [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-02-15

    The purpose of this study was to demonstrate the usefulness of digital subtraction cystography to identify communicating holes between a spinal extradural arachnoid cyst (SEAC) and the subarachnoid space prior to cyst removal and hole closure. Six patients with SEAC were enrolled in this retrospective study. Digital subtraction cystography and subsequent CT myelography were performed for every patient. The presence and location of the communicating holes on cystography were documented. We evaluated the MRI characteristics of the cysts, including location, size, and associated spinal cord compression; furthermore, we reviewed cystographic images, CT myelograms, procedural reports, and medical records for analysis. If surgery was performed after cystography, intraoperative findings were compared with preoperative cystography. The location of the communicating hole between the arachnoid cyst and the subarachnoid space was identified by digital subtraction cystography in all cases (n = 6). Surgical resection of SEAC was performed in 4 patients, and intraoperative location of the communicating hole exactly corresponded to the preoperative identification. Fluoroscopic-guided cystography for SEAC accurately demonstrates the presence and location of dural defects. Preoperative digital subtraction cystography is useful for detection of a communicating hole between a cyst and the subarachnoid space.

  12. Lianas as a food resource for brown howlers (Alouatta guariba and southern muriquis (Brachyteles arachnoides in a forest fragment

    Directory of Open Access Journals (Sweden)

    M. M. Martins

    2009-01-01

    Full Text Available Lianas as a food resource for brown howlers (Alouatta guariba and southern muriquis (Brachyteles arachnoides in a forest fragment.— Lianas, woody vines, are abundant and diverse in tropical forests, but their relative contribution as a source of food for herbivores has been neglected. I compared feeding rates on lianas and trees of two sympatric primates, A. guariba and B. arachnoides, in Southeastern Brazil. Availability of liana foods was gathered in parallel with primate behavioral data collection. Liana represented 33.9% and 27.3% of food sources for A. guariba and B. arachnoides, respectively. Foods coming from trees, rather than from lianas, were significantly more consumed by B. arachnoides. However, both species took advantage of the continuously renewable and ephemeral food resources provided by liana. Availability of liana flowers correlated positively with A. guariba feeding proportions. The nutritional supply provided by lianas is apparently beneficial, or at least unharmful, but experiments comparing primate choices in forests with different liana abundances will help to shed light on their possible negative effect on communities.

  13. Adhesive arachnoiditis causing cauda equina syndrome in ankylosing spondylitis: CT and MRI demonstration of dural calcification and a dorsal dural diverticulum

    Energy Technology Data Exchange (ETDEWEB)

    Bilgen, I.G.; Yunten, N.; Ustun, E.E. [Ege Univ., Dept. of Radiology, Izmir (Turkey); Oksel, F.; Gumusdis, G. [Ege Univ., Dept. of Rheumatology, Izmir (Turkey)

    1999-07-01

    We present the radiological features of a 42-years-old man with long-standing inactive ankylosing spondylitis (AS), demonstrating that arachnoiditis is a cause of a cauda equina syndrome (CES) in this disease. CT showed a dorsal arachnoid diverticulum causing scalloped erosion of the laminae, and punctate and curvilinear dural calcification. MRI revealed adhesion and convergence of the cauda equina dorsally into the arachnoid pouch, causing the dural sca to appear empty canal. To the best of our knowledge, dural calcification on CT is a new finding in AS, which may be related to the CES. Our findings support the hyopthesis that chronic adhesive arachnoiditis with subsequent loss of meningeal elasticity may be the main cause of CES in AS. (orig.)

  14. Comparative Study on Two Surgical Procedures for Middle Cranial Fossa Arachnoid Cysts

    Institute of Scientific and Technical Information of China (English)

    Liang ZENG; Li FENG; Jun WANG; Jun LI; Yuping WANG; Jincao CHEN; Jian CHEN; Ting LEI; Ling LI

    2008-01-01

    In this study, we explored the operation options for middle cranial fossa arachnoid cysts(MCFAC). One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y(mean=5.4 y). All these patients were divided into three subgroups according to Galassi classification.Long-term outcome and complications were studied respectively. Fenestration (F) resulted in a more favorable long-term outcome and less complication for cysts of types Ⅰ and Ⅱ, whereas a favorable outcome was noted in type Ⅲ patients who underwent cysto-peritoneal shunting (S). We are led to conclude that Fenestration is suitable for cysts of types Ⅰ and Ⅱ (Galassi classification),cysto-peritoneal shunting is better for cysts of type Ⅲ.

  15. Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia

    Directory of Open Access Journals (Sweden)

    Vijay P Joshi

    2013-01-01

    Full Text Available Acquired cerebellar tonsillar herniation and syringomyelia associated with posterior fossa mass lesions is an exception rather than the rule. In the present article, we describe the neuroimaging findings in a case of 28-year-old female patient presented with a history of paraesthesia involving right upper limb of 8-month duration. Magnetic resonance imaging showed a giant retrocerebellar arachnoid causing tonsillar herniation with cervical syringomyelia. The findings in the present case supports that the one of the primary mechanism for the development of syringomyelia may be the obstruction to the flow of cerebrospinal fluid causing alterations in the passage of extracellular fluid in the spinal cord and leading to syringomyelia.

  16. Transsphenoidal cyst cisternostomy with a keyhole dural opening for sellar arachnoid cysts: technical note.

    Science.gov (United States)

    Oyama, Kenichi; Fukuhara, Noriaki; Taguchi, Manabu; Takeshita, Akira; Takeuchi, Yasuhiro; Yamada, Shozo

    2014-04-01

    A less invasive transsphenoidal approach with a keyhole dural opening for intrasellar arachnoid cysts is described. This approach was used to address seven sellar cystic lesions with suprasellar extension; they were six intrasellar arachnoid cysts (IACs) and one Rathke's cleft cyst (RCC). In all cases, preoperative MRI revealed cerebrospinal fluid (CSF) intensity on both T1- and T2-weighted images. On preoperative contrast-enhanced MRI, five of the six IACs manifested posterior displacement of the flattened pituitary gland toward the dorsum sellae; one of the six IACs and the RCC exhibited a flattened pituitary gland on the anterior surface of the cyst. Wide cyst cisternostomy through a keyhole dural opening was carried out safely using a microscope with the support of a thin angled endoscope (30° and/or 70°, diameter 2.7 mm). As we aimed to avoid iatrogenic injury of the pituitary function, we found it difficult to obtain a sufficiently wide and precise opening of the cyst wall when the pituitary gland was located on the anterior surface of the cyst wall. Our approach facilitates safe cyst cisternostomy as wide as that obtainable by transcranial manipulation. In addition, CSF leakage is prevented by dural plasty using the fascia lata and stitching with 6-0 monofilament sutures. This technique can be adapted to address various sellar cystic lesions. However, as the posterior or anterior displacement of the normal pituitary gland in the presence of IACs or RCCs, respectively, affects the width of the cyst opening, our technique is more suitable for IACs than RCCs.

  17. Experimental model of posttraumatic syringomyelia: the role of adhesive arachnoiditis in syrinx formation.

    Science.gov (United States)

    Cho, K H; Iwasaki, Y; Imamura, H; Hida, K; Abe, H

    1994-01-01

    An experimental model was devised to elucidate the role of spinal blockade in posttraumatic syringomyelia. Thirty-eight Japanese White rabbits, each weighing about 3 kg, were used in this study. The animals were divided into four groups: in Group 1, eight animals received traumatic injury only; in Group 2, 12 animals received traumatic injury following injection of 100 mg kaolin suspended in 1 cc normal saline solution into the subarachnoid space at the site of trauma; in Group 3, nine animals received traumatic injury following injection of 200 mg kaolin in 1 cc normal saline solution into the subarachnoid space at the site of trauma; and in Group 4, nine animals without traumatic injury received an injection of 200 mg kaolin in 1 cc normal saline solution into the subarachnoid space. The subjective criteria for syrinx formation were the presence of a definite round cyst having a smooth margin and an upper or lower extension of more than 2 cm from the injured site. Syrinx formation was seen in 12.5% (one of eight rabbits) in Group 1, 41.7% (five of 12 animals) in Group 2, 55.5% (five of nine rabbits) in Group 3 and 0% (none of nine animals) in Group 4 (p duration of survival, was also statistically significant. In summary, subarachnoid block secondary to adhesive arachnoiditis is important in initiating the extension of the syringomyelia cavity.

  18. Chronic subdural hematoma associated with sylvian arachnoid cyst in juvenile athletes: report of two cases and literature review

    Institute of Scientific and Technical Information of China (English)

    ZENG Tao; SHI Song-sheng; LIN Yu-feng

    2011-01-01

    The association of chronic subdural hematoma (CSDH) and arachnoid cyst (AC) is uncommon.We reported 2 juvenile athletes with CSDH associated with AC which occurred in their daily sports activities and reviewed the literature. Both of them were treated surgically, with satisfactory outcome. AC is a common predisposing factor in young patients with CSDH. The complication of intracranial bleeding is an indication for surgical management. Though there are still controversies in the treatment of asymptomatic AC, it is the consensus that the patients with AC should avoid violent sports so as to reduce the incidence of intracranial hemorrhage resulted from head injuries.

  19. Sport-related structural brain injury associated with arachnoid cysts: a systematic review and quantitative analysis.

    Science.gov (United States)

    Zuckerman, Scott L; Prather, Colin T; Yengo-Kahn, Aaron M; Solomon, Gary S; Sills, Allen K; Bonfield, Christopher M

    2016-04-01

    OBJECTIVE Arachnoid cysts (ACs) are congenital lesions bordered by an arachnoid membrane. Researchers have postulated that individuals with an AC demonstrate a higher rate of structural brain injury after trauma. Given the potential neurological consequences of a structural brain injury requiring neurosurgical intervention, the authors sought to perform a systematic review of sport-related structural-brain injury associated with ACs with a corresponding quantitative analysis. METHODS Titles and abstracts were searched systematically across the following databases: PubMed, Embase, CINAHL, and PsycINFO. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed case reports, case series, or observational studies that reported a structural brain injury due to a sport or recreational activity (hereafter referred to as sport-related) with an associated AC were included. Patients were excluded if they did not have an AC, suffered a concussion without structural brain injury, or sustained the injury during a non-sport-related activity (e.g., fall, motor vehicle collision). Descriptive statistical analysis and time to presentation data were summarized. Univariate logistic regression models to assess predictors of neurological deficit, open craniotomy, and cystoperitoneal shunt were completed. RESULTS After an initial search of 994 original articles, 52 studies were found that reported 65 cases of sport-related structural brain injury associated with an AC. The median age at presentation was 16 years (range 4-75 years). Headache was the most common presenting symptom (98%), followed by nausea and vomiting in 49%. Thirteen patients (21%) presented with a neurological deficit, most commonly hemiparesis. Open craniotomy was the most common form of treatment (49%). Bur holes and cyst fenestration were performed in 29 (45%) and 31 (48%) patients, respectively. Seven patients (11%) received

  20. 松果体区脑池和蛛网膜的显微解剖研究%Microsurgical anatomy of cisterns and arachnoid membranes in pineal region

    Institute of Scientific and Technical Information of China (English)

    樊俊; 漆松涛; 张喜安; 石瑾

    2011-01-01

    目的 系统研究松果体区脑池及其蛛网膜结构的显微解剖学特点,为手术入路及手术操作提供解刮学依据.方法 在手术显微镜下观察20例尸头松果体区各个脑池的形态、边界、内容物及相关蛛网膜结构.结果 松果体区的蛛网膜结构包括蛛网膜袖套、环中脑后膜和小脑前中央膜.其中蛛网膜袖套由枕叶底、内侧面及小脑上表面蛛网膜在幕尖处汇合而成,包裹Galen静脉系统、松果体及松果体七隐窝;环中脑后膜由枕叶底面及小脑上表面蛛网膜在幕切迹处汇合形成,环绕并附着于中脑背侧;小脑前中央膜由小脑上表面蛛网膜和蛛网膜袖套汇合处发出,前下方附着于下丘.四叠体池与小脑上池通过小脑前中央膜分隔,与后胼周池通过蛛网膜袖套分隔.与环池后部通过环中脑后膜的升段分隔,环池后部与小脑中脑裂池通过环中脑后膜的水平段分隔.结论 重新划分了松果体区各个脑池的范围与交通情况,明确了蛛网膜的形态与分布.%Objective To study micro-anatomical features of cisterns and their arachnoid membranes in pineal region. Methods Cisterns in pineal region including their shapes, borders, contents and arachnoidal membranes were observed in 20 cadaveric brains using an operating microscope. Results Arachnoid membranes of the pineal region include the arachnoidal envelope, the posterior perimesencephalic membrane and the cerebellar precentral membrane. At the level of the tentorial apex, arachnoid membranes covering the inferior-medial surface of occipital lobe and the superior surface of cerebellum converge to form the arachnoidal envelope, which encloses the vein of Galen with its tributaries, the pineal gland and the suprapineal recess. The posterior perimesencephalic membrane arises from the outer arachnoid membranes covering the inferior occipital lobe and the superior cerebellum at the tentorial edge. It surrounds and is attached

  1. The Effects of 910-MHz Electromagnetic Field on Rat Cranial Arachnoid and Dura Mater Collagen. The Axial Periodicity of Collagen Fibrils

    OpenAIRE

    Margaret Tzaphlidou; Evangelos Fotiou

    2004-01-01

    The axial periodicity of rat arachnoid and dura mater collagen fibrils exposed to 910 MHz for 2 h/day for 30 consecutive days was measured by means of image analysis of electron-optical data. Such measurements were compared with those from sham-exposed animals. These measurements reveal that on exposure, the intermolecular interactions during collagen fibril assembly are affected.

  2. 颅内蛛网膜囊肿治疗中的有关问题%Clinical analysis of intracranial arachnoid

    Institute of Scientific and Technical Information of China (English)

    刘海鹏; 黄其林; 杨辉; 周政

    2011-01-01

    Objective To explore the indications and surgical methods of intracranial arachnoid cyst. Methods The clinical data of 209 patients with intracranial arachnoid cysts were analyzed retrospectively. Results Of 209 patients, 198 patients were performed by CT subarachnoidcisternography,47 with noncommunicating intracranial arachnoid cyst were underwent operation, in which cystectomics were perfomed in 43, ventricular-peritoneal shunts in 3 and cystoperitoneal shunt in 1. All patients were sucessfully operated. There are advantages and disadvantages in these surgical methods. Conclusions The treatment method of intracranial arachnoid cyst was determined by the cyst size, symptomes and signs, communicate or not with subarachnoid space and age. Cystectomy can reduce the cyst volume and improve symptoms caused by intracranial arachnoid cyst.%目的 探讨颅内蛛网膜囊肿的手术指征和手术方法.方法 回顾性分析209例颅内蛛网膜囊肿患者的临床表现、影像学资料、治疗方法等临床资料.结果 其中198例行CT蛛网膜下腔-脑池造影,非交通性47例均行于术治疗.43例行囊肿大部切除+脑池开放术,3例行脑室-腹腔分流术,1例行囊肿-腹腔分流术.所有手术病人手术顺利,各种术式各有利弊.结论 颅内蛛网膜囊肿应根据囊肿大小、临床症状体征、与蛛网膜下腔是否交通及年龄来决定治疗方式.手术首选囊肿切除+脑池开放术.

  3. Analysis on clinical characteristics of intracranial Arachnoid Cysts in 488 pediatric cases.

    Science.gov (United States)

    Huang, Jian-Huang; Mei, Wen-Zhong; Chen, Yao; Chen, Jian-Wu; Lin, Zhi-Xiong

    2015-01-01

    To summarize the clinical characteristics of intracranial arachnoid cysts (IACs) in pediatric cases. A retrospective analysis was carried out on clinical characteristics of IACs in 488 pediatric cases who were treated at our hospital from January 2003 to September 2013. There were 342 males and 146 females (male-to-female ratio, 2.34:1), aged 5.61±3.25 years on average. 221 cases (45.29%) were diagnosed accidentally, 267 cases had clinical complaints (54.71%), among which relationships between clinical complaints and IACs were identified in 123 (46.07%). Simple IACs occurred in 364 cases (4.59%), and concurrent congenital abnormalities occurred in 124 cases (4.59%). In terms of location, 355 had IACs in middle cranial fossa (72.75%), 82 cases in posterior cranial fossa (16.80%), 20 cases in anterior cranial fossa (4.10%), 12 cases in dorsolateral surface (2.46%), 7 cases in suprasellar cistern (1.43%), 5 cases in cerebral ventricle (1.02%), 5 cases in quadrigeminal cistern (1.02%), and 2 cases in interhemispheric region (0.41%). There were 449 cases with single IAC (92.01%) and 39 cases with multiple IACs (7.99%). On MRI, the cysts produced tension in 127 cases (26.02%), but not in the remaining 361 cases (73.98%). Surgery was performed on 76 of 488 cases (15.57%), while conservative observation was accepted in 412 cases (84.43%). For the former, the symptoms and the cyst volume were improved to varying extent; for the latter, the follow-up lasting for 3-72 months (average 32.43±8.92 months) showed that the cyst volume remained stable in 407 cases (98.78%), enlarged with aggravated symptoms in 3 cases (0.73%), and shrank in 2 cases (0.49%). Clinical complaints of IACs varied in pediatric cases, and the relationships between clinical complaints and IACs were established only partially. Some pediatric cases were combined with other congenital abnormalities. The cyst volume largely remained stable during the disease course, and surgery was required for only a few

  4. Periventricular nodular heterotopia, frontonasal encephalocele, corpus callosal dysgenesis and arachnoid cyst: A constellation of abnormalities in a child with epilepsy

    Directory of Open Access Journals (Sweden)

    Prasad Krishnan

    2014-01-01

    Full Text Available A 7-year-old male child presented with poorly controlled generalized tonic-clonic seizures. On examination, he was mentally retarded, deaf and had a swelling at the root on the nose. Computed tomography scan done previously revealed a left temporal arachnoid cyst (AC due to which he was referred for surgery. However, magnetic resonance imaging revealed a constellation of abnormalities - all of which could be responsible for his seizures. The combination of periventricular nodular heterotopias with encepaholcele is rarely described in the literature, and more infrequently so its combination with AC and callosal dysgenesis - the Chudley-Mccullough syndrome. We describe the case and review relevant literature on this subject.

  5. Cisto de aracnóide e pseudotumor cerebral: relato de caso Arachnoid cyst and pseudotumor cerebri: case report

    Directory of Open Access Journals (Sweden)

    Nilton Domingos Cabral

    1996-06-01

    Full Text Available Relato do caso de paciente de 12 anos de idade com cisto de aracnóide na fossa craniana posterior e pseudotumor cerebral dependente de derivação cisto-peritoneal previamente instalada. Esta constatação corrobora assertivas da literatura que sugerem um mecanismo fisiopatológico em comum para estas duas entidades e que estaria relacionado a defeito no fluxo do líquido cefalorraqueano.Report on a 12 years old patient with an arachnoid cyst of posterior cranial fossa and pseudotumor cerebri. This patient is a shunt dependent of his cyst-peritoneal shunt. This association and evolution of this pacient suggest a common and specifical pathogenic mechanism of these two pathologies based in a disturbance of the cerebral fluid circulation.

  6. Radioisotopic studies of the sub-arachnoid space in cerebral cysticercosis; correlation of scintigraphic with pneumoencephalographic findings

    International Nuclear Information System (INIS)

    Cerabral cysticercosis is a grave public health problem in Ecuador and is caused by a tapeworm, which is parasite of man. The larvae of this tapeworm lodge in various tissues, notably in the brain, causing blockage of the sub-arachnoid space and leading to epileptic seizures and to mental deterioration. The present investigation on 115 patients has compared clinical and radiological findings with those from radionuclide cisternography, performed with a gamma camera after injection of 15-200μCi131I-albumin into the cerebro-spinal fluid. The results from 86 patients have been selected for detailed analysis. Radiological techniques such as pneumoencephalography were in general found to be more precise in determining the site of obstruction than cisternography

  7. Human arachnoid granulations Part I: a technique for quantifying area and distribution on the superior surface of the cerebral cortex

    Directory of Open Access Journals (Sweden)

    Holman David W

    2007-07-01

    Full Text Available Abstract Background The arachnoid granulations (AGs are herniations of the arachnoid membrane into the dural venous sinuses on the surface of the brain. Previous morphological studies of AGs have been limited in scope and only one has mentioned surface area measurements. The purpose of this study was to investigate the topographic distribution of AGs on the superior surface of the cerebral cortex. Methods En face images were taken of the superior surface of 35 formalin-fixed human brains. AGs were manually identified using Adobe Photoshop, with a pixel location containing an AG defined as 'positive'. A set of 25 standard fiducial points was marked on each hemisphere for a total of 50 points on each image. The points were connected on each hemisphere to create a segmented image. A standard template was created for each hemisphere by calculating the average position of the 25 fiducial points from all brains. Each segmented image was mapped to the standard template using a linear transformation. A topographic distribution map was produced by calculating the proportion of AG positive images at each pixel in the standard template. The AG surface area was calculated for each hemisphere and for the total brain superior surface. To adjust for different brain sizes, the proportional involvement of AGs was calculated by dividing the AG area by the total area. Results The total brain average surface area of AGs was 78.53 ± 13.13 mm2 (n = 35 and average AG proportional involvement was 57.71 × 10-4 ± 7.65 × 10-4. Regression analysis confirmed the reproducibility of AG identification between independent researchers with r2 = 0.97. The surface AGs were localized in the parasagittal planes that coincide with the region of the lateral lacunae. Conclusion The data obtained on the spatial distribution and en face surface area of AGs will be used in an in vitro model of CSF outflow. With an increase in the number of samples, this analysis technique can be used

  8. Cisto aracnóideo intracraniano: relato de nove casos operados Intracranial arachnoid cysts: report of nine operated cases

    Directory of Open Access Journals (Sweden)

    JOSÉ CORREIA DE FARIAS BRITO

    1998-06-01

    Full Text Available Análise de nove casos de cisto aracnóideo intracraniano operados no período de 1974 a 1995. Os procedimentos cirúrgicos consistiram de derivação cistoperitoneal em sete pacientes e craniotomia com membranectomia nos outros dois casos. Complicações pós-cirúrgicas, do tipo infecção bacteriana e falha no sistema de drenagem, ocorreram em três casos, as quais foram debeladas e corrigidas, respectivamente. Baseados em revisão de literatura, alguns aspectos fisiopatológicos, diagnósticos e terapêuticos são discutidos.Analysis of nine patients with intracranial arachnoid cysts surgically treated from 1974 to 1995. The treatment consisted of cystoperitoneal shunt in seven patients and craniotomy with excision of cyst membrane in the other two cases. After surgery, bacterial meningitis and failure shunt device were observed in three cases. Both the infectious process and the shunt device were respectively treated and corrected at once. It has been observed total clinical improvement in all nine cases. A review of the literature has been made and some pathophysiological, diagnostic and therapeutic aspects are discussed.

  9. Experience of surgical treatment of intracranial arachnoid cyst%颅内蛛网膜囊肿手术的治疗体会

    Institute of Scientific and Technical Information of China (English)

    孙彬; 王瑞珩

    2014-01-01

    目的:探讨颅内蛛网膜囊肿的手术治疗方式及其疗效。方法回顾性分析35例手术治疗的颅内蛛网膜囊肿患者的临床资料,其中行显微镜下囊壁部分切除+囊肿-脑池造瘘术16例,囊肿-腹腔分流术11例,脑室镜下囊壁部分切除+囊肿-脑室或脑池造瘘术8例。结果随访6个月~2年,30例患者经手术治疗后症状明显改善,33例患者蛛网膜囊肿体积显著减小。结论蛛网膜囊肿患者一旦产生临床症状,均应积极手术治疗,应综合考虑患者的年龄、囊肿位置、大小等因素,进行个体化手术方式。%Objective To explore the surgical approaches of intracranial arachnoid cyst and the effects. Methods The clinical data of 35 patients with intracranial arachnoid cyst treated with surgery were retrospectively analyzed.The mi-croscope cystic wall resection+cyst-cisternal stoma was conducted in 16 cases,cyst-abdominal cavity stoma was con-ducted in 11 cases,ventricle endoscopic partial resection of cyst wall+ventricular or cisternal stoma was conducted in 8 cases. Results Patients were followed-up for 6 months to 2 years.The symptoms of 30 patients got improved after treat-ment. Significant reduction of cyst size was found in 33 cases of arachnoid cysts.Conclusion Patients with symptomatic arachnoid cysts should be treated actively,and such factors as the age,the size and position of cyst should be considered comprehensively to choose individual operation method.

  10. [Bilateral cerebellopontine arachnoid cyst].

    Science.gov (United States)

    Gelabert-Gonzalez, M; Aran-Echabe, E; Pita-Buezas, L

    2016-06-16

    Introduccion. Los quistes aracnoideos bilaterales del angulo pontocerebeloso son excepcionales, y unicamente existen tres casos publicados en la bibliografia. Caso clinico. Niña de 14 años, previamente sana, que acude a consultas por presentar cefalea bifrontal de seis semanas de evolucion. La exploracion clinica era normal y la resonancia magnetica craneal mostraba dos lesiones extraaxiales localizadas en ambos angulos pontocerebelosos, siendo ligeramente mayor la izquierda. Las lesiones se comportaban como homogeneamente intensas en T1 e hiperintensas en T2, no captaban contraste y no existia restriccion en las secuencias de difusion. No se indico tratamiento quirurgico. Conclusiones. Los quistes aracnoideos bilaterales situados en el angulo pontocerebeloso son excepcionales. La principal indicacion para el tratamiento quirurgico es la presencia de sintomas o signos neurologicos coincidentes con la localizacion de los quistes.

  11. Tubercular Optochiasmatic Arachnoiditis

    Directory of Open Access Journals (Sweden)

    A K Ghosh

    2009-08-01

    Full Text Available What is your diagnosis?"nA 25-year-old woman presented with a low-grade fever, loss of weight and appetite of 4 months duration and intermittent vomiting of two months duration. The diagnosis was tubercular meningitis and the patient was on anti-tubercular therapy from one month. Two weeks ago, a rapidly progressive visual loss emerged in two days. In general observation, she was thin, had mild pallor and no icterus, was conscious and also irritable. In physical examination, she was febrile (100o F, there were bilateral crepitations in the chest and she had mild neck rigidity. On eye examination, there were bilateral dilated sluggishly reacting to light pupils, no projection or rays or perception of light in both eyes, the fundus showed bilateral papilloedema with features of secondary optic atrophy. Extra ocular movements were restricted in all directions suggestive of 3rd, 4th and 6th nerve paresis. Other cranial nerves were normal. There were no focal motor or sensory deficits. Blood investigations were normal except for a raised erythrocyte sedimentation rate (64 mm in the 1st hour. Three consecutive samples of sputum for acid fast bacilli were negative. The brain CT scan showed mild dilation of the third and lateral ventricles and thick basal exudates (Fig. 1.A&B. MRI of the brain showed hypertrophy of the chiasma and the cisternal segment of both optic nerves after contrast enhancement (Figs. 2&3.

  12. Tubercular Optochiasmatic Arachnoiditis

    OpenAIRE

    Ghosh, A.K.; Agrawal, A; S Singhal

    2009-01-01

    What is your diagnosis?"nA 25-year-old woman presented with a low-grade fever, loss of weight and appetite of 4 months duration and intermittent vomiting of two months duration. The diagnosis was tubercular meningitis and the patient was on anti-tubercular therapy from one month. Two weeks ago, a rapidly progressive visual loss emerged in two days. In general observation, she was thin, had mild pallor and no icterus, was conscious and also irritable. In physical examination, she was febr...

  13. 儿童颅内蛛网膜囊肿的外科治疗探讨%Surgical treatment of intracranial arachnoid cysts in children

    Institute of Scientific and Technical Information of China (English)

    潘蔚然; 徐书刚; 董欣明; 李钢; 刘国军; 葛信波; 刘云会

    2008-01-01

    Objective To explore the techniques, indications and complications of the surgery for intracranial arachnoid cysts (IACs) in children. Methods The clinical data of 53 children with intracranial arachnoidal cysts were anlyzed retrospectivley. The craniotomy was performed for resecting part of the walls of IACs and opening subarachnoid cavity and relative cistern in 42 patients; the cystoperitoneal shunt was performed in 10 patients, and the endoscopic fenestrations of IACs in 1 case. Results All the patients have good recovery after the operation, the clinical symptoms got improved in different degrees. 13 cases showed hyperpyrexia (>39.1℃) after operation and consistant fever (duration was longer than 3 days); Subcutanous hydrops happened in 8 cases. 2 cases took duraneoplast again. CT scans which were took more than 3 months after operation showed that IACs were completely obliterated or obviously decreased in 50 cases and unchanged in 3 cases. Conclusions All the above 3 operation types were effective methods to cure IACs of children, we should pay more attention to individualized healing and prevention of the complications after the operations.%目的 探讨儿童颅内蛛网膜囊肿外科治疗的手术方法、适应证及并发症.方法 回顾分析53例手术患儿的临床资料,囊肿切除并脑池交通术42例,囊肿-腹腔分流术10例,神经内镜下囊肿切除并造瘘术1例.结果 患者术后恢复均良好,临床症状均有不同程度改善.术后高热(>39.1℃)及持续发热(>3d)13例;形成皮下积液8例,再次硬膜修补术2例.术后随访3个月以上,CT证实囊肿缩小或消失50例,无明显变化3例.结论 上述三种术式均是治疗儿童颅内蛛网膜囊肿的有效方案,但应综合多种因素采取个体化的治疗,并重视预防其相关术后并发症.

  14. Dynamic CT Cisternography in the Diagnosis and Treatment of Intracranial Arachnoid Cysts%CT脑池造影动态扫描在蛛网膜囊肿诊治中的应用

    Institute of Scientific and Technical Information of China (English)

    王翔; 姜曙; 刘艳辉; 毛庆

    2011-01-01

    Objective To investigate the communication between intracranial arachnoid cysts and subarachnoid space using CT cisternography (CTC) and consecutive CT scans. Methods CTC were performed in 38 symptomatic patients with arachnoid cysts before treatment decisions were made. Consecutive CTC images were obtained 2 days after intrathecal omnipaque administrations. The enhancement in cysts was measured quantitatively and compared with neighbouring subarachnoid spaces. Patients with cysts showing early fillings (n=10) were followed up without surgeries. Whereas, patients with cysts showing non-early fillings (n=28) were given surgical treatment through craniotomy. Another 36 patients with arachnoid cysts were given craniotomy without CTC evaluation. Results Arachnoid cysts were classified into complete, incomplete and noncommunicating cysts based on the CTC results. The symptoms of all surgical patients with CTC evaluations were relieved. Only one patient without surgery showed clinical deterioration. In the 36 patients without CTC evaluation, 6 patients did not gain benefit from surgeries. Conclusion The classification of arachnoid cysts based on CTC is useful for the diagnosis and treatment of intracranial arachnoid cysts.%目的 应用CT脑池造影(CTC)动态扫描的方法对蛛网膜囊肿进行分类和治疗.方法 共纳入74例症状性蛛网膜囊肿患者.其中38例患者在治疗前进行CTC检查.腰穿碘海醇注入蛛网膜下腔后的1、3、6、12、24及48 h分别行CT扫描,测量蛛网膜囊肿内及囊外蛛网膜下腔的CT值,评估囊内外脑脊液交通情况.另外36例对照组患者未行CTC,直接行手术治疗.结果 根据CTC及动态扫描的结果,蛛网膜囊肿被分为3种类型:完全交通性,不完全交通性及非交通性囊肿.其中诊断为不完全交通性及非交通性蛛网膜囊肿的28例患者进行手术囊肿切除,其他10例完全交通性蛛网膜囊肿进行观察随访.在CTC组中,所有手术治

  15. Puberdade precoce central como única manifestação de cisto aracnoide supraselar Central precocious puberty as a sole manifestation of suprasellar arachnoid cyst

    Directory of Open Access Journals (Sweden)

    Adriana Mangue E. Aun

    2011-03-01

    Full Text Available OBJETIVO: Os cistos aracnoides são achados raros. Em 10% dos casos, sua localização é supraselar e ocorrem quase exclusivamente em crianças. Em geral, apresentam manifestações neurológicas e visuais, sendo incomum a puberdade precoce central como sinal clínico de sua presença. DESCRIÇÃO DO CASO: Menina avaliada aos dois anos e sete meses por telarca iniciada com um ano e oito meses e pubarca e axilarca com dois anos, com aumento da velocidade de crescimento (13cm/ano e da idade óssea (sete anos e um mês. Ao exame, apresentou peso de 22,6kg (Z+4,0, estatura de 106cm (Z+3,5 e Tanner de M3P2. Exames realizados: teste de estímulo com GnRH (LH basal 8,3 UI/L, pico aos 30 minutos 94,3 UI/L; FSH basal=10,1 UI/L, pico aos 30 minutos 29,5 UI/L, ressonância nuclear magnética de crânio com cisto aracnoide supraselar e demais testes de função hipofisária normais. Foi iniciado tratamento com análogo de GnRH. Atualmente, aos quatro anos e três meses com estadio puberal M3P2, velocidade de crescimento e desenvolvimento neuropsicomotor normais para a idade. COMENTÁRIOS: A puberdade precoce central pode ser manifestação única de um cisto aracnoide, sendo essenciais o diagnóstico e o tratamento precoces, além de seguimento prolongado, uma vez que outras disfunções hipofisárias podem ocorrer tardiamente.OBJECTIVE: Arachnoid cysts (AC are a rare finding; 10% of them are suprasellar and occur almost exclusively in children. They are frequently associated with neurological and visual manifestations. Central precocious puberty as a sole manifestation is uncommon. CASE DESCRIPTION: Girl evaluated at the age of two years and seven months. She started breast development at the age of one year and eight months, pubic and axillary hair at the age of two years, with growth velocity acceleration (13cm/year and increased bone age (seven years and one month. On exam: weight: 22.6kg (Z+4.0, height: 106cm (Z+3.5 and puberal stage of B3P2. The Gn

  16. Posterior communicating artery cistern and associated arachnoid membrane:the microsurgical anatomy and clinal significance%后交通动脉池及相关蛛网膜的显微解剖研究及临床意义

    Institute of Scientific and Technical Information of China (English)

    宋海民; 漆松涛; 樊俊; 黄广龙; 黄理金; 冯文峰; 李伟光; 陆云涛

    2011-01-01

    Objective To investigate the microsurgical anatomic features and clinical significances of the posterior communicating artery cistern (PComA cisterns) and associated arachnoid membranes. Methods 10 cases (20 sides )of formalin-fixed cadaveric head specimens were microdissected to observe structures of PComA cistern and related arachnoid membranes under the operating microscope. Results The frequency rate of PComA cistern was about 60% (12 sides from all of specimens).The anterior wall of the cistern was the posterior communicating membranes. The carotid cistern directly communicated with the PComA cistern in the absence of the posterior communicating membranes. The posterior wall of the cistern was diencephalic and mesencephalic leaves of liliequist membranes. The medial wall was the carotid membranes and the lateral wall of diencephalic and mesencephalic leaves of liliequist membranes. The anterolateral wall was the lateral carotid membranes or the medial temporal lobe, and the posterlaeral wall the arachnoid trabeculaes arising from mesencephalic leaves of liliequist membranes which attached to the oculomotor nerve and posterior communicating artery. The superior lateral wall was incrual membranes, and the bottom wall the arachnoid membranes of base skull and diencephalic leaves of liliequist membranes. The features of different membranes were distinct. Conclusions This study identifies the features of the PComA cistern and associated arachnoid membrane, which is a valuable reference for clinic application.%目的 对后交通动脉池(PComA池)及相关蛛网膜的显微解剖特点进行描述并探讨其临床意义.方法 在手术显微镜下,对10例(20侧)福尔马林固定的尸头标本进行显微解剖,观察PComA池及相关蛛网膜的膜显微特点.结果 PComA池出现率60%(12侧).组成PComA池前壁为后交通膜,若此膜缺失,则与与颈内动脉池(ICA池)相通;后壁为liliequist膜间脑叶和中脑叶;内侧壁为颈内动脉内侧

  17. Herniation of the cerebellar tonsils after suprasellar arachnoid cyst shunt: case report Herniação das tonsilas cerebelares após shunt de cisto aracnóide supra-selar: relato de caso

    Directory of Open Access Journals (Sweden)

    Rodrigo Mendonça

    2006-06-01

    Full Text Available It is known that the caudal dislocation of the cerebellar tonsils may occur associated with clinical conditions such as an intracranial mass lesion or Chiari I and II malformation. It may also be acquired after repeated lumbar punctures or lumboperitoneostomy. The occurrence of cerebellar herniation after derivation of intracranial arachnoid cyst is extremely rare, and there are only three cases reported in the medical literature. We present the case of a 9-year-old boy with precocious puberty and suprasellar arachnoid cyst who developed a symptomatic herniation of the cerebellar tonsils three years after a cystoperitoneostomy. The patient underwent a suboccipital craniectomy with duraplasty and partial tonsilectomy, showing afterwards, remission of the symptoms. We discussed the pathogenesis suggested in the literature.Sabe-se que o deslocamento caudal das tonsilas cerebelares pode ocorrer em associação com condições clínicas tais como: lesão expansiva intracraniana ou malformação de Chiari I e II. Pode ainda ser adquirido após repetidas punções lombares ou lomboperitoniostomia. A ocorrência de herniação cerebelar após derivação de cisto aracnóide intracraniano é evento extremamente raro, existindo apenas três casos relatados na literatura médica. O caso de menino de 9 anos de idade, com puberdade precoce e cisto aracnóide supra-selar, que desenvolveu herniação sintomática das tonsilas cerebelares três anos após cistoperitoniostomia. O paciente foi submetido a craniectomia suboccipital com plástica dural e tonsilectomia parcial, apresentando remissão dos sintomas. Discutimos a patogênese sugerida na literatura.

  18. 显微手术治疗颈胸腰段椎管内硬膜外蛛网膜囊肿%Microsurgical treatment for cervical, thoracic and lumbar spinal extradural arachnoid cysts

    Institute of Scientific and Technical Information of China (English)

    高海浩; 尚爱加; 程诚; 张远征; 乔广宇; 佟怀宇

    2014-01-01

    目的 探讨颈胸腰段椎管内硬膜外蛛网膜囊肿的临床特点和治疗方法.方法 回顾性分析2011年1月至2013年11月收治的有明确症状的15例颈胸腰椎管内硬膜外蛛网膜囊肿患者.其中,1例发生于颈段,12例发生于胸腰段,2例发生于腰段.症状以腰腿疼痛为主,部分患者存在间歇性跛行和感觉功能障碍.结果 15例均行显微手术切除囊肿,术中探查并找到囊肿和硬脊膜囊交通孔予以封闭.术后早期患者症状改善明显.随访1 ~32个月,平均19个月,均未见囊肿复发.其中,11例症状消失,4例症状缓解,不影响正常生活.结论 对有明确症状的椎管内硬膜外蛛网膜囊肿患者,应首选显微手术治疗.手术方法采用囊肿切除、交通孔封闭、椎板复位,临床疗效良好.%Objective To explore the clinical features and surgical treatment of cervical,thoracic and lumbar spinal extradural arachnoid cysts.Methods The clinical data of 15 patients with cervical,thoracic and lumbarspinal extradural arachnoid cysts in our department from Jan 2011 to Nov 2013 were analyzed respectively.Of 15 patients,1 case occurred in cervical segment,12 in thoracolumbar segment,and 2 in lumbar segment.The symptom was given priority to the pain of lumbosacral region,followed by intermittent claudication and sensory dysfunction.Results 15 patients were treated by microsurgical operation to remove the cysts,explore and close the access hole between the cyst and dural sac.In early postoperative period,the symptoms were relieved significantly.15 patients were followed-up from 1 to 32 months (mean duration:19 months) and there was no cyst recurrence.The symptoms of 11 patients were disappeared,and 4 with relief of symptoms and without influence on their daily life.Conclusions Microsurgery was recommended for the patients with spinal extradural arachnoid cysts who suffered from significant symptoms,which included the cyst resection,access hole closure and lamina

  19. Correlación de hallazgos radiológicos con los eventos adversos que posiblemente hayan causado aracnoiditis Correlation between radiological findings and adverse events probably causing arachnoiditis

    Directory of Open Access Journals (Sweden)

    J. A. Aldrete

    2005-07-01

    íces en racimo, deformidades del saco dural y tejido cicatricial y fibrótico en el espacio epidural intervenido quirúrgicamente.Clinical diagnosis of arachnoiditis is characterized by a burning, ardent pain with dysesthesia and vesical, rectal and sexual dysfunction that appear after an adverse event during a spinal surgical procedure; it can be confirmed through magnetic resonance or myelogram followed by lumbar spine tomography. In this study, a retrospective review was conducted of image studies from 436 patients referred to a pain clinic with diagnosis of arachnoiditis in order to identify specific patterns on the radiological images that could help to determine the potential etiology of this disease. The apparent cause was correlated to the appearance of neurological changes after spine injections, interventions or surgical procedures. Neurological deficits were observed in 160 patients after myelograms, rachidian or peridural anesthesia, epidural blood patches or injection of steroids or neurolytic drugs for the management of chronic pain. Eleven (6.8% of these patients had inflammation of roots, 135 (84.3% had roots in bunches and 12 cases (7,5% had roots adhered to the dural sac. Two cases of syringomyelia were observed in patients with thoracal or high lumbar peridural anesthesia. Of 276 other patients in which the clinical diagnosis of arachnoiditis was established after spine surgical procedures, 259 patients (93.8% had roots in bunches, 152 (55% had a deformed dural sac and peridural fibrosis was observed in 241 patients (87.3%. Pseudomeningocele and intrathecal calcifications were observed in 21 (7.6% and 4 (0.15% of the surgical cases, respectively. It is concluded that radiological images in cases of arachnoiditis caused by injections and invasive procedures are only characterized by roots in bunches. However, surgical patients have, in addition to roots in bunches, deformation of the dural sac and healing and fibrotic tissue at the epidural space

  20. 基质金属蛋白酶-9在后交通动脉瘤瘤周蛛网膜中的表达及临床意义%Expression of matrix metalloproteinase-9 in the arachnoid membrane around posterior communicating artery aneurysms

    Institute of Scientific and Technical Information of China (English)

    冯文峰; 王刚; 张国忠; 李伟光; 李明洲; 何小艳; 张龙; 漆松涛

    2013-01-01

    Objective To investigate the expression of matrix metalloproteinase-9 (MMP-9) in the arachnoid membrane around posterior communicating artery aneurysms.Methods Twelve patients with posterior communicating artery aneurysms undergoing surgical intervention in our hospital between November,2010 and November,2011 were enrolled as the case group along with 6 concurrent patients with severely head trauma or epilepsy as controls.The expression of MMP-9 in the aneurysmal walls and the arachnoid membrane was examined in immunohistochemistry,and HE staining and Sirus red staining were performed to examine the pathological changes.Results The perianeurysmal arachnoid membrane showed tissue destruction and disruption of the connections between the membrane and the artery wall with local detachment.Compared with that in the control group,the level of MMP-9 in the arachnoid membrane was significantly higher in the case group (P<0.05),but significantly lower than that in the aneurysm wall within the same sample (P<0.05).No differences were found in the levels of MMP-9 in the aneurysm patients with different ages or Hunt-Hess scale scores.Conclusion MMP-9 is closely related with the formation of posterior communicating artery aneurysms by causing degradation of extracellular matrix of the vascular wall and the arachnoid membrane.%目的 初步探讨基质金属蛋白-9(MMP-9)在后交通动脉瘤瘤周蛛网膜中的表达及意义.方法 选取南方医科大学南方医院2010年11月~2011年11月手术切除的颅内动脉瘤标本12例作为颅内动脉瘤组,并选取同期行海绵状血管瘤手术或颞叶癫痫手术患者后交通动脉起始部附近蛛网膜组织6例作为对照组.标本行常规HE染色,并采用Envision法行免疫组化染色,比较组间MMP-9的阳性表达情况.结果 HE染色提示动脉瘤瘤周的蛛网膜存在一定的组织破坏,表现为蛛网膜结构松散,与血管壁之间的连接程度下降,局部存在脱离现象.动

  1. 听神经瘤安全切除及术中面神经保护解剖学基础%Microanatomy of the relationship between acoustic neuroma and the arachnoid

    Institute of Scientific and Technical Information of China (English)

    黄广龙; 漆松涛; 张喜安; 石瑾; 潘军; 邱晓瑜

    2013-01-01

    目的 探讨听神经瘤的安全切除、术中面神经保护技术及解剖学基础.方法 121例听神经瘤全部采用枕下乙状窦后入路,在显微外科基础上采用神经电生理监测技术,配合超声吸引(CUSA)和激光刀切除肿瘤,术后采用House-Brackmann (HB)分级方法对面神经功能进行评价. 结果 肿瘤全切除100%(121例).面神经解剖保留93.4%(113例),蜗神经解剖保留90.1%(109例),无死亡病例.术后3个月回访121例,按House-Brackmann分级对面神经功能评估,Ⅰ-Ⅱ级71.9% (87例),Ⅲ-Ⅳ级25.6% (31例),Ⅴ-Ⅵ级3.3%(4例). 结论 掌握听神经瘤与蛛网膜关系的解剖学基础是听神经瘤安全切除及面神经功能保护的关键.%Objective To review microsurgical techniques and facial nerve preservation issues in resection of acoustic neuroma.Methods Clinical data of 121 patients with acoustic neuroma who were surgically treated in our hospital from Jan 2009 to Oct 2012 were retrospectively analyzed.Acoustic neurinomas were removed by microsurgical technique through the suboccipital retrosigrnoid approach accompanied by face nerve EMG monitoring.Results Total separation was achieved in 100% (121 cases).The facial nerve was preserved anatomically in 93.4% (113 cases) and the cochlear nerve in 90.1% (109 cases).There was no surgery-related fatality.In a 3-month follow-up,according to House-Brackmann,the function of facial never was Ⅰ-Ⅱ level in 71.9% (87 cases),Ⅲ-Ⅳ in 25.6% (31cases),Ⅴ-Ⅵ in 3.3% (4 cases).Conclusion Profound understanding of the relationship between the acoustic neuroma and the arachnoid can drastically reduce the incidence of acial nerve damage during resection of acoustic neuromas.

  2. 皮质电极监测在致痫性蛛网膜囊肿手术中的应用%APPLICATION OF CORTICAL ELECTRODE MONITORING IN SURGERY FOR EPILEPTOGENIC ARACHNOID CYSTS

    Institute of Scientific and Technical Information of China (English)

    姜志锋; 金澎; 李照建; 季涛; 刘霞; 张欣; 孙鹏

    2012-01-01

    目的 探讨术中皮质电极监测在致痫性蛛网膜囊肿手术治疗中的应用价值.方法 蛛网膜囊肿病人19例,术前均有癫痫发作史,CT或MRI检查确诊.术前常规脑电图检查正常3例,轻度异常8例,中度异常6例,重度异常2例.常规开颅行蛛网膜囊壁全部或部分切除,同时行皮质电极监测,根据癫痫波位置行致痫灶切除或软膜下横切术.结果 19例病人术中皮质电极均监测到癫痫波,其中12例行致痫灶切除术,4例行多处软膜下横切术,3例行多处软膜下横切并颞极、海马切除术.术后常规脑电图检查均未见癫痫波.随访6个月~4年,18例癫痫消失;1例发作明显减少,口服药物可控制.结论 在致痫性蛛网膜囊肿病人手术中,使用皮质电极监测致病灶,定位准确,灵敏度高.%Objective To evaluate the value of cortical electrode monitoring (CEM) in surgery for epileptogenic intracrani-al arachnoid cysts (EIAC). Methods Nineteen patients with EIAC, who had a preoperative history of seizure disorder, were confirmed by CT or MRI. A preoperative EEG showed normal in three cases, slightly abnormal in eight, moderately abnormal in six and severely abnormal in two. The cysts were totally or partially resected through craniotomy, and, at the same time, CEM was conducted, the epileptogenic foci were removed or subpial transections performed according to the location of the epilepsy wave. Results Epilepsy wave was detected in all the patients during surgery. Of the 19 patients, a lumpectomy was done in 12 cases, multiple subpial transection in four, and multiple subpial transaction plus anterior temporal lobectomy and hippocampectomy in three. A postoperative EEG showed no epilepsy waves were found. A follow-up of from six months to four years indicated that 18 cases were epilepsy-free, and one experienced obvious decrease of seizures that could be controlled by oral medication. Conclusion In surgical therapy for EIAC, the use of

  3. Spinal arachnoid cyst; Torbiel pajeczynowki rdzenia

    Energy Technology Data Exchange (ETDEWEB)

    Lebkowski, W.J. [Akademia Medyczna, Bialystok (Poland)

    1993-12-31

    Four patients treated operatively have been presented. In 2 cases complete recovery has been achieved, in one case lower extremities plegia has been slightly reduced and in one case only the pain has been eliminated. (author). 15 refs, 3 figs.

  4. Arachnoiditis ossificans and syringomyelia: A unique presentation

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    Charles F Opalak

    2015-01-01

    Conclusion: This case demonstrates a unique presentation of AO and highlights the need for CT imaging when a noncommunicating syringx is identified. In addition, surgical decompression can achieve good results when AO is associated with concurrent compressive lesions.

  5. Shunt dependency after cyst-peritoneal shunting for the arachnoid cyst of the temporal lobe: report of thirteen cases and literature review%颞叶蛛网膜囊肿-腹腔分流术后分流管依赖综合征13例并文献复习

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    李春德; 阴鲁鑫; 姜涛; 宫剑; 甲戈; 罗世琪

    2014-01-01

    Objective To investigate the mechanism,diagnosis,and treatment of shunt dependency syndrome in patients with temporal lobe arachnoid cysts who were initially treated with cystoperitoneal (CP) shunting.Methods Thirteen patients with temporal lobe arachnoid cysts who had initially been with CP shunts placement and had developed shunt dependency syndrome were treated by the authors at Tiantan Hospital between April 2010 and January 2012.The clinical manifestation,neuroimaging findings,intracranial pressure (ICP) data,treatment methods,and therapeutic results were reviewed retrospectively.Results The study included 10 males and 3 females.The mean age at the time of development of shunt dependency was 12.3 years (range 5.5-24.0years).In most patients,neuroimaging findings showed a collapsed cyst (the cyst appeared almost unchanged in only one patient) and normal or small ventricles (only one patient had enlarged ventricles).Three patients underwent simple replacement of the shunt,four underwent ventriculoperitoneal shunt placement,and the other six underwent lumboperitoneal shunt placement.All patients experienced resolution of their symptoms postoperatively.The mean duration of follow-up was 20 months.Conclusions Shunt dependency syndrome was a rare but serious complication of cystoperitoneal (CP) shunting for arachnoid cysts.The condition was similar to the slit ventricle syndrome,but also had some differences.ICP monitoring could confirm the diagnosis when there was no significant radiological findings.%目的 探讨颞叶蛛网膜囊肿-腹腔分流术后分流管依赖综合征的发生机制、诊断标准及治疗方法.方法 对2010年4月至2012年1月北京天坛医院小儿病区收治的13例颞叶蛛网膜囊肿-腹腔分流术后分流管依赖患者的临床资料进行回顾性分析,并对相关文献进行复习.结果 13例患者,男10例,女3例,平均年龄12.3岁(5.5~24.0岁),首发症状多为头痛及恶心呕吐等高颅压症状,影像学

  6. Hemorragia de tronco cerebral após remoção cirúrgica de cisto aracnóide da fissura silviana: Relato de caso Brainstem hemorrhage after surgical removal of arachnoid cyst of the sylvian fissure: case report

    Directory of Open Access Journals (Sweden)

    Guilherme Borges

    1995-12-01

    Full Text Available Os autores relatam um caso de hemorragia de tronco cerebral após craniotomia para ressecção de grande cisto aracnóide de fissura silviana esquerda. A sintomatologia inicial pré-operatória incluía sinais de hipertensão intracraniana e a tomografia computadorizada mostrava desvio de linha média. Diversos fatores são discutidos para explicar o sangramento parenquimatoso pós-operatório: edema cerebral, diminuição do retorno venoso e de fluxo sanguíneo no lado comprimido. Entretanto a fisiopatologia da hemorragia parenquimatosa em casos como o relatado permanece obscura. Uma abordagem cirúrgica mais cautelosa é proposta nesses pacientes com de hipertensão intracraniana.The authors report a case of a hemorrhage of the brainstem after craniotomy for resection of a huge arachnoid cyst of the sylvian fissure on the left hemisphere. The previous simptomatology included clinical signs of increased intracranial pressure, and the computerized tomography showed midline shift. Some factors may contribute to brain hemorrhage post-operatively: cerebral edema, ipsilateral changes in the venous reflux and blood perfusion, although the physiopathology remains obscure. A more careful approach is suggested in such cases with intracranial hypertension.

  7. 以慢性硬膜下血肿为首诊的儿童颅内蛛网膜囊肿五例并文献复习%Clinical study on patients of intracranial arachnoid cyst concurring initially chronic subdural hematoma in children: report of five cases and literature review

    Institute of Scientific and Technical Information of China (English)

    梅文忠; 林志雄

    2012-01-01

    Objective To explore the etiopathogenisis and treatment strategies of chronic subdural hematoma associated with arachnoid cyst in children.Methods A retrospective analysis was made for 5 cases of chronic subdural hematoma associated with arachnoid cyst in children from January 2006 to April 2012.There were 4 males and 1 female with a mean age of 7.2 years old ( rang:4 - 11 ).The symptom of intracranial hypertension was appeared in all cases,as well as,epilepsy in 1 case and paralysis in another.History of previous head injury was found in lcase and no history of injury in 4 cases.Results The symptoms were relieved without neurologic deficits by undergoing burr hole evacuation.The absence of the subdural hematoma were ocuured in 1 to 3 days for 4 cases wih tension cysts and 6 days for another case complicating intracystic hematoma postoperatively.The ensuing operation of cyst - peritoneal shunt for 3 cases with tension cysts were preformed in three weeks to three months later.The follow - up duration was vary from six month to two years,None had recurrent subdural hematoma and cysts disappear approximatively for the patients of undergoing cyst - peritoneal shunt.Conclusions Arachnoid cyst is a causative factor for subdural hematoma in preschoolers and school children.The subdural hematoma perhaps was a secondary event from local inflammatory reaction,which was prevoked by restoring the leakage of arachnoid cyst wall.A burr hole evacuation is a first - line treatment and has a full recovery.%目的 探讨儿童颅内蛛网膜囊肿相关性的慢性硬膜下血肿的病因机制及治疗方法.方法 回顾性分析福建医科大学附属第一医院2006年1月至2012年4月5例以慢性硬膜下血肿为首诊患儿的临床资料,男4例,女1例,年龄4 ~11岁,平均7.2岁,均以典型颅高压表现首诊,其中1例并发癫痫,另1例并发健侧肢体无力;发病前3个月内明确颅脑损伤史1例,无明确外伤史4例.结果 5例患儿术后颅高压

  8. Associação singular de síndrome de Kallmann e cisto aracnóide da fossa média: relato de caso Singular association of Kallmann's syndrome and arachnoid cyst of middle fossa: case report

    Directory of Open Access Journals (Sweden)

    Yvens B. Fernandes

    1995-09-01

    disabilities. On physical examination he exhibited mild eunuchoid aspect, 162 cm height (z score = -2,17, pubertal development on stage G II, P II, and 4 cm5 testis. Laboratory investigation revealed pre-pubertal levels of testosterone and normal results of the combined test of anterior pituitary function, except for in GnRH acute and prolonged test. Brain CT showed an arachnoid cyst on left middle fossa with expansion to suprasellar cisterna. He was diagnosed as having hypogonadotrophic hypogonadism secondary to compression by the cyst, and a cyst-peritoneal derivation was performed. After surgery there was no improvement of the pubertal state and bilateral anosmia was discovered, so Kallmann's syndrome was then diagnosed and was confirmed by MRI, even though the hormonal results are not totally matched with the refered syndrome. We did not find in the literature any description of the association between Kallmann's syndrome and arachnoid cyst and we believe that in this case the results of the hormonal measurement may be due to such association that provoked an additional hypophysis dysfunction.

  9. 儿童蛛网膜囊肿-腹腔分流术后继发裂隙脑室综合征的治疗%The therapeutic strategies for the slit ventricle syndrome after cyst -peritoneal shunting for the temporal arachnoid cyst in children: six cases report and literatures review

    Institute of Scientific and Technical Information of China (English)

    方铁; 徐金山; 李维芳; 王社军; 邢俭

    2011-01-01

    Objective To investigate early diagnosis evidences, optimal therapeutic strategies and the prophylactic methods of the slit - ventricle syndrome(SVS) in the temporal lobe arachnoid cysts patients who received the cyst - peritoneal(CP) shunting.Method Six cases of SVS in the temporal lobe arachnoid cysts patients who received the CP shunting were treated by the senior author from Jan 2005 to Jan 2009.The radiological data, treatment process and therapeutic results were reviewed retrospectively.Results There were 4 male and 2 female patients.The mean age of presentation was 57.5 months.The final treatment was to change the original shunt with the programmable valve or combined with the ventricular - peritoneal(VP)shunting.All the symptoms of the patients disappeared totally, and the mean follow - up duration was 30mouths.Conclusions To use programmable shunts to substitute for the original shunt or combined with inserting a VP shunt is an optimal therapeutic method for SVS.The use of low - pressure shunts to treat the ararchoid systs should be abandoned unless dictated by specific indications.%目的 探讨颞叶蛛网膜囊肿行囊肿-腹腔分流术后出现的裂隙脑室综合征的早期诊断依据,合理有效的治疗方法以及预防这种并发症的措施.方法 回顾性分析研究了经过本文通信作者治疗的6例颞叶蛛网膜囊肿行囊肿-腹腔分流术后出现裂隙脑室综合征患儿的影像学资料、治疗经过和治疗结果.结果 男4例,女2例.平均发病年龄57.5个月.治疗方法为使用可调压力的抗虹吸分流管泵更换原有分流管泵或联合使用脑室-腹腔分流.6例患者临床症状完全消失,平均随访30个月,未见症状复发.结论 使用可调压力的抗虹吸分流管泵更换原有分流管泵或联合脑室-腹腔分流术对于裂隙脑室综合征是一种有效的治疗措施.避免使用低压的无抗虹吸作用的分流管能够有效地预防蛛网膜囊肿-腹腔分流术后出现裂隙脑室综合征.

  10. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... had this encephalocele, this mass in between his nose, and there are many different kinds of encephalocele. ... The two most common are either in the nose here in the front, which tend to be ...

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    Full Text Available ... actually, in the skull and this resulted in brain protruding out in between the eyes. And I ... What an encephalocele is essentially a bit of brain herniating or pushing out through a whole in ...

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    Full Text Available ... re fortunate enough today to have Dr. Ed Smith from the Department of Neurosurgery, and David Walton ... be essentially a perfect contour. 3 And Dr. Smith is going to remove that bone for me, ...

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    Full Text Available ... medical care. “OR-Live,” the vision of improving health. Well good afternoon. Welcome to Boston. This is ... of Neurosurgery, and David Walton from Partners in Health. Ed, I’m going to let you lead ...

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    Full Text Available ... mass in between his eyes. This is what led to the initial diagnosis and had him brought ... the opposite side of his body, and this led to us talking about a little bit about ...

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    Full Text Available ... in Boston. And Dumanel initially came to our attention about a little over a year ago when ... actually that’s initially when Dumanel came to our attention. Actually, John Meara, who is here with us ...

  1. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... of encephalocele causes is something called the “long-nose deformity.” And so when you’re reconstructed the frontal orbital band O and the nose, that’s an important thing to address in reducing ...

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    Full Text Available ... so CFS leak, infection, which you mentioned, the importance of adequate closure. There could be infections of ... what you’re going to see is my team is dissecting around the external portion of the ...

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    Full Text Available ... encephalocele, the part of brain that isn’t healthy and isn’t, you know, functional anymore is ... bipolars,” is to cauterize the tissue between the healthy brain on the left and the unhealthy brain ...

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    Full Text Available ... I’m John Meara from the Department of Plastic Surgery, and we’re fortunate enough today to have ... for any of the types of brain tumor surgery or other types of craniofacial repairs ... with the plastic surgeons quite a bit. I have another interesting ...

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    Full Text Available ... could comment on, you know, what is the role of surgery in Partners and Health? How important ... so CFS leak, infection, which you mentioned, the importance of adequate closure. There could be infections of ...

  7. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... here in the United States, which is the occipital encephalocele, or here in the back of the ... in other parts of the brain, for example occipital encephaloceles, we can sometimes be able to reduce ...

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    Full Text Available ... who are pediatric fellowship trained -- I mean pediatric board certified pediatric surgeons, and we were able to ... patient and make sure that the post-op management is appropriate and that is very comforting, given ...

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    Full Text Available ... could comment on, you know, what is the role of surgery in Partners and Health? How important ... Children’s to have a lot of multi-disciplinary teams where it’s not just the surgeons looking at ...

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    Full Text Available ... garden-variety stuff that comes in off the street or complex stuff that comes in from halfway ... cavity that can fill up with blood or old tissue. So those are some potential complicated from ...

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    Full Text Available ... to someone having appendicitis is really a basic service that one needs, really, to consider one’s self- ... of the care in Haiti is fee-for-service. And so whenever -- you know, he spent many, ...

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    Full Text Available ... have Dr. Ed Smith from the Department of Neurosurgery, and David Walton from Partners in Health. Ed, ... know that a number of us from the Neurosurgery Department, including my colleague, Mark Proctor, who has ...

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    Full Text Available ... see our most complex patients. It’s a fascinating model and it’s been highly successful. So I guess ... patient and make sure that the post-op management is appropriate and that is very comforting, given ...

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    Full Text Available ... rough estimate would be to say about two-thirds of patients to three-quarters of patients who ... term cure, and about a quarter to a third end up needing a shunt. Again, there’s a ...

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    Full Text Available ... the risk of this developing later on in life into cancer?” And, you know, my understanding is ... in there for the rest of the child’s life. So that’s the new frontal segment there that ...

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    Full Text Available ... continual medical care in the sense of getting medicines every day, but he is getting frequent follow- ... of our patients sometimes are on blood-thinning medicines or aspirin, you want to make sure that’s ...

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    Full Text Available ... webcast screen and open the door to informed medical care. “OR-Live,” the vision of improving health. ... of taking care of the Haitians, our own medical staff, taking care of people of Haiti. That’s ...

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    Full Text Available ... the central plateau of Haiti with our Haitian staff. We do have Haitian surgeons who, you know, ... taking care of the Haitians, our own medical staff, taking care of people of Haiti. That’s a ...

  2. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... something that you determine at the time of surgery. The risk factors for trying to figure out if a ... larger encephaloceles and sphenoidal encephaloceles, sometimes that’s a risk either ... function is like before surgery and have a good sense of what it ...

  3. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... well, then fluid can leak out through the seams basically and build up pressure underneath the scalp, and that pressure can inhibit healing and make the hole repair at risk. So as you see at the bottom of the video screen here, there’s that white tube, and I mentioned earlier there was an external ...

  4. Optochiasmatic arachnoiditis and neurotuberculosis: Prognostic indicators and therapeutic strategies

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    Gourie-Devi M

    2010-12-01

    Full Text Available Tuberculous meningitis (TBM is a serious meningitic infection commonly found to occur in the developing countries endemic to tuberculosis. Based on the clinical features alone, the diagnosis of TBM can neither be made nor excluded with certainty. Unfortunately there is still no single diagnostic method that is both sufficiently rapid and sensitive. Most factors found to correlate with poor outcome can be directly traced to the stage of the disease at the time of diagnosis. The only way to reduce the mortality and morbidity is by early diagnosis and timely recognition of complications and institution of the appropriate treatment strategies.

  5. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    ... on remediating health inequalities amongst the rural and urban poor, including a program here in Boston. But ... a lot easier to sort of tackle either garden-variety stuff that comes in off the street ...

  6. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... on remediating health inequalities amongst the rural and urban poor, including a program here in Boston. But ... a lot easier to sort of tackle either garden-variety stuff that comes in off the street ...

  7. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... management a little bit more complex. So one thing I think would be good to talk about now a little bit is ... interestingly, he had this weakness on the opposite side of his body because it’s a very large cyst and seems to be pushing on the brain. The other thing is probably he had a little bit of ...

  8. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... was seen down in Haiti to have this large deformity in between his eyes. This is something ... about how Dumanel not only had this very large encephalocele but also had another surprise, which made ...

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    Full Text Available ... of the slides just to lay some ground work for us about the frontal encephalocele. Yeah. This ... know, for laying a little bit of ground work. Let’s start looking at the surgery, and I ...

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    Full Text Available ... the dura, the meninges, and by establishing an edge there, we’ll have a sharp edge, which we can sew to and establish that ... or at the site where you remove the edge of the brain. As an example of that ...

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    Full Text Available ... you know, Partners in Health does a wide diversity of procedures down there, and the very special ... who are pediatric fellowship trained -- I mean pediatric board certified pediatric surgeons, and we were able to ...

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    Full Text Available ... you know, Partners in Health does a wide diversity of procedures down there, and the very special ... Children’s to have a lot of multi-disciplinary teams where it’s not just the surgeons looking at ...

  13. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... the globe. It was originally founded by Paul Farmer, Ophelia Dahl, Todd McCormick and others in 1983. ... However, there family is extremely poor. They are farmers that I do subsistence farming, and so -- excuse ...

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    Full Text Available ... here was that he had this encephalocele, this mass in between his nose, and there are many ... that he had this large defect -- sorry, large mass in between his eyes. This is what led ...

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    Full Text Available ... that’s appropriate for that venue and collaborated with academic medical centers for care that really can’t ... colleague, Mark Proctor, who has a lot of experience with these cases, yourself, Gary Rogers, a number ...

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    Full Text Available ... can tell you that from the standpoint of managing shunts in Haiti, it’s actually very difficult. And ... here at Children’s. We also have a big group of neurosurgeons, all of who are pediatric fellowship ...

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    Full Text Available ... really highlighted sort of benefit of having a team approach, which maybe John can talk a little ... and, subsequently, brain pressure, that you have a team that’s dedicated, and we work with a very ...

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    Full Text Available ... but also had another surprise, which made his management a little bit more complex. So one thing ... shunts can be pretty dicey in term of management. Uh-huh. I would comment that, you know, ...

  19. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... inequalities amongst the poor in developing nations and right here in Boston. And Dumanel initially came to ... and you see on the image on the right a very large area of black empty space, ...

  20. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... many complications that can arise and, again, many emergencies that can arise in children with shunts. You ... so that’s a bit more of a neurosurgical emergency. In Dumanel’s case, he was fortunate to have ...

