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Sample records for arachnoiditis

  1. Arachnoiditis

    Science.gov (United States)

    ... legs. Some people with arachnoiditis will have debilitating muscle cramps, twitches, or spasms. It may also affect bladder, ... legs. Some people with arachnoiditis will have debilitating muscle cramps, twitches, or spasms. It may also affect bladder, ...

  2. Arachnoid Cysts

    Science.gov (United States)

    ... Rare Disorders (NORD) See all related organizations Publications Quistes aracnoideos Patient Organizations National Organization for Rare Disorders (NORD) See all related organizations Publications Quistes aracnoideos Definition Arachnoid cysts are cerebrospinal fluid-filled ...

  3. Extradural Spinal Arachnoid Cysts

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-11-01

    Full Text Available A 14-year-old boy with multiple spinal arachnoid cysts and paraplegia, and 37 similar cases in the literature are reviewed by neurosurgeons and radiologist at Univ of Sao Paulo, Brazil.

  4. 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...

  5. Perineural arachnoidal gliomatosis: case report

    OpenAIRE

    2008-01-01

    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....

  6. Two spinal arachnoid cysts

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    Puijlaert, J.B.C.M.; Vielvoye, G.J.; Dulken, H. van

    1985-05-01

    Two cases of spinal arachnoid cysts are reported. One is extradurally located, the other intradurally. The first is only documented with myelography, the second also by subsequent CT scanning. Some clinical and diagnostic aspects of the lesion are discussed. The aim of this report is to add two new cases to the literature and to emphasize the role of high-resolution CT scanning in the diagnosis of these lesions.

  7. [Arachnoid cysts: Embriology and pathology].

    Science.gov (United States)

    García-Conde, Mario; Martín-Viota, Lucia

    2015-01-01

    There is still great controversy surrounding the origin of the arachnoid cyst. The most accepted theory in the case of congenital cysts explains how they are formed from an anomalous development of the arachnoid membrane, which is unfolded allowing the accumulation of cerebrospinal fluid inside and creating a cyst. This theory seems to explain the origin of convexity and sylvian cistern arachnoid cysts, whereas those in other locations might be due to other mechanisms. In the anatomopathological analysis, the arachnoid cyst wall can be seen as having few differences from normal, although thickened due to an increase quantity of collagenous material. A description of the embryological development of the arachnoid layer and cyst formation is presented, describing the main anatomopathological findings.

  8. Computed tomography of arachnoid cyst

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    Jung, Min Gi; Bae, Weon Tae; Kim, Jae Kyu; Park, Jin Gyoon; Kang, Heoung Keun; Chung, Hyun De [College of Medicine, Chonnam National University, Kwangju (Korea, Republic of)

    1988-02-15

    The preoperative diagnosis of intracranial arachnoid cysts has been simplified, and made more rapid and accurate with computed tomography (CT). Using CT cisternography, detailed anatomic and physiologic information of arachnoid cysts could be obtained. CT features of pathologically proven 21 arachnoid cysts that were examined at Chonnam National University Hospital from June 1983 to May 1987 were analyzed. The results were as follows: 1.Prevalent age group was the 1st decade (8 cases) and male to female ratio was 17:4. 2.Clinical features were related to the location of arachnoid cyst, common symptoms were headache (53.3%), convulsion, mental change and walking disturbance. 3.Location of the arachnoid cyst were in supratentorial region (15 cases) most in middle cranial fossa (12 cases), and infratentorial region (6 cases), common at the retrocerebellar cisternal space (3 cases). 4.Shapes of arachnoid cyst were biconvex with straight inner margin (8 cases), spherical (7 cases), simple biconvex (3 cases) and others (3 cases). 5.Size of the arachnoid cyst, in the greatest dimension, was ranged from 2cm to 9cm and commonly distributed between 3cm to 5cm (14 cases). 6.Of all 14 cases, who did CT cisternography using metrizamide (11 cases) and iopamidol (3 cases), 2 cases had communication with the subarachnoid space.

  9. 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.

  10. 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.

  11. Prenatal diagnosis of arachnoid cyst

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    Korkut Daglar

    2016-12-01

    Full Text Available Arachnoid cysts are rare, usually benign, space-occupying central nervous system lesion. They are the results of an accumulation of cerebrospinal-like fluid between the cerebral meninges and diagnosed prenatally as a unilocular, simple, echolucent area within the fetal head. They may be primary (congenital (maldevelopment of the meninges or secondary (acquired (result of infection trauma, or hemorrhage. The primary ones typically dont communicate with the subarachnoid space whereas acquired forms usually communicate. In recent years, with the development of radiological techniques, the clinical detectability of arachnoid cysts seems to have increased. We report a case of primary arachnoid cyst that were diagnosed prenatally by using ultrasonography and magnetic resonance imaging . [Cukurova Med J 2016; 41(4.000: 792-795

  12. Arachnoid cyst in oculomotor cistern

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    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.

  13. Spontaneous hygroma in intracranial arachnoid cyst

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    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.

  14. Suprasellar arachnoid cyst - a case report -

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    Kim, Sun Young; Byun, Woo Mok; Park, Bok Hwan; Choi, Byung Yearn; Cho, Soo Ho [Yeungnam University College of Medicine, Kyungsan (Korea, Republic of)

    1988-10-15

    Arachnoid cysts are relatively common disease entity, but its location at sarsaparilla region it is important to differentiate with ependymal cysts or third ventricle or third ventricular enlargement secondary to either aqueductal stenosis of extraventricular obstructive hydrocephalus. We recently experienced a case of suprasellar arachnoid cyst and reviewed literature.

  15. Recurrent spinal adhesive arachnoiditis: a case report

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    James Pitágoras de Mattos

    1988-03-01

    Full Text Available Spinal adhesive arachnoiditis is not an uncommon disease, usually having a monophasic course. We studied an atypical patient with recurrent spinal adhesive arachnoiditis nine years after intrathecal anesthesia and the first attack of the disease. Also noteworthy was the favorable evolution after surgery.

  16. Cranial arachnoid membranes: some aspects of microsurgical anatomy.

    Science.gov (United States)

    Lü, Jian; Zhu, Xian-Li

    2007-07-01

    Although the arachnoid membranes have been known for more than 300 years, the anatomy of the arachnoid membranes has not been studied in detail. This study was performed to explore the microanatomical features of the cranial arachnoid membranes. The arachnoid membranes and cisterns were observed in eight Han Chinese adult human cadaveric brains with an operating microscope, without staining of intracranial structures or injection of colored material into blood vessels. Twenty seven arachnoid membranes and 21 subarachnoid cisterns were identified. The topographical features of each arachnoid membrane were described. On the basis of the arachnoid membranes we identified, the arachnoidal limits of the cisterns were discussed. The microsurgical anatomical research on the arachnoid membranes is a supplement to the anatomical study of the subarachnoid cisterns. The understanding of the topographical features of the arachnoid membranes is valuable to the reasonable dissection of the cisterns and the minimally invasive manipulations during microsurgical procedures.

  17. Arachnoid granulation affected by subarachnoid hemorrhage

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    R.P. Chopard

    1993-11-01

    Full Text Available The purpose of this study was to investigate using light microscopy the fibro-cellular components of arachnoid granulations affected by mild and severe subarachnoid hemorrage. The erythrocytes were in the channels delimitated by collagenous and elastic bundles and arachnoid cells, showing their tortuous and intercommunicating row from the pedicle to the fibrous capsule. The core portion of the pedicle and the center represented a principal route to the bulk outflow of cerebrospinal fluid and erythrocytes. In the severe hemorrhage, the fibrocellular components are desorganized, increasing the extracellular channels. We could see arachnoid granulations without erythrocytes, which cells showed big round nucleous suggesting their transformation into phagocytic cells.

  18. Asymptomatic spinal arachnoiditis in patients with tuberculous meningitis

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    Srivastava, T. [Department of Neurology, CN Centre, All India Institute of Medical Sciences, New Delhi (India); Department of Medicine, S.P. Medical College, Bikaner, Rajasthan (India); Kochar, D.K. [Department of Medicine, S.P. Medical College, Bikaner, Rajasthan (India)

    2003-10-01

    Spinal arachnoiditis is one of the common and disabling complication of tuberculous meningitis (TBM). We focused on early diagnosis of spinal arachnoiditis by spinal MRI in asymptomatic patients in whom neurological examination was normal. We studied 16 patients with a diagnosis of probable or highly probable TBM with symptoms for less than 1 month; three had radiological evidence of spinal arachnoiditis. High cerebrospinal fluid protein appeared to be a risk factor for development of spinal arachnoiditis. MRI is sensitive to detect early spinal arachnoiditis. Earlier diagnosis may be helpful in management of spinal arachnoiditis in TBM. (orig.)

  19. Intracranial localization of arachnoid granulations in rats

    Institute of Scientific and Technical Information of China (English)

    Yanan Dong; Min Yu; Lei Meng; Yong Jiang; Jun Gao; Honghai Peng; Jianguo Shi

    2008-01-01

    BACKGROUND: This paper describes histomorphologic studies on arachnoid granulations in rats, which have not been investigated in China to our knowledge.OBJECTIVE: To observe the distribution of intracranial arachnoid granulations in rats. DESIGN, TIME AND SETTING: The observational experiment was performed in the Academy of Life Sciences of Shandong Taishan Medical College from May to August 2004.MATERIALS: Thirty healthy adult Wistar rats (3-4 months old) of SPF grade, equal numbers of each sex, were selected for this study. Methylene blue parenteral solution was provided by Jiangsu Jichuan Pharmaceutical Company (China), and an optical microscope (Type: CH20; Olympus Co. Ltd., Japan) was used for observation of the histomorphology of the arachnoid granulations.METHOD: Injection of methylene blue parenteral solution into the cerebellomedullary cistern of rats.MAIN OUTCOME MEASURE: The blue stained parts of the lateral sinus were sectioned, stained by hematoxylin and eosin, and then observed under the microscope.RESULTS: The cavitas subarachnoidealis had extensive blue staining after methylene blue injection, while the arachnoid and dura were without dye accumulation. The blue dye indicated the location of the arachnoid granulations. The location of these granulations was fixed, mainly in the lateral sinus at both sides of confluence within 4 mm of the internal jugular vein.CONCLUSION: The arachnoid granulations of the rat were located mainly in the lateral sinuses of the dura mater.

  20. 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.

  1. 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.

  2. Arachnoiditis ossificans and syringomyelia: A unique presentation

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    Opalak, Charles F.; Opalak, Michael E.

    2015-01-01

    Background: Arachnoiditis ossificans (AO) is a rare disorder that was differentiated from leptomeningeal calcification by Kaufman and Dunsmore in 1971. It generally presents with progressive lower extremity myelopathy. Though the underlying etiology has yet to be fully described, it has been associated with various predisposing factors including vascular malformations, previous intradural surgery, myelograms, and adhesive arachnoiditis. Associated conditions include syringomyelia and arachnoid cyst. The preferred diagnostic method is noncontrast computed tomography (CT). Surgical intervention is still controversial and can include decompression and duroplasty or durotomy. Case Description: The authors report the case of a 62-year-old male with a history of paraplegia who presented with a urinary tract infection and dysautonomia. His past surgical history was notable for a C4–C6 anterior fusion and an intrathecal phenol injection for spasticity. A magnetic resonance image (MR) also demonstrated a T6-conus syringx. At surgery, there was significant ossification of the arachnoid/dura, which was removed. After a drain was placed in the syrinx, there was a significant neurologic improvement. 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. PMID:26693389

  3. Multiple lumbar arachnoid cysts. Case report.

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    Pappalardo, S; Cassarino, A; Braidotti, P

    1986-09-01

    Arachnoid cysts are a rare cause of compression of the contents of the lumbar spinal canal; in the literature only about 100 cases are reported. The various methods of diagnosis are discussed in the light of a recent case observed by the authors.

  4. Neurologic deficits and arachnoiditis following neuroaxial anesthesia.

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    Aldrete, J A

    2003-01-01

    Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil-based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma. Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal. Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.