  1. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... so that nothing scary happens while we’re operating, and then once we had him in position, ... in terms of length of time, the actual operating time, I believe was four to five hours ...

  2. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... nice because then you don’t have a foreign body in there for the rest of the ... can avoid it. The idea being the fewer foreign materials you have the better. But there are ...

  3. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... terms of his ability to live a long life without having subsequent neurosurgical issues. David asks, “Is there any inevitable neurologic damage after the surgery?” You know, and I guess my ...

  4. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... did the procedure take, and what does the future hold for the child? And I think in ... of ICU observations. In terms of what the future holds, you know, I think we already know, ...

  5. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... let me just say we have some interesting e-mails coming in already, and maybe we can ... an additional workup and then potentially coordinate over e-mail or phone or Internet with the staff ...

  6. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... to Dumanel, I think he’s got an excellent prognosis. David, we have an interesting question here. It ... determine at the time of surgery. The risk factors for trying to figure out if a cyst ...

  7. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... ago, Ed and I would have been using titanium plates and screws, but now we’re using ... midline because of their displacement. So this is titanium wire, which is very nocuous. The body doesn’ ...

  8. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... external drain, before we remove it, we can challenge the child by raising or lowering the drain ... patient and make sure that the post-op management is appropriate and that is very comforting, given ...

  9. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... work for the hospitals who live in the community. They do a number of things. They’re called -- essentially they’re called “accompan’tures” or “community health workers.” And they help us; the physicians, ...

  10. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... up here to Children’s. As part of the evaluation, as I mentioned, what is normally done is ... something of monetary value, they then sell these items that can, you know, generate some income for ...

  11. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... previously is a 501C3 charity. We, for the purposes of this discussion, I’ll focus on primarily ... them, and they came for a very specific purpose, which was to focus on cleft lip and ...

  12. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... manage him surgically and really highlighted sort of benefit of having a team approach, which maybe John ... children aren’t just little adults. And we benefit here at Children’s, obviously, from having trained pediatric ...

  13. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... any other major risks that we need to be concerned with? Well I think any time you operate on the ... You know, and I guess my comment would be in this case, no, everything went very well and, Ed, you already commented on the potential ...

  14. [Congenital Minamata disease accompanied by arachnoid cyst (author's transl)].

    Science.gov (United States)

    Hira, K; Harada, M; Takehara, S; Kabashima, K; Tatetsu, S; Fujioka, M; Yasutake, H; Ozaki, M

    1982-03-01

    A male, born on December 8, 1956, during the period when many Minamata diseases broke out in a district. His parents who ate much fish and shell fish taken in Minamata Bay suffered from the light, incomplete Minamata disease showing sensory disturbance, the constriction of the visual field, muscular weakness, etc. He weighed 3,225 gr. upon the normal birth given 10 months after pregnancy. His abnormalities were noted since his head was not stabilized on the neck even six months after the birth. Because of the delay in the development of the motor function, he became barely able to sit, stand up and begin walking at the ages of 3, 5 and 6 respectively. In 1962 (at the age of 6), his congenital Minamata disease was diagnosed in view of his clinical symptoms and epidemiological conditions. The mercury value in the hair and blood upon the birth is not known because a considerable time had elapsed after the birth when his mercury poisoning was discovered. However, the clinical symptoms included intelligence disturbance, character change, dysarthria, primitive reflexes, strabismus, hypersalivation, ataxia and hyperkinesia, indicating a typical congenital Minamata disease. Until he became 13 years old (1969) or so, his mental and motor function developed, both gradually. In the same year, he was admitted to a special class for the handicapped. EEG examination revealed that there was a slow alpha activity in the basic pattern and that 6 Hz positive spike was found in the sleep EEG. The constriction of the visual field was classified through examination.2+ PMID:7093064

  15. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... December, that he’s doing extremely well. And the motor function on his left side is improving. I’ ... What are your thoughts about extensive improvement of motor function. Well, you know, the hope here is ...

  16. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... good understanding of the Haitian health care delivery system, you know, with a child like this who ... If you have access to a health care system nearby where the tube can be fixed and ...

  17. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... get referred up here, and many times the treatment for them is surgery. When Dumanel was diagnosed ... help administer these medications. They can directly observe therapy, meaning the patients will never miss a dose ...

  18. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... the collaboration that we have with Children’s to send children who have very, very complicated issues here ... they need to buy -- if they need to send their kid to school or if they need ...

  19. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... do is somehow deflate it to make the water inside of it, the spinal fluid that even ... had a balloon inside your sink, and normally water can flow around the balloon and drain down ...

  20. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... to have this large deformity in between his eyes. This is something that was noticed since birth ... resulted in brain protruding out in between the eyes. And I wonder, Dave, if you can talk ...

  1. Craniofacial Procedure to Treat Encephalocele and an Arachnoid Cyst

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    Full Text Available ... we treat very shortly after birth while the mother is still -- while the child is still in ... that is very, very low in order of single percentage points or less. In terms of the ...

  2. PRE-EMPTIVE ORAL CLONIDINE FOR IMMEDIATE POSTOPERATIVE PAIN IN SURGERIES UNDER SUB-ARACHNOID BLOCK

    Directory of Open Access Journals (Sweden)

    Priti

    2014-10-01

    Full Text Available : BACKGROUND: Pre-emptive analgesia is a treatment that is initiated before the surgical procedure in order to reduce sensitization of central and peripheral pain pathways produced by pain signals evoked by tissue damage. Clonidine has demonstrated efficacy in clinical trials as pre-emptive analgesic in postoperative pain management. OBJECTIVE: The present study was conducted to evaluate postoperative analgesic benefit in patients administered clonidine or placebo for below umbilical surgeries to be performed under subarachnoid block (SAB using 3ml 0.5%bupivacaine & to compare their postoperative efficacy with respect to duration of analgesia, 24hrs postoperative requirements of total analgesics and study side effects. MATERIAL & METHODS: Sixty patients of either sex (30 per group, 20-65yrs, ASA class I-II received either oral placebo (group PC or clonidine 150µg (group CL one hr preoperatively. The postoperative Visual Analogue Scale (VAS score was assessed for 24hrs every 2hrly. The patients were given iv Diclofenac75mg as rescue analgesic at VAS ≥4.The time at which patient demanded rescue analgesic for first time & total requirement of 24 hrs postoperative analgesics was noted. STATISTICAL ANALYSIS: Software used in the analysis was EPI info software (3.4.3. Data was reported as mean value ± SD, P-value of < 0.05 was considered statistically significant. Unpaired T – test was used to find out significance between two samples. The comparison of normally distributed continuous variables between the groups was performed by means of one-way analysis of variance (ANOVA and, if appropriate, followed by Dunnett multiple comparison tests. Nominal categorical data among study groups were compared using the chi-square test. Results: Total duration of analgesia in Group-CL was significantly more than Group-PC. (492.66 ±78.29 min. Group-CL, 264.83 ±13.67 min. Group-PC, p=0.000, lower rescue analgesic requirement in Group-CL than in Group-PC (2.20 ±0.61 Group-CL, 4.03 ± 0.66 Group-PC, p=0.000. CONCLUSION: Pre-emptive oral clonidine appears to be effective in prolongation of postoperative analgesia with decreased rescue analgesic requirements. The main side effects observed were hypotension & bradycardia.

  3. Acute hydrocephalus in a child with a third ventricle arachnoid cyst and coincidental enteroviral meningitis

    NARCIS (Netherlands)

    Jeltema, Hanne-Rinck; Kuijlen, Jos M. A.; Hoving, Eelco W.

    2014-01-01

    We present a 2.5-year-old child suffering from acute hydrocephalus. First, the child was diagnosed with aseptic viral meningitis. The PCR of the cerebrospinal fluid (CSF) was positive for enterovirus. Subsequently, MRI revealed that the hydrocephalus was caused by a cyst in the third ventricle. Duri

  4. SU-E-I-67: Arachnoid Cysts: The Role of the BLADE Technique

    Energy Technology Data Exchange (ETDEWEB)

    Mavroidis, P [University of North Carolina, Chapel Hill, NC (United States); Vlachopoulou, A; Kostopoulos, S; Ninos, C; Glotsos, D; Bakas, A; Oikonomou, G; Roka, V; Lavdas, E [Technological Education Institute of Athens, Athens, Attika (Greece); Kapsalaki, E; Tsirika, A [University of Thessaly, Larissa, Thessaly (Greece); Papanikolaou, N [University of Texas HSC SA, San Antonio, TX (United States); Stathakis, S [Cancer Therapy and Research Center, San Antonio, TX (United States)

    2015-06-15

    Purpose: The purpose of this study is first to show the extent by which BLADE sequences can reduce all the image artifacts and second to verify that the usefulness of this technique in certain pathological conditions is significant. Methods: In this study, fourteen consecutive patients (5 females, 9 males), who routinely underwent MRI brain examination, between 2010–2014, were selected. The applied routine protocols for brain MR examination included the following sequences: 1) T2-W FLAIR axial; 2) T2-W TSE axial; 3) T2*-W axial, 4) T1-W TSE sagittal; 5) DWI-W axial; 6) T1-W TSE axial; 7) T1-W TSE axial+contrast. In cases of cystic tumors, the T2-W FLAIR BLADE sequence was added to the protocol. All the images were evaluated independently at two separate settings with 3 weeks interval by two radiologists. The radiologists also evaluated the presence of image artifacts (motion, flow, chemical shift, Gibbs ringing). To evaluate the size of the cyst, the two radiologists compared the two techniques (conventional and BLADE) by assessing the extent of the divergence in the measurements of the cysts. Results: Regarding the extent of the cyst size, BLADE measurements were found to be more reliable than the conventional ones with the differences being statistically significant (p<0.01). The qualitative measurements indicated that the T2 FLAIR BLADE sequences were superior to the conventional T2 FLAIR with statistically significant differences (p<0.001) in the following characteristics: 1) overall image quality, 2) CSF nulling; 3) contrast at the pathology and its surrounding; 4) limits of the pathology; 5) motion artifacts; 6) flow artifacts; 7) chemical shift artifacts and 8) Gibbs ringing artifacts. Conclusion: BLADE sequence was found to decrease both flow artifacts in the temporal lobes and motion artifacts from the orbits and it is proposed for clinical use.

  5. Clínica de animais de companhia: seizures: an intracranial arachnoid cyst as cause with surgical treatment

    OpenAIRE

    Lavareda, Diana Isabel Carvalho

    2014-01-01

    The last year of Veterinary Medicine’s MSc degree is reserved to do an internship where the veterinary student has the opportunity to improve his skills. This internship report is the final result from six months of internship done in two different veterinary hospitals, one from Sydney (Australia) and the other one from Oporto (Portugal). The first part of this document is focus on the activities undertaken along the internship, outlined by graphs and tables. There are also des...

  6. OBSERVATIONAL STUDY ON SUB ARACHNOID BLOCK IN PRE SUBDUED CHILDREN IS A CHEAP, EFFECTIVE, SAFE ALTERNATIVE TO GENERAL ANAESTHESIA

    OpenAIRE

    Srilakshmi; Venkata Ramana

    2014-01-01

    Technically, carrying out Spinal Anaesthesia in adults, may not pose much problems, because of patient co-operation, but same is not always so in case of toddlers and children, because of inherent fear of Hospital atmosphere, detachment from parents, immaturity and other. This study aims at performing Spinal Anaesthesia, in children, if they are pre-medicated, and pre-subdued, might pave way for the comfort of both patient and Anesthesiologists. So, pre-medicated, pre-subdued ...

  7. OBSERVATIONAL STUDY ON SUB ARACHNOID BLOCK IN PRE SUBDUED CHILDREN IS A CHEAP, EFFECTIVE, SAFE ALTERNATIVE TO GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Srilakshmi

    2014-08-01

    Full Text Available Technically, carrying out Spinal Anaesthesia in adults, may not pose much problems, because of patient co-operation, but same is not always so in case of toddlers and children, because of inherent fear of Hospital atmosphere, detachment from parents, immaturity and other. This study aims at performing Spinal Anaesthesia, in children, if they are pre-medicated, and pre-subdued, might pave way for the comfort of both patient and Anesthesiologists. So, pre-medicated, pre-subdued Spinal Technique may be cheaper, safer alternative to General Anaesthesia. In our Observational study, results are satisfactory, with no occurrence of described complications, and study needs to be done in large number of cases.

  8. A COMPARATIVE STUDY BETWEEN INTRATHECAL MORPHINE AND INTRATHECAL BUPRENORPHINE FOR POST - OPERATIVE ANALGESIA FOLLOWING CAESARIAN SECTION UNDER SUB ARACHNOID BLOCK

    Directory of Open Access Journals (Sweden)

    Anish M

    2015-05-01

    Full Text Available BACKGROUND: Good pain relief following caesarian section is of great importance and intrathecal opioids provide good quality postoperative analgesia for longer duration. So the following study describes a comparative study between intrathecal morphine and intrathecal buprenorphine for postoperative pain relief following caesarian section (CS under subarachnoid blockade. AIMS: The study was conducted to compare intrathecal morphine and buprenorphine for post of analgesia following CS, to achieve analgesia without seda tion for better maternal child bondage and to popularize intrathecal opioids . MATERIALS AND METHODS: 60 patients posted for CS under SAB were randomly allocated into group A and group B of 30 each, the group A received morphine 0.1 mg and buprenorphine 0 . 0 3 mg was given for group B patients along with the local anaesthetic. Subjective assessment of post - operative analgesia was done by direct questioning of the patient and by a five point pain scores. Duration of analgesia was taken as the time interval betw een the time of injection of intrathecal opiate and the time at which the patient felt pain and requested for additional analgesics. Data’s were analyzed using SPSS 16th version. OBSERVATION AND RESU LTS: The mean duration of post - operative analgesia with i ntrathecal morphine was 24.19+4 . 8 hours and that with buprenorphine was only 11.7+3.28 hours. Over weight patients reported a lower mean duration of analgesia. None of the patients in the study showed any bradycardia, hypotension, desaturation or respirato ry depression. Intrathecal opiates decreased the parenteral opiate requirements. The main side effects noticed were nausea in about 43% of patients in morphine group and 33% of patients in buprenorphine group. CONCLUSIONS: Intrathecal morphine 0 . 1 mg gives good post - operative analgesia of longer duration than buprenorphine 0 . 03mg. The quality of analgesia provided by intrathecal morphine was superior to intrathecal buprenorphine. There was no incidence of respiratory depression or sedation.

  9. SUB-ARACHNOID BLOCK FOR AN ELDERLY PATIENT WITH CHRONIC RENAL FAILURE, RIGHT SIDE LOCULATED PNEUMOTHORAX AND WITH COMPLETE HEART BLOCK ON PACEMAKER

    Directory of Open Access Journals (Sweden)

    Krishna Prabu

    2014-05-01

    Full Text Available : Patients presenting for an elective or emergency surgery with pre-existing chronic renal failure (CRF has certain anesthetic considerations. Central neuraxial block for these patients is controversial, because all these patients will be invariably on fluid restriction. If such patient presents with pulmonary complications and cardiac complications which are relative contraindications for general anesthesia then the anesthetic management becomes trickier. We had a patient with CRF, presented with inter-trochanteric fracture of femur for surgical fixation. The patient also had left side loculated pneumothorax, right side bronchiectatic changes and permanent cardiac pacemaker for complete heart block which were challenges for general anesthesia too. Finally the surgery was done under central neuraxial block with dopamine support successfully.

  10. Procollagen I C-propeptide in the cerebrospinal fluid of neonates with posthaemorrhagic hydrocephalus

    OpenAIRE

    Heep, A; Stoffel-Wagner, B.; Soditt, V; Aring, C; Groneck, P; Bartmann, P.

    2002-01-01

    Background: The pathogenesis of posthaemorrhagic hydrocephalus (PHHC) following intraventricular haemorrhage (IVH) in premature infants includes a fibroproliferative reaction leading to arachnoidal fibrosis, ultimately causing malresorption of cerebrospinal fluid (CSF) at the arachnoid villi.

  11. 解剖观察内听道蛛网膜及术中观察其与听神经瘤的关系%Anatomic observation of the arachnoid membrane in the internal auditory canal and intraoperative observation of the relationship between vestibular schwannomas and the arachnoid membrane

    Institute of Scientific and Technical Information of China (English)

    蔺友志; 刘恩重; 李俊石

    2004-01-01

    目的探讨内听道蛛网膜解剖结构;术中观察听神经瘤与蛛网膜之间的关系.方法解剖观察尸头后术中观察蛛网膜与肿瘤及神经之间的关系.结果内听道蛛网膜是桥小脑角池蛛网膜的延续,并达到内听道底部.肿瘤和神经之间没有蛛网膜间隔.结论听神经瘤是蛛网膜内位肿瘤,锐性和明视下切除肿瘤有助于神经功能的保护.

  12. 前庭神经雪旺细胞瘤和蛛网膜关系的术中观察%Operative observation of relationship between vestibular schwannoma and arachnoid membrane

    Institute of Scientific and Technical Information of China (English)

    蔺友志; 刘恩重; 李俊石

    2003-01-01

    目的探讨前庭神经雪旺细胞瘤和蛛网膜之间的关系以及神经功能的保护.方法手术中观察蛛网膜、肿瘤和神经的关系.结果肿瘤的后面、上下极表面有蛛网膜覆盖,脑干侧、肿瘤和面听神经之间没有蛛网膜间隔.结论前庭神经雪旺细胞瘤是蛛网膜内位肿瘤,肿瘤表面的蛛网膜是桥小脑角池固有的蛛网膜,强调明视下的神经分离和肿瘤切除.

  13. Treatment of suprasellaer arachnoid cysts in children with neuroendoscopy%神经内镜造瘘术治疗小儿鞍上池蛛网膜囊肿(附15例报告)

    Institute of Scientific and Technical Information of China (English)

    李庆国; 周煜; 韩彤; 李亚斌; 亢建民; 闫学江; 杨玉山

    2012-01-01

    目的 探讨脑室囊肿造瘘联合囊肿桥前池造瘘术(VCC)在治疗小儿鞍上池蛛网膜囊肿(SACs)的有效性和安全性.方法 总结2008年1月至2011年10月天津市环湖医院收治的15例小儿鞍上池囊肿患者,全部病例应用神经内镜脑室囊肿联合囊肿脑池造瘘手术,手术前后进行对比分析,评价指标包括脑积水症状缓解,鞍上池囊肿引起的内分泌改变,影像学脑积水缓解程度,囊肿缩小程度,视交叉和脑干恢复情况,导水管开放.结果 全部病例造瘘手术顺利完成,术中观察到导水管开放,术后脑积水症状改善明显,内分泌症状中多饮多尿缓解最明显,影像学检查脑积水缓解,囊肿缩小,视交义位置下降并后移,脑干位置部分恢复,造瘘口和(或)导水管可见脑脊液流动影像,上述指标术前后对比差异有统计学意义.结论 神经内镜囊肿造瘘沟通脑室和囊肿以及囊肿与脑池的手术方式有效地解决了由鞍上池囊肿引起的各类症状,该术式有效且安全.%Objective To investigate the effectiveness and safty of the ventriculocystostomy (VC)combined with cystocisternostomy (CC) in dealing with the suprasellae arachaid cysts (SACs) and secondary hydrocephalus.Methods 15 pediatric patients with SACs and secondary hydrocephalus were admitted into Tianjin Huanhu Hospital during Jan.2008 to Oct.2011.They received operation with neuroendoscopy to make fenestrations to communicate the suprasellar cyst with lateral ventricules and the prepontine cistern named ventriculocystocister nostomy (VCC).The outcomes were analyzed contrastively with several indexes,such as neuroendocrine symptoms improvements,shrinkage of the cyst,replacement of the pontine,optic chiasm and the opening of the Sylvian aqueduct.With the method of MRI-cine,the CSF flowing could be observed at the inferior fistula ora and/or Sylvian aqueduct.Results The operation were achieved and symptoms of hyhrocephalus were released in all patients.Intraoperatively,opening of Sylvian aqueduct was fouud in most of the patients.Among all neuroendocrine symptoms,the diabetes insipidus improved most markedly.The indexes evaluating the effectiveness of the VCC showed remarkably difference between post and pre-operation.Conclusions The procedure of VCC is effective in dealing with the symptoms with few complications and signs derived from the SACs.

  14. Neurocysticercosis: Correlative pathomorphology and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lotz, J.; Hewlett, R.; Alheit, B.; Bowen, R.

    1988-02-01

    CT and MR images of 32 patients with neurocysticercosis were correlated with pathomorphology. Gross morphological features of cystic larvae, complex arachnoid cysts, granulomatous abscesses, basal meningitis and mineralised nodules correlated closely with the images obtained, especially on MR, where resolution permitted visualisation of larval protoscolices. Our material indicates three forms of the natural history of neurocysticercosis related chiefly to anatomic location, and provides details of the evolution of large, complex arachnoid cysts.

  15. Compressive brainstem deformation resulting from subdural hygroma after neurosurgery: a case report

    Institute of Scientific and Technical Information of China (English)

    YU Shu-qing; WANG Ji-sheng; JI Nan

    2008-01-01

    @@ Acute and chronic subdural hygromas are common postoperative clinical complications of ventricular shunting, arachnoid cyst marsupialization and arachnoid cyst resection.1 This article introduces a case of subdural hygroma after resection of a space-occupying lesion in the left lateral ventricle that resulted in compressive brainstem deformation and reviewed the recent related literature. The conclusion is that in related surgical procedures, prevention of rapid cerebrospinal fluid loss and excessive fluctuations in intracranial pressure are especially important.

  16. HIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA) : a randomized single- blind controlled trial of induced hypertension vs. no induced hypertension in the treatment of delayed cerebral ischemia after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Gathier, C. S.; van den Bergh, W. M.; Slooter, A. J. C.

    2014-01-01

    RationaleDelayed cerebral ischemia (DCI) is a major complication after aneurysmal subarachnoid hemorrhage (SAH). One option to treat delayed cerebral ischemia is to use induced hypertension, but its efficacy on the eventual outcome has not been proven in a randomized clinical trial. This article des

  17. 持续腰大池引流术引流与多次腰椎穿刺术引流治疗重型颅脑损伤合并蛛网膜下腔出血%Continuous Lumbar Cistern Drainage and Drainage with Lumbar Puncture and Drainage in the Treatment of Multiple Injury Complicated with Sub-arachnoid Hemorrhage and Severe Craniocerebral

    Institute of Scientific and Technical Information of China (English)

    王伟丰; 杨瑞生; 黄春波

    2015-01-01

    Objective To study the effect of the continuous lumbar cistern drainage and drainage with lumbar puncture and drainage in the treatment of multiple injury complicated with subarachnoid hemorrhage and severe craniocerebral. Methods Se-lected combined subarachnoid hemorrhage in 70 cases as the object of study into the hospital for treatment of severe craniocerebral injury, by using randomly were divided into the observation group and the control group, the control group underwent repeated lumbar puncture drainage treatment, the observation group with continuous lumbar cistern drainage drainage treatment, for Glasgow coma score (GCS), Glasgow Outcome Scale (GOS), recording the cerebrospinal fluid red blood cell count of less than 100í106/L time, observed the rate of complications within 1 month. Results In observation group after treatment, GCS(12.52±1.51)was signifi-cantly lower than that of the control group, CSF erythrocyte<100í106/L time was (7.24±1.53)days, which was significantly shorter than the control group, the difference was statistically significant (P<0.05). Observation of 1 months of epilepsy, hydrocephalus, cerebral infarction group after treatment, the incidence rates were 0%, 5.71%, 2.86%, which were significantly lower than the con-trol group 11.43%, 22.86%, 22.86%, the differences were statistically significant (P<0.05). Good rate was 57.14% in observation group was significantly higher than the control group 31.43%, mortality of 0%was lower than that of the control group 14.29%, the difference was statistically significant (P<0.05). Conclusion Continuous lumbar cistern drainage drainage can shorten the drainage time, reduce the incidence of postoperative complications, which can improve the prognosis of the patients.%目的:探讨持续腰大池引流术引流与多次腰椎穿刺术引流治疗重型颅脑损伤合并蛛网膜下腔出血的效果。方法随机选取入医院治疗的重型颅脑损伤合并蛛网膜下腔出血患者70例作为研究对象,采用数字随机法将患者分为对照组和观察组,对照组行多次腰椎穿刺术引流治疗,观察组采用持续腰大池引流术引流治疗,行格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS),记录脑脊液红细胞计数低于100×106/L的时间,观察术后1个月内并发症发生率。结果观察组治疗后GCS为(12.52±1.51)分显著高于对照组,脑脊液红细胞约100×106/L时间为(7.24±1.53)d显著短于对照组,差异有统计学意义(P<0.05)。观察组治疗后1个月内癫痫、脑积水、脑梗死的发病率分别为0.0%、5.71%、2.86%显著低于对照组11.43%、22.86%、22.86%,差异有统计学意义(P<0.05)。观察组良好率为57.14%明显高于对照组31.43%,死亡率为0.0%明显低于对照组14.29%,差异有统计学意义(P<0.05)。结论持续腰大池引流术引流能够缩短引流时间,降低术后并发症发生率,可改善患者预后。

  18. The analysis of the pathophysiology of syringomyelia by means of magnetic resonance imaging

    International Nuclear Information System (INIS)

    The pathophysiology of syringomyelia was examined with magnetic resonance imaging (MRI) in 70 patients. According to complications, syringomyelia was classified as being associated with (1) Chiari malformation, (2) both Chiari malformation and basal arachnoiditis, (3) basal arachnoiditis, (4) an obstruction of the foramen Magendie, and (5) spinal arachnoiditis. MRI features in Type 1 included: wedge-shaped herniated tonsils with the cisterna magna, pencil-shaped rostral end of the intraspinal syrinx, and obliterated caudal part of the fourth ventricle. These findings suggested that the herniated tonsils might result in the disturbance of cerebro-spinal fluid (CSF) circulation. In Type 2, the tip of the herniated tonsils was round; a triangular space was noted between the herniated tonsils and the upper spinal cord; the rostral end of the intraspinal syrinx was round; and the caudal part of the fourth ventricle was well visualized. These findings revealed that the brain stem and spinal cord were less pressed, suggesting that CSF circulatory disturbance resulted from basal arachnoiditis around the foramen magnum. In Type 3, the cisterna magna was narrowed by a thickened arachnoid membrane. In type 4, the intraspinal syrinx was directly connected with the fourth ventricle via the patent central canal associated with hydrocephalus. The position of the cerebellar tonsils and the size of the cisterna magna were both normal. In Type 5, a partial adhesion of the arachnoid membrane around the spinal cord was shown, and the syrinx was found extended toward the rostral as well as the caudal direction of the arachnoid adhesion. The rostral end of the syrinx was sometimes changed in size during MRI examinatin. This phenomenon sustained William's theory of 'suck and slosh mechanism' of intraspinal syrinx extension. (N.K.)

  19. Syringomyelia caused by intrathecal remnants of oil-based contrast medium.

    Science.gov (United States)

    Kubota, Mayumi; Shin, Masahiro; Taniguchi, Makoto; Terao, Toru; Nakauchi, Jun; Takahashi, Hiroshi

    2008-02-01

    Oily contrast medium had been in use since the early 19th century as a radiographic agent for detecting spinal lesions and spinal cord tumors until the late 20th century. At that point computed tomography scanning and magnetic resonance imaging, or other hydrophilic contrast medium substituted for it. Adverse effects of oil-based dye, both acute and chronic, had been reported since the middle of the 20th century. In this paper the authors report the case of syringomyelia that seemed to be caused mainly by remaining oily contrast medium for 44 years. Syringomyelia secondary to adhesive arachnoiditis caused by oily contrast medium after a long period of time is well known. In the present case, however, surgery revealed only mild arachnoiditis at the level of syringomyelia as well as both solid and liquid remnants of contrast medium. Generally, cerebrospinal fluid (CSF) blockage due to an arachnoid adhesion is considered to cause syringomyelia following adhesive arachnoiditis. The authors speculated that in the present case syringomyelia was induced by a mechanism different from that in the previously reported cases; the oily contrast medium itself seems to have induced the functional block of CSF and impaired the buffer system of the intrathecal pressure. No reports on thoracic adhesive arachnoiditis and syringomyelia caused by oil-based dye referred to this mechanism in reviewing the literature. PMID:18248289

  20. Role of diffusion-weighted MR imaging in discrimination between the intracranial cystic masses

    Directory of Open Access Journals (Sweden)

    Ahmed Farid Yousef

    2014-09-01

    Results and conclusions: Patients in this study were categorized into three main groups; first group is brain abscesses (36 cases, 91.6% of them showed restricted diffusion, second group is malignant cystic or necrotic brain tumors, 28 cases of high grade necrotic glioma, 60.7% of them are free diffusion, and third group is benign cystic masses, arachnoid and epidermiod cysts (11 cases; all arachnoid cysts are free diffusion. From these results diffusion-weighted imaging is playing an important role in discrimination of cystic intracranial masses.

  1. Prenatal diagnosis of Chudley-McCullough syndrome.

    Science.gov (United States)

    Chapman, Teresa; Perez, Francisco A; Ishak, Gisele E; Doherty, Dan

    2016-09-01

    Chudley-McCullough syndrome (CMS) is an autosomal-recessive disorder characterized by a complex brain malformation and profound congenital sensorineural hearing loss. Postnatal brain imaging findings include ventriculomegaly, partial agenesis of corpus callosum, inferior cerebellar dysplasia, arachnoid cysts, and malformations of cortical development including frontal subcortical heterotopia and polymicrogyria. Prenatal diagnosis of CMS is important due to the markedly less severe neurodevelopmental prognosis compared to disorders with similar brain imaging findings. We report prenatal imaging features that help distinguish CMS from other disorders, including slit-like frontal horns, agenesis of the corpus callosum, frontal subcortical heterotopia, arachnoid cysts, and cerebellar dysplasia. © 2016 Wiley Periodicals, Inc. PMID:27312216

  2. In situ staining of the primo vascular system in the ventricles and subarachnoid space of the brain by trypan blue injection into the lateral ventricle

    Institute of Scientific and Technical Information of China (English)

    Jingxing Dai; Byung-Cheon Lee; Ping An; Zhendong Su; Rongmei Qu; Ki Hoon Eom; Kwang-Sup Soh

    2011-01-01

    We examined a new method for visualization of the primo vascular system in the rat brain in-volving lateral ventricle injection of trypan blue. Results showed that the primo vascular system in the lateral ventricles and arachnoid mater of the brain were preferentially stained relative to blood vessels and fascia. The primo-vessels along blood vessels in the brain were clearly ex-hibited. In addition, the primo vascular system was evident between the fourth ventricle and the quadrigeminal cistern. Our experimental findings indicate that this new technique of lateral ventricle injection of trypan blue can visualize the primo vascular system in lateral ventricles and arachnoid mater of rats in situ.

  3. Interstitial deletion of chromosome 4p associated with mild mental retardation, epilepsy and polymicrogyria of the left temporal lobe

    DEFF Research Database (Denmark)

    Møller, R S; Hansen, C P; Jackson, G D;

    2007-01-01

    In this study, we present a 38-year-old woman with an interstitial deletion of 4p15.1-15.3, mild mental retardation, epilepsy and polymicrogyria adjacent to an arachnoid cyst of the left temporal lobe. The deletion was ascertained through array-comparative genome hybridization screening of patien...

  4. Imaging and outcome in severe complications of lumbar epidural anaesthesia: report of 16 cases

    Energy Technology Data Exchange (ETDEWEB)

    Chiapparini, L.; Savoiardo, M. [Department of Neuroradiology, Istituto Nazionale Neurologico, Milano (Italy); Sghirlanzoni, A.; Pareyson, D. [Department of Neurology, Istituto Nazionale Neurologico, Milano (Italy)

    2000-08-01

    We reviewed the clinical and neuroradiological features in 16 patients with serious neurological complications of lumbar epidural anaesthesia. We observed acute, transient or permanent and delayed complications. Four patients had symptoms immediately after the procedure. One patient developed a subacute flaccid paraparesis. Two other patients had infectious spondylodiscitis at lumbar puncture level. Eight patients had a delayed progressive spastic paraparesis and were found to have subarachnoid cysts and irregularities of the surface of the spinal cord consistent with arachnoiditis; six of them had an extensive, complex syrinx within the cord. One patient had a severe lumbar polyradiculopathy, and MRI showed adhesive arachnoiditis involving the cauda equina. Although epidural anaesthesia is generally considered safe, rare but severe complications, such as radiculopathy, infectious disease, myelopathy from ischemia and arachnoiditis with a syrinx may occur. The patients with arachnoiditis had a relentless progression of the disease and a poor outcome: five are confined to a wheelchair, one is bedridden. Complications of epidural anaesthesia are easily recognised when they develop immediately; their relationship to the anaesthesia may be ignored or underestimated when they appear after a delay. Awareness of the possibility of delayed complications is important. (orig.)

  5. Myelopathy due to intrathecal chemotherapy: report of six cases.

    Science.gov (United States)

    Bay, Ali; Oner, Ahmet Faik; Etlik, Omer; Yilmaz, Cahide; Caksen, Huseyin

    2005-05-01

    Intrathecal chemotherapy and systemic chemotherapy are used for both prophylaxis and treatment of central nervous system disease in hematologic malignancies. However, intrathecal treatment has some adverse effects, such as arachnoiditis, progressive myelopathy, and leukoencephalopathy. The authors describe six children in whom myelopathy and adhesive arachnoiditis developed after administration of intrathecal chemotherapy including methotrexate, cytosine arabinoside, and prednisolone. Urinary retention and incontinence, the main presenting complaints in all patients, developed within 12 hours after intrathecal therapy and spontaneously resolved within 7 days. Two patients were unable to walk. In these two, weakness in the lower extremities gradually recovered by 1 month but urinary incontinence did not improve. None of the children had sensory loss. On follow-up periodic recurrent urinary tract infection was noted in four patients. MRI findings corresponded to arachnoiditis. No response was recorded on tibial nerve somatosensory evoked potentials in all patients. Intrathecal chemotherapy, especially methotrexate, can cause spinal cord dysfunction in children with acute lymphoblastic leukemia and non-Hodgkin's lymphoma. Arachnoiditis should be kept in mind as a causative factor in recurrent urinary tract infection in patients receiving intrathecal chemotherapy.

  6. Cysticercose of the central nervous system: II. Spinal cysticercose

    Directory of Open Access Journals (Sweden)

    Benedicto Oscar Colli

    1994-06-01

    Full Text Available The compromising of the spinal canal by cysticercus is considered infrequent, varying from 16 to 20% in relation to the brain involvement. In the spinal canal the cysticercus predominantly places in the subarachnoid space. Clinical signs in spinal cysticercosis can be caused by direct compression of the spinal cord/roots by cisticerci and by local or at distance inflammatory reactions (arachnoiditis. Another mechanism of lesion is degeneration of the spinal cord due to pachymeningitis or circulatory insufficiency. The most frequent clinical features are signs of spinal cord and/or cauda equina compression. The diagnosis of spinal cysticercosis is based on evidence of cerebral cysticercosis and on neuroradiological examinations (myelography and myelo-CT that show signs of arachnoiditis and images of cysts in the subarachnoid space and sometimes, signs of intramedullary lesions, but the confirmation can only be made through immunological reactions in the CSF or during surgery. The clinical course of 10 patients with diagnosis of spinal cysticercosis observed among 182 patients submitted to surgical treatment due to this diasease are analyzed. The clinical pictures in all cases were signs of spinal cord or roots compression. All but two presented previously signs of brain cysticercosis. Neuroradiological examinations showed signs of arachnoiditis in 4 patients, images of cysts in the subarachnoid space in 5, and signs of arachnoiditis and images of cysts in one. The 6 patients that presented intraspinal cysts were submitted to exeresis of the cysts and 2 patients with total blockage of the spinal canal underwent surgery for diagnosis. The 2 remaining patients with arachnoiditis and blockge of the spinal canal were clinically treated. All of the six patients submitted to cyst exeresis had initial improvement but 4 of them later developed arachnoiditis and recurrence of the clinical signs and only 2 remained well for long-term. The 2 non operated

  7. Cervicomedullary neurocysticercosis causing obstructive hydrocephalus.

    Science.gov (United States)

    Wang, Doris D; Huang, Michael C

    2015-09-01

    We present a 45-year-old man with tussive headache and blurred vision found to have obstructive hydrocephalus from a neurocysticercal cyst at the cervicomedullary junction who underwent surgical removal of the cyst. We performed a suboccipital craniectomy to remove the cervicomedullary cyst en bloc. Cyst removal successfully treated the patient's headaches without necessitating permanent cerebrospinal fluid diversion. Neurocysticercosis is the most common parasite infection of the central nervous system causing seizures and, less commonly, hydrocephalus. Intraventricular cysts or arachnoiditis usually cause hydrocephalus in neurocysticercosis but craniocervical junction cysts causing obstructive hydrocephalus are rare. Neurocysticercosis at the craniocervical junction may cause Chiari-like symptoms. In the absence of arachnoiditis and leptomeningeal enhancement, surgical removal of the intact cyst can lead to favorable outcomes.

  8. Spinal leptomeningeal cysticercosis

    International Nuclear Information System (INIS)

    The spinal forms of neurocysticercosis are extremely rare, with a frequency under 1% in large series. The types of involvement are a) subarachnoid cysts and b) intramedullary lesions (less frequent). The authors report the case of a 56-year-old female with central nervous system infection by the larval form of Taenia Solium, which conduced to a hydrocephalus, treated by neurosurgical ventricular-peritoneal shunting. After 2 years, the patient consulted due to paraesthesia, spastic paraparesis and incontinence. MRI showed an homogeneous cystic mass compressing the spinal cord at D5-D6 level. Laminectomies were performed and the arachnoid membrane appeared thickened (arachnoiditis); the larval cyst was removed. Anatomo-pathologic exam revealed a leptomeningeal cysticercosis. The patient had a favorable clinical evolution without spinal compression sings or symptoms. (author)

  9. The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

    Directory of Open Access Journals (Sweden)

    Eduardo A. S. Vellutini

    2014-12-01

    Full Text Available The classical surgical technique for the resection of vestibular schwannomas (VS has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.

  10. Intraventricular racemose type neurocysticercosis with anterior interhemispheric fissure cyst: A rare case report

    Directory of Open Access Journals (Sweden)

    Pankaj Gupta

    2015-01-01

    Full Text Available Racemose type of neurocysticercosis (NCC is a rare form of parasitic infestation of central nervous system. Most commonly it is found in fourth ventricle and cisterns. On reviewing the PubMed and Google databases, we found that this would be the first reported case of racemose type NCC in occipital horn of lateral ventricle with obstructive hydrocephalus, along with an incidental interhemispheric fissure arachnoid cyst.

  11. A role for myelography in assessing paraparesis.

    LENUS (Irish Health Repository)

    Merwick, A

    2012-02-03

    Imaging of the spine is a fundamental part of assessment of paraparesis. Since the advent of MRI the indications for myelograms have diminished. However, a myelogram, although an invasive test, should still be considered a useful investigation for localising lesions in the spinal cord and for identifying rare causes of myelopathy. This case illustrates how a CT myelogram identified an arachnoid cyst, which is a potentially treatable cause of paraparesis.

  12. Usage of innovative precipitating liquid embolics for the endovascular occlusion of broadbased intracranial aneurysms

    OpenAIRE

    Tesmer, Kai

    2011-01-01

    Intracranial aneurysms do not usually become clinically apparent before their rupture. This medical emergency is connected with high morbidity and mortality. An aneurysm rupture is typically accompanied by a subarachnoid haemorrhage (SAH) as bleeding in the external CSF spaces between the arachnoid und pia mater. The primary aim when treating a patient with aneurismal SAH is the speedy elimination of the ruptured aneurysm in order to prevent an often fatal recurrence of the haemorrhaging. In ...

  13. A pituitary abscess masquerading as recurrent hypernatremia and aseptic meningitis

    OpenAIRE

    Gonzales, Michael; Marik, Paul Ellis; Khardori, Romesh K.; O'Brian, John T

    2012-01-01

    Pituitary abscess is a rare condition. In the setting of multiple surgical interventions, the risk of its development increases. A 49-year-old man presented with episodes of altered mental status. He had two surgeries for a recurrent suprasellar arachnoid cyst. The second surgery was complicated by a persistent cerebrospinal fluid (CSF) leak that required two repairs following which he developed panhypopituitarism and central diabetes insipidus. Twelve months after his last surgery he was dia...

  14. Antioxidants: The new frontier for translational research in cerebroprotection

    OpenAIRE

    Anurag Tewari; Vidhi Mahendru; Ashish Sinha; Federico Bilotta

    2014-01-01

    It is important for the anesthesiologist to understand the etiology of free radical damage and how free-radical scavengers attenuate this, so that this knowledge can be applied to diverse neuro-pathological conditions. This review will concentrate on the role of reactive species of oxygen in the pathophysiology of organ dysfunction, specifically sub arachnoid hemorrhage (SAH), traumatic brain injury (TBI) as well as global central nervous system (CNS) hypoxic, ischemic and reperfusion states....

  15. MR IMAGING OF MENINGEAL CARCINOMATOSIS BY SYSTEMIC MALIGNANCY

    Institute of Scientific and Technical Information of China (English)

    马林; 于生元; 蔡幼铨; 梁丽; 郭行高

    2003-01-01

    Objective.To investigate the magnetic resonance(MR)features of meningeal carcinomatosis,and to improve the ability in understanding and diagnosing meningeal carcinomatosis by MR findings. Methods. Eleven cases with proven meningeal carcinomatosis were studied by conventional and Gd-DTPA enhanced MR imaging. The enhancement patterns and features,as well as the types of meningeal involvement,were retrospectively analyzed. Results. Conventional MR imaging showed no evident meningeal abnormalities. After the administration of Gd-DTPA,abnormal pia mater enhancement was detected in 9 cases,demonstrating as the continuous,thin,and lineal high signal intensity on the brain surface that could descend into the sulci. The abnormal pial enhancement occurred on the cortical surfaces of cerebellum,brainstem,and cerebrum. No abnormal enhancement in the subarach-noid space was found. Abnormal dura-arachnoid enhancement was seen in 3 cases,showing as the continuous,thick,and curvilineal high signal intensity over the convexities or in the tentorium without extension into the cortical sulci. Cerebral dura-arachnoid involvement was found in all 3 cases and one of them also showed abnormal enhancement in cerebellar dura-arachnoid and tentorium. Of the 11 cases,9 with pial involvement had abnormal cerebrospinal fluid(CSF)results,2 involving only the dura-arachnoid had normal CSF results. Conclusion. Meningeal carcinomatosis could be well demonstrated by Gd-DTPA enhanced MR imaging,and its type could be differentiated by the enhancement features. Combined with the clinical information,Gd-enhanced MR imaging may lead to the diagnosis and guide the therapy of meningeal carcinomatosis.

  16. Asuhan Keperawatan pada An. K dengan Prioritas Masalah Defisit Perawatan Diri di RSUD. dr.Pirngadi Medan

    OpenAIRE

    Batubara, Julianti

    2015-01-01

    Meningitis adalah radang dari selaput otak (arachnoid dan piamater). Bakteri dan virus merupakan penyebab utama dari meningitis. Meningitis disebabkan oleh berbagai macam organisme, tetapi kebanyakan pasien dengan meningitis mempunyai faktor predisposisi seperti fraktur tulang tengkorak, infeksi, operasi otak atau sum-sum tulang belakang. Seperti disebutkan di atas bahwa meningitis itu disebabkan oleh virus dan bakteri, maka meningitis dibagi menjadi dua bagian besar yaitu : meningitis purule...

  17. Arterial compression of nerve is the primary cause of trigeminal neuralgia

    OpenAIRE

    Chen, Guo-Qiang; Wang, Xiao-Song; Wang, Lin; Zheng, Jia-ping

    2013-01-01

    Whether arterial or venous compression or arachnoid adhesions are primarily responsible for compression of the trigeminal nerve in patients with trigeminal neuralgia is unclear. The aim of this study was to determine the causes of trigeminal nerve compression in patients with trigeminal neuralgia. The surgical findings in patients with trigeminal neuralgia who were treated by micro vascular decompression were compared to those in patients with hemifacial spasm without any signs or symptoms of...

  18. Imaging of brain tumors

    International Nuclear Information System (INIS)

    The contents are diagnostic approaches, general features of tumors -hydrocephalus, edema, attenuation and/or intensity value, hemorrhage, fat, contrast enhancement, intra-axial supratentorial tumors - tumors of glial origin, oligodendrogliomas, ependymomas, subependymomas, subependymal giant cell astrocytomas, choroid plexus papilloma; midline tumors - colloid cysts, craniopharyngiomas; pineal region tumors and miscellaneous tumors i.e. primary intracerebral lymphoma, primitive neuroectodermal tumors, hemangioblastomas; extraaxial tumors - meningiomas; nerve sheath tumors -schwannomas, epidermoids, dermoids, lipomas, arachnoid cysts; metastatic tumors (8 refs.)

  19. Spinal cysticercosis

    International Nuclear Information System (INIS)

    Spinal cysticercosis is an extremely uncommon condition. We have examined four patients with complaints that resembled nervous root compression by disk herniation. Myelography was shown to be an efficient method to evaluate spinal involvement, that was characterized by findings of multiple filling defect images (cysts) plus signs of adhesive arachnoiditis. One cyst was found to be mobile. Because of the recent development of medical treatment, a quick and precise diagnosis is of high importance to determine the prognosis of this condition. (author)

  20. Hydrocephalus, skeletal anomalies, and mental disturbances in a mother and three daughters: A new syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ferlini, A.; Zanetti, A.; Milan, M.; Calzolari, E. [Universita di Ferrara, London (United Kingdom)] [and others

    1995-12-04

    We report on a family in which a mother and her 3 daughters have delayed psychomotor development and/or psychosis, hydrocephalus with white matter alterations, arachnoid cysts, skeletal anomalies consisting of brachydactyly, and Sprengel anomaly. Biochemical and cytogenetic analyses were normal on all 4 patients. The pattern of inheritance, clinical manifestations, and variability of expression suggest that this is a new hydrocephalus syndrome possibly transmitted as an X-linked dominant trait. 24 refs., 6 figs., 1 tab.

  1. [Restorative electric stimulation of the optic nerve in patients with diseases of the chiasmal-sellar area].

    Science.gov (United States)

    Khi'lko, V A; Gaĭdar, B V; Lyskov, E B; Kondra'teva, M I; Niko'lskaia, I M

    1989-01-01

    Presented is the clinical experience with vision restitution by direct electrostimulation (ES) of lesioned visual nerves in 128 operated patients with chiasmal-sellar diseases (chiasmal-sellar tumors and optico-chiasmatic arachnoiditis). Comparative analysis of ES-treated and control group was performed. Indications for this technique were determined in different forms of the disease depending on its severity and duration. ES showed positive results increasing the reliability and speed of vision restitution in operated patients.

  2. Intracranial Hypotension Syndrome, Diagnosis and Treatment in Radiology Clinics

    OpenAIRE

    Albayram, S

    2005-01-01

    Introduction & Background: Only 12 years ago the first report on pachymeningeal gadolinium enhance-ment in low-pressure headaches appeared in the lit-erature. Intracranial hypotension is a result of low CSF volume caused by either spontaneous or postoperative leakage. The syndrome has been reported to occur after head trauma, a tear in a spinal nerve root sheath, perineural cyst, or spinal arachnoid diverticulum. Iatrogenic causes include lumbar puncture or overdraining ventricular or spi...

  3. Differentially Expressed MicroRNAs in Meningiomas Grades I and II Suggest Shared Biomarkers with Malignant Tumors

    Directory of Open Access Journals (Sweden)

    Mohamed Raafat El-Gewely

    2016-03-01

    Full Text Available Meningiomas represent the most common primary tumors of the central nervous system, but few microRNA (miRNA profiling studies have been reported so far. Deep sequencing of small RNA libraries generated from two human meningioma biopsies WHO grades I (benign and II (atypical were compared to excess dura controls. Nineteen differentially expressed miRNAs were validated by RT-qPCR using tumor RNA from 15 patients and 5 meninges controls. Tumor suppressor miR-218 and miR-34a were upregulated relative to normal controls, however, miR-143, miR-193b, miR-451 and oncogenic miR-21 were all downregulated. From 10 selected putative mRNA targets tested by RT-qPCR only four were differentially expressed relative to normal controls. PTEN and E-cadherin (CDH1 were upregulated, but RUNX1T1 was downregulated. Proliferation biomarker p63 was upregulated with nuclear localization, but not detected in most normal arachnoid tissues. Immunoreactivity of E-cadherin was detected in the outermost layer of normal arachnoids, but was expressed throughout the tumors. Nuclear Cyclin D1 expression was positive in all studied meningiomas, while its expression in arachnoid was limited to a few trabecular cells. Meningiomas of grades I and II appear to share biomarkers with malignant tumors, but with some additional tumor suppressor biomarkers expression. Validation in more patients is of importance.

  4. Non-schwannomatosis lesions of the internal acoustic meatus-a diagnostic challenge and management: a series report of nine cases.

    Science.gov (United States)

    Moura da Silva, Luis Fernando; Buffon, Viviane Aline; Coelho Neto, Maurício; Ramina, Ricardo

    2015-10-01

    Vestibular schwannomas (VS) are the most common lesions of cerebellopontine angle (CPA) corresponding to 76-91 % of the cases. Usually, these lesions present typical CT and MRI findings. Non-schwannomatous tumors restricted to the internal auditory meatus (IAM) are rare and their preoperative radiological diagnosis may be difficult. This article describes nine surgically treated intrameatal non-schwannomatous lesions (NSL) and reviews the literature. In the last 16 years, a total of 471 patients with diagnosis of VS were operated on in our department. Preoperatively, 42 patients had diagnosis of intrameatal schwannomas, but surgery revealed in nine cases NSL (3 meningiomas, 3 arachnoiditis/neuritis, 1 cavernoma, 1 vascular loop, and 1 arachnoid cyst). Most frequent symptoms presented by patients with NSL were hearing loss 89 % (8/9) of patients, tinnitus 78 % (7/9), and vertigo 33 % (3/9). Almost all lesions (8/9) presented MRI findings of isointense signal in T1W with contrast enhancement. The only exception was the arachnoid cyst with intracystic bleeding, which was hyperintense in T1W that is not enhanced with contrast. This series shows an occurrence of 21.4 % of non-schwannomatous tumors in 42 cases of lesions restricted to the IAM. Whenever a solely intrameatal enhanced tumor is detected, it is necessary to think about other diagnostic possibilities rather than VS. Therapeutic management may be changed, specially if radiosurgical treatment is considered. PMID:25957055

  5. Direct communication of the spinal subarachnoid space with the rat dorsal root ganglia.

    Science.gov (United States)

    Joukal, Marek; Klusáková, Ilona; Dubový, Petr

    2016-05-01

    The anatomical position of the subarachnoid space (SAS) in relation to dorsal root ganglia (DRG) and penetration of tracer from the SAS into DRG were investigated. We used intrathecal injection of methylene blue to visualize the anatomical position of the SAS in relation to DRG and immunostaining of dipeptidyl peptidase IV (DPP-IV) for detecting arachnoid limiting the SAS. Intrathecal administration of fluorescent-conjugated dextran (fluoro-emerald; FE) was used to demonstrate direct communication between the SAS and DRG. Intrathecal injection of methylene blue and DPP-IV immunostaining revealed that SAS delimited by the arachnoid was extended up to the capsule of DRG in a fold-like recess that may reach approximately half of the DRG length. The arachnoid was found in direct contact to the neuronal body-rich area in the angle between dorsal root and DRG as well as between spinal nerve roots at DRG. Particles of FE were found in the cells of DRG capsule, satellite glial cells, interstitial space, as well as in small and medium-sized neurons after intrathecal injection. Penetration of FE from the SAS into the DRG induced an immune reaction expressed by colocalization of FE and immunofluorescence indicating antigen-presenting cells (MHC-II+), activated (ED1+) and resident (ED2+) macrophages, and activation of satellite glial cells (GFAP+). Penetration of lumbar-injected FE into the cervical DRG was greater than that into the lumbar DRG after intrathecal injection of FE into the cisterna magna. Our results demonstrate direct communication between DRG and cerebrospinal fluid in the SAS that can create another pathway for possible propagation of inflammatory and signaling molecules from DRG primary affected by peripheral nerve injury into DRG of remote spinal segments. PMID:26844624

  6. [Image-guided stereotaxic biopsy of central nervous system lesions].

    Science.gov (United States)

    Nasser, J A; Confort, C I; Ferraz, A; Esperança, J C; Duarte, F

    1998-06-01

    In a series of 44 image guided stereotactic biopsy from August 1995 until March 1997, findings were as follows (frequency order). Tumors, glioblastoma was the most frequent. Primary lymphoma and other conditions associated to AIDS. Metastasis, three cases, Vasculites, two cases, Arachnoid cyst, Creutzfeldt-Jakob, cortical degeneration, inespecific calcification (one case each). The age varied from 1 to 83 years. Forty one lesions were supratentorial, two infratentorial, and one was outside the brain (dura and skull) and we used stereotaxy to localize it. There was no mortality and morbidity was 2.3%. The literature is reviewed. We conclude that this procedure is safe and highly diagnostic. PMID:9698729

  7. [Deafness and sarcoidosis].

    Science.gov (United States)

    Moine, A; Frachet, B; Van Den Abbeele, T; Tison, P; Battesti, J P

    1990-01-01

    The cochleovestibular tract is seldom involved by sarcoidosis (about 50 cases have been described since 1948). As a clinical expression of sarcoidosis, deafness is fluctuant in 50% of all cases, bilateral, and most often associated with facial palsy and uveitis, the vestibular reflexes being reduced. The histological studies demonstrate lesions at all levels from the cochlea to be brain stem, but the main mechanism is an infiltration of the arachnoid vessels. The prognosis of sarcoidosis deafness is usually poor in spite of corticosteroid therapy. This paper is illustrated by 3 cases observed in Avicenne Hospital.

  8. Pathology of the vestibulocochlear nerve

    Energy Technology Data Exchange (ETDEWEB)

    De Foer, Bert [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: bert.defoer@GZA.be; Kenis, Christoph [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: christophkenis@hotmail.com; Van Melkebeke, Deborah [Department of Neurology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Deborah.vanmelkebeke@Ugent.be; Vercruysse, Jean-Philippe [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: jphver@yahoo.com; Somers, Thomas [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Thomas.somers@GZA.be; Pouillon, Marc [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: marc.pouillon@GZA.be; Offeciers, Erwin [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Erwin.offeciers@GZA.be; Casselman, Jan W. [Department of Radiology, AZ Sint-Jan AV Hospital, Ruddershove 10, Bruges (Belgium); Consultant Radiologist, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium); Academic Consultent, University of Ghent (Belgium)], E-mail: jan.casselman@azbrugge.be

    2010-05-15

    There is a large scala of pathology affecting the vestibulocochlear nerve. Magnetic resonance imaging is the method of choice for the investigation of pathology of the vestibulocochlear nerve. Congenital pathology mainly consists of agenesis or hypoplasia of the vestibulocochlear nerve. Tumoral pathology affecting the vestibulocochlear nerve is most frequently located in the internal auditory canal or cerebellopontine angle. Schwannoma of the vestibulocochlear nerve is the most frequently found tumoral lesion followed by meningeoma, arachnoid cyst and epidermoid cyst. The most frequently encountered pathologies as well as some more rare entities are discussed in this chapter.

  9. Acute respiratory failure after endoscopic third ventriculostomy: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Essam A Elgamal

    2012-01-01

    Full Text Available Endoscopic third ventriculostomy (ETV is a relatively safe procedure. However, postoperative acute respiratory failure may be fatal. The authors report an 8-month-old patient with obstructive hydrocephalus secondary to posterior fossa cyst, and Chiari malformation. After ETV he developed difficulty in breathing, and had to be reintubated and ventilated. The infant recovered fully after craniocervical decompression and insertion of cystoperitoneal shunt. We speculate that respiratory failure is related to relative expansion of the posterior fossa arachnoid cyst, causing significant compression on the brain stem. Supportive care with mechanical ventilation and brain stem decompression were the mainstay of treatment.

  10. A rare case of Langerhans cell histiocytosis of the skull in an adult: a systematic review

    Directory of Open Access Journals (Sweden)

    Corinna Chiong

    2013-07-01

    Full Text Available We report a 41-year old male who presented to the Emergency Department after falling while water-skiing. He had a previous medical history included chronic headaches, which had persisted for the last 2-3 months prior to presentation. Computed tomography of the head showed a small hypersensitivity with a small extra axial collection with a maximum thickness of 1 mm. Differential diagnoses included an arachnoid cyst, haemangioma, meningioma or a secondary lesion. A diagnosis of Langerhans Cell Histiocytosis was made based on the histopathology examination and the immunoperoxidase staining.

  11. Diffusion-weighted MR imaging (DWI) in two intradural spinal epidermoid cysts

    Energy Technology Data Exchange (ETDEWEB)

    Thurnher, Majda M. [Medical University of Vienna, Vienna (Austria)

    2012-11-15

    Epidermoid cysts are rare, benign, congenital, slow-growing inclusion cysts. On T1 and T2 weighted NMR images epidermoid cysts show heterogeneity and lack of contrast enhancement. Based on signal intensities on conventional sequences, epidermoid cysts cannot be distinguished from other neoplastic lesions. When located in the spinal cord, differential diagnosis includes ependymoma, astrocytoma, cavernoma and metastasis. Diffusion-weighted imaging (DWI) has been shown to accurately distinguish intracranial epidermoid tumors from arachnoid cysts. DWI findings in two patients with surgically proven epidermoid cysts in the spinal canal are reported.

  12. Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele

    Directory of Open Access Journals (Sweden)

    Santiago Portillo

    2014-01-01

    Full Text Available In Argentina there is national program for fortifying flour with folic acid. Prenatal diagnosis is not always accurate. Closure according to standard technique. We close muscle layer. We don × t favor corpectomy for kyphosis. We suture the placode to restore cylinder shape of the cord. We close muscle layer. Hydrocephalus: V-P shunt. Third ventriculostomy is not effective. Chiari II: Cervical laminectomy. Syringomyelia: We shunt the syrinx to the peritoneum. MMCL is the most common neural tube defect. It consists of a neural placode exposed to environment. The placode is surrounded by arachnoid and by thin epithelial tissue.

  13. Global scale concentrations of volcanic activity on Venus: A summary of three 23rd Lunar and Planetary Science Conference abstracts. 1: Venus volcanism: Global distribution and classification from Magellan data. 2: A major global-scale concentration of volcanic activity in the Beta-Atla-Themis region of Venus. 3: Two global concentrations of volcanism on Venus: Geologic associations and implications for global pattern of upwelling and downwelling

    Science.gov (United States)

    Crumpler, L. S.; Aubele, Jayne C.; Head, James W.; Guest, J.; Saunders, R. S.

    1992-01-01

    As part of the analysis of data from the Magellan Mission, we have compiled a global survey of the location, dimensions, and subsidiary notes of all identified volcanic features on Venus. More than 90 percent of the surface area was examined and the final catalog comprehensively identifies 1548 individual volcanic features larger than approximately 20 km in diameter. Volcanic features included are large volcanoes, intermediate volcanoes, fields of small shield volcanoes, calderas, large lava channels, and lava floods as well as unusual features first noted on Venus such as coronae, arachnoids, and novae.

  14. Obstetrical brachial plexus injuries: a MRI diagnostic approach

    International Nuclear Information System (INIS)

    Purpose: To demonstrate the utility of Magnetic Resonance (MR) imaging in the evaluation of the obstetric injuries of the brachial plexus. Material and methods: 23 patients with semiology of brachial plexus palsy have been evaluated with high field MR. Patients were evaluated with a brain coil in axial, oblique coronal and sagittal planes with T1, T2 and STIR sequences. Results: In four patients (17%) the study was normal. In 19 patients (83%) we got pathological findings (pseudomeningoceles, neuromas, tumour and arachnoid cyst). Conclusion: The MR is a non-invasive method that permits to determinate the site and range of the brachial plexus damage, allowing to plan therapy. (author)

  15. Post-traumatic cerebrospinal fluid fistula: a case report; Fistula liquorica pos-traumatica - relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Tamburus, Wander Miguel; Figueiredo Wanderley, Eliana Christina; Maciel, Damacio Ramon Kaimen; Narciso, Avelino Jose Soares; Sendenski, Mauricio Michalak [Universidade Estadual de Londrina, PR (Brazil). Centro de Ciencias da Saude

    1996-10-01

    Fronto-basal fracture occurs in around 5% of cranioencephalic trauma. the involved structures are: arachnoid, dura-mater, osseous base and the mucosa, and there us contact between the brain and the environment. Even with rupture of all these structures cerebrospinal fluid leakage may not occur; regardless of this, there may be infectious complications, such as bacterial meningitis or brain abscess. the authors report the case of a patient with head injury and four bacterial meningitis, the diagnosis of post-traumatic liquoric fistula being made only through magnetic resonance imaging. (author) 10 refs., 1 fig.

  16. Cysts of the central nervous system : a clinicopathologic study of 145 cases.

    Directory of Open Access Journals (Sweden)

    Sundaram C

    2001-07-01

    Full Text Available Non-neoplastic, non-inflammatory cysts of the central nervous system may cause symptoms because of pressure, rupture or secondary inflammation. A total of 145 cases of cysts were reviewed during a study period of 12 years. The clinical details and histological features were noted in all cases. During this period 53 epidermoid cysts, 16 dermoid cysts, 38 colloid cysts, 23 arachnoid cysts, 5 neurenteric cysts, 5 ependymal and glial cysts, 2 Rathke′s cleft cysts and 3 unclassified cysts were encountered. The possible histogenesis is also discussed.

  17. [Studies of the epidermal pattern system of the palms and soles of the howler monkeys (Alouatta) (author's transl)].

    Science.gov (United States)

    Brehme, H; Newell-Morris, L

    1981-01-01

    The epidermal pattern frequencies and pattern intensity values of the palms and soles are described for 110 male and 80 female howler monkeys (genus Alouatta) including the species A. belzebul, A. seniculus, A. caraya and A. villosa. Interspecific comparisons are made and obvious sex and side differences are noted. The plantar surface tends to show greater interspecific variability than does the palmar surface. A. caraya is possibly the most divergent species of the genus. Comparison of the results with those for Ateles and Lagothrix confirms the aberrant position of Ateles arachnoides. PMID:7319428

  18. Neurological Fallacies Leading to Malpractice: A Case Studies Approach.

    Science.gov (United States)

    Johnston, James C; Wester, Knut; Sartwelle, Thomas P

    2016-08-01

    A young woman presents with an intracranial arachnoid cyst. Another is diagnosed with migraine headache. An elderly man awakens with a stroke. And a baby delivered vaginally after 2 hours of questionable electronic fetal monitoring patterns grows up to have cerebral palsy. These seemingly disparate cases share a common underlying theme: medical myths. Myths that may lead not only to misdiagnosis and treatment harms but to seemingly never-ending medical malpractice lawsuits, potentially culminating in a settlement or judgment against an unsuspecting neurologist. This article provides a case studies approach exposing the fallacies and highlighting proper management of these common neurologic presentations.

  19. [The results of direct electrostimulation of the involved optic nerves in neurosurgical patients].

    Science.gov (United States)

    Khil'ko, V A; Gaĭdar, B V; Kondrat'eva, M I; Nikol'skaia, I M; Usanov, E I

    1989-01-01

    The article generalizes experience in the restoration of vision by direct stimulation of damaged optic nerves after operations for pathological conditions of the chiasmal-sellar region (tumors of the chiasmal-sellar region, optochiasmic arachnoiditis, damage of the optic nerve in the bone canal) in 111 patients. The therapeutic effect was favourable in two thirds of the patients. Indications are determined for the use of the method in various types, duration, and severity of the disease. The use of the method with due regard for the determined indications increases the reliability, degree, and rate of restoration of vision in patients who underwent operation.

  20. [Image-guided stereotaxic biopsy of central nervous system lesions].

    Science.gov (United States)

    Nasser, J A; Confort, C I; Ferraz, A; Esperança, J C; Duarte, F

    1998-06-01

    In a series of 44 image guided stereotactic biopsy from August 1995 until March 1997, findings were as follows (frequency order). Tumors, glioblastoma was the most frequent. Primary lymphoma and other conditions associated to AIDS. Metastasis, three cases, Vasculites, two cases, Arachnoid cyst, Creutzfeldt-Jakob, cortical degeneration, inespecific calcification (one case each). The age varied from 1 to 83 years. Forty one lesions were supratentorial, two infratentorial, and one was outside the brain (dura and skull) and we used stereotaxy to localize it. There was no mortality and morbidity was 2.3%. The literature is reviewed. We conclude that this procedure is safe and highly diagnostic.

  1. Abnormal origin of the ophthalmic artery from the anterior cerebral artery: Neuroradiological and intraoperative findings

    International Nuclear Information System (INIS)

    A 7-year old male child with an abnormal ophthalmic artery arising from the A1 segment of the anterior cerebral artery is described. The patient suffered growth inhibition which was thought to be caused by a craniobasal cystic lesion affecting the hypothalamus. Preoperative angiograms revealed no vascular abnormalities. The right ophthalmic artery, however, could not be identified. During resection of a large arachnoid cyst the ophthalmic artery was found to arise from the A1 segment of the anterior cerebral artery. To the best of our knowledge, this exact anomaly has not previously been reported. The clinical, neuroradiological and intraoperative findings are presented. (orig.)

  2. Symptomatic surgically treated non-neoplastic cysts of the central nervous system: a clinicopathological study from pakistan

    International Nuclear Information System (INIS)

    To report clinicopathologic features of symptomatic surgically removed non-neoplastic cysts of the central nervous system (CNS). Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2003 to 2012. Methodology: All non-neoplastic CNS cysts reported during the study period were retrieved and reviewed. Age, gender, location, histologic type and clinical features were noted. Results: A total of 124 cysts were diagnosed in the study period. These included 44 epidermoid cysts (mean age 30.5 ± 13.8 years), 35 colloid cysts (mean age 31 ± 13.2 years), 32 arachnoid cysts (mean age 24.8 ± 20.2 years), 6 dermoid cysts, 3 enterogenous cysts and Rathke's cleft cysts each and 1 ependymal cyst. All cyst types mainly presented in young adults in both genders with signs and symptoms of a mass lesion. Conclusion: Non-neoplastic cyst mainly presented like a CNS mass lesion in young adults. Epidermoids were the most common type of these cysts in the present series followed by the colloid and the arachnoid cysts. (author)

  3. Microscopic Posterior Transdural Resection of Cervical Retro-Odontoid Pseudotumors.

    Science.gov (United States)

    Fujiwara, Yasushi; Manabe, Hideki; Sumida, Tadayoshi; Tanaka, Nobuhiro; Hamasaki, Takahiko

    2015-12-01

    Retro-odontoid pseudotumors are noninflammatory masses formed posterior to the odontoid process. Because of their anatomy, the optimal surgical approach for resecting pseudotumors is controversial. Conventionally, 3 approaches are used: the anterior transoral approach, the lateral approach, and the posterior extradural approach; however, each approach has its limitations. The posterior extradural approach is the most common; however, it remains challenging due to severe epidural veins. Although regression of pseudotumors after fusion surgery has been reported, direct decompression and a pathologic diagnosis are ideal when the pseudotumor is large. We therefore developed a new microscopic surgical technique; transdural resection. After C1 laminectomy, the dorsal and ventral dura was incised while preserving the arachnoid. Removal of the pseudotumor was performed and both of the dura were repaired. The patient's clinical symptoms subsequently improved and the pathologic findings showed degenerative fibrocartilaginous tissue. In addition, no neurological deterioration, central spinal fluid leakage, or arachnoiditis was observed. Currently, the usefulness of the transdural approach has been reported for cervical and thoracic disk herniation. According to our results, the transdural approach is recommended for resection of retro-odontoid pseudotumors because it enables direct decompression of the spinal cord and a pathologic diagnosis. PMID:26544168

  4. Sudden cardiac arrest in a patient with epilepsy induced by chronic inflammation on the cerebral surface

    Institute of Scientific and Technical Information of China (English)

    Yuxi Liu; Weicheng Hao; Xiaoming Yang; Yimin Wang; Yu Su

    2012-01-01

    The present study analyzed a patient with epilepsy due to chronic inflammation on the cerebral surface underwent sudden cardiac arrest. Paradoxical brain discharge, which occurred prior to epileptic seizures, induced a sudden cardiac arrest. However, when the focal brain pressure was relieved, cardiac arrest disappeared. A 27-year-old male patient underwent pre-surgical video-electroencephalogram monitoring for 160 hours. During monitoring, secondary tonic-clonic seizures occurred five times. A burst of paradoxical brain discharges occurred at 2-19 seconds (mean 8 seconds) prior to epileptic seizures. After 2-3 seconds, sudden cardiac arrest occurred and lasted for 12-22 seconds (average 16 seconds). The heart rate subsequently returned to a normal rate. Results revealed arachnoid pachymenia and adhesions, as well as mucus on the focal cerebral surface, combined with poor circulation and increased pressure. Intracranial electrodes were placed using surgical methods. Following removal of the arachnoid adhesions and mucus on the local cerebral surface, paradoxical brain discharge and epileptic seizures occurred three times, but sudden cardiac arrest was not recorded during 150-hour monitoring. Post-surgical histological examination indicated meningitis. Experimental findings suggested that paradoxical brain discharge led to cardiac arrest instead of epileptic seizures; the insult was associated with chronic inflammation on the cerebral surface, which subsequently led to hypertension and poor blood circulation in focal cerebral areas.

  5. Large/giant meningiomas of posterior third ventricular region: Falcotentorial or velum interpositum?

    Directory of Open Access Journals (Sweden)

    Sanjay Behari

    2014-01-01

    Full Text Available Surgical excision of rare, large-to-giant posterior third ventricular (PTV meningiomas [including velum-interpositum meningiomas (VIM; postero-superior venous complex displacement; without falco-tentorial attachment and falco-tentorial meningiomas (FTM; falco-tentorial attachment; displacing major veins antero-inferiorly] is extremely challenging. To study the management nuances in the excision of large-to-giant PTV meningiomas. Tertiary care referral center. Four patients with large (>3 cm; n = 2 and giant (>5 cm; n = 2 meningiomas (FTM = 2; VIM = 2, mean tumor size = 4.9 cm underwent occipital transtentorial approach (OTT for tumor excision. One also underwent a second-stage supracerebellar infratentorial (SCIT approach. The side of approach was determined by lateral tumor extension and venous displacement (right = 3, left = 1. Near-total removal or subtotal excision (<10% remaining with radiotherapy was performed in 2 patients each, respectively. At follow-up (mean: 14.75 months, clinical improvement without tumor recurrence/re-growth was achieved. Extent of excision was determined by position of great vein of Galen; tumor attachment to falco-tentorium or major veins; its consistency; its lateral and inferior extent; and, presence of a good tumor-neuraxial arachnoidal plane. OTT is the preferable approach for large-to-giant meningiomas as it provides a wider corridor and better delineation of tumor-neurovascular arachnoidal interface.

  6. Microsurgical cerebral aneurysm training porcine model

    Directory of Open Access Journals (Sweden)

    Jon Olabe

    2011-01-01

    Full Text Available The authors developed a simple reproducible technique for aneurysm creation and adapted it to mimic intracranial dissection conditions using glue application as a pseudo-arachnoid type layer. Ten 1-2-month-old healthy domestic swine were employed under general anesthesia. A novel technique for bifurcation aneurysm creation was developed using two arteries and a vein. After aneurysm creation, diluted sulfuric acid was applied on the dome with a micropipette to increase aneurysm fragility in selected zones. The surgical field was then dried and contact glue was applied around the vascular complex in a circular manner so as to emulate arachnoidal connection fibers. Microsurgical dissection of the aneurysm and surrounding vessels was performed by delicately removing the adhesive substance. Diverse aneurysm clipping techniques, emergency rupture situations and vascular reconstruction procedures were trained. Twenty-two aneurysms were created at several vascular sites, one aneurysm dome ruptured during application of sulfuric acid, two aneurysm models were proved to be thrombosed, two aneurysms ruptured during the dissection and no intraoperative deaths occurred. All aneurysms were clipped in an acceptable manner. This bifurcation aneurysm model provides a novel training system to be used not only by neurosurgeons but also by neurovascular interventionists.

  7. MRI of intraspinal cysticercosis

    International Nuclear Information System (INIS)

    To describe the MR features of intraspinal cysticercosis. Medical records and MR images of four cases of intraspinal cysticercosis were retrospectively reviewed. The MR findings were described with regard to the location and signal intensity of the lesions, contrast enhancement, presence or absence of associated intracranial cysticerci, and other findings. There were three cases of subarachnoidal form and one case of intramedullary form. Cysticerci of subarachnoidal form in three cases were located in retromedullary space at C2 level, anterior to cord at C1-C6 levels, and lumbosacral area, respectively. The signal intensities of the lesions were same as those of CSF. Localized arachnoidal enhancement was found in all three cases. In one case there was a large area of high signal intensity within the spinal cord on T2-weighted image suggesting either ischemia secondary to vascular compromise or inflammatory edema. All of these three cases accompanied intracranial cysticercosis. Intramedullary cysticercosis in one case was shown as a single 1 cm cystic lesion at C2 level, which showed hypointense signal on T1-weighted image, hyperintense signal on T2-weighted image, and signet-ring-like enhancement. This lesion did not accompany intracranial cysticerci. Intraspinal cysticercosis manifested as single or multiple cysts within either spinal cord or subarachnoid space, and were frequently associated with arachnoiditis

  8. MRI of intraspinal cysticercosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Cheol; Chang, Kee Hyun; Han, Moon Hee; Han, Gi Seok [Seoul Natioal University College of Medicine, Seoul (Korea, Republic of); Hwang, Hee Young [Chung Ang Gil Hospital, Incheon (Korea, Republic of)

    1995-01-15

    To describe the MR features of intraspinal cysticercosis. Medical records and MR images of four cases of intraspinal cysticercosis were retrospectively reviewed. The MR findings were described with regard to the location and signal intensity of the lesions, contrast enhancement, presence or absence of associated intracranial cysticerci, and other findings. There were three cases of subarachnoidal form and one case of intramedullary form. Cysticerci of subarachnoidal form in three cases were located in retromedullary space at C2 level, anterior to cord at C1-C6 levels, and lumbosacral area, respectively. The signal intensities of the lesions were same as those of CSF. Localized arachnoidal enhancement was found in all three cases. In one case there was a large area of high signal intensity within the spinal cord on T2-weighted image suggesting either ischemia secondary to vascular compromise or inflammatory edema. All of these three cases accompanied intracranial cysticercosis. Intramedullary cysticercosis in one case was shown as a single 1 cm cystic lesion at C2 level, which showed hypointense signal on T1-weighted image, hyperintense signal on T2-weighted image, and signet-ring-like enhancement. This lesion did not accompany intracranial cysticerci. Intraspinal cysticercosis manifested as single or multiple cysts within either spinal cord or subarachnoid space, and were frequently associated with arachnoiditis.

  9. The dural tail sign of meningiomas

    International Nuclear Information System (INIS)

    This prospective study was performed to clarify the radiological and pathological features of the dural tail sign in MRIs of meningiomas. We investigated 65 cases of intracranial meningiomas including 23 cases on the cerebral convexity. The dural tail sign was recognized in 47 cases and in 19 cases of convexity lesions, showing continuous enhancement with lengths ranging from 5 to 45 mm. Dura mater marginal to the tumors were resected as widely as possible and analyzed histologically in serial sections. Twenty-two cases was graded as grade I and only one case was as grade II according to World Health Organization (WHO) grading criteria. Subdural proliferation of arachnoidal cells was found in 4 cases and venous dilatation of dura was seen in 7 cases. In contrast, clusters of tumor cells were recognized in 5 cases in the arachnoid, 7 cases along the subdural space, and in 3 cases invading into the dura. These results suggest that infiltration of tumor cells occurs frequently in the dural tail sign of meningiomas. (author)

  10. Multiple burr hole surgery as a treatment modality for pediatric moyamoya disease

    Directory of Open Access Journals (Sweden)

    Ravindranath Kapu

    2010-01-01

    Full Text Available Objective : To re-emphasize that indirect revascularization surgery alone, where multiple burr holes and arachnoid openings are made over both cerebral hemispheres, is beneficial in the treatment of moyamoya disease (MMD in children. Clinical Presentation : We report a 10-year-old boy who presented with complaints of episodic headache for the last 5 years. At the peak of his headache he had visual disturbances and acute onset weakness of left-sided limbs, recovering within a few minutes. He had no focal neurological deficits. Radiological investigations revealed abnormal findings, demonstrating the features of MMD. Surgical Management : He underwent bilateral multiple burr holes, dural and arachnoid opening over the frontal, parietal and temporal regions of each hemisphere. The elevated periosteal flap was placed in contact with the exposed brain through each burr hole. Results : On 6-months follow-up he had only one episode of transient ischemic attack. Postoperative four vessel angiogram demonstrated excellent cerebral revascularization around the burr hole sites, and single photon emission computerized tomography imaging showed hypoperfusion in the right temporo-occipital area suggestive of an old infarct with no other perfusion defect in the rest of the brain parenchyma. Conclusion : In children with MMD this relatively simple surgical technique is effective and safe, and can be used as the only treatment without supplementary revascularization procedures. This procedure can be done in a single stage on both sides and the number of burr holes made over each hemisphere depends on the extent of the disease.

  11. Clinical Applications of Cine Balanced Steady-State Free Precession MRI for the Evaluation of the Subarachnoid Spaces.

    Science.gov (United States)

    Li, A E; Wilkinson, M D; McGrillen, K M; Stoodley, M A; Magnussen, J S

    2015-12-01

    The purpose of this article is to review the physiology of normal brain and spinal cord motion in the subarachnoid space, principles of cine balanced steady-state free precession (bSSFP) magnetic resonance imaging (MRI), clinical applications, and the pitfalls encountered with this technique. The brain and spinal cord are dynamic structures that move with each heartbeat due to transmitted arterial pulse waves. Conventional MRI sequences do not allow anatomic evaluation of the pulsatile movement of the neural structures in the subarachnoid space due to limitations in temporal resolution. Cine bSSFP MRI uses cardiac gating to evaluate dynamically the brain and spinal cord with high contrast and temporal resolution.Cine bSSFP can be used in the evaluation of idiopathic syringomyelia to assess an underlying treatable cause, including arachnoid bands, which are usually not well visualized with conventional MR sequences due to motion artifact. This MRI technique is also useful in the evaluation of intraspinal and intracranial arachnoid cysts and the degree of mass effect on the cord. Other applications include preoperative and postoperative evaluation of Chiari I malformation and the evaluation of lateral ventricular asymmetry. The major limitation of cine bSSFP is the presence of banding artifacts, which can be reduced by shimming and modifying other scan parameters.

  12. [Tuberculous meningitis in an immunocompetent adult: contribution of cerebral imaging techniques to the diagnosis and follow-up].

    Science.gov (United States)

    Louvel, D; Babo, P; Sollet, J P; Barret, F; Tillier, J N; Davous, P

    1999-11-01

    We have studied 5 men, mean age 47 years, affected by tuberculous meningitis (TM) without documented immunodepression. The diagnosis of TM was supported by clinical and biological investigations and confirmed by the cultures of CSF. All the patients received a four-drug combination therapy and steroids. No drug resistance of the bacilli was observed. Cerebral imaging by CT and MRI was rarely diagnostic but most useful during the follow-up. All the patients developed complications including tuberculomas (5), hydrocephalus (4), ischemic lesions (2), arachnoiditis (1) and abscess of spinal cord (1). Four patients recovered and one died. The mean duration of the follow-up was 16 months. MRI was more sensitive than CT scan to identify inflammatory lesions such as granulomas, angeitis or arachnoiditis and to follow their outcome. Tuberculomas and hydrocephalus were easily diagnosed by CT scan with contrast enhancement. Recommendations of sequential imaging are suggested to identify unexpected or asymptomatic complications of TM during therapy and evaluate the outcome.

  13. [Diagnosis of syringomyelia and its classification on the basis of symptoms, radiological appearance, and causative disorders].

    Science.gov (United States)

    Terae, Satoshi; Hida, Kazutoshi; Sasaki, Hidenao

    2011-09-01

    Although it is easier to accurately diagnose syringomyelia with the advent of magnetic resonance (MR) imaging, syringomyelia still poses challenges to clinicians because of its complex symptomatology, uncertain pathogenesis and multiple treatment options. Here, we propose criteria for classification of syringomyelia not related to those associated with spinal intramedullary tumors. The classification aims to distinguish between the presyrinx state and syringomyelia, between asymptomatic and symptomatic syringomyelia and to clarify the associated disorders such as Chiari malformations, spinal arachnoiditis and spinal cord trauma. Diagnostic criteria for Chiari I and II malformations with MR imaging were also defined. Several hypotheses proposed to explain the pathogenesis of syringomyelia associated with Chiari I malformation were reviewed. A questionnaire survey on syringomyelia based on the proposed criteria conducted between November 2009 and April 2010 in Japan revealed that 160 (22.6%) of the 708 patients were asymptomatic. Chiari I malformation was the most frequent causative disorder (48.3%), followed by spinal arachnoiditis (15.8%). The proposed criteria for classification of syringomyelia will facilitate a nationwide survey of syringomyelia in Japan. Such a survey will inform us of its prevalence and prognosis more precisely, and enable us to build a reliable database that may help determine the optimal treatment for the disease in the future. PMID:21878699

  14. 原发性三叉神经痛显微血管减压术后复发相关因素的研究%Related factors of recurrence of primary trigeminal neuralgia after microvascular decompression

    Institute of Scientific and Technical Information of China (English)

    唐四强; 漆松涛; 刘忆; 陈铭; 张喜安; 潘军; 曹永福

    2014-01-01

    Objective To evaluate the related factors of the recurrence of primary trigeminal neuralgia after microvascular decompression(MVD).Methods 147 patients with initial primary trigeminal neuralgia treated with MVD in our departerment were retrospectively analyzed.The preoperative treatment,clinical presentation,operative findings and postoperative outcomes were recorded.The related factors of recurrence were statically analyzed.Results The mean follow-up time was 39.5 months and the recurrence rate was 11.6% (17/147).The univariate analysis showed that the duration of disease(x2 =8.226,P =0.016),clinical presentation (x2 =4.940,P =0.026),offending artery (x2 =45.759,P =0.000),compression degree(x2 =13.811,P =0.003),decompression degree (x2 =39.910,P =0.000),outer arachnoid(x2 =33.117,P =0.000),arachnoidcompression (x2 =27.245,P =0.000) and arachnoid adhesion(x2 =20.710,P =0.000)were statically related to the recurrence of neuralgia.After the Logistic regression analysis,the outer arachnoid (P =0.033),arachnoid trabecula compression (P =0.008),offending artery (P =0.002) and decompression degree (P =0.004) were the predictors of the recurrence.Conclusions MVD was effective in the treatment of primary trigeminal neuralgia.The arachnoid factors might play an important role in the pathogenesis of trigeminal neuralgia and MVD.%目的 探讨原发性三叉神经痛显微血管减压术后复发的相关因素.方法 回顾性分析我院147例首次经微血管减压术治疗的原发性三叉神经痛患者的临床资料,包括术前治疗方式、临床特征、术中所见、术后第1周时的疗效,并分析随访期内复发的相关因素.结果 147例患者平均随访39.5个月,17例(11.6%)复发;复发的单因素分析显示病程(x2=8.226,P=0.016),临床特征(x2=4.940,P=0.026),责任血管(x2 =45.759,P=0.000),压迫程度(x2=13.811,P=0.003),减压程度(x2=39.910,P=0.000),外层蛛网膜(x2=33.117,P=0.000),蛛网膜卡压(x2=27.245,P=0.000),

  15. Multiplicity of cerebrospinal fluid functions: New challenges in health and disease

    Directory of Open Access Journals (Sweden)

    Stopa Edward G

    2008-05-01

    and excretory benefits. Finally, CSF reabsorption via multiple pathways (olfactory and spinal arachnoidal bulk flow is likely complemented by fluid clearance across capillary walls (aquaporin 4 and arachnoid villi when CSFP and fluid retention are markedly elevated. A model is presented that links CSF and ISF homeostasis to coordinated fluxes of water and solutes at both the blood-CSF and blood-brain transport interfaces. Outline 1 Overview 2 CSF formation 2.1 Transcription factors 2.2 Ion transporters 2.3 Enzymes that modulate transport 2.4 Aquaporins or water channels 2.5 Receptors for neuropeptides 3 CSF pressure 3.1 Servomechanism regulatory hypothesis 3.2 Ontogeny of CSF pressure generation 3.3 Congenital hydrocephalus and periventricular regions 3.4 Brain response to elevated CSF pressure 3.5 Advances in measuring CSF waveforms 4 CSF flow 4.1 CSF flow and brain metabolism 4.2 Flow effects on fetal germinal matrix 4.3 Decreasing CSF flow in aging CNS 4.4 Refinement of non-invasive flow measurements 5 CSF volume 5.1 Hemodynamic factors 5.2 Hydrodynamic factors 5.3 Neuroendocrine factors 6 CSF turnover rate 6.1 Adverse effect of ventriculomegaly 6.2 Attenuated CSF sink action 7 CSF composition 7.1 Kidney-like action of CP-CSF system 7.2 Altered CSF biochemistry in aging and disease 7.3 Importance of clearance transport 7.4 Therapeutic manipulation of composition 8 CSF recycling in relation to ISF dynamics 8.1 CSF exchange with brain interstitium 8.2 Components of ISF movement in brain 8.3 Compromised ISF/CSF dynamics and amyloid retention 9 CSF reabsorption 9.1 Arachnoidal outflow resistance 9.2 Arachnoid villi vs. olfactory drainage routes 9.3 Fluid reabsorption along spinal nerves 9.4 Reabsorption across capillary aquaporin channels 10 Developing translationally effective models for restoring CSF balance 11 Conclusion

  16. 蛛网膜下腔出血护理的伦理学探讨%The Ethical Consideration for Nursing Patients with Subarachnoid Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    颜超; 张敏; 祝刚

    2011-01-01

    Care for patients with subarachnoid hemorrhage involved in four aspects: professional competence of nursing staff; doctor - nurse communication related to treat the patients; psychological care of patients with sub-arachnoid hemorrhage and communication and psychological counseling with families of patients; humanistic hospice care. These tissues were explored from the perspective of medical ethics .%针对蛛网膜下腔出血护理工作实践中涉及的四个方面:护理人员的专业能力;针对患者治疗的医护沟通;蛛网膜下腔出血患者的心理护理及患者家属的心理沟通和疏导;临终的人文关怀,从医学伦理学的角度予以探讨.

  17. Craniospinal dissemination of clival chondroid chordoma

    Directory of Open Access Journals (Sweden)

    Shinde S

    2005-01-01

    Full Text Available Chondroid chordoma commonly presents as clival osseous and extradural mass. A 15-year-old boy presented with progressive visual deficit, headaches and diplopia since three years. Computed tomography (CT scan showed a skull base tumour, but was wrongly reported at the time as chronic sphenoidal sinusitis and nasal polyps. In the past three months, he developed dysphagia, urinary retention and constipation. Terminally, he had weakness of all limbs. Fundoscopy showed optic atrophy. Temporal and spatial variation in symptoms led to a clinical diagnosis of multiple sclerosis with optic neuritis. Partial brain autopsy revealed small gelatinous tumour nodules in the subarachnoid space of middle cranial fossa encasing base of brain like arachnoiditis. Tumour deposits extended down into the spinal cord along the subarachnoid space as far as vision allowed. Histopathology and immunohistochemistry confirmed a diagnosis of chondroid chordoma. Awareness of this rare mode of dissemination will avoid misdiagnosis and delay in treatment

  18. Evaluation of the Production and Absorption of Cerebrospinal Fluid.

    Science.gov (United States)

    Miyajima, Masakazu; Arai, Hajime

    2015-01-01

    The traditional hypothesis of cerebrospinal fluid (CSF) hydrodynamics presumes that CSF is primarily produced in the choroid plexus (CP), then flows from the ventricles into the subarachnoid spaces, and mainly reabsorbed in the arachnoid granulations. This hypothesis is necessary to reconsider in view of recent research and clinical observations. This literature review presents numerous evidence for a new hypothesis of CSF hydrodynamics-(1) A significantly strong relationship exists between the CSF and interstitial fluid (IF), (2) CSF and IF are mainly produced and absorbed in the parenchymal capillaries of the brain and spinal cord. A considerable amount of CSF and IF are also absorbed by the lymphatic system, and (3) CSF movement is not unidirectional flow. It is only local mixing and diffusion. PMID:26226980

  19. Imaging techniques for diagnosis after surgery for degenerative disc disease. Bildgebende Diagnostik nach spinaler Diskushernienoperation

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S. (Abt. fuer Osteologie, MR-Inst., Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria)); Kramer, J. (Abt. fuer Osteologie, MR-Inst., Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria)); Muehlbauer, M. (Neurochirurgische Univ.-Klinik, Vienna (Austria)); Kainberger, F. (Abt. fuer Osteologie, MR-Inst., Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria)); Imhof, H. (Abt. fuer Osteologie, MR-Inst., Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria))

    1993-10-01

    The magnetic resonance imaging findings recorded in patients after surgery for degenerative disc disease in the lumbar and cervical spine are discussed in comparison with conventional radiographs and computed tomography findings. In the lumbar spine normal postoperative findings in the immediate postoperative period can be demonstrated by MR imaging. Contrast-enhanced MR imaging can differentiate disc herniation from postoperative scar formation with a greater degree of confidence than other imaging modalities. MR imaging improves differentiation between other causes of failed back syndrome such as postoperative hematoma and infection, lateral spinal stenosis and arachnoiditis. In the cervical spine types of operative approaches, the appearance of bony stenosis and disc herniations by MR imaging are discussed. Computer tomography still has a role in the assessment of osseous complications such as central or foraminal stenosis. (orig.)

  20. Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: Imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Kivrak, Ali Sami [Selcuk University, Meram Medical Faculty, Department of Radiology, 42080 Konya (Turkey)], E-mail: alisamikivrak@hotmail.com; Koc, Osman; Emlik, Dilek; Kiresi, Demet; Odev, Kemal [Selcuk University, Meram Medical Faculty, Department of Radiology, 42080 Konya (Turkey); Kalkan, Erdal [Selcuk University, Meram Medical Faculty, Department of Neurosurgery, Konya (Turkey)

    2009-07-15

    Computed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening.

  1. Pleuropulmonary paragonimiasis with migrated lesions cured by multiple therapies

    Directory of Open Access Journals (Sweden)

    Yun Hu

    2016-01-01

    Full Text Available Paragonimiasis is an infectious disease caused by Trematodes of the genus Paragonimus that is endemic in Asia, Africa, and South America. Most patients with paragonimiasis are cured by standard praziquantel treatment. However, several cases have been reported to have unsatisfactory responses to the standard praziquantel treatment. To probe the clinical characteristics, possible cause, and management of the paragonimiasis individuals improved by multiple therapies, we present a 12-year-old Chinese boy, who was infected with Paragonimus accompanied by arachnoid cyst involvement, as not having typical clinical symptoms, but repeatedly presenting with migrated lesions between the lung and pleura. He responded to treatment with 3 cycles of praziquantel and 1 cycle of albendazole.

  2. Valuation for magnetic resonance of neuro tuberculosis

    International Nuclear Information System (INIS)

    The increased incidence of neuro tuberculosis (NTB), due to the world epidemic of resistant strains and AIDS, has made of magnetic resonance (MR) imaging the study of choice for the early detection of lesions that lead the clinicians to an effective treatment. We present our experience with six cases of NTB, with meningoencephalic (4 cases), spinal, (1 case) and epidural (1 case) involvement. We identified basal arachnoiditis that was also seen on CT. Two cases demonstrated non-classifying tuberculomas, the spinal lesion consisted of casseifying tuberculoma that responded to treatment and disappeared on a follow up MR study. Epidural involvement consisted of Pott's disease with displacement and edema of the spinal cord. The differential diagnosis of these lesions includes mycoses, cysticercosis, sarcoidosis and leptomeningeal metastases

  3. Reduced GABA{sub A} receptor density contralateral to a potentially epileptogenic MRI abnormality in a patient with complex partial seizures

    Energy Technology Data Exchange (ETDEWEB)

    Kuwert, T. [Dept. of Nuclear Medicine, Muenster Univ. (Germany); Stodieck, S.R.G. [Dept. of Neurology, Muenster Univ. (Germany); Puskas, C. [Dept. of Nuclear Medicine, Muenster Univ. (Germany); Diehl, B. [Dept. of Neurology, Muenster Univ. (Germany); Puskas, Z. [Inst. of Clinical Radiology, Muenster Univ. (Germany); Schuierer, G. [Inst. of Clinical Radiology, Muenster Univ. (Germany); Vollet, B. [Dept. of Nuclear Medicine, Muenster Univ. (Germany); Schober, O. [Dept. of Nuclear Medicine, Muenster Univ. (Germany)

    1996-01-01

    Imaging cerebral GABA{sub A} receptor density (GRD) with single-photon emission tomography (SPET) and iodine-123 iomazenil is highly accurate in lateralizing epileptogenic foci in patients with complex partial seizures of temporal origin. Limited knowledge exists on how iomazenil SPET compares with magnetic resonance imaging (MRI) in this regard. We present a patient with complex partial seizures in whom MRI had identified an arachnoid cyst anterior to the tip of the left temporal lobe. Contralaterally to this structural abnormality, interictal electroencephalography (EEG) performed after sleep deprivation disclosed an intermittent frontotemporal dysrhythmic focus with slow and sharp waves. On iomazenil SPET images GRD was significantly reduced in the right temporal lobe and thus contralaterally to the MRI abnormality, but ipsilaterally to the pathological EEG findings. These data suggest that iomazenil SPET may significantly contribute to the presurgical evaluation of epileptic patients even when MRI identifies potentialy epileptogenic structural lesions. (orig.)

  4. Case Report: Acute obstructive hydrocephalus associated with infratentorial extra-axial fluid collection following foramen magnum decompression and durotomy for Chiari malformation type I [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Sunil Munakomi

    2016-01-01

    Full Text Available Acute obstructive hydrocephalus due to infratentorial extra-axial fluid collection (EAFC is an extremely rare complication of foramen magnum decompression (FMD and durotomy for Chiari malformation type I. Presence of infratentorial  EAFC invariably causes obstruction at the level of the fourth ventricle or aqueduct of Silvius, thereby indicating its definitive role in hydrocephalus. Pathogenesis of EAFC is said to be a local arachnoid tear as a result of durotomy, as this complication is not described in FMD without durotomy. Controversy exists in management. Usually EAFC is said to resolve with conservative management; so hydrocephalus doesn’t require treatment. However, in this case EAFC was progressive and ventriculo-peritoneal shunting (VPS was needed for managing progressive and symptomatic hydrocephalus.

  5. The value of magnetic resonance imaging in evaluation of postoperative lumbar spine; Wartosc badania rezonansu magnetycznego w ocenie powiklan pooperacyjnych dyskow ledzwiowych

    Energy Technology Data Exchange (ETDEWEB)

    Lakomiec, B.; Samson, B.; Zabek, M.; Walecki, J.; Krolicki, L. [Wojewodzki Szpital Zespolony, Warsaw (Poland)

    1996-12-31

    Extruded lumbar discs are common reasons of lumbar pain and required appropriate surgical treatment. In 10-40% patients appear postoperative complications (e.g. recurrent lumbar disc on the same or different level, scar tissues involving nerve roots, arachnoiditis, discitis, postoperative pseudomeningocele, wrong level laminectomy) resulting recurrent lumbar pain and neurological symptoms. In our study 20 out of 216 patients have suffered recurrent back pain: 12 patients due to scar tissues, 6 patients due to recurrent discs, 2 patients due to postoperative discitis. Authors try to show the role of magnetic resonance imaging in evaluation of postoperative lumbar spine, result of surgical treatment, analyze the reasons of recurrent back pain. (author) 5 refs, 3 figs

  6. Meningitis tuberculosa: Clinical findings and results of cranial computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Trautmann, M.; Loddenkemper, R.; Hoffmann, H.G.

    1982-10-01

    Guided by 9 own observations between 1977 and 1981, new diagnostic facilities in tuberculous meningitis are discussed. For differentiation from viral meningitis, measurement of CSF lactic acid concentration in addition to that of CSF glucose has proved to be of value in recent years. In accordance with the literature, two cases of this series which were examined for CSF lactic acid concentration showed markedly elevated levels of 8,4 rsp. 10,4 mmol/l. In contrast to this, in viral meningitis usually values of less than 3.5 mmol/l are found. Additionally, the presence of hypochlor- and hyponatremia, which could be demonstrated in 6 of our 9 patients, may raise the suspicion of tuberculous etiology. In the series presented, cranial computed tomography was of greatest diagnostic value, enabling the diagnosis of hydrocephalus internus in 5, and basal arachnoiditis in 2 cases.

  7. The acrocallosal syndrome in first cousins: widening of the spectrum of clinical features and further support for autosomal recessive inheritance.

    Science.gov (United States)

    Schinzel, A

    1988-05-01

    First cousins, related through their mothers, showed a pattern of craniofacial, brain, and limb anomalies consistent with the acrocallosal syndrome. Both patients had a defect of the corpus callosum, macrocephaly with a protruding forehead and occiput, hypertelorism, non-horizontal palpebral fissures, a small nose, notched ear lobes, and postaxial polydactyly of the hands. The boy, in addition, had hypospadias, cryptorchidism, inguinal hernias, duplication with syndactyly of the phalanges of the big toe, and a bipartite right clavicle. The girl had an arachnoidal cyst, a calvarian defect, and digitalisation of the thumbs. Motor and mental development was retarded in both patients. This observation provides further evidence of probable autosomal recessive inheritance of the acrocallosal syndrome and widens the spectrum of clinical findings and the variability of features in this rare malformation syndrome. PMID:3385741

  8. Collagenous Tissues upon Lithium Treatment: A Quantitative Ultrastructural Study

    Directory of Open Access Journals (Sweden)

    Margaret Tzaphlidou

    2004-01-01

    Full Text Available In this review, the influence of lithium treatment in mouse, rat, and rabbit skin, liver, bone, and aorta, as well as arachnoid and dura mater collagen fibrils, is examined using electron microscopy and image processing. Structural changes (fibril architecture and diameter are detected at the ultrastructural level in specimens from all lithium-treated tissues. The overall collagen fibril architecture is disturbed as compared with specimens from normal species. The mean diameter values of treated collagen fibrils are significantly smaller than those from controls in all tissues examined. The banding patterns of fibrils are normal in all cases. Measurements by a computerized method of measuring axial periodicity of fibrils indicate no effect of lithium on this parameter. Computer analysis shows no differences in charged amino acid composition between lithium-treated and -untreated samples. Under the present experimental conditions, lithium can induce permanent structural collagen alterations.

  9. Circadian Variation Of Stroke Onset

    Directory of Open Access Journals (Sweden)

    Kamath vasantha

    2003-01-01

    Full Text Available Diurnal variations in various physiological and biochemical functions and certain pathological events like myocardial infarction and stroke have been documented. We studied prospectively one hundred and seven patients of acute onset stroke confirmed by computed tomography for the exact time of onset, risk factors and type of stroke. Patients who were unclear of time of onset and with a diagnosis of cerebral venous thrombosis or sub-arachnoid hemorrhage were excluded. Infarction was detected in 71 patients and hemorrhage in 33 patients. Men out numbered women (1:6:1. Hypertension was more frequent in hemorrhage in the morning time (5 AM-12 noon and more infarction between 12-6 pm. However there was no relation between the time of onset of stroke and various risk-factors of stroke.

  10. Spontaneous successful pregnancy in posthypophysectomy hypopituitarism: A rare case report

    Directory of Open Access Journals (Sweden)

    Indu Lata

    2014-01-01

    Full Text Available Pregnancy in patients with pan-hypopituitarism following surgery of pituitary adenoma is rare and considered high risk. Hormonal dysfunction in these patients involves more than one axis (gonadotrophic, thyroidal, and adrenal. However, advance in infertility treatment have led to the increased pregnancy rate in hypopituitarism women. We present a case of nonfunctioning pituitary macroadenoma, who after pituitary surgery (hypophysectomy developed hypopituitarism followed by multiple tuberculoma brain with hydrocephalus with arachnoiditis. She conceived spontaneously after 9 years of pituitary surgery and carried her pregnancy to the term. Elective caesarean section was done at 38 weeks and both infant and mother are well. The case highlights the rarity of the phenomenon and the safe outcome of the pregnancy with proper replacement.

  11. [Neuroinfections and pregnancy].

    Science.gov (United States)

    Gusev, V A; Koniaeva, V V

    1985-01-01

    The course of neuroinfections (both acute and chronic) associated with pregnancy was studied in a series of 156 women. The patients were divided into two groups. Out of the 36 women comprising the first group who fell ill during gestation, 12 had a fulminant course of the disease with five lethal cases, 24 women had a subacute course and pregnancy progressed to a normal delivery. The second group included 120 patients who conceived in the presence of the residual manifestations of the previous cerebral arachnoiditis, arachnoencephalitis, encephalitis and diencephalitis. The authors describe the clinical course of the residual forms of neuroinfections in relation to pregnancy, parturition and puerperium and offer recommendations on the obstetrical management of pregnancy complicated by neuroinfections.

  12. Anatomy and development of the meninges: implications for subdural collections and CSF circulation

    Energy Technology Data Exchange (ETDEWEB)

    Mack, Julie [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Squier, Waney [John Radcliffe Hospital, Department of Neuropathology, Oxford (United Kingdom); Eastman, James T. [Lancaster General Hospital, Department of Pathology and Laboratory Medicine, Lancaster, PA (United States)

    2009-03-15

    The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system. (orig.)

  13. 'Subarachnoid cyst' after evacuation of chronic subdural hematoma: Case report of an unusual postoperative morbidity.

    Science.gov (United States)

    Sharon, Low Y Y; Wai Hoe, N G

    2016-01-01

    Burr-hole drainage of chronic subdural hematomas are routine operative procedures done by neurosurgical residents. Common postoperative complications include acute epidural and/or subdural bleeding, tension pneumocephalus, intracranial hematomas and ischemic cerebral infarction. We report an interesting post-operative complication of a 'subarachnoid cyst' after burr-hole evacuation of a chronic subdural hematoma. The authors hypothesize that the 'cyst' is likely secondary to the splitting of the adjacent neomembrane within its arachnoid-brain interface by iatrogenic irrigation of the subdural space. Over time, this 'cyst' develops into an area of gliosis which eventually causes long-term scar epilepsy in the patient. As far as we are aware, this is the first complication of such a 'subarachnoid cyst' post burr-hole drainage reported in the literature. PMID:27366276

  14. Outer brain barriers in rat and human development

    DEFF Research Database (Denmark)

    Brøchner, Christian B; Holst, Camilla Bjørnbak; Møllgård, Kjeld

    2015-01-01

    diffusion restriction between brain and subarachnoid CSF through an initial radial glial end feet layer covered with a pial surface layer. To further characterize these interfaces we examined embryonic rat brains from E10 to P0 and forebrains from human embryos and fetuses (6-21st weeks post...... of the arachnoid blood-CSF barrier. Collagen 1 delineated the subarachnoid space and stained pial surface layer. BLBP defined radial glial end feet layer and SSEA-4 and YKL-40 were present in both leptomeningeal cells and end feet layer, which transformed into glial limitans. IL-13Rα2 and EAAT1 were present...... in the end feet layer illustrating transporter/receptor presence in the outer CSF-brain barrier. MAP2 immunostaining in adult brain outlined the lower border of glia limitans; remnants of end feet were YKL-40 positive in some areas. We propose that outer brain barriers are composed of at least 3 interfaces...

  15. TIPIT: A randomised controlled trial of thyroxine in preterm infants under 28 weeks gestation: Magnetic Resonance Imaging and Magnetic Resonance Angiography protocol

    DEFF Research Database (Denmark)

    Sze M., Ng,; Mark A., Turner; Carrol, Gamble,;

    2008-01-01

    of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks corrected gestational age. The secondary outcomes will be thyroid hormone concentrations, the hypothalamic pituitary axis status and auxological data between birth and expected date of delivery; thyroid gland...... on the developing foetal brain. This is an explanatory double blinded randomised controlled trial which is aimed to assess the effect of thyroid hormone supplementation on brain size, key brain structures, extent of myelination, white matter integrity and vessel morphology, somatic growth and the hypothalamic......-pituitary-adrenal axis. Methods The study is a multi-centred double blinded randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks corrected gestational age. The primary outcomes will be width...

  16. Meningitis due to Enterobacter aerogenes subsequent to resection of an acoustic neuroma and abdominal fat graft to the mastoid

    Directory of Open Access Journals (Sweden)

    Fida A. Khan

    2004-10-01

    Full Text Available Meningitis is an uncommon complication of neurosurgical procedures, with an incidence of 1.1% to 2.5%. Although unusual, the frequency of nosocomial Gram-negative meningitis appears to be increasing. Gram-negative meningitis has been documented following disruption of the dura-arachnoid barrier secondary to trauma or surgery. The association of Gram-negative bacillary meningitis with neurosurgical procedures was first reported in the 1940's. Wolff et al. described the association between Enterobacter species and post-neurosurgical infection. More recently, risk factors for nosocomial Enterobacter meningitis have been characterized by Parodi et al. Adipose graft, as an independent risk factor has not yet been reported. A patient with acoustic neuroma resection, who developed bacterial meningitis from an abdominal fat pad graft to a mastoidectomy bed is described. A brief overview was made of post-neurosurgical Gram-negative meningitis.

  17. Epidermal nevus syndrome associated with unusual neurological, ocular, and skeletal features

    Directory of Open Access Journals (Sweden)

    Reena Sharma

    2012-01-01

    Full Text Available Epidermal nevus syndrome (ENS is a rare disease, the pathogenesis of which is largely elusive. We, hereby, report an exclusive case of a 20-year-old man with verrucous ENS presented with dark colored papules and plaques along the Blaschko′s lines present over the head and neck area along with fleshy growth in both eyes since birth. Limb length discrepancy and kyphoscoliosis were remarkable. Skin biopsy was compatible with verrucous epidermal nevus while the biopsy of the ocular lesion confirmed complex choristoma. MRI brain revealed calcification in the right temporal lobe. Bilateral arachnoid cyst in the middle cranial fossa, scleral osteoma in the posterior part of the right eyeball, and deformed calvarium were evident on CECT skull and orbit. The present illustration emphasizes the importance of a punctilious work up of the case.

  18. Delleman Oorthuys syndrome

    Directory of Open Access Journals (Sweden)

    Syed Wajahat A Rizvi

    2015-01-01

    Full Text Available Oculocerebrocutaneous or Delleman syndrome is a rare congenital syndrome characterized by microphthalmia/anophthalmia with or without orbital cysts, focal skin defects, intracranial cysts and skin appendages. We here report a case of 1-year-old male child with periocular skin tags, lid colobomas, and dermal hypoplasia. The patient had delayed developmental milestones and history of tonic-clonic seizures. Magnetic resonance imaging of the head revealed a large arachnoid cyst, aplastic cerebellar vermis and polymicrographic pattern of the cerebral cortex. A complex cyst of spleen was also noted on abdominal ultrasonography. Orbital cysts depending on the size can be excised or left alone. Neuroimaging evaluation of patients with congenital orbital cysts and skin appendages is emphasized for early and appropriate management.

  19. [Continuous intrathecal opiate therapy with a portable drug pump in cancer pain].

    Science.gov (United States)

    Motsch, J; Bleser, W; Ismaily, A J; Distler, L

    1988-10-01

    Terminal cancer patients report substantial pain frequently. Pain control can be achieved in many patients with conventional methods and analgesics. However, significant numbers of patients remain in pain. For these patients, continuous intrathecal narcotics delivered by an external portable pump via a subcutaneous port, offer substantially improved pain control with minimal risk of serious systemic complications. Duration of treatment in our 40 cancer patients lasted up to 11 month. Continuous intrathecal morphine or fentanyl relieved pain till death due to cancer. Supraspinal side effects of opioids were only seen during the first week of intrathecal narcotic treatment. No serious complications like meningitis or other infections were observed. Postmortem examination also could not detect changes of the cord or signs of arachnoiditis due to intrathecal narcotics or the implanted catheter. We conclude, that continuous intrathecal narcotic infusion by means of small portable pump is a very efficient method to control terminal cancer pain and enables treatment on an outpatient basis until death.

  20. The role of lumboperitoneal shunts in the treatment of syringomyelia.

    Science.gov (United States)

    Oluigbo, Chima O; Thacker, Karen; Flint, Graham

    2010-07-01

    OBJECT The role of thecoperitoneal shunts in the management of syringomyelia is not well defined. In this study, the authors analyze the outcome of lumboperitoneal shunt procedures carried out to treat syringomyelia in their institution. METHODS The authors retrospectively reviewed the medical records of 19 patients who underwent lumboperitoneal shunt procedures for syringomyelia. RESULTS The mean follow-up duration was 25 months (range 3-51 months). Of 16 cases followed up, only 5 patients reported clinical improvement in their preoperative symptoms, but of these, 2 had clear radiological evidence of improvement. Three of 6 patients with syringomyelia due to spinal arachnoiditis improved. CONCLUSIONS Lumboperitoneal shunts may lead to useful improvement in the symptoms of a patient with syringomyelia while avoiding the risk of neurological deterioration inherent in myelotomies required for syrinx shunting procedures.

  1. Treatment for recurrent medulloblastoma with intrathecal liposomal cytarabine and systemic metronomic combination therapy.

    Science.gov (United States)

    Nygaard, Randi; Kivivuori, Sanna-Maria

    2012-03-01

    The prognosis of recurrent medulloblastoma is dismal, with a median survival of less than 1 year. Our patient was initially diagnosed with high-risk medulloblastoma when he was 14 years old. He had a recurrence 18 months after the end of therapy. Recurrence treatment consisted of 13 intrathecal applications of liposomal cytarabine over an 18-month period, and oral metronomic antiangiogenic therapy with thalidomide, celecoxib, and etoposide. Side effects from the intrathecal treatment were most likely related to arachnoiditis despite prolonged prophylaxis with steroids. He also developed partial hearing loss. Neutropenia was the main side effect of the metronomic therapy. He remains alive, with a good quality of life and without evidence of disease 34 months from the start of recurrence therapy. This combination of local antineoplastic and systemic antiangiogenic therapy seems to be promising for recurrent medulloblastoma. However, more patients and standardized protocols are needed to verify the benefit of this combination therapy and to define the correct duration of treatment.

  2. [Lumbar myelography with metrizamid (author's transl)].

    Science.gov (United States)

    Kehler, M

    1977-03-01

    A series of lumbar myelographies -- 105 in 98 patients - was carried out with water-soluble Metrizamid (Amipaque R) in a concentration of 170 mg I/ml and showed side-effects in 32% and a quality of contrast similar to that of other water-soluble contrast media used before. The side effects were mild, of short duration and needed no treatment. There were no epileptic fits, tonic or clonic carried out 1 - 12 months later showed no signs of arachnoiditis. Dangers of more serious complications appeared to increase, the higher the level of injection into the spinal canal. A short survey of contrast media used in myelography and earlier experience of experimental or clinical side effects caused by Medtrizamid in myelography follows.

  3. Paraplegia and intracranial hypertension following epidural anesthesia: report of four cases

    Directory of Open Access Journals (Sweden)

    Frederico A. D. Kliemann

    1975-09-01

    Full Text Available Four patients who received epidural anesthesia presented sustained myelopathy; three of them had complete paraplegia and one a lumbo-sacral myelopathy with urinary retention. All four patients complained of very intense radicular pains immediately after the analgesic effect of Lidocaine was over. Two patients in whom lumbar puncture was done in the first 24 hours presented an aseptic meningitic reaction in CSF. Paraplegia completed in two to ten months in three patients and in two of them severe intracranial hypertension developped at this time. It is proposed that the disease runs a two-stages course, at least in some cases, characterized by an aseptic meningitis, followed, after a silent period of some months, by signs of adhesive spinal and intracranial arachnoiditis. Intracranial hypertension was controlled by ventriculo-peritoneal shunt; in two patients a transitory effect of intrathecal injections of methyl-prednisolone acetate was observed. Two patients recovered almost completely from paraplegia.

  4. Classification, mechanism and surgical treatments for spinal canal cysts

    Institute of Scientific and Technical Information of China (English)

    Jianjun Sun

    2016-01-01

    A variety of cystic lesions may develop in spinal canal. These cysts can be divided into intramedullary, intradural, extradural, cervical, thoracic, lumbar, and sacral cysts according to anatomical presentation, as well as arachnoid, meningeal, perineural, juxtafacet, discal, neurenteric cysts, and cyst-like lesions according to different etiologies. Mechanisms of initiation and growth vary for different cysts, such as congenital, trauma, bleeding, inflammatory, instability, hydrostatic pressure, osmosis of water, secretion of cyst wall, and one-way-valve effect, etc. Up to now, many treatment methods are available for these different spinal canal cysts. One operation method can be applied in cysts with different types. On the other hand, several operation methods may be utilized in one type of cyst according to the difference of location or style. However, same principle should be obeyed in surgical treatment despite of difference among spinal canal cysts, given open surgery is melely for symptomatic cyst. The surgical approach should be tailored to the individual patient.

  5. MRI--the investigation of choice in syringomyelia?

    Science.gov (United States)

    Dowling, R J; Tress, B M

    1989-11-01

    During a 12 month period of operation of a 0.3 Tesla MRI iron cored resistive scanner 74 cases of syringomyelia were diagnosed on clinical, radiological and/or surgical grounds. Without knowledge of any clinical or radiological data the syrinxes were classified into five groups--idiopathic, idiopathic associated with Chiari malformation, tumour associated, post-traumatic and arachnoiditis associated--and the lesion characteristics within each group were compared. Although MRI was extremely sensitive in picking up even small syrinxes, there was considerable overlap of MRI characteristics across the sub-groups, so that two post-traumatic syrinxes had lesion characteristics identifiable with those of tumour syrinx and one intramedullary tumour syrinx had the MRI characteristics of a benign, idiopathic syrinx. It is concluded that meticulous attention to technique, including axial as well as sagittal T1 weighted sequences, and the administration of intravenous paramagnetic contrast media are necessary for detection and accurate classification of syrinxes. PMID:2633734

  6. Computed tomographic findings of cerebral paragonimiasis

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Weon Tae; Jung, Min Ki; Kang, Heoung Keun; Chung, Hyon De [Chonnam University Medicine School, Gwangju (Korea, Republic of)

    1988-10-15

    Authors analyzed the computed tomographic (CT) findings of 19 cases pathologically and clinically proven cerebral paragonimiasis that were performed at Chonnam University Hospital from April 1983 through March 1987. The results were as follows: 1. Male to female ratio was 15:4 and the most prevalent age group was 3rd decade (7 cases). The common symptoms were epileptic seizure (16 cases) and headache (12 cases). 2. The multiplicity of cerebral paragonimiasis was 7 of 19 cases and the distributions of lesion were occipital (11 cases), temporal (6 cases), frontal (5 cases) and parietal (5 cases) lobe. 3. The calcification on CT scan were single (7 cases) or multiple (7 cases) and the shape of calcification were nodular (10 cases), soap babble of ring (8 cases), and stippled (6 cases). The pattern of contrast enhancement were ring (5 cases) or nodular (1 case), and along the basal cistern (1 case with arachnoiditis). 4. 12 out of 13 cases, had long clinical symptoms over 3 years with calcifications, could be analyzed according to Valentine's vascular territory; 6 cases in PCA territory, 3 in MCA and 3 in ACA. 5. CT findings were noted according to the duration of symptoms; 5 cases, had symptoms less than 1 year, showed abscess (5 cases) and arachnoiditis (1 case) with brain edema, mass effect, hydrocephalus and contrast enhancement but no calcification in all. One case, had symptom of 1 year and 2 months, showed partially calcified granulomatous lesion with perifocal edema and contrast enhancement, 13 cases, had symptoms over 3 years, showed multiple calcification with brain atrophy (10 cases), but no contrast enhancement in all cases.

  7. Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study

    Directory of Open Access Journals (Sweden)

    Savas Yildiray

    2009-06-01

    Full Text Available Abstract Background Treatment modalities in Chiari malformation type 1(CMI accompanied by syringomyelia have not yet been standardized. Pathologies such as a small posterior fossa and thickened dura mater have been discussed previously. Various techniques have been explored to enlarge the foramen magnum and to expand the dura. The aim of this clinical study was to explore a new technique of excision of the external dura accompanied by widening the cisterna magna and making longitudinal incisions in the internal dura, without disturbing the arachnoid. Methods Ten patients with CMI and syringomyelia, operated between 2004 and 2006, formed this prospective series. All cases underwent foramen magnum decompression of 3 × 3 cm area with C1–C2 (partial laminectomy, resection of foramen magnum fibrous band, excision of external dura, delamination and widening of internal dura with longitudinal incisions. Results Patients were aged between 25 and 58 years and occipital headache was the most common complaint. The mean duration of preoperative symptoms was 4 years and the follow-up time was 25 months. Clinical progression was halted for all patients; eight patients completely recovered and two reported no change. In one patient, there was a transient cerebrospinal fluid (CSF fistula that was treated with tissue adhesive. While syringomyelia persisted radiologically with radiological stability in five patients; for three patients the syringomyelic cavity decreased in size, and for the remaining two it regressed completely. Conclusion Removal of the fibrous band and the outer dural layer, at level of foramen magnum, together with the incision of inner dural layer appears to be good technique in adult CMI patients. The advantages are short operation time, no need for duraplasty, sufficient posterior fossa decompression, absence of CSF fistulas as a result of extra arachnoidal surgery, and short duration of hospitalization. Hence this surgical technique has

  8. Renal and extrarenal manifestations of autosomal dominant polycystic kidney disease

    Directory of Open Access Journals (Sweden)

    E.A. Romão

    2006-04-01

    Full Text Available The objective of the present study was to determine the frequency of the most common clinical features in patients with autosomal dominant polycystic kidney disease in a sample of the Brazilian population. The medical records of 92 patients with autosomal dominant polycystic kidney disease attended during the period from 1985 to 2003 were reviewed. The following data were recorded: age at diagnosis, gender, associated clinical manifestations, occurrence of stroke, age at loss of renal function (beginning of dialysis, and presence of a family history. The involvement of abdominal viscera was investigated by ultrasonography. Intracranial alterations were prospectively investigated by magnetic resonance angiography in 42 asymptomatic patients, and complemented with digital subtraction arteriography when indicated. Mean age at diagnosis was 35.1 ± 14.9 years, and mean serum creatinine at referral was 2.4 ± 2.8 mg/dL. The most frequent clinical manifestations during the disease were arterial hypertension (63.3%, lumbar pain (55.4%, an abdominal mass (47.8%, and urinary infection (35.8%. Loss of renal function occurred in 27 patients (mean age: 45.4 ± 9.5 years. The liver was the second organ most frequently affected (39.1%. Stroke occurred in 7.6% of the patients. Asymptomatic intracranial aneurysm was detected in 3 patients and arachnoid cysts in 3 other patients. In conclusion, the most common clinical features were lumbar pain, arterial hypertension, abdominal mass, and urinary infection, and the most serious complications were chronic renal failure and stroke. Both intracranial aneurysms and arachnoid cysts occurred in asymptomatic patients at a frequency of 7.14%.

  9. The usefulness of diffusion weighted imaging in the differential diagnosis of various intracranial cystic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Ihn, Yon Kwon; Jun, Jeong Su; Hwang, Seong Su; Baik, Jun Hyun; Park, Young Ha [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2004-06-01

    The purpose of this study was to evaluate the usefulness of diffusion-weighted imaging (DWI) for the differential diagnosis of various intracranial cystic lesions. This study included 19 patients (13 males, 6 females) with a mean age of 42.5 years. The final histopathological diagnoses for 14 patients were pyogenic brain abscess (n=3), glioblastoma (n=3), ependymoma (n=1), anaplastic astrocytoma (n=1), pilocytic astrocytoma (n=1), hemangioblastoma (n=2), arachnoid cyst (n=1), epidermoid (n=1) and schwannoma (n=1). The other cases of metastasis (n=4) and arachnoid cyst (n=2) were diagnosed on the basis of clinical, laboratory and imaging data. DWI imaging studies were performed with a 1.5 T MR system. A single shot spin echo EPI pulse sequence was applied. B values were set at 0 and 1000 sec/mm{sup 2}. The apparent diffusion coefficient (ADC) were calculated from the ADC map of 10 different cystic brain lesions. Conventional MR imaging included T2WI, T1WI, FLAIR and contrast enhanced T1WI. We analyzed the location, nature, signal intensity on DWI, and the enhancement pattern of the lesions. All of the 3 cases of brain abscess, 1 of 4 cases of metastasis and 1 case of epidermoid showed hyperintensity on DWI. The mean ADC value of brain abscess (2 cases) was less than 1.15 (0.13x10{sup -3} mm{sup 2}/s). The mean ADC values of the other cystic lesions (8 cases) were variable, ranging from 2.840.66 to 3.100.16 (10{sup -3} mm{sup 2}/sec). DWI and ADC values were useful in the differential diagnosis of various intracranial cystic lesions, but some metastatic tumors may mimic a brain abscess on DWI. Therefore, a clinical correlation is mandatory.

  10. Evaluation of usefulness of scintigraphic imaging in diagnosis of intrathecal drug delivery system malfunction – a preliminary report

    International Nuclear Information System (INIS)

    Implantable intrathecal drug delivery systems (IDDS) are basic tool enabling chronic intrathecal pharmacotherapy. Lack of expected clinical results of IDDS therapy necessitates search for the cause with the help of diagnostic imaging methods among other things. Beside radiological techniques, it is also possible to visually assess IDDS systems by nuclear medicine methods. In this study we assess utility of radioisotopic methods in differential diagnosis of failure of therapy with IDDS systems. Scintigraphic studies were performed in selected patients with neurological diseases associated with spasticity, who had IDDS system implanted and were unable to maintain satisfying clinical effect of inrathecally infused baclofen. After emptying the IDDS system of the drug, radiotracer (99mTc-DTPA) solution was injected into the pump reservoir. Subsequently, a series of scintigraphic images was registered, demonstrating passage and distribution of the infused radiotracer. In all investigated cases, scintigraphic study resulted in acquiring relevant additional diagnostic information. Normal or disrupted distribution of radiotracer in spinal canal allowed for a diagnosis drug resistance or demonstrated presence of arachnoid adhesions respectively. Early appearance of radiotracer in blood was considered a proof of leak. Our examinations had decisive influence on further patient treatment, allowing for diagnosis of drug resistance in one patient or complication related to IDDS system in three other cases including breakage of a catheter, pump malfunction and arachnoid adhesions. Scintigraphic methods carry significant amount of information facilitating final diagnosis of the cause of IDDS therapy failure. They should become an important element complementing the diagnostic strategy in patients with suspected failure of intrathecal drug administration systems. Interpretation of radioisotopic studies, since they are purely functional, must be performed in strict relation to

  11. Utilizing multiple scale models to improve predictions of extra-axial hemorrhage in the immature piglet.

    Science.gov (United States)

    Scott, Gregory G; Margulies, Susan S; Coats, Brittany

    2016-10-01

    Traumatic brain injury (TBI) is a leading cause of death and disability in the USA. To help understand and better predict TBI, researchers have developed complex finite element (FE) models of the head which incorporate many biological structures such as scalp, skull, meninges, brain (with gray/white matter differentiation), and vasculature. However, most models drastically simplify the membranes and substructures between the pia and arachnoid membranes. We hypothesize that substructures in the pia-arachnoid complex (PAC) contribute substantially to brain deformation following head rotation, and that when included in FE models accuracy of extra-axial hemorrhage prediction improves. To test these hypotheses, microscale FE models of the PAC were developed to span the variability of PAC substructure anatomy and regional density. The constitutive response of these models were then integrated into an existing macroscale FE model of the immature piglet brain to identify changes in cortical stress distribution and predictions of extra-axial hemorrhage (EAH). Incorporating regional variability of PAC substructures substantially altered the distribution of principal stress on the cortical surface of the brain compared to a uniform representation of the PAC. Simulations of 24 non-impact rapid head rotations in an immature piglet animal model resulted in improved accuracy of EAH prediction (to 94 % sensitivity, 100 % specificity), as well as a high accuracy in regional hemorrhage prediction (to 82-100 % sensitivity, 100 % specificity). We conclude that including a biofidelic PAC substructure variability in FE models of the head is essential for improved predictions of hemorrhage at the brain/skull interface.

  12. Diffusion-weighted MRI in cystic or necrotic intracranial lesions

    Energy Technology Data Exchange (ETDEWEB)

    Park, S.H.; Chang, K.H.; Song, I.C.; Kim, Y.J.; Kim, S.H.; Han, M.H. [Dept. of Diagnostic Radiology, Seoul National University Hospital (Korea)

    2000-10-01

    Our purpose was to investigate the signal intensities of cystic or necrotic intracranial lesions on diffusion-weighted MRI (DWI) and measure their apparent diffusion coefficients (ADC). We examined 39 cystic or necrotic intracranial lesions in 33 consecutive patients: five malignant gliomas, seven metastases, two other necrotic tumours, a haemangioblastoma, three epidermoids, an arachnoid cyst, seven pyogenic abscesses, 12 cases of cysticercosis and one of radiation necrosis. DWI was performed on a 1.5 T unit using a single-shot echo-planar spin-echo pulse sequence with b 1000 s/mm{sup 2}. The signal intensity of the cystic or necrotic portion on DWI was classified by visual assessment as markedly low (as low as cerebrospinal fluid), slightly lower than, isointense with, and slightly or markedly higher than normal brain parenchyma. ADC were calculated in 31 lesions using a linear estimation method with measurements from b of 0 and 1000 s/mm{sup 2}. The cystic or necrotic portions of all neoplasms (other than two metastases) gave slightly or markedly low signal, with ADC of more than 2.60 x 10{sup -3} mm{sup 2}/s. Two metastases in two patients showed marked high signal, with ADC of 0.50 x 10{sup -3} mm{sup 2}/s and 1.23 x 10{sup -3} mm{sup 2}/s, respectively. Epidermoids showed slight or marked high signal, with ADC of less than 1.03 x 10{sup -3} mm{sup 2}/s. The arachnoid cyst gave markedly low signal, with ADC of 3.00 x 10{sup -3} mm{sup 2}/s. All abscesses showed marked high signal, with ADC below 0.95 x 10{sup -3} mm{sup 2}/s. The cases of cysticercosis showed variable signal intensity; markedly low in five, slightly low in three and markedly high in four. (orig.)

  13. Diffusion-weighted MRI in cystic or necrotic intracranial lesions

    International Nuclear Information System (INIS)

    Our purpose was to investigate the signal intensities of cystic or necrotic intracranial lesions on diffusion-weighted MRI (DWI) and measure their apparent diffusion coefficients (ADC). We examined 39 cystic or necrotic intracranial lesions in 33 consecutive patients: five malignant gliomas, seven metastases, two other necrotic tumours, a haemangioblastoma, three epidermoids, an arachnoid cyst, seven pyogenic abscesses, 12 cases of cysticercosis and one of radiation necrosis. DWI was performed on a 1.5 T unit using a single-shot echo-planar spin-echo pulse sequence with b 1000 s/mm2. The signal intensity of the cystic or necrotic portion on DWI was classified by visual assessment as markedly low (as low as cerebrospinal fluid), slightly lower than, isointense with, and slightly or markedly higher than normal brain parenchyma. ADC were calculated in 31 lesions using a linear estimation method with measurements from b of 0 and 1000 s/mm2. The cystic or necrotic portions of all neoplasms (other than two metastases) gave slightly or markedly low signal, with ADC of more than 2.60 x 10-3 mm2/s. Two metastases in two patients showed marked high signal, with ADC of 0.50 x 10-3 mm2/s and 1.23 x 10-3 mm2/s, respectively. Epidermoids showed slight or marked high signal, with ADC of less than 1.03 x 10-3 mm2/s. The arachnoid cyst gave markedly low signal, with ADC of 3.00 x 10-3 mm2/s. All abscesses showed marked high signal, with ADC below 0.95 x 10-3 mm2/s. The cases of cysticercosis showed variable signal intensity; markedly low in five, slightly low in three and markedly high in four. (orig.)

  14. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients.

    Science.gov (United States)

    Wang, J C; Bohlman, H H; Riew, K D

    1998-12-01

    We reviewed the results of acute management of patients who had sustained a dural tear during an operation on the lumbar spine, and we attempted to determine the long-term sequelae of this complication. In the five years from July 1989 to July 1994, 641 consecutive patients had a decompression of the lumbar spine, performed by the senior one of us; of these patients, eighty-eight (14 percent) sustained a dural tear, which was repaired during the operation. The duration of follow-up ranged from two to eight years (average, 4.3 years). Postoperative management consisted of closed suction wound drainage for an average of 2.1 days and bed rest for an average of 2.9 days. Of the eighty-eight procedures that resulted in a dural tear, forty-five were revisions; these revisions were performed after an average of 2.2 previous operations on the lumbar spine, all of which resulted in a scar adherent to the dura. Only eight patients had headaches related to the spinal procedure and photophobia in the postoperative period; these symptoms resolved in all but two patients, both of whom had had a revision operation. Each of the two patients had symptoms of a persistent leak of spinal fluid and needed a reoperation for repair. Overall, seventy-six patients had a good or excellent result and twelve had a poor or satisfactory result with some residual back pain. One patient had arachnoiditis, and another had symptoms of viral meningitis one month postoperatively. A dural tear that occurs during an operation on the lumbar spine can be treated successfully with primary repair followed by bed rest. Such a tear does not appear to have any long-term deleterious effects or to increase the risk of postoperative infection, neural damage, or arachnoiditis. Closed suction wound drainage does not seem to aggravate the leak and can be used safely in the presence of a dural repair.