  5. Intracranial arachnoid cyst (review of 20 cases

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    Alireza Birjandi

    2008-07-01

    Full Text Available Introduction: The purpose of this study is to evaluate the distribution, clinical features, and treatment modalities of arachnoid cyst in our department. The study was carried out between April 1, 1996 and October 1, 2006 at the neurosurgery department, Ghaem hospital, Mashhad university of medical sciences. Material and Methods: Twenty patients with arachnoid cyst underwent surgery between April 1, 1996 until October 1, 2006, consisting of 12 males and 8 females ranging in age 5 to 68 years (mean age 32.4 years. Twelve patients underwent surgery and one patient underwent endoscopic fenestration, and cystoperitoneal shunting (medium pressure was performed in 7 patients. All patients were followed for minimum of 6 months after surgery. Results: During the study period, 20 patients were investigated. The cysts had strong predilection for the middle cranial fossa in 12 patients (60%, suprasellar region in 1 patient (5%, the cerebral convexity in 1 patient (5%, posterior cranial fossa in 2 patients (10%, cerebellopontine angle in 3 patients (15%, quadrigeminal cisterns in 1 patient (5%. All of 20 cysts had clearly unilateral distribution, 12 (60% were located on the left side and 8 (40% on the right side. The most common symptoms on presentation were epileptic seizures (46%, increased intracranial pressure (34%, visual impairment (5%, headache (10%, cerebellar sign (5%. Conclusion: Arachnoid cysts have a strong predilection for the middle cranial fossa that may be explained by a meningeal maldevelopment theory. We also conclude that the major indication for surgery in patients with arachnoid cyst is the presence of intractable seizures, increased intracranial pressure, and compression of neuronal tissues. Headache only is not a surgical indication.    

  6. Endoscopic treatment of the suprasellar arachnoid cyst

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    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.

  7. 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

  8. [Intradural arachnoid cyst associated with syringomyelia: a case report].

    Science.gov (United States)

    Ishi, Yukitomo; Aoyama, Takeshi; Kurisu, Kota; Hida, Kazutoshi; Houkin, Kiyohiro

    2014-05-01

    An intradural arachnoid cyst is a relatively rare condition, occurring within the spinal subarachnoid space. We present the even-more rare case of an intradural arachnoid cyst associated with syringomyelia at the same spinal level. The patient was a 66-year-old man who presented with bilateral leg numbness and gait disturbance. Magnetic resonance imaging (MRI) revealed an intradural arachnoid cyst located dorsal to, and compressing, the thoracic spinal cord at the level of the 7th thoracic vertebra (Th 7). In addition, syringomyelia existed at the level of Th 8, slightly caudal to the intradural arachnoid cyst. We dissected the cyst but did not perform any surgical procedures for the syringomyelia. Post-operative MRI showed that the cyst had disappeared and the syringomyelia had spontaneously shrunk. The patient was discharged with improvement in his numbness and gait disturbance. There are a few case reports of intradural arachnoid cysts associated with syringomyelia, but recent evidence suggests that its occurrence is more common than previously thought. A combination of these two diseases is thought to be caused by blockage of cerebrospinal fluid (CSF) flow, which is also thought to cause adhesive arachnoiditis. For this reason, resection of the arachnoid cyst could improve the CSF flow and contribute to the shrinkage of syringomyelia. Furthermore, early treatment may correlate with improvement in radiological findings and neurological symptoms.

  9. Syringomyelia associated with adhesive spinal arachnoiditis: MRI

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    Inoue, Y.; Nemoto, Y.; Daikokuya, H.; Tashiro, T.; Shakudo, M.; Nakayama, K.; Yamada, R. [Dept. of Radiology, Osaka City University Medical School (Japan); Ohata, K.; Hakuba, A.; Nagai, K. [Dept. of Neurosurgery, Osaka City University Medical School (Japan)

    2001-04-01

    We reviewed the MRI of seven patients with syringomyelia associated with surgically proven adhesive spinal arachnoiditis to describe clinical and MRI findings in this condition. Using 0.5, 1.0 or 1.5 tesla units, we obtained sagittal T1- and T2-weighted spin-echo and axial T1-weighted images. Additional sagittal T2-weighted images were obtained without using motion-artefact suppression. Contrast medium was given intravenously to five patients. The syrinx cavities were thoracic in five cases, cervicothoracic in one, and extended from C4 to L1 in one. No Chiari malformation or craniovertebral junction anomaly was demonstrated. Meningeal thickening was seen on T2-weighted sagittal images only in one case. Cord deformity due to adhesion or displacement due to an associated arachnoid cyst was seen in all cases best demonstrated on axial images. Focal blurring of the syrinx wall on axial images was seen in six patients. Flow voids were seen in the syrinx fluid in all cases on T2-weighted images obtained without motion-artefact suppression. No abnormal contrast enhancement was demonstrated. (orig.)

  10. Giant nontraumatic intradiploic arachnoid cyst in a young male*

    Science.gov (United States)

    Sharma, Rajesh; Gupta, Puneet; Mahajan, Manik; Sharma, Poonam; Gupta, Anchal; Khurana, Arti

    2016-01-01

    Intradiploic arachnoid cysts have scarcely been reported in the literature, most reported cases being secondary to trauma. Nontraumatic arachnoid cysts are quite rare and have been reported mostly in adults. Here, we report the case of a 16-year-old male presenting with a slowly growing mass in the occipital region and intermittent headaches. On the basis of the findings of X-rays, computed tomography scans, and magnetic resonance imaging scans of the head, the mass was diagnosed as a giant intradiploic arachnoid cyst. PMID:27818549

  11. Giant nontraumatic intradiploic arachnoid cyst in a young male

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    Rajesh Sharma

    Full Text Available Abstract Intradiploic arachnoid cysts have scarcely been reported in the literature, most reported cases being secondary to trauma. Nontraumatic arachnoid cysts are quite rare and have been reported mostly in adults. Here, we report the case of a 16-year-old male presenting with a slowly growing mass in the occipital region and intermittent headaches. On the basis of the findings of X-rays, computed tomography scans, and magnetic resonance imaging scans of the head, the mass was diagnosed as a giant intradiploic arachnoid cyst.

  12. An arachnoid cyst presenting as an intramedullary tumour

    NARCIS (Netherlands)

    Willems, P W; van den Bergh, W M; Vandertop, W P

    2000-01-01

    A case of thoracic intradural extramedullary arachnoid cyst is presented in which an intramedullary low grade glioma was suspected preoperatively. The cyst was widely fenestrated and postoperatively, the patient experienced considerable improvement in her symptoms. As postoperative MRI studies also

  13. Brain Herniation into Giant Arachnoid Granulation: An Unusual Case

    Science.gov (United States)

    Santos, Gonçalo Roque

    2017-01-01

    Arachnoid granulations are structures filled with cerebrospinal fluid (CSF) that extend into the venous sinuses through openings in the dura mater and allow the drainage of CSF from subarachnoid space into venous system. Usually they are asymptomatic but can be symptomatic when large enough to cause sinus occlusion. We report a rare case of a brain herniation into a giant arachnoid granulation in an asymptomatic elderly male patient, which was discovered incidentally. PMID:28392955

  14. 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.

  15. [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.

  16. Fibromyalgia and arachnoiditis presented as an acute spinal disorder

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    Zamzuri Idris

    2014-01-01

    Full Text Available Background: Adhesive arachnoiditis is a chronic, insidious condition that causes debilitating intractable pain and a range of other neurological problems. Its pathophysiology is not well understood. This manuscript discusses its presentations, which can mimic an acute spinal disorder, its hypothetical pathophysiology, treatment, and its relationship with fibromyalgia. Case Description: The authors present a case of a 47-year-old female who presented with clinical features mimicking an acute spinal disorder but later found to have an adhesive arachnoiditis. She was admitted following a trauma with complaints of back pain and paraplegia. On examination, there was marked tenderness over thoracolumbar spine with lower limbs upper motor neuron weakness. An urgent magnetic resonance imaging (MRI of the spine revealed multiple lesions at her thoracic and lumbar spinal canals, which did not compress the spinal cord. Therefore, conservative management was initiated. Despite on regular therapies, her back and body pain worsened and little improvement in her limbs power was noted. Laminectomy was pursued and found to have spinal cord arachnoiditis. Subsequently, she was operated by other team members for multiple pelvic masses, which later proved to be benign. After gathering all the clinical information obtained at surgery and after taking detailed history inclusive of cognitive functions, diagnosis of an adhesive arachnoiditis syndrome was made. Currently, she is managed by neuropsychologist and pain specialist. Conclusion: This case report highlights the importance of knowing an adhesive arachnoiditis syndrome - a rarely discussed pathology by the neurosurgeon, which discloses a significant relationship between immune and nervous systems.

  17. Two cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage

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    Gunduz Burak

    2010-01-01

    Full Text Available Arachnoid cysts are developmental anomalies which are usually asymptomatic. Intracystic hemorrhage after trauma is a well known complication; however, spontaneous intracystic hemorrhage is rare. This report presents two rare cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage. The first patient was admitted following transient loss of consciousness and speech disturbance, and a subacute subdural hematoma at the left temporal region was diagnosed. The second patient presented with severe headache of four days duration and a subdural hematoma at the left temporoparietal region was diagnosed. In both the patients, both on radiological examination and during surgical intervention, hematomas were found to be intracystic.

  18. Retrocerebellar arachnoid cyst with syringomyelia : a case report.

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    Jain R

    2000-01-01

    Full Text Available Association of syringomyelia with retrocerebellar arachnoid cysts is rare. A case of 14 year old female is being reported, who presented with hydrocephalus caused by a large midline retrocerebellar infravermal arachnoid cyst leading to obstruction of the outlet foramina of the fourth ventricle. There was associated syringomyelia. The pathogenesis of syringomyelia is discussed. The need to evaluate cervical spinal cord by taking T1 weighted sagittal sections in all the patients of large posterior fossa mass lesions causing obstruction to the outlet foramina of the fourth ventricle has been stressed, in order to detect associated syringomyelia.

  19. Identification of an intraspinal arachnoidal cyst by CT

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    Agnoli, A.L.

    1984-11-01

    Clarification of the subjective complaints caused by meningeal malformations represented by an arachnoidal cyst in the sacral region was achieved for the first time by analysing an arachnoidal cyst which had been determined by myelography, computed tomography, biopsy and histological examination. Principles of mechanics and dynamics play an important part. The pattern of complaints is mainly due to the communication between the cyst and the CSF space, as well as a valve mechanism with filling of the cyst. Surgical reduction or removal of the cyst, and elimination of the connection with the CSF, produced freedom from complaints.

  20. Petrous apex arachnoid cyst extending into Meckel's cave.

    Science.gov (United States)

    Batra, Arun; Tripathi, Rajendra Prasad; Singh, Anil Kumar; Tatke, Medha

    2002-09-01

    A rare case of arachnoid cyst involving the petrous apex with an unusual clinical presentation has been described with special emphasis in the imaging features and importance of accurate presurgical diagnosis. Differentiation from the other benign lesions involving the petrous apex and the role of newer MR techniques in the diagnosis of these lesions has been highlighted.

  1. Arachnoid granules: Dandy was Dandy, Cushing and Weed were not.

    Science.gov (United States)

    Maurizi, Charles P

    2010-08-01

    Errors can be instructive. It seems that Harvey Cushing and Louis Weed provided the medical world with a faulty theory of cerebrospinal fluid absorption. Louis Weed, working in Harvey Cushing's laboratory, initially studied the movement of substances in the cerebrospinal fluid by using low-pressure studies. Results of the low-pressure studies were considered unsatisfactory and high pressure experiments were undertaken and these had results similar to earlier work done by others in human cadavers. High pressure results demonstrating movement of fluid through the arachnoid granules were deemed correct. Because of Cushing's position of authority, the theory became accepted as fact and in time proved to be entrenched dogma. Walter Dandy demonstrated in experiments on hydrocephalus and the surgical removal of the arachnoid granule system that the fluid was produced by the choroid plexuses and not absorbed by the arachnoid granules. His work was dismissed by Weed as unreliable. Examination of the pattern of deposition of corpora amylacea on the surface of the brain provides evidence that cerebrospinal fluid does not pass through arachnoid granules but passes through the choroid fissure and is recycled through choroid plexus portals. The choroid plexus portal theory can explain the findings in the low-pressure experiments of Weed. Bias and pride seem to be the source of the faulty theory. Entrenched dogma is resistant to challenge.

  2. [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.

  3. Arachnoid cyst in a patient with psychosis: Case report

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    Guimarães João

    2007-06-01

    Full Text Available Abstract Background The aetiology of a psychotic disturbance can be due to a functional or organic condition. Organic aetiologies are diverse and encompass organ failures, infections, nutritional deficiencies and space-occupying lesions. Arachnoid cysts are rare, benign space-occupying lesions formed by an arachnoid membrane containing cerebrospinal fluid (CSF. In most cases they are diagnosed by accident. Until recently, the coexistence of arachnoid cysts with psychiatric disturbances had not been closely covered in the literature. However, the appearance of some references that focus on a possible link between arachnoid cysts and psychotic symptoms has increased the interest in this subject and raised questions about the etiopathogeny and the therapeutic approach involved. Clinical presentation We present the clinical report of a 21-year-old man, characterised by the insidious development of psychotic symptoms of varying intensity, delusional ideas with hypochondriac content, complex auditory/verbal hallucinations in the second and third persons, and aggressive behaviour. The neuroimaging studies revealed a voluminous arachnoid cyst at the level of the left sylvian fissure, with a marked mass effect on the left temporal and frontal lobes and the left lateral ventricle, as well as evidence of hypoplasia of the left temporal lobe. Despite the symptoms and the size of the cyst, the neurosurgical department opted against surgical intervention. The patient began antipsychotic therapy and was discharged having shown improvement (behavioural component, but without a complete remission of the psychotic symptoms. Conclusion It is difficult to be absolutely certain whether the lesion had influence on the patient's psychiatric symptoms or not. However, given the anatomical and neuropsychological changes, one cannot exclude the possibility that the lesion played a significant role in this psychiatric presentation. This raises substantial problems when it

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

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    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.