  15. 囊肿脑池造瘘治疗儿童中颅窝蛛网膜囊肿%Cystocistern fenestration for the treatment of middle cranial fossa cyst in children

    Institute of Scientific and Technical Information of China (English)

    李禄生; 张雨婷; 梁平; 李映良; 翟瑄; 周渝冬

    2012-01-01

    Objective To evaluate the curative effect of cystocistern fenestration for the treatment of middle cranial fossa cyst in children and the value of post-operative evaluation using phase-contrast MRI.(PC-MRI).Methods 28 patients with intracranial arachnoid cysts (IAC) underwent PC-MRI assessment.Cystocistern fenestration was decided in those who were found to have NCIAC.A retrospective study was carried out analysing the clinical manifestations before and after surgery,postoperative decrease of the cyst size using phase-contrast cine MRI scan in these cases.The fistula flow of cerebrospinal fluid,the cerebrospinal fluid dynamics index (peak velocity,flow and flow wave) were obtained.Results Phase-contrast cine MR imaging showed no communication between IAC and the adjacent subarachnoid space in 20 of 28 patients pre-operation and they underwent cystocistern fenes tration.In these patients,arachnoid cysts reduced in size post-operatively.Furthermore,the clinical symptoms were improved or cured.CSF flow direction in the fistula of the basal cistern were bi-directional,which was similar to normal aqueduct flow waveform,suggesting patent fistula.In the 8 patients who were diagnosed to have communicating arachnoid cyst (CIAC),there was no clinical manifestation and no progressive increase in cyst size.Conclusions 1.Cystocistern fenestration could be an effective treatment of children with middle cranial fossa cysts; 2.PC cine MRI can be used to diagnose and assess post-operative progress of non-communicating IAC.%目的 探讨囊肿脑池造瘘术治疗儿童中颅窝蛛网膜囊肿(intracranial arachnoid cyst,IAC)的效果及MRI相位对比电影(phase-contrast cine,PC cine)用于囊肿分型诊断及术后疗效评估的价值.方法 对28例中颅窝IAC患儿行PC cine检查,选择非交通性蛛网膜囊肿(non-communicating intracranial arachnoid cysts,NCIAC)的患儿,行显微镜下囊肿脑池造瘘术.回顾分析术前术后临床表现、术后随

  16. 颅内非感染性囊肿的MRI诊断及鉴别诊断研究%DIAGNOSIC AND DIFFERENTIAL DIAGNOSIC STUDY OF INTRACRANIAL NONINFECTIOUS CYSTS BY MRI

    Institute of Scientific and Technical Information of China (English)

    葛丽红; 牛广明; 韩晓东

    2011-01-01

    Objective :To explore the characteristic MRI findings of intracranial noninfectious cysts and guide clinic diagnosis and differential diagnosis.Methods: 170 intracranial noninfectious cysts having complete clinical data and partly verified by operation and pathology were analyzed.To detect cyst 's location, shape, MRI signal feature.Results :92 arachnoid, 53 located in cysts middle cranial fossa.24 epidermoid cysts, 22 located in cerebellopontine angle cistern, DWI all showed hyperintensity; 14pineal cysts.14 located in pineal gland.12 enlarged perivascular space(PVS), 10 located in basal/midbrain.10 Rathke cleft cysts, 10 located in sellar or suprasella.8 perencephalic cysts, 8 located in cerebral hemispheres.5 neuroglial cysts, 5 located in temporal lobe.4 ependymal cysts, 4 located in lateral ventricle.1 choroid plexus cysts, 1 located in lateral ventricle, arachnoid, PVS, neuroglia, ependyma, porencephalic cysts demonstrated markedly hypointensity on FLAIR, the others showed slightly hypointensity.Conclusion:Arachnoid cysts are common,the cyst' position, DWI and FLAIR are important for differential diagnosis.%目的:探讨颅内非感染性囊肿MRI影像特点,用以指导临床诊断及鉴别诊断.方法:回顾性分析170例颅内非感染性囊肿的MRI资料,其中部分囊肿经手术或病理证实,总结病变发病部位、形态、MRI信号特点.结果:92例蛛网膜囊肿,位于中颅窝颞前部53例;表皮样囊肿24例,22例位于桥前池或桥小脑角区,DWI均表现为高信号;14例松果体囊肿,全部位于松果体区;12例血管周围间隙,10例位于底节区或中脑;10例Rathke裂囊肿,均位于鞍内或鞍上;8例脑穿通畸形,均位于大脑半球;5例脉络膜裂囊肿,均位于颞叶;4例室管膜囊肿,均位于侧脑室三角区;1例脉络丛囊肿位于侧脑室三角区.蛛网膜囊肿、血管周围间隙、脑穿通畸形、脉络膜裂囊肿、室管膜囊肿内液体FLAIR序列上被抑制,表皮样囊肿、松果

  17. Glossopharyngeal neuralgia: MR findings

    International Nuclear Information System (INIS)

    Objective: To investigate the possibility of MRI on visualizing the relationship between glossopharyngeal nerve and surrounding vessels, and to evaluate the significance of MRI in the diagnosis and treatment of glossopharyngeal neuralgia. Methods: MRI findings were analyzed retrospectively in 12 patients with glossopharyngeal neuralgia, and were compared with surgical findings and effect of pain relief. Results: The artery compression or contact of the glossopharyngeal entry zone, as revealed during operation in 10 patients with glossopharyngeal neuralgia, was visualized on MRI in 9 and not seen in 1. The venous compression of the glossopharyngeal entry zone was not identified on MRI in 1. The conglutinative arachnoids of the glossopharyngeal entry, zone was not visualized on MRI in 1. MRI demonstrated the affected glossopharyngeal nerve root entry zone was compressed or contacted by the posterior inferior cerebellar artery. (PICA) in 8 patients and by the vertebral artery in 1 patient. One patient's offending vessel was confirmed to be the anterior inferior cerebellar artery (AICA) by the operation, and the surgical findings were corresponded with MRI in others. Vascular compression or' contact of the affected glossopharyngeal nerve was not visualized on MRI in 3 patients, and operation confirmed that the glossopharyngeal nerve root entry zone was compressed by unknown artery in 1, by small vein in 1, and by conglutinative arachnoids in 1, respectively. Eight patients presented with symptoms of the ipsilateral trigeminal neuralgia concurrently. The compression of the affected trigeminal nerve root by superior cerebellar artery (SCA) was visualized on MRI in 6 patients, and operation did not reveal the source of artery compression in 1 and corresponded with MRI findings in other 5 cases. Vascular compression of affected trigeminal nerve was not visualized on MRI in 2 patients, and intraoperative inspection revealed that trigeminal nerve root was compressed by

  18. Fetal Central Nervous System Anomalies Detected by Magnetic Resonance Imaging: A Two-Year Experience

    Directory of Open Access Journals (Sweden)

    Sepideh Sefidbakht

    2016-06-01

    Full Text Available Background Magnetic resonance imaging (MRI is gradually becoming more common for thorough visualization of the fetus than ultrasound (US, especially for neurological anomalies, which are the most common indications for fetal MRI and are a matter of concern for both families and society. Objectives We investigated fetal MRIs carried out in our center for frequency of central nervous system anomalies. This is the first such report in southern Iran. Materials and Methods One hundred and seven (107 pregnant women with suspicious fetal anomalies in prenatal ultrasound entered a cross-sectional retrospective study from 2011 to 2013. A 1.5 T Siemens Avanto scanner was employed for sequences, including T2 HASTE and Trufisp images in axial, coronal, and sagittal planes to mother’s body, T2 HASTE and Trufisp relative to the specific fetal body part being evaluated, and T1 flash images in at least one plane based on clinical indication. We investigated any abnormality in the central nervous system and performed descriptive analysis to achieve index of frequency. Results Mean gestational age ± standard deviation (SD for fetuses was 25.54 ± 5.22 weeks, and mean maternal age ± SD was 28.38 ± 5.80 years Eighty out of 107 (74.7% patients who were referred with initial impression of borderline ventriculomegaly. A total of 18 out of 107 (16.82% patients were found to have fetuses with CNS anomalies and the remainder were neurologically normal. Detected anomalies were as follow: 3 (16.6% fetuses each had the Dandy-Walker variant and Arnold-Chiari II (with myelomeningocele. Complete agenesis of corpus callosum, partial agenesis of corpus callosum, and aqueductal stenosis were each seen in 2 (11.1% fetuses. Arnold-Chiari II without myelomeningocele, anterior spina bifida associated with neurenteric cyst, arachnoid cyst, lissencephaly, and isolated enlarged cisterna magna each presented in one (5.5% fetus. One fetus had concomitant schizencephaly and complete

  19. Increased leakage of brain antigens after traumatic brain injury and effect of immune tolerance induced by cells on traumatic brain injury

    Institute of Scientific and Technical Information of China (English)

    YAN Hua; ZHANG Hong-wei; WU Qiao-li; ZHANG Guo-bin; LIU Kui; ZHI Da-shi; HU Zhen-bo; ZENG Xian-wei

    2012-01-01

    Background Although traumatic brain injury can lead to opening the blood-brain barrier and leaking of blood substances (including water) into brain tissue,few studies of brain antigens leaking into the blood and the pathways have been reported.Brain antigens result in damage to brain tissues by stimulating the immune system to produce anti-brain antibodies,but no treatment has been reported to reduce the production of anti-brain antibodies and protect the brain tissue.The aim of the study is to confirm the relationship between immune injury and arachnoid granulations following traumatic brain injury,and provide some new methods to inhibit the immune injury.Methods In part one,methylene blue was injected into the rabbits' cisterna magna after traumatic brain injury,and concentrations of methylene blue and tumor necrosis factor (TNF)-α in blood were detected to determine the permeability of arachnoid granulations.In part two,umbilical cord mesenchymal stem cells and immature dendritic cells were injected into veins,and concentrations of interleukin 1 (IL-1),IL-10,interferon (IFN)-y,transforming growth factor (TGF)-β,anti-brain antibodies (ABAb),and IL-12 were measured by ELISA on days 1,3,7,14 and 21 after injury,and the numbers of leukocytes in the blood were counted.Twenty-one days after injury,expression of glutamate in brain tissue was determined by immunohistochemical staining,and neuronal degeneration was detected by H&E staining.Results In part one,blood concentrations of methylene blue and TNF-α in the traumatic brain injury group were higher than in the control group (P <0.05).Concentrations of methylene blue and TNF-α in the trauma cerebrospinal fluid (CSF)injected group were higher than in the control cerebrospinal fluid injected group (P <0.05).In part two,concentrations of IL-1,IFN-y,ABAb,IL-12,expression of glutamate (Glu),neuronal degeneration and number of peripheral blood leukocytes were lower in the group with cell treatment compared to the

  20. The pathogeny and microsurgery treatment of glossopharyngeal neuralgia(a report of 9 cases)%舌咽神经痛的病因与显微手术治疗(附9例临床分析)

    Institute of Scientific and Technical Information of China (English)

    郭红军; 王虎山

    2011-01-01

    目的 探讨舌咽神经痛的发病因为和神经根切断术治疗效果.方法 对9例舌咽神经痛患者,经乙状窦后进路行桥小脑角探查并舌咽神经切断术.结果 9例患者中,6例术中探查发现有4例小脑上动脉压迫,2例神经根部蛛网膜增厚粘连者只行舌咽神经切断术.3例术中探查未见责任血管压迫和蛛网膜者增厚粘连,行舌咽神经根及迷走神经根上部1~2根丝切断术.术后疼痛症状均消失.结论 舌咽神经血管压迫和蛛网膜增厚粘连可能是舌咽神经痛的发病因为,但不是唯一因为;舌咽神经根切断术疗效肯定.%Objective To investigate the etiopathogenesis of glossopharyngeal neuralgia,and to research the curative effect of rhizotomy. Methods Nine patients with glossopharyngeal neuralgia were treated by operation in which the glossopharyngeal nerves were explored and sectioned. Results 4 of 9 patients were explored that their glossopharyngeal nerve were compressed by the posterior inferior cerebellar arteries. 2 of 9 patients were adhered by thickening arachnoid,they were treated by glossopharyngeal neuralgia rhizotomy, and 3 of 9 patients were neither,They were severed 1-2 branch superior part of pneumogastric nerve on the basis of glossopharyngeal nerves rhizotomy. 9 patients algesic symptom disappear after operation. Conclusion Vascular compression and arachnoid adhesion may be the causes of glossopharyngeal neuralgia,but not the only one. The curative effect of section of glossopharyngeal nerve is sure.

  1. Syringomyelia associated with cervical spondylosis: A rare condition.

    Science.gov (United States)

    Landi, Alessandro; Nigro, Lorenzo; Marotta, Nicola; Mancarella, Cristina; Donnarumma, Pasquale; Delfini, Roberto

    2013-06-16

    , finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these "complications" of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.

  2. Diffusion-weighted images of intracranial cyst-like lesions

    Energy Technology Data Exchange (ETDEWEB)

    Bergui, M.; Zhong, J.; Sales, S. [Dept. of Neuroradiology, University of Turin (Italy); Bradac, G.B. [Dept. of Neuroradiology, University of Turin (Italy); Neuroradiologia Universitaria, Ospedale S. G. Battista, Turin (Italy)

    2001-10-01

    Magnetic resonance sequences may be designed to evaluate the diffusion movements of the protons (diffusion-weighted images, DWI). In these images, a bright signal identifies a region where the diffusion along a spatial axis is restricted. The contents of a cystic lesion frequently have the signal intensities of a generic homogeneous hyperproteinic fluid (hypointensity in T1-, hyperintensity in T2-weighted images). DWI may give further information about the microscopic organisation of these fluids: a hyperintense signal indicates the presence of a restricted diffusion, due to some kind of microscopic organisation, at the cellular or macromolecular level. This may provide additional information useful for clinical purposes. We obtained DWI in 24 consecutive patients with intracranial cystic lesions, (19 intra-axial: five abscesses, five gliomas, six metastases, two demyelinating lesions, one neurocysticercosis; five extra-axial: two arachnoid cysts, two epidermoid cysts, one cholesteatoma). We found a strongly hyperintense signal, indicating restricted diffusion, in brain abscesses, epidermoid cysts and cholesteatoma; all the remaining lesions were hypointense or mildly hyperintense. We found these data useful in critical diagnoses, such as in differentiating abscesses from tumours, and in identifying elusive tumours such as epidermoid cysts. (orig.)

  3. Computed tomograms of the newborn

    International Nuclear Information System (INIS)

    Computed tomograms (CT) from 204 cases of premature and full term infants were studied. 1) In 70 infants of hyaline membrane disease, primary apnea and asymptomatic transient hypoglycemia and hypocalcemia, without any abnormal CT findings such as intracranial hemorrhage, periventricular lucency was found in 65 cases (93%) and a wide extracerebral space of the temporal lobes was found in 60 cases (86%) before 44 weeks of gestation. A wide interhemispheric fissure was found in 11 cases of extremely premature infants before term. Periventricular lucency and a wide extracerebral space of temporal lobes may not be the result of the intracranial pathological changes, but they may represent a stage of brain development. 2) In 204 cases, intracranial hemorrhage was found in 39 cases; intra ventricular 14 cases, subependymal 2 cases, intracerebral 4 cases, subarachnoid 19 cases. CT was useful in evaluating the site and extent of hemorrhage. Among 14 cases of intraventricular hemorrhage, 9 cases with massive hemorrhage died and 2 cases had developmental retardation. Other intracranial pathologic changes included hydrocephalus (17 cases), arachnoid cyst (3 cases), and agenesis of corpus callosum (1 case). Diffuse low density of the cerebral cortex was found in 8 cases. Two cases died and 5 cases had developmental retardation. Early ventricular dilatation was found in 19 cases, 2 with intravfouricularhemorrhage and 5 with diffuse low density of the cerebral cortex. Among them 11 cases had developmental retardation. Neurological prognosis was poor in infants with massive intraventricular hemorrhage, diffuse low density of the cerebral cortex and early ventricular dilatation. (author)

  4. Imaging findings in patients with ventral dural defects and herniation of neural tissue

    Energy Technology Data Exchange (ETDEWEB)

    Baur, A.; Staebler, A.; Reiser, M. [Department of Diagnostic Radiology, Klinikum Grosshadern, Ludwig-Maximilians-Universitaet, Marchioninistrasse 15, D-81 377 Munich (Germany); Psenner, K. [Department of Diagnostic Radiology, Allgemeines Regionalkrankenhaus Bozen (Italy); Hamburger, C. [Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-Universitaet, Marchioninistrasse 15, D-81 377 Munich (Germany)

    1997-10-01

    The aim of this paper is to describe clinical and imaging findings in three patients with ventral dural defects and herniation of the spinal cord or cauda equina. The literature is reviewed and the clinical, radiological and operative findings are compared. Three patients with ventral dural defects of different etiologies are presented. One patient gave a longstanding history of ankylosing spondylitis, the second patient presents 37 years after spinal trauma, and the third patient presents with spontaneous spinal cord herniation. All patients had typically slowly progressive neurological symptoms with multiple hospitalizations until diagnosis was made. Characteristic findings in postmyelographic CT included a ventral or ventrolateral displacement with deformation of the spinal cord or the cauda equina. Sagittal MRI showed this abrupt and localized anterior deviation of the spinal cord or the cauda equina to the posterior portions of a vertebral body with or without a bony vertebral defect optimally. Additionally, due to the ventral displacement of the spinal cord, the dorsal subarachnoid space was relatively enlarged without evidence of an arachnoid cyst, in all patients. Magnetic resonance imaging and postmyelographic CT can diagnose ventral dural defects with spinal cord herniation or nerve root entrapment. Dural defects must be considered in the presence of neurological symptoms in cases of longstanding ankylosing spondylitis, late sequelae of fractures of vertebral bodies, and without history of spinal trauma or surgery. (orig.). With 3 figs.

  5. Histopathological and Immunohistochemical Evaluation of Meningiomas with Reference to Proliferative Markers p53 and Ki-67

    Science.gov (United States)

    Telugu, Ramesh Babu; Rukmangadha, Nandyala; Patnayak, Rashmi; Phaneendra, Bobbidi Venkata; Prasad, Bodapati Chandra Mowliswara; Reddy, Mandyam Kumaraswamy

    2016-01-01

    Introduction Meningiomas are slow growing primary central nervous system (CNS) tumours attached to the duramater, which arise from the meningothelial cells of the arachnoid. Grading of meningioma based on histological findings assisted with supplementary immunohistochemical studies, predicts the prognosis of meningioma with good precision. Aim To evaluate proliferative markers and correlate with various histological subtypes and grade. Materials and Methods A total of 224 meningiomas, diagnosed between January1995 and October 2011were graded according to WHO 2007 criteria. Immunostaining for p53 and Ki-67 markers were performed on 100 cases. Results There was female predominance. There were 194 Grade I, 24 Grade II and 6 Grade III meningiomas. Brain invasion noted in 18(8%) meningiomas predominantly in grade III followed by grade II. Recurrence was seen in 7 (3.1%) cases, most common in psammomatous followed by angiomatous meningioma. Immunostaining showed p53 positivity in 72.5% of grade I, 83.3% of grade II and all the cases of grade III tumours. Ki-67 Labelling Index (LI) consistently increased from grade I to grade III tumours. Conclusion p53 and Ki-67 LI correlated well with increasing histological grade and biological behaviour of meningioma. PMID:26894073

  6. Host-pathogen interactions in bacterial meningitis.

    Science.gov (United States)

    Doran, Kelly S; Fulde, Marcus; Gratz, Nina; Kim, Brandon J; Nau, Roland; Prasadarao, Nemani; Schubert-Unkmeir, Alexandra; Tuomanen, Elaine I; Valentin-Weigand, Peter

    2016-02-01

    Bacterial meningitis is a devastating disease occurring worldwide with up to half of the survivors left with permanent neurological sequelae. Due to intrinsic properties of the meningeal pathogens and the host responses they induce, infection can cause relatively specific lesions and clinical syndromes that result from interference with the function of the affected nervous system tissue. Pathogenesis is based on complex host-pathogen interactions, some of which are specific for certain bacteria, whereas others are shared among different pathogens. In this review, we summarize the recent progress made in understanding the molecular and cellular events involved in these interactions. We focus on selected major pathogens, Streptococcus pneumonia, S. agalactiae (Group B Streptococcus), Neisseria meningitidis, and Escherichia coli K1, and also include a neglected zoonotic pathogen, Streptococcus suis. These neuroinvasive pathogens represent common themes of host-pathogen interactions, such as colonization and invasion of mucosal barriers, survival in the blood stream, entry into the central nervous system by translocation of the blood-brain and blood-cerebrospinal fluid barrier, and induction of meningeal inflammation, affecting pia mater, the arachnoid and subarachnoid spaces. PMID:26744349

  7. A CLINICAL AND EPIDEMIOLOGICAL STUDY OF MENINGEAL TUMORS

    Directory of Open Access Journals (Sweden)

    Channappa

    2016-01-01

    Full Text Available INTRODUCTION The meninges surround and protect the central nervous system. They are composed of connective tissue proper and comprise three membranes the dura mater, the arachnoid and the pia mater. These membranes are composed of collagen fibres, a small number of elastic fires and endothelial cells. The incidence of intracranial tumors depends on the sources and methods used to collect the data. The general consensus is that the annual incidence rate of primary intracranial neoplasm is between 10 and 12 per 100,000 and these constitute approximately 9% of all primary cancers. AIMS AND OBJECTIVES The aim is to study the most common signs that the patient presents in the clinic and to study the epidemiology of the disease. The material used in this study was obtained from 100 cases of intracranial tumours in various colleges of South of India, which I have worked. The sample was obtained over a period of 5 years from May 2007 to May 2012. The most common symptoms that were found in the present study was consistent headache and projectile vomiting. There were 9 grade 1 meningiomas, out of which 5 were meningothelial, microscopically composed of meningothelial cells with ovoid large pale nuclei with vacuoles of cytoplasmic invagination and inconspicuous cytoplasmic borders, the cells are arranged concentrically around calcified blood vessels or connective tissue.

  8. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance

    International Nuclear Information System (INIS)

    To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients' symptoms and clinical findings were recorded. Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. (orig.)

  9. Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?

    Directory of Open Access Journals (Sweden)

    Deb Kumar Mojumder

    2014-01-01

    Full Text Available Hyperdensity in the middle cerebral artery (MCA or posterior cerebral artery (PCA on non-contrast head CT, suggests the presence of a thrombus inside these vessels, often referred to as the "MCA sign" or "PCA sign" respectively. These two signs are classically associated with strokes secondary to cardiovascular etiologies and are only infrequently reported with other types of stroke. Whereas stroke is a recognized complication of pneumococcal meningitis hyperdense large vessel sign (in this case a combination of MCA and PCA has not been previously reported. We report a case of rapidly progressive pneumococcal meningitis that presented as acute stroke involving large vessels in the vicinity of the circle of Willis in a patient with a history of non-Hodgkin lymphoma (NHL in remission for 6 years. This patient had received a week of high dose steroids before admission. Head CT scan on admission showed the presence of hyperdense MCA and PCA signs. The patient rapidly deteriorated and a follow-up head CT revealed diffuse brain edema and increased density in the basal cisterns without evidence of sub arachnoid hemorrhage.Tc99m exametazime brain flow scan showed no intracerebral blood flow both supra and infratentorially. Steptococcus pneumoniae, NHL cells and high-dose steroid use can upregulate tissue factor synthesis and may have led to a hypercoagulable state via activation of the extrinsic pathway in the large intracerbral arteries.

  10. Dose distribution to spinal structures from intrathecally administered yttrium-90

    Energy Technology Data Exchange (ETDEWEB)

    Mardirossian, George [Oklahoma University Health Sciences Center, 825 N.E. 10th Street, OUPB 1430 Oklahoma City, OK 73104 (United States); Hall, Michael [Oklahoma University Health Sciences Center, 825 N.E. 10th Street, OUPB 1430 Oklahoma City, OK 73104 (United States); Montebello, Joseph [Ohio State University Department of Radiation Oncology, 300 W 10th Avenue, Columbus, OH 43210 (United States); Stevens, Patrick [Oklahoma University Health Sciences Center, 825 N.E. 10th Street, OUPB 1430 Oklahoma City, OK 73104 (United States)

    2006-01-07

    Previous treatment of cerebrospinal fluid (CSF) malignancies by intrathecal administration of {sup 131}I-radiolabelled monoclonal antibodies has led to the assumption that more healthy tissue will be spared when a pure beta-emitter such as {sup 90}Y replaces {sup 131}I. The purpose of this study is to compare and quantitatively evaluate the dose distribution from {sup 90}Y to the CSF space and its surrounding spinal structures to {sup 131}I. A 3D digital phantom of a section of the T-spine was constructed from the visible human project series of images which included the spinal cord, central canal, subarachnoid space, pia mater, arachnoid, dura mater, vertebral bone marrow and intervertebral disc. Monte Carlo N-particle (MCNP4C) was used to model the {sup 90}Y and {sup 131}I radiation distribution. Images of the CSF compartment were convolved with the radiation distribution to determine the dose within the subarachnoid space and surrounding tissues. {sup 90}Y appears to be a suitable radionuclide in the treatment of central nervous system (CNS) malignancies when attached to mAb's and the dose distribution would be confined largely within the vertebral foramen. This choice may offer favourable dose improvement to the subarachnoid and surface of spinal cord over {sup 131}I in such an application.

  11. Laminectomy-induced arachnoradiculitis: a postoperative serial MRI study

    Energy Technology Data Exchange (ETDEWEB)

    Matsui, H. [Departments of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Faculty of Medicine, Toyama (Japan); Tsuji, H. [Departments of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Faculty of Medicine, Toyama (Japan); Kanamori, M. [Departments of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Faculty of Medicine, Toyama (Japan); Kawaguchi, Y. [Departments of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Faculty of Medicine, Toyama (Japan); Yudoh, K. [Departments of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Faculty of Medicine, Toyama (Japan); Futatsuya, R. [Departments of Radiology, Toyama Medical and Pharmaceutical University, Faculty of Medicine, Toyama (Japan)

    1995-11-01

    Time-related changes of laminectomy-induced cauda equina adhesions were investigated by MRI in ten patients with degenerative spinal disease who underwent posterior surgery to the lumbar spine; seven had disc herniations and three spinal stenosis. Axial MRI was performed before and 3, 7, 21 and 42 days after surgery. Cauda equina adhesions were most severe at the laminectomised levels L3-4, L4-5 and L5-S1 (n = 16); partial adhesions were found in 9 of 16 levels at 6 weeks after surgery. At the L3-4 or L5-S1 levels (n = 14), the area of laminar exposure without laminectomy, the cauda equina adhesions continued 1 week after surgery, but thereafter resolved; only partial adhesions were seen at 5 of 14 levels 6 weeks after surgery. Shrinkage of the arachnoid sac was also found at the level of the laminectomy, but it re-expanded 3 weeks after surgery in all cases. Cauda equina adhesions and shrinkage of the sac were correlated closely with laminectomy, with or without discectomy, suggesting that an inflammatory process of deep wound healing may be involved in the mechanism of a laminectomy-induced arachnoradiculitis which may be correlated with postoperative leg symptoms. (orig.). With 7 figs., 1 tab.

  12. Dynamic oxygen-enhanced MRI of cerebrospinal fluid.

    Directory of Open Access Journals (Sweden)

    Taha M Mehemed

    Full Text Available Oxygen causes an increase in the longitudinal relaxation rate of tissues through its T1-shortening effect owing to its paramagnetic properties. Due to such effects, MRI has been used to study oxygen-related signal intensity changes in various body parts including cerebrospinal fluid (CSF space. Oxygen enhancement of CSF has been mainly studied using MRI sequences with relatively longer time resolution such as FLAIR, and T1 value calculation. In this study, fifteen healthy volunteers were scanned using fast advanced spin echo MRI sequence with and without inversion recovery pulse in order to dynamically track oxygen enhancement of CSF. We also focused on the differences of oxygen enhancement at sulcal and ventricular CSF. Our results revealed that CSF signal after administration of oxygen shows rapid signal increase in both sulcal CSF and ventricular CSF on both sequences, with statistically significant predominant increase in sulcal CSF compared with ventricular CSF. CSF is traditionally thought to mainly form from the choroid plexus in the ventricles and is absorbed at the arachnoid villi, however, it is also believed that cerebral arterioles contribute to the production and absorption of CSF, and controversy remains in terms of the precise mechanism. Our results demonstrated rapid oxygen enhancement in sulcal CSF, which may suggest inhaled oxygen may diffuse into sulcal CSF space rapidly probably due to the abundance of pial arterioles on the brain sulci.

  13. Recurrent back pain after diskectomy: MRI findings MR of the postoperative lumbar spine

    International Nuclear Information System (INIS)

    Purpose: To show the morphological changes in postoperative lumbar spine. Material and methods: We reviewed 128 Magnetic Resonance Imaging (MRI) studies of lumbar spine. All patients complained of low back pain and had a previous lumbar surgery (1 month to 8 years). All the examinations include axial and sagittal Gadopentate-dimeglumine enhanced T1 weighted imaging. Results: Only 7,8% have the normal appearance of the postoperative lumbar spine. Epidural scar was found in 69% of examinations; of this group, 72% showed radicular involvement, and 28% had no radicular involvement. Recurrent disc herniation was found in 14,8% of exams, using gadopentate-dimeglumine to assist the differentiation from epidural fibrosis; infections like spondylodiscitis and abscess in 12,5%. Other findings included arachnoiditis, pseudomeningoceles and seromas. Conclusions: MRI is a useful method to study the postoperative lumbar spine, specially when enhanced with gadopentate-dimeglumine. Enhanced images can differentiate two of the major complication like epidural fibrosis, and recurrent disc herniation. Spondylodiscitis are important and frequent too. Although the findings of complications in our series in the postoperative lumbar spine represent 92,18 %, these not always explain the symptomatology. Therefore, the interrelation is important with the surgeon to determine which abnormalities are clinically significant. (authors)

  14. Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications

    Directory of Open Access Journals (Sweden)

    Timothy J Kovanda

    2014-01-01

    Full Text Available Background: A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA, which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex. Methods: In this article, the authors describe technical nuances to improve the safety of SA. Results: Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation. Conclusion: SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy.

  15. An enlarged parietal foramen in the late archaic Xujiayao 11 neurocranium from Northern China, and rare anomalies among Pleistocene Homo.

    Directory of Open Access Journals (Sweden)

    Xiu-Jie Wu

    Full Text Available We report here a neurocranial abnormality previously undescribed in Pleistocene human fossils, an enlarged parietal foramen (EPF in the early Late Pleistocene Xujiayao 11 parietal bones from the Xujiayao (Houjiayao site, northern China. Xujiayao 11 is a pair of partial posteromedial parietal bones from an adult. It exhibits thick cranial vault bones, arachnoid granulations, a deviated posterior sagittal suture, and a unilateral (right parietal lacuna with a posteriorly-directed and enlarged endocranial vascular sulcus. Differential diagnosis indicates that the perforation is a congenital defect, an enlarged parietal foramen, commonly associated with cerebral venous and cranial vault anomalies. It was not lethal given the individual's age-at-death, but it may have been associated with secondary neurological deficiencies. The fossil constitutes the oldest evidence in human evolution of this very rare condition (a single enlarged parietal foramen. In combination with developmental and degenerative abnormalities in other Pleistocene human remains, it suggests demographic and survival patterns among Pleistocene Homo that led to an elevated frequency of conditions unknown or rare among recent humans.

  16. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Battal, Bilal; Hamcan, Salih; Akgun, Veysel; Sari, Sebahattin; Tasar, Mustafa [Gulhane Military Medical School, Department of Radiology, Ankara (Turkey); Oz, Oguzhan [Gulhane Military Medical School, Department of Neurology, Ankara (Turkey); Castillo, Mauricio [University of North Carolina School of Medicine, Division of Neuroradiology, Department of Radiology, Chapel Hill, NC (United States)

    2016-06-15

    To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients' symptoms and clinical findings were recorded. Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. (orig.)

  17. Managing leptomeningeal melanoma metastases in the era of immune and targeted therapy.

    Science.gov (United States)

    Smalley, Keiran S M; Fedorenko, Inna V; Kenchappa, Rajappa S; Sahebjam, Solmaz; Forsyth, Peter A

    2016-09-15

    Melanoma frequently metastasizes to the brain, with CNS involvement being clinically evident in ∼30% of patients (as high as 75% at autopsy). In ∼5% cases melanoma cells also metastasize to the leptomeninges, the sub-arachnoid space and cerebrospinal fluid (CSF). Patients with leptomeningeal melanoma metastases (LMM) have the worst prognosis and are characterized by rapid disease progression (mean survival 8-10 weeks) and a death from neurological causes. The recent years have seen tremendous progress in the development of targeted and immune therapies for melanoma that has translated into an increased survival benefit. Despite these gains, the majority of patients fail therapy and there is a suspicion that the brain and the leptomeninges are a "sanctuary" sites for melanoma cells that escape both targeted therapy and immunologic therapies. Emerging evidence suggests that (1) Cancer cells migrating to the CNS may have unique molecular properties and (2) the CNS/leptomeningeal microenvironment represents a pro-survival niche that influences therapeutic response. In this Mini-Review, we will outline the clinical course of LMM development and will describe how the intracranial immune and cellular microenvironments offer both opportunities and challenges for the successful management of this disease. We will further discuss the latest data demonstrating the potential use of BRAF inhibitors and immune therapy in the management of LMM, and will review future potential therapeutic strategies for the management of this most devastating complication of advanced melanoma. PMID:27084046

  18. Supracerebellar infratentorial sitting craniotomy for a pinealoblastoma.

    Science.gov (United States)

    Choudhri, Omar; Chang, Steven D

    2016-01-01

    Pinealoblastomas are WHO grade IV tumors of the pineal region and comprise up to 50% of all pineal parenchymal tumors. They are highly aggressive tumors that spread along the craniospinal axis and are most commonly seen in children. The standard of care involves maximal surgical resection and chemoradiation following tissue diagnosis. We present the rare case of a large pinealoblastoma in an 18-year-old girl who presented with headaches and Parinaud's syndrome from tectal compression. An attempt was made at endoscopic transventricular biopsy of the tumor at an outside hospital, but it was aborted given bleeding at the biopsy site. We performed a supracerebellar infratentorial approach in a sitting position to achieve a gross-total resection of the tumor. This video case illustrates techniques for setting up a sitting craniotomy and approaching a previously biopsied hemorrhagic pinealoblastoma. The venous conglomerate at the tentorial incisura was found to be enveloped by the tumor and a thickened arachnoid scar. Surgical anatomy of the third ventricle and the pineal region is illustrated in this case through the process of surgical dissection and tumor resection. The video can be found here: https://youtu.be/CzB0lFQ7AyI .

  19. Incidental findings on magnetic resonance imaging in patients with tinnitus

    Directory of Open Access Journals (Sweden)

    Parmod Kalsotra

    2015-01-01

    Full Text Available Introduction: Tinnitus is "a sound in one ear or both ears, such as buzzing, ringing, or whistling, occurring without an external stimulus." Magnetic resonance imaging (MRI is a well-established, cost-effective investigation for the patients with tinnitus. Aim: The purpose of the study was to define the frequency of incidental findings on MRI scans, of patients with a history of tinnitus but with normal clinical examination, audiometry and otoacoustic emissions. Materials and Methods: A total of 62 patients were enrolled for the present study with a history of gradually increasing tinnitus and normal clinical ENT examination. All these patients underwent MRI scan to find out any lesion that would cause tinnitus. Results and Conclusion: In the present study, evaluation of MRI scans of 62 patients with gradually increasing tinnitus was done, with ipsilateral vestibular schwannoma and neurofibromatosis II being diagnosed in 1 patient (1.61% each. Incidental findings were demonstrated in 26 cases (41.93%; with 8 cases (12.90% of white matter lesions, 5 cases (8.66% of vascular anomalies, 3 cases (4.83% of arachnoid cyst, 2 cases (3.22% of empty sella, 4 cases (6.45% of sinus involvement, 2 cases (3.22% of cerebral atrophy and 2 cases (3.22% of vascular infarcts, though none of these findings were serious and neither warranted an urgent surgical intervention but a few cases required assessment by other specialties and were referred accordingly.

  20. Fetal central nervous system anomalies: fast MRI vs ultrasonography

    International Nuclear Information System (INIS)

    Objective: To evaluate the ability of fast MRI to detect fetal central nervous system (CNS) anomalies and to compare its performance with that of prenatal ultrasonography (US). Methods Forty-eight pregnant women were detected by conventional prenatal US and MRI. Twenty-two fetuses with CNS anomalies were conformed by autopsy and follow-up. The MR and US appearances of fetal CNS structure were compared to each other and to that of autopsy. Results: A total of 26 CNS anomalies were identified by autopsy (n=17) and follow-up (n=9) including anencephaly (n=6), rachischisis (n=2), encephalocele (n=3), congenital hydrocephalus (n=7), alobar holoprosencephaly (n=1), porencephalia (n=3), arachnoid cyst (n=2) and choroids plexus cyst (n=2). US diagnosed 24 CNS anomalies, the correct diagnostic rate was 92.3%, the false-positive rate was 3.8%, the missed-diagnostic rate was 3.8%. MRI diagnosed 23 CNS anomalies, the correct-diagnostic rate was 88.5%, the false-positive rate was 3.8% ,the missed-diagnostic rate was 7.7%. There was no difference between US and MRI (P>0.05), but MRI have larger FOV, higher tissues resolution, and can demonstrate gray-white matter in detail. Conclusions: MR imaging has a similar sensitivity to that of US in the detection of fetal CNS anomalies. (authors)

  1. Uptake of amino acids in brain tumours using positron emission tomography as an indicator for assessing metabolic activity and malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Schober, O.; Meyer, G.J.; Duden, C.; Lauenstein, L.; Niggemann, J.; Mueller, J.A.; Hundeshagen, H.; Gaab, M.R.; Dietz, H.; Becker, H.

    1987-11-01

    Diagnosis and post-therapeutic follow-up of tumour patients necessitates morphological and particularly functional imaging methods. For the latter approach positron emission tomography has proven a valid tool for the measurement of perfusion, of energy consumption parameters such as oxygen extraction, glucose metabolism and amino acid uptake. However, neither perfusion nor energy consumption parameters have yielded unambiguous information on the clinical status of various tumours in respect of their malignancy and their growth status. It is shown in this paper that amino acid uptake seems to be a valid measure for the functional activity of tumour tissue for a broad range of neoplasms. The uptake of /sup 11/C-L-Methionine was measured in 33 patients having various brain tumours, and was compared with 6 patients who had an infarction, and with 8 patients suffering from arachnoidal cysts. The amino acid uptake correlated well with the histological grading of the tumours and the clinical status of the patient. The uptake was well differentiated against metabolically inactive lesions. Parallel investigations on the uptake mechanisms of amino acids in an animal model have shown that transport phenomena regulate the uptake rather than protein synthesis rates. However, protein synthesis may nevertheless exercise a control function on the transport process.

  2. Postoperative epidural hematoma contributes to delayed upper cord tethering after decompression of Chiari malformation type I

    Directory of Open Access Journals (Sweden)

    Antonio Lopez-Gonzalez

    2014-01-01

    Full Text Available Background: Symptomatic arachnoiditis after posterior fossa surgical procedures such as decompression of Chiari malformation is a possible complication. Clinical presentation is generally insidious and delayed by months or years. It causes disturbances in the normal flow of cerebrospinal fluid and enlargement of a syrinx cavity in the upper spinal cord. Surgical de-tethering has favorable results with progressive collapse of the syrinx and relief of the associated symptoms. Case Description: A 30-year-old male with Chiari malformation type I was treated by performing posterior fossa bone decompression, dura opening and closure with a suturable bovine pericardium dural graft. Postoperative period was uneventful until the fifth day in which the patient suffered intense headache and progressive loose of consciousness caused by an acute posterior fossa epidural hematoma. It was quickly removed with complete clinical recovering. One year later, the patient experienced progressive worsened of his symptoms. Upper spinal cord tethering was diagnosed and a new surgery for debridement was required. Conclusions: The epidural hematoma compressing the dural graft against the neural structures contributes to the upper spinal cord tethering and represents a nondescribed cause of postoperative fibrosis, adhesion formation, and subsequent recurrent hindbrain compression.

  3. Suboccipital bony decompression combined with removal of the dural band as treatment for Chiari I malformation

    Institute of Scientific and Technical Information of China (English)

    周大彪; 赵继宗; 张东; 赵元立

    2004-01-01

    @@ Chiari I malformation (CMI) is a disorder involving hindbrain maldevelopments characterized by herniation of the cerebellar tonsils through the foramen magnum. The clinical presentations of CMI are related to the direct compression of the brainstem and cerebellum and to disturbances to cerebral spinal fluid (CSF) circulation. Surgical intervention is indicated in symptomatic patients with neuroradiological abnormalities. Though many different surgical options are available, suboccipital decompression has been widely accepted as a preferred procedure with or without additional manipulations.1-11 Nevertheless, any intradural procedures will risk related complications, including meningitis or arachnoiditis, CSF leakage, pseudomeningoceles, vascular injuries, brainstem dysfunction, as well as delayed neurological deterioration. Since the main benefit of surgery for CMI is to arrest the progression of the disease and stabilize the patient's neurological state,2,12 additional procedures seem to be unnecessary. To achieve acceptable therapeutic results for CMI, it is beneficial to perform a simple and effective procedure involving a minimal extent of surgery. The purpose of this article is to present an extradural technique for the modification of suboccipital decompression and to evaluate its efficacy based on clinical and neuroradiological results.

  4. Surgical treatment of type I Chiari malformation: the role of Magendie’s foramen opening e tonsils manipulation

    Directory of Open Access Journals (Sweden)

    Claudio Henrique Fernandes Vidal

    2015-02-01

    Full Text Available The treatment for type 1 Chiari malformation (CM 1 is one of the most controversial topics in the neurosurgical field. The present study evaluated two of the most applied surgical techniques to treat CM 1. Method 32 patients were evaluated and divided in two groups: group 1 had 16 patients that were submitted to decompression of occipital bone and dura mater of the craniovertebral junction (CVJ; group 2 also had 16 patients and in addition to the previous procedure, they were submitted to Magendie’s foramen opening e tonsils manipulation. The comparison between the groups included neurological exam and cerebrospinal fluid flow imaging during pre and postoperative periods. Results Both techniques were equivalents in terms of neurological improvement of the patients (p > 0.05, but the group 2 had more surgical complications, with relative risk of 2.45 (CI 1.55-3.86 for adverse events. Whatever the cerebrospinal fluid flow at CVJ, the patients of the group 1 achieved greater amount of flow than the group 2 (p < 0.05 during the postoperative period. Conclusion The cranial and dural decompression of the CVJ without arachnoidal violation was the best surgical intervention for treatment of CM 1, between these two compared techniques.

  5. Syringomyelia as a presenting feature of shunt dysfunction: Implications for the pathogenesis of syringomyelia

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    Natarajan Muthukumar

    2012-01-01

    Full Text Available The pathogenesis of syringomyelia continues to be an enigma. The patency of the central canal and its role in the pathogenesis of communicating syringomyelia continues to elicit controversy. The case reported here provides an opportunity to retest some of the hypotheses of syringomyelia. A 33 year old female presented with sensory disturbances over the left upper extremity and trunk and was diagnosed to have panventriculomegaly with communicating syringomyelia. She was initially treated with ventriculoperitoneal shunting. As there was no change in her neurological status following shunt, this was followed by foramen magnum decompression with excision of an arachnoid veil covering the fourth ventricular outlet. She had clinical and radiological improvement after foramen magnum decompression. Five months later she had reappearance of the symptoms of syringomyelia and was found to have shunt dysfunction and holocord syrinx. She improved following shunt revision. This case is being reported to highlight the following points: 1. In patients with communicating syringomyelia and hydrocephalus, shunt dysfunction can present with symptoms of syringomyelia without the classical clinical features of shunt dysfunction, 2. In patients with communicating syringomyelia, the central canal of the spinal cord acts as an "exhaust valve" for the ventricular system, and, 3. studies about the patency of the central canal are reviewed in the context of this case and the role of the central canal in the pathogenesis of communicating syringomyelia is reviewed.

  6. Amygdala kindling induces nestin expression in the leptomeninges of the neocortex.

    Science.gov (United States)

    Ninomiya, Shogo; Esumi, Shigeyuki; Ohta, Kunimasa; Fukuda, Takaichi; Ito, Tetsufumi; Imayoshi, Itaru; Kageyama, Ryoichiro; Ikeda, Toshio; Itohara, Shigeyoshi; Tamamaki, Nobuaki

    2013-02-01

    Nestin is an intermediate filament found in neurogenic progenitors and non-neuronal cells. Nestin-immunoreactivity (IR) in the brain often increases after brain damage. Here we show that amygdala kindling, which mimics the epileptic seizures, also induces nestin expression in the brain. Nestin-IR was greatly enhanced in the leptomeninges (pia and arachnoid maters) and neocortical parenchyma, but not much in the SVZ around the lateral ventricle, SGZ in the dentate gyrus, or the endothelial progenitor cells of blood vessels, fimbria, or choroid plexus after kindling. Electron microscopy revealed that nestin-IR in the leptomeninges was localized to granule cells, where it co-localized with GAD67-IR after electrical stimulation. The nestin-positive granule cells in the leptomeninges, especially around the emissary vein, were proliferative. However, nestin-IR in the neocortical parenchyma was expressed in NG2 glia and did not co-localize with GAD67-IR. Deletion of nestin-positive cells resulted in a high susceptibility to electrical stimulation. Consequently, almost all of the mice died or dropped out during kindling progression in 20 days, from naturally generated epileptic seizure or exhaustion. We speculate that the nestin-positive cells activated by amygdala kindling may involve in the protection of the brain from epilepsy.

  7. Medical-surgical treatment of progressive tuberculous (Pott's) paraplegia in Gabon.

    Science.gov (United States)

    Loembe, P M

    1995-10-01

    The present study deals with the results of the medical-surgical treatment of 22 patients with Pott's tetraplegia or paraplegia. Seventeen had progressive tetraplegia-paraplegia which failed to respond solely to medical treatment. On admission, four patients exhibited an acute onset tetraplegia-paraplegia, and one had a 'spinal tumour syndrome'. In addition to antituberculous therapy, seven patients had anterior spinal surgery, consisting of four corporectomies, two anterior debridments and grafting, and one debridment alone. Moreover, one patient had a posterior interbody fusion, four had laminotomies, and 10 had laminectomies. The causes of the spinal cord or cauda equina compression, as was determined at operation, were extradural abscess in eight patients, bony compressions in 11, arachnoiditis in two, and posterior neural arch tuberculosis in one patient. Neurological recovery began between 10 and 21 days postoperatively. The mean length of follow-up was 42.36 months (range 8-144 months). Fourteen patients were found to be functionally and neurologically normal at follow-up examinations (63%). Eighty-two percent recovered sufficiently to walk unaided. Two patients were left paralysed and unable to walk. Two patients were able to get about on crutches. The onset of objective improvement soon after surgical decompression suggests a causal effect. It was concluded that early neural decompression and spinal stabilisation provided the maximum potential for neurological recovery. PMID:8848312

  8. The analysis of MR findings of the postoperative diskitis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Min; Lee, Sang Woo; Huh, Suh Ku; Lee, Kyeong Hee; Kim, Chang Soo [Maryknoll Hospital, Pusan (Korea, Republic of)

    1997-05-01

    To evaluate MR findings of postoperative diskitis following operation for intervertebral disk herniation. Twelve cases with postoperative diskitis following operation for intervertebral disk herniation were included in this study. MR findings of postoperative diskitis were analysed to determine 1)the extent and pattern of alteration of the involved disks, 2)the pattern of destruction of endplates and vertebral bodies, and 3)the pattern of inflammatory extension into the surrounding soft tissue. 1)Disk alteration developed mainly at the middle and posterior portions of the disk, and was characterized by loss of intranuclear cleft at the involved portion of the disk and intranuclear abscess formation 2)Vertebral bodies involved ware symmetrically adjacent to involved disks and in three cases, bone abscesses within the endplates were detected. 3)The extension of inflammation yielded prevertebral or pre-/paravertebral masses(7 cases), epidural abscesses(5 cases), arachnoiditis(6 cases), and inflammatory masses(2 cases) beneath the posterior longitudinal ligament. Disk involvement was mainly at the middle and posterior portions of the disks, and there was accompanying intranuclear cleft loss. Symmetric involvement of the vertebral bodies adjacent to the involved disks was noted.

  9. Spaceflight-Induced Intracranial Hypertension: An Overview

    Science.gov (United States)

    Traver, William J.

    2011-01-01

    This slide presentation is an overview of the some of the known results of spaceflight induced intracranial hypertension. Historical information from Gemini 5, Apollo, and the space shuttle programs indicated that some vision impairment was reported and a comparison between these historical missions and present missions is included. Optic Disc Edema, Globe Flattening, Choroidal Folds, Hyperopic Shifts and Raised Intracranial Pressure has occurred in Astronauts During and After Long Duration Space Flight. Views illustrate the occurrence of Optic Disc Edema, Globe Flattening, and Choroidal Folds. There are views of the Arachnoid Granulations and Venous return, and the question of spinal or venous compliance issues is discussed. The question of increased blood flow and its relation to increased Cerebrospinal fluid (CSF) is raised. Most observed on-orbit papilledema does not progress, and this might be a function of plateau homeostasis for the higher level of intracranial pressure. There are seven cases of astronauts experiencing in flight and post flight symptoms, which are summarized and follow-up is reviewed along with a comparison of the treatment options. The question is "is there other involvement besides vision," and other Clinical implications are raised,

  10. Germline and somatic mutations in meningiomas.

    Science.gov (United States)

    Smith, Miriam J

    2015-04-01

    Meningiomas arise from the arachnoid layer of the meninges that surround the brain and spine. They account for over one third of all primary central nervous system tumors in adults and confer a significant risk of location-dependent morbidity due to compression or displacement. A significant increase in risk of meningiomas is associated with neurofibromatosis type 2 (NF2) disease through mutation of the NF2 gene. In addition, approximately 5% of individuals with schwannomatosis disease develop meningiomas, through mutation of the SWI/SNF chromatin remodeling complex subunit, SMARCB1. Recently, a second SWI/SNF complex subunit, SMARCE1, was identified as a cause of clear cell meningiomas, indicating a wider role for this complex in meningioma disease. The sonic hedgehog (SHH)-GLI1 signaling pathway gene, SUFU, has also been identified as the cause of hereditary multiple meningiomas in a large Finnish family. The recent identification of somatic mutations in components of the SHH-GLI1 and AKT1-MTOR signaling pathways indicates the potential for cross talk of these pathways in the development of meningiomas. This review describes the known meningioma predisposition genes and their links to the recently identified somatic mutations. PMID:25857641

  11. Central nervous system tuberculosis: MRI

    International Nuclear Information System (INIS)

    The MRI findings of 18 proven cases of central nervous system (CNS) tuberculosis were reviewed; 10 patients were seropositive for HIV. All had medical, laboratory, or surgical proof of CNS tuberculosis. Eleven patients had meningitis, of whom two also had arachnoiditis. Five patients had focal intra-axial tuberculomas: four brain masses and one an intramedullary spinal lesion. Two patients had focal extra-axial tuberculomas: one in the pontine cistern, and one in the spine. In all 11 patients with meningitis MRI showed diffuse, thick, meningeal enhancement. All intraparenchymal tuberculomas showed low signal intensity on T2-weighted images and ring or nodular enhancement. The extra-axial tuberculomas had areas isointense or hypointense relative to normal brain and spinal cord on T2-weighted images. Although tuberculous meningitis cannot be differentiated from other meningitides on the basis of MR findings, intraparenchymal tuberculomas show characteristic T2 shortening, not found in most other space-occupying lesions. In the appropriate clinical setting, tuberculoma should be considered. (orig.)

  12. Spontaneous Cervical Intradural Disc Herniation Associated with Ossification of Posterior Longitudinal Ligament

    Directory of Open Access Journals (Sweden)

    Dachuan Wang

    2014-01-01

    Full Text Available Intradural herniation of a cervical disc is rare; less than 35 cases have been reported to date. A 52-year-old man with preexisting ossification of posterior longitudinal ligament developed severe neck pain with Lt hemiparesis while asleep. Neurological exam was consistent with Brown-Séquard syndrome. Magnetic resonance images showed a C5-6 herniated disc that was adjacent to the ossified ligament and indenting the cord. The mass was surrounded by cerebrospinal fluid signal intensity margin, and caudally the ventral dura line appears divided into two, consistent with the “Y-sign” described by Sasaji et al. Cord edema were noted. Because of preexisting canal stenosis and spinal cord at risk, a laminoplasty was performed, followed by an anterior C6 corpectomy. Spot-weld type adhesions of the posterior longitudinal ligament to the dura was noted, along with a longitudinal tear in the dura. An intradural extra-arachnoid fragment of herniated disc was removed. Clinical exam at 6 months after surgery revealed normal muscle strength but persistent mild paresthesias. It is difficult to make a definite diagnosis of intradural herniation preoperatively; however, the clinical findings and radiographic signs mentioned above are suggestive and should alert the surgeon to look for an intradural fragment.

  13. Immunodeficiency, Centromeric instability, Facial anomalies (ICF) syndrome, due to ZBTB24 mutations, presenting with large cerebral cyst

    Science.gov (United States)

    Cerbone, Manuela; Wang, Jun; Van der Maarel, Silvère M.; d’Amico, Alessandra; d’Agostino, Antonio; Romano, Alfonso; Brunetti-Pierri, Nicola

    2012-01-01

    The Immunodeficiency, Centromeric instability, Facial anomalies (ICF) syndrome is an autosomal recessive disease presenting with immunodeficiency secondary to hypo- or agammaglobulinemia, developmental delay, and facial anomalies. Centromeric instability is the cytogenetic hallmark of the disorder which results from targeted chromosomal rearrangements related to a genomic methylation defect. We describe a patient carrying a homozygous mutation of the ZBTB24 gene, which has been recently shown to be responsible for ICF syndrome type 2. Our patient presented with intellectual disability, multiple café-au-lait spots, and a large cerebral arachnoidal cyst. Although laboratory signs of impaired immune function, such as reduced serum IgM were detected, our patient did not present clinical manifestations of immunodeficiency. Brain malformations have not been reported so far in ICF syndrome and it can be speculated that ZBTB24 mutations may alter cerebral development. Nevertheless, we cannot rule out that the presence of the cerebral cyst in the patient is coincidental. In summary, our patient illustrates that clinical evidence of immunodeficiency is not a universal feature of ICF2 syndrome type 2 and suggests that brain malformations may be present in other ICF cases. PMID:22786748

  14. MRI of the hypothalamic-pituitary axis in children

    Energy Technology Data Exchange (ETDEWEB)

    Argyropoulou, Maria I. [University of Ioannina, Department of Radiology, Medical School, Ioannina (Greece); Kiortsis, Dimitrios Nikiforos [University of Ioannina, Department of Physiology, Medical School, Ioannina (Greece)

    2005-11-01

    In childhood, the MR characteristics of the normal pituitary gland are well established. During the first 2 months of life the adenohypophysis demonstrates high signal. Pituitary gland height (PGH) decreases during the 1st year of life and then increases, reaching a plateau after puberty. The magnetization transfer ratio (MTR) increases in both sexes up to the age of 20 years. On dynamic contrast-enhanced studies, the posterior pituitary lobe enhances simultaneously with the straight sinus, and the adenohypophysis later, but within 30 s. In genetically determined dysfunctional states, the adenohypophysis may be normal, hypoplastic, or enlarged. Pituitary enlargement, observed in Prop 1 gene mutations, is characterized by a mass interposed between the anterior and posterior lobes. An ectopic posterior lobe (EPP), associated with a hypoplastic or absent pituitary stalk, may be observed in patients with hypopituitarism. Tumors of the hypothalamic-pituitary (HP) axis may be the origin of adenohypophyseal deficiencies. A small hypointense adenohypophysis is found in iron overload states and is often associated with hypogonadotrophic hypogonadism. Absence of the posterior lobe bright signal, with or without a thick pituitary stalk or a mass at any site from the median eminence to the posterior pituitary lobe, may be found in diabetes insipidus. Hydrocephalus, suprasellar arachnoid cysts, hypothalamic hamartomas and craniopharyngiomas may result in central precocious puberty (CPP). Increased PGH in girls with idiopathic CPP is useful for its differential diagnosis from premature thelarche (PT). Pituitary adenomas, observed mainly in adolescents, present the same MR characteristics as those in adults. (orig.)

  15. Segmentation of brain parenchyma and cerebrospinal fluid in multispectral magnetic resonance images.

    Science.gov (United States)

    Lundervold, A; Storvik, G

    1995-01-01

    Presents a new method to segment brain parenchyma and cerebrospinal fluid spaces automatically in routine axial spin echo multispectral MR images. The algorithm simultaneously incorporates information about anatomical boundaries (shape) and tissue signature (grey scale) using a priori knowledge. The head and brain are divided into four regions and seven different tissue types. Each tissue type c is modeled by a multivariate Gaussian distribution N(mu(c),Sigma(c)). Each region is associated with a finite mixture density corresponding to its constituent tissue types. Initial estimates of tissue parameters {mu(c),Sigma(c )}(c=1,...,7) are obtained from k-means clustering of a single slice used for training. The first algorithmic step uses the EM-algorithm for adjusting the initial tissue parameter estimates to the MR data of new patients. The second step uses a recently developed model of dynamic contours to detect three simply closed nonintersecting curves in the plane, constituting the arachnoid/dura mater boundary of the brain, the border between the subarachnoid space and brain parenchyma, and the inner border of the parenchyma toward the lateral ventricles. The model, which is formulated by energy functions in a Bayesian framework, incorporates a priori knowledge, smoothness constraints, and updated tissue type parameters. Satisfactory maximum a posteriori probability estimates of the closed contour curves defined by the model were found using simulated annealing. PMID:18215837

  16. Fetal magnetic resonance imaging in prenatal diagnosis of central nervous system abnormalities

    International Nuclear Information System (INIS)

    The diagnostic value of fetal magnetic resonance imaging (MRI), performed in 42 pregnant women whose fetuses had structural abnormalities of the central nervous system identified with transabdominal ultrasonography from 1995 through 2002, was analyzed retrospectively. Half-Fourier acquisition single-shot turbo spin-echo (HASTE) T2-weighted imaging clearly delineated the cerebrospinal fluid (CSF) space and the malformed brain and spinal cord and provided valuable information for the diagnosis of structural abnormalities related to the CSF space, such as spina bifida with Chiari type II malformation (7 cases), colpocephaly with agenesis of the corpus callosum (7 cases), holoprosencephaly (6 cases), porencephaly (2 cases), lissencephaly with hydrocephalus (2 cases), and middle fossa arachnoid cyst (1 case). However, some difficulty was encountered in the diagnosis of rare pathologic conditions that were not related to the CSF space, such as epignathus, multiple arteriovenous fistulae, trapped suboccipital meningocele, and Turner syndrome. We conclude that HASTE T2-weighted imaging, which provides useful diagnostic images in a reasonable time, is a useful adjunct to ultrasonography to confirm or exclude certain abnormalities related to the CSF space. (author)

  17. Imaging of cerebellopontine angle lesions: an update. Part 2: intra-axial lesions, skull base lesions that may invade the CPA region, and non-enhancing extra-axial lesions

    Energy Technology Data Exchange (ETDEWEB)

    Bonneville, Fabrice; Chiras, Jacques [Pitie-Salpetriere Hospital, Department of Neuroradiology, Paris (France); Savatovsky, Julien [Adolphe de Rothschild Foundation, Department of Radiology, Paris (France)

    2007-11-15

    Computed tomography (CT) and magnetic resonance (MR) imaging reliably demonstrate typical features of vestibular schwannomas or meningiomas in the vast majority of mass lesions responsible for cerebellopontine angle (CPA) syndrome. However, a large variety of unusual lesions can also be encountered in the CPA. Covering the entire spectrum of lesions potentially found in the CPA, these articles explain the pertinent neuroimaging features that radiologists need to know to make clinically relevant diagnoses in these cases, including data from diffusion- and perfusion-weighted imaging or MR spectroscopy, when available. A diagnostic algorithm based on the lesion's site of origin, shape and margins, density, signal intensity and contrast material uptake is also proposed. Non-enhancing extra-axial CPA masses are cystic (epidermoid cyst, arachnoid cyst, neurenteric cyst) or contain fat (dermoid cyst, lipoma). Tumours can also extend into the CPA by extension from the skull base (paraganglioma, chondromatous tumours, chordoma, cholesterol granuloma, endolymphatic sac tumour). Finally, brain stem or ventricular tumours can present with a significant exophytic component in the CPA that may be difficult to differentiate from an extra-axial lesion (lymphoma, hemangioblastoma, choroid plexus papilloma, ependymoma, glioma, medulloblastoma, dysembryoplastic neuroepithelial tumour). (orig.)

  18. Cranial x-ray CT and MRI in congenital muscular dystrophy

    International Nuclear Information System (INIS)

    The involvements of central nervous system in those cases of congenital muscular dystrophy (CMD), especially in Fukuyama type CMD, have been observed both radiologically and pathologically. The recent development of MRI made it easier to detect fine structural changes in brain matter than the X-ray CT. Then, we tried to evaluate the central nervous system abnormalities of six cases of CMD by both X-ray CT and MRI. In one case, X-ray CT revealed diffuse hypodensity of cerebral white matter, and MRI showed high intensity on long spin-echo image and low intensity on inversion-recovery image. In another case, X-ray CT showed no abnormal findings, but long spin-echo image revealed two high intensity spots in cerebral white matter. In other four cases, brain atrophy was demonstrated by X-ray CT and/or MRI, one case of these patients had bilateral congenital arachnoid cysts in the middle cranial fossa and hypogenesis of temporal lobes. Although we could not demonstrate polymicrogyria and agyria in all cases by MRI, white matter changes and structural changes were revealed more clearly than X-ray CT. The combination of X-ray CT and MRI seems to make a noteworthy contribution to estimate the central nervous system abnormalities in CMD. (author)

  19. Postoperative cerebrospinal-fluid fistula associated with erosion of the dura. Findings after anterior resection of ossification of the posterior longitudinal ligament in the cervical spine.

    Science.gov (United States)

    Smith, M D; Bolesta, M J; Leventhal, M; Bohlman, H H

    1992-02-01

    Of twenty-two patients who had had anterior decompression of the spinal canal for ossification of the posterior longitudinal ligament and cervical myelopathy, seven had absence of the dura adjacent to the ossified part of the ligament. The spinal cord and nerve-roots were visible through this defect. Although the arachnoid membrane appeared to be intact and watertight in most patients, a cerebrospinal-fluid fistula developed postoperatively in five, and three had a second operation to repair the defect in the dura. On the basis of this experience, we recommend use of autogenous muscle or fascial dural patches, immediate lumbar subarachnoid shunting, and modification of the usual postoperative regimen, such as limitation of mechanical pulmonary ventilation to the shortest time that is safely possible and use of anti-emetic and antitussive medications to protect the remaining coverings of the spinal cord when the dura is found to be absent adjacent to an ossified portion of the posterior longitudinal ligament in the cervical spine. PMID:1541620

  20. Spinal dermoid cyst. Characteristic CT findings after metrizamide myelography

    Energy Technology Data Exchange (ETDEWEB)

    Miyamoto, Yoshihisa; Makita, Yasumasa; Nabeshima, Sachio; Tei, Taikyoku; Keyaki, Atsushi; Takahashi, Jun; Kawamura, Junichiro

    1987-10-01

    A 25-year-old male complained of intermittent, sharp pains about the left eye and in the left side of the chest. Neurological examination revealed paresthesia and impaired perception of touch and pin-pricks in the dermatomes of Th8 and Th9 on the left side. In all four extremities, the muscle stretch reflexes were equal and slightly hyperactive, without weakness or sensory deficits. Metrizamide myelography showed defective filling at the level between the upper 8th and 9th thoracic vertebrae. The lesion was also demonstrated by computed tomography (CT) scan performed 1 hour later, appearing as an oval, radiolucent mass in the left dorsal spinal canal, which compressed the spinal cord forward and toward the right. Serial sections of the spinal canal revealed the lesion to be partly filled with contrast medium. Repeat CT scan 24 hours after metrizamide myelography showed more contrast medium in the periphery of the lesion, giving it a doughnut-shaped appearance. At surgery a smooth-surfaced cyst containing sebum and white hair was totally removed from the intradural extramedullary space. The histological diagnosis was dermoid cyst. There have been a few reported cases of intracranial epidermoid cyst in which filling of the cyst was suggested on metrizamide CT myelography. These findings may complicate the differential diagnosis of arachnoid cyst and dermoid or epidermoid cyst when only CT is used.

  1. The postsurgical spine.

    Science.gov (United States)

    Santos Armentia, E; Prada González, R; Silva Priegue, N

    2016-04-01

    Failed back surgery syndrome is the persistence or reappearance of pain after surgery on the spine. This term encompasses both mechanical and nonmechanical causes. Imaging techniques are essential in postoperative follow-up and in the evaluation of potential complications responsible for failed back surgery syndrome. This review aims to familiarize radiologists with normal postoperative changes and to help them identify the pathological imaging findings that reflect failed back surgery syndrome. To interpret the imaging findings, it is necessary to know the type of surgery performed in each case and the time elapsed since the intervention. In techniques used to fuse the vertebrae, it is essential to evaluate the degree of bone fusion, the material used (both its position and its integrity), the bone over which it lies, the interface between the implant and bone, and the vertebral segments that are adjacent to metal implants. In decompressive techniques it is important to know what changes can be expected after the intervention and to be able to distinguish them from peridural fibrosis and the recurrence of a hernia. It is also crucial to know the imaging findings for postoperative infections. Other complications are also reviewed, including arachnoiditis, postoperative fluid collections, and changes in the soft tissues adjacent to the surgical site.

  2. Mythology and Neurosurgery.

    Science.gov (United States)

    Ökten, Ali İhsan

    2016-06-01

    Myths are the keystone of mythology. They are interpretations of events that have been told as stories and legends for thousands of years, inherited from generation to generation, and have reached the present day. Although most myths are considered figments of the imagination or fictitious legends, all of them contain references to facts from the time they occurred. Mythology, which is a collection of figments of imagination concerning nature and human beings, is a product of human effort to perceive, explain, and interpret the universe and the world, much like science. The interaction between mythology and science dates back to the early days of civilization. Mythology, a reflection of human creativity, is extensively used in modern science, particularly in a terminological context. This article aims to reveal the texture of mythology in neurosurgery, by analyzing the birth of medicine in mythology; heroes such as Apollo and Asklepios, the gods of healing and medicine, as well as Hygieia, the goddess of health and hygiene; and mythological terms and phrases such as Achilles tendon, atlas vertebra, gigantism, priapism syndrome, hippocampus, lethargy, syrinx, and arachnoid. Through the use of symbols, mythology has attempted to explain several subjects, such as human nature, disease, birth, and death. In this respect, mythology and medicine dance arm in arm, and this dance has been going on for centuries. As a result, mythology has manifested itself in many fields within medicine, either anatomically or by giving names to various diseases. PMID:26970479

  3. Neurocysticercosis: radiologic-pathologic correlation.

    Science.gov (United States)

    Kimura-Hayama, Eric T; Higuera, Jesús A; Corona-Cedillo, Roberto; Chávez-Macías, Laura; Perochena, Anamari; Quiroz-Rojas, Laura Yadira; Rodríguez-Carbajal, Jesús; Criales, José L

    2010-10-01

    Neurocysticercosis is a neurologic parasitic disease caused by the encysted larva of the tapeworm Taenia solium and is the most important parasitic disease of the human central nervous system. It is the most common cause of acquired epilepsy in endemic settings and constitutes a public health challenge for most of the developing world. Nowadays, however, as a result of globalization, neurocysticercosis is being seen more frequently in developed countries as well. Neurocysticercosis is acquired through fecal-oral contamination, and the disease course is complex, with two intermediate hosts (ie, pigs and humans) and a definitive host (humans). Traditionally, it has been classified into active and nonactive forms according to disease location. Radiologists must be aware of its imaging appearance, which is quite variable, as is the differential diagnosis. Imaging findings depend on several factors, including the stage of the life cycle of T solium at presentation; the number and location (ie, subarachnoid, cisternal, or intraventricular) of parasites; and associated complications such as vascular involvement (ie, arteritis with or without infarction), inflammatory response (ie, edema, gliosis, or arachnoiditis), and, in ventricular forms, degree of obstruction. Thus, the diagnostic approach, management, and prognosis for neurocysticercosis differ widely depending on the type of infection. PMID:21071384

  4. Síndrome do nevus organóide: relato de caso Organoid nevus syndrome: case report

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    Priscilla Luppi Ballalai

    2001-08-01

    Full Text Available Os autores apresentam um caso de uma criança com síndrome do nevus organóide, que se caracteriza pela presença de uma lesão epibulbar em olho direito, associada a nevus sebáceo de Jadassohn em couro cabeludo e cisto de aracnóide na fossa temporal. O exame anatomopatológico da lesão ocular revelou a presença de tecidos de origem ectodérmica e mesodérmica, levando ao raro diagnóstico de coristoma epibulbar complexo. A síndrome é raramente descrita na literatura oftalmológica. São feitas considerações a respeito das alterações oftalmológicas e sistêmicas associadas a esta síndrome.The authors present a case of a child with organoid nevus syndrome, characterized by epibulbar choristoma in the right eye, Jadassohn's nevus sebaceous in the scalp and arachnoid cist. The pathology of the ocular lesion revealed a mixture of ectodermal and mesodermal elements, leding to the rare diagnosis of epibulbar complex choristoma.The syndrome is rarely described in the ophthalmologic literature. Some considerations are made regarding ophthalmologic and systemic associations.