  5. Progressive post traumatic tearing of an arachnoid cyst membrane resulting in intracystic and subdural haemorrhage.

    Science.gov (United States)

    Pascoe, Heather M; Phal, Pramit M; King, James A J

    2015-05-01

    We report the case of a 43-year-old man with a middle cranial fossa arachnoid cyst who presented post trauma with neurological symptoms. The initial CT scan of the brain did not detect acute changes in the arachnoid cyst but subsequent imaging revealed abnormalities which progressed over time. Arachnoid cysts are usually a benign and incidental finding. Rare complications such as intracystic haemorrhage and subdural haemorrhage can occur. It is important to be aware of these complications so that patients with arachnoid cysts are appropriately investigated when presenting with neurological symptoms.

  6. 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.

  7. The next extreme sport? Subdural haematoma in a patient with arachnoid cyst after head shaking competition.

    Science.gov (United States)

    Hopkin, J; Mamourian, A; Lollis, S; Duhaime, T

    2006-04-01

    A young man, engaged in a head shaking competition presented with headache, nausea and vomiting. Imaging revealed a subdural haematoma and ipsilateral arachnoid cyst. This novel mechanism of trauma underscores the predisposition to haemorrhage in patients with arachnoid cysts, even with minor trauma. Aetiology, imaging and possible treatment options are discussed.

  8. 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.

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

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    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.

  10. 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.

  11. Evaluation of tenoxicam on prevention of arachnoiditis in rat laminectomy model.

    Science.gov (United States)

    Cemil, Berker; Kurt, Gokhan; Aydın, Cansel; Akyurek, Nalan; Erdogan, Bulent; Ceviker, Necdet

    2011-08-01

    Post laminectomy arachnoiditis has been shown by experiments with rats and post operative radiological imaging in humans. The purpose of this experimental study was to determine the efficacy of tenoxicam in preventing arachnoiditis in rats. Twenty-four Wistar rats were divided into two groups, and L3 laminectomy was performed. In the tenoxicam group, 0.5 mg/kg tenoxicam was applied intraperitoneally. Normal saline was applied intraperitoneally in the control group. Later, the rats were killed at weeks 3 and 6, and the laminectomy sites were evaluated pathologically for arachnoiditis. The results showed that 6 weeks after surgery, the tenoxicam group showed lowest arachnoiditis grades. However, statistically significant difference was not found in arachnoiditis between the control group and the tenoxicam group. Based on these findings it is concluded that application of the tenoxicam after lumbar laminectomy did not effectively reduce arachnoiditis. Performing the most effective surgical technique without damage around tissue in a small surgical wound and having meticulous hemostasis in surgery seem to be the key for preventing arachnoiditis effectively.

  12. 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.

  13. Spinal arachnoid cysts associated with syringomyelia: a review of the literature and report of a case.

    Science.gov (United States)

    Tucer, Bulent; Yilmaz, Muhammet Bahadır; Ekici, Mehmet Ali; Menku, Ahmet; Koc, Kemal

    2014-01-01

    Syringomyelia is a not infrequent pathology that develops related to changes in cerebrospinal fluid dynamics due to many etiological factors. The development of syringomyelia through a spinal arachnoid cyst is quite rare and has been defined in only 31 cases in the literature. A case due to thoracic epidural lipomatosis has also been reported. There have been no previous reports of thoracic region epidural lipomatosis with underlying arachnoid cyst and syringomyelia as in our case. We present a 27-year-old patient who developed thoracic arachnoid cyst and underlying syringomyelia because of the pressure of the thoracic epidural fat tissue and also evaluate the characteristics of patients with syringomyelia by virtue of an arachnoid cyst previously reported in the literature.

  14. 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.

  15. 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.

  16. Contrast-enhanced MRI of intrasellar arachnoid cysts: relationship between the pituitary gland and cyst

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    Nomura, M. [National Cardiovascular Center, Osaka (Japan). Dept. of Neurosurgery]|[Kanazawa Univ. School of Medicine (Japan). Dept. of Neurosurgery; Tachibana, O. [Kanazawa Univ. School of Medicine (Japan). Dept. of Neurosurgery; Hasegawa, M. [Kanazawa Univ. School of Medicine (Japan). Dept. of Neurosurgery; Kohda, Y. [Kanazawa Univ. School of Medicine (Japan). Dept. of Neurosurgery; Nakada, M. [Kanazawa Univ. School of Medicine (Japan). Dept. of Neurosurgery; Yamashima, T. [Kanazawa Univ. School of Medicine (Japan). Dept. of Neurosurgery; Yamashita, J. [Kanazawa Univ. School of Medicine (Japan). Dept. of Neurosurgery; Suzuki, M. [Kanazawa Univ. School of Medicine (Japan). Dept. of Radiology

    1996-08-01

    We recently encountered two large intrasellar arachnoid cysts extending to the suprasellar region. The intensity of the cyst contents was identical to that of the cerebrospinal fluid on both T1- and T2-weighted MRI. On contrast-enhanced MRI, the pituitary gland was compressed posteroinferiorly and flattened in the sella turcica. In this report of rare intrasellar arachnoid cysts the discussion is focused on dislocation of the pituitary gland. (orig.)

  17. 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.

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

    Science.gov (United States)

    Sayal, Parag P; Zafar, Arif; Carroll, Thomas A

    2016-01-01

    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.

  19. [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.

  20. 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

  1. Foramen Magnum Arachnoid Cyst Induces Compression of the Spinal Cord and Syringomyelia: Case Report and Literature Review

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    Haiyan Huang, Yuanqian Li, Kan Xu, Ye Li, Limei Qu, Jinlu Yu

    2011-01-01

    Full Text Available It is very rare that a foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia, and currently there are few treatment experiences available. Here we reported the case of a 43-year-old male patient who admitted to the hospital due to weakness and numbness of all 4 limbs, with difficulty in urination and bowel movement. MRI revealed a foramen magnum arachnoid cyst with associated syringomyelia. Posterior fossa decompression and arachnoid cyst excision were performed. Decompression was fully undertaken during surgery; however, only the posterior wall of the arachnoid cyst was excised, because it was almost impossible to remove the whole arachnoid cyst due to toughness of the cyst and tight adhesion to the spinal cord. Three months after the surgery, MRI showed a reduction in the size of the arachnoid cyst but syrinx still remained. Despite this, the symptoms of the patient were obviously improved compared to before surgery. Thus, for the treatment of foramen magnum arachnoid cyst with compression of the spinal cord and syringomyelia, if the arachnoid cyst could not be completely excised, excision should be performed as much as possible with complete decompression of the posterior fossa, which could result in a satisfying outcome.

  2. A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation

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    Yoshinori Kadono

    2015-01-01

    Full Text Available Spinal epidural arachnoid cyst (EAC is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.

  3. [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.

  4. 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.

  5. 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.

  6. Tuberculous lumbar arachnoiditis mimicking conus cauda tumor: A case report and review of literature

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    Subhas K Konar

    2011-01-01

    Full Text Available Tuberculous spinal arachnoiditis involving cauda equina is rare. A patient with lumbar tuberculous arachnoiditis in the absence of both vertebral and meningeal tuberculosis, which was mimicking spinal intradural extramedullary tumor is described here. Diagnosis was made based on intraoperative findings and was confirmed by histopathology. Surgical decompression along with a combination of steroid and antitubercular therapy resulted in a good outcome. At 3 months follow-up, the patient regained bladder control and was able to walk with support. Clinical features, magnetic resonance imaging, and intraoperative findings are described. Pathology and the relevant literature are discussed. Based on the patient′s clinical and radiologic findings, it was believed that the patient had a conus cauda tumor and was operated on. Histologic examination of the mass revealed tuberculoma. Surgical decompression followed by antituberculosis medication resulted in good outcome. Hence tuberculous arachnoiditis should be considered in differential diagnosis of conus cauda tumors.

  7. Arachnoid membrane: the first and probably the last piece of the roadmap.

    Science.gov (United States)

    Lü, Jian

    2015-03-01

    Most neurosurgical procedures could be performed noninvasively by working through the natural corridors provided by the subarachnoid cisterns. In consequence, the subarachnoid cisterns have been considered as the roadmaps for the microneurosurgeons. The concept and the contents of the cisterns have been well known and described, but the knowledge of the detailed anatomy of the arachnoid membranes, which are the real septa of the cisterns and provide the practical and important landmarks and planes for the dissections during the brain surgeries, is still lacking. The present article reviews the previous reports of the intracranial arachnoid membranes with a special emphasis on the microsurgical anatomy and the clinical significance.

  8. 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

  9. 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.

  10. 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.

  11. Focal adhesive arachnoiditis of the spinal cord: Imaging diagnosis and surgical resolution

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    Hiroki Morisako

    2010-01-01

    Full Text Available Background: Although adhesive arachnoiditis of the spinal cord can cause progressive symptoms associated with syringomyelia or myelomalacia, its surgical resolution based on the imaging diagnosis is not well characterized. This study aims to describe the use of imaging for the diagnosis of focal adhesive arachnoiditis of the spinal cord and its surgical resolution using microsurgical arachnoidolysis. Materials and Methods: Four consecutive patients with symptomatic syringomyelia or myelomalacia caused by focal adhesive arachnoiditis underwent microsurgical arachnoidolysis. Comprehensive imaging evaluation using constructive interference in steady-state (CISS magnetic resonance imaging (MRI or myelographic MR imaging using true fast imaging with steady-state precession (TrueFISP sequences was included before surgery to determine the surgical indication. Results: In all four patients a focal adhesion was identified at the cervical or thoracic level of the spinal cord, a consequence of infection or trauma. Three patients showed modest or minor improvement in neurological function, and one patient was unchanged after surgery. The syringomyelia or myelomalacia resolved after surgery and no recurrence was noted within the follow-up period, which ranged from 5 months to 30 months. Conclusions: MRI diagnosis of focal adhesive arachnoiditis is critical to determine the surgical indication. Microsurgical arachnoidolysis appears to be a straightforward method for stabilizing the progressive symptoms, though the procedure is technically demanding.

  12. Recurrent Attacks of Raised Intracranial Pressure in Case of Tuberculous Arachnoiditis

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    N. O. Ameli

    1960-01-01

    Full Text Available A ase of recurre'nt raised interacranial pressure is described. At operation posterio-rcfossa arachnoiditis was found. Histological examination suggested a Tuberculous etiology. Four months after the operation she died from an apparently acute tuberculoua meningiti

  13. Language localization in cases of left temporal lobe arachnoid cyst : Evidence against interhemispheric reorganization

    NARCIS (Netherlands)

    Stowe, LA; Go, KG; Pruim, J; den Dunnen, W; Meiners, LC; Paans, AMJ

    2000-01-01

    We investigated whether left-hemisphere arachnoid cysts lead to reorganization of the language function using PET. A group analysis demonstrated that patients showed no more right-hemisphere activation than a matched control group. Several patients had clear language localizations in the left hemisp

  14. Apparent paradoxical vault changes with middle cranial fossa arachnoid cysts - Implication for aetiology

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    Redla, Sridhar; Husami, Yahya; Colquhoun, Iain R

    2001-10-01

    Three cases of middle cranial fossa arachnoid cyst with paradoxical bone changes in the adjacent vault are described, namely, a small middle cranial fossa and pneumosinus dilatans. This association is unusual and unique. The existing literature is reviewed and the probable aetiological factors discussed. Redla, S., Husani, Y. and Colquhoun, I.R. (2001)

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. A CASE OF OPEN LIP SCHIZENCEPHALY ASSOCIATED WITH ABSENT SEPTUM PELLUCIDUM AND ARACHNOID CYST

    Directory of Open Access Journals (Sweden)

    Chris

    2014-07-01

    Full Text Available Schizencephaly (spilt brain is an uncommon disorder of cerebral cortical development, characterized by congenital clefts spanning the cerebral hemispheres from the pial surface to the lateral ventricles and lined by dysplastic cortical gray matter, the condition is present at birth and present early in life. Here we present an adult patient of open lip schizencephaly associated with absent septum pellucidum and arachnoid cyst presenting with seizure on and off for past four years.

  20. 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.

  1. [Postoperative sciatica from epidural fibrosis and lumbar arachnoiditis. Results of 38 repeat operations].