  5. Performance of language tasks in patients with ruptured aneurysm of the left hemisphere worses in the post-surgical evaluation

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    Ana Cláudia C. Vieira

    2016-08-01

    Full Text Available ABSTRACT Sub-arachnoid hemorrhage (SAH promotes impairment of upper cortical functions. However, few information is available emphasizing changes in language after aneurismal SAH and aneurysm location influence. Objective To assess the language and verbal fluency performance in aneurismal SAH pre- and post-surgery in patients caused by an aneurysm of the anterior communicating artery (AcomA, left middle cerebral artery (L-MCA and left posterior comunicating artery (L-PcomA. Methods Assessment in 79 patients with SAH, on two occasions: pre- and post surgical treatment. They were divided into three groups by the aneurysms’ location. Results Deterioration is detected in the performance of all patients during the post-surgical period; L-MCA aneurysm patients displayed a reduction in verbal naming and fluency; L-PcomA patients deteriorated in the written language and fluency tasks. Conclusion After the surgical procedure the patients decreased in various language tasks and these differences in performance being directly related to the location of the aneurysm.

  6. Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region

    Directory of Open Access Journals (Sweden)

    Nurgul Ceran

    2011-02-01

    Full Text Available Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83% and fever (44%. All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations.

  7. Cerebellar ependymal cyst in a dog.

    Science.gov (United States)

    Wyss-Fluehmann, G; Konar, M; Jaggy, A; Vandevelde, M; Oevermann, A

    2008-11-01

    An 11-week-old, male, Staffordshire Bull Terrier had a history of generalized ataxia and falling since birth. The neurologic findings suggested a localization in the cerebellum. Magnetic resonance imaging of the brain was performed. In all sequences the area of the cerebellum was almost replaced by fluid isointense to cerebrospinal fluid. A complete necropsy was performed after euthanasia. Histologically, the lesion was characterized by extensive loss of cerebellar tissue in both hemispheres and vermis. Toward the surface of the cerebellar defect, the cavity was confined by ruptured and folded membranes consisting of a layer of glial fibrillary acidic (GFAP)-positive glial cells covered multifocally by epithelial cells. Some of these cells bore apical cilia and were cytokeratin and GFAP negative, supporting their ependymal origin. The histopathologic features of our case are consistent with the diagnosis of an ependymal cyst. Its glial and ependymal nature as demonstrated by histopathologic and immunohistochemical examination differs from arachnoid cysts, which have also been reported in dogs. The origin of these cysts remains controversial, but it has been suggested that they develop during embryogenesis subsequent to sequestration of developing neuroectoderm. We speculate that the cyst could have been the result of a pre- or perinatal, possibly traumatic, insult because hemorrhage, and tissue destruction had occurred. To our knowledge, this is the first description of an ependymal cyst in the veterinary literature.

  8. Retrospective study on structural neuroimaging in first-episode psychosis.

    Science.gov (United States)

    Coentre, Ricardo; Silva-Dos-Santos, Amilcar; Talina, Miguel Cotrim

    2016-01-01

    Background. No consensus between guidelines exists regarding neuroimaging in first-episode psychosis. The purpose of this study is to assess anomalies found in structural neuroimaging exams (brain computed tomography (CT) and magnetic resonance imaging (MRI)) in the initial medical work-up of patients presenting first-episode psychosis. Methods. The study subjects were 32 patients aged 18-48 years (mean age: 29.6 years), consecutively admitted with first-episode psychosis diagnosis. Socio-demographic and clinical data and neuroimaging exams (CT and MRI) were retrospectively studied. Diagnostic assessments were made using the Operational Criteria Checklist +. Neuroimaging images (CT and MRI) and respective reports were analysed by an experienced consultant psychiatrist. Results. None of the patients had abnormalities in neuroimaging exams responsible for psychotic symptoms. Thirty-seven percent of patients had incidental brain findings not causally related to the psychosis (brain atrophy, arachnoid cyst, asymmetric lateral ventricles, dilated lateral ventricles, plagiocephaly and falx cerebri calcification). No further medical referral was needed for any of these patients. No significant differences regarding gender, age, diagnosis, duration of untreated psychosis, in-stay and cannabis use were found between patients who had neuroimaging abnormalities versus those without. Discussion. This study suggests that structural neuroimaging exams reveal scarce abnormalities in young patients with first-episode psychosis. Structural neuroimaging is especially useful in first-episode psychosis patients with neurological symptoms, atypical clinical picture and old age. PMID:27257547

  9. The Usefulness of Lumbar Spine MRI for Cauda Equina Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Tae Yong; Baik, Seong Kug [Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan(Korea, Republic of); Lee, In Sook [Dept. of Radiology and Medical Research Institite, Pusan National University Hosptal, Pusan (Korea, Republic of)

    2011-05-15

    To understand the usefulness of the lumbar MRI studies to establish therapeutic plans for cauda equina syndrome (CES) including the management of rectal and bladder dysfunction symptoms. We retrospectively reviewed the lumbar MRI studies of 10 patients with CES. Their diagnoses included four adhesive arachnoiditis of cauda equina (CE), three conus medullaris atrophies, three spinal canal stenoses, one tuberculous leptomeningitis, one metastatic tumor on the sacral canal, and one dural arteriovenous fistula with venous congestion of the conus medullaris. In 6 of the 10 total cases the symptoms of rectal and bladder dysfunction were resolved by decompression laminectomies (n=2), irradiation (n=1), glue embolization (n=1), anticholine and steroid infusion (n=1), and anti-tuberculous medication (n=1) within at least 5 days. The 4 other cases were settled by lumboperitoneal shunting and neural stem cell implants. The study results indicate that lumbar MRI is the modality of choice in search for the causative lesion and to subsequently set up the best therapeutic plans for patients with CES.

  10. Stereotactic CO2 laser therapy for hydrocephalus

    Science.gov (United States)

    Kozodoy-Pins, Rebecca L.; Harrington, James A.; Zazanis, George A.; Nosko, Michael G.; Lehman, Richard M.

    1994-05-01

    A new fiber-optic delivery system for CO2 radiation has been used to successfully treat non-communicating hydrocephalus. This system consists of a hollow sapphire waveguide employed in the lumen of a stereotactically-guided neuroendoscope. CO2 gas flows through the bore of the hollow waveguide, creating a path for the laser beam through the cerebrospinal fluid (CSF). This delivery system has the advantages of both visualization and guided CO2 laser radiation without the same 4.3 mm diameter scope. Several patients with hydrocephalus were treated with this new system. The laser was used to create a passage in the floor of the ventricle to allow the flow of CSF from the ventricles to the sub-arachnoid space. Initial postoperative results demonstrated a relief of the clinical symptoms. Long-term results will indicate if this type of therapy will be superior to the use of implanted silicone shunts. Since CO2 laser radiation at 10.6 micrometers is strongly absorbed by the water in tissue and CSF, damage to tissue surrounding the lesion with each laser pulse is limited. The accuracy and safety of this technique may prove it to be an advantageous therapy for obstructive hydrocephalus.

  11. In vitro hydrodynamic, transient, and overtime performance of a miniaturized valve for hydrocephalus.

    Science.gov (United States)

    Schwerdt, Helen N; Amjad, Usamma; Appel, Jennie; Elhadi, Ali M; Lei, Ting; Preul, Mark C; Bristol, Ruth E; Chae, Junseok

    2015-03-01

    Reliable cerebrospinal fluid (CSF) draining methods are needed to treat hydrocephalus, a chronic debilitating brain disorder. Current shunt implant treatments are characterized by high failure rates that are to some extent attributed to their length and multiple components. The designed valve, made of hydrogel, steers away from such protracted schemes and intends to provide a direct substitute for faulty arachnoid granulations, the brain's natural CSF draining valves, and restore CSF draining operations within the cranium. The valve relies on innate hydrogel swelling phenomena to strengthen reverse flow sealing at idle and negative pressures thereby alleviating common valve failure mechanisms. In vitro measurements display operation in range of natural CSF draining (cracking pressure, PT ~ 1-110 mmH2O and outflow hydraulic resistance, Rh ~ 24-152 mmH2O/mL/min), with negligible reverse flow leakage (flow, QO > -10 µL/min). Hydrodynamic measurements and over-time tests under physically relevant conditions further demonstrate the valve's operationally-reproducible properties and strengthen its validity for use as a chronic implant.

  12. A study of brain MRI findings in children with epilepsy

    International Nuclear Information System (INIS)

    Magnetic resonance imaging in the brain was performed in 293 patients with childhood-onset (<15 y.o.) epilepsy who had been classified into 4 groups, idiopathic localization-related epilepsy (ILRE), 78 patients; idiopathic generalized epilepsy (IGE), 116 patients; symptomatic localization-related epilepsy (SLRE), 68 patients and symptomatic generalized epilepsy (SGE), 31 patients, with the Classification of Epilepsies and Epileptic Syndrome (1989 International League Against Epilepsy). The examination was performed with a 1.5 T magnet. One hundred twenty-five patients (42.7%) showed abnormal findings, and the incidence in each group was as follows: Idiopathic epilepsy: The rate of abnormal findings in the ILRE and IGE groups was 21.8% and 20.7%, respectively. Most of the abnormal findings were secondary changes, such as diffuse or localized brain atrophy. Of the congenital abnormalities, the main finding was arachnoid cyst. Symptomatic epilepsy: The rate of abnormality in the SLRE patients was 88.2%, and 85% of the findings were secondary changes, i.e., brain atrophy, or degeneration of the white matter. In the SGE group, the rate was 77.4%, with an almost equal percentage of congenital and secondary changes. Of 255 patients who were examined by electroencephalography (EEG) on the same day as MRI, about 50% showed a correlation between the EEG records and the MRI abnormalities. However, only 8 patients showed a correlation in localization between the EEG and MRI abnormalities. (author)

  13. Imaging diagnosis of various small lesions in the cerebellopontine angle by Suboccipital air CT cisternography

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    Tsukahara, Kaoru (Toho Univ., Tokyo (Japan). School of Medicine)

    1989-11-01

    A modified air CT cisternography technique, characterized by suboccipital air infusion was carried out in a total of 180 patients over the past 5 years. The patients were divided into two groups according to their suspected lesions. The first group consisted of 151 patients who were diagnosed as having retrolabyrinthine lesions by neurootological examinations; 29 patients with facial twitching or trigeminal neuralgia were classified in the second group. In the first group, air CT cisternography revealed 21 cases of small acoustic tumors including intracanalicular tumors. Additionally, several unexpected small lesions were detected in the cerebellopontine angle. These included small meningiomas, osteoma, osteogenic tumor, nodulated acoustic nerve in neurofibromatosis, primary acoustic nerve atrophy, adhesive arachnoiditis, elongated basilar artery and patulous acoustic meatus. In the second group, the causative artery of neurovascular compression at the nerve exit zone failed to be confirmed in many cases, but satisfactory preoperative information concerning nerves and vessels in the cerebellopontine angle were provided by air CT cisternography. The advantages and disadvantages of air CT cisternography and MRI-CT for the diagnosis of small lesions in the cerebellopontine angle are also discussed. (author).

  14. Therapeutic approaches to cerebral vasospasm complicating ruptured aneurysm

    Directory of Open Access Journals (Sweden)

    Mohamed Barbarawi

    2009-10-01

    Full Text Available Cerebral vasospasm is a serious complication of ruptured aneurysm. In order to avoid short- and long-term effects of cerebral vasospasm, and as there is no single or optimal treatment modality employed, we have instituted a protocol for the prevention and treatment of vasospasm in patients suffering aneurysmal sub-arachnoid hemorrhage (SAH. We then reviewed the effectiveness of this protocol in reducing the mortality and morbidity rate in our institution. In this study we present a retrospective analysis of 52 cases. Between March 2004 and December 2008 52 patients were admitted to our service with aneurysmal SAH. All patients commenced nimodipine, magnesium sulphate (MgSO4 and triple H therapy. Patients with significant reduction in conscious level were intubated, ventilated and sedated. Intracranial pressure (ICP monitoring was used for intubated patients. Sodium thiopental coma was induced for patients with refractory high ICP; angiography was performed for diagnosis and treatment. Balloon angioplasty was performed if considered necessary. Using this protocol, only 13 patients (25% developed clinical vaso-spasm. Ten of them were given barbiturates to induce coma. Three patients underwent transluminal balloon angioplasty. Four out of 52 patients (7.7% died from severe vasospasm, 3 patients (5.8% became severely disabled, and 39 patients (75% were discharged in a condition considered as either normal or near to their pre-hemorrhage status. Our results confirm that the aforementioned protocol for treatment of cerebral vasospasm is effective and can be used safely.

  15. The desmosomal plaque and the cytoskeleton.

    Science.gov (United States)

    Franke, W W; Cowin, P; Schmelz, M; Kapprell, H P

    1987-01-01

    Two major plasma membrane domains are involved in the architectural organization of the cytoskeleton. Both are junctions of the adherens category characterized by the presence of dense plaques associated with the cytoplasmic surface of their membranes. The plaques serve as specific anchorage structures for two different types of cytoplasmic filaments. Intermediate-sized filaments (IF) of several types, i.e. cytokeratin IF in epithelial cells, desmin IF in cardiac myocytes and vimentin IF in arachnoidal cells of meninges, meningiomas and several other cells, attach to the desmosomal plaques, whereas actin-containing microfilaments associate with non-desmosomal adhering junctions such as the zonula adherens, fascia adherens and punctum adherens. The plaques of both kinds of adhering junctions contain a common acidic polypeptide of Mr 83,000 identical to 'band 5 protein' of bovine snout epidermal desmosomes. However, other plaque components are mutually exclusive to one of the two subclasses of adhering junctions. The desmosomal plaque structure, which does not contain vinculin and alpha-actinin, comprises representatives of cytoplasmic, non-membrane-integrated proteins such as desmoplakin(s) and the cytoplasmic portions of transmembrane glycoproteins such as 'band 3 glycoprotein'. The analysis of both categories of junction-associated plaques should provide a basis for understanding the establishment and the dynamics of junction-cytoskeleton interaction.

  16. Measurement of fluorescent probes concentration ratio in the cerebrospinal fluid for early detection of Alzheimer's disease

    Science.gov (United States)

    Harbater, Osnat; Gannot, Israel

    2014-03-01

    The pathogenic process of Alzheimer's Disease (AD), characterized by amyloid plaques and neurofibrillary tangles in the brain, begins years before the clinical diagnosis. Here, we suggest a novel method which may detect AD up to nine years earlier than current exams, minimally invasive, with minimal risk, pain and side effects. The method is based on previous reports which relate the concentrations of biomarkers in the Cerebrospinal Fluid (CSF) (Aβ and Tau proteins) to the future development of AD in mild cognitive impairment patients. Our method, which uses fluorescence measurements of the relative concentrations of the CSF biomarkers, replaces the lumbar puncture process required for CSF drawing. The process uses a miniature needle coupled trough an optical fiber to a laser source and a detector. The laser radiation excites fluorescent probes which were prior injected and bond to the CSF biomarkers. Using the ratio between the fluorescence intensities emitted from the two biomarkers, which is correlated to their concentration ratio, the patient's risk of developing AD is estimated. A theoretical model was developed and validated using Monte Carlo simulations, demonstrating the relation between fluorescence emission and biomarker concentration. The method was tested using multi-layered tissue phantoms simulating the epidural fat, the CSF in the sub-arachnoid space and the bone. These phantoms were prepared with different scattering and absorption coefficients, thicknesses and fluorescence concentrations in order to simulate variations in human anatomy and in the needle location. The theoretical and in-vitro results are compared and the method's accuracy is discussed.

  17. Analysis of intracranial cystic disease on 1H MR spectroscopy

    International Nuclear Information System (INIS)

    Objective: To analyze the features of intracrayze the features of intracranial cystic diseases on 1H MRS, and to evaluate the applicable value of 1H MRS. Methods: Fifty-two patients were examinated by single voxel 1H MRS, included I-II graded astrocytomas (n=8), glioblastomas (n=9), metastasis (n=13), brain abscesses (n=10), epidermoids (n=4), anachnoid cysts (n=5), brain Cysticerciasis (n=3). Results: (1) There was only Lac in I-II graded astrocytomas. But in glioblastomas, as were as all showed Lac, 4 cases showed low Cho and NAA and 2 cases Lip. (2) In 13 metastasis patients, 7 cases only presented Lac, 6 cases showed Cho, 3 cases showed low NAA and 6 ones Lip. (3) In brain abscesses, all showed Lac, 9 cases displayed AA, 6 cases showed Ace, 5 cases appeared Suc and Ala, 2 eases had Lip. (4) Four eases of epidermoid showed Lac, one showed Lip. In 4 arachnoid cysts, 2 cases had low Lac, one showed Lip. Three cases of cysticercosis showed Lac, Ace, Suc, Ala and no AA, Cho, NAA. Conclusion: Lac is the most common resonance peak on 1H MRS in intracranial cystic diseases and for no diagnostic specificity. AA combined Ace, Suc, and Ala are highly specificity for brain abscess. Ace, Suc and Ala appearance cues the the possible existence of cysticercosis. 1H MRS is helpful for the qualitative diagnosis of intracranial disease. (authors)

  18. A STUDY OF POSTERIOR FOSSA MALFORMATIONS: MR IMAGING

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    Ravi

    2015-02-01

    Full Text Available AIMS AND OBJECTIVES: The aim of our study is to describe the imaging findings of various posterior fossa malformations and to evaluate the supratentorial abnormalities associated with posterior fossa malformations. MATERIALS AND METHODS: MR images of 30 patients wi th posterior fossa malformations detected in the department of Radiodiagnosis, BMCRI over a period of two years, from December 2012 to December 2014 were evaluated retrospectively. The various posterior fossa malformations were evaluated. Associated suprat entorial abnormalities were noted. RESULTS: 30 patients with posterior fossa malformations were included in the study. The age group of patients ranged from 1year to 53years. There were 18 males and 12 females. The various posterior fossa malformations det ected were Dandy Walker malformation (1 case, Dandy Walker variant (2 cases, mega cisterna magna (8 cases, arachnoid cysts (5 cases, Chiari 1 malformation (5 cases, Chairi 2 malformation (2 cases, Joubert malformation (1 case, lipoma (2 cases, verm ian and/or cerebellar hypoplasia without posterior fossa CSF collection or cyst (4 cases. Associated supratentorial abnormalities were seen in 8 cases . CONCLUSION: MRI is the imaging modality of choice in the evaluation of posterior fossa malformations. I t is very important to know the imaging findings of these malformations and to have knowledge about the various supratentorial and spinal abnormalities associated with them so as to provide an accurate diagnosis which is very essential for predicting the p rognosis and planning further management.

  19. Epilepsy and ring chromosome 20: case report

    Directory of Open Access Journals (Sweden)

    Gomes Marleide da Mota

    2002-01-01

    Full Text Available We present the clinical, electroencephalographic, neuroimaging (brain magnetic resonance image - MRI and spectroscopy by MRI and cytogenetic findings of a young male patient with a rare cytogenetic anomaly characterised by a de novo 46,XY,r(20(p13q13.3 karyotype. He presents with mental retardation, emotional liability, and strabismus, without any other significant dysmorphies. There are brain anomalies characterised by corpus callosum, uvula, nodule and cerebellum pyramid hypoplasias, besides arachnoid cysts in the occipital region. He had seizures refractory to pharmacotherapy and long period of confusional status with or without a motor component. The authors recognised that the EEG pattern was not fixed but changed over time, specially for bursts of slow waves with great amplitude accompanied or not by sharp components, and bursts of theta waves sharply contoured. Previously, epilepsy solely has been assigned to region 20q13. However, the important structural cerebral alterations present in our case has not been reported associated to such chromosomal abnormality and may indicate possible new chromosomal sites where such atypical neurological characteristics could be mapped.

  20. Critical ventriculo-peritoneal shunt failure due to peritoneal tuberculosis: Case report and diagnostic suggestions for abdominal pseudocyst

    Directory of Open Access Journals (Sweden)

    Hajime Takase

    2014-01-01

    Full Text Available Background: Tuberculous peritonitis (TBP is a well-known complication of ventriculo-peritoneal (VP shunt treatment for hydrocephalus resulting from tuberculous meningitis (TBM. However, a case of hydrocephalus unrelated to TBM resulting from VP shunt malfunction due to TBP has not been reported. Case Description: A 21-year-old male presented with nausea, abdominal pain, and headache. VP and cysto-peritoneal (CP shunts had been inserted to treat hydrocephalus due to a suprasellar arachnoid cyst, replaced the VP and removed the CP in his childhood. Computed tomography demonstrated acute hydrocephalus and an abdominal pseudocyst surrounding the distal end of the peritoneal tube. Initial laboratory data showed elevated white blood cell count and C-reactive protein level, but no causative pathogen was identified. External drainage of cerebrospinal fluid (CSF and of the fluid in the peritoneal cyst was established, and empirical antibiotic therapy was initiated. Bacterial cultures eventually revealed Mycobacterium tuberculosis infection, and TBP was diagnosed. The patient responded well to antituberculosis (anti-TB agents and insertion of a ventriculo-pleural shunt. Conclusion: This case highlights the possibility of CSF shunt failure and concomitant neurological sequelae from TB infection even when the pathogen has not invaded the central nervous system, as in TBM. Moreover, TBP is rare in developed countries and therefore may be misdiagnosed because of nonspecific clinical features and low sensitivity of common TB screening methods.

  1. MRI in intraspinal tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, R.K. (Dept. of Radiology, Sanjay Gandhi Postgraduate Inst. of Medical Sciences, Lucknow (India)); Gupta, S. (Dept. of Radiology, Sanjay Gandhi Postgraduate Inst. of Medical Sciences, Lucknow (India)); Kumar, S. (Dept. of Radiology, Sanjay Gandhi Postgraduate Inst. of Medical Sciences, Lucknow (India)); Kohli, A. (Dept. of Neurology, Sanjay Gandhi Postgraduate Inst. of Medical Sciences, Lucknow (India)); Misra, U.K. (Dept. of Neurology, Sanjay Gandhi Postgraduate Inst. of Medical Sciences, Lucknow (India)); Gujral, R.B. (Dept. of Radiology, Sanjay Gandhi Postgraduate Inst. of Medical Sciences, Lucknow (India))

    1994-01-01

    We studied 20 patients with intraspinal tuberculosis (TB), to characterise the MRI features of tuberculous meningitis and myelitis. MRI leptomeningitis and intramedullary involvement in 11 patients, intramedullary lesions alone in 5, leptomeningitis alone in 2, and isolated extradural disease in 2. TB leptomeningitis was characterised by loculation of the cerebrospinal fluid (CSF), nerve root thickening and clumping (seen only in the lumbar region) or complete obliteration of the subarachnoid space on unenhanced images. Gd-DTPA-enhanced images proved useful in 6 cases, revealing linear enhancement of the surface of the spinal cord and nerve roots or plaque-like enhancement of the dura-arachnoid mater complex. Intramedullary lesions included tuberculomas (8), cord oedema (5) and cavitation (3). In seven cases of intramedullary tuberculoma multiple lesions with skip areas were seen, without significant cord swelling. One patient had an isolated lesion in the conus medullaris. The lesions were iso- or hypointense on T1-weighted images, iso-, hypo- or hyperintense on T2-weighted images and showed rim or nodular enhancement with contrast medium. (orig.)

  2. Increased anisotropy in neonatal meningitis: an indicator of meningeal inflammation

    Energy Technology Data Exchange (ETDEWEB)

    Trivedi, Richa; Gupta, Rakesh K.; Nath, Kavindra [Sanjay Gandhi Post Graduate Institute of Medical Sciences, Department of Radiodiagnosis, Lucknow, UP (India); Malik, Gyanendra K.; Gupta, Amit [King George' s Medical University, Department of Pediatrics, Lucknow (India); Prasad, Kashi N. [Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Microbiology, Lucknow (India); Purwar, Ankur; Rathore, Divya; Rathore, Ram K.S. [Indian Institute of Technology, Department of Mathematics, Kanpur (India); Narayana, Ponnada A. [University of Texas Medical School at Houston, Department of Diagnostic and Interventional Imaging, Houston, TX (United States)

    2007-09-15

    Increased anisotropy in brain abscesses has been shown to be due to adhesion of inflammatory cells and is suggestive of an active inflammatory process. The objective of this study was to determine if similar changes occur in the pia-arachnoid on the surface of the cerebral cortex in patients with pyogenic meningitis, and if these changes regress following antibiotic therapy. Diffusion tensor imaging (DTI) was performed on 14 term neonates (mean age 13 days) with bacterial meningitis and 10 healthy age- and sex-matched controls. Regions of interest (ROIs) were placed on areas including the leptomeninges, the cerebral cortex and adjoining subcortical white matter for quantitation of mean fractional anisotropy (FA) and diffusivity (MD) values. Follow-up MRI was performed in five of the neonates in the patient group after 2 weeks of antibiotic treatment. FA and MD values were compared in patients before and after antibiotic treatment as well as with those in the healthy controls. Significantly higher FA values but no difference in MD values were observed in the patient group as compared to the healthy controls at both time points (before and after antibiotic treatment). Significantly decreased FA values in the frontal, occipital and temporal cortical regions were observed in patients following antibiotic treatment. DTI-derived FA may be of value in the noninvasive assessment of meningeal inflammatory activity and treatment response in neonates. (orig.)

  3. Surgical Outcome of Intradural Spinal Tumors.

    Science.gov (United States)

    Ahsan, M K; Sakeb, N; Ali, M Y; Awwal, M A; Khan, S I; Goni, M M; Mia, M B; Alam, M B; Zaman, N; Jannat, S N

    2016-07-01

    Results of 63 surgically treated intradural spinal tumors between the period of October 2003 and December 2014 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and in our private settings, Dhaka, were analyzed retrospectively. There were 33 males, 30 females with an average age of 52.4 years (13-70 years) and followed up for at least a year. The preoperative symptom with duration, tumors location and intradural space occupancy and the histopathological diagnosis were analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The tumors were located as, thoracic (n=32, 50.79%), lumbar (n=16, 25.39%), cervical (n=05, 07.93%), and junctional (n=10, 15.87%, CervicoThoracic-01, Thoracolumbar-09). The histopathological diagnosis included schwannoma (n=30, 47.7%), meningiomas (n=14, 22.3%), neurofibroma, arachnoid cyst and myxopapillary ependymoma (n=03, 04.76%) each and paraganglioma (n=01, 01.59%). Among the intramedullary tumors, ependymoma (n=03, 04.76%), astrocytoma and epidermoid cyst (n=02, 03.17%), haemangioblastoma, paraganglioma and cavernous haemangioma (n=01, 01.59%) each. The VAS score was reduced in all cases from 8.0±1.2 to 1.2±0.8 (pbedsore and recurrence (Ependymoma) (n=01, 01.59%). Aggressive surgical excision potentially minimizes neurologic morbidity and improved outcome except intramedullary tumors where initial treatment consists of maximum safe surgical resection or biopsy. PMID:27612900

  4. [Hematopoietic growth factor EPO has neuro-protective and neuro-trophic effects--review].

    Science.gov (United States)

    Zhou, Zhuo-Yan; Yang, Mo; Fok, Tai-Fai

    2005-04-01

    Erythropoietin (EPO) is an acidic glycoprotein that was first detected as a hematopoietic factor and its synthesis is triggered in response to cellular hypoxia-sensing. EPO binds to type I cytokine receptors, which associate with the non-receptor tyrosine kinase Jak2, and thereby activate Stat 5a/5b, Ras/MAPK, and PI3-K/Akt signaling pathways. The recent discovery shows that there is a specific EPO/EPO-receptor system in the central nervous system (CNS), independently of the haematopoietic system. Hypoxia and anemia can up-regulate EPO/EPOR expressions in the CNS. Further studies demonstrate that EPO has substantial neuro-protective effects and acts as a neurotrophic factor on central cholinergic neurons, influencing their differentiation and regeneration. EPO also exerts neuro-protective activities in different models of brain damage in vivo and in vitro, such as hypoxia, cerebral ischaemia and sub-arachnoid haemorrhage. EPO may also be involved in synaptic plasticity via the inhibition or stimulation of various neurotransmitters. Therefore, human recombinant EPO that activate its receptors in the central nervous system might be utilized in the future clinical practice involving neuroprotection and brain repair. PMID:15854305

  5. Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

    Science.gov (United States)

    Richardson, R R; Siqueira, E B; Cerullo, L J

    1979-09-01

    Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

  6. Safety and toxicity of intrathecal liposomal cytarabine (Depocyte) in children and adolescents with recurrent or refractory brain tumors: a multi-institutional retrospective study.

    Science.gov (United States)

    Benesch, Martin; Siegler, Nele; Hoff, Katja von; Lassay, Lisa; Kropshofer, Gabriele; Müller, Hermann; Sommer, Constanze; Rutkowski, Stefan; Fleischhack, Gudrun; Urban, Christian

    2009-10-01

    This retrospective study aimed to evaluate the safety and toxicity of intrathecal liposomal cytarabine (Depocyte) in children and adolescents with refractory or recurrent brain tumors. Nineteen heavily pretreated patients (males, n = 14; females, n = 5; median age at diagnosis 8.5 years; range, 1.4-22 years) were given intrathecal liposomal cytarabine on a compassionate use basis for recurrent refractory medulloblastoma (n = 12), mixed germ cell tumor (n = 2), central nervous system primitive neuroectodermal tumors of the pons (n = 1), anaplastic ependymoma (n = 1), anaplastic oligodendroglioma (n = 1), atypical teratoid rhabdoid tumor (n = 1), or rhabdoid papillary meningioma (n = 1). Eighteen patients received concomitant systemic radiochemotherapy. A total of 88 intrathecal injections of liposomal cytarabine (dose range, 20-50 mg) were administered with concomitant dexamethasone prophylaxis. The median number of doses per patient was four (range, 1-10). Duration of treatment ranged from (1/2) to 10 months. Eleven patients (57.9%) did not show any side effects, whereas eight patients (42.1%) developed side effects related to either chemical arachnoiditis (n = 4) or neurological progression (n = 2). Less typical treatment-related symptoms (e.g. lethargy, ataxia, and slurred speech) were observed in two patients. Treatment with intrathecal liposomal cytarabine was discontinued twice because of side effects. In conclusion, although intrathecal liposomal cytarabine was generally well tolerated, it should be used cautiously and only with dexamethasone prophylaxis in extensively pretreated patients with recurrent brain tumors. Proof of efficacy requires a prospective single-agent phase II study.

  7. Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region.

    Science.gov (United States)

    Ceran, Nurgul; Turkoglu, Recai; Erdem, Ilknur; Inan, Asuman; Engin, Derya; Tireli, Hulya; Goktas, Pasa

    2011-01-01

    Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83%) and fever (44%). All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months) was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations.

  8. Ventriculoperitoneal shunt in cryptococcal meningitis with hydrocephalus.

    Science.gov (United States)

    Tang, L M

    1990-05-01

    Fourteen patients with cryptococcal meningitis were reviewed. All patients had a ventriculoperitoneal shunt for hydrocephalus. Early recognitions and prompt relief of hydrocephalus were useful for eight patients who showed rapid deterioration of consciousness or signs of cerebral herniation. There was no surgical response in four patients who had had weeks of confusion or mental change. It seems, therefore, that the duration of disturbance of consciousness or change of mentality before shunting is critical in determination of the outcome of the treatment. Ventricular shunting was effective in relieving papilledema in five patients. However, the surgery did not prevent the development of papilledema to optic atrophy and subsequent blindness in two patients. Hence, in addition to hydrocephalus with increased intracranial pressure, conditions such as direct invasion of the optic pathways by Cryptococcus neoformans or optochiasmatic arachnoiditis may be responsible for the visual failure. Ventricular shunting was also helpful in restoring paraparesis in one patient. Of the cerebrospinal fluid determinations, low protein concentration was a favorable indicator for surgery. Of the seven patients who received the surgical procedure before the start of antifungal therapy, four showed a significant improvement despite active infection of the central nervous system. None of the seven patients deteriorated because of the surgical operation. Thus, active stage of cryptococcal meningitis does not contraindicate the necessity of shunting, and premedication with antifungal drugs is unnecessary. Also, no shunt-related morbidity and mortality was seen in this study.

  9. Favorable results with syringosubarachnoid shunts for treatment of syringomyelia.

    Science.gov (United States)

    Tator, C H; Meguro, K; Rowed, D W

    1982-04-01

    From 1969 to 1979, 20 patients with syringomyelia were treated with a syringosubarachnoid shunt. The principal indications for this procedure were: significant progressive neurological deterioration and absent or minimal tonsillar ectopia. There were 15 patients with idiopathic syringomyelia, four with posttraumatic syringomyelia, and one with syringomyelia secondary to spinal arachnoiditis. The operations were performed with an operating microscope, and attention was directed to preserving thearachnoid membrane to ensure proper placement of the distal end of the shunt in an intact subarachnoid space. In all cases, a silicone rubber ventricular catheter was inserted into the syrinx through a posterior midline myelotomy. The average follow-up period was 5 years. A favorable result was obtained in 15 of the 20 patients (75%), including an excellent result with improvement of neurological deficit in 11 patients and a good result with cessation of progression in four patients. In the remaining five patients the result was poor with further progression of neurological deficit. A short duration of preoperative symptoms was usually a favorable prognostic feature. Four patients with a history of less than 6 months all had excellent results. Thirteen patients had a syringosubarachnoid shunt only, and all had good or excellent results. Seven patients had other surgical procedures, before, accompanying, or after shunt placement, and two had favorable results. Thus, the syringosubarachnoid shunt is an effective therapeutic modality for many patients with syringomyelia, particularly if there is little or no tonsillar herniation.

  10. Treatment of syringomyelia with a syringosubarachnoid shunt.

    Science.gov (United States)

    Tator, C H; Briceno, C

    1988-02-01

    The surgical results in 40 patients with syringomyelia, treated with a syringosubarachnoid shunt or other procedures are reviewed. The principal indication for surgery was that of significant neurological deterioration. There were 12 patients with idiopathic syringomyelia without tonsillar ectopia, 12 with an associated Chiari malformation, 11 with post-traumatic syringomyelia and five patients with spinal arachnoiditis. There were 38 syringosubarachnoid shunts performed in 35 patients, and an excellent or good result was achieved in 26 patients (74.3%). In terms of the type of syringomyelia, the best results were obtained in the idiopathic group without tonsillar ectopia and in the post-traumatic group. A short duration of pre-operative symptoms favoured a better outcome, and in our opinion, early surgical treatment is indicated for all patients with neurological deterioration. All eight patients in whom a posterior fossa decompression was performed as the initial surgical procedure required a second operation, either a syringosubarachnoid or syringoperitoneal shunt to achieve neurological improvement or stabilization. Thus, the syringosubarachnoid shunt is an effective therapeutic modality for patients with syringomyelia, particularly for the idiopathic and post-traumatic groups. More than one surgical procedure may be required to achieve cessation of deterioration. Overall, excellent or good results were achieved in 29 (72.5%) of the 40 patients.

  11. Synteny of human chromosomes 14 and 15 in the platyrrhines (Primates, Platyrrhini

    Directory of Open Access Journals (Sweden)

    Cristiani Gifalli-Iughetti

    2009-01-01

    Full Text Available In order to study the intra- and interspecific variability of the 14/15 association in Platyrrhini, we analyzed 15 species from 13 genera, including species that had not been described yet. The DNA libraries of human chromosomes 14 and 15 were hybridized to metaphases of Alouatta guariba clamitans, A. caraya, A. sara, Ateles paniscus chamek, Lagothrix lagothricha, Brachyteles arachnoides, Saguinus midas midas, Leontopithecus chrysomelas, Callimico goeldii, Callithrix sp., Cebus apella, Aotus nigriceps, Cacajao melanocephalus, Chiropotes satanas and Callicebus caligatus. The 14/15 hybridization pattern was present in 13 species, but not in Alouatta sara that showed a 14/15/14 pattern and Aotus nigriceps that showed a 15/14/15/14 pattern. In the majority of the species, the HSA 14 homologue retained synteny for the entire chromosome, whereas the HSA 15 homologue displayed fragmented segments. Within primates, the New World monkeys represent the taxon with the highest variability in chromosome number (2n = 16 to 62. The presence of the HSA 14/15 association in all species and subspecies studied herein confirms that this association is the ancestral condition for platyrrhines and that this association has been retained in most platyrrhines, despite the occurrence of extensive inter- and intrachromosomal rearrangements in this infraorder of Primates.

  12. Synteny of human chromosomes 14 and 15 in the platyrrhines (Primates, Platyrrhini)

    Science.gov (United States)

    2009-01-01

    In order to study the intra- and interspecific variability of the 14/15 association in Platyrrhini, we analyzed 15 species from 13 genera, including species that had not been described yet. The DNA libraries of human chromosomes 14 and 15 were hybridized to metaphases of Alouatta guariba clamitans, A. caraya, A. sara, Ateles paniscus chamek, Lagothrix lagothricha, Brachyteles arachnoides, Saguinus midas midas, Leontopithecus chrysomelas, Callimico goeldii, Callithrix sp., Cebus apella, Aotus nigriceps, Cacajao melanocephalus,Chiropotes satanas and Callicebus caligatus. The 14/15 hybridization pattern was present in 13 species, but not in Alouatta sara that showed a 14/15/14 pattern and Aotus nigriceps that showed a 15/14/15/14 pattern. In the majority of the species, the HSA 14 homologue retained synteny for the entire chromosome, whereas the HSA 15 homologue displayed fragmented segments. Within primates, the New World monkeys represent the taxon with the highest variability in chromosome number (2n = 16 to 62). The presence of the HSA 14/15 association in all species and subspecies studied herein confirms that this association is the ancestral condition for platyrrhines and that this association has been retained in most platyrrhines, despite the occurrence of extensive inter- and intrachromosomal rearrangements in this infraorder of Primates. PMID:21637455

  13. Blood-brain barrier and blood-cerebrospinal fluid barrier in normal and pathological conditions.

    Science.gov (United States)

    Ueno, Masaki; Chiba, Yoichi; Murakami, Ryuta; Matsumoto, Koichi; Kawauchi, Machi; Fujihara, Ryuji

    2016-04-01

    Blood-borne substances can invade into the extracellular spaces of the brain via endothelial cells in sites without the blood-brain barrier (BBB), and can travel through the interstitial fluid (ISF) of the brain parenchyma adjacent to non-BBB sites. It has been shown that cerebrospinal fluid (CSF) drains directly into the blood via the arachnoid villi and also into lymph nodes via the subarachnoid spaces of the brain, while ISF drains into the cervical lymph nodes through perivascular drainage pathways. In addition, the glymphatic pathway of fluids, characterized by para-arterial pathways, aquaporin4-dependent passage through astroglial cytoplasm, interstitial spaces, and paravenous routes, has been established. Meningeal lymphatic vessels along the superior sagittal sinus were very recently discovered. It is known that, in mice, blood-borne substances can be transferred to areas with intact BBB function, such as the medial regions of the hippocampus, presumably through leaky vessels in non-BBB sites. In the present paper, we review the clearance mechanisms of interstitial substances, such as amyloid-β peptides, as well as summarize models of BBB deterioration in response to different types of insults, including acute ischemia followed by reperfusion, hypertension, and chronic hypoperfusion. Lastly, we discuss the relationship between perivascular clearance and brain disorders. PMID:26920424

  14. A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting

    Directory of Open Access Journals (Sweden)

    Obinna V Ajuzieogu

    2011-01-01

    Full Text Available Objective: To compare the outcome of subarachnoid block (spinal anesthesia and general anesthesia in Cesarean delivery for women with severe pre-eclampsia. Methods: A retrospective study of women with severe pre-eclampsia requiring Cesarean section from January 2005 to June 2009 was carried out. Maternal age, parity, gestational age at delivery, booking status, Apgar scores, maternal and perinatal mortality of the sub-arachnoid block group were compared with those of general anesthesia group using c2 , Student t-test and Fischer exact test. Results: There were no significant difference between the two groups in overall maternal mortality (5.4% vs. 11.9%, P=0.5 and perinatal mortality (2.7% vs. 11.9%, P=0.15. The general anesthesia group had significantly more birth asphyxia than the spinal group (55.9% vs. 27.0%, P=0.0006. Conclusion: There was no significant difference in the maternal and perinatal mortality outcome of cesarean delivery between women with severe pre-eclampsia who had regional anesthesia and those that had general anesthesia. There was significantly higher proportion of birth asphyxia in babies of women who received general anesthesia.

  15. Neurofibromatosis: Evaluation of Clinical Features of 11 Cases

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    Gülşen Akoğlu

    2013-12-01

    Full Text Available Objective: Neurofibromatosis (NF is one of the most commonly seen autosomal dominantly inherited neurocutaneous syndromes. The most common subtypes are NF1 and NF2. The clinical course of NF may be heterogeneous.In this study, clinical features of patients with NF and its rare manifestations were described. Methods: Records of 11 patients with NF diagnosed between May 2008 and August 2011 were retrospectively reviewed. Demographic and clinical features of patients were detailed. Results: Six female and 5 male patients were enrolled. Patients' ages ranged between 1.5 and 58 years. Seven of them had positive family history for NF. A 1.5-year-old baby presented early appearance of Lisch nodules. One female patient had unilateral segmentally distributed pigmentary macules with bilateral Lisch nodules. Severe scoliosis and multiple painful neurofibromas were observed in a male patient. An asymptomatic arachnoid cyst was detected incidentally in a female patient. A male patient with NF1 had diffuse large B cell lymphoma and glioblastoma multiforme. Conclusion: Patients with NF may present with diverse clinical manifestations. Since patients may first apply to a dermatology outpatient clinic with only cutaneous complaints, early diagnosis of NF both in the patients and in their first degree relatives by careful dermatological and ophthalmological examinations and radiological evaluations can be possible.

  16. A study of brain MRI findings in children with epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Kanematsu, Sachiko; Sumida, Sawako; Muto, Ayako; Osawa, Makiko; Ono, Yuko [Tokyo Women' s Medical Coll. (Japan); Uchida, Moriyasu; Maruyama, Hiroshi

    2000-06-01

    Magnetic resonance imaging in the brain was performed in 293 patients with childhood-onset (<15 y.o.) epilepsy who had been classified into 4 groups, idiopathic localization-related epilepsy (ILRE), 78 patients; idiopathic generalized epilepsy (IGE), 116 patients; symptomatic localization-related epilepsy (SLRE), 68 patients and symptomatic generalized epilepsy (SGE), 31 patients, with the Classification of Epilepsies and Epileptic Syndrome (1989 International League Against Epilepsy). The examination was performed with a 1.5 T magnet. One hundred twenty-five patients (42.7%) showed abnormal findings, and the incidence in each group was as follows: Idiopathic epilepsy: The rate of abnormal findings in the ILRE and IGE groups was 21.8% and 20.7%, respectively. Most of the abnormal findings were secondary changes, such as diffuse or localized brain atrophy. Of the congenital abnormalities, the main finding was arachnoid cyst. Symptomatic epilepsy: The rate of abnormality in the SLRE patients was 88.2%, and 85% of the findings were secondary changes, i.e., brain atrophy, or degeneration of the white matter. In the SGE group, the rate was 77.4%, with an almost equal percentage of congenital and secondary changes. Of 255 patients who were examined by electroencephalography (EEG) on the same day as MRI, about 50% showed a correlation between the EEG records and the MRI abnormalities. However, only 8 patients showed a correlation in localization between the EEG and MRI abnormalities. (author)

  17. MRI - the investigation of choice in syringomyelia?

    International Nuclear Information System (INIS)

    During a 12 month period of operation of a 0.3 Tesla Magnetic Resonance Imaging (MRI) iron cored resistive scanner 74 cases of syringomyelia were diagnosed on clinical, radiological and/or surgical grounds. Without knowledge of any clinical or radiological data the syrinxes were classified into five groups - idiopathic, idiopathic associated with Chiari malformation, tumour associated, post-traumatic and arachnoiditis associated - and the lesion characteristics within each group were compared. Although MRI was extremely sensitive in picking up even small syrinxes, there was considerable overlap of MRI characteristics across the sub-groups, so that two post-traumatic syrinxes had lesion characteristics identifiable with those of tumour syrinx and one intramedullary tumour syrinx had the MRI characteristics of a benign, idiopathic syrinx. It is concluded that meticulous attention to technique, including axial as well as sagittal T1 weighted sequences, and the administration of intravenous paramagnetic contrast media are necessary for detection and accurate classification of syrinxes. 26 refs., 15 figs., 1 tab

  18. Intracranial Hypotension Syndrome, Diagnosis and Treatment in Radiology Clinics

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    S. Albayram

    2005-08-01

    Full Text Available Introduction & Background: Only 12 years ago the first report on pachymeningeal gadolinium enhance-ment in low-pressure headaches appeared in the lit-erature. Intracranial hypotension is a result of low CSF volume caused by either spontaneous or postoperative leakage. The syndrome has been reported to occur after head trauma, a tear in a spinal nerve root sheath, perineural cyst, or spinal arachnoid diverticulum. Iatrogenic causes include lumbar puncture or overdraining ventricular or spinal shunts. Spontaneous intracranial hypotension is thought to result from rupture of a spinal arachnoid membrane that allows CSF passage into the subdural or epidural space. It is typically not attributable to a major traumatic event or prior diagnostic or therapeutic intervention; however, intracranial hypotension may be associated with a history of minor trauma such as sports activities or severe coughing. Diffuse pachymeningeal enhancement is thought to reflect the Monro-Kellie rule, which describes the inverse relationship of CSF volume and intracranial blood volume within the rigid confines of the skull. This reflex mechanism protects nervous tissue by maintaining a constant buffer (ie, blood or CSF subjacent to its bony covering. Though this principle was described for intracranial processes and helps to explain the reason for intracranial pachymeningeal enhancement, it can also be applied to the bony spinal canal. Explaining pachymeningeal enhancement in the spine becomes more difficult because the hypervascular outer dural layer covering the brain does not extend to cover the spine, and the single layer of dura that does cover the spine is relatively avascular. Perhaps reports of pachymeningeal enhancement along the spinal canal in intracranial hypotension more accurately reflect prominent epidural venous engorgement. In all cases of intracranial hypotension reported in the literature, patients presented with headaches. These headaches are typically

  19. Comparative Analyses of Pachygyria Concomitant Lesions between Uyghur and Han Nationality%维吾尔族与汉族巨脑回畸形伴发病的对比分析

    Institute of Scientific and Technical Information of China (English)

    李亮杰; 刘志飞; 安尼瓦尔

    2013-01-01

    Objective:To evaluate whether the type of pachygyria concomitant lesions between Uyghur and Han patients is consistent. Method:From 2004-2012 year,Collected MRI image data of 16 Uygur pachygyria deformity patients,retrospectively analysed the type of concomitant lesions and comparison with the Han concomitant patients.Result:Four in Uygur 16 patients were associated with communicating hydrocephalus;three were associated with leukodystrophies;two were associated with Dandy-Walker malformation;One was associated with corpus callosum hypoplasia absence of the septum pellucidum;One was associated with gray matter shift;Three were associated with arachnoid cyst;six were not clearly associated malformations.Conclusion:The type of pachygyria concomitant lesions between Uyghur and Han patients is inconsistent. As for heterotopic gray matter, Han patients are reported in the literature up to 50%,while only 6%for Uyghur patients;Among 16 cases of pachygyria concomitant lesions,there are three cases with leukodystrophies,and three with arachnoid cysts,and no other documents are reported.%目的:探讨维吾尔族与汉族患者巨脑回畸形伴发病变的类型是否一致。方法:收集本院2004-2012年16例维吾尔族巨脑回畸形患者的MRI影像资料,回顾性分析其伴发病变类型,通过所得资料与汉族患者文献资料数据进行对比分析。结果:维吾尔族16例患者中4例伴发交通性脑积水,3例伴发脑裂畸形,3例伴发脑白质营养不良,2例伴发Dandy-Walker畸形,1例伴发胼胝体发育不全、透明隔缺如,1例伴发有灰质移位,3例伴发蛛网膜囊肿,6例未见明确伴发畸形。结论:维吾尔族与汉族患者巨脑回畸形伴发病变的类型是不一致的,灰质异位,汉族患者文献报道可达50%,而维吾尔族患者仅占6%;16例维吾尔族巨脑回患者中伴发脑白质营养不良3例,伴发蛛网膜囊肿者3例,其他文献未见报道。

  20. Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients Impressão basilar, malformação de Chiari e siringomielia: estudo retrospecivo de 53 casos operados

    Directory of Open Access Journals (Sweden)

    José Alberto Gonçalves da Silva

    2003-06-01

    Full Text Available The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI, Chiari malformation (CM, and syringomyelia (SM. The patients were divided into two groups. Group I (24 patients underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior- caudal direction, avoiding, in this way, its adherence to the cerebellum.São analisados os resultados obtidos com o tratamento cirúrgico de 53 casos de impressão basilar (IB, malformação de Chiari (MC e siringomielia (SM. Os pacientes foram divididos em dois grupos: no grupo I (24 casos foi realizada a descompressão osteodural, caracterizada por craniectomia ampla occipital inferior, laminectomia variável de C 1 a C 3, abertura da dura-máter em forma de Y, dissecção das aderências aracnóideas das tonsilas cerebelares com o bulbo e medula cervical, abertura ampla do quarto ventrículo e enxerto dural; no grupo II (29 casos foi utilizada a descompressão osteodural-neural, caracterizada pelos mesmos detalhes técnicos empregados no grupo I, acrescidos da

  1. 核素脑池显像对脑脊液循环障碍的评估%Evaluation of circulatory disturbance of cerebrospinal fluid with radionuclide cisternography

    Institute of Scientific and Technical Information of China (English)

    童冠圣; 文哲; 樊军; 胡志强; 关峰; 李征

    2011-01-01

    目的 探讨核素脑池显像的影像特征及其对脑积水脑脊液循环障碍的评估价值.方法 回顾性分析72例经CT或MRJ证实为脑积水病人的临床资料,根据年龄分为儿童组(37例)和成人组(35例).均行核素脑池显像检查.结果 经核素脑池显像诊断交通性脑积水38例,其中儿童21例,成人17例;大脑凸面显像剂分布减少或无分布30例(79%),分布接近正常8例(21%);儿童组伴颅内蛛网膜囊肿10例(48%),成人组伴颅内蛛网膜囊肿2例(12%),交通性脑积水病人未发现囊肿与蛛网膜下腔相交通.非交通性脑积水34例,其中儿童组16例,成人组18例;大脑凸面显像剂分布减少或无分布17例(50%),分布接近正常17例(50%);儿童组伴颅内蛛网膜囊肿5例(31%),其中囊肿与蛛网膜下腔相交通3例,成人组伴颅内蛛网膜囊肿2例(11%),未见囊肿与蛛网膜下腔交通.结论 核素脑室显像有助于鉴别脑积水的类型和脑脊液吸收情况,并可判断蛛网膜囊肿是否与蛛网膜下腔相通,对选择合适的治疗方案有重要参考价值.%Objective To investigate the imaging characteristics of radionuclide cisternography (RC) and its evaluation value for circulatory disturbance of cerebrospinal fluid (CSF) in patients with hydrocephalus. Methods Clinical data of 72 patients with hydrocephalus confirmed by CT or MRI were analyzed retrospectively. The patients were divided into child group (n=37) and adult group (n=35) according to the age, and RC were performed in all the patients. Results Communicating hydrocephalus was diagnosed by RC in 38 cases, including 21 in child group and 17 in adult group. RC showed decrease or absence of radiotracer distributing in cerebral convexities in 30 cases (79%), and closed to normal in 8 (2 1 %). Communicating hydrocephalus accompanied by intracrauial arachnoid cysts were found in 10 cases (48%) in child group and 2 (12%) in adult group, and there was no communication between

  2. Afferent and efferent immunological pathways of the brain. Anatomy, function and failure.

    Science.gov (United States)

    Carare, R O; Hawkes, C A; Weller, R O

    2014-02-01

    Immunological privilege appears to be a product of unique lymphatic drainage systems for the brain and receptor-mediated entry of inflammatory cells through the blood-brain barrier. Most organs of the body have well-defined lymphatic vessels that carry extracellular fluid, antigen presenting cells, lymphocytes, neoplastic cells and even bacteria to regional lymph nodes. The brain has no such conventional lymphatics, but has perivascular pathways that drain interstitial fluid (ISF) from brain parenchyma and cerebrospinal fluid (CSF) from the subarachnoid space to cervical lymph nodes. ISF and solutes drain along narrow, ∼100 nm-thick basement membranes within the walls of cerebral capillaries and arteries to cervical lymph nodes; this pathway does not allow traffic of lymphocytes or antigen presenting cells from brain to lymph nodes. Although CSF drains into blood through arachnoid villi, CSF also drains from the subarachnoid space through channels in the cribriform plate of the ethmoid bone into nasal lymphatics and thence to cervical lymph nodes. This pathway does allow the traffic of lymphocytes and antigen presenting cells from CSF to cervical lymph nodes. Efferent pathways by which lymphocytes enter the brain are regulated by selected integrins on lymphocytes and selective receptors on vascular endothelial cells. Here we review: (1) the structure and function of afferent lymphatic drainage of ISF and CSF, (2) mechanisms involved in the efferent pathways by which lymphocytes enter the brain and (3) the failure of lymphatic drainage of the brain parenchyma with age and the role of such failure in the pathogenesis of Alzheimer's disease. PMID:24145049

  3. A balanced view of the cerebrospinal fluid composition and functions: Focus on adult humans.

    Science.gov (United States)

    Spector, Reynold; Robert Snodgrass, S; Johanson, Conrad E

    2015-11-01

    In this review, a companion piece to our recent examination of choroid plexus (CP), the organ that secretes the cerebrospinal fluid (CSF), we focus on recent information in the context of reliable older data concerning the composition and functions of adult human CSF. To accomplish this, we define CSF, examine the methodology employed in studying the CSF focusing on ideal or near ideal experiments and discuss the pros and cons of several widely used analogical descriptions of the CSF including: the CSF as the "third circulation," the CSF as a "nourishing liquor," the similarities of the CSF/choroid plexus to the glomerular filtrate/kidney and finally the CSF circulation as part of the "glymphatic system." We also consider the close interrelationship between the CSF and extracellular space of brain through gap junctions and the paucity of data suggesting that the cerebral capillaries secrete a CSF-like fluid. Recently human CSF has been shown to be in dynamic flux with heart-beat, posture and especially respiration. Functionally, the CSF provides buoyancy, nourishment (e.g., vitamins) and endogenous waste product removal for the brain by bulk flow into the venous (arachnoid villi and nerve roots) and lymphatic (nasal) systems, and by carrier-mediated reabsorptive transport systems in CP. The CSF also presents many exogenous compounds to CP for metabolism or removal, indirectly cleansing the extracellular space of brain (e.g., of xenobiotics like penicillin). The CSF also carries hormones (e.g., leptin) from blood via CP or synthesized in CP (e.g., IGF-2) to the brain. In summary the CP/CSF, the third circulation, performs many functions comparable to the kidney including nourishing the brain and contributing to a stable internal milieu for the brain. These tasks are essential to normal adult brain functioning. PMID:26247808

  4. Early neurosurgical intervention of spinal cord contusion: an analysis of 30 cases

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background The incidence of spinal injury with spinal cord contusion is high in developed countries and is now growing in China. Furthermore, spinal cord injury happens mostly in young people who have a long life expectance. A large number of patients thus are wheelchair bound for the rest of their lives. Therefore, spinal cord injury has aroused great concern worldwide. Despite great efforts, recovery from spinal cord injury remains unsatisfactory. Based on the pathology of spinal cord contusion, an idea of early neurosurgical intervention has been formulated in this study. Methods A total of 30 patients with "complete" spinal cord injury or classified as American Spinal Injury Association (ASIA)-A were studied. Orthopedic treatment of the injured vertebra(e), internal fixation of the vertebral column, and bilateral laminectomy for epidural decompression were followed directly by neurosurgical management, including separation of the arachnoid adhesion to restore cerebrospinal fluid flow and debridement of the spinal cord necrotic tissue with concomitant intramedullary decompression. Rehabilitation started 17 days after the operation. The final outcome was evaluated after 3 months of rehabilitation. Pearson chi-square analysis was used for statistical analysis. Results All the patients recovered some ability to walk. The least recovered patients were able to walk with a wheeled weight support and help in stabilizing the weight bearing knee joint (12 cases, 40%). Thirteen patients (43%) were able to walk with a pair of crutches, a stick or without any support. The timing of the operation after injury was important. An optimal operation time window was identified at 4-14 days after injury. Conclusions Early neurosurgical intervention of spinal cord contusion followed by rehabilitation can significantly improve the locomotion of the patients. It is a new idea of a therapeutic approach for spinal cord contusion and has been proven to be very successful.

  5. Posterior fossa reconstruction in the treatment of Chiari I malformation associated with syringomyelia%颅后窝重建术治疗Chiari I畸形合并脊髓空洞症

    Institute of Scientific and Technical Information of China (English)

    沈建; 方黎明; 濮宏健; 朱岁军; 唐超; 周永庆; 黄红光

    2011-01-01

    Objective To evaluate posterior fossa reconstruction (posterior cranial fossa decompression,duraplasty, resection of the cerebellar tonsil and separation of the arachnoid membrane from the dura) in the treatment of Chiari Ⅰ malformation.Methods A total of 46 patients suffered from Chiari Ⅰ malformation associated with syringomyelia received posterior fossa reconstruction in our department from November 2002 to January 2008.Results The rate of symptom improvement post - operation was 84.8%.The length of syringomyelia was decreased significantly and KPS got remarkable improvement.Conclusion Posterior fossa reconstruction is a rational option for the treatment of Chiari Ⅰ malformation associated with syringomyelia.%目的 探讨后颅窝重建术(后颅窝减压+硬脑膜成形+小脑扁桃体切除+蛛网膜粘连分解)治疗Chiari I畸形合并脊髓空洞症的方法及疗效.方法 2002年11月至2008年1月对收治的46例Chiari I畸形合并脊髓空洞症患者行后颅窝重建术.结果 后颅窝重建术症状改善率84.8%,脊髓空洞长度明显减小,KPS评分显著改善.结论后颅窝重建术是治疗Chiari I畸形合并脊髓空洞症较为合理的术式.

  6. Pathogenesis of cerebral malformations in human fetuses with meningomyelocele

    Directory of Open Access Journals (Sweden)

    Brouwer Oebele F

    2008-03-01

    Full Text Available Abstract Background Fetal spina bifida aperta (SBA is characterized by a spinal meningomyelocele (MMC and associated with cerebral pathology, such as hydrocephalus and Chiari II malformation. In various animal models, it has been suggested that a loss of ventricular lining (neuroepithelial/ependymal denudation may trigger cerebral pathology. In fetuses with MMC, little is known about neuroepithelial/ependymal denudation and the initiating pathological events. The objective of this study was to investigate whether neuroepithelial/ependymal denudation occurs in human fetuses and neonates with MMC, and if so, whether it is associated with the onset of hydrocephalus. Methods Seven fetuses and 1 neonate (16–40 week gestational age, GA with MMC and 6 fetuses with normal cerebral development (22–41 week GA were included in the study. Identification of fetal MMC and clinical surveillance of fetal head circumference and ventricular width was performed by ultrasound (US. After birth, MMC was confirmed by histology. We characterized hydrocephalus by increased head circumference in association with ventriculomegaly. The median time interval between fetal cerebral ultrasound and fixing tissue for histology was four days. Results At 16 weeks GA, we observed neuroepithelial/ependymal denudation in the aqueduct and telencephalon together with sub-cortical heterotopias in absence of hydrocephalus and/or Chiari II malformation. At 21–34 weeks GA, we observed concurrence of aqueductal neuroepithelial/ependymal denudation and progenitor cell loss with the Chiari II malformation, whereas hydrocephalus was absent. At 37–40 weeks GA, neuroepithelial/ependymal denudation coincided with Chiari II malformation and hydrocephalus. Sub-arachnoidal fibrosis at the convexity was absent in all fetuses but present in the neonate. Conclusion In fetal SBA, neuroepithelial/ependymal denudation in the telencephalon and the aqueduct can occur before Chiari II malformation

  7. MRI and {sup 1}H MRS findings in Smith-Lemli-Opitz syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Caruso, P.A. [Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Poussaint, T.Y. [Department of Radiology, Children' s Hospital, 300 Longwood Avenue, MA 02115, Boston (United States); Tzika, A.A.; Astrakas, L.G. [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Zurakowski, D. [Department of Biostatistics, Children' s Hospital Boston, Boston, MA (United States); Elias, E.R. [Department of Pediatrics and Genetics, Children' s Hospital, Denver, CO (United States); School of Medicine, University of Colorado, Denver, CO (United States); Bay, C. [Department of Medical Genetics, Children' s Hospital of Pittsburgh, Pittsburgh, PA (United States); Irons, M.B. [Division of Clinical Genetics and Metabolism, Children' s Hospital Boston, Boston, MA (United States)

    2004-01-01

    Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive disorder characterized by a defect in cholesterol biosynthesis, associated with mental retardation and multisystem structural abnormalities. This study investigated the prevalence of congenital CNS abnormalities by MRI in a large series of patients with SLOS and the correlation of the clinical and biochemical findings with the results of MRI and {sup 1}H MRS. Eighteen patients were studied; all underwent MRI of the brain, and 16 had {sup 1}H MRS of the cerebral white matter. The ratios choline:NAA, lipid:NAA, and lipid:choline metabolite were found to be correlated with the clinical degree of disease severity, serum total sterol ratios (cholesterol/cholesterol + 7-dehydrocholesterol + 8-dehydrocholesterol) and in two cases with the effect of cholesterol therapy. Abnormal CNS findings were noted in five patients, including callosal abnormalities (n=4), Dandy-Walker variant (n=1), and arachnoid cyst (n=1). Holoprosencephaly was noted in one patient with a prevalence of 6%. Choline:NAA was elevated in seven patients. There was a statistically significant positive correlation between the lipid:choline ratio and the serum cholesterol precursor, 8-dehydrocholesterol. In two patients {sup 1}H MRS demonstrated abnormally elevated lipids prior to cholesterol therapy, which improved on therapy. The use of MRI and {sup 1}H MRS is an effective way to demonstrate brain structural abnormalities in patients with SLOS and may prove to be an effective method for the assessment of the effects of cholesterol replacement therapy in the brain. (orig.)

  8. [Pregnancy and childbirth in a patient with a spinal cord lesion].

    Science.gov (United States)

    Vanderbeke, I; Boll, D; Verguts, J K

    2008-05-17

    A 37-year-old woman with a spinal cord lesion at the level of TvIII due to a car-accident, became pregnant. She had posttraumatic syringomyely at Cv-TvIII, for which she underwent syringo-arachnoidal drainage. At approximately six weeks of amenorrhoea she presented at the emergency room with vaginal bleeding. She was treated with dalteparine 5000 IU once daily given by intramuscular injection until 6 weeks post partum. Weekly urine checks were advised. At 36 6/7 weeks of pregnancy, the patient was admitted to hospital for daily cardiotocography and 4-hourly contraction monitoring. After spontaneous rupture of the membranes she went into labour and had a vaginal delivery of a son weighing 3320 g. His Apgar score was 6 after 1 min and 9 after 5 min; arterial pH was 7.31. For three months after giving birth she received specialist care at home as well as help and counselling from a rehabilitation centre. In pregnant women with a spinal cord lesion, special attention should be paid to urinary tract infections, pressure areas, anaemia and thrombo-embolic symptoms. During partus, cardiotocographic monitoring should be carried out, also in patients with TvI-Tx lesions regularly from 36 weeks. In pregnant women with lesions from TvI, medical attendants should be aware of the possibility of autonomous dysreflection. Epidural anaesthesia should be administered and episiotomy or rupture avoided. Post partum, the bladder should always be completely emptied and pressure areas and signs ofthrombo-embolic complications monitored. A urological bladder function consultation should be requested, and, ifepisiotomy or rupture does occur, extra care should be taken to avoid infection. The ergonomic situation at home should be evaluated to ensure that any ergonomic changes necessary for the care of the patient and her newborn, take place in time.

  9. Localization of Epileptic Foci in Temporal Lobe Epilepsy by MR and EEG%颞叶癫 的EEG和MR术前定位研究

    Institute of Scientific and Technical Information of China (English)

    高翔; 江澄川; 洪震; 俞丽云

    2000-01-01

    Aim:To discuss pre-operative localization of epileptic foci in intractable temporal epilepsy by EEG and MR. Meth-ods: MR and EEG were used to localize the epileptic foci in 20 patients with intractable temporal lobe epilepsy (TLE)pre-oper-atively,all the patients had intra-operative cortical EEG examination and post-operative follow-up. Restults: 17 patients' seizurefoci were localized by MR and EEG examination ,among them l 0 patients have hippocampus sclerosis, 3 cases tephromalacia, 2cases arachnoid cyst, 1 case glioma. Another 3 cases were localized hy repetitive EEG examinaticm while MR examinationswere normal. All patients were followed up after operation,the result was satisfactory. Conclusion:EEG is the most importantlocalizing method for temporal lobe epilepsy,MR is useful for the secondary TLE.Examination of hippocampus for HS will behelpful while the ordinary MR examination is normal.%目的:探讨EEG、MR对颞叶癫 (TLE)术前定位。方法:用MR、EEG对20例TLE病例进行术前定位与术中EEG和术后随访结果比较。结果:20例病例中17例依据MR及EEG获得定位,主要在海马区域病变12例,前颞叶5例,另3例MR检查正常,依据多次EEG检查获得定位,随访疗效满意。结论:EEG是诊断TLE的重要手段,MR可对继发性TLE作出正确诊断,MR对海马硬化检查可协助EEG对TLE定位诊断。

  10. Imaging studies for failed back surgery syndrome; Imagerie du rachis lombaire opere

    Energy Technology Data Exchange (ETDEWEB)

    Cosnard, G.; Cordoliani, Y.S.; Sarrazin, J.L.; Soulie, D. [Hopital des Armees du Val-de-Grace, 75 - Paris (France)

    1995-09-01

    In patients with failed back surgery syndrome, magnetic resonance imaging (MRI) can be the best first-line imaging study because it simplifies the diagnosis. This update is based on over 600 cases. MRI shows the scar tissue at the surgical site, persistent evidence of disk herniation for several weeks after surgery, and evidence of local and regional edema in one-fourth of cases. The edema is most marked between two months and two years after the operation and can misleadingly suggest discitis. MRI is the best investigation for detecting recurrent herniation at the same vertebral level or another level. Herniated disk material is seen as a mass that does not enhance after gadolinium, in contrast to the vascularized scar tissue. Free fragments are often clearly visible within the scar tissue. Fragments that migrate to the epidural space can give rise to granulomatous reactions. Scar tissue can be seen in the epidural space and within the disk; it can show enhancement after gadolinium for several years. The scar can be atrophic or hypertrophic and can encase or impinge on the dural sac and nerve roots. Pathological fibrosis cannot be differentiated from ordinary scar tissue. Arachnoiditis causing adherence of the nerve roots to the dura mater or to each other occurs in 5 % to 10 % of cases. Nerve root enhancement after gadolinium is seen in three-fourths of cases. Bone lesions are common, especially some time after surgery; they are usually accompanied with other lesions. Hematomas are seen in less than 10 % of cases. Infections are similarly rare (0.25 % each for discitis and epiduritis). The diagnosis of discitis is difficult and requires percutaneous biopsy of the disk, especially when MRI shows fluid within the disk, with decreased signal intensity on T2 images, and non enhancement after intravenous gadolinium. (authors). 19 refs., 7 figs.

  11. Hindlimb Suspension (HLS) in Rodents for the Study of Intracranial Pressure, Molecular and Histologic Changes in the Eye, and CSF Production Regulation and Resorption: A Status Report of Two Studies

    Science.gov (United States)

    Theriot, C. A.; Taibbi, G.; Vizzeri, G.; Parsons-Wingerter, P.; Chevez-Barrios, P.; Rivera, A.; Zanello, S. B.

    2016-01-01

    This status report corresponds to two studies tied to an animal experiment being executed at the University of California Davis (Charles Fuller's laboratory). The animal protocol uses the well-documented rat hindlimb suspension (HLS) model, to examine the relationship between cephalic fluid shifts and the regulation of intracranial (ICP) and intraocular (IOP) pressures as well as visual system structure and function. Long Evans rats are subjected to HLS durations of 7, 14, 28 and 90 days. Subgroups of the 90-day animals are studied for recovery periods of 7, 14, 28 or 90 days. All HLS subjects have age-matched cage controls. Various animal cohorts are planned for this study: young males, young females and old males. In addition to the live measures (ICP by telemetry, IOP and retinal parameters by optical coherence tomography) which are shared with the Fuller study, the specific outcomes for this study include: -Gene expression analysis of the retina -Histologic analysis - Analysis of the microvasculature of retina flat mounts by NASA's VESsel GENeration Analysis (VESGEN) Software. To date, the young male and female cohorts are being completed. Due to the need to keep technical variation to a minimum, the histologic and genomic analyses have been delayed until all samples from each cohort are available and can be processed in a single batch per cohort. The samples received so far correspond to young males sacrificed at 7,14, 28 and 90 days of HLS and at 90 days of recovery; and from young females sacrificed at 7, 14 and 28 of HLS. A complementary study titled: "A gene expression and histologic approach to the study of cerebrospinal fluid (CSF) production and outflow in hindlimb suspended rats" seeks to study the molecular components of CSF production and outflow modulation as a result of HLS, bringing a molecular and histologic approach to investigate genome wide expression changes in the arachnoid villi and choroid plexus of HLS rats compared to rats in normal

  12. 颅脑外伤性硬膜下积液演变成慢性硬膜下血肿的临床治疗分析%Analysis of the clinical treatment of chronic subdural hematoma after traumatic subdural effusion

    Institute of Scientific and Technical Information of China (English)

    黄学

    2015-01-01

    Objective to study the cerebral traumatic subdural effusion (TSE) evolve into chronic subdural hematoma (CSDH) in the mechanism and characteristics.Methods in our hospital in February 2010 to February 2015 were 18 cases of brain traumatic subdural effusion into analyzing observation in patients with chronic subdural hematoma.Result s18 cases were clear history of head injury, cerebral TSE turned into CSDH time for 1 to 3 months, hematoma in 12 cases, unilateral frontotemporal bilateral frontal temporal 6 cases, all patients after surgery are back to normal.Conclusion cerebrospinal fluid mixed with blood is cerebral TSE evolved into a mechanism of CSDH, sees more at old people, mainly in the bone crest and arachnoid is weaker.%目的 探讨颅脑外伤性硬膜下积液(TSE)演变成慢性硬膜下血肿(CSDH)的机制及特点.方法 对我院2010年2月至2015年2月收治的18例颅脑外伤性硬膜下积液演变成慢性硬膜下血肿患者进行观察分析.结果 18例均有明确的头部外伤史,颅脑TSE演变成CSDH的时间为1~3月,血肿在单侧额颞12例,双侧额颞6例,所有患者经手术治疗均恢复正常.结论 脑脊液与血液混合是颅脑TSE演变成CSDH的发生机理,多见于老年人,主要是在骨嵴与蛛网膜较薄弱处.

  13. Functional redundancy and complementarities of seed dispersal by the last neotropical megafrugivores.

    Directory of Open Access Journals (Sweden)

    Rafael S Bueno

    Full Text Available BACKGROUND: Functional redundancy has been debated largely in ecology and conservation, yet we lack detailed empirical studies on the roles of functionally similar species in ecosystem function. Large bodied frugivores may disperse similar plant species and have strong impact on plant recruitment in tropical forests. The two largest frugivores in the neotropics, tapirs (Tapirus terrestris and muriquis (Brachyteles arachnoides are potential candidates for functional redundancy on seed dispersal effectiveness. Here we provide a comparison of the quantitative, qualitative and spatial effects on seed dispersal by these megafrugivores in a continuous Brazilian Atlantic forest. METHODOLOGY/PRINCIPAL FINDINGS: We found a low overlap of plant species dispersed by both muriquis and tapirs. A group of 35 muriquis occupied an area of 850 ha and dispersed 5 times more plant species, and 13 times more seeds than 22 tapirs living in the same area. Muriquis dispersed 2.4 times more seeds in any random position than tapirs. This can be explained mainly because seed deposition by muriquis leaves less empty space than tapirs. However, tapirs are able to disperse larger seeds than muriquis and move them into sites not reached by primates, such as large forest gaps, open areas and fragments nearby. Based on published information we found 302 plant species that are dispersed by at least one of these megafrugivores in the Brazilian Atlantic forest. CONCLUSIONS/SIGNIFICANCE: Our study showed that both megafrugivores play complementary rather than redundant roles as seed dispersers. Although tapirs disperse fewer seeds and species than muriquis, they disperse larger-seeded species and in places not used by primates. The selective extinction of these megafrugivores will change the spatial seed rain they generate and may have negative effects on the recruitment of several plant species, particularly those with large seeds that have muriquis and tapirs as the last living

  14. Role and limitation of fetal and neonatal MRIs for delineation of neural tube defects

    International Nuclear Information System (INIS)

    Development of MRI has contributed to the perioperative diagnosis of neural tube defect (NTD). We assessed the usefulness of fetal MRI in NTD in comparison with neonatal MRI. Fourteen consecutive cases suspected of NTDs (11 spina bifida, 2 cranium bif ida, 1 other) were evaluated with fetal and/or neonatal MRIs (Philips, 1.5T). Some initial abnormalities were suspected 27w6d (mean) of gestation from ultrasonography (US) and fetal MRIs were performed at 31w3d of gestation in 10 cases (4 other cases were transferred to us after birth). The infants were delivered 37w6d of gestation on average and neonatal MRIs were performed 2.4d (mean, 0-23d) after birth in 13 cases, except one patient with myeloschisis who underwent emergency operation just after the birth. Mean diameter of the lesions was 48.6 mm. Skin defect and deviation of the distal end of the cord were observed in fetal MRI. Deviated cords in the myelomeningoceles were confirmed in 2 cases by fetal MRI and in 4 cases by neonatal MRI. Neonatal MRIs showed the lesions to be covered with skin in 9 out of 10 cases (including 2 encephalomeningoceles) without postnatal cerebrospinal fluid (CSF) leakage, while fetal MRIs showed this possibility in only 3 cases. Concerning complications, hydrocephalus was demonstrated with fetal MRIs in 4 cases, for which ventriculo-peritoneal shunt operations were necessary after birth, while Chiari malformations were barely detected, even in 3 cases in which they were suspected through neonatal MRIs. One case suspected of NTD with sacral cystic lesion through US was diagnosed as having teratoma, which was depicted as a presacral mass by fetal MRI. Fetal MRI was useful in differentiating myeloschisis, myelomeningocele and other lumbosacral mass lesions and in delineating coexisting hydrocephalus. Limitations of fetal MRIs in comparison with neonatal MRIs have become evident, however, in depicting skin coverings on lesions, arachnoids (CSF leakage) and Chiari malformations. (author)

  15. Liposomal cytarabine for central nervous system embryonal tumors in children and young adults.

    Science.gov (United States)

    Partap, Sonia; Murphy, Patricia A; Vogel, Hannes; Barnes, Patrick D; Edwards, Michael S B; Fisher, Paul G

    2011-07-01

    To assess the tolerability and efficacy of liposomal cytarabine (LC), an encapsulated, sustained-release, intrathecal (IT) formulation of cytosine arabinoside, in de novo and relapsed central nervous system (CNS) embryonal tumors in children and young adults. We studied retrospectively all patients less than age 30 at our institution treated consecutively with LC for medulloblastoma (MB), primitive neuroectodermal tumor (PNET), and atypical teratoid rhabdoid tumor (ATRT). Seventeen patients received LC (2 mg/kg up to 50 mg, every 2 weeks to monthly) at diagnosis of high-risk CNS embryonal tumor (2 PNET, 3 ATRT) or relapse of MB (12 MB; 9 had leptomeningeal metastases). Sixteen patients received concurrent systemic chemotherapy. A total of 108 doses were administered (IT 82, intraventricular 26) with a mean of six (range 1-16) treatments per patient. Only three administrations were associated with adverse effects of arachnoiditis or headache. None developed malignant cerebrospinal fluid (CSF) cytology while receiving LC. All the six evaluable patients with malignant CSF cytology and treated with at least two doses cleared their CSF (mean 3 doses, range 1-5). Median overall survival in relapse patients was 9.1 months. Five patients (4 de novo and 1 relapsed) remain alive in complete remission for a median 26.8 months from first LC. Liposomal cytarabine is an easily administered, well-tolerated, and active drug in patients with high-risk embryonal neoplasms. One-third of our cohort remains in remission from otherwise fatal diagnoses. Our findings warrant a phase II trial of LC in newly diagnosed or recurrent CNS embryonal tumors. PMID:20859651

  16. Magnetic resonance imaging of racemous cysticercosis of the cauda equina; Ressonancia magnetica de paciente com cisticercose racemosa da cauda equina

    Energy Technology Data Exchange (ETDEWEB)

    Costa Junior, Leodante Batista da; Lemos, Sandro Pedroso [Hospital da Baleia, Belo Horizonte, MG (Brazil). Servico de Neurocirurgia; Lambertucci, Jose Roberto [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Medicina. Servico de Doencas Infecciosas e Parasitarias

    2003-12-01

    37-year-old man presented with low back pain for the last 6 months followed by sensation of numbness in the lower limbs that evolved with paraparesis, urinary retention and impotence. Subsequently, he lost control over the bowel function. Neurological examination revealed increased muscle tone along with grade zero power in both lower limbs. Knee and ankle jerks were exaggerated. Nine months prior to admission, a type II diabetes mellitus was diagnosed and he has been taking insulin ever since. MRI revealed multiple cystic lesions in the cauda equina opposite the L1-S1 vertebral bodies with no involvement of the spinal cord (Figure A: sagittal section T1-weighted image after contrast with cystic lesions on the left side - yellow arrow -, and T2-weighted image on the right - red arrows pointing cystic lesions). The cysts were hypointense on T1-weighted images (Figure B: horizontal section - yellow arrows) and hyperintense in T2-weighted images (Figure A - red arrows). Computerized tomography of the brain showed moderate ventricle dilatation (Figure C) with no intra or extra axial lesions. He was submitted to laminectomy and the cysts were surgically removed. An intense inflammatory process (arachnoiditis) involving the nerve roots of the cauda equina was reported. Histology of the surgical specimen confirmed the diagnosis of racemous cysticercosis. He improved quickly after surgery. Three months later, at the outpatient clinic, he walked with support, resumed sphincter control of the bladder and bowel and had no more pain. Ten months later he returned to hospital walking with crutches, with hypoesthesia and paraesthesia on the left leg and urinary incontinence. He refused treatment with albendazole and steroids. (author)

  17. Antigen-specific immune reactions to ischemic stroke

    Directory of Open Access Journals (Sweden)

    Xabier eUrra

    2014-09-01

    Full Text Available Brain proteins are detected in the CSF and blood of stroke patients and their concentration is related to the extent of brain damage. Antibodies against brain antigens develop after stroke, suggesting a humoral immune response to the brain injury. Furthermore, induced immune tolerance is beneficial in animal models of cerebral ischemia. The presence of circulating T cells sensitized against brain antigens, and antigen presenting cells (APCs carrying brain antigens in draining lymphoid tissue of stroke patients support the notion that stroke might induce antigen-specific immune responses. After stroke, brain proteins that are normally hidden from the periphery, inflammatory mediators, and danger signals can exit the brain through several efflux routes. They can reach the blood after leaking out of the damaged blood-brain barrier or following the drainage of interstitial fluid to the dural venous sinus, or reach the cervical lymph nodes through the nasal lymphatics following CSF drainage along the arachnoid sheaths of nerves across the nasal submucosa. The route and mode of access of brain antigens to lymphoid tissue could influence the type of response. Central and peripheral tolerance prevents autoimmunity, but the actual mechanisms of tolerance to brain antigens released into the periphery in the presence of inflammation, danger signals, and APCs, are not fully characterized. Stroke does not systematically trigger autoimmunity, but under certain circumstances, such as pronounced systemic inflammation or infection, autoreactive T cells could escape the tolerance controls. Further investigation is needed to elucidate whether antigen-specific immune events could underlie neurological complications impairing stroke outcome.

  18. CT of the infants and children with mental and/or physical handicaps

    International Nuclear Information System (INIS)

    Computed tomography (CT) was performed on 47 children and adolescents with mental and/or physical handicaps. Of these series, 22 cases of morphological change were noted. Another 25 cases showed no overt CT abnormality. These 47 cases were divided into three groups in the following manner. Group 1, with no CT abnormality; Group 2, with ventricular dilatation and/or cerebral atrophy, and Group 3, with a major morphological anomaly of the brain. Group 1 (25 cases) showed a marked dissociation between the CT findings and the IQ. EEG showed normal findings in two cases, diffuse abnormality in 5 cases, and focal abnormality in 9 cases. This group alone included 8 cases of athetosis. Group 2 (14 cases). Seven cases of EEG showed diffuse abnormality in 3 cases and focal abnormality in 4 cases. So-called cerebral palsy was noted in 11 cases. Group 3 (8 cases). This group included cases of hemihydranencephaly, porencephaly, agenesis of the corpus callosum, and arachnoid cyst. The mean and standard deviations of the IQ's in the groups are 57.1 +- 21.6, 65.2 +- 20.5, and 72.0 +- 8.0. That is, an inverted correlation between the CT abnormality and the IQ was noted. CT is a noninvasive study and a reasonable method of investigation for mentally handicapped children. DeMyer gave three categories of cerebral malformation: cytogenetic malformations, organogenetic disorders, and histogenetic disorders. On the other hand, EEG aimed at evaluating cerebral function and CT undertaken for morphological evaluation reveal no intimate correlation with one another. Rather, these two procedures each have their one value for the evaluation of the function and the structure of the brain. Mentally and/or physically handicapped patients without any overt cerebral anomaly have been found to be as follows: Murobushi, 12.29%; Malamud, 34%; Gross, 15.8%; Benda, 15%, and Hamada, 45.4%. (author)

  19. Mucopolysaccharidosis type IVA: evidence of primary and secondary central nervous system involvement.

    Science.gov (United States)

    Borlot, Felippe; Arantes, Paula Ricci; Quaio, Caio Robledo; Franco, José Francisco da Silva; Lourenço, Charles Marques; Gomy, Israel; Bertola, Debora Romeo; Kim, Chong Ae

    2014-05-01

    Mucopolysaccharidosis type IVA is a rare lysosomal storage disease caused by a deficiency of N-acetylgalactosamine 6-sulfatase. Studies usually focus on skeletal abnormalities and their consequences. This study explores the neurological manifestations in a cohort of mucopolysaccharidosis type IVA patients, with a detailed focus on brain and spinal magnetic resonance imaging (MRI) findings. We performed a cross-sectional study involving nine patients with a biochemical confirmation of mucopolysaccharidosis type IVA. The protocol consists of a comprehensive clinical examination and brain and spinal cord MRI analysis for all subjects. The mean age was 16.4 years (±5.7) and the mean onset of symptoms was 11.5 months (±6.3). Overall, cognition was spared in all but one patient and motor weakness was a constant finding in all patients. Deep sensation impairment was found in six patients. The brain MRIs showed non-specific white matter changes in two patients. Other abnormalities such as clival hypoplasia, basilar invagination, and arachnoid cists appeared in seven of the nine patients. Eight patients presented spinal cord compression, and in three of them, two spinal levels were compromised. Odontoid hypoplasia and degenerative features in the neuroaxis were present in all patients. Our experience with mucopolysaccharidosis type IVA patients supports the evidence of central nervous system involvement. We emphasize the importance of regular clinical assessments with complete MRI studies, as an attempt to detect the early signs of spinal cord compression. This evaluation may be especially important before surgical interventions, as occult lesions may become symptomatic and promote postoperative unfavorable outcomes.

  20. Intraparenchymal epidermoid cysts in the brain: diagnostic value of MR diffusion-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hu, X.-Y. [Medical Imaging Center, The First Affiliated Hospital of Suzhou, Jiangsu Province (China); Hu, C.-H. [Imaging Center, Soochow University (China)], E-mail: wpdrhxy@hotmail.com; Fang, X.-M.; Cui, L.; Zhang, Q.-H. [Medical Imaging Center, The First Affiliated Hospital of Suzhou, Jiangsu Province (China)

    2008-07-15

    Aim: To evaluate the value of magnetic resonance (MR) diffusion-weighted imaging (DWI) and apparent diffusion coefficients (ADC) maps in the diagnosis of intraparenchymal epidermoid cysts (ECs). Materials and methods: Six cases of histopathologically proven intraparenchymal ECs were studied. All patients were examined with conventional MR (T1WI, T2WI, contrast-enhanced T1WI) and DWI sequences. Along with the mean ADC values (mADC) of the ECs, the cerebrospinal fluid (CSF) and grey matter (GM) were measured. Qualitative and quantitative assessments, as well as MRI findings, were retrospectively analysed using a double blind method by three radiologists in consensus. Results: Four lesions were located in the cerebellum, among them, one was accompanied by an arachnoid cyst; one huge lesion crossed the parenchyma of the frontal and temporal lobes; the other was located in the left temporal lobe. Two lesions had a homogeneous CSF-like intensity on both T1WI and T2WI. The other four were of mixed-intensity on both T1WI and T2WI. All lesions were strikingly hyperintense on DWI, and iso- or slightly hypointense on ADC (relative to the brain). The mADCs of the ECs were significantly higher than that of GM, but significantly lower than that of CSF. Three cases (3/6) were accurately diagnosed using conventional MR sequences without DWI, but in the remaining three cases, correct diagnosis could only be made with help of DWI. Conclusion: DWI sequences can facilitate the diagnosis of intraparenchymal ECs, thus alerting surgeons of the risk of chemical meningitis at surgery. The MR findings of intraparenchymal ECs are basically as the same as those of extracerebral ECs, but the former is likely to have a mixed signal. The hyperintense signal of ECs on DWI is probably caused by the T2 shine-through effect in tumour tissue.

  1. MRI findings of temporal lobe epilepsy

    International Nuclear Information System (INIS)

    MRI findings were analyzed retrospectively in 46 patients with temporal lobe epilepsy in which the side of epileptogenic focus had been confirmed by EEG studies. T1- and T2-weighted images were obtained by the use of a 1.0 or 1.5 T superconducting-type MRI machine with a coronal scan perpendicular to the axis of the temporal horn of the lateral ventricle. Additional axial and sagittal scans were performed in some cases. The area of the hippocampal body was measured quantitatively using a computerized image-analysis system in 26 cases in which the hippocampus had been visualized with enough contrast on T1-weighted coronal images. Abnormal findings were observed in 31/46 (67%) cases. Hippocampal (HC) and temporal lobe (TL) atrophy were observed in 18/46 (39%) and 23/46 (50%) cases respectively, and the side of the atrophy corresponded with the side of the epileptogenic focus, as confirmed by EEG studies, with specificities of 89% and 74% respectively. A quantitative measurement of the area of the hippocampal body showed unilateral hippocampal atrophy more than 10% in 18/25 (69%) cases (10-25%: 10 cases, 25-50%: 7 cases, 50%2 abnormality was observed in only 4 cases. Structural lesions were observed in 4 cases including an arachnoid cyst, an astrocytoma in amygdala, the Dandy-Walker syndrome, and tuberous sclerosis, using the more efficient imaging qualities than the CT scan. From these observations, it is apparant that superconducting MRI is extremely useful in the diagnosis of the epileptogenic topography of temporal lobe epilepsy. Particularly, hippocampal atrophy was found to correspond with the side of the epileptogenic focus on EEG with a high specificity; its quantitative evaluation could be one of the most important standards in detecting the operative indications for temporal lobe epilepsy. (author)

  2. Petrous apex cephalocele and empty sella: Is there any relation?

    Energy Technology Data Exchange (ETDEWEB)

    Alorainy, Ibrahim A. [Department of Radiology and Diagnostic Imaging, College of Medicine and King Khalid University Hospital, King Saud University, PO Box: 9047, Riyadh 11413 (Saudi Arabia)]. E-mail: alorainy@ksu.edu.sa

    2007-06-15

    Objective: To document the presence of incidental petrous apex cephalocele (PAC) in association with empty sella in a group of patients and propose an etiologic/pathologic relation between the two lesions. Materials and methods: Retrospective review of our imaging archive for the period from October 2001 to October 2006 revealed five patients with PAC (four females and one male; age range, 25-60 years; mean, 47 years). All patients underwent enhanced MR examination of the skull base and four of them underwent CT examination. Lesions were evaluated for size, content, signal intensity, enhancement, and relation to Meckel's cave and petrous apex. Images were also evaluated for the presence of empty sella. Results: The presenting symptoms in all patients were not attributable to PAC. None of the patients had symptoms related to the trigeminal nerve or history of CSF leak. Four patients had bilateral PAC and one had left PAC (total nine lesions). The lesions ranged from 6 mm to 15 mm (mean 9 mm) in the maximum diameter. All lesions were centered posterolateral to Meckel's cave and had low attenuation on CT with sharply demarcated margins. No lesion reached the inner ear structures, internal auditory canal, or mastoid air cells. On MR imaging, all lesions demonstrated CSF signal intensity that is continuous with that of the Meckel's cave. Only the periphery of the lesions demonstrated mild enhancement. All patients had empty sella. One patient had small arachnoid cysts in the middle cranial fossa, bilaterally. Conclusion: PAC and empty sella are similar mechanically in terms of CSF extension and erosion into petrous apex and sella, respectively. Both conditions are seen predominantly in females and have been reported in association with CSF leak, which raises a possibility of etiologic/pathologic relation between the two.

  3. [Pregnancy and childbirth in a patient with a spinal cord lesion].

    Science.gov (United States)

    Vanderbeke, I; Boll, D; Verguts, J K

    2008-05-17

    A 37-year-old woman with a spinal cord lesion at the level of TvIII due to a car-accident, became pregnant. She had posttraumatic syringomyely at Cv-TvIII, for which she underwent syringo-arachnoidal drainage. At approximately six weeks of amenorrhoea she presented at the emergency room with vaginal bleeding. She was treated with dalteparine 5000 IU once daily given by intramuscular injection until 6 weeks post partum. Weekly urine checks were advised. At 36 6/7 weeks of pregnancy, the patient was admitted to hospital for daily cardiotocography and 4-hourly contraction monitoring. After spontaneous rupture of the membranes she went into labour and had a vaginal delivery of a son weighing 3320 g. His Apgar score was 6 after 1 min and 9 after 5 min; arterial pH was 7.31. For three months after giving birth she received specialist care at home as well as help and counselling from a rehabilitation centre. In pregnant women with a spinal cord lesion, special attention should be paid to urinary tract infections, pressure areas, anaemia and thrombo-embolic symptoms. During partus, cardiotocographic monitoring should be carried out, also in patients with TvI-Tx lesions regularly from 36 weeks. In pregnant women with lesions from TvI, medical attendants should be aware of the possibility of autonomous dysreflection. Epidural anaesthesia should be administered and episiotomy or rupture avoided. Post partum, the bladder should always be completely emptied and pressure areas and signs ofthrombo-embolic complications monitored. A urological bladder function consultation should be requested, and, ifepisiotomy or rupture does occur, extra care should be taken to avoid infection. The ergonomic situation at home should be evaluated to ensure that any ergonomic changes necessary for the care of the patient and her newborn, take place in time. PMID:18549144

  4. Magnetic resonance imaging of racemous cysticercosis of the cauda equina

    International Nuclear Information System (INIS)

    37-year-old man presented with low back pain for the last 6 months followed by sensation of numbness in the lower limbs that evolved with paraparesis, urinary retention and impotence. Subsequently, he lost control over the bowel function. Neurological examination revealed increased muscle tone along with grade zero power in both lower limbs. Knee and ankle jerks were exaggerated. Nine months prior to admission, a type II diabetes mellitus was diagnosed and he has been taking insulin ever since. MRI revealed multiple cystic lesions in the cauda equina opposite the L1-S1 vertebral bodies with no involvement of the spinal cord (Figure A: sagittal section T1-weighted image after contrast with cystic lesions on the left side - yellow arrow -, and T2-weighted image on the right - red arrows pointing cystic lesions). The cysts were hypointense on T1-weighted images (Figure B: horizontal section - yellow arrows) and hyperintense in T2-weighted images (Figure A - red arrows). Computerized tomography of the brain showed moderate ventricle dilatation (Figure C) with no intra or extra axial lesions. He was submitted to laminectomy and the cysts were surgically removed. An intense inflammatory process (arachnoiditis) involving the nerve roots of the cauda equina was reported. Histology of the surgical specimen confirmed the diagnosis of racemous cysticercosis. He improved quickly after surgery. Three months later, at the outpatient clinic, he walked with support, resumed sphincter control of the bladder and bowel and had no more pain. Ten months later he returned to hospital walking with crutches, with hypoesthesia and paraesthesia on the left leg and urinary incontinence. He refused treatment with albendazole and steroids. (author)

  5. Magnetic Resonance Imaging of Normal Pressure Hydrocephalus.

    Science.gov (United States)

    Bradley, William G

    2016-04-01

    Normal pressure hydrocephalus (NPH) is a syndrome found in the elderly, which is characterized by ventriculomegaly and deep white matter ischemia (DWMI) on magnetic resonance imaging (MRI) and the clinical triad of gait disturbance, dementia, and urinary incontinence. NPH has been estimated to account for up to 10% of cases of dementia and is significant because it is treatable by ventriculoperitoneal shunting. Patients with a known cause of chronic communicating hydrocephalus, that is, meningitis or hemorrhage, tend to respond better than patients with the so-called "idiopathic" form, most likely because of poor selection criteria in the past. Good response to shunting has been associated with hyperdynamic cerebrospinal fluid (CSF) flow through the aqueduct. In the early days of MRI, patients with a large CSF flow void extending from the foramen of Monro through the aqueduct to the fourth ventricle had an excellent chance of responding to ventriculoperitoneal shunting (P < 0.003). Today, we use phase-contrast MRI to measure the volume of CSF flowing through the aqueduct in either direction over a cardiac cycle. When this aqueductal CSF stroke volume is sufficiently elevated, there is an excellent chance of shunt responsiveness (100% positive predictive value in 1 study). Idiopathic NPH appears to be a "two-hit" disease-benign external hydrocephalus (BEH) in infancy followed by DWMI in late adulthood. As BEH occurs when the sutures are still open, these infants present with large heads, a finding also noted in patients with NPH. Although BEH has been attributed to immature arachnoidal granulations with decreased CSF resorptive capacity, this now appears to be permanent and may lead to a parallel pathway for CSF resorption via the extracellular space of the brain. With DWMI, the myelin lipid is lost, exposing the polar water molecules to myelin protein, increasing resistance to CSF outflow and leading to backing up of CSF and hydrocephalus. PMID:27063662

  6. Experimental bacterial meningitis in rabbit; evaluation with CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jeong Jin; Kang, Heoung Keun; Chu, Sung Nam; Kim, Yun Hyeon; Jeong, Yong Yeon; Chung, Hyon De [Chonnam Univ. Medical School, Kwangju (Korea, Republic of)

    1996-01-01

    The purpose of this study was to evaluate the usefulness of computed tomography(CT) and magnetic resonance imaging(MRI) in experimental bacterial meningitis. CT and MR images of experimental bacterial meningitis were obtained after inoculation of 1ml suspension of 10-6/ml Staphylococcus aureus directly into the supratentorial arachnoid space of 18 New Zealand white rabbits. Each animal was studied with both pre-enhanced and post-enhanced CT and MRI at 12, 24, 48 hours and 1 week. Cerebrospinal fluid of all of 18 rabbits were sampled and cultured for bacterial growth. All of 18 rabbits had the clinical symptoms such as neck stiffness and anorexia within 24 hours after the inoculation. Cerebrospinal fluid cultures were positive for Staphylococcus aureus growth. Gd-enhanced MRI exhibited diffuse enhancement along the thickened supratentorial meninges earlier than CT. In Gd-enhanced MRI, the mean contrast enhancement along the thickened supratentorial meninges earlier than CT. In Gd-enhanced MRI, the mean contrast enhancement ratio(CER) at supratentorial meninges increased to 1.93 at 12 hours and 2.99 at 24 hours from 1.06 at 0 hour. Histologic evaluation demonstrated inflammatory cell infiltration into the meninges. MRI also identified the complications of meningitis such as ependymitis and hydrocephalus more effectively than CT. These results indicated that Fd-enhanced MRI detectred earlier the abnormal findingfs of bacterial meningitis and evaluated more effectively the complications of meningitis compared with CT. MRI was more useful than CT in evaluation of the bacterial meningitis.

  7. TIPIT: A randomised controlled trial of thyroxine in preterm infants under 28 weeks' gestation

    Directory of Open Access Journals (Sweden)

    Victor Suresh

    2008-03-01

    Full Text Available Abstract Background Infants born at extreme prematurity (below 28 weeks' gestation are at high risk of developmental disability. A major risk factor for disability is having a low level of thyroid hormone which is recognised to be a frequent phenomenon in these infants. At present it is unclear whether low levels of thyroid hormone are a cause of disability, or a consequence of concurrent adversity. Methods We propose an explanatory multi-centre double blind randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks' corrected gestational age. The primary outcome will be brain growth. This will be assessed by the width of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks' corrected gestational. The secondary outcomes will be (a thyroid hormone concentrations measured at increasing postnatal age, (b status of the hypothalamic pituitary axis, (c auxological data between birth and 36 weeks' corrected gestational age, (d thyroid gland volume, (e volumes of brain structures (measured by magnetic resonance imaging, (f determination of the extent of myelination and white matter integrity (measured by diffusion weighted MRI and brain vessel morphology (measured by magnetic resonance angiography at expected date of delivery and (g markers of morbidity including duration of mechanical ventilation and chronic lung disease. We will also examine how activity of the hypothalamic-pituitary-adrenal axis modulates the effects of thyroid supplementation. This will contribute to decisions about which confounding variables to assess in large-scale studies. Trial registration Current Controlled Trials ISRCTN89493983

  8. 三岁儿童头部有限元模型的建立及验证%Development and Validation of Three-year-old Child Head FE Model

    Institute of Scientific and Technical Information of China (English)

    曹立波; 高海涛; 冒浩杰; 杨金海

    2013-01-01

    A highly anatomically detailed finite element model for three-year-old child head is built with ANSYS ICEM CFD and HYPERMESH softwares. The model consists of cerebrum, corpus callosum, cerebellum, brainstem, falx, tentorium, cerebro-spinal fluid with pia-arachnoid complex, dura mater, skull and scalp. A typical falling down accident is reconstructed using software MADYMO and a simulation is conducted with LS-DYNA. The results show that the intracranial pressure exhibits apparent gradient distribution, confirming to linear acceleration theory, so the model built can be used for the follow-up in-depth research in injury biomechanics.%运用ANSYS ICEM CFD和HYPERMESH软件建立了三岁儿童头部的具有高度解剖学细节的有限元模型.模型由大脑、胼胝体、小脑、脑干、脑镰、脑幕、脑脊液(包含软脑膜和蛛网膜)、硬脑膜、颅骨和头皮组成.运用MADYMO软件对一典型跌落事故进行重建,并在LS-DYNA中进行仿真分析.结果表明,颅内压力呈明显的梯度分布,且符合线性加速度理论,故所建的模型可用于后续深入的损伤生物力学研究.

  9. Clinical Value of MR in Diagnosis of Tumors in the Angle of the Bridge%桥小脑角区肿瘤MR诊断价值

    Institute of Scientific and Technical Information of China (English)

    刘付广

    2015-01-01

    目的探讨桥小脑角区(CPA)肿瘤MR诊断价值。方法搜集经手术和病理证实的单侧桥小脑角区肿瘤56例,回顾性分析其MR表现。结果听神经瘤29例,三叉神经瘤10例,脑膜瘤6例,胆脂瘤(表皮样囊肿)6例,蛛网膜囊肿4例,转移瘤1例。结论听神经瘤是桥小脑角区最常见的肿瘤,MR因其具有无颅骨伪影和多维成像的特点成为CPA区肿瘤诊断的重要方法。%Objective To investigate the cerebel opontine angle (CPA) value of MR in diagnosis of tumor. Methods Col ected by 56 cases of unilateral cerebel opontine angle operation and pathology of tumors, retrospective analysis of the MR performance. Results 29 cases of acoustic neuroma, 10 cases of trigeminal neuroma, 6 cases of meningioma, cholesteatoma (epidermoid cyst) in 6 cases, 4 cases of arachnoid cyst, 1 cases of metastatic tumor. Conclusion Acoustic neuroma is the most common cerebel opontine angle tumors, MR because of its characteristic of skul artifacts and multi-dimensional imaging has become an important method for tumor diagnosis CPA.

  10. Identification of Mutations in TMEM5 and ISPD as a Cause of Severe Cobblestone Lissencephaly

    Science.gov (United States)

    Vuillaumier-Barrot, Sandrine; Bouchet-Séraphin, Céline; Chelbi, Malika; Devisme, Louise; Quentin, Samuel; Gazal, Steven; Laquerrière, Annie; Fallet-Bianco, Catherine; Loget, Philippe; Odent, Sylvie; Carles, Dominique; Bazin, Anne; Aziza, Jacqueline; Clemenson, Alix; Guimiot, Fabien; Bonnière, Maryse; Monnot, Sophie; Bole-Feysot, Christine; Bernard, Jean-Pierre; Loeuillet, Laurence; Gonzales, Marie; Socha, Koryna; Grandchamp, Bernard; Attié-Bitach, Tania; Encha-Razavi, Férechté; Seta, Nathalie

    2012-01-01

    Cobblestone lissencephaly is a peculiar brain malformation with characteristic radiological anomalies. It is defined as cortical dysplasia that results when neuroglial overmigration into the arachnoid space forms an extracortical layer that produces agyria and/or a “cobblestone” brain surface and ventricular enlargement. Cobblestone lissencephaly is pathognomonic of a continuum of autosomal-recessive diseases characterized by cerebral, ocular, and muscular deficits. These include Walker-Warburg syndrome, muscle-eye-brain disease, and Fukuyama muscular dystrophy. Mutations in POMT1, POMT2, POMGNT1, LARGE, FKTN, and FKRP identified these diseases as alpha-dystroglycanopathies. Our exhaustive screening of these six genes, in a cohort of 90 fetal cases, led to the identification of a mutation in only 53% of the families, suggesting that other genes might also be involved. We therefore decided to perform a genome-wide study in two multiplex families. This allowed us to identify two additional genes: TMEM5 and ISPD. Because TMEM has a glycosyltransferase domain and ISPD has an isoprenoid synthase domain characteristic of nucleotide diP-sugar transferases, these two proteins are thought to be involved in the glycosylation of dystroglycan. Further screening of 40 families with cobblestone lissencephaly identified nonsense and frameshift mutations in another four unrelated cases for each gene, increasing the mutational rate to 64% in our cohort. All these cases displayed a severe phenotype of cobblestone lissencephaly A. TMEM5 mutations were frequently associated with gonadal dysgenesis and neural tube defects, and ISPD mutations were frequently associated with brain vascular anomalies. PMID:23217329

  11. Direct-trauma model of posttraumatic syringomyelia with a computer-controlled motorized spinal cord impactor.

    Science.gov (United States)

    Wong, Johnny H Y; Song, Xin; Hemley, Sarah J; Bilston, Lynne E; Cheng, Shaokoon; Stoodley, Marcus A

    2016-05-01

    OBJECTIVE The pathogenesis of posttraumatic syringomyelia remains enigmatic and is not adequately explained by current theories. Experimental investigations require a reproducible animal model that replicates the human condition. Current animal models are imperfect because of their low reliability, severe neurological deficits, or dissimilar mechanism of injury. The objective of this study was to develop a reproducible rodent model of posttraumatic syringomyelia using a spinal cord impactor that produces an injury that more closely mimics the human condition and does not produce severe neurological deficits. METHODS The study consisted of 2 parts. Seventy animals were studied overall: 20 in Experiment 1 and 48 in Experiment 2 after two rats with severe deficits were killed early. Experiment 1 aimed to determine the optimal force setting for inducing a cystic cavity without neurological deficits using a computer-controlled motorized spinal cord impactor. Twenty animals received an impact that ranged from 50 to 150 kDyn. Using the optimal force for producing an initial cyst determined from Experiment 1, Experiment 2 aimed to compare the progression of cavities in animals with and those without arachnoiditis induced by kaolin. Forty-eight animals were killed at 1, 3, 6, or 12 weeks after syrinx induction. Measurements of cavity size and maximum anteroposterior and lateral diameters were evaluated using light microscopy. RESULTS In Experiment 1, cavities were present in 95% of the animals. The duration of limb weakness and spinal cord cavity size correlated with the delivered force. The optimal force chosen for Experiment 2 was 75 kDyn. In Experiment 2, cavities occurred in 92% of the animals. Animals in the kaolin groups developed larger cavities and more vacuolations and enlarged perivascular spaces than those in the nonkaolin groups. CONCLUSIONS This impact model reliably produces cavities that resemble human posttraumatic syringomyelia and is suitable for further

  12. CSF ADENOSINE DEAMINASE (ADA ACTIVITY IN PATIENTS WITH MENINGITIS

    Directory of Open Access Journals (Sweden)

    Justin

    2016-05-01

    Full Text Available Meningitis is inflammation of the meninges (pia, arachnoid and dura mater covering the brain and the spinal cord. ADA is an enzyme in the purine salvage pathway which is found in abundance in active T-lymphocytes. Hence, an attempt was made to estimate the CSF ADA level in patients with suspected meningitis and throw light on its use in differentiating the various types of meningitis. AIMS AND OBJECTIVES To estimate the level of CSF adenosine deaminase level in different types of meningitis. To assess its usefulness in differentiating the various types (bacterial, viral and tuberculous of meningitis. MATERIALS AND METHODS The study was conducted at the medical wards of Govt. Rajaji Hospital, Madurai, a prospective analytical study from a period of April 2012 to September 2012. OBSERVATION AND RESULTS Tuberculous meningitis occurred more in the age group of 21–40 years. Bacterial meningitis was seen mainly in patients < 20 years of age. Viral meningitis was seen in all age groups. CSF ADA level was highest in tuberculous meningitis, the mean value being 24.5 U/L. The mean value of ADA in bacterial meningitis was 4.54 U/L and viral meningitis patients had lowest mean ADA value of 2.65 U/L. CONCLUSION In our study, 50 patients with meningitis admitted in Government Rajaji Hospital from April 2012 to September 2012 were evaluated. Meningitis predominantly affected people in the age group of 20-40 years in our study with a male: female ratio of 1.9:1. Cases of tuberculous meningitis constituted 48% of the study group and bacterial and viral meningitis were 26% each. CSF protein values were higher and sugar values lower in patients with tuberculous and bacterial meningitis. CSF cell counts were higher in patients with bacterial meningitis.

  13. Direct-trauma model of posttraumatic syringomyelia with a computer-controlled motorized spinal cord impactor.

    Science.gov (United States)

    Wong, Johnny H Y; Song, Xin; Hemley, Sarah J; Bilston, Lynne E; Cheng, Shaokoon; Stoodley, Marcus A

    2016-05-01

    OBJECTIVE The pathogenesis of posttraumatic syringomyelia remains enigmatic and is not adequately explained by current theories. Experimental investigations require a reproducible animal model that replicates the human condition. Current animal models are imperfect because of their low reliability, severe neurological deficits, or dissimilar mechanism of injury. The objective of this study was to develop a reproducible rodent model of posttraumatic syringomyelia using a spinal cord impactor that produces an injury that more closely mimics the human condition and does not produce severe neurological deficits. METHODS The study consisted of 2 parts. Seventy animals were studied overall: 20 in Experiment 1 and 48 in Experiment 2 after two rats with severe deficits were killed early. Experiment 1 aimed to determine the optimal force setting for inducing a cystic cavity without neurological deficits using a computer-controlled motorized spinal cord impactor. Twenty animals received an impact that ranged from 50 to 150 kDyn. Using the optimal force for producing an initial cyst determined from Experiment 1, Experiment 2 aimed to compare the progression of cavities in animals with and those without arachnoiditis induced by kaolin. Forty-eight animals were killed at 1, 3, 6, or 12 weeks after syrinx induction. Measurements of cavity size and maximum anteroposterior and lateral diameters were evaluated using light microscopy. RESULTS In Experiment 1, cavities were present in 95% of the animals. The duration of limb weakness and spinal cord cavity size correlated with the delivered force. The optimal force chosen for Experiment 2 was 75 kDyn. In Experiment 2, cavities occurred in 92% of the animals. Animals in the kaolin groups developed larger cavities and more vacuolations and enlarged perivascular spaces than those in the nonkaolin groups. CONCLUSIONS This impact model reliably produces cavities that resemble human posttraumatic syringomyelia and is suitable for further

  14. [Neurotoxicity of intrathecally administrated agents].

    Science.gov (United States)

    Malinovsky, J M; Pinaud, M

    1996-01-01

    Spinal anaesthetics can induce histopathologic lesions and regional haemodynamic alterations in the spinal cord. There are numerous causes of neurologic lesions, including direct trauma of the spinal cord and nerve roots during puncture or catheter insertion, compromised spinal cord perfusion and direct neurotoxic effect. Histopathologic lesions are localized either in meninges (meningitis or arachnoiditis) or in neuraxis (myelitis or axonal degeneration). Neurotoxicity can result from decrease in neuronal blood supply, elicited by high concentrations of the solutions, long duration exposure to local anaesthetics, and the use of adjuvants. They have been implicated in the occurrence of cauda equina syndrome after continuous spinal anaesthesia using hyperbaric solution of lidocaine and tetracaine given through small diameter catheters. Selective spinal analgesia is induced by spinal opioids without motor blockade except for meperidine. Complications occurred in patients after high doses of morphine, which were related to one of its metabolites, morphine-3-glucuronide. Preservative-free opioid solutions are to be preferred for spinal anaesthesia. There is no report of neurotoxicity neither in animal studies, nor in humans, using spinal clonidine. In order to reduce the incidence of neurotoxicity, some safety rules should be followed. The lowest efficient dose of local anaesthetics must be given. Incomplete blockade should not necessarily lead to a reinjection. Large volume of hyperbaric lidocaine or repeated injections of such solutions must be avoided as well as preservative-containing solutions. The administration of new compounds by the spinal route must be supported by data of spinal neuropharmacology and the lack of neurotoxicity must have been previously checked with animal studies.

  15. [Dynamic MRI in the evaluation of syringomyelic cysts].

    Science.gov (United States)

    Brugières, P; Iffenecker, C; Hurth, M; Parker, F; Fuerxer, F; Idy-Peretti, I; Bittoun, J

    1999-06-01

    We report the results of a MR velocity study of the cerebrospinal fluid including 36 patients with syringomyelic cysts (25 with a foraminal syringomyelia, 7 with a post-traumatic cyst, 2 with a tumoral spinal cord cyst, 2 with a spinal arachnoiditis). Velocity measurements were performed in the cysts and in the pericystic subarachnoid spaces and compared with clinical data, evolutive pattern of the disease, cyst volume, degree of stenosis of the cranio-cervical junction (in patients with Chiari I) or of the spinal canal (in post-traumatic cases), and with the extension of the cyst (post-traumatic cases). Cyst velocities correlated in the pre operative course with the clinical status of the patients and with the volume of the cyst. Correlation with the degree of foraminal stenosis was uncertain and no correlation was found with the duration of the disease course. In the post-operative course cyst velocity decreased and velocity of the subarachnoid spaces increased. Onset of the systolic peak occurred sooner in the cyst than in the subarachnoid spaces. We believe that this point may be important in the pathogenesis of the disease. We consider that systolic and diastolic cyst velocities respectively greater than 2.3 cm/s and 1.5 cm/s in the post-operative course may characterize aggressive cysts. In the future comparison of velocity measurements in patients with Chiari I without syrinx and patients with Chiari I related syringomyelia may be helpful for a better understanding of the natural history of the syringomyelia.

  16. A double-blind comparison between epidural morphine and epidural clonidine in patients with chronic non-cancer pain.

    Science.gov (United States)

    Glynn, C; Dawson, D; Sanders, R

    1988-08-01

    In a randomised double-blind study of 20 patients with chronic pain, epidural morphine 5 mg in 5 ml of saline was compared with epidural clonidine 150 micrograms in 5 ml of saline. Thirteen patients had a clinical and radiological diagnosis of arachnoiditis, 6 had low back pain and 1 had post-operative scar pain. There were 18 females and 2 males with an average age of 52 years, range 22-76 years. There was no difference found between the 2 solutions in the resultant analgesia measured by the visual analogue scale for pain, pain relief or the pain word score during the 3 h period of the study. No difference was found in the patient's mood which was also measured with the visual analogue scale. Two patients had no analgesia from either injection, 2 patients did not obtain any relief from clonidine and another 2 obtained no relief from morphine. Six patients reported that clonidine was better than morphine, 5 reported that morphine and clonidine were the same and 3 reported that morphine was better than clonidine. The duration of analgesia from the clonidine varied from 6 h to 1 month; the duration of analgesia from morphine varied from 6 to 24 h. Clonidine was associated with sedation and a fall in blood pressure of greater than 20 mm Hg in all patients, 1 patient required ephedrine to treat hypotension. Twelve patients had pruritus, 7 nausea and 2 vomiting following the morphine. Statistically there was no difference found between morphine and clonidine for short-term (3 h) analgesia in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. 老年性蛛网膜下腔出血非典型症状30例分析%Analysis of atypical symptoms in 30 cases of senile Subarachnoid hemorrhage

    Institute of Scientific and Technical Information of China (English)

    李秋茹; 王晓明; 龙存国

    2003-01-01

    @@ CLINICAL DATA Subjects came from 30 patients with senile subarachnoid hemrrhagetreated in our hospital from January 1999 to December 2001 in-cluding 12 males and 18 females aged 60-78(mean: 65) yearsold. 24 patients presented with onset in action, 6 patients at rest; 26cases presented with acute onset and 4 cases subacute onset. Acuteheadache as first symptom was in 13 cases; pain at neck, waist,sacral as first symptom in 7 cases. 3 patients searched medical ser-vice for headache within 1 week; 2 patients for severe pain of bothlimbs and unable to walk; 2 patients for headache and vomiting at 2week. 7 patients were once treated out of our hospital and sciaticawas diagnosed in 4 cases, cold in 3 cases. Pain at shoulder, back,upper limb in action occurred in 2 cases as first symptom, consciousdisturbance was the first symptom in 4 cases, grand mal of epilepsyas first symptom in 3 cases. 1 patient searched medical service forright head pain, auricle pain for 20 days. Stiff neck ( + ) appeared in25 patients at hospitalization and (-) in 5 patients. 24 patientspresented with positive Kernig' s sign. 21 patients were complicatedwith hypertension, 1 patient was complicated with peripheral facialparalysis and left hemihypoesthesia, 3 patients with transient hemi-paresis of both lower limhs, 2 cases with bilateral ptosis, 1 case withexotropia of bilateral eyeball, pupil dilation, 6 cases with consciousdisturbance. Auxilliary examination: (1) Skull CT scanning: Sub-arachnoid hemorrhage was found in 20 cases, no abnormality in 7cases and 3 cases didn't undergo CT scanning. (2) Examination ofspinal fluid: patients with positive CT findings didn' t undergo lumbarpuncture, even hemic spinal fluid was found in 6 patients and yellowspinal fluid and shrinking red blood cell in 4 cases. Prognosis: Allcases were treated according to subarachnoid hemorrhage, 6 patientsdied and other 24 patients were cured after 6 - 8 weeks of treatment.

  18. CT SCAN FINDINGS IN PATIENTS WITH SEIZURES IN NOTHERN CHHATTISGARH : A RETROSPECTIVE STUDY

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    Archana

    2015-09-01

    Full Text Available A five years study of CT scan findings in seizure patients is carried out to know the different etiology. Seizure is a finite event of altered cerebral function because of excessive and abnormal electrical discharges of the brain cells. Epilepsy is a chronic condition predisposing a person to recurrent seizures. This study is designed to establish usefulness of CT in defining the etiology of seizures in various age groups in people of Northern Chhattisgarh. This is a retrospective hospital - based study conducted in Radio - diagnosis Department of Chhattisgarh Institute of Medical Sciences, Bilaspur, Chhattisgarh. The study was carried out over a 5 year period. Hospital admissions with history of seizures are very common. Almost 3 - 9% p er 1000 population of total hospital emergencies is seizure cases. Epilepsy is an important health problem in developing countries, where its prevalence can be up to 57 per 1000 population. This study has high prevalence of seizures in First, second, third and fourth decades with decreasing pattern with increasing age. Prevalence in first decade is low as compare to second and third decades. Tuberculoma (9.39% and Neurocysticercosis (3.60% has highest prevalence in partial seizures followed by Focal Cereb ral Edema (6.22% whereas Diffuse Cerebral edema (4.91% seen with Generalised Seizures Cerebral infarct has equally seen in both types of seizures. Brain tumour presented mostly with Generalised seizure (2.07% than in partial seizures (0.98% . Other abno rmal findings like Cerebral calcifications, Diffuse cortical atrophy, Focal cortical atrophy, Sub Arachnoid hemorrhage, Intracerebral Hemorrhage, Hypoxic Ischemic Encephalopathy, Hydrocephalus and few rare diseases like Fahr disease and Tuberous sclerosis have also seen in CT scan in seizure patients. CT scan is valuable in making a diagnosis particularly in Indian subcontinent, where infective causes in form of space occupying lesions and infections are most

  19. Pattern of spinal compression (retrospective and prospective clinical study)

    International Nuclear Information System (INIS)

    Seventy two patients with spinal cord compressions were admitted to the national centre for neurological sciences in the period between january 1995 and december 1996. Male female ratio was 2.5:1 and the mean age was 40.5 years, myelogram was found to be the most helpful investigation in (90.3%) of patients and plain x-ray was abnormal in (43%) of patients. Tumors were found as the cause of compression in (26.4%), disc prolapse in (26.4%) of patients, spinal injuries in 13.8%, arachnoid cysts in (8.3%) of patients and tuberculosis in (8.3%). Other causes like spinal osteopathy, syringomyelia, spinal hematomas, spinal canal stenosis and spinal haemangiomas were also encountered. Thick ligamentum flavum was found in (25%) of cases, mostly in association with other pathologies, and as the sole compressing pathology in only two patients. The patients were followed up for a period from one month to two years, 41.6% of them were cured completely, while 37.5% were partially improved, 5.6% showed no improvement, 5.6% were died, 9.7% lost their follow up. The factors affecting the outcome were found to be, the duration of the condition before presentation for treatment, presence of blocks in myelograms, and the type of the pathology, disc and benign tumors gave the best outcome. Urinary complications like urine incontinence, urinary tract infection, and urine retention, were observed in (26.4%, 30.6%, 11.1%) of patients respectively, D.V.T. occurred in (15.3%) of patients and the mortality rate was (5.6%) and the major cause of death was pulmonary embolism. (Author)

  20. [Epidemiology of syringomyelia in Japan--the nationwide survey].

    Science.gov (United States)

    Moriwaka, F; Tashiro, K; Tachibana, S; Yada, K

    1995-12-01

    The nationwide epidemiological survey of syringomyelia was carried out in Japan by sending inquiries to neurologists, child neurologists, neurosurgeons and orthopedic surgeons for the period of 1991 and 1992. A total of 1,243 cases of syringomyelia were ascertained. Among them, 622 were men and 619 women, and the average age of onset was 28 years old. The classification by Barnett et al was used, presenting syringomyelia with Chiari malformation in 684 cases (51.2%), dysraphism in 47 (3.7%), post traumatic syringomyelia in 139 (11%), post-spinal arachnoiditis in 76 (6%), spinal cord tumor in 132 (10.5%) and others in 204. Its predominant clinical course was slowly progressive, but 202 cases (17.9%) showed rather stable course including spontaneous resolution in 29 cases. The main initial symptoms were numbness in 522 cases (42%), motor disturbance in 504 (40.5%), and pain in 296 (23.8%). Neurologic signs noted in the abnormality of deep tendon reflexes in 836 cases (67.3%), motor disturbance in 763 (60.4%) and positive pathological reflexes in 383 (30.1%). Sensory disturbance was found in 942 cases (75.8%) and the dissociated type were 559 out of them (59.3%). It is noteworthy that 982 out of 1,243 were documented by MRI and surgical operations such as foramen magnum decompression, syringo-subarachnoid shunt and others were performed in 829 cases. Syringobulbia was confirmed on MRI in 101 cases of syringomyelia in which spinal cord tumors were most frequently associated. PMID:8752408

  1. HISTOLOGICAL DESCRIPTION OF MENINGEAL AND PERIOSTEAL DURAL LAYERS AT THE PORUS OF INTERNAL ACOUSTIC CANAL IN THE VESTIBULAR SCHWANNOMA

    Directory of Open Access Journals (Sweden)

    Agung Budi Sutiono

    2015-07-01

    Full Text Available Objective: To study the transformation point of meningeal and periosteal dural at the porus of internal acoustic canal (IAC in order to verify the different thickness of meningeal and periosteal dura in vestibular schwannomas (VS. Methods: Three IAC cadaver specimens and ten samples of VS patients from porus were obtained and analyzed. Samples were stained by using Masson trichrome technique after cutting in 6 micron of thickness. The samples were then observed under light microscopes to understand the meninges pattern in the IAC. Results: The meningeal dura is becoming thin at the porus and disappears at the meatal portion to form epineurium. However, the periosteal dura is lining continuously to the fundus. In VS, the meningeal dura becomes thick and forms a pseudo-capsule in the middle of meatus, known as perineurium. The residual nerve filament was compressed by the tumor parenchyma. Between the tumor and nerve interface, three or more perineureal layers are seen. The perineurium in the cisternal portion was consistently loose and forms the tumor and arachnoid nerve interface. Almost all the nerve filaments are displaced to the tumor periphery near the pseudocapsule. In contrast, the periosteal dural of VS is becoming thin and disappear nearby the middle of meatal portion. This changing site establishes “meningo-periosteal ring” of VS because of the encircling nearby the porus. Conclusions: In IAC, the meningeal dural becomes thin. The periosteal dura is lining continuously to the fundus. In VS, the meningeal dura becomes thick, joins perineurium and forms pesudocapsule near the porus, but the periosteal dura disappeared. This changing point is called meningo-periosteal ring.

  2. TIPIT: A randomised controlled trial of thyroxine in preterm infants under 28 weeks gestation: Magnetic Resonance Imaging and Magnetic Resonance Angiography protocol

    Directory of Open Access Journals (Sweden)

    Tietze Anna

    2008-06-01

    Full Text Available Abstract Background Infants born at extreme prematurity are at high risk of developmental disability. A major risk factor for disability is having a low level of thyroid hormone described as hypothyroxinaemia, which is recognised to be a frequent phenomenon in these infants. Derangements of critical thyroid function during the sensitive window in prematurity when early development occurs, may have a range of long term effects for brain development. Further research in preterm infants using neuroimaging techniques will increase our understanding of the specificity of the effects of hypothyroxinaemia on the developing foetal brain. This is an explanatory double blinded randomised controlled trial which is aimed to assess the effect of thyroid hormone supplementation on brain size, key brain structures, extent of myelination, white matter integrity and vessel morphology, somatic growth and the hypothalamic-pituitary-adrenal axis. Methods The study is a multi-centred double blinded randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks corrected gestational age. The primary outcomes will be width of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks corrected gestational age. The secondary outcomes will be thyroid hormone concentrations, the hypothalamic pituitary axis status and auxological data between birth and expected date of delivery; thyroid gland volume, brain size, volumes of key brain structures, extent of myelination and brain vessel morphology at expected date of delivery and markers of morbidity which include duration of mechanical ventilation and/or oxygen requirement and chronic lung disease. Trial registration Current Controlled Trials ISRCTN89493983

  3. 飞行人员颅内肿瘤20例分析及航空医学鉴定标准探讨%Discussions on medical evaluation standard for 20 cases of the aircrews with intracranial tumor

    Institute of Scientific and Technical Information of China (English)

    刘红巾; 付兆君; 熊巍; 刘晶; 张扬; 金占国; 崔丽; 郑军; 徐先荣

    2015-01-01

    Objective To explore the method and standard of the aeromedical evaluation of the aircrews with intracranial tumor (ICT).Methods The clinical data of 20 cases of the aircrews with ICT from January 2004 to December 2013 were analyzed and related literatures were reviewed.Results In 20 ICT cases,there were 9 cases of arachnoids' cyst,6 cases of pituitary adenoma,2 cases of acoustic neuroma and 4 others.One case was pituitary adenoman with arachoids' cyst.The medical evaluation concluded 11 qualified,2 temporarily grounding and 7 disqualified cases.①Arachnoids' cyst:6 cases of cysts were in temporal,the rest 3 in frontal,lateral fissure pool and cerebellum respectively.Four cases were asymptomatic and with normal relevant inspection results and 1 case was with pituitary adenoma but without obvious symptoms.They were qualified.One case with airsickness and 1 case with hyperthyroidism and ground syncope were both disqualified.Two cases with headache and vestibular dysfunction respectively were temporary grounding.②Pituitary adenoma:one case was complicated with arachnoids' cyst as mentioned above.A female who suffered from micro adenoma was with asymptomatic and the rising prolactin returned to normal after drug treatment,she was qualified.One case had mild visual field defect but the rising prolactin returned to normal after drug treatment and then was qualified.An asymptomatic case that was with rising prolactin and took medicine for a longtime was finally normal and qualified.The case of acromegalia with rising growth hormone underwent sphenoid sinus of pituitary adenoma resection and recovered well,but was grounded due to overage.A high performance fighter pilot with irregular headache.He was received hormonal therapy instead but with unsatisfied result.He was finally disqualified.③ Acoustic neuroma:2 cases were both suffered from hearing loss and tinnitus.One underwent operation and one received gamma knife treatment.The effects were good and both of them

  4. Cysticercosis of the central nervous system. I. Surgical treatment of cerebral cysticercosis: a 23 years experience in the Hospital das Clínicas of Ribeirão Preto Medical School.

    Science.gov (United States)

    Colli, B O; Martelli, N; Assirati Júnior, J A; Machado, H R; Salvarani, C P; Sassoli, V P; Forjaz, S V

    1994-06-01

    Cysticercosis is the most frequent parasitosis of the nervous system and nowadays it is widespread through the world. Despite the development of anticysticercal drugs (praziquantel and albendazole), their efficacy is more marked in cases with parenchymal active cysts and they do not prevent complications such as hydrocephalus. Thus, many patients with neurocysticercosis require surgical intervention, generally of palliative nature, but that may occasionally produce a cure. The clinical outcome of 180 patients with cerebral cysticercosis who underwent surgical treatment form 1970 to 1993 was analyzed. Surgical treatment was performed to control increased ICP in 177 patients and due to local compression of cranial nerves or brainstem in five. Some patients had more than one surgical procedure, totalizing 287 interventions. Increased intracranial pressure (ICP) was caused by hydrocephalus in 91%, by intracranial mass lesion (tumoral form) in 6.2% and by pseudotumor cerebri (pseudotumoral form) in 2.8% of the case. Based on the pathophysiological mechanisms of intracranial hypertension identified through conventional CT-scan, ventriculography, cysternotomography, ventriculotomography and MRI, different surgical approaches were indicated. Patients with tumoral form were submitted to direct approach and cyst removal and generally they had benefits from this procedure. Patients with pseudotumoral form whose clinical treatment failure underwent decompressive craniectomies and had a poor outcome (40% of good results). Direct removal of ventricular/cisternal cysts and/or ventriculoatrial/peritoneal shunting (VA/VPS) was performed in patients with hydrocephalus. Removal of free ventricular cysts in patients who had no ependimitis/arachnoiditis generally allowed a good outcome. Patients with adherent cysts and inflammatory process needed a VA/VPS posteriorly and the outcome was not so good. One hundred thirty-two patients were submitted to VA/VPS (109 as the first procedure

  5. Application of ultrasound differential diagnosis in abnormalities of fetus central nerve system%超声鉴别诊断技术在胎儿中枢神经系统畸形诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    邓学东; 李红; 梁青; 常红梅; 姜小力; 唐亚奇; 梁泓; 冯鸿; 陆伟

    2011-01-01

    Objective To improve the clinical application of ultrasound differential diagnosis in abnormalities of fetus central nerve system. Methods Ultrasound imaging features in 217 cases of abnormalities in central nerve system confirmed by autopsy or follow-up were analyzed retrospectively. Results A total of 217 cases of anomaly in the central never system were examined prenatally by ultrasound and each showed typical imaging feature. Among these cases , there were 45 cases of anencephaly, 4 cases of hydranencephaly, 5 cases of arachnoid' s cyst, 2 cases of aneurysm of the vein of Galen, 78 cases of ventriculomegaly ( among them 46 cases of aqueduct stenosis), 13 cases of cephalocele, 17 cases of Dandy-Walker complex, 23 cases of spina bifida, 9 cases of holoprosencephaly, 5 cases of agenesis of the corpus callosum,8 cases of sacrococcygeal teratoma and 8 cases of choroid plexus cysts.Conclusion Application of ultrasound differential diagnosis by ultrasound for detection of abnormalities in fetus central nerve system( i. e. three sections and 12clues ), is extremely important.%目的 探讨产前超声鉴别诊断技术在胎儿中枢神经系统畸形诊断中的应用.方法 对经随访或引产证实217例中枢神经系统畸形的声像图特征进行回顾性分析.结果 产前超声诊断217例胎儿中枢神经系统畸形,其中无脑儿45例、水脑畸形4例、蛛网膜囊肿5例、Galen静脉瘤2例、脑室扩张78例(其中46例是中脑导水管狭窄)、脑膨出13例、Dandy-Walker综合征17例、开放性脊柱裂23例、前脑无裂畸形9例、胼胝体缺失5例、骶尾部畸胎瘤8例、脉络丛囊肿8例.结论 掌握超声检查胎儿中枢神经系统畸形的鉴别诊断技术,即三个切面和12种分析思路,对产前超声检查极为重要.

  6. Scanning electron microscopy of chronically implanted intracortical microelectrode arrays in non-human primates

    Science.gov (United States)

    Barrese, James C.; Aceros, Juan; Donoghue, John P.

    2016-04-01

    Objective. Signal attenuation is a major problem facing intracortical sensors for chronic neuroprosthetic applications. Many studies suggest that failure is due to gliosis around the electrode tips, however, mechanical and material causes of failure are often overlooked. The purpose of this study was to investigate the factors contributing to progressive signal decline by using scanning electron microscopy (SEM) to visualize structural changes in chronically implanted arrays and histology to examine the tissue response at corresponding implant sites. Approach. We examined eight chronically implanted intracortical microelectrode arrays (MEAs) explanted from non-human primates at times ranging from 37 to 1051 days post-implant. We used SEM, in vivo neural recordings, and histology (GFAP, Iba-1, NeuN). Three MEAs that were never implanted were also imaged as controls. Main results. SEM revealed progressive corrosion of the platinum electrode tips and changes to the underlying silicon. The parylene insulation was prone to cracking and delamination, and in some instances the silicone elastomer also delaminated from the edges of the MEA. Substantial tissue encapsulation was observed and was often seen growing into defects in the platinum and parylene. These material defects became more common as the time in vivo increased. Histology at 37 and 1051 days post-implant showed gliosis, disruption of normal cortical architecture with minimal neuronal loss, and high Iba-1 reactivity, especially within the arachnoid and dura. Electrode tracts were either absent or barely visible in the cortex at 1051 days, but were seen in the fibrotic encapsulation material suggesting that the MEAs were lifted out of the brain. Neural recordings showed a progressive drop in impedance, signal amplitude, and viable channels over time. Significance. These results provide evidence that signal loss in MEAs is truly multifactorial. Gliosis occurs in the first few months after implantation but does

  7. DIFFERENTIAL DIAGNOSIS OF ORGANIC ACIDEMIA: CLINICAL AND NEUROIMAGING FINDINGS

    Directory of Open Access Journals (Sweden)

    Mahmoud Reza ASHRAFI

    2012-03-01

    maple syrup urine disease (MSUD, and abnormalities of the globus pallidus in methylmalonic acidemia. Macrocephaly is common in GA I.• Some differential agnosis of MRI findings in organic academia is consist of: HIE, mucopolysacaridosis, middle fossa arachnoid cyst, leighdisease, hexachlorophene toxicity in neonates, myelin splitting disorders.• Some organic aciduria such as L-2-Hydroxyglutaricaciduria may suggest leukodystrophy in MRI.