    Science.gov (United States)

    Benoist, M; Ficat, C; Baraf, P; Massare, C; Bard, M; Sarre, J; Cauchoix, J

    1979-11-01

    Lumbar epiduro-arachnoiditis is a well-known complication of surgery of the intervertebral disc. The epidural fibrous scar is the normal outcome of inflammatory activity secondary to the mechanical tissue disturbance resulting from surgery. In certain individuals, perhaps genetically predisposed as excessive quantity of fibrous tissue is deposited in the epi and/or nitradural space. This abnormal situation, comparable to cheloid cutaneous scars, is perhaps at the origin of the clinical symptoms. The authors report the clinical and radiological signs observed in 38 patients having had at least one operation for discal hernia, and who underwent further operations in the aim of freeing the roots and the dural sack from fibrous compression. Results of excision of the epidural "cheloid" were good in 13 cases, and average in 8 others. There was a complete failure in 17 other patients. Three explanations were offered to explain the frequency of the failures: 1) formation of a new cheloid, 2) difficulty of neurolysis of the arachnoiditis, 3) possibility of intrinsic lesions of the nerve associated with the epiduro-arachnoiditis.

  2. Spontaneous resolution of a Meckel's cave arachnoid cyst causing sixth cranial nerve palsy.

    Science.gov (United States)

    Jacob, Maud; Gujar, Sachin; Trobe, Jonathan; Gandhi, Dheeraj

    2008-09-01

    A 32-year-old pregnant woman developed a progressive right sixth cranial nerve palsy as an isolated finding. Brain MRI disclosed a discrete lobulated lesion centered in the right Meckel's cave with intermediate signal on T1, high signal on T2, and diffusion characteristics similar to those of cerebrospinal fluid on apparent diffusion coefficient mapping. The initial radiologic diagnosis was schwannoma or meningioma. No intervention occurred. Shortly after cesarean delivery, the abduction deficit began to lessen spontaneously. One month later, the abduction deficit had further improved; 7 months later it had completely resolved. Repeat MRI after delivery failed to disclose the lesion, which was now interpreted as consistent with an arachnoid cyst arising within Meckel's cave. Twenty-one similar cases of Meckel's cave arachnoid cyst or meningocele have been reported, 7 found incidentally and 14 causing symptoms, 2 of which produced ipsilateral sixth cranial nerve palsies. All previously reported symptomatic patients were treated surgically. This is the first report of an arachnoid cyst arising from Meckel's cave in pregnancy and having spontaneous resolution.

  3. Aracnoidite constritiva causada por pantopaque resultando em siringomielia e paraparesia: relato de caso Thoracic constrictive arachnoiditis after pantopaque myelography causing syringomyelia and paraparesis: case report

    Directory of Open Access Journals (Sweden)

    José Alberto Gonçalves da Silva

    2001-09-01

    Full Text Available Relatamos caso de aracnoidite constritiva torácica, verificada 10 anos após o uso de pantopaque, que foi utilizado em mielografia no diagnóstico de cisto aracnóideo.We present an unusual case of thoracic constrictive arachnoiditis after pantopaque myelography, used 10 years before in the diagnosis of intradural arachnoid cyst.

  4. Syringomyelia and spinal arachnoiditis resulting from aneurysmal subarachnoid hemorrhage: Report of two cases and review of the literature

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    Taylor J Abel

    2014-01-01

    Full Text Available Syringomyelia resulting from arachnoiditis secondary to aneurysmal subarachnoid hemorrhage (SAH is an extremely rare clinical entity with few cases reported in the literature. The presentation, management, and pathogenesis of syringomyelia in this setting is poorly understood. We describe the presentation, radiology, management, and outcomes in two patients with syringomyelia resulting from arachnoiditis secondary to aneurysmal SAH and review the literature on this rare condition. Case number 1 was treated successfully with syrinx-subarachnoid shunt after extensive lysis of adhesions. Case number 2 was treated with syringoperitoneal shunt. Both patients had radiographic decreased syrinx size postoperatively. These patients add to the small literature on syringomyelia occurring secondary to SAH-associated arachnoiditis. The radiographic outcomes demonstrate that in the appropriately selected patient, syrinx-subarachnoid or syringoperitoneal shunting are viable options.

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

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    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. 

  6. 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.

  7. Arachnoid cyst of the cavum velum interpositum in a septuagenarian: radiological features and differential diagnosis.

    Science.gov (United States)

    Rajesh, S; Bhatnagar, Shorav; Chauhan, Udit; Gupta, Shailesh; Agarwal, Nitesh; Kasana, Vivek

    2014-04-01

    The cavum velum interpositum (CVI) is a thin, triangular-shaped cerebrospinal fluid (CSF)-filled space between the lateral ventricles that lies below the fornices and above the third ventricle. It is a normal variant seen in premature and newborn infants and usually disappears with brain maturation. CVI is rarely seen in adults as a persistent primitive structure. Although moderate cystic dilatation of the CVI may sometimes be observed, a true large cyst is extremely rare with only a handful of reported cases, mostly in children and adolescents. We describe the case of CVI arachnoid cyst diagnosed on imaging in a septuagenarian with the complaint of occasional headaches.

  8. Homicide and subsequent catatonia associated with a large arachnoid cyst: case report.

    Science.gov (United States)

    Margetić, Branimir; Palijan, Tija Zarković; Kovacević, Drazen

    2013-12-01

    The existence of a focal brain lesion that might be the crucial cause for the development of diverse psychiatric phenomena and certain characteristics of personality is often a controversial issue. The patient was a 29-year-old male when he killed his father with a single knock with the blunt side of an axe. Subsequently to the act, the patient developed a 10-month-long catatonic stupor during which he experienced intensive fear, delusions, and affective symptoms. He was an emotionally blunted person with no medical record and without prior history of aggressive behavior. Magnetic resonance image revealed a large, right-sided arachnoid cyst that was associated with right temporal and frontal lobe hypoplasia and bilateral changes of perfusion in peri-insular regions. The treatment with clozapine and diazepam showed to be therapeutic. This could be the second case of homicide committed by a person with arachnoid cyst and without past history of aggression, and the second description of an adult patient with cyst who developed catatonic stupor. This is the first description of long-lasting organic catatonic stupor treated with clozapine and diazepam. Relevant literature is reviewed and some controversial issues are discussed.

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

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    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.

  10. Increased NKCC1 expression in arachnoid cysts supports secretory basis for cyst formation.

    Science.gov (United States)

    Helland, Christian A; Aarhus, Mads; Knappskog, Per; Olsson, Lisa K; Lund-Johansen, Morten; Amiry-Moghaddam, Mahmood; Wester, Knut

    2010-08-01

    Arachnoid cysts (AC) are filled with liquid very similar to cerebrospinal fluid (CSF). The mechanisms of fluid accumulation have remained unknown; previous studies have however indicated both fluid secretion and a one-way valve as a mechanism. If the filling was caused by fluid secretion, mechanisms similar to those underlying CSF production would be anticipated. We have investigated the expression levels of all genes known to be involved in mammalian CSF production in surgically removed AC. Based on mRNA microarray analysis of AC and normal arachnoid tissue, we extracted the RNA expression profiles of all genes known to code for proteins involved in CSF production. A selection of genes was further investigated with quantitative real-time polymerase chain reaction (qRT-PCR). For selected CSF production proteins, electron microscopic immunogold techniques (EM) and Western blots were performed. Seven genes were expressed in both cysts and controls. The gene encoding the Na(+)-K(+)-2Cl(-) cotransporter NKCC1 was significantly up-regulated in AC. Gene expression data were supported by Western blot. EM demonstrated NKCC1 expressed at the plasma membranes of the cyst-lining cells. This result points at secretion as the main mechanism of cyst filling, and NKCC1 as the key candidate of fluid transport. Based on these findings, we hypothesize that selective NKCC1 inhibitors could be used in preventing expansion of temporal AC.

  11. 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.)

  12. Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region.

    Science.gov (United States)

    Sun, Liyong; Emich, Stephan; Fu, Wenzhuo; Chen, Zan; Hao, Wu; Ling, Feng; Jian, Fengzeng

    2016-04-01

    A retrocerebellar arachnoid cyst causing syringomyelia is extremely rare without tonsillar herniation. The authors present a 44-year-old woman with symptoms of foramen magnum compression and syringomyelia. Magnetic resonance imaging demonstrated a large retrocerebellar arachnoid cyst with a large cervicothoracic syrinx but no signs of tonsillar herniation or hydrocephalus. The patient underwent a foramen magnum decompression with C1 laminectomy, microsurgical fenestration of the cyst, and duraplasty. After successful reconstruction of CSF flow, the patient experienced a relief of symptoms and a significant reduction of the syrinx. The intraoperative findings support the theory of a piston mechanism in the development of syringomyelia. Additional arachnoidal adhesions may also obstruct the CSF flow around the craniocervical junction. We recommend the surgical treatment should consist of an adequate decompression of the foramen magnum, wide microsurgical arachnoidal debridement, and duraplasty with autologous grafts sutured in a watertight way.

  13. 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.

  14. Cine-magnetic resonance imaging evaluation of communication between middle cranial fossa arachnoid cysts and cisterns.

    Science.gov (United States)

    Eguchi, T; Taoka, T; Nikaido, Y; Shiomi, K; Fujimoto, T; Otsuka, H; Takeuchi, H

    1996-06-01

    Cine-magnetic resonance (MR) imaging examinations were performed in 10 patients with middle cranial fossa arachnoid cysts to evaluate communication between the cysts and the normal cerebrospinal fluid (CSF) space. Eight of 10 patients were evaluated by time of flight cine-MR imaging, and two by phase contrast cine-MR imaging. Two patients underwent membranectomy of the cysts, and were evaluated both pre- and postoperatively. Computed tomography cisternography was used to confirm communication between the cysts and the surrounding cisterns. Pulsatile fluid motion within the cysts was present in all patients. However, marked fluid motion and jet flow between the cysts and the surrounding cisterns were only observed in communicating cysts. In the two patients who underwent membranectomy, postoperative examination found greater fluid motion and jet flow not previously present. Cine-MR imaging demonstration of marked pulsatile fluid motion accompanied by jet flow suggests that a cyst communicates with the normal CSF space.

  15. Cerebrospinal fluid absorption disorder of arachnoid villi in a canine model of hydrocephalus

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    Zhao Ke

    2010-01-01

    Full Text Available Background: Hydrocephalus results from inadequate passage of cerebrospinal fluid (CSF from its point of production within the cerebral ventricles to its point of absorption into systemic circulation. Aims: The objective of this study was to investigate the disorders of CSF absorption by arachnoid villi during the different phases of hydrocephalus. Materials and Methods: Silicone oil was injected into the fourth ventricle of 15 canines as an experimental group. Saline solution (0.9% NaCl was injected in another nine canines as a control group. In order to block CSF transport through the cribriform plate, an external ethmoidectomy was performed in five dogs from experimental group and three dogs from control group at three days (acute stage, two weeks (sub-acute stage, and 12 weeks (chronic stage respectively. Tritiated water was injected into the canines′ cortical subarachnoid space and blood levels were measured at intervals of 1h, 4h, 8h, 16h and 48h respectively. Time-concentration curve of tritiated water was drafted. The area under the curve (AUC was calculated for variance analysis and t-testing. Results: In the chronic group, the tritiated water concentration rose slowly to a peak at 16h. It was significantly lower than other groups at 1h, 4h, 8h and 16h, but was higher than other groups at 48h. Analysis of the AUC showed significant differences among all the groups (P<0.01. There were no significant differences in the AUC between control groups, the acute group, and the sub-acute group (P>0.05; however, the AUC of the chronic group was significantly lower than other groups (P<0.05. Conclusions: The CSF absorption ability of arachnoid villi is significantly damaged in a long-term state of hydrocephalus.

  16. Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography.