  8. Plastic repairing of the cistern magna to treat the Chiari malformation complicated with syringomyelia%枕大池成形术治疗Chiari畸形合并脊髓空洞症

    Institute of Scientific and Technical Information of China (English)

    刘永生; 申明峰

    2010-01-01

    目的 回顾性分析枕大池成形术治疗Chiari畸形合并脊髓空洞症的疗效.方法 采用枕大池成形术(后颅凹减压+硬脑膜成形+小脑扁桃体切除+蛛网膜粘连松解)治疗17例Chiari畸形合并脊髓空洞症患者.对其近期疗效和远期疗效进行总结.结果 近期疗效:17例患者术后临床症状消失或改善15例(有效率为90%),MRI检查提示下疝扁桃体消失,脊髓空洞缩小.远期疗效:MRI检查提示枕大池成形,脊髓空洞消失或明显变细,脊髓蛛网膜下腔增宽.治疗有效12例(有效率70%).结论 枕大池成形术治疗Chiari畸形合并脊髓空洞症效果满意,是一种较为合理的治疗方法.%Objective To evaluate retrospectively the efficacy of cistema magna plastic repair in the treatment of Chiari malformation complicated with syringomyelia Methods Fifty-one patients suffered from Chiari malformation complicated with syringomyelia were treated in our department from May 2004 to October 2009. Seventeen patients received cistema magna plastic repairment (the decompression of posterior cranial fossa, duraplastic repair,resection of hernia below cerebellar tonsil and separation of adherence of arachnoid membrane). Results Clinical symptoms disappeared or improved in 15 cases (effective rate of 90%). MRI showed tonsillar herniation disappeared,syringomyelia narrow. MRI showed cistema magna plastic repair, syringomyelia disappeared or significantly thinned and spinal cord subarachnoid space widened. Effective treatment obtained in 12 cases (effective rate 70%). Conclusions The efficiency of Cistern magna plastic repair treating Chiari malformation with syringomyelia is satisfied.

  9. 两种不同术式治疗Chiari畸形合并脊髓空洞症的疗效分析%Two different surgical therapies in the treatment of Chiari malformation complicated with syringomyelia

    Institute of Scientific and Technical Information of China (English)

    沈建; 徐庆生; 叶科; 钱晓波; 沈剑峰; 周永庆; 詹仁雅; 黄红光

    2008-01-01

    Objective To evaluate and compare retrospectively the efficacy between posterior cranial fossa plastic repair and cisterna magna plastic repair in the treatment of Chiari malformation complicated with syringomyelia. Methods 85 patients suffered from Chiari malformation complicated with syringomyelia were treated in our department from November 2000 to January 2006. 39 patents received posterior cranial fossa plastic repair ( the decompression of posterior cranial fessa and dura plastic repair), the other 46 patients with cistema magna plastic repair ( the decompression of posterior cranial fossa, duraplastic repair, resection of hernia below cerebellar tonsil and separation of adherence of arachnoid membrane). Results There were significant differences between two groups in postoperative syringomyelia length and long-term effects, with the rate of improvement of 64% and 90%, and the rate of deterioration 19% and 3%, respectively. Conclusion Cisterna magna plastic repair is a reasonable option for the treatment of Chiari malformation with syringomyelia, compared with posterior cranial fossa plastic repair.%目的 通过回顾性比较后颅窝成形术及枕大池成形术对Chiari畸形合并脊髓空洞症的治疗,明确两种不同术式治疗Chiari畸形合并脊髓空洞的疗效.方法 对收治的85例Chiari畸形合并空洞患者,其中39例患者行后颅窝成形术(后颅窝减压+硬脑膜成形);46例患者行枕大池成形术(后颅窝减压+硬脑膜成形+小脑扁桃体切除+蛛网膜粘连分解).结果 两组远期疗效相比有统计学意义,症状改善率分别为64%和90%,恶化19%和3%;术后脊髓空洞长度改变,两组比较有统计学意义.结论 枕大池成形术是治疗Chiari畸形合并脊髓空洞症较为合理的术式,疗效优于后颅窝成形术.

  10. Expansive posterior fossa eranioplnsty with occipital flip for arnold-chiari Ⅰ malforma-tion%自体骨瓣后颅窝扩大成形治疗Chiari Ⅰ型畸形(附9例临床分析)

    Institute of Scientific and Technical Information of China (English)

    张亚召; 蔡恩源; 李盛善; 唐兆伟; 李海校

    2013-01-01

    Objective To explore the treatment of expansive posterior fossa cranioplasty with occipital flips for Arnold-chiari I malformation. Methods Methods 9 cases of the patients with Arnold-chiari I malformation all use surgical treatment, do the decompression of posterior cranial fossa,duraplastic repair, resection of hernia below cerebellar tonsil and separation of adherence of arachnoid membrane. Results Postoperative MRI studies revealed that cerebellar ton-sillar lower edge of the cases are rising to the foramen magnum level above, the posterior fossa volume increase,8 cases symptoms improved significantly, 1 cases no improvement. Follow-up of 3-18 months, all patients got good clinical outcomes with symptoms relief. MRI showed sy-ringomyelia disappeared in 2cases, significantly thinned in 5 cases, no improvem. Conclusion Conclusion Expansive posterior fossa cranioplasty using occipital flip is effective for arnold-chiari I malformation.%目的 探讨利用自体骨瓣进行后颅窝扩大成形术治疗Chiari Ⅰ型畸形的临床效果.方法 本组9例Chiari Ⅰ型患者均采用手术治疗,行后颅窝自体骨骨瓣扩大成形、硬脑膜成形、小脑扁桃体切除及粘连蛛网膜分解术.结果 9例患者术后均复查MRI示小脑扁桃体下缘均上升到枕骨大孔水平以上,后颅窝容积增大.8例症状改善明显,1例改善不明显.随访3~18个月,所有病例症状体征较术前改善.MRI示7例合并脊髓空洞患者中,2例空洞消失,5例脊髓空洞明显缩小.结论 自体骨瓣后颅窝扩大成形治疗Chiari Ⅰ畸形患者,临床症状改善,效果满意.

  11. Mental retadation: a MRI study of 146 Brazilian children Deficiência mental: um estudo de ressonância magnética em 146 crianças brasileiras

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    Armando Freitas da Rocha

    2006-06-01

    Full Text Available We report results of a magnetic ressonance imaging (MRI study of 146 Brazilian children, whose intelligence quotient scored less than 70. 50% of MRI examinations did not exhibit any signal of structural lesion (N group, whereas a focal thinning at the junction of the body and splenium of the corpus callosum; ventricular asymmetry; periventricular leukomalacia; gliosis and arachnoid cysts were among the most frequent findings in the remaining of subjects (L group. Maternal stress and altered blood pressure were the most frequent findings in the pre-natal history of both N and L children. Familial antecedents of mental deficiency were reported in 30% of both groups, whereas familiar history of alcoholism was important in N group (60% in N versus 0% in L groups. Neuropsychomotor development was delayed in 80% of the children in both groups. Aggressiveness is the most frequent finding in the post-natal children history.Estudamos, através de ressonância magnética (RM, 146 crianças com quociente de inteligência menor que 70. 50% das RM não exibiram nenhum sinal de lesão (grupo N, enquanto adelgaçamento focal da junção do corpo e esplênio do corpo caloso, assimetria ventricular, leucomalácia periventricular, gliose e cisto aracnóide foram os achados mais freqüentes no restante das crianças (grupo L. Estresse materno e alteração da pressão arterial foram os achados mais freqüentes da história do pré-natal das crianças de ambos os grupos. Antecedentes familiares de deficiência mental apareceram em 30% de ambos os grupos. História de alcoolismo foi importante no grupo N. Atraso no desenvolvimento neuropsicomotor foi encontrado em 80% das crianças de ambos os grupos. Agressividade foi o achado mais freqüente na história pós-natal destas crianças.

  12. 内窥镜手术治疗脑积水及颅内囊性占位病灶的临床分析%Endoscopic surgery for cystic lesion hydrocephalus and intracranial lesions

    Institute of Scientific and Technical Information of China (English)

    纪涛; 林恒州; 何毅

    2011-01-01

    目的 探讨神经内窥镜治疗梗阻性脑积水及颅内囊性占位病灶的临床特点.方法 回顾性分析该院2005年2月~2008年2月应用神经内窥镜技术治疗颅内病变患者48例临床资料,其中梗阻性脑积水26例,蛛网膜囊肿12例,透明隔囊肿6例,鞍上巨大囊肿3例,鞍上囊性颅咽管瘤1例.术后随访24个月,观察患者并发症及治疗效果.结果 并发症:发热3例,硬膜下积液2例,脑室出血1例,并发症发生率仅12.5%;疗效:42例有效,有效率高达87.5%,6例无效(脑积水5例,鞍上巨大囊肿1例).结论 神经内窥镜治疗颅内病变具有创伤小、直观、并发症少、有效率高等优点,但要严格掌握手术适应证.%Aim To explore clinical features of endoscopic treatment of obstructive hydrocephalus and nerve intracranial lesions cystic le sion. Methods Retrospective analysis was made in 48 patients with intracranial lesions admitted from February 2005 to February 2008,including obstructive hydrocephalus 26 cases, arachnoid cysts 12 cases, transparent insulation cyst 6 cases, saddle huge cyst 3 cases,saddle cystic cranial pharynx article 1 case. With 24-month follow-up, patients were observed in complications and therapeutic effect. Results The complications included calorific 3 cases, subdural effusion 2 cases, ventricle bleeding 1 case, with a morbidity of only 12.5%. Treatments in 42 patients were effective, efficient rate as high as 87.5% ,6 cases invalid( hydrocephalus in 5 cases, saddle huge cyst in 1 case ). Conclusion Endoscopic treatment of intracranial lesions has small trauma, intuitiveness, fewer complications, and the advantages of high efficiency, but surgical indications should be controlled strictly.

  13. Related immune response of clinic heterogeneity and pathology in neurocysticercosis%脑囊虫病临床异质性、病理变化与免疫反应

    Institute of Scientific and Technical Information of China (English)

    陈小华; 谷俊朝

    2012-01-01

    脑囊虫病,由猪囊尾蚴寄生于中枢神经系统引起.脑囊虫病临床异质性表现为从无症状到颅内高压、脑积水、蛛网膜炎、癫痫,甚至死亡.脑囊虫病病理变化表现为血脑屏障破坏、脑实质肉芽肿形成、局部及外周多种免疫细胞共同参与.脑囊虫病的临床异质性与病理变化均与宿主抗猪囊尾蚴免疫反应密切相关.本文就与脑囊虫病临床异质性、病理变化相关的抗囊尾蚴免疫、影响因素(囊尾蚴发育阶段、大小、数量、位置、基因组学;宿主年龄、性别、遗传背景)与免疫机制等做一综述.%Neurocysticercosis (NO is caused by infection of the central nervous system with Taenia solium metacestode (Cysticercus). Clinical heterogeneity of NC can range from a totally asymptomatic course to severe illness, with intracra-nial hypertension, hydrocephalus, arachnoiditis, seizures, and even death. Pathologic changes caused by NC include breakdown of the blood-brain barrier, parenchymal granuloma formation, involvement of various local and systemic im-munocytes. Both the clinical heterogeneity of NC and the pathologic changes it leads to are closely related to host immune response. This article reviews the immune response in relation to the clinical heterogeneity and pathologic changes of NC, influencing factors (developmental stages, size, number, location, and genetics of Taenia solium as well as the age, gender, and genetics of the host), and mechanisms of immune response to NC.

  14. Fístula de líquido cefalorraquídeo recidivante postraumática asociada a meningocele esfenoidal: Técnica abierta-endoscópica Cerebrospinal fluid fistula associated with posttraumatic recurrent sphenoidal meningocele: Open-endoscopic technique

    Directory of Open Access Journals (Sweden)

    Ignacio Zubillaga Rodríguez

    2012-12-01

    Full Text Available Introducción: Las fístulas de líquido cefalorraquídeo surgen tras la ruptura de las barreras que separan la cavidad nasal y senos paranasales de los espacios subaracnoideos: base craneal, duramadre y membrana aracnoidea. Aproximadamente el 80% surgen en el contexto de traumatismos craneofaciales con fracturas de la base craneal. La elección del abordaje y técnica quirúrgica más adecuada en cada caso es esencial para la obtención de resultados quirúrgicos globales satisfactorios. El desarrollo de la cirugía endoscópica endonasal ha supuesto un arma terapéutica menos invasiva y eficaz, siendo las fístulas de líquido cefalorraquídeo una indicación bien establecida para su tratamiento definitivo. Caso clínico: Se presenta el caso de una paciente con fístula de líquido cefalorraquídeo recurrente con meningoencefalocele asociado tratada vía endoscópica. Discusión: Se discute el tratamiento conservador versus quirúrgico de las fístulas de líquido cefalorraquídeo. Ventajas y desventajas de los distintos tipos de abordajes relacionados con el manejo definitivo.Introduction: Cerebrospinal fluid fistulas arise after the breakdown of the barriers that separate the nasal cavity and paranasal sinuses of the subarachnoid space, skull base, dura and arachnoid membrane. Approximately 80% arise in the context of craniofacial trauma with fractures of the skull base. The choice of approach, appropriate surgical technique in each case is essential to achieve a good overall surgical outcome. Development of endoscopic endonasal surgery has become a less invasive and effective therapeutic tool, with cerebrospinal fluid fistulas being a well-established indication for definitive treatment. Case report: A case of a patient with cerebrospinal fluid fistula associated with recurrent meningoencephalocele, treated endoscopically. Discussion: We discuss the surgical versus conservative treatment of spinal fluid fistulas, and the advantages and

  15. Brain Tumors and Brain Tumor Research Progress in Image Classification%脑肿瘤及脑肿瘤图像分类的研究进展

    Institute of Scientific and Technical Information of China (English)

    俞海平; 邬立保

    2011-01-01

    Many methods of brain tumor classification,there is no uniform classification^! A variety of tumors and pathological features of the different tissue, the study of benign and malignant, and things are not the same characteristics. Usually can be classified as histological.-(l) Originated in glial tumors: astrocytoma, less support glial cell tumors, medulloblastoma, etc.(2) Originated in meningeal tumors: meningioma, meningeal sarcoma, arachnoid cyst.(3) Originated in the pituitary tumors: tired color cell adenoma, acidophilic, basophilic cell adenoma.(4) Originated in cranial nerve tumors: acoustic neuroma, trigeminal nerve sheath tumors and other tumors.(S) Originated from residual embryonic tissue: craniopharyngioma, chordoma, dermoid cyst (6) Originated in vascular cells: vascular tumors and vascular reticular cell tumor, etc.(7) Transfer or by other parts of the tumor invasion: a variety of metastatic tumors, and nasopharyn-geal carcinoma, etc.%脑肿瘤分类的方法很多,目前尚无统一的分类方法,并且各种肿瘤的组织发生与病理特征不同,其良性与恶性以及物学特性也不一样.通常按组织学可分类如下:(1)发源于神经胶质的肿瘤:星形细胞瘤、少支胶质细胞瘤、髓母细胞瘤等.(2)发源于脑膜的肿瘤:脑膜瘤、脑膜内瘤、蛛网膜囊肿等.(3)发源于垂体的肿瘤:厌色细胞腺瘤,嗜酸、嗜碱性细胞腺瘤.(4)发源于颅神经的肿瘤:听神经瘤、三叉神经瘤等各种神经鞘瘤.(5)发源于胚胎残余组织:颅咽管瘤、脊索瘤、皮样囊肿等.(6)发源于血管细胞:血管瘤及血管网织细胞瘤等.(7)由其它部位转移或侵入的肿瘤:各种转移瘤及鼻咽癌等.

  16. MRI reporting by radiographers: Findings of an accredited postgraduate programme

    International Nuclear Information System (INIS)

    Aim: To analyse the objective structured examination (OSE) results of the first three cohorts of radiographers (n = 39) who completed an accredited postgraduate certificate (PgC) programme in reporting of general magnetic resonance imaging (MRI) investigations and to compare the agreement rates with those demonstrated for a small group of consultant radiologists. Method: Forty MRI investigations were used in the OSE which included the following anatomical areas and abnormal appearances: knee; meniscal/ligament injuries, bone bruises, effusions and osteochondral defects; lumbar spine: intervertebral disc morphology, vertebral collapse, tumours (bone and soft tissue), spinal stenosis and/or nerve root involvement; internal auditory meati (IAM): acoustic neuroma. Incidental findings included maxillary polyp, arachnoid cyst, renal cyst, hydroureter, pleural effusion and metastases (adrenal, lung, perirenal and/or thoracic spine). Sensitivity, specificity and total percentage agreement rates were calculated for all radiographers (n = 39) using all reports (n = 1560). A small representative subgroup of reports (n = 27) was compared to the three consultant radiologists' reports which were produced when constructing the OSE. Kappa values were estimated to measure agreement in four groups: consultant radiologists only; radiographers and each of the consultant radiologists independently. Results: The sensitivity, specificity and agreement rates for the three cohorts (combined) of radiographers were 99.0%, 99.0% and 89.2%, respectively. For the majority (5/9) of anatomical areas and/or pathological categories no significant differences (p < 0.05) were found between the mean Kappa scores (K = 0.47-0.76) for different groups of observers, whether radiographers were included in the group analysis or not. Where differences were apparent, this was in cases (4/9) where the variation was either not greater than found between radiologists and/or of no clinical significance. These

  17. Microvascular decompression for trigeminal neuralgia

    International Nuclear Information System (INIS)

    Background: Trigeminal Neuralgia (TGN) is the most frequently diagnosed type of facial pain. In idiopathic type of TGN it is caused by the neuro-vascular conflict involving trigeminal nerve. Microvascular decompression (MVD) aims at addressing this basic pathology in the idiopathic type of TGN. This study was conducted to determine the outcome and complications of patients with idiopathic TGN undergoing MVD. Method: In a descriptive case series patients with idiopathic TGN undergoing MVD were included in consecutive manner. Patients were diagnosed on the basis of detailed history and clinical examination. Retromastoid approach with craniectomy was used to access cerebellopontine angle (CP-angle) and microsurgical decompression was done. Patients were followed up for 6 months. Results: A total of 53 patients underwent MVD with mean age of 51.6±4.2 years and male predominance. In majority of cases (58.4 percentage) both Maxillary and Mandibular divisions were involved. Per-operatively superior cerebellar artery (SCA) was causing the neuro-vascular conflict in 33 (62.2 percentage) of the cases, anterior inferior cerebellar artery (AICA) in 6 (11.3 percentage) cases, both CSA and AICA in 3 (5.6 percentage) cases, venous compressions in only 1 (1.8percentage) patient and thick arachnoid adhesions were seen in 10 (18.9 percentage) patients. Postoperatively, 33 (68 percentage) patients were pain free, in 14 (26.45 percentage) patients pain was significantly improved whereas in 3 (5.6 percentage) patients there was mild improvement in symptoms. Three (5.6 percentage) patients did not improve after the primary surgery. Cerebrospinal fluid (CSF) leak was encountered in 7 (13.2 percentage) patients post-operatively, 4 (7.5 percentage) patients developed wound infection and 1 (1.8 percentage) patient developed aseptic meningitis. Three (5.6 percentage) patients had transient VII nerve palsy while one patient developed permanent VII nerve palsy. Conclusion: MVD is a safe and

  18. Referral of epileptic patients in North East Coast of West Malaysia an area with poor MRI coverage: an analysis.

    Science.gov (United States)

    Mohamed, Y; Alias, N N; Shuaib, I L; Tharakan, J; Abdullah, J; Munawir, A H; Naing, N N

    2006-11-01

    atrophy (5), hippocampal sclerosis (4), infarct/gliosis (3), cortical dysgenesis (2) and tumors (2). One patient had an arachnoid cyst in the right occipital region. Of the 17 patients with an abnormal MRI, 14 had an abnormal EEG, this difference was not statistically significant. There was no significant associaton between epileptographic changes and MRI findings (p = 0.078). EEG findings were associated with MRI findings (p = 0.004). The association between an abnormal EEG and an abnormal MRI had a specificity of 82.4%, while epileptogenic changes had a specificity of 64.7% in relation to abnormal MRI findings. This meants that those patients in rural hospitals with abnormal EEGs should be referred to a neurology center for further workup and an MRI to detect causes with an epileptic focus.

  19. Cysticercosis of the central nervous system. I. Surgical treatment of cerebral cysticercosis: a 23 years experience in the Hospital das Clínicas of Ribeirão Preto Medical School.

    Science.gov (United States)

    Colli, B O; Martelli, N; Assirati Júnior, J A; Machado, H R; Salvarani, C P; Sassoli, V P; Forjaz, S V

    1994-06-01

    Cysticercosis is the most frequent parasitosis of the nervous system and nowadays it is widespread through the world. Despite the development of anticysticercal drugs (praziquantel and albendazole), their efficacy is more marked in cases with parenchymal active cysts and they do not prevent complications such as hydrocephalus. Thus, many patients with neurocysticercosis require surgical intervention, generally of palliative nature, but that may occasionally produce a cure. The clinical outcome of 180 patients with cerebral cysticercosis who underwent surgical treatment form 1970 to 1993 was analyzed. Surgical treatment was performed to control increased ICP in 177 patients and due to local compression of cranial nerves or brainstem in five. Some patients had more than one surgical procedure, totalizing 287 interventions. Increased intracranial pressure (ICP) was caused by hydrocephalus in 91%, by intracranial mass lesion (tumoral form) in 6.2% and by pseudotumor cerebri (pseudotumoral form) in 2.8% of the case. Based on the pathophysiological mechanisms of intracranial hypertension identified through conventional CT-scan, ventriculography, cysternotomography, ventriculotomography and MRI, different surgical approaches were indicated. Patients with tumoral form were submitted to direct approach and cyst removal and generally they had benefits from this procedure. Patients with pseudotumoral form whose clinical treatment failure underwent decompressive craniectomies and had a poor outcome (40% of good results). Direct removal of ventricular/cisternal cysts and/or ventriculoatrial/peritoneal shunting (VA/VPS) was performed in patients with hydrocephalus. Removal of free ventricular cysts in patients who had no ependimitis/arachnoiditis generally allowed a good outcome. Patients with adherent cysts and inflammatory process needed a VA/VPS posteriorly and the outcome was not so good. One hundred thirty-two patients were submitted to VA/VPS (109 as the first procedure

  20. Assessing ventricular size: is subjective evaluation accurate enough? New MRI-based normative standards for 19-year-olds

    International Nuclear Information System (INIS)

    To create new standards for radiological indices of dilated ventricles and to compare these with subjectively assessed ventricular size. One hundred healthy controls (54 females), birth weight above 3,000 g, were followed throughout childhood as part of a longitudinal study of ex-prematures. All had a 3 Tesla brain magnetic resonance scan at age 17-20, and the following measurements were performed: biparietal and occipitofrontal diameters, width and depth of the frontal and occipital horns, diameter of the third ventricle and the frontal sub-arachnoid space. Ventricular size was judged subjectively by two neuroradiologists as being normal, or mildly, moderately or severely dilated. Head circumference was 31 mm higher for males than for females (95% confidence interval (CI) 25-28, p < 0.001). Similar, ventricular size except for the depth of the right frontal horn was larger for male; however, the observed differences were partly accounted for by the larger head circumference. Normative sex specific standards for different cerebral measurements were presented as mean and ranges and additional 2.5, 10, 50, 90, 97.5 percentiles. The mean depth of the left ventricle was larger than the right for males, with an observed difference of 0.6 mm in male (95% CI 0.2-0.9, p = 0.005). The mean width of the left ventricle was larger than the right for females, with an observed difference of 0.4 mm in male (95% CI 0.1-0.7, p = 0.018). Two subjects were judged to have moderately and 36 to have mildly dilated ventricles by observer one, while figures for observer two were one and 14. Overall, the two observers agreed on 15 having either mild or moderate dilatation (kappa 0.43). For both sexes, the mean depth of the frontal horns as well as of the larger occipital horns differed significantly between the no dilatation and the mild/moderate dilatation groups. In our unselected cohort of healthy 19-year-olds, a high total of 14% was diagnosed to have dilated cerebral ventricles when

  1. MRI reporting by radiographers: Findings of an accredited postgraduate programme

    Energy Technology Data Exchange (ETDEWEB)

    Piper, Keith [Allied Heath Professions Department, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU (United Kingdom)], E-mail: keith.piper@canterbury.ac.uk; Buscall, Kaie [Allied Heath Professions Department, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU (United Kingdom); Thomas, Nigel [X-Ray Department, Trafford General Hospital, Manchester M41 5SL (United Kingdom)

    2010-05-15

    Aim: To analyse the objective structured examination (OSE) results of the first three cohorts of radiographers (n = 39) who completed an accredited postgraduate certificate (PgC) programme in reporting of general magnetic resonance imaging (MRI) investigations and to compare the agreement rates with those demonstrated for a small group of consultant radiologists. Method: Forty MRI investigations were used in the OSE which included the following anatomical areas and abnormal appearances: knee; meniscal/ligament injuries, bone bruises, effusions and osteochondral defects; lumbar spine: intervertebral disc morphology, vertebral collapse, tumours (bone and soft tissue), spinal stenosis and/or nerve root involvement; internal auditory meati (IAM): acoustic neuroma. Incidental findings included maxillary polyp, arachnoid cyst, renal cyst, hydroureter, pleural effusion and metastases (adrenal, lung, perirenal and/or thoracic spine). Sensitivity, specificity and total percentage agreement rates were calculated for all radiographers (n = 39) using all reports (n = 1560). A small representative subgroup of reports (n = 27) was compared to the three consultant radiologists' reports which were produced when constructing the OSE. Kappa values were estimated to measure agreement in four groups: consultant radiologists only; radiographers and each of the consultant radiologists independently. Results: The sensitivity, specificity and agreement rates for the three cohorts (combined) of radiographers were 99.0%, 99.0% and 89.2%, respectively. For the majority (5/9) of anatomical areas and/or pathological categories no significant differences (p < 0.05) were found between the mean Kappa scores (K = 0.47-0.76) for different groups of observers, whether radiographers were included in the group analysis or not. Where differences were apparent, this was in cases (4/9) where the variation was either not greater than found between radiologists and/or of no clinical significance

  2. Recurrence of trigeminal neuralgia after microvascular decompression and its microsurgical management%显微血管减压术治疗三叉神经痛术后复发与再手术

    Institute of Scientific and Technical Information of China (English)

    杨德宝; 王之敏; 蒋栋毅; 陈寒春; 周强; 万意; 沈李奎

    2013-01-01

    目的 探讨显微血管减压术治疗三叉神经痛术后复发的因素和再手术治疗方法.方法 对苏州九龙医院神经外科自2006年1月至2011年12月收治的21例显微血管减压术后复发患者行手术治疗,术中辅助性应用神经内镜,17例行显微血管减压术,2例行单纯蛛网膜松解术,1例行三叉神经感觉根部分切断术,1例行显微血管减压术加三叉神经感觉根部分切断术. 结果 21例患者平均随访28.5月,随访再手术有效率为95.2%,术后面部麻木2例,轻度面瘫1例. 结论 显微血管减压术后复发原因是多样的,血管压迫仍是主要病因;再手术仍应首选显微血管减压术,神经内镜辅助可提高手术疗效及安全性.%Objective To study the influencing factors of recurrence of trigeminal neuralgia after microvascular decompression and its microsurgical management.Methods Twenty one patients with recurrent trigeminal neuralgia after microvascular decompression (MVD),admitted to our hospital from 2006 to 2011,were treated by microsurgical operations assisted by neuroendoscope.MVD was performed again in 17 patients,arachnoid membranes reflaxation in 2,partial rhizotomy (PR) in 1,and both MVD and PR in 1.Results All patients were followed up for about 28.5 months (mean duration).The total effective rate during the follow-up period was 95.2%.Facial numbness was found in 2 patients and light facial paralysis in 1.Conclusion Many factors were responsible for the recurrence of trigeminal neuralgia after MVD; and vascular compression is still the main cause; MVD should be the first choice; curative effect and safety would be improved by the assistance ofneuroendoscope.

  3. Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis. A report of 50 cases.

    Science.gov (United States)

    Gómez-Aranda, F; Cañadillas, F; Martí-Massó, J F; Díez-Tejedor, E; Serrano, P J; Leira, R; Gracia, M; Pascual, J

    1997-07-01

    immediately after angiography. SPECT, performed on only three patients in the symptomatic period, revealed focal areas of decreased uptake consistent with the clinical symptoms. PMP aetiology remains a mystery; chronic arachnoiditis, viral meningoencephalitis or migraine are not plausible aetiological explanations. Because a number of patients had had a prodromic viral-like illness, we hypothesize here that such a viral infection could activate the immune system, thereby producing antibodies that would induce an aseptic inflammation of the leptomeningeal vasculature, possibly accounting for this clinical picture.

  4. Comparison of Clinical Effect of Different Cerebrospinal Fluid Displace-ments for Spontaneous Subarachnoid Hemorrhage after operation%自发性蛛网膜下腔出血术后采取不同脑脊液置换方法的临床效果对比研究

    Institute of Scientific and Technical Information of China (English)

    鲁克升

    2015-01-01

    目的 探讨自发性蛛网膜下腔出血术后采取不同脑脊液置换方法的临床效果. 方法 随机选取2013年2月-2014年10月该院接收的60例SAH患者. 按入院的先后顺序将患者分为观察组和对照组,各30例. 给予对照组常规的置换治疗,而对观察组的脑脊液进行充分置换.比较两组的疗效及住院的时间、头痛持续的时间及脑膜刺激征的消失时间.结果 观察组的治疗有效率达到了86.7%,明显高于对照组治疗有效率66.7%(P<0.05);观察组的住院的时间、头痛持续的时间、脑膜刺激征的消失时间明显低于照组(P<0.05). 结论 充分置换脑脊液对于自发性蛛网膜下腔出血术后的患者有着不错的治疗效果.%Objective To comparatively study the clinical effects of different cerebrospinal fluid displacement for spontaneous sub-arachnoid hemorrhage (SAH) after operation. Methods 60 patients with SAH admitted to the hospital between February 2013 and October 2014 were included. They were assigned, according to admission time, to undergo conventional displacement (control group, n=30) and (observation group, n=30) full cerebrospinal fluid displacement. The efficacy, hospital stay, headaches duration, and disappearance of meningeal irritation sign were compared between the two groups. Results The treatment efficiency (86.7% vs 66.7%) was significantly higher in the observation group than in the control group, P<0.05;the hospital stay duration of headaches, disappearance time of meningeal irritation sign were all less in the observation group than in the control group, P<0.05. Conclu-sion Full cerebrospinal fluid displacement has a good effect on curing the spontaneous subarachnoid hemorrhage after surgery.

  5. 侧脑室内胶质瘤与脑膜瘤的碰撞瘤一例并文献复习%Cocurrent meningioma after recurrent astrocytoma in the lateral ventricle: one case report of collision tumors and review of the literature

    Institute of Scientific and Technical Information of China (English)

    于金录; 曲丽梅; 许冰; 黄海燕

    2012-01-01

    Objective To report one case of a collision tumor composed of intraventricular meningioma and astrocytoma and explore the cause.Methods A 39 - year - old male patient previously underwent excision of astrocytoma in the triangle area of the lateral ventricle and had good postsurgery recovery.The astrocytoma recurred in situ 6 years after the surgery,and it was also complicated with another lesion. The pathological results confirmed a collision tumor composed of intraventricular malignant meningioma and glioma In addition to reporting this case,we also performed a literature review of collision tumors.Results The patient recovered well after surgery to treat the recurrence and was given radiotherapy after discharge.Based on this literature review,we proposed several hypotheses on the formation of collision tumors.Conclusions We conclude that one possible reason of the collision tumor formed between the intracranial meningioma and the astrocytoma was the recurrence of astrocytoma - induced malignancy of arachnoid cells in the choroid plexus.%目的 报告1例罕见的侧脑室内胶质瘤与脑膜瘤的碰撞瘤,并探讨其发生原因.方法 39岁男性,6年前曾行侧脑室内胶质瘤切除术;此次以头痛及头晕发病,MRI示胶质瘤原位复发,且同时合并另一占位性病变,予以手术切除.术后病理证实为胶质瘤与脑膜瘤的碰撞瘤;本文同时也对这种碰撞瘤进行文献复习.结果 术后患者恢复满意,并行伽玛刀放射治疗,随访1年时患者状态良好.本文在复习侧脑室内胶质瘤与脑膜瘤的碰撞瘤发生原因后,总结了几种假设.结论 复发的胶质瘤诱发脉络丛内的蛛网膜细胞恶性转化可能是导致脑膜瘤的原因,同时胶质瘤的刺激也可能诱导了脑膜瘤的生长.

  6. Clinical and imaging features of spontaneous intracranial hypotension%自发性低颅压综合征的临床及影像学特点分析

    Institute of Scientific and Technical Information of China (English)

    穆雪侠; 王建武; 邓大丽; 吴蕾; 胡伟; 余锋

    2012-01-01

    回顾性分析17例临床诊断明确的自发性低颅压综合征(SIH)患者的临床表现及影像资料.直立性头痛是最常见的临床表现,11例伴有恶心、呕吐,1例耳鸣,2例颈项强直.腰椎穿刺结果提示全部患者脑脊液压力均低于8 kPa,10例蛋白质增高,7例白细胞计数升高,7例红细胞计数升高.全部患者均行颅脑磁共振检查,硬脑膜弥漫性强化是最常见的脑MRI表现,脊髓MRI可见硬膜外静脉丛充血扩张.提示直立性头痛和MRI的特征性表现是SIH诊断的关键,硬脑膜弥漫性强化是最常见的早期影像学表现,随疾病发展渐渐出现脑下垂和硬膜下水瘤.%Clinical manifestation and imaging data of 17 cases diagnosed as spontaneous intracranial hypotension ( SIH) syndrome were retrospectivly analyzed Orthostatic headache was the most common symptom , 11 cases with nausea and vomiting, 1 case tinnitus, 2 cases of neck stiffness. Lumbar puncture results suggested that all cerebro -spinal fluid pressure below 8 kPa, with 10 cases of protein increased , 7 cases of white blood cell raised and 7 cases of red blood cell elevated Diffuse pachymeningeal enhancement ( DFE ) was the most common in brain MRI, and engorgement of the spinal epidural venous plexus was observed in spinal MRI study . Orthostatic headache with typi -cal findings on magnetic resonance imaging (MRI) were the key to diagnosis. In the brain, diffuse dural-arachnoid enhancement is the most common imaging abnormality , and DFE is the earliest MRI manifestation of SIH syn -drome, while subdural fluid collections and descent of the brain are indicators of the severe hypotensive state .

  7. Paraplegia and intracranial hypertension following epidural anesthesia: report of four cases Paraplegia e hipertensão craniana após anestesia epidural: relato de 4 casos

    Directory of Open Access Journals (Sweden)

    Frederico A. D. Kliemann

    1975-09-01

    Full Text Available Four patients who received epidural anesthesia presented sustained myelopathy; three of them had complete paraplegia and one a lumbo-sacral myelopathy with urinary retention. All four patients complained of very intense radicular pains immediately after the analgesic effect of Lidocaine was over. Two patients in whom lumbar puncture was done in the first 24 hours presented an aseptic meningitic reaction in CSF. Paraplegia completed in two to ten months in three patients and in two of them severe intracranial hypertension developped at this time. It is proposed that the disease runs a two-stages course, at least in some cases, characterized by an aseptic meningitis, followed, after a silent period of some months, by signs of adhesive spinal and intracranial arachnoiditis. Intracranial hypertension was controlled by ventriculo-peritoneal shunt; in two patients a transitory effect of intrathecal injections of methyl-prednisolone acetate was observed. Two patients recovered almost completely from paraplegia.Quatro pacientes que receberam anestesia epidural apresentaram mielopatia de longa evolução; em três ocorreu paraplegia completa e um apresentou uma síndrome medular lombo-sacra com retenção urinária. Todos os pacientes se queixaram de intensas dores radiculares imediatamente após a cessação do efeito analgésico da lidocaína. Dois pacientes apresentaram uma reação meningítica asséptica no líquido cefalorraqueano nas primeiras 24 horas. A paraplegia tornou-se completa em 2 a 10 meses após a anestesia; dois pacientes tiveram hipertensão craniana severa. Em alguns casos, senão em todos, esta afecção apresenta uma evolução em duas etapas, caracterizadas por meningite asséptica imediata, seguida, depois de um período silencioso de poucos meses, de sinais de aracnoidite adesiva espinal e intracraniana. A hipertensão intracraniana foi controlada por derivação ventriculo-peritoneal; em 2 pacientes houve melhora transit

  8. Research progress of FLAIR vascular hyperintensity%液体衰减反转恢复序列血管高信号征的研究进展

    Institute of Scientific and Technical Information of China (English)

    张卫; 朱幼玲; 朱双根; 翟登月; 张文

    2014-01-01

    Vascular hyperintensities have been defined as focal,tubular,or serpentine hyperintensity relative to gray matter in the sub-arachnoid space or extending into the parenchyma.FVH mainly obtained in the setting of acute stroke and intracranial steno-occlusive disease,and it signicantly associated with severe stenosis or occlusion of blood vessels.The formation mechanism of FVHs may be steno-sis or occlusion of slow blood flow within the vascular distal collateral,not intravascular thrombosis.FVH closely associated with acute ischemic stroke.It is important for the diagnosis of intracranial artery stenosis or occlusion,and can be used to assess the collateral cir-culation and the severity and prognosis of acute ischemic stroke patients.This review summarizes the FVH etiology,common site,patho-physiological mechanisms and clinical significance of research progress.%血管高信号征(FVH)定义为磁共振成像(magnetic resonance imaging,MRI)液体衰减反转恢复序列(fluid-attenuated inver-sion recovery,FLAIR)上大脑半球沿脑沟或脑表面分布的点状、线状或管状的高强度信号。FVH主要出现于急性脑卒中和颅内动脉狭窄-闭塞性疾病患者中,其与血管严重狭窄或闭塞显著相关。FVH的形成机制可能是狭窄或闭塞血管远端侧支血管内的缓慢、紊乱的血流,而非血管内血栓形成。FVH与急性缺血性脑卒中密切相关,不仅可用于诊断颅内动脉狭窄或闭塞病变,而且可预测患者侧支循环的形成情况,从而对于评估其临床病情严重程度及预后具有重要价值。该文总结了FVH的定义、发生率、常见部位、病理生理机制、临床意义等研究进展。

  9. Novel theory of the human brain: information-commutation basis of architecture and principles of operation

    Directory of Open Access Journals (Sweden)

    Bryukhovetskiy AS

    2015-02-01

    . In the brain, the pia mater is an information carrier and the arachnoid is a system administrator and a software carrier. Horizontal commutation between different parts of the brain proceeds extraneurally in holograms formed by the interference and diffraction of reference and object electromagnetic waves of the information-commutation modules of the brain cortex in cerebrospinal fluid. Vertical commutation of the information-commutation modules of various information-commutation platforms is achieved by package impulse transfer of current along axons, and horizontal commutation is performed biochemically by secretomes of cells and synapses in the nervous tissue of the brain. Practical application of this novel theory is demonstrated in an explanation of the pathogenesis and clinical symptoms of several nervous system and psychiatric diseases. Keywords: brain theory, information-commutation theory, alternative brain theory, understanding the brain, brain structure

  10. Mobility training using a bionic knee orthosis in patients in a post-stroke chronic state: a case series

    Directory of Open Access Journals (Sweden)

    Byl Nancy N

    2012-07-01

    Full Text Available Abstract Introduction An emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke. Many of the robotic devices currently available rely on computer-driven locomotive algorithms combined with partial bodyweight-supported treadmill training that drive reflex stepping with minimal patient intention during therapy. In this case series, we examined the effect of task-oriented mobility training in patients in a post-stroke chronic state using a novel, wearable, mobile, intention-based robotic leg orthosis. Case presentation Three individuals, all of whom had reached a plateau with conventional bodyweight-supported treadmill training, participated in task-oriented mobility therapy (1.5 hours, two to four times per week for four weeks with a robotic leg orthosis under supervision by a physical therapist. Participant 1 was a 59-year-old Caucasian man, who had an ischemic left stroke six years previously with resultant right hemiparesis. Participant 2 was a 42-year-old Caucasian woman with left hemiparesis after a right stroke 15 months previously. Participant 3 was a 62-year-old Caucasian woman with a history of a right middle cerebral artery aneurysm with third degree sub-arachnoid hemorrhage 10 years ago. Immediately after training, all participants demonstrated improved gait speed (10 meter walk, stride length and walking endurance (6 minute walk compared with baseline measurements. Improvements were maintained one month after training. Timed up and go and five times sit-to-stand were maintained for all three participants, with only one individual remaining outside the safety performance norm. Conclusions Lower extremity training integrating an intention-based robotic leg orthosis may improve gait speed, endurance and community levels of participation in select patients in a post-stroke chronic state after plateauing within a bodyweight

  11. 脑静脉窦狭窄的影像解剖特征与临床诊治的探讨%Image anatomic characteristics and clinical diagnosis and treatment of cerebral venous sinus stenosis

    Institute of Scientific and Technical Information of China (English)

    李宝民; 梁永平; 曹向宇; 王君; 刘新峰; 杨春水; 王传明

    2015-01-01

    and occipital hemorrhage during the procedure of artery thrombolysis, and 1 patient developed epidural hematoma in the transverse sinus area.All the 3 patients had a satisfactory prognosis through symptomatic treatment.There was no recurrence for all the patients during the follow-up period ranging from 1 to 9 years.9 patients who had recurring dizziness were confirmed no stent stenosis or thrombosis by DSA.The sites of stenosis in 168 patients (97%) were in the connect area of sigmoid and transverse sinuses or in the middle segment of superior sagittal sinus, where arachnoid granulations were focused on according to the anatomic characteristics.Conclusions There is significant correlation between the cerebral venous sinuses stenosis and the abnormal growth of arachnoid granulations in the sinuses;the neurologic deficits caused by venous sinus stenosis can be relieved and eliminated by anticoagulation, thrombolysis, or stent implantation.Favorable medium-long term outcome is showed in the study population.

  12. Initial etiological research of intracranial dural arteriovenous fistulas%硬脑膜动静脉瘘形成机制的初步探讨

    Institute of Scientific and Technical Information of China (English)

    陈亮; 赵曜; 毛颖; 周良辅

    2009-01-01

    Objective To investigate the pathogenesis of intracranial dural arteriovenous fistula, with a focus on the role of angiogenic factors and chronic brain hypoperfusion in it. Methods 120 Sprague-Dawley rats were randomly divided into 4 groups: 1) Group A (n=25) , sham operation; 2) Group B (n = 25), thrombosis of the sagittal sinus; 3) Group C (n = 35), anastomosis of the right common carotid artery(CCA) to the external jugular vein(EJV) and occlusion of the proximate-cardiac end of the transverse sinus on the left; 4) Group D(n =35) , procedures done as Group C and thrombosis of the sagittal sinus was added. Mean arterial pressure, sinus pressure, blood flow of the brain were monitored during the operation and again tested 1, 2, 4, 12 weeks after operation in subgroups of animals, respectively. Histological examination was used to test the distribution and concentration of VEGF and MMP-9 in dura mater, arachnoid membrane, cortex and basal ganglia. Perfusion MRI of the brain was done to compare blood flow in different site of the brain. Results In group C and D, the mean blood pressure decreased soon after operation, and the sinus pressure elevated to (28.55±4. 92) mm Hg and kept stable at (22. 34 ±3.24) mm Hg 4 weeks later. The blood flow of the brain went down significantly after operation in group C and D, with markedly reduction in the right occipital lobe versus any of the other sites. Two weeks later the blood flow had returned to the normal level in the left side but remained abnormal in the right occipital lobe. Perfusion MRI found higher blood volume and longer mean time to enhance in the right occipital lobe, than in its contralateral side. Immunohistological stain of VEGF was positive in basal ganglia, right occipital lobe and arachnoid membrane one week after operation, but weakened in basal ganglia two weeks later. VEGF expression was weak in dura mater one week after operation, but became strongly positive from the 4th to 12th week after operation

  13. A clinical investigation of the mechanism of growing skull fractures in children%儿童颅骨生长性骨折的机制再探讨及早期手术

    Institute of Scientific and Technical Information of China (English)

    鲍南; 徐织; 杨波; 宋云海; 陈成

    2012-01-01

    Objective Many theories have been offered to explain growing skull fractures (GSFs),such as dural tears,arachnoid herniation,increased intracranial pressure,bone absorption due to the ischemia of the fracture line,and delayed or ceased bone growth.These theories,however,are limited by certain inadequacies.In this prospective study,we sought to uncover the mechanisms of GSFs,and their treatment method in children.Methods Ten patients with GSFs who received treatment at our hospital between November 2000 and June 2010 were retrospectively analyzed.The age at injury,duration from the time of injury to the appearance of the GSFs,fracture width,and imaging characteristics were analyzed.Cranioplasty was carried out,while duraplasty was not performed.Results The age at injury ranged from 2 to 21 months,and the age at surgery ranged from 3 to 5 years.The injuries included 7 fail injuries and 3 automobile collision injuries.All were linear skull fractures.The duration from the time of injury to the appearance of a GSFs was < 1 month in 4 cases and < 2 months in 6 cases.Six patients had frontal bone fractures,2 had parietal bone fractures,and 2 had occipital bone fractures.The fracture width ranged from 1.5 to 2.5 cm.The growing fractures became stationary just after the onset,without further progression.Computed tomography (CT) revealed 4 cases of encephalocele underneath the fracture and 6 cases of encephalomalacia due to brain contusion.Follow - up ranged from 1 to 7 years.Titanium plate fixation was stable,without loosening or displacement.There were no skull deformities in any patient.Conclusion GSFs usually occur in young children.The dural tear and the rapid growth of the brain in young children produce an outward expansion force,which plays a crucial role in GSFs development.It is possible that the current theories such as arachnoid herniation,increased intracranial pressure,bone absorption due to ischemia of the fracture line,and delayed or ceased bone growth

  14. Analysis of related factor of subarachnoid hemorrhage headache%蛛网膜下腔出血头痛的相关因数分析

    Institute of Scientific and Technical Information of China (English)

    刘立伟

    2015-01-01

    目的:研究分析蛛网膜下腔出血头痛的相关因数.方法:选取2013-04/2014-01我院的96例蛛网膜下腔出血头痛患者作为研究对象,对其临床资料进行回顾性分析,将其分为两组,其中观察组为52例老年SAH患者,对照组为44例非老年性SAH患者,分析蛛网膜下腔出血头痛患者出血量、颅压、脑脊液改变与头痛程度的关系.结果:观察组患者中等量出血及中等量以上出血者发生头痛程度与少量出血者、CT阴性患者比较无明显差异(P>0.05);对照组患者中CT阴性、少量出血者和中等量以上出血者发生头痛程度比较存在显著差异(P <0.01);观察组的头痛程度比照组明显轻(P <0.01).脑脊液为血色或粉红色时,对照组的头痛程度较重(P<0.01),观察组脑脊液为新鲜出血时头痛明显(P <0.01),观察组头痛程度较对照组轻(P<0.01).结论:CSF血性变是造成蛛网膜下腔的炎性反应发生的原因之一,老年人在CSF血性变程度较轻,头痛程度也较非老年人轻.%AIM:To study and analyze the related factor of sub-arachnoid hemorrhage headache.METHODS:Ninety six pa-tients in our hospital,from April 2013 to January 2014,with sub-arachnoid hemorrhage were selected and their clinical data were analyzed retrospectively. All patients were divided into two groups,52 patients of elderly patients with SAH in the observation group and 44 patients of senile patients with SAH in the control group.The relationship of subarachnoid hemorrhage,cranial pres-sure,changes in cerebrospinal fluid and the degree of headache were analyzed.RESULTS:The comparison of the headache de-gree between patients with moderate bleeding/more moderate de-gree in the observation group and patients with small amount of bleeding/CT-negative patients was not significant different (P>0.05);the comparison of the headache degree among CT

  15. Use of a simple intraoperative hydrostatic pressure test to assess the relationship between mobility of the ventricular stoma and success of third ventriculostomy.

    LENUS (Irish Health Repository)

    Kamel, Mahmoud Hamdy

    2012-02-03

    poorly mobile floor and a negative test (p < 0.05). The positive predictive value of the hydrostatic test was 86.9%, negative predictive value 85.7%, sensitivity 95.2%, and specificity 66.6%. CONCLUSIONS: The authors concluded that the hydrostatic test is an easy, brief test. A positive test result confirms a mobile ventricular floor and adequate flow through the created ventriculostomy. Mobility of the stoma is an important predictor of ETV success provided that there is no obstruction at the level of the arachnoid granulations or venous outflow. A thin, redundant, mobile third ventricle floor indicates a longstanding pressure differential between the third ventricle and the basal cisterns, which is a crucial factor for ETV success. A positive hydrostatic test may avert the need to insert a ventricular reservoir, thus avoiding associated risks of infection.

  16. Computed tomography scan of the head in patients with migraine or tension-type headache Tomografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional

    Directory of Open Access Journals (Sweden)

    Marcelo Moraes Valença

    2002-09-01

    Full Text Available A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%, cysticercosis (3.9%, unruptuted cerebral aneurysm (2.6%, basilar impression (2.6%, intracranial lipoma (2.6%, arachnoid cyst (2.6%, empty sella (2.6%, intracranial neoplasm (2.6%, and others (2.6%. None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.Um estudo retrospectivo foi realizado visando avaliar a frequência de anormalidades encontradas durante a realização de estudo por tomografia computadorizada (TC em 78 pacientes com migrânea ou cefaléia do tipo tensional. A TC foi normal em 61,5% dos pacientes examinados. Em um terço dos pacientes estudados foram detectadas anormalidades, como doença inflamatória dos seios paranasais (19,2%, cisticercose (3,9%, aneurisma cerebral não-roto (2,6%, impressão basilar (2,6%, lipoma intracraniano (2,6%, cisto aracnoideo (2,6%, sela vazia (2,6%, neoplasia intracraniana (2,6% e outras afecções (2,6%. Nenhuma destas lesões era sintomática (achado incidental. Concluindo, o encontro fortuito de algumas anormalidades na TC é frequentemente mais elevado do que se prediz em pacientes com cefaléia primária. Nós discutimos brevemente alguns

  17. Ventral extradural spinal meningeal cyst causing cord compression: neurosurgical treatment Cisto meníngeo extradural ventral do canal espinhal causando compressão medular: tratamento neurocirúrgico

    Directory of Open Access Journals (Sweden)

    Daniel Monte-Serrat Prevedello

    2005-09-01

    Full Text Available Spinal extradural meningeal cysts are typically formed by a thin fibrotic membranous capsule, macroscopically similar that of an arachnoid membrane, filled by cerebro spinal fluid and related to a nerve root or to the posterior midline. Ventral location is extremely rare and when it occurs they usually cause spinal cord herniation through the ventral dural gap. A 61 year-old man who began with a two years long history of insidious tetraparesis, spasticity and hyperreflexia in lower extremities, and flaccid atrophy of upper limbs, without sensory manifestations, is presented. Investigation through magnetic resonance imaging demonstrated an extensive spinal ventral extradural cystic collection from C6 to T11. The lesion was approached through a laminectomy and a cyst-peritoneal shunt was introduced. The cyst reduced in size significantly and the patient is asymptomatic over a 48 months follow-up. This is the first reported case of a spontaneous ventral extradural spinal meningeal cyst causing cord compression. Cyst-peritoneal shunt was effective in the treatment of the case and it should be considered in cases in which complete resection of the cyst is made more difficult or risky by the need of more aggressive surgical maneuvers.Cistos meníngeos extradurais espinhais são formados tipicamente por estreita cápsula membranosa fibrótica, macroscopicamente semelhante a uma membrana de aracnóide, repleta de líquor e relacionada com uma raiz nervosa ou com a linha média posterior. Eles são extremamente raros em posição anterior e, quando ocorrem, habitualmente causam herniação da medula espinhal pela falha dural ventral. O caso de um homem de 61 anos de idade que iniciou com tetraparesia, espasticidade e hiperreflexia em membros inferiores, e flacidez com hipotrofia nos membros superiores, sem manifestação sensitiva, é apresentado. A investigação com ressonância magnética demonstrou extensa coleção cística extradural ventral

  18. Analysis of 285 cases with infratentorial lessions operated by minimally invasive keyhole approach of ;craniotomy%微创锁孔幕下手术285例分析

    Institute of Scientific and Technical Information of China (English)

    周明卫; 傅震; 朱风仪; 赵春生; 曹胜武; 骆慧; 刘宁

    2015-01-01

    目的总结微创锁孔开颅幕下手术的临床效果。方法285例幕下病变在微创锁孔显微镜及神经内镜下完成。皮肤切口3‐5 cm ,骨瓣直径1‐3 cm。小脑半球病变共4例采用锁孔中线入路;桥小脑角区手术281例采用锁孔枕下乙状窦后入路。结果成功实施了肿瘤切除152例;其中,听神经瘤96例,脑膜瘤23例,胆脂瘤17例,三叉神经鞘瘤12例(全切除8例,4例跨中颅窝的为次全切除)。成功完成微血管减压术129例、畸形血管切除3例和巨大蛛网膜囊肿切除1例。结论显微镜下神经内镜微创锁孔入路在幕下手术中能获得有效的操作空间,具有创伤小、并发症少、恢复快等优点,可应用于小脑、桥小脑角区病变的手术。%Objective To summary the outcomes of minimally invasive keyhole approach of craniotomy for infratentorial lesions .Methods The minimally invasive keyhole approach of craniotomy was performed in 285 cases with infratentorial lesions .The skin incision was 3‐5 cm in length and the bone flap was 1‐3 cm in diameter .The post‐middle line keyhole approach was used in 4 cases with cerebellar hemisphere lesions and the suboccipital retrosigmoid keyhole approach was used in 281 cases with the lesions in cerebellopontine angle area .Results Tumor resection surgeries were performed successfully in 152 cases ,of whom 96 cases were with acoustic neurinoma ,23 cases with meningioma ,17 cases with cholesteatoma ,and 12 cases with trigeminal neurinoma(total resection in 8 cases and partial resection in 4 cases due to extending to the middle cranial fossa) .The cranial neural micro‐vascular decompression was performed in 129 cases ,and the resections of three deformed vessels and one large arachnoid cyst were carried out ,which were all successful .Conclusion Asisted by microscope and endoscope ,the minimally invasive keyhole approach of craniotomy has the advantages of providing effective space

  19. Microanatomical study of the nutrient artery of the glossopharyngeal nerve root

    Institute of Scientific and Technical Information of China (English)

    Jinhua Zheng; Xiaohua He

    2008-01-01

    BACKGROUND:Because the artery leading to the glossopharyngeal nerve is small and complex,insufficient blood supply can occur due to atherosclerosis,occlusion,or injury.This sometimes results in corresponding newe degeneration,demyelination,and/or arachnoid adhesion.OBJECTIVE:To observe the nutrient artery origin of the glossopharyngeal nerve root in the medulla oblongata region,as well as the relationship between the artery and glossopharyngeal nerve root,to verify dependence of primary glossopharyngeal neuralgia,which is related to contact and compression of the nutrient artery of the glossopharyngeal nerve root.DESIGN,TIME AND SETTING:Repetitive measurement.The experiment was performed at Harbin Medical University and Daqing Oilfields General Hospital between November 2006 and April 2007.MATERIALS:Ten cadaver heads(seven male and three female)were supplied bv the Department of Anatomy,Harbin Medical University.A total of 15 patients(nine male and six female),aged 38-56,that suffered from glossopharyngeal neuralgia were treated at Daqing Oilfields General Hospital and were between 38-56 years old.All cadaver heads were strictly handled according to the Guideline for Medical Ethics Committee.The patients agreed to the criteria set for the study objects.METHODS:(1)The bilateral veins of the nutrient artery were dissected under a surgery microscope.A sliding caliper was used to measure the length of the glossopharyngeal nerve from the oblongata to the iugular foramen.The origin of the nutrient artery was noted.as well as the courser and diameter to explore the relationship between the glossopharyngeal nerve root and the vertebral artery.posterior inferior cerebellar artery,anterior inferior cerebellar artery,as well as the branching veins.(2)A total of 15 patients received glossopharyngeal neuralgia surgery.Contact or oppression of the glossopharyngeal nerve with the posterior inferior cerebellar artery,the anterior inferior cerebellar artery,vertebral artery,and its

  20. MRI在胎儿颅脑病变产前诊断中的临床应用%The clinical application of magnetic resonance imaging in prenatal diagnosis of fetal brain disease

    Institute of Scientific and Technical Information of China (English)

    衣蕾; 周爱玲; 李伟凯; 刘凯

    2016-01-01

    Objective:To discuss the clinical prenatal diagnostic value of magnetic resonance imaging (MRI) in fetal cerebral abnormalities. Methods:78 gravidas with ultrasound (US) suspected fetal problems or diagnostic uncertainty underwent MRI. MRI imaging findings of the fetus were analyzed and compared with 2 cases postnatal brain MRI diagnosis and 38 cases in-duced labor MRI diagnosis or postmortem examination,assess the clinical value of MRI. Results:Agenesis of corpus callosum 32 cases,including midline cysts 2 cases,Dandy-Walker syndrome 6 cases,and cerebellar hypoplasia 4 cases,intracranial widespread calcification 1 case,intracranial hemorrhage 15 cases,subacute hemorrhage 15 cases,intracranial space occupying lesions 13 cas-es. Malignant teratoma 1 cases after induced labor and arachnoid cysts 12 cases (midline cysts 2 cases,suprasellar cistern 2 cases,cisterna ambiens 1 case,cisterna magna 7 case),Dandy-Walker 12 cases,including hydrocephaly 2 cases,schizencephaly 1 case,gyrus retardation 1 case,lissencephaly 2 cases,Jourbert syndrome 2 cases,unilateral megalencephaly 1 case,Apert syndrome 1 case. Conclusions:Magnetic resonance imaging techniques take part in the import role in diagnosis of fetal cerebral abnor-malities. It is a complementary and verification,it can even correct US diagnosis. MRI can provide more accurate and complete information for clinic.%目的:探讨MRI在胎儿颅脑病变诊断中的临床应用价值。方法:对78例超声怀疑颅脑病变的胎儿行MRI检查,并与产后2例及引产的38例胎儿的影像表现进行对照分析。结果:胼胝体发育不全32例,其中合并中线囊肿2例,并Dandy-Walker畸形6例,小脑发育不全4例,颅内广泛钙化1例;颅内出血15例,均为亚急性出血;颅内占位性病变13例,其中1例引产后病理证实为恶性畸胎瘤,囊肿12例(中线囊肿2例,鞍上池2例,环池1例,颅后窝7例);Dandy-Walker畸形12例,其中合并脑积水2

  1. Reações inflamatórias leptomeníngeas em neurocirurgia Acute inflammatory leptomeningeal reactions in neurosurgery

    Directory of Open Access Journals (Sweden)

    A. Gama da Rocha

    1971-03-01

    divided in three groups: probably aseptic RIL (72 cases, probably septic RIL (26 cases and septic RIL (7 cases. Only in the last group the bacteriological examination of the CSF sample was positive. In 59 cases there occurred the association of RIL and sub-arachnoid haemorrhage. The severity of this association was pointed out based upon the incidence of deaths among the patients studied. Twenty four patients have died; in 20 the RIL and subarachnoid haemorrhage association has occurred.

  2. Analysis of the Application Value of Ultrasonography in the Diagnosis of Fetal Malformation of the Central Nervous System%超声检查在胎儿中枢神经系统畸形诊断中的应用价值探析

    Institute of Scientific and Technical Information of China (English)

    花秋菊; 关云萍; 项宇识

    2015-01-01

    that the fetal malformation of the central nervous system in all the fetuses in-cluded 1 case with arachnoid cyst, 3 cases with spina bifida, 11 cases with encephalomeningocele and meningiocele, 23 cases with hydrocephalus, 32 cases with anencephaly. the clinical coincidence rate of ultrasonography with pathelogical examination was 98.9%, the misdiagnosis rate was 1.1%. Conclusion Ultrasonography is non-invasive and easy to operate, and has high rate for the diagnosis of fetal malformation of the central nervous system, which can be used as an important method for prenatal exclusion of fetal central nervous system malformation.

  3. PROSPECTIVE RANDOMIZED DOUBLE BLINDED PLACEBO CONTROLLED STUDY TO EVALUATE THE EFFECTS OF INTRAVENOUS DEXMEDETOMIDINE ON SPINAL BUPIVACAINE ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Janaki Babu

    2016-02-01

    Full Text Available BACKGROUND AND AIMS There is a dearth of studies on the effect of intravenously administered Dexmedetomidine in Sub Arachnoid Block hence, this study was conducted to compare the effects of intravenously administered Dexmedetomidine prior to the administration of subarachnoid block with bupivacaine 0.5% heavy, on hemodynamic variables and the level and onset and duration of sensory and motor blockade. MATERIAL AND METHODS After obtaining ethical Committee approval, a double-blind, randomized prospective clinical study was conducted on 90 American Society of Anesthesiologist Grade I and II patients in the age group of 18-55 years, divided randomly into two groups: Group D received 50 ml solution containing Inj. Dexmedetomidine infusion at 0.5 mcg/kg for 10 minutes, and Group P received 50 ml of solution 0.9% Normal Saline as infusion at 10 minutes time. Subsequently Spinal Anaesthesia is carried out with Bupivacaine heavy 0.5%, and carried out recordings as per protocol. Besides Hemodynamic parameters other parameters observed were effectiveness, Sedation score; highest level of sensory block achieved; Motor and Sensory block; Time for first rescue analgesic requirement were recorded. RESULTS Group D (n=45 (Mean±SD Sedation Score 3.42±0.621 and Group P (n=45 (Mean±SD Sedation Score 1.80±0.405. Better sedation was seen in Group – D with a p value of less than 0.0001.The highest level of sensory blockade achieved was significantly higher in Group D when compared to the control group, and mean duration (in minutes to achieve the highest sensory blockade in both the groups: Group D (n=45 (Mean±SD 7.91±2.42 and Group P (n=45 (Mean±SD 9.82±3.973 p Value< 0.0001. The highest level of sensory blockade achieved was significantly higher in Group D when compared to the control group, and mean duration (in minutes to achieve the highest sensory blockade in both the groups. Group D (n=45 (Mean±SD 7.91±2.42 and Group P(n=45 (Mean±SD 9.82±3.973 p

  4. Pathological features and origin of primary pineal mixed germ cell tumors%原发性松果体区混合性生殖细胞肿瘤病理特点及其起源探讨

    Institute of Scientific and Technical Information of China (English)

    肖罡; 方陆雄; 邱炳辉; 漆松涛

    2011-01-01

    目的 通过影像学表现、术中所见及病理成分探讨松果体区混合性生殖细胞肿瘤的起源.方法 回顾分析我院2000年1月致2010年9月间经术后病理证实的15例松果体区混合性生殖细胞肿瘤的术前影像学表现和病理标本.结果 影像学表现,12例存在钙化,10例含有囊变,5例含有脂质.矢状位类圆或类椭圆状6例,边缘均较光滑,不规则形状9例,边缘多突起;术中所见,所有肿瘤均位于大脑大静脉蛛网膜袖套包绕形成的松果体隐窝内;病理成分,13例含有生殖细胞成分,9例含有畸胎瘤成分,4例含有胚胎性癌成分,3例含有绒癌成分,7例含有卵黄囊瘤成分,3例含有横纹肌瘤成分.在7例标本边缘发现牛殖细胞瘤,10例患者生殖细胞瘤成分与其余成分相互穿插或被其它成分包绕.结论 松果体区混合性生殖细胞肿瘤起源于松果体周围残余生殖细胞,其极有可能来自单一的原始生殖细胞.%To investigate the origin of mixed germ cell tumors in the pineal region based on the image data,surgical findings and pathological examination of the tumor. Methods The preoperative CT and magnetic resonance imaging (MRI) findings and tumor specimens were retrospectively analyzed in 15 cases of pineal mixed germ cell tumors confirmed by postoperative histological examination between January 2000 and September 2010. Results Radiographic examination of the tumor revealed calcification in 12 cases, cystic changes in 10 cases, and the presence of lipid in 5 cases. On the anteroposterior images, the tumors appeared round or elliptic with smooth edge in 6 cases,and showed irregular shape with multiple processes on the edge in 9 cases. Surgical exploration found all the tumors located in the the suprapineal recess enclosed by the arachnoidal envelope of the Galen vein. Pathologically, 13 specimens contained germinoma component, 9 contained teratoma component, 4 had embryonic carcinoma component, 3 had

  5. The biological significance of brain barrier mechanisms: help or hindrance in drug delivery to the central nervous system? [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Norman R. Saunders

    2016-03-01

    Full Text Available Barrier mechanisms in the brain are important for its normal functioning and development. Stability of the brain’s internal environment, particularly with respect to its ionic composition, is a prerequisite for the fundamental basis of its function, namely transmission of nerve impulses. In addition, the appropriate and controlled supply of a wide range of nutrients such as glucose, amino acids, monocarboxylates, and vitamins is also essential for normal development and function. These are all cellular functions across the interfaces that separate the brain from the rest of the internal environment of the body. An essential morphological component of all but one of the barriers is the presence of specialized intercellular tight junctions between the cells comprising the interface: endothelial cells in the blood-brain barrier itself, cells of the arachnoid membrane, choroid plexus epithelial cells, and tanycytes (specialized glial cells in the circumventricular organs. In the ependyma lining the cerebral ventricles in the adult brain, the cells are joined by gap junctions, which are not restrictive for intercellular movement of molecules. But in the developing brain, the forerunners of these cells form the neuroepithelium, which restricts exchange of all but the smallest molecules between cerebrospinal fluid and brain interstitial fluid because of the presence of strap junctions between the cells. The intercellular junctions in all these interfaces are the physical basis for their barrier properties. In the blood-brain barrier proper, this is combined with a paucity of vesicular transport that is a characteristic of other vascular beds. Without such a diffusional restrain, the cellular transport mechanisms in the barrier interfaces would be ineffective. Superimposed on these physical structures are physiological mechanisms as the cells of the interfaces contain various metabolic transporters and efflux pumps, often ATP-binding cassette (ABC

  6. 脑胶质瘤患者血清及脑脊液中游离DNA的检测%Diagnostic value of the content and integrity of free DNA in patients with glioma

    Institute of Scientific and Technical Information of China (English)

    陈建; 施炜; 吕成林; 夏亮; 戚青; 景蓉蓉; 鞠少卿

    2012-01-01

    目的 检测不同级别脑胶质瘤患者血清及脑脊液中游离DNA的含量及完整性,探讨其对脑胶质瘤的诊断及预后判断的意义.方法 术前采集70例脑胶质瘤患者和22例健康对照的外周血;其中30例胶质瘤患者同时采集脑脊液.通过实时荧光定量聚合酶链反应( RT-qPCR)方法检测血清及脑脊液中游离DNA短串联重复序列(ALU)的长片段(247 bp)与短片段(115 bp)的含量以及DNA完整性.结果 血清中ALU-247 bp与115 bp含量以及游离DNA完整性在胶质瘤组与对照组间差异无统计学意义(P>0.05).脑脊液中游离DNA ALU-247 bp与115 bp含量均较非肿瘤对照组高,DNA完整性(ALU-247/ALU-115 bp)较对照组也显著增高.ROC曲线分析ALU-247 bp,ALU-115 bp含量与DNA完整性的AUC分别为0.775、0.875和0.912.结论 胶质瘤患者术前脑脊液中游离DNA ALU-247 bp、ALU-115 bp的含量以及DNA完整性对胶质瘤的术前诊断具有一定价值.%Objective To detect the content of free DNA and the DNA integrity in serum and cerebrospinal fluid (CSF) from glioma patients in order to assess their diagnostic value for the glioma.Methods Serum samples were obtained from 70 patients with glioma and 22 healthy volunteers as controls,and CSF samples from 20 patients with glioma and 8 nonneoplastic controls with hydrocephalus or arachnoid cyst.Free DNA concentration and integrity were detected by using real-time quantitative polymerase chain reaction (RT-qPCR) before operation.With 2 primers sets amplifying short and long free DNA fragments ( ALU115 and ALU247 ),free DNA integrity was determined by ratio of the concentration of ALU247 over ALU115 (ALU 247/115).Results The concentration of serum ALU had no significant differences between glioma patients and healthy controls.ALU115 and ALU247 contents,and free DNA integrity in CSF were significantly higher in glioma patients than in the controls ( all P<0.05 ).Area under curve of ROC curve analysis for the CSF

  7. 基层医院蛛网膜下腔出血急诊处置策略的探讨附37例报道%Countermeasures of Basic-level Hospital Emergency Treatment of Subarachnoid Hemorrhage With 37 Cases Reported

    Institute of Scientific and Technical Information of China (English)

    韩永峰; 段晋宁; 张娟

    2015-01-01

    remaining 34 cases security transfer admission, onset to hospital emergency time average (3.2±0.4) h. Referral for treatment of 7 cases, 0 cases of death, 1 cases rebleeding, non referral treated 27 cases underwent conservative treatment, 3 cases of death, 4 cases rebleeding. The prognosis of patients with significant correlation with age, hypertension history, transfer or not, onset to hospital emergency time (P<0.05). ConclusionPrehospital and multi-channel cooperation is the primary hospital treatment effective scheme arachnoid subarachnoid hemorrhage; prognosis of patients with general information age, previous history is closely related to the clinical treatment must pay attention to such information.

  8. Diffusion-weighted MR of the brain: methodology and clinical applications

    International Nuclear Information System (INIS)

    tensor, has a fundamental role in the assessment of brain maturation and of white matter diseases of the fetus, in the neonate and in the child. Diffusion MR imaging enables a better characterisation of the lesions demonstrated by conventional MR imaging, for instance in the hypoxic-ischaemic encephalopathy, in infections and in the inherited metabolic diseases, and in particularly important for the longitudinal evaluation of these conditions. Diffusion-weighted MR imaging has an established role in the differential diagnosis between brain abscess and cystic tumour and between epidermoid tumour and arachnoid cyst. On the other hand, the results obtained with diffusion MR in the characterization of type and extension of glioma do not yet allow decision making in the individual patient. Diffusion is one of the most relevant MR techniques to have contributed to a better understanding of the pathophysiological mechanisms of multiple sclerosis (MS). In fact, it improves the specificity of MR in characterizing the different pathological substrata underlying the rather uniform lesion appearance on the conventional images and enables detection of damage in the normal-appearing white and grey matter. In MS patients, the ADC or D values in the normal-appearing white matter are increased as compared to control values, albeit to a lesser degree than in the lesions demonstrated by T2-weighted images. In addition, the D of the normal appearing grey matter is increased in MS patients and his change correlates with the cognitive deficit of these patients. Histogram analysis in MS patients shows that the peak of the brain D is decreased and right-shifted, reflecting an increase of its value, and the two feature correlate with the patient's clinical disability. Ageing is associated to a mild but significant increase of the brain ADC or D which is predominantly due to changes in the white matter. Region of interest and histogram studies have demonstrated that D and ADC are increased in

  9. Application of 64 slice spiral CT angiography in subarachnoid hemorrhage%64层螺旋 CT 血管成像在自发性蛛网膜下腔出血中的应用

    Institute of Scientific and Technical Information of China (English)

    韩璐璐; 张锡海; 张爱霞; 王俊英; 董乐

    2015-01-01

    目的:为了进一步提高临床对自发性蛛网膜下腔出血(SAH)的治疗效果,分析和探讨64层螺旋 CT血管成像在自发性 SAH 中的应用价值。方法按照随机双盲的原则抽取2014年1月-2015年1月治疗的38例考虑自发性 SAH 的患者作为研究对象,所有入组的患者均常规给予64层螺旋 CT 血管成像(CTA)及数字减影脑血管造影(DSA)检查,其中 CT 血管成像均应用最大密度投影(MIP)、容积再现技术(VR),通过和 DSA 结果对比分析 CTA 在发现自发性 SAH 中的病因诊断中的应用价值和意义。结果以 DSA 诊断结果作为评价标准,CTA 的诊断结果准确率和 DSA 相比较,差异亦无统计学意义(P ﹥0.05);而 CTA 组在诊断血管瘤大小方面和 DSA 诊断结果准确率和 DSA相比较示,差异无统计学意义(P ﹥0.05)。结论临床上在诊断自发性 SAH 的过程中应用64层螺旋 CT 血管成像,不仅简单、快捷和方便,而且有利于发现病因和提高诊断准确率,值得推广。%Objective To further improve the effectiveness of our hospital in terms of t spontaneous subarachnoid hemorrhage(SAH)and to reduce and prevent the occurrence probability of a variety of adverse events,analysis and discussion of the meaning and value of 64-slice CT angiography(CTA). Methods Selected 38 cases of patients with spontaneous sub-arachnoid hemorrhage(SAH)in our hospital from January 2014 to January 2015 according to the randomized double blind controlled principles as a study object,all patients with acute SAH underwent 64-slice CTA and digital subtraction angiography (DSA). Three-dimensional post-processing techniques including volume rendering( VR),maximum intensity projection (MIP),curved planar reformation(CPR)and multi-planar reconstruction(MPR)were underwent. Results Taking the DSA result as the standard,CTA diagnosis accuracy compared with DSA the difference between the two groups weren

  10. 数字减影CTA诊断破裂颅内动脉瘤的价值%Detection value of ruptured intracranial aneurysms with digital subtraction computed tomographic angiography

    Institute of Scientific and Technical Information of China (English)

    刘元早; 翟昭华; 王霖

    2015-01-01

    Objective:To evaluate the diagnostic performance of 64-section DSCTA to detect ruptured intracranial aneurysms compared with 3D-DSA,as a reference standard. Materials and Methods:This study was approved by the institutional review board;written informed consent was obtained. One hundred and forty-four consecutive patients suspected of having aneurismal subarachnoid hemorrhage were recruited from January 2012 to November 2013. All patients underwent both 64-detector DSCTA and 3D-DSA for the detection of intracranial aneurysms. Source images were post-processed to reconstruct three-dimensional image and measure the aneuris-mal size. With 3D-DSA findings as the reference standard,sensitivity and specificity of digital subtraction CTA in depicting aneurysm were calculated. The sensitivity,specificity of DSCTA in depicting aneurysms of different diameter (ie,< 3 mm,≥3mm and <5 mm,≥5mm and <10 mm,≥10 mm) and of aneurysms at different locations in the anterior and posterior circulation were calculated. Re-sults:One hundred and ninety-nine aneurysms were seen in one hundred and forty-four patients. Of those,DSCTA detected 196. On a per-aneurysm basis,the sensitivity and specificity of CT angiography was 98. 5% and 100%,respectively. For aneurysms smaller than 3 mm,sensitivity was 91. 2%. However,the sensitivity and specificity were both 100% for aneurysms larger than 3 mm and all of ruptured intracranial aneurysms. Conclusion:64-slice DSCTA can be used as the primary screening method for patients who had aneurismal sub-arachnoid hemorrhage in the diagnostic routine.%目的::以3D-DSA为参考标准,探讨64层螺旋CT数字减影CTA对破裂颅内动脉瘤的诊断性能。材料与方法:所有病例经伦理审查委员会批准,患者或家属签订知情同意书。回顾性分析2012年1月至2013年11月期间的144例经过数字减影CTA和3D-DSA检查的动脉瘤性蛛网膜下腔出血(aneurysmal Subarachnoid Hemorrhage,SAH)患者。所有源图像

  11. Cisto intraespinal em comunicação com o disco intervertebral na coluna lombar: relato de um caso e revisão da literatura Quiste intraespinhal en comunicación con el disco intervertebral em la columna lumbar: reporte de caso y revisión de la literatura Intraspinal cyst communicating with the intervertebral disk in the lumbar spine: case report and literature review

    Directory of Open Access Journals (Sweden)

    Mauricio Marteleto Filho

    2012-12-01

    ículo se describen las características de esta entidad clínica, incluyendo el aspecto clínico, radiológico e histológico, para discutir la posible patogénesis y tratamiento.Herniated lumbar disc is an important as well as the most common cause of low back pain and sciatica. Many cases can be readily diagnosed by simple semiological examination. Magnetic resonance imaging (MRI provides a definitive diagnosis even in an outpatient basis. Several types of intraspinal cysts with different pathogenesis have been reported in the past, such as perineural cysts, synovial cysts, arachnoid cysts, and ganglion cysts, diseases that are difficult to differentiate from lumbar disc herniation. Recently, the authors have observed one case of intraspinal cyst communicating with the corresponding intervertebral disk, presenting clinical symptoms, signs, and even some radiographic findings undistinguishable from those of herniated disks. The diagnosis established by MRI and confirmed at surgery. This paper describes the features of this distinct clinical condition, including clinical findings, images, and histological aspects, to discuss possible pathogenesis and management.

  12. Global Stratigraphy of Venus: Analysis of a Random Sample of Thirty-Six Test Areas

    Science.gov (United States)

    Basilevsky, Alexander T.; Head, James W., III

    1995-01-01

    The age relations between 36 impact craters with dark paraboloids and other geologic units and structures at these localities have been studied through photogeologic analysis of Magellan SAR images of the surface of Venus. Geologic settings in all 36 sites, about 1000 x 1000 km each, could be characterized using only 10 different terrain units and six types of structures. These units and structures form a major stratigraphic and geologic sequence (from oldest to youngest): (1) tessera terrain; (2) densely fractured terrains associated with coronae and in the form of remnants among plains; (3) fractured and ridged plains and ridge belts; (4) plains with wrinkle ridges; (5) ridges associated with coronae annulae and ridges of arachnoid annulae which are contemporary with wrinkle ridges of the ridged plains; (6) smooth and lobate plains; (7) fractures of coronae annulae, and fractures not related to coronae annulae, which disrupt ridged and smooth plains; (8) rift-associated fractures; and (9) craters with associated dark paraboloids, which represent the youngest 1O% of the Venus impact crater population (Campbell et al.), and are on top of all volcanic and tectonic units except the youngest episodes of rift-associated fracturing and volcanism; surficial streaks and patches are approximately contemporary with dark-paraboloid craters. Mapping of such units and structures in 36 randomly distributed large regions (each approximately 10(exp 6) sq km) shows evidence for a distinctive regional and global stratigraphic and geologic sequence. On the basis of this sequence we have developed a model that illustrates several major themes in the history of Venus. Most of the history of Venus (that of its first 80% or so) is not preserved in the surface geomorphological record. The major deformation associated with tessera formation in the period sometime between 0.5-1.0 b.y. ago (Ivanov and Basilevsky) is the earliest event detected. In the terminal stages of tessera fon

  13. Lesões neurológicas na blastomicose sul-americana estudo anatomopatológico de 14 casos

    Directory of Open Access Journals (Sweden)

    Walter C. Pereira

    1965-06-01

    Full Text Available Several case reports of involvement of the nervous system by Paracoccidioides brasiliensis have been published, changing thus the concept that the nervous system would no be adequate to the proliferation of this fungus. In the material of the Department of Pathology of the University of São Paulo Medical School, collected up to September 1964, 145 cases of paracoccidioidomycosis were found. In 14 of them there were lesions of the nervous system, giving an incidence of 9,65%. This high incidence contradicts the frequent assumption that the involvement of the nervous system in cases of South American blastomycosis is exceptional. In our material most of the cases of neuroblastomycosis had not systemic lesions, 2 of them having isolated involvement of the nervous system. This fact does not agree with the frequent observation of patients with lesions in all organs but the nervous system. There are no pathophysiologic reasons to explain such contradiction, but it can be assumed that individual conditions, in some cases, make the nervous system vulnerable to the parasite. Of the 14 cases studied, 5 had lesions of the meninges and 9 had gra-nulomata of the brain. Of the 5 cases with meningitis, 3 had an isolated basilar leptomeningitis; in 1 case lesions of the pia-arachnoid of the brain convexity were also found, and in another one the spinal meninges were also involved as well the spinal roots. The granulomata of the brain were isolated in 5 cases and multiple in 4. The most frequent site of the lesions was the cerebral hemispheres (6 cases; in 2 cases the cerebellum was involved; the thalamus, pons and medulla were involved in one case each. This predominance of the hemispheric localization must be related to the larger blood supply of this parte of the nervous system, owing to the hematogenic route followed by the parasite. In our material no lesions of the spinal cord were found. However, no definitive conclusions can be drawn, as there was no

  14. 听神经瘤显微手术面神经损伤的预防%Prevention of facial nerve injury in acoustic neuroma microsurgery

    Institute of Scientific and Technical Information of China (English)

    雷霆; 李龄

    2008-01-01

    目的 总结与分析听神经瘤显微手术中预防面神经损伤的方法.方法 经MRI和(或)CT检查确诊的大型听神经瘤(≥4.0 cm)180例(72%)及中型听神经瘤(2.4~4.0 cm)70例(28%).均采用经患侧枕下乙状窦后入路保留面神经的显微手术.注意三大解剖关系:骨性解剖、蛛网膜解剖、神经与血管的解剖.肿瘤囊内减压后,确认面神经的起始位置、面神经与肿瘤的关系、面神经变形与扭曲、面神经分离的方法、面神经的断裂端-端吻合.随访6个月~1年.结果 肿瘤全切除240例(96.0%);次全切除10例(4.0%),其中死亡1例(0.4%).面神经功能评定:Ⅰ级214例(85.6%);Ⅱ级25例(10.0%);Ⅲ级5例(2.1%);Ⅳ级5例(2.1%).结论 术中注意典型的解剖位置,正确的手术入路和显微手术技术可达到较高的肿瘤全切除率,提高面神经的功能保全率.%Objective To summarize and analyse the techniques of avoiding facial nerve iniury during acoustic neuroma microsurgery.Methods One hundred and eighty patients with large acoustic neuroma(≥4 cm)and 70 patients with medium acoustic neuroma(2.4-4.0 cm)Were diagnosed by MRI/CT scan before operation and confirmed by postoperational pathologic examination.All of patients were treated by sub-occipital retrosigmoid approach for tumor removal and facial nerve reservation during operation.The relationships among the bone,arachnoid,nerve and vascular anatomy were panicularly observed during the operation. After decompression of the tumor,the origination and location of the facial nerve as well as the relationship between the tumor and the facial nerve should be identified.The patients were followed-up from 6 months to 1 year postoperatively and assessed by House-Brackmann facial nerve function grading system.Results Total tumor resection was achieved in 240 of 250 cases (96%)and subtotal in 10 cases including 1 case died because of cerebellar encephalomalacia after operation. According to the House

  15. Molecular biology of the blood-brain and the blood-cerebrospinal fluid barriers: similarities and differences

    Directory of Open Access Journals (Sweden)

    Redzic Zoran

    2011-01-01

    Full Text Available Abstract Efficient processing of information by the central nervous system (CNS represents an important evolutionary advantage. Thus, homeostatic mechanisms have developed that provide appropriate circumstances for neuronal signaling, including a highly controlled and stable microenvironment. To provide such a milieu for neurons, extracellular fluids of the CNS are separated from the changeable environment of blood at three major interfaces: at the brain capillaries by the blood-brain barrier (BBB, which is localized at the level of the endothelial cells and separates brain interstitial fluid (ISF from blood; at the epithelial layer of four choroid plexuses, the blood-cerebrospinal fluid (CSF barrier (BCSFB, which separates CSF from the CP ISF, and at the arachnoid barrier. The two barriers that represent the largest interface between blood and brain extracellular fluids, the BBB and the BCSFB, prevent the free paracellular diffusion of polar molecules by complex morphological features, including tight junctions (TJs that interconnect the endothelial and epithelial cells, respectively. The first part of this review focuses on the molecular biology of TJs and adherens junctions in the brain capillary endothelial cells and in the CP epithelial cells. However, normal function of the CNS depends on a constant supply of essential molecules, like glucose and amino acids from the blood, exchange of electrolytes between brain extracellular fluids and blood, as well as on efficient removal of metabolic waste products and excess neurotransmitters from the brain ISF. Therefore, a number of specific transport proteins are expressed in brain capillary endothelial cells and CP epithelial cells that provide transport of nutrients and ions into the CNS and removal of waste products and ions from the CSF. The second part of this review concentrates on the molecular biology of various solute carrier (SLC transport proteins at those two barriers and underlines

  16. The biological significance of brain barrier mechanisms: help or hindrance in drug delivery to the central nervous system?

    Science.gov (United States)

    Saunders, Norman R; Habgood, Mark D; Møllgård, Kjeld; Dziegielewska, Katarzyna M

    2016-01-01

    Barrier mechanisms in the brain are important for its normal functioning and development. Stability of the brain's internal environment, particularly with respect to its ionic composition, is a prerequisite for the fundamental basis of its function, namely transmission of nerve impulses. In addition, the appropriate and controlled supply of a wide range of nutrients such as glucose, amino acids, monocarboxylates, and vitamins is also essential for normal development and function. These are all cellular functions across the interfaces that separate the brain from the rest of the internal environment of the body. An essential morphological component of all but one of the barriers is the presence of specialized intercellular tight junctions between the cells comprising the interface: endothelial cells in the blood-brain barrier itself, cells of the arachnoid membrane, choroid plexus epithelial cells, and tanycytes (specialized glial cells) in the circumventricular organs. In the ependyma lining the cerebral ventricles in the adult brain, the cells are joined by gap junctions, which are not restrictive for intercellular movement of molecules. But in the developing brain, the forerunners of these cells form the neuroepithelium, which restricts exchange of all but the smallest molecules between cerebrospinal fluid and brain interstitial fluid because of the presence of strap junctions between the cells. The intercellular junctions in all these interfaces are the physical basis for their barrier properties. In the blood-brain barrier proper, this is combined with a paucity of vesicular transport that is a characteristic of other vascular beds. Without such a diffusional restrain, the cellular transport mechanisms in the barrier interfaces would be ineffective. Superimposed on these physical structures are physiological mechanisms as the cells of the interfaces contain various metabolic transporters and efflux pumps, often ATP-binding cassette (ABC) transporters, that

  17. 桥小脑角区小型占位致继发性三叉神经痛的手术疗效分析%Surgical outcome after resection of small cerebellopontine angle lesions resulted in secondary trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    陶传元; 魏攀; 庄进学; 陈登奎; 程宏炜; 宋朝理; 李海龙; 薛峰; 张炜; 郑小强

    2011-01-01

    目的 评估桥小脑角区(CPA)小型占位致继发性三叉神经痛的手术疗效.方法 回顾分析我科自2005年1月~2010年12月期间该类患者的临床资料,包括年龄、症状及体征、影像学表现、手术方式、疗效及并发症.结果 6年期间手术治疗三叉神经痛372例,其中CPA区小型病变(最大直径<3cm)致继发性三叉神经痛23例,约占6.2%;病种包括胆脂瘤12例、神经鞘瘤6例、脑膜瘤3例、蛛网膜囊肿2例;所有患者行乙状窦后入路显微镜下切除病变,3例另行三叉神经感觉根部分切断术;术后疼痛消失20例,面部麻木3例;术后并发症包括无菌性脑膜炎、脑脊液漏、颅内感染、短暂耳鸣及面瘫,均恢复,无死亡.随访1~5年,无疼痛复发.结论 CPA区小型占位所致继发性三叉神经痛患者由于病变小、易于全切,加之镜下暴露充分,手术疗效满意;术中若发现病变与三叉神经无确切关系,则需行微血管减压或三叉神经部分感觉根切断术.%Objective To evaluate the surgical outcome after resection of small cerebel-lopontine angle lesions resulted in secondary trigeminal neuralgia (TN). Methods Clinical data including age, symptom and sign, image manifestation, surgical modality, surgical outcome and complications in patients diagnosed secondary TN resulted from small cerebellopontine angle lesions are analyzed retrospectively between 2005. 1 and 2010. 12. Results Of 6 years duration, 372 cases of TN underwent operations. There were 23 cases of such kind (the largest diameter less than 3cm) accounting for 6. 2% among them which involved 12 cholesteatomas, 6 schwanno-mas, 3 meningiomas and 2 arachnoid cysts. All lesions were resected under microscope through retrosigmoid approach and additional partial sensory rhizotomy was performed in 3 cases. After operation, 20 cases got complete pain relief and the rest had facial numbness. Postoperative complications included aseptic

  18. Subtemporal transtentorial approach for excision of tumors in mid-superior petroclival region: a report of 43 cases%颞下经小脑幕入路手术切除中上岩斜区肿瘤(附43例报告)

    Institute of Scientific and Technical Information of China (English)

    邢学民; 杨文涛; 夏勋; 马原; 赵凯; 张修忠; 林龙; 曾凡俊; 顾建文; 孔滨; 匡永勤; 贺伟旗; 程敬民; 杨涛; 程林; 黄海东

    2011-01-01

    目的 探讨颢下经小脑幕入路切除中上岩斜区肿瘤的手术技巧.方法 回顾性分析2003年6月- 2010年4月收治的43例中上岩斜区肿瘤,其中男19例,女24例,年龄23~64岁,平均42岁,病程2个月-3年,平均14个月,均采用颞下经小脑幕入路,对肿瘤与中上岩斜区毗邻结构关系进行评估,分离肿瘤与天幕及岩斜部脑膜的近端粘连,由近及远分块切除肿瘤,逐渐分离扩大脑干、下视丘、海绵窦与肿瘤之间的间隙,避免直接接触上述重要结构,彻底切除肿瘤.观察术后疗效和并发症.结果 43例患者中肿瘤完全切除31例(72.1%),次全切除7例(16.3%),大部切除5例(11.6%),死亡1例(2.3%).23例术后出现部分神经功能障碍.术后随访3~48个月,神经功能障碍均得到不同程度恢复.结论 颞下经小脑幕入路切除中上岩斜区肿瘤具有手术路径短、容易暴露的优点.缩小肿瘤体积、扩大操作空间是此类手术的关键.%Objective To explore the surgical technique for excision of mid-superior petroclival region tumor through subtemporal transtentorial approach. Methods Forty-three patients with tumor at superior-middle petroclival region hospitalized from Jun. 20003 to Apr. 2010 were involved in present study, and their clinical data were retrospectively analyzed. Of the 43 patients, 19 were male and 24 were female, age ranged from 23 to 64 vears (with mean of 42 vears) , disease duration ranged from 2 months to 3 years (with average of 14 months). All the patients underwent tumor resection via subtemporal transtentorial approach. The relationship between tumors and adjacent superior-middle petroclival structures was evaluated, and then the adhesion between tumor and tentorium cerebelli or petroclival memnges was separated, the tumor was resected piecemeal from closest area to distant part. The arachnoidal planes between tumor and brain stem, hypothalamus, or cavernous was dissected to enlarge the gap between the

  19. Application of laminoplasty in spinal epidural cyst resection%椎板成形术在椎管内硬膜外囊肿切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    金铂; 苏亦兵; 张岩; 王汉斌; 王科大

    2014-01-01

    目的 探讨椎板成形术在椎管内硬膜外蛛网膜囊肿(SEAC)外科治疗中的意义.方法 回顾性分析24例SEAC患者,患者分为非椎板成型组(A组)及椎板成型组(B组).对比两组患者的手术时间、手术出血量、术前及术后患者JOA评分以及神经功能恢复率、术前及术后脊柱Kyphotic角度等.结果 B组的手术出血量为(111.1 ±48.6) ml,显著少于A组(513.3±131.6) ml(t=-8.755,P=0.000).B组的手术时间为(45.4 ±5.3)min,显著短于A组(89.8±19.1)min(t=-8.443,P=0.000).B组术后Kyphotic角度为6.8°±1.2°,显著小于A组10.1°±1.2°(t=-6.388,P=0.000).而两组的术前Kyphotic角度、术前JOA评分、术后JOA评分和神经功能恢复率差异均无统计学意义(P>0.05).结论 以铣刀为基础的椎板成形术治疗SEAC,效果良好并能减少术后并发症,是安全、快捷的方法之一.%Objective To explore the significance of laminoplasty in the surgical treatment of spinal extradural arachnoid cyst (SEAC).Methods 24 patients with SEAC,who were admitted and operated in the department of neurosurgery in Beijing Jishuitan hospital from May 2011 to June 2013 were retrospectively analyzed.According to the different surgical methods,all the patients were divided into two groups:non-laminoplasty group (group A) and laminoplasty group (group B).The data of patients in each group involving operative time,blood loss,preoperative and postoperative JOA scores and neurological function recovery rate,preoperative and postoperative spine Kyphotic angle were analyzed retrospectively.Results The surgical bleeding in group B was (111.1 ± 48.6) ml,which was significantly less than the (513.3± 131.6)ml in group A (t =-8.755,P =0.000).The operative duration time in group B was (45.4 ± 5.3) rman,which was significantly shorter than the (89.8 ± 19.1) min in group A (t =-8.443,P =0.000).The group B Kyphotic angle of 6.8° ± 1.2°was significantly lower than the 10.1° ± 1.2°in group A (t =-6

  20. Application of early diagnosis and curative effect for HIE ultrasonography%超声在新生儿缺氧缺血性脑病早期诊断及疗效评估中的应用

    Institute of Scientific and Technical Information of China (English)

    段世玲; 周平安; 张振显

    2011-01-01

    Objective: To investigate sonographic appearance and the changes of hemodynamics of HIE, also to comprehensively evaluate its application in the brain damage after blrth asphyxia and observe the condition of active. Methods :Take advantage of a two-dimensional ultrasound , color doppler (CDFI, and energy doppler(CDE)and the doppler frequency(PW)to observe and contrast 58 cases which were newly born babies with HIE and 20 normal ones about the change of brain parenchyma, size of lateral ventricle and the blood parameters after 48 hours , 3 to 4 days , and part of them following up to 12 months. Results : 46 of the HIE cases display the enhancement of brain parenchyma in different degrees. The shape and size of cerebral ventricle vary according to different conditions. 7 of the brain parenchyma hemorrhage; 4 lateral ventricle hemorrhage ; one hard-faced probe hemorrhages and one arachnoid hemorrhages. There were no obvious differences between the HIE group and contrast group in the brain bloodstream spectrum and dynamics parameter. All of speed of blood drops and resistance index increases (P< 0. 05) except one severe HIE case who presents hyperperfusion syndrome. When we follow up to 12 months, 2 of them form cystic lesions in brain parenchyma; 2 of their lateral ventricle expands and 5 babies' lateral ventricle expand slightly and there were no evidence of being.Conclusion:The skull ultrasound is the best way to make early diagnosis and make dynamic follow-up.%目的:探讨新生儿缺氧缺血性脑病(HIE)的脑部声像图表现及脑血流动力学变化,综合评价其对新生儿窒息后早期脑损伤的应用及病情的动态观察.方法:应用二维超声、彩色多普勒(CDFI)、能量多普勒(CDE)及频谱多普勒(PW)观查了58例HIE患儿及20例正常新生儿出生后48h内、3~4d、7d及部分随访至12个月的脑实质回声改变、侧脑室大小及脑血流参数变化并进行对照.结果:HIE患儿中46例脑实质回声显示不

  1. Anatomic features of the the Dorello's canal and its clinical significance%Dorello管区的解剖学特点及其临床意义

    Institute of Scientific and Technical Information of China (English)

    张毅; 虞昊; 金国华; 陈霞

    2012-01-01

    目的 为颅底外科提供Dorello管区的解剖学资料. 方法 50例头颅标本进行血管灌注红、蓝乳胶或硅橡胶,对Dorello管区的构成、毗邻关系、内容物等进行观察和测量.对岩斜段展神经进行苏木精-伊红染色,研究该段展神经硬脑膜鞘的构成.结果 Dorello管由Gruber韧带、颞骨岩部尖端、上斜坡外缘构成,管内走行脑膜背侧动脉、展神经及其硬脑膜鞘.展神经硬脑膜鞘由硬脑膜和蛛网膜构成.Gruber韧带可以分为6型:Y-型,蝴蝶型,三角型,镰型,爪型和复干(条索状)型.展神经存在多种变异,复干型展神经出现率为16%,双侧都为复干型展神经的出现率为5%.展神经在Dorello管区出现转折,按转折的程度分为:重型(<120°)占60%(60侧),中型(120°~150°)占36%(36侧),轻型(150°~180°)占4%(4侧).结论 Dorello管区结构复杂,展神经变异多,对Dorello管区的研究有助于在手术中减少神经、血管的损伤,同时阐明展神经损伤的机理.%Objective To provide microanatomical data of the Dorello's canal for the skull base surgery. Methods The microsurgical anatomy of the Dorello's canal and its structures, adjacent structures and contents were observed and measured in each side of 50 adult cadaveric heads fixed in formalin, in which the arteries and veins were injected red and blue latex. HE staining of the abducens nerve in the petroclival segment was taken to observe the construction of dural sheath of the nerve. Results Dorello's canal was composed of Gruber's ligament, petrous apex and the lateral border of the upper part of clivus. The dorsal meningeal artery, abducens nerve and a dural sheath of the abducens nerve entered the Dorello's canal. The abducens nerve was surrounded by a sheath which consists of dura mater and arachnoid. Gruber's ligament was found in six patterns: Y-shaped, butterfly-shaped, triangular-shaped, falciform-shaped, claw-shaped, and duplicate (iunicular

  2. Nontraumatic Convexal Subarachnoid Hemorrhage Concomitant with Acute Ischemic Stroke:Case Report and Literature Review%凸面蛛网膜下腔出血伴急性缺血性卒中1例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    李杜娟; 连立飞; 梁钧昱; 梁奇明; 朱遂强

    2015-01-01

    目的:凸面蛛网膜下腔出血(cSAH)是一种罕见的卒中亚型,本研究旨在报道 cSAH 伴缺血性卒中,以提高对该病的认识。方法:报道 cSAH 伴同侧急性缺血性卒中1例;应用“凸面蛛网膜下腔出血、颅内动脉狭窄、颈动脉狭窄和缺血性中风”等主题词在 Pubmed 数据库和 CNKI 数据库纳入另外13例有详细资料的cSAH 伴缺血性卒中和(或)大动脉闭塞/狭窄患者。分析其一般状况、临床和影像学特征、发病机制、治疗和预后。结果:共纳入患者14例。男9例,女5例;平均发病年龄为(54.9±10.3)岁;多具有明显的血管危险因素。临床表现以局灶损害体征为主;出血部位以中央沟附近最为常见,且主要发生在血管闭塞或严重狭窄的同侧,抗血小板聚集治疗可能有效,预后好。结论:cSAH 伴急性缺血性卒中是一种罕见的临床表现,抗血小板治疗可能有效且预后好。%Objective:Nontraumatic convexal subarachnoid hemorrhage (cSAH) is a relatively rare entity and we would report cSAH cases associated with acute ischemic stroke. Methods: We described 1 patient of cSAH who presented with ipsilateral acute ischemic stroke and identified an additional 13 cases in the Pubmed database and Chinese CNKI database using the MeSH terms convexal subarachnoid hemorrhage, intracranial stenosis, carotid stenosis, and ischemic stroke. We analyzed the background characteristics, clinical course, and outcomes of the 14 cases. Results: Fourteen cases were included, 9 male and 5 female cases. The average onset age was (54.9±10.3) years. Patients often presented with transient sensory and/or motor symptoms, whereas headaches typical of sub-arachnoid hemorrhage were rare. There were vascular risk factors in most cases. Predominant site of the cSAH lo-cated in the vicinity of the central sulcus. The cSAH typically showed ipsilateral involvement of severe intracranial stenosis or

  3. Endovascular embolization treatment of ruptured intracranial aneurysms at the acute stage with micro - coils%微弹簧圈血管内栓塞治疗急性期破裂颅内动脉瘤

    Institute of Scientific and Technical Information of China (English)

    夏吉勇; 焦铁鹰; 李志强; 路长宇; 苗林; 郭吉卫

    2015-01-01

    Objective To investigate the efficacy and safety of the microcoil embolization treatment of ruptured intracranial aneurysms at the acute stage. Methods The clinical data of 30 cases(34 aneurysms)were retrospectively analyzed. All the patients were diagnosed as sub-arachnoid hemorrhage by CT. All cases were confirmed by DSA for intracranial aneurysms. And all of them underwent endovascular embolization within 72 hours after aneurysm rupture. Results Complete embolization was achieved in 24 of 34 aneurysms,95% embolization in 6 aneurysms, 90% embolization in 2 aneurysms,80% embolization in 2 aneurysms. The operation associated complications occurred in 6 patients. The last coil extruding into the patent artery was observed in 1 patient. Re - rupture of aneurysm during the operation in 1 patient,severe cerebral angiospasm in 2 patients and cerebral infarction in 2 patients. After operation,25 patients recovered well,4 patients with mild disability or paralysis,1 patient died of postoperative gastrointestinal bleeding. During the follow - up of 1 ~ 6 months,no rebleeding occurred. Conclusion Microcoil emboliza-tion is a safe and effective method to treat acutely ruptured intracranial aneurysms. Early intracranial surgery and timely treatment after operation is important to reduce fatality and disability.%目的:探讨微弹簧圈血管内栓塞治疗急性期破裂颅内动脉瘤的安全性及有效性。方法回顾性分析30例颅内动脉瘤在破裂出血后72小时内行微弹簧圈血管内栓塞治疗的临床资料。30例患者发病后均行 CT 检查,诊断为蛛网膜下腔出血,并经全脑血管造影证实为颅内动脉瘤,共检出34枚动脉瘤,其中单发26例,2枚4例。结果34枚动脉瘤中,100%栓塞24枚,95%栓塞6枚,90%栓塞2枚,80%栓塞2枚。术后发生手术相关并发症6例,包括微弹簧圈脱出至载瘤动脉1例,术中动脉瘤破裂1例,严重脑血管痉挛2例,术后脑梗死2

  4. Intradurallysis and peripheral nerve implantation for obsolete incomplete rupture of spinal cord%硬脊膜内松解自体周围神经植入治疗脊髓陈旧性不完全性断裂伤

    Institute of Scientific and Technical Information of China (English)

    郑旭东; 张少成; 梁俊刚; 黄进; 杨恺

    2009-01-01

    [目的]探讨脊髓减压松解、神经组织植入治疗陈旧性脊髓不完全性断裂伤的临床效果.[方法]对16例外伤性陈旧性不全瘫患者,采用显微外科技术切开硬脊膜,将蛛网膜、软脊膜、齿状韧带、神经根起始段与脊髓的粘连及周围的纤维条索彻底解除.将质地外观异常段的脊髓行3~6个切口纵行切开;若发现脊髓内囊肿,则切开后吸出其中液体.然后,将自身腓肠神经用显微外科方法去除外膜、束膜并剪开,将其排列呈多条状、纵行植入已切开的脊髓处或原囊肿腔内.最后修复硬脊膜或用骶棘肌瓣覆盖.[结果]16例患者术后随访2~4年(平均2.5年),感觉和运动均增加1级以上,其中6例双下肢主要肌群肌力较术前增加2级,恢复达4级,恢复行走能力.[结论]硬脊膜内粘连松解、瘢痕段脊髓切开、自体周围神经组织植入桥接治疗外伤性陈旧性不全瘫患者的初步临床观察效果良好.%[Objective]To research the later period treatment for the traumatic incomplete paralysis. [Method]Sixteen patients who suffered from traumatic obsolete incomplete paralysis underwent intradurallysis and peripheral nerve implantation by microsurgery technique. The endorachis was opened, and the fibrous bands adhering to the spinal cord, from arachnoid, pia mater spinalis.ligamenta denticulatum,initiative part of never root were completely relieved. The abnormally watched spinal cord was opened by 3 -6 incisions. The cyst found in the spinal cord was opened and the liquid in it was drained. After that,denuded spi-neurium and perineurium of the autogenous sura] nerve was grafted. The nerves were lined up into several strips and longitudinally implanted into the incised spinal cord and cyst. And it was sutured with pia mater spinalis. Finally,the endorachis was sutured or covered by sacrospinal muscle. [ Result] Sixteen patients were followed up for 2 -4 years (mean 2.5 years). The sensibility and

  5. The diagnosis and treatment of chiari malformation%小脑扁桃体下疝畸形的临床诊断及治疗

    Institute of Scientific and Technical Information of China (English)

    乌拉别克·毛力提; 艾克拜尔·亚里坤

    2016-01-01

    Objective To study the diagnosis and treatment of chiari malformation so as to provide references for clinical practices.Methods Forty-one patients meeting diagnostic criteria of chiari malformation who received posterior fossa decom-pression and partial tonsillectomy from January 2012 to January 2014 were selected.The prognosis was evaluated by using Glasgow scale in one month after operation and the improvement of symptoms and complications were observed in the 6-12 months follow-up period.Results One month after operation for all 41 cases,there were 33 cases with good recovery (75.61%),10 cases with weak efficacy(24.39%).Of the 39 survivals,symptoms improved well occurred in 22 cases,good in 13 cases,with the total effective rate of 89.74%.Postoperative fever ranging from 38 ℃ to 39 ℃ happened to 10 cases,with fe-ver time less than one week.During the follow-up,there was no one presenting cerebrospinal fluid leakage,intracranial infec-tion,cerebral spinal-arachnoiditis and other severe complications.Conclusion We should combine clinical symptoms with ima-ging exanimation to diagnosis chiari malformation.The Application of posterior fossa decompression and partial tonsillectomy as well as expanding repair of dura mater with artificial mesh may play clinical roles in improving the clinical symptoms,reduc-ing postoperative complications and improving progress.%目的:研究小脑扁桃体下疝畸形的临床诊断及治疗方法,以期为临床诊治提供一定的依据。方法选取2012-01—2014-01收治的符合小脑扁桃体下疝畸形诊断标准的患者41例,所有患者均行后颅窝减压术及部分扁桃体切除术。术后1个月复查,根据格拉斯哥预后评分评价治疗效果。术后随访6~12个月,观察患者的症状改善及并发症情况。结果41例患者中术后1个月复查,恢复良好33例(75.61%),疗效较差10例(24.39%)。39例生存患者中,症状改善优22例,良13例,总有效率为89.74%

  6. The Study of Relationship Between Acute Cerebral Hemorrhage and Electrocardiographic Changes%急性脑出血与心电图改变的关系研究

    Institute of Scientific and Technical Information of China (English)

    杨法; 苏明兰; 李小珠; 张斌

    2014-01-01

    , there were significant differences with other ECG, P<0.05, there was statistically significant; Among lobe, putamen, thalamus, arachnoid lower chamber, cerebellar hemorrhage of ECG changes were high speciifcity. Conclusion The bleeding site and the actual disease in patients with acute cerebral hemorrhage is the main reason impacting of the patient's electrocardiogram changes, mainly in moderate to severe acute cerebral hemorrhage patients.

  7. 脑卒中患者神经功能缺损程度与既往高血压治疗行为的关系%Relationship between defect level of neural functions and previous treatment of hypertension in patients with stroke

    Institute of Scientific and Technical Information of China (English)

    王逢强; 赵燕萍; 诸卫英; 陆伟; 柳青

    2004-01-01

    背景:有关高血压与脑卒中之间的关系以及血压高低对脑卒中发病率影响的研究比较多见,而高血压的治疗情况与脑卒中起病后的神经功能缺损程度方面的研究还未广泛开展.目的:探讨高血压脑卒中患者卒中后神经功能缺损程度与既往高血压治疗情况之间的关系.设计:病例对照研究.地点和对象:选择复旦大学附属上海市第五人民医院急诊科高血压脑卒中患者,非高血压脑卒中患者及蛛网膜下腔出血患者不属于研究对象.根据其既往高血压治疗情况将研究对象分为持续治疗组(82例)、间断治疗组(95例)与无治疗组(103例).主要观察指标:观察各组患者的神经功能缺损程度、脑卒中类型的构成.结果:间断治疗组、无治疗组与持续治疗组相比,神经功能缺损程度较重,脑出血较多见(P均<0.000 1).结论:规则的抗高血压治疗有望减少高血压性脑卒中尤其是脑出血的发生、减轻脑卒中的病情.因此,有必要采取措施使更多的高血压患者接受规则的抗高血压治疗.%BACKGROUND:There are quite a number of researches on the relationship between hypertension and stroke as well as the effects of blood pressure to the incidence of stroke. However, the research on the treatment of hypertension and neural function defects post stroke is limited.OBJECTIVE: To explore the relationship between the defects of neural functions in patients with stroke and the previous treatment of hypertension.DESIGN:Retrospective non-randomized case control study.SETTING and PARTICIPANTS:Patients with stroke due to hypertension were selected from the Department of Emergency, Affiliate Fifth Hospital of Fudan University,Whereas patients with non-hypertensive stroke and sub arachnoid hemorrhage were exclusive. Participants were divided into continuous treatment group(82 cases), intermitted treatment group(95 cases) and no treatment group( 103 cases).MAIN OUTCOME MEASURES

  8. Evaluation of prognosis of convexity meningioma by using MRI imaging parameters%应用磁共振影像学参数评估凸面脑膜瘤预后的研究

    Institute of Scientific and Technical Information of China (English)

    高修众; 汪潮湖; 邝欢; 张世超; 刘忆; 潘军; 漆松涛

    2016-01-01

    Objectives To investigate the correlation of preoperative MRI imaging parameters and pathological grades and prognosis of convexity meningioma and to initially establish the imaging scoring method for predicting of the prognosis and biological behavior of meningiomas.Methods From January 2003 to December 2006,the preoperative imaging parameters of 246 patients underwent resection of convexity meningioma (Simpson grade Ⅰ) at the Department of Neurosurgery,Nanfang Hospital,Southern Medical University were analyzed retrospectively.The preoperative imaging parameters included the signal intensity of diffusion tensor imaging (DTI),T1 enhanced images,subarachnoid layer on T2-weighted images,peritumoral edema on T2-weighted images and tumor shape.The relationship between imaging features of tumors and clinical pathological grades was detected by the univariate analysis.Kaplan-Meier survival analysis and multivariate logistic regression analysis were used to evaluate whether the imaging parameters could predict the occurrence of high-grade meningiomas.According to preoperative imaging parameters,the patients were graded and grouped.Cox regression model was used to analyze the relationship between the imaging scores in patients with convexity meningioma and the overall survival (OS) and progression-free survival (PFS).The credibility of preoperative imaging scores was analyzed by the Kappa coefficient test.Results Univariate analysis results indicated that there were significant differences in diffusion tensor imaging (DWI) signal intensity,T1 enhancement images,arachnoid layer on T2 weighted imaging,peritumoral edema on T2-weighted images,and tumor shape in different grades of convexity meningiomas (all P < 0.05).Multivariate logistic regression analysis indicated that DWI hyperintensity is the most important independent predictor of high-grade meningiomas (P < 0.01,OR,17,95% CI 5.8-47.6),others were disruption of arachnoid layer (P <0.01,OR,14,95% CI 4

  9. Microsurgical resection of ventral foramen magnum meningiomas via a far-lateral suboccipital approach

    Institute of Scientific and Technical Information of China (English)

    Zhihua Cheng; Zhilin Guo; Meixiu Ding

    2006-01-01

    expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned.Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up.MATN OUTCOME MEASURES: Operative effect.RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2patients still had lower cranial nerve deficit and others recovered from

  10. 颞叶癫痫的临床、脑电图特征及认知功能分析%Clinical and electroencephalographic characteristics and cognitive function analysis of Temporal lobe epilepsy

    Institute of Scientific and Technical Information of China (English)

    曾锦英

    2014-01-01

    Objective To explore the pathogen ,clinical and electroencephalographic characteristics and cognitive function analysis at seizure stage of temporal lobe epilepsy.Methods The clinical features ,EEG and neurological imaging science and cognitive function were of 62 temporal lobe epilepsy patients were retrospectively analyzed.Results In 62 patients ,38 patients were generalized tonic-clonic seizures (GTCS) ,52 patients were complex partial seizures (CPS) ,and 15 cases were simple par-tial seizures (SPS).A total of 19 clinical seizures were discovered by conventional EEG and EEG after sleep deprivation.The EEG of all patients showed unilateral or bilateral temporal lobe spikes ,spike and wave ,sharp waves ,sharp slow release except 13 patients.35 cases were positive in 40 sphenoid electrodes patients.EEG showed 38 cases were normal under normal waking state.43 cases were observed epileptiform discharges by sphenoid electrodes at a sleep state.Neural imaging studies showed ,29 cases were abnormal ,accounting for 46.8 percent ,including vascular malformations ,tumors ,hippocampal sclerosis and dys-plasia ,arachnoid cyst ,temporal lobe atrophy ,varying amounts.The intelligence of 21 children patients were normal ,with the rate of 53.84%.And the intelligence of 19 adult patients were normal in 23 cases ,with the rate of 82.61%.Conclusion EEG combined sphenoid electrodes examination in sleeping can be effectively applied to the sphenoid temporal lobe epilepsy positio-ning ,with neurological examination and clinical characteristics of radiographic analysis can help early detection and early treat-ment.%目的:探讨颞叶癫痫的病因、临床特征、发作期及发作间期脑电图特点和认知功能状况。方法对62例诊断为颞叶癫痫病人的临床特征、脑电图和神经影像学资料及认知功能进行回顾性分析。结果62例患者中38例有强直性阵挛发作(GTCS),52例有复杂部分性发作(CPS),其中15例合并有单

  11. Clinical characteristics and treatment for vertebral basilar artery dissection%椎-基底动脉夹层的临床特点和治疗

    Institute of Scientific and Technical Information of China (English)

    郑峥; 程琼; 李永坤; 刘君鹏; 陈莹; 汪银洲

    2012-01-01

    Objective To investigate the clinical characteristics, therapeutic strategies and efficacy of vertebral basilar artery dissection (VAD). Methods Twenty-eight patients with VAD diagnosed by DSA or CTA were collected. 21 of the patients wilh posterior circulation ischemia (PCI) were treated with clopidogrel (75 mg/d) or aspirin (100 mg/d) alone, 3 underwent endovascular treatment, and 2 with sub-arachnoid hemorrhage (SAH) were treated with stent-assisted coil embolization of the aneurysms and vertebral artery occlusion. The clinical characteristics and follow-up results were analyzed. Results ①In the 28 patients, 24 had clear causes or incentive factors, including abnormal movement of the head and neck (15/24, 53.6% ), atherosclerosis (4/24, 16.7%), upper respiratory tract infection (12.5% , 3/24), thrombocytosis (4. 2% , 1/24), and alcoholism (4.2% , 1/24); 4 were cryptogenic. ② In the 28 patients, 25 (89.3% ) had PCI (21 of them had posterior circulation infarct, 4 had repeated transient episodes of vertigo), and 3 patients( 10.7% ) had SAH. ③DSA or CTA showed that 30 vertebral arteries and 1 basilar artery had dissection, 16 (51.6%) showed "linear sign", 9 (29.0%) showed fusiform or saccular aneurysm6, 6(19.4%) showed "pearl and string sign", and 2(6.5%) had double-lumen sign. Most dissections were oc-cured in the V4 segments (71.0% ,up to 22/31), then Mowed by V2 segments (19.4% , 6/31). ④In the 25 patients with PCI, 21 were treated with medication, 19 had good and 2 had poor prognosis. 9 patients received CTA or DSA reexamination, the degree of vascular stenosis reduced in 4 patients, no significant change in 4 patients, and 1 patient's vertebral artery was occluded. Three patients treated with endovascular treatment, and their prognosis was good. CTA reexamination no vascular restenosis or aneurysm recurrence was found. Two of the 3 patients with SAH had good prognosis. CTA reexamination showed no recurrence of aneurysms; 1 patient was only treated with

  12. 经纵裂入路相关的大脑静脉的显微解剖与临床应用%Microanatomy of cerebral veins related to approaches through interhemisphere fissure and its clinical application

    Institute of Scientific and Technical Information of China (English)

    王雅栋; 李壮志; 丰育功; 李进京

    2009-01-01

    Objective To study the means by which we can gain ideal operative exposure without hurting bridging veins in the approach through interhemisphere fissure by microsurgical anatomy study and superficial location of the superior cerebral veins. Methods The superior cerebral veins of twenty adult cadaveric heads fixed with formalin were anatomized and measured under operative microscope.Results (1)There was a segment of "safe region" in the posterior part of the frontal region of superior sagittal sinus in which there was no bridging vein flows, which could be named as "the first safe region";the occipital region of superior sagittal sinus had a segment of "safe region"too, which could be named as "the second safe region"."The first safe region" was located 32.6 mm in front of the coronal suture and 7.5 mm behind the coronal suture,"the second safe region"was located between the point 5.5 mm below the lambdoid suture and the external occipital protuberance.(2) Fully separation of the bridging veins near the interhemisphere fissure could broaden the opening width of the interhemisphere fissure.As the data showed,it could broaden the opening wi dth at 2~3 mm in frontal polar, 4~11 mm in"the first safe region",10~17 mm in"the second safe region". Conclusions (1)The external points opening the cranial bone in the anterior transcallosal approach should be set before 32.6 mm in front of the coronal suture and 7.5 mm behind the coronal suture.The external points opening the crinial bone in Poppen approach should be set 5.5 nun below the lambdoid suture and the external occipital protuberance. (2) Fully separation of the sticking segment and arachnoid segment of the bridging veins in the interhemisphere fissure could broaden the opening width of the interhemisphere fissure without raising the tension of bridging veins, thus bridging veins could be protected.%目的 通过对大脑上静脉进行显微外科解剖及体表定位,研究经纵裂入路获得理想手术视

  13. 儿童先天性脑积水的诊治探讨%Diagnosis and treatment of congenital hydrocephalus in children

    Institute of Scientific and Technical Information of China (English)

    刘智强; 刘水源; 林志雄; 梅文忠; 龚清永; 何理盛; 康德智; 吴喜跃

    2013-01-01

    目的 探讨并总结儿童先天性脑积水的诊治经验. 方法 回顾性分析福建医科大学附属第一医院神经外科自2007年6月至2011年6月收治的29例儿童先天性脑积水患者的临床资料,其中合并神经系统畸形27例,包括胼胝体缺如或发育不全6例、导水管狭窄5例、脑膜膨出3例、脊膜膨出3例、Dandy-Walker畸形2例、Chiari 1型畸形1例、脑灰质异位并脑裂畸形1例、脑发育不全1例、脑裂畸形1例、神经纤维瘤病1型1例、第四脑室囊肿1例、枕大池囊肿1例、透明隔囊肿1例;伴其他脏器畸形4例,包括胸7半椎体脊柱侧弯并右足马蹄内翻足1例、乳糜漏1例、腹股沟斜疝1例、脐疝1例.26例患者行脑室腹腔分流术,3例行囊肿腹腔分流术,均应用可调压分流管. 结果 29例患者中有效26例,疗效不佳3例.术后出现并发症13例,其中分流管感染3例,分流管近端堵塞或引流不畅3例,分流管腹腔端堵塞或引流不畅3例,硬膜下积液1例,硬膜下积液并硬膜下血肿1例,腹腔囊肿1例,分流管人右侧阴囊并阴囊肿胀1例. 结论 儿童先天性脑积水常合并脏器发育畸形,应注意相关检查以明确,并针对性治疗,以改善预后.%Objective To summarize the diagnosis and treatment experience of congenital hydrocephalus in children.Methods The clinical data of 29 children with congenital hydrocephalus,admitted to our hospital from June 2007 to June 2011,were analyzed retrospectively; in these patients,27 had combined nervous system malformations,including corpus callosum agenesis or hypoplasia in 6,aqueduct stenosis in 5,meningocele in 3,spinal meningocele in 3,Dandy-Walker malformation in 2,Chiaril malformation in 1,Heterotopic gray matter combined with schizencephaly in 1,atelencephalia in 1,schizencephaly in 1,neurofibromatosis type 1 in 1,fourth ventricle cysts in 1,arachnoid cyst in cerebello-medullary cistern in 1 and septum pellucidum cysts in 1; 4 was

  14. Neuroendoscopic therapy for hydrocephalus caused by cysts of the posterior fossa%神经内镜治疗后颅窝囊肿合并脑积水31例分析

    Institute of Scientific and Technical Information of China (English)

    刘华; 彭玉平; 漆松涛; 韦拳堂; 宋烨

    2011-01-01

    Objective To explore the process and technique ofneuroendoscopic operation in obstructive hydrocephalus caused by cysts of the posterior fossa. Methods An analysis of 31 patients with obstractive hydrocephalus caused by cysts of the posterior fossa, admitted to our hospital from April 2004 to August 2010, was performed; CT and MRI were performed on these patients. Among all the 31patients, 19 had arachnoid cyst of the posterior fossa, 5 Dandy-Walker malformations, 2 Blake' s pouch cyst, and 5 cysts after resection of the tumor. Treatment efficacy was determined according to the improvement of clinical symptoms, imaging manifestations and appearing of relative complications.Results Endoscopic management (n=14), microsurgery (n=9) and ventriculoperitoneal shunt (n=8) were performed. All the patients' postoperative hydrocephalus was alleviated in early stage of treatnent.Subsequent follow-up, ranged from 0.6 to 6 years, revealed a sharp reduction of sizes of the cyst and ventricle system under MRI in 28 patients, with a total effective rate of 87.1%. The effective rate and incidence of complications were 92.9% and 14.3% in patients performed endoscopic management, 88.9%and 33.3% in patients performed microsurgery, and 75% and 50% in patients performed ventriculoperitoneal shunt, respectively.Conclusion Neuroendoscopic procedure is a safe and effective technique for hydrocephalus caused by cysts of the posterior fossa; as compared with those with microsurgery and ventriculoperitoneal shunt, higher success rate and less operative complications are achieved in patients with endoscopic management.%目的 探讨神经内镜治疗后颅窝囊肿合并脑积水的诊治方法。 方法 回顾性分析南方医院神经外科自2004年4月至2010年8月收治的31例后颅窝扩大囊室合并脑积水患者资料,所有患者均经头颅CT和MRI证实。其中后颅窝真性蛛网膜囊肿19例,Dandy walker畸形5例,布莱克囊肿2

  15. Diffusion-weighted MR of the brain: methodology and clinical applications; Diffusione in RM dell'encefalo: metodologia e applicazioni cliniche

    Energy Technology Data Exchange (ETDEWEB)

    Mascalchi, Mario [Firenze Univ., Firenze (Italy). Dipartimento di Fisiopatologia clinica, Sezione di Radiodiagnostica; Filippi, Massimo [Istituto Scientifico Ospedale S. Raffaele, Milano (Italy)Unita di Neuroimaging Quantitativo; Floris, Roberto [Tor Vergata Univ., Roma (Italy). Dipartimento di Diagnostica per immagini e radiologia interventistica; Fonda, Claudio [Ospedale Meyer, Firenze (Italy). Servizio di radiologia; Gasparotti, Roberto [Brescia Univ., Brescia (Italy). Neuroradiologia; Villari, Natale

    2005-03-01

    tensor, has a fundamental role in the assessment of brain maturation and of white matter diseases of the fetus, in the neonate and in the child. Diffusion MR imaging enables a better characterisation of the lesions demonstrated by conventional MR imaging, for instance in the hypoxic-ischaemic encephalopathy, in infections and in the inherited metabolic diseases, and in particularly important for the longitudinal evaluation of these conditions. Diffusion-weighted MR imaging has an established role in the differential diagnosis between brain abscess and cystic tumour and between epidermoid tumour and arachnoid cyst. On the other hand, the results obtained with diffusion MR in the characterization of type and extension of glioma do not yet allow decision making in the individual patient. Diffusion is one of the most relevant MR techniques to have contributed to a better understanding of the pathophysiological mechanisms of multiple sclerosis (MS). In fact, it improves the specificity of MR in characterizing the different pathological substrata underlying the rather uniform lesion appearance on the conventional images and enables detection of damage in the normal-appearing white and grey matter. In MS patients, the ADC or D values in the normal-appearing white matter are increased as compared to control values, albeit to a lesser degree than in the lesions demonstrated by T2-weighted images. In addition, the D of the normal appearing grey matter is increased in MS patients and his change correlates with the cognitive deficit of these patients. Histogram analysis in MS patients shows that the peak of the brain D is decreased and right-shifted, reflecting an increase of its value, and the two feature correlate with the patient's clinical disability. Ageing is associated to a mild but significant increase of the brain ADC or D which is predominantly due to changes in the white matter. Region of interest and histogram studies have demonstrated that D and ADC are increased

  16. Influencing factors of elderly injury mechanism of traumatic subarachnoid hemorrhage and its prognostic%老年外伤性蛛网膜下腔出血的损伤机制及影响预后的相关因素

    Institute of Scientific and Technical Information of China (English)

    蒋为; 董韬; 李京臣; 丁绍峰

    2015-01-01

    Objective: to study the old age injury mechanism of traumatic subarachnoid hemorrhage and prognosis influencing factor. Methods:of 110 cases of craniocerebral injury in our hospital as the object of study, all patients on admission to offer check imaging methods such as CT, depending on whether a patient with traumatic subarachnoid hemorrhage will be divided in-to two groups, one in 50 patients with traumatic subarachnoid hemorrhage, 45. 5%. Respectively compared with traumatic sub-arachnoid hemorrhage and without traumatic subarachnoid hemorrhage by the prognosis of patients, and elderly patients with traumatic subarachnoid hemorrhage CT score, observe the type of brain damage, and analyzes its injury mechanism and influenc-ing factors. Results:compared two group patients of treatment effect, visible has trauma sex Cobweb film xià cavity bleeding and no trauma sex Cobweb film xià cavity bleeding of patients recovery good, and mild disability, and in the heavy degrees dis-ability by accounted for proportions zhĪ jiān of copared no significantly differences, but has trauma sex Cobweb film xià cavity bleeding of patients bad prognosis (plant survival and death) occurred rate significantly above no trauma sex Cobweb film xià cavity bleeding of patients, compared has statistics differences (P<0. 05) . Conclusions:the traumatic subarachnoid hemor-rhage are common in acute brain injury patients, more serious and traumatic brain injury, traumatic subarachnoid hemorrhage incidence is higher, the prognosis is worse.%目的:研究探讨老年外伤性蛛网膜下腔出血的损伤机制和预后影响因素。方法:选取我院收治的老年颅脑损伤患者110例作为研究对象,所有患者在入院时即给予CT等影像学手段进行检查,根据患者是否合并有外伤性蛛网膜下腔出血的情况将其分为两组,其中50例患者有外伤性蛛网膜下腔出血,占45.5%。分别比较有外伤性蛛网膜下腔出血和没有外伤性

  17. Diffusion Weighted and Trace Images

    Directory of Open Access Journals (Sweden)

    Helen Nayeri

    2009-01-01

    purulent abscess there is restriction of free water move- ment (hyperintensity on the DWI, iso- to hypointensity on the ADC maps. Whereas in cystic and necrotic areas of tumors there is reduced restriction due to the disruption of the intrinsic physical and chemical barriers to water diffusion. "nDifferences in the restriction of free water movement also can result from differences in tumor cellularity. Extraaxial lesions such as arachnoid cysts therefore can be easily distinguished from epidermoid tumors using DWI as the former have an elevated ADC characteristic of solid tissue. Diffusion weighted images show different patterns in acute and chronic demyelinating lesions due to anisotropic and isotropic characteristics of the lesions. DWI as well as other quantitative MR techniques including diffusion tensor imaging, magnetization transfer MRI, and MR spectroscopy can be used as different MR techniques to help characterize the evolution and extent of tissue damage and repair in MS patients. 

  18. 微创枕大池重建术辅助术中B 超评价ChiariⅠ型畸形合并脊髓空洞症临床疗效%The efficacy of intraoperative ultrasonography-assisted microinvasive cisterna magna reconstruction for Chiari malformation typeⅠwith syringomyelia

    Institute of Scientific and Technical Information of China (English)

    李鹏超; 刘勇; 邱险峻; 靳玉强; 李玥堃; 杨淑琴; 邢志霞

    2012-01-01

    目的 探讨微创枕大池重建术治疗ChiariⅠ型畸形术中辅助B 超判断枕大池重建效果的可行性.方法 选择2008 年1-12 月诊断明确的ChiariⅠ型畸形合并脊髓空洞症患者共93 例,施行微创枕大池重建术.术中保留寰椎后弓,并于切开硬膜前通过B 超实时观察小脑扁桃体下疝形态、大小、"活塞"样往复运动状态,以及枕大池形态和大小;并于切除部分小脑扁桃体后对枕大池重建效果进行判断.分别于术后6 和30 个月时通过Tator法进行临床疗效评价.结果 所有患者均顺利完成手术,术后并发症包括小脑出血(1 例)、小脑梗死(1 例)、脑积水(1 例)、皮下积液(2 例),均经对症治疗痊愈出院.术后6 个月随访93 例患者,临床症状好转36 例、稳定55 例、加重2 例,MRI 显示脊髓空洞缩小或完全消失90 例、无变化3 例;术后30 个月随访80 例患者,原症状稳定者中12 例好转、1 例加重,MRI显示脊髓空洞无进一步变化.结论 微创枕大池重建术治疗ChiariⅠ型畸形损伤小、术后恢复迅速、效果稳定、并发症少、安全性高.术中通过B 超判断枕大池重建效果简单易行,数据可靠.%Objective To report the method and effect of intraoperative ultrasonography-assisted microinvasive cisterna magna reconstruction for Chiari malformation type I with syringomyelia. Methods Ninty-three patients suffered from Chiari malformation type I with syringomyelia were treated by microinvasive cisterna magna reconstruction. The skin incision was 1.50-3.00 cm. The bone removal of foramen magnum was 1.50 cm X 2.00 cm with C1 reserved. Dura and arachnoid were incised and sutured linearly. All of the patients underwent cerebellar tonsillar resection and exploration of median aperture of fourth ventricle. Intraoperative ultrasonography was performed both before and after cerebellar tonsillar resection to judge the effect of cisterna magna reconstruction. According to Tator

  19. Clinical analysis of 10 patients with paroxysmal sympathetic hyperactivity%阵发性交感神经过度兴奋10例患者的临床特征分析

    Institute of Scientific and Technical Information of China (English)

    厉含之; 李国良; 李琛; 杨欢; 李静; 刘宝琼

    2013-01-01

    1 case,hypoxic ischemic encephalopathy 1 case,arachnoid cyst 1 case and cryptococcal meningoencephalitis 1 case.All patients developed at least 5 of 7 features which contained paroxysmal agitation,hyperthemia,diaphoresis,tachypnea,tachycardia,hypertension and dystonia.PSH occurred within 24 hours after brain injury in 3 patients; 24 hours to 3 weeks in 5 patients ; 5 months in 1 patient; 9 years in 1 patient.The frequency varied from one time in several days to several times in one day.The duration varied from 1 minute to 3 hours.The episodes in 4 patients occurred more often at night,1 around palinesthesia and the frequency of other 5 patients showed no differences between day and night.There were 2 cases appeared sober-minded,and the states of consciousness of the other 8 cases were hard to judge during PSH.The Glasgow Coma Scale scores of 8 cases were 3 to 8 points and the other 2 cases were 15 points.No epileptic-form activity was detected by EEG and no particular lesions were responsible.Neuro-imaging examinations suggested frontal lobe,temporal lobe,parietal lobe,occipital lobe,basal ganglion,pons and lateral ventricle were damaged.And 9 patients received an ineffective antiepileptic drug treatment.The efficacy in the management of PSH with dopamine agonists combining with β-blockers was observed.Two patients achieved complete remission,6 patients had a reduction in episode frequency,1 patient showed no response to the therapy and 1 patient discharged and could not be connected.Conclusions PSH can occur after various types and different degrees of brain injury.PSH is often misdiagnosed as epilepsy,and anticonvulsant therapies are useless.PSH receives good responses to β-blockers and dopamine agonists.

  20. Clinical characteristics of subarachnoid hemorrhage patients with nosocomial infections and prevention countermeasures%蛛网膜下腔出血患者的医院感染临床特点与预防措施

    Institute of Scientific and Technical Information of China (English)

    何金峰; 徐小辉; 程珍珍; 洪海

    2015-01-01

    OBJECTIVE To explore the clinical characteristics of the subarachnoid hemorrhage patients with nosoco-mial infections,analyze the risk factors,and put forward the prevention countermeasures so as to provide scientific basis for early prevention and control of nosocomial infections in the subarachnoid hemorrhage patients.METHODS The clinical data of 148 patients with subarachnoid hemorrhage who were hospitalized from Jan 2010 to Dec 2013 were retrospectively analyzed,the clinical characteristics and risk factors for the nosocomial infections were ob-served,and the prevention countermeasures were put forward.RESULTS The nosocomial infections occurred in 30 of 148 subarachnoid hemorrhage patients with the infection rate of 20.27%,among whom the patients with respir-atory tract infections accounted for 43.33%,the patients with urinary tract infections 20.00%,the patients with gastrointestinal tract infections 13.33%,the patients with skin and soft tissue infections 10.00%.A total of 45 strains of pathogens have been isolated from the submitted specimens from the 30 cases of nosocomial infections, including 28 (62.22%)strains of gram-negative bacteria,13 (28.89%)strains of gram-positive cocci,and 4 (8.89%)strains of fungi.The age,underlying disease,disturbance of consciousness,smoking history,hemiple-gia,invasive operation,and hospitalization duration were the risk factors for the nosocomial infections in the sub-arachnoid hemorrhage patients (P<0.05).CONCLUSION The subarachnoid hemorrhage patients is the population at high risk of nosocomial infections.It is necessary to conduct targeted surveillance for the high risk factors and formulate corresponding prevention countermeasures based on the clinical characteristics so as to reduce the inci-dence of nosocomial infections in the subarachnoid hemorrhage patients.%目的:探讨蛛网膜下腔出血医院感染的临床特点、危险因素及预防对策,为早期预防和控制蛛网膜下腔出血医院感染提