    Science.gov (United States)

    Schultz, Randall; Steven, Andrew; Wessell, Aaron; Fischbein, Nancy; Sansur, Charles A; Gandhi, Dheeraj; Ibrahimi, David; Raghavan, Prashant

    2017-03-24

    OBJECTIVE Dorsal arachnoid webs (DAWs) and spinal cord herniation (SCH) are uncommon abnormalities affecting the thoracic spinal cord that can result in syringomyelia and significant neurological morbidity if left untreated. Differentiating these 2 entities on the basis of clinical presentation and radiological findings remains challenging but is of vital importance in planning a surgical approach. The authors examined the differences between DAWs and idiopathic SCH on MRI and CT myelography to improve diagnostic confidence prior to surgery. METHODS Review of the picture archiving and communication system (PACS) database between 2005 and 2015 identified 6 patients with DAW and 5 with SCH. Clinical data including demographic information, presenting symptoms and neurological signs, and surgical reports were collected from the electronic medical records. Ten of the 11 patients underwent MRI. CT myelography was performed in 3 patients with DAW and in 1 patient with SCH. Imaging studies were analyzed by 2 board-certified neuroradiologists for the following features: 1) location of the deformity; 2) presence or absence of cord signal abnormality or syringomyelia; 3) visible arachnoid web; 4) presence of a dural defect; 5) nature of dorsal cord indentation (abrupt "scalpel sign" vs "C"-shaped); 6) focal ventral cord kink; 7) presence of the nuclear trail sign (endplate irregularity, sclerosis, and/or disc-space calcification that could suggest a migratory path of a herniated disc); and 8) visualization of a complete plane of CSF ventral to the deformity. RESULTS The scalpel sign was positive in all patients with DAW. The dorsal indentation was C-shaped in 5 of 6 patients with SCH. The ventral subarachnoid space was preserved in all patients with DAW and interrupted in cases of SCH. In no patient was a web or a dural defect identified. CONCLUSIONS DAW and SCH can be reliably distinguished on imaging by scrutinizing the nature of the dorsal indentation and the integrity of

  17. 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.

  18. Arachnoid cysts

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    Agnoli, A.L.; Ellams, E.T.

    1984-11-01

    The clinical features and neuroradiological and computertomographic findings in 125 patients with cystic intracranial processes, which were neither due to tumour nor of vascular origin, have been analysed. The intrathecal injection of iodinated contrast media is absolutely essential for the differential diagnosis of congenital cysts. CT demonstration using 2 mm. slices and coronal and sagittal reconstruction makes it possible to relate the lesions to surrounding brain structures. Additional anomalies of the brain can be diagnosed and considered when planning treatment. Air studies are no longer necessary, but plain films remain the first diagnostic step. In view of modern micro-surgical techniques, angiography remains of value in order to diagnose vascular anomalies at a pre-operative stage.

  19. Tridimensional architecture of the collagen element in the arachnoid granulations in humans: a study on scanning electron microscopy

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    Conegero Celso Ivan

    2003-01-01

    Full Text Available The arachnoid granulations of adult individual of both sexes were studied through scanning electron microscopy. The dura mater and arachnoid meninges of individuals were collected at the Service of Death Verification of São Paulo - USP and fixed in Karnovsky solution. After this period the material was prepared for analysis in electron microscope. Our results demonstrated that the arachnoid granulations are formed by a pedicle, body and apex, being surrounded by a capsule of connective tissue, which in turn is composed of, basically, bundles of collagen fibers that line pores of different shapes and sizes. The smaller pores are lined by tiny bundles and are located at the apical region of the granulation and the larger are lined by thicker bundles and are located at the lateral regions. In the body we verified that the bundles of collagen fibers compose a fibrous meshwork and in some regions these bundles have circular orientation, forming pores similar to those found at the region of the capsule.

  20. [Subdural, extra-arachnoid block as a complication of stellate ganglion block: documentation with ultrasound].

    Science.gov (United States)

    Kapral, S; Krafft, P; Gosch, M; Fridrich, P; Weinstabl, C

    1997-10-01

    We present a patient who developed a high central neural block after stellate-ganglion-blockade. The underlying pathophysiology was assessed via sonographic imaging. Stellate ganglion block was performed in a 19-year old patient according to the standard technique. Multiple aspiration tests were negative and a test dose of 3 ml bupivacaine 0.25% was injected. After a 3 min interval another 5 ml were injected. Two minutes after the local anaesthetic administration the patient reported nausea and sensations in the upper extremity. Spontaneous respiration efforts stopped, and the patient became unconscious. Tracheal intubation was performed, and the patient was ventilated in a controlled mode for two hours. Heart rate as well as blood pressure remained within the normal range. Neurologic recovery occurred rapidly and extubation was performed about two and a half hours after the event. Our sonographic studies demonstrated a local anaesthetic depot directly at the root of C 6, with a mean diameter of 10 mm and a length of 5 to 6 cm (about a third smaller than expected). Sonographic studies and clinical symptoms of our patient are most likely to occur with a subdural extra-arachnoidal block. Ultrasonographic guided puncture enhances the patient's safety by the opportunity to directly visualise transverse process, nerval root as well as local anaesthetic depot. In case of depot formation directly at the nerval root, injection may be stopped and the needle repositioned. Furthermore, direct visualisation of the great vessels (A. vertebralis) prevents intravascular injection and haematoma formation.

  1. Thoracolumbar Arachnoid Cyst with Horner Syndrome: A Case Report and Review of the Literature.

    Science.gov (United States)

    Gao, Yang; Zhang, Hui; Yang, Jiancheng; Fu, Qiang; Zheng, Jianfeng; Shuai, Ming; Hu, Zhengbo; Tan, Wei; Cao, Wei; Yang, Xiao; Jin, Anmin; Zhou, Renshi; Lu, Hai

    2015-04-01

    Horner syndrome (HS) results from the interruption of sympathic pathway, and the patients have a group of signs including miosis, ptosis, enophthalmos, and anhydrosis. While HS is mainly caused by cervical sympathetic nerve injury such as sympathetic chain tumor, we report here a HS case caused by a thoracolumbar arachnoid cyst. Imageological examination showed the cyst existed in spinal canal from the T11 to L3 level, which was further confirmed by operation. The tumor attacked the lateral margin of intervertebral foramen at certain stages. In MRI scan, no abnormality was found in the patient's crania, cervical vertebra, thoracic vertebra, or the other parts. After removal of the cyst with operation, the patient's HS symptoms and weakness of lower limbs were relieved apparently. Although the sympathetic center origins from the cornu laterale medullae spinalis of T1 to L3, there are many reports about HS caused by lumbar anesthesia and epidural anesthesia according to our literature review, and there is no report about HS results from intraspinal space-occupying lesion below T11 level. Our finding suggests that when the sympathetic center below the level of T11 emits nerve to dominate abdominal viscera, it can also control the sweat glands from face to feet, including pupils and eyelids. When physicians encounter patients with HS and one side of the body and abdominal viscera sympathetic syndromes, the pathological changes in lower thoracic vertebra or lumbar vertebra should be taken in consideration.

  2. 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.

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

    Science.gov (United States)

    Krishnan, Prasad; Chattopadhyay, Arijit; Saha, Manash

    2014-01-01

    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.

  4. 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

  5. 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

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. Motor Speech Apraxia in a 70-Year-Old Man with Left Dorsolateral Frontal Arachnoid Cyst: A [18F]FDG PET-CT Study

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    Nicolaas I. Bohnen

    2016-01-01

    Full Text Available Motor speech apraxia is a speech disorder of impaired syllable sequencing which, when seen with advancing age, is suggestive of a neurodegenerative process affecting cortical structures in the left frontal lobe. Arachnoid cysts can be associated with neurologic symptoms due to compression of underlying brain structures though indications for surgical intervention are unclear. We present the case of a 70-year-old man who presented with a two-year history of speech changes along with decreased initiation and talkativeness, shorter utterances, and dysnomia. [18F]Fluorodeoxyglucose (FDG Positron Emission and Computed Tomography (PET-CT and magnetic resonance imaging (MRI showed very focal left frontal cortical hypometabolism immediately adjacent to an arachnoid cyst but no specific evidence of a neurodegenerative process.

  11. Motor Speech Apraxia in a 70-Year-Old Man with Left Dorsolateral Frontal Arachnoid Cyst: A [18F]FDG PET-CT Study

    Science.gov (United States)

    Haugen, Jacob; Kluin, Karen; Kotagal, Vikas

    2016-01-01

    Motor speech apraxia is a speech disorder of impaired syllable sequencing which, when seen with advancing age, is suggestive of a neurodegenerative process affecting cortical structures in the left frontal lobe. Arachnoid cysts can be associated with neurologic symptoms due to compression of underlying brain structures though indications for surgical intervention are unclear. We present the case of a 70-year-old man who presented with a two-year history of speech changes along with decreased initiation and talkativeness, shorter utterances, and dysnomia. [18F]Fluorodeoxyglucose (FDG) Positron Emission and Computed Tomography (PET-CT) and magnetic resonance imaging (MRI) showed very focal left frontal cortical hypometabolism immediately adjacent to an arachnoid cyst but no specific evidence of a neurodegenerative process. PMID:28003922

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

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    Margaret Tzaphlidou

    2004-01-01

    Full Text Available 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.

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

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    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

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

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    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.

  15. Protein profiling reveals inter-individual protein homogeneity of arachnoid cyst fluid and high qualitative similarity to cerebrospinal fluid

    Directory of Open Access Journals (Sweden)

    Berle Magnus

    2011-05-01

    Full Text Available Abstract Background The mechanisms behind formation and filling of intracranial arachnoid cysts (AC are poorly understood. The aim of this study was to evaluate AC fluid by proteomics to gain further knowledge about ACs. Two goals were set: 1 Comparison of AC fluid from individual patients to determine whether or not temporal AC is a homogenous condition; and 2 Evaluate the protein content of a pool of AC fluid from several patients and qualitatively compare this with published protein lists of cerebrospinal fluid (CSF and plasma. Methods AC fluid from 15 patients with temporal AC was included in this study. In the AC protein comparison experiment, AC fluid from 14 patients was digested, analyzed by LC-MS/MS using a semi-quantitative label-free approach and the data were compared by principal component analysis (PCA to gain knowledge of protein homogeneity of AC. In the AC proteome evaluation experiment, AC fluid from 11 patients was pooled, digested, and fractionated by SCX chromatography prior to analysis by LC-MS/MS. Proteins identified were compared to published databases of proteins identified from CSF and plasma. AC fluid proteins not found in these two databases were experimentally searched for in lumbar CSF taken from neurologically-normal patients, by a targeted protein identification approach called MIDAS (Multiple Reaction Monitoring (MRM initiated detection and sequence analysis. Results We did not identify systematic trends or grouping of data in the AC protein comparison experiment, implying low variability between individual proteomic profiles of AC. In the AC proteome evaluation experiment, we identified 199 proteins. When compared to previously published lists of proteins identified from CSF and plasma, 15 of the AC proteins had not been reported in either of these datasets. By a targeted protein identification approach, we identified 11 of these 15 proteins in pooled CSF from neurologically-normal patients, demonstrating that

  16. [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.

  17. Tubercular Optochiasmatic Arachnoiditis

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    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.

  18. 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...

  19. 环池及其附属蛛网膜结构的显微手术学解剖研究%Microsurgical anatomy of the ambient cistern and its related arachnoidal membranes

    Institute of Scientific and Technical Information of China (English)

    樊俊; 漆松涛; 张喜安; 石瑾

    2011-01-01

    目的 研究环池及其蛛网膜的显微解剖学特点,并探讨其临床意义.方法 在手术显微镜下观察20例尸头环池的形态、边界、内容物及相关蛛网膜结构.结果 环中脑膜由覆盖幕缘及鞍背的外层蛛网膜发出并环绕中脑,可分为前、后两个部分;环池位于该膜的上方,主要包括脉络膜前动脉、大脑后动脉、基底静脉,有时可见部分小脑上动脉.环池分别与颈内动脉池、脚间池、动眼神经池、小脑脑桥角池、小脑中脑裂池及四叠体池交通.结论 环池是一个幕上脑池,了解环池及其蛛网膜的解剖结构,有助于显微手术操作及手术入路的设计.%Objective To study microanatomy features and clinical significance of ambient cisterns and their arachnoidal membranes in detail. Method Ambient cisterns including their shapes, borders,contents and arachnoidal membranes were observed in 20 cadaveric brains using an operating microscope. Results The perimesencephalic membrane arises from the outer arachnoid membranes covering the tentorial edge and the dorsum sellae. The ambient cistern is located above the perimesencephalic membrane, with 4 walls ( top, bottom, medial and lateral ) anteriorly and 5 walls ( top, bottom, medial, lateral and posterior- medial)posteriorly. The cistern contains the anterior choroidal arteries, the posterior cerebral arteries,the basal vein, and sometimes the segments of the superior cerebellar arteries. The ambient cistern communicates with the carotid cistern anteriorly, the interpeduncular cistern medially, the oculomotor cistern inferomedially, the cerebellopontine and cerebellomesencephalic cistern inferiorly, and the quadrigeminal cistern posteromedially. Conclusions The anatomic features of the ambient cistern and its arachnoid membranes, boundaries, contents and relationships with other cisterns were identified in this study. The ambient cistern is situated above the level of the tentorium. The knowledge

  20. 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.

  1. Experimental syringohydromyelia induced by adhesive arachnoiditis in the rabbit: changes in the blood-spinal cord barrier, neuroinflammatory foci, and syrinx formation.

    Science.gov (United States)

    Kobayashi, Shigeru; Kato, Katsura; Rodríguez Guerrero, Alexander; Baba, Hisatoshi; Yoshizawa, Hidezo

    2012-06-10

    There are many histological examinations of syringohydromyelia in the literature. However, there has been very little experimental work on blood permeability in the spinal cord vessels and ultrastructural changes. We prepared an animal model of spinal adhesive arachnoiditis by injecting kaolin into the subarachnoid space at the eighth thoracic vertebra of rabbits. The animals were evaluated 4 months later. Of the 30 rabbits given kaolin injection into the cerebrospinal fluid, 23 showed complete circumferential obstruction. In the 7 animals with partial obstruction of the subarachnoid space, intramedullary changes were not observed. However, among the 23 animals showing complete obstruction of the subarachnoid space, dilatation of the central canal (hydromyelia) occurred in 21, and intramedullary syrinx (syringomyelia) was observed in 11. In animals with complete obstruction, fluorescence microscopy revealed intramedullary edema around the central canal, extending to the posterior columns. Electron microscopy of hydromyelia revealed a marked reduction of villi on the ependymal cells, separation of the ependymal cells, and cavitation of the subependymal layer. The dilated perivascular spaces indicate alterations of fluid exchange between the subarachnoid and extracellular spaces. Syringomyelia revealed that nerve fibers and nerve cells were exposed on the surface of the syrinx, and necrotic tissue was removed by macrophages to leave a syrinx. Both pathologies differ in their mechanism of development: hydromyelia is attributed to disturbed reflux of cerebrospinal fluid, while tissue necrosis due to disturbed intramedullary blood flow is considered to be involved in formation of the syrinx in syringomyelia.

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

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    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

  3. Reversible dyscognition in patients with a unilateral, middle fossa arachnoid cyst revealed by using a laptop based neuropsychological test battery (CANTAB).

    Science.gov (United States)

    Torgersen, Johan; Helland, Christian; Flaatten, Hans; Wester, Knut

    2010-11-01

    The aim of this study was to evaluate and validate the Cambridge Neuropsychological Test Automated Battery (CANTAB) in a Norwegian group of patients undergoing surgery for middle fossa arachnoid cysts (AC). We also wanted to assess health related quality of life (HRQOL) in these patients to see if it could be improved by decompression of the AC. Adult patients (>18 years) with unilateral middle fossa AC and no previous history of neurological disease, head injury, or a psychiatric disorder were eligible for inclusion. We used four tests from CANTAB to assess the level of neuropsychological performance: paired associate learning (PAL) and delayed matching to sample (DMS) assessed temporal lobe functions, while Stockings of Cambridge (SOC) and intra-extra dimensional (IED) shift focused on frontal lobe functions. Patients with postoperative cerebral complications were reported, but excluded from neuropsychological follow-up. In addition to the CANTAB data, pre- and postoperative clinical and radiological data were collected. HRQOL was assessed using Short Form 36 (SF-36) pre- and postoperatively. We found significant improvement in the two temporal tests assessing memory, but no improvement in the two frontal tests assessing executive function. HRQOL was significantly reduced preoperatively in two of eight SF-36 domains and improved significantly in four domains postoperatively. CANTAB facilitates detection of cognitive improvements after decompression of the cyst in patients with AC in the middle fossa. The improvements were detected on the tests sensitive to temporal lobe problems only, not on the tests more sensitive to frontal lobe affection. This establishes construct validity for CANTAB for the first time in this population.

  4. [Arachnoid cysts of the middle cranial fossa in children. A review of 75 cases, 47 of which have been operated in a comparative study between membranectomy with opening of cisterns and cystoperitoneal shunt].

    Science.gov (United States)

    Lena, G; Erdincler, P; Van Calenberg, F; Genitori, L; Choux, M

    1996-01-01

    The authors report their experience concerning 75 cases of middle fossa arachnoid cysts observed in children during the period 1975-1993, 47 of which (62.6%) were operated upon. The aim of this study was to study the clinical presentation of these cysts, to discuss the surgical indications and to compare the results of the various techniques used to treat these malformations. Head injury was revealing in 17 cases (22.6%) and among these, 12 patients presented intracranial complications (subdural effusions; 6 cases, subdural hematomas: 4 cases and intracystic hematomas: 2 cases). The most usual signs and symptoms were: intracranial hypertension (25.3%), epilepsy (16%) and temporal bulging (24%). Twenty-one patients (44.7%) underwent a cystoperitoneal shunt; 20 patients (42.5%) were treated by membranectomy with opening of the basal cisterns and removal of intracystic (2 cases) or subdural hematoma (4 cases); 2 patients (4.3%) were treated using membranectomy, opening of the cisterns and cystoperitoneal shunt and 4 patients (8.4%) underwent a subduroperitoneal shunt. The long-term results were good regardless of the surgical procedure; nevertheless, only one patient among 20 cases treated by membranectomy and opening of the cisterns developped complications (5%), while multiple shunt revisions were necessary in 11 children (40.7%) out of 27 where a shunt was inserted. The authors conclude that membranectomy and opening of the basal cisterns is the procedure of choice to treat middle fossa arachnoid cysts in children.

  5. 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

  6. 后交通动脉池及周围脑池与蛛网膜的解剖研究%Anatomical study of posterior communicating artery cistern,its surrounding cisterns and related arachnoid membranes

    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

    2011-01-01

    目的:研究后交通动脉池(PCoA池)及周围脑池与相关蛛网膜的显微解剖特点,并探讨其临床意义.方法:显微镜下对10例福尔马林固定的尸头标本进行解剖,观察PCoA池及周围脑池与相关蛛网膜的显微特点并录像记录.结果:PCoA池为一个独立存在脑池,本组出现12侧(60%).其前方是颈内动脉池,本组出现20侧(100%);下外侧是动眼神经池,本组出现20侧(100%);内侧为非对称脚间池,本组出现10侧(100%);后外侧为环池,本组出现20侧(100%).分隔颈内动脉池与PCoA池为后交通膜,本组出现12侧(60%);分隔动眼神经池与PCoA池为Liliequist膜,本组出现10例(100%);分隔脚间池与PCoA池为Liliequist膜侧壁;分隔环池与PCoA池为环中脑膜前部发出的蛛网膜小梁.结论:PCoA池及其周围脑池是基底脑池的重要组成部分,了解基底脑池与相关蛛网膜结构对于了解此区的病变和手术具有重要意义.%Objective To study the anatomical features of the posterior communicating artery (PCoA) cistern, surrounding cisterns and their related arachnoid membranes and discuss the clinical significance of these structures. Methods The microanatomical study was performed in 10 formalin-fixed cadaveric head specimens under microscope. The PCoA cistern, surrounding cisterns and related arachnoid membranes were observed, photographed and videotaped during the surgical procedure. Results The PCoA cistern existed independently in 12 sides (60%). The internal carotid artery (ICA) cistern was at the anterior of the PCoA cistern in 20 sides (100%), oculomotorius cistern was in the lateral-inferior side of the PCoA cistern in 20 sides (100%), asymmetric interpeduncular cisterns was in the inside in 10 sides (100%), ambient cistern was in the posterior-lateral part in 20 sides (100%). The ICA cistern and PCoA cistern were separated by the posterior communicating membrane in 12 sides (60%), oculomotorius cistern and PCoA cistern

  7. 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.

  8. 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

  9. 皮质脑电监测下显微手术治疗儿童蛛网膜囊肿伴发癫痫%Microsurgical treatment on pediatric intracranial arachnoid cyst associated epilepsy under electrocortico-gram

    Institute of Scientific and Technical Information of China (English)

    尹浩; 王超; 王俊; 熊云彪; 刘窗溪; 韩国强; 高方友; 宋伟正; 王曲; 马骏

    2010-01-01

    Objective To value the therapeutic effect of surgical treatment on pediatric intracranial arachnoid cysts associated epilepsy. Methods 30 patients were retrospectively analyzed. Preoperative neuroimaging scan and neuro-electrophysiological study were performed. Intraoperative electrocor-ticograms were carried out to locate the cysts before resection. They were then put on medication for 0.5 to 1 year post-operatively. Results All patients were follow-up for 0.5 to 6 years. Twenty four patients fully recovered. The curative rate was 80% for grade Ⅰ and Ⅱ (Eagel classification).There was no complicatioa Conclusions Surgical resection under electrocorticogram is an effective management for pediatric intracranial arachnoid cyst associated epilepsy.%目的 探讨儿童颅内蛛网膜囊肿伴发癫痫的显微外科治疗的疗效.方法 回顾性分析30例患儿的临床资料,术前均采用影像学及神经电生理的检查严格评估手术方案,术中均采用皮质脑电图检测,依据术中癫痫波的情况,选择采用囊肿切除、致痫灶切除、辅助以多处软脑膜下横纤维切断术、脑皮层横行纤维低功率热灼术等治疗.术后正规服药半年到1年.结果 随访半年至6年,24例患儿获治愈,按Engel分级Ⅰ~Ⅱ级为80%,无明显并发症.结论 儿童蛛网膜囊肿伴发癫痫经术中皮质脑电监测下显微外科治疗,可以取得良好的疗效.

  10. 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

  11. 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.

  12. 侧裂池蛛网膜结构及其与大脑中动脉分级关系的解剖学研究%Anatomical study of arachnoidal structures around sylvain fissure and it’s relationship to the branches of middle cerebral artery

    Institute of Scientific and Technical Information of China (English)

    陆云涛; 漆松涛; 刘忆; 陈铭; 潘军; 石瑾; 刘亚伟

    2014-01-01

    目的:研究颅内侧裂池蛛网膜层次及其和大脑中动脉(MCA)各级分支间的关系及其临床意义。方法取成人尸头6例(12侧),显微镜下观察外侧裂膜性结构层次及侧裂池构成,解剖MCA各支分布及其和膜性层次间的关系。结果侧裂池由外向内共有4层蛛网膜结构,分别是远外侧侧裂膜(FLSa)、外侧侧裂膜(LSa)、中间侧裂膜(MiSa,内层和外层)和内侧侧裂膜(MeSa)。12侧标本中,4层膜性结构均完整的6侧。FLSa通常菲薄,覆盖在侧裂浅静脉表面,和静脉外膜粘连紧密;LSa相对致密,构成了侧裂池的真正外侧壁,并分隔MCA M3和M4段;沿MCA M3段走行,有相对菲薄的MiSa浅层覆盖并将其固定在侧裂池内;在M2和M3段交汇处,见相对致密的MiSa深层,包绕M3段起始部,并将侧裂池分为前后两部,3侧标本中该层菲薄稀疏,呈网眼状;而在M1和M2段间有非常致密的MeSa,分隔侧裂池和颈内动脉池,5侧标本中,该膜菲薄呈网眼状。结论侧裂池蛛网膜的分层分布和MCA各级动脉关系密切,掌握其解剖特点有利于术中充分解剖侧裂池和颈内动脉池。其膜性分布的个体化差异,可能影响MCA动脉瘤的出血方式。%Objective This study aims to investigate the layers of arachnoidal structures and illustrate the relationship between the arachnoid membranes with branches of middle cerebral artery (MCA). The related clinical issues are discussed. Methods Six cases of adult cadaveric heads (twelve sides) were dissected under the microscopy. The construction of Sylvain fissure cistern and the different layers of arachnoidal membranes were observed. The course of MCA’s branches and its relationship to the aforementioned membranes were analyzed. Results A total of four layers of membranes composed the sylvain fissure cistern. From outer to inner, it was far lateral sylvain arachnoid (FLSa), lateral

  13. 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

  14. Medical image of the week: arachnoid cyst

    Directory of Open Access Journals (Sweden)

    Erisman M

    2016-10-01

    Full Text Available No abstract available. Article truncated at 150 words. A 40 year-old woman with adult attention deficit hyperactive and bipolar 1 disorder presents with an altered mental status. Per her family, she had been non-verbal, with reduced oral intake, confusion and sedated for the past three days. Per her husband, she had episodes of diarrhea and abdominal discomfort. She was on multiple medications including ramelteon 8mg nightly, atomoxetine 40mg daily, hydroxyzine 25mg twice daily, bupropion 75mg twice daily and risperidone 2mg daily with recent addition of lithium ER 1200mg/daily started one month prior to presentation with unknown adherence. Upon arrival, vital signs were within normal limits. Physical exam revealed an overweight Caucasian woman with a significant coarse tremor visible at rest, restlessness and diaphoresis. Neurological examination was limited by patient hesitancy, however, it did not demonstrate focal deficits except for altered consciousness with Glasgow Coma Scale of 10. Notable laboratory findings were Na+ 134 mEq/L, K+ 3.2 mEq/L, and ...

  15. 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.

  16. Arachnoiditis ossificans and syringomyelia: A unique presentation

    Directory of Open Access Journals (Sweden)

    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.

  17. Treatment options for intracranial arachnoid cysts

    DEFF Research Database (Denmark)

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

    2012-01-01

    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...

  18. 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

    Institute of Scientific and Technical Information of China (English)

    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

  19. 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.

  20. 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

  1. 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.

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Microsurgical anatomy of the supratentorial arachnoidal trabecular membranes and cisterns.

    Science.gov (United States)

    Vinas, F C; Fandino, R; Dujovny, M; Chavez, V

    1994-12-01

    We examined the microsurgical anatomy of the supratentorial subarachnoid cisterns with a surgical microscope in 20 brains prepared using the immersion technique. The adult brains were immersed in Ringer's solution and air was injected into the subarachnoid cisterns while the brains remained submerged in solution. We identified nine trabecular membranes that limit the 15 cisterns. We specifically looked at the anatomical relationship between the supratentorial trabecular membranes and cisterns to their corresponding vessels and cranial nerves. The cistern divisions and the dispositions of trabecular membranes were closely related to the vascular division patterns of the principal brain arteries. A clear and thorough understanding of the neuroanatomical structures of the subarachnoid cisterns is important because they provide natural pathways to neurovascular and cranial nerve structures. These pathways allow access to intracranial arteries, veins, and nerves during microvascular procedures without disturbing surrounding important brain structures.

  5. 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.

  6. 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

  7. A re-evaluation of subspecific variation and canine dimorphism in woolly spider monkeys (Brachyteles arachnoides).

    Science.gov (United States)

    Leigh, S R; Jungers, W L

    1994-12-01

    A recent study suggests that differing populations of woolly spider monkeys exhibit a substantial degree of morphological, cytogenetic, and behavioral variation. We re-evaluate the differences between populations in the degree of canine tooth height sexual dimorphism and in the frequency of thumbs. Statistical analysis of variation in the degree of canine sexual dimorphism between these populations fails to provide strong evidence for subspecific variation: differences in the degree of canine dimorphism cannot be considered statistically significant. Differences between populations in the frequency of thumbs are, however, statistically significant. The lack of clear distinctions between populations in the degree of canine dimorphism complicates assessments of behavioral variation between these populations. We suggest that the level of geographic variation in woolly spider monkey canine dimorphism is not consistent with subspecific status.

  8. Thunderclap headache: It is always sub-arachnoid hemorrhage. Is it? - A case report and Review

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    Raghunath Aladakatti

    2014-01-01

    Full Text Available Background: Spontaneous intracranial hypotension (SIH is one of the relatively misdiagnosed pathophysiological entities by virtue of its presentation. SIH is a condition involving reduced intracranial pressure usually secondary to dural tear. There is recent increase in reporting of its varied presentation in literature.Critical care physicians and neurosurgeons are recognizing it in higher numbers than before. SIH is characterized by sudden onset of orthostatic headache and may be associated with neck stiffness, nausea, vomiting, tinnitus, deafness, and cognitive abnormalities. Since its imaging characteristics resemble classic subdural hematoma from other causes wrong diagnosis and intervention might have devastating outcome. Case Description: Here we discuss a case presented to us with severe headache of sudden onset without any associated problems. Patient was initially being treated as sinusitis and later diagnosed as bilateral subdural hematoma and surgical intervention was being considered. Thorough history taking and physical examination lead to strong suspicion of intracranial hypotension (IH and patient showed dramatic improvement with epidural blood patch. Conclusion: S IH is a commonly misdiagnosed entity. A high index of suspicion is required for timely diagnosis, in order to minimize unwanted therapeutic interventions that can worsen the patient′s condition and to help initiate early and simple interventions.

  9. Microsurgical anatomy of the arachnoidal trabecular membranes and cisterns at the level of the tentorium.

    Science.gov (United States)

    Vinas, F C; Dujovny, M; Fandino, R; Chavez, V

    1996-08-01

    A clear and thorough understanding of the neuroanatomical structures of the subarachnoid cisterns is important because they provide natural pathways to intracranial arteries, veins, and nerves during microvascular procedures without disturbing surrounding important brain structures. Using a surgical microscope, we examined the microsurgical anatomy of the trabecular membranes and subarachnoid cisterns in 20 adult cadaver brains. The brains were immersed in Ringer's solution and air was injected into the subarachnoid cisterns while the brains remained submerged in solution. We identified seven trabecular membranes that limit six cisterns. We specifically looked at the anatomical relationship between the trabecular membranes and cisterns and their corresponding vessels and cranial nerves. The cistern divisions and the dispositions of trabecular membranes were closely related to the vascular division patterns of the principal brain arteries.

  10. 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.

  11. 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.

  12. 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 ...

  13. 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.

  14. Syringomyelia associated with arachnoid septum at the craniovertebral junction, contradicting the currently prevailing theory of syringomyelia formation.

    Science.gov (United States)

    Chang, Han Soo; Tsuchiya, Tsukasa; Fujisawa, Naoaki; Oya, Soichi; Matsui, Toru

    2012-01-01

    Despite a number of various hypotheses in the literature, the pathophysiology of syringomyelia is still not well understood. In this article, we report two cases of cervical syringomyelia not associated with Chiari I malformation. Both cases had a septum-like structure in the subarachnoid space on the dorsal side of the cord at the craniovertebral junction. Cardiac-gated phase-contrast cine-mode magnetic resonance imaging (MRI) demonstrated decreased cerebrospinal fluid (CSF) flow on the dorsal side of the spinal cord. Surgical excision of this septum, restoring the CSF flow, resulted in a prompt reduction of the syrinx size in both cases. Findings in these cases contradict the currently prevailing hypothesis of syrinx formation that postulate that the piston-like movement of the cerebellar tonsils enhance the pulsatile CSF flow in the spinal subarachnoid space, driving the CSF into the syrinx through the perivascular space of Virchow and Robin. The authors propose that a mechanism based on the decreased pulsatile CSF flow in the spinal subarachnoid space will be more suitable as a hypothesis in studying the pathophyisiology of syringomyelia. These cases also provide an important lesson in managing the patients with syringomyelia not associated with Chiari I malformation.

  15. 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...

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. Microscopic morphology and histology of the human meninges.

    Science.gov (United States)

    Weller, R O

    2005-03-01

    The meninges comprise the dura mater and the leptomeninges (arachnoid and pia mater). Dura forms an outer endosteal layer related to the bones of the skull and spine and an inner layer closely applied to the arachnoid mater. Leptomeninges have multiple functions and anatomical relationships. The outer parietal layer of arachnoid is impermeable to CSF due to tight intercellular junctions; elsewhere leptomeningeal cells form demosomes and gap junctions. Trabeculae of leptomeninges compartmentalize the subarachnoid space and join the pia to arachnoid mater. In bacterial meningitis leptomeningeal cells secrete cytokines. Pia mater is reflected from the surface of the brain and spinal cord onto arteries and veins, thus separating the subarachnoid space from the brain and cord. A sheath of leptomeninges accompanies arteries into the brain and is related to the pathways for the drainage of interstitial fluid that play a role in inflammatory responses in the brain and appear to be blocked by amyloid-beta in Alzheimer's disease. Specialised leptomeningeal cells in the stroma of the choroid plexus form collagen whorls that become calcified with age. Leptomeningeal cells also form channels in the core and apical cap of arachnoid granulations for the drainage of CSF into venous sinuses. In the spine, leptomeninges form highly perforated intermediate sheets of arachnoid and delicate ligaments that compartmentalize the subarachnoid space; dentate ligaments anchor subpial collagen to the dura mater and stabilize the spinal cord. Despite the multiple anatomical arrangements and physiological functions, leptomeningeal cells retain many histological features that are similar from site to site.

  1. 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

  2. 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。

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

    Energy Technology Data Exchange (ETDEWEB)

    Abe, Toshiaki (Jikei Univ., Tokyo (Japan). School of Medicine)

    1992-12-01

    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.).

  4. St. Finbarr's Hospital, Douglas Road, Cork.

    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.

  5. 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.

  6. 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.

  7. Pseudoarachnoiditis in Spontaneous Intracranial Hypotension

    Directory of Open Access Journals (Sweden)

    Özlem Alkan

    2011-03-01

    Full Text Available Spontaneous intracranial hypotension is an important cause of new daily persistent headaches in young and middle-aged individuals. The diagnosis is made based on low cerebrospinal fluid pressure with characteristic findings upon brain and spinal magnetic resonance imaging (MRI. We present the case of a 15-year-old boy with spontaneous intracranial hypotension. Although his brain MRI was normal, his lumbar spinal MRI showed clustering of the nerve roots characteristic of arachnoiditis. Radionuclide cisternography revealed an epidural leak, which was treated with an epidural blood patch. The patient reached a near-full recovery within 24 h, and the lumbar spinal MRI findings mimicking arachnoiditis disappeared.

  8. 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...

  9. 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.)

  10. Spinal syringomyelia following subarachnoid hemorrhage.

    Science.gov (United States)

    Nakanishi, Kinya; Uchiyama, Takuya; Nakano, Naoki; Fukawa, Norihito; Yamada, Kimito; Yabuuchi, Tomonari; Kato, Amami

    2012-04-01

    Subarachnoid blood has been reported as a cause of chronic spinal arachnoiditis. Although syringomyelia has been thought to be caused by spinal arachnoiditis, reports of syringomyelia following aneurysmal subarachnoid hemorrhage (SAH) are very rare. We describe two patients with syringomyelia associated with chronic spinal arachnoiditis following SAH. From January 2001 to December 2010, 198 patients with aneurysmal SAH were treated at Kinki University School of Medicine. Two of the 198 patients had syringomyelia following aneurysmal SAH; thus the rate of syringomyelia associated with aneurysmal SAH was 1.0%. Patient 1 was a 54-year-old woman who presented with back pain, back numbness and gait disturbance 20 months after SAH. Her MRI revealed syringomyelia of the spinal cord from C2 to T10. She underwent shunting of the syrinx to the subarachnoid space. Patient 2 was a 49-year-old man, who was admitted to the hospital with headache, diplopia, hoarseness, dysphagia and ataxia five months after SAH. MRI revealed syringomyelia from the medulla oblongata to C6, and an enlargement of the lateral and fourth ventricles. After foramen magnum decompression and C1 laminectomy, a fourth ventricle-subarachnoid shunt was placed by insertion of a catheter. Spinal arachnoiditis and spinal syringomyelia are rare but important chronic complications after SAH.

  11. Spinal cord stimulation combined with microsurgical DREZotomy for pain due to syringomyelia.

    Science.gov (United States)

    Shu, Wei; Li, Yongjie; Tao, Wei; Hu, Yongsheng

    2016-10-01

    A 49-year-old man with lower extremity neuropathic pain thought to be caused by spinal cord syringomyelia was treated with a combination of using spinal cord stimulation, decompression of the syrinx, relief of arachnoid adhesions and microsurgical DREZotomy. The patient had significant pain relief and has stable neurological status at follow-up.

  12. Central Nervous System Tuberculosis

    OpenAIRE

    Bano, Shahina; Chaudhary, Vikas; Yadav, Sachchidanand

    2012-01-01

    Central nervous system tuberculosis is a rare presentation of active tuberculosis and accounts for about 1% of cases (1). The three clinical categories include meningitis, intracranial tuberculomas, and spinal tuberculous arachnoiditis. We report a case of a young man who presented with active pulmonary tuberculosis in addition to tuberculous meningitis and the presence of numerous intracranial tuberculomas.

  13. Microsurgical anatomy of the posterior fossa cisterns.

    Science.gov (United States)

    Matsuno, H; Rhoton, A L; Peace, D

    1988-07-01

    The microsurgical anatomy of the posterior fossa cisterns was examined in 15 cadavers using 3X to 40X magnification. Liliequist's membrane was found to split into two arachnoidal sheets as it spreads upward from the dorsum sellae: an upper sheet, called the diencephalic membrane, which attaches to the diencephalon at the posterior edge of the mamillary bodies, and a lower sheet, called the mesencephalic membrane, which attaches along the junction of the midbrain and pons. Several other arachnoidal membranes that separate the cisterns were identified. These include the anterior pontine membrane, which separates the prepontine and cerebellopontine cisterns; the lateral pontomesencephalic membrane, which separates the ambient and cerebellopontine cisterns; the medial pontomedullary membrane, which separates the premedullary and prepontine cisterns; and the lateral pontomedullary membrane, which separates the cerebellopontine and cerebellomedullary cisterns. The three cisterns in which the arachnoid trabeculae and membranes are the most dense and present the greatest obstacle at operation are the interpeduncular and quadrigeminal cisterns and the cisterna magna. Numerous arachnoid membranes were found to intersect the oculomotor nerves. The neural and vascular structures in each cistern are reviewed.

  14. Phlebography of the sella turcica by a trans-sphenoidal technique

    Energy Technology Data Exchange (ETDEWEB)

    Tvete, S.; Mork, J.

    1982-02-01

    A trans-sphenoidal approach to the filling of spaces within the sella turcica with contrast medium in cadavers is described. The hypophysis appeared on roentgenograms as a contrast medium filling defect. No injury to the hypophysis, carotid arteries or chiasma was seen. The implications of an arachnoid extension into the sella are discussed.

  15. 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.

  16. Radiographic studies of the ventricles in syringomyelia

    Energy Technology Data Exchange (ETDEWEB)

    West, R.J.; Williams, B.

    1980-08-01

    Radiographic investigations of 171 patients with communicating syringomyelia have been reviewed. Hydrocephalus was found in one third of the cases and has occasionally progressed after operation on the posterior fossa, sometimes with accompanying clinical deterioration. The outlets of the fourth ventricle were usually abnormal; tonsillar descent, arachnoiditis and both together were seen. Arachnoiditis correlated strongly with a history of difficult birth. The foramen of Magendie was sometimes patent and sometimes blocked. There was no consistent level of occlusion corresponding to a persistent roof of the fourth ventricle. The cisterna magna was usually small or obliterated but some examples of large cisterns or subarachnoid pouches were found. Radiological demonstration of a communication from the fourth ventricle to the syrinx occurred in only seven patients by positive contrast material and not by air. It is suggested that a sizable communication is rare at the time when patients seek treatment.

  17. 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.

  18. Preclinical Mouse Models of Neurofibromatosis

    Science.gov (United States)

    2005-11-01

    rapid tumorigenesis through conditional inversion of the tumor sup- pressor gene Snf5. Cancer Cell . 2002;2:415- 425. 31. Gerber HP, Malik AK, Solar GP...Ultrastructurally, normal arachnoid cells are characterized by loosely interdigitating cellular processes connected by junctional complexes; between the cellular...and cell biology of NF1 and NF2-associated tumors, it has proven difficult to translate these advances into new treatments. The development of

  19. 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.

  20. Sacral radicular cysts in autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Peces, Ramón; Peces, Carlos; Pérez-Dueñas, Virginia; Vega-Cabrera, Cristina; Campos, Isabel

    2009-10-01

    This is the first report of a case of sacral radicular cysts in a patient with autosomal dominant polycystic kidney disease (ADPKD). A 46-year-old woman with ADPKD was found to have bilateral sacral radicular cysts discovered incidentally by magnetic resonance imaging (MRI). Cysts arising from arachnoid or spinal meningeal sac should be considered one of the manifestations of a more widespread connective tissue disorder associated with ADPKD.

  1. Magnetic resonance imaging in syringomyelia; Ressonancia magnetica na siringomielia

    Energy Technology Data Exchange (ETDEWEB)

    Minguetti, Guilberto [Parana Univ., Curitiba, PR (Brazil). Dept. de Clinica Medica; Tamanini, Alexandro; Nogara, Heloisa

    1998-10-01

    The authors present 13 cases of idiopathic syringomyelia, not associated to trauma, tumors, arachnoiditis or vascular disease. They show the site and extension of the lesions as well as the association with Chiari I (7 cases), enlargement of the spinal canal (2 cases), Klippel-Feil (1 case), basilar impression (1 case) and platibasia (1 case). They concluded that MRI is the diagnostic modality of choice in the diagnosis and evaluation of treatment of syringomyelia. (author) 11 refs., 9 figs., 2 tabs.

  2. 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.

  3. 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.

  4. 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.

  5. Tick (Amblyomma chabaudi) infestation of endemic tortoises in southwest Madagascar and investigation of tick-borne pathogens.

    Science.gov (United States)

    Ehlers, Julian; Ganzhorn, Jörg U; Silaghi, Cornelia; Krüger, Andreas; Pothmann, Daniela; Ratovonamana, R Yedidya; Veit, Alexandra; Keller, Christian; Poppert, Sven

    2016-03-01

    Little is known about the role of endemic ticks as vectors for bacterial and protozoan pathogens for animals and humans in Madagascar and their interaction in anthropogenic habitats where humans, their livestock and native Malagasy species (vectors and hosts) come into more frequent contact than in natural forest ecosystems. The aims of the study were (1) to test whether habitat degradation is associated with increased infestation of tortoises by ticks and (2) to investigate whether ticks carried Babesia, Borrelia or Rickettsia species that might be pathogenic for humans and livestock. We studied hard ticks of two endemic Malagasy tortoises, Astrochelys radiata and Pyxis arachnoides in March and April 2013 in southwest Madagascar. Two tortoise habitats were compared, the National Park of Tsimanampetsotsa and the adjacent degraded pasture and agricultural land at the end of the wet season. Ticks were screened for protozoan and bacterial pathogens via PCR on DNA isolated from ticks using genus-specific primers. Only one out of 42 A. radiata collected from both habitats had ticks. The low prevalence did not allow further analyses of the effect of habitat degradation. Forty-two P. arachnoides were found in the anthropogenic habitat and 36 individuals in the national park. Tick infestation rates of P. arachnoides differed significantly between the two study sites. Tortoises inside the park had lower tick prevalence than outside (8 of 36 (22%) versus 32 of 42 individuals (76%)) and infected animals tended to have fewer ticks inside than outside the park. All ticks collected in both habitats were adults of the ixodid tick Amblyomma chabaudi, which is supposed to be a host-specific tick of P. arachnoides. Screening for Borrelia sp. and Babesia sp. was negative in all ticks. But all A. chabaudi ticks were infected with Rickettsia africae, known to cause spotted fever in humans. Thus, habitat degradation seems to be linked to higher infestation of tortoises with ticks with

  6. [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.

  7. 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.

  8. Pseudo subarachnoid Hemorrhage: A Finding of Diffuse Cerebral Edema Leading to Misdiagnosis

    Directory of Open Access Journals (Sweden)

    Eda Kılıç Çoban

    2015-12-01

    Full Text Available Increased attenuation of the basal cisterns and subarachnoid spaces on CT scans is a characteristic finding of acute subarachnoid hemorrhage. CT mimics of SAH have been called pseudo-SAH. Our case is presented to underline the differentiation of two diagnosis. A 63-year-old man was admitted to the emergency room with right-sided hemiparesis and aphasia. He had middle cerebral artery enfarct on his CT. A week after his hospitalisation his neurological examination was deteriorated. A plain CT-scan of brain was consistent with sub-arachnoid hemorrhage. His antiagregant therapy was ended and anti edema therapy started. Urgent neurosurgical consultation was sought & surgery was not planned. Brain death was the finding in his CT angiography. So the CT-scan findings turned out to be `pseudo sub-arachnoid haemorrhage’.Pseudo sub-arachnoid haemorrhage is a rare CT scan finding that has been reported in different cerebral disease with cerebral edema. MR imaging studies, CSF examination by lumbar puncture and the criterias proposed by Yazawa can be useful to make the diagnosis. The aim is the unnecessary termination of antiagregant and anticoagulant therapy.

  9. 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.

  10. Role of Merlin/NF2 in mTOR Signaling and Meningioma Growth

    Science.gov (United States)

    2012-04-01

    Nonidet p - 40 (NP- 40 ) containing calyculin (50 nmol/L; Cell Signaling Technology), 1...IP kinase In vitro assay EGF-stimulated arachnoid cells 0 20 40 60 80 100 120 con RNAi NF2 RNAi A ve ra g e re la ti ve A kt S 47 3 p h o...R T - P R T pAKT S473 pp70 S6K T389 Akt pAKT S473 (long exposure) 1 h 24 h BA pAkt S473 DC p70 S6K 1 h 24 h 0 10 20 30 40

  11. 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.

  12. Intraorbital Encephalocele Presenting with Exophthalmos and Orbital Dystopia : CT and MRI Findings.

    Science.gov (United States)

    Asil, Kiyasettin; Gunduz, Yasemin; Yaldiz, Can; Aksoy, Yakup Ersel

    2015-01-01

    A 15-year-old female patient with progressive pulsatile exophthalmos caused by intraorbital encephalocele was evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) in our clinic. She had no history of trauma or reconstructive surgery. When she was a little girl, she had undergone surgery for congenital glaucoma on the right eye. On the three-dimensional image of CT, a hypoplasic bone defect was observed in the greater wing of the right sphenoid bone. MRI and CT scan showed herniation through this defect of the arachnoid membrane and protruded cerebral tissue into the right orbita. Intraorbital encephalocele is an important entity that can cause pulsatile exophthalmos and blindness.

  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. 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.

  15. Renal failure in a patient with autosomal dominant polycystic kidney disease and coexisting dermato-polymyositis: first report in the literature.

    Science.gov (United States)

    Bahceci, Funda; Sari, Ramazan; Sarikaya, Metin; Atik, Esin; Karincaoglu, Yelda; Sevinc, Alper

    2004-06-01

    Autosomal dominant polycystic kidney disease is a multisystem disorder characterized by multiple, bilateral renal cysts and is also associated with cysts in other organs, such as the liver, pancreas, and arachnoid membranes. Dermatomyositis is a disease which mainly involves the skin and muscles, although occasionally other organs are affected. In this report, a 56-year-old male patient with a four-year history of autosomal dominant polycystic kidney disease was presented. Renal failure was exacerbated by a coexisting dermato-polymyositis. Prednisone treatment with hemodialysis improved the situation. This is the first report renal failure in a patient with autosomal dominant polycystic kidney disease and dermato-polymyositis.

  16. Chiari II malformation. Pt. 4

    Energy Technology Data Exchange (ETDEWEB)

    Naidich, T.P.; McLone, D.G.; Fulling, K.H.

    1983-08-01

    Computed tomography successfully delineates the multiple components of the Chiari II malformation at the craniocervical junction, the hindbrain, and the cervical spinal cord. These include wide foramen magnum and upper cervical spinal canal; incomplete fusions of the posterior arches of C1 and lower cervical vertebrae; cascading protrusions of vermis, fourth ventricle, medulla, and cervical cord into the spinal canal; cervicomedullary ''kinking''; anterior displacement and sequential sagittal compression of each protrusion by the protrusions posterior to it; compression of all protrusions by the posterior lip of foramen magnum and the posterior arch of C1; and associated cervical hydromyelia, cervical diastematomyelia, and cervical arachnoid cysts.

  17. A symptomatic lumbosacral perineural cyst -A case report-

    Science.gov (United States)

    Choi, Byung Hee; Kim, Jin Mo

    2012-01-01

    Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms. PMID:22679550

  18. [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.

  19. Computed tomography of sellar and parasellar lesions

    Energy Technology Data Exchange (ETDEWEB)

    Hatano, Mitsunori; Aoki, Hideo (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1982-06-01

    Neuroradiological modalities, particularly CT, for sellar and parasellar lesions were reviewed. Although accurate preoperative diagnosis is sometimes difficult, CT diagnosed 83% as far as pituitary adenoma, craniopharyngioma and meningioma were concerned and demonstrated abnormal findings in 95% of parasellar tumors. At the authors' department, CT visualized abnormalities in all cases, with the exception of suprasellar arachnoid cyst, but a histological diagnosis was possible only in 84%. Since lesions including tumors cannot be completely denied even if CT shows normal images, findings by modalities such as plain craniography, cerebral tomography, cerebral angiography and cisternography should be judged comprehensively.

  20. Preclinical Mouse Models of Neurofibromatosis

    Science.gov (United States)

    2007-10-01

    arachnoidal cells is rate-limiting for meningioma development in the mouse. Genes & Development, 2002, 16:1060-1065. Kissil JL, Johnson KC, Eckman MS and...doubly mutant Nf1 and Wv hematopoietic cells. Blood 2003; 101: 1984-1986. Shannon, K.M. 35 Kissil JL, Wilker EW, Johnson KC, Eckman MS, Yaffe M, and... Paul E. McKeever, Shannon, K.M. 38 Megan Lim, Simon J. Conway, Luis F. Parada, Yuan Zhu, and Sean J. Morrison. 2007. The loss of Nf1 transiently

  1. [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.

  2. 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.

  3. Primary intrathoracic meningioma: histopathological, immunohistochemical and ultrastructural study of two cases.

    Science.gov (United States)

    Falleni, M; Roz, E; Dessy, E; Del Curto, B; Braidotti, P; Gianelli, U; Pietra, G G

    2001-08-01

    Meningiomas are common, usually benign slow-growing neoplasms of the central nervous system thought to arise from meningocytes capping arachnoid villi. Primary ectopic meningiomas are exceedingly rare extracranial and extraspinal tumors of controversial origin; they are usually limited to the head and neck region or to the paravertebral soft tissues. Only one mediastinal ectopic meningioma and few pulmonary ectopic meningiomas have been described in the literature until now. Because of their rarity and their intriguing pathogenesis, we report here a second case of primary mediastinal meningioma and an additional case of primary pulmonary meningioma. Their possible origin and differential diagnosis are discussed.

  4. 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.

  5. Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele

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    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.

  6. Paediatric intraventricular meningiomas. A report of two cases

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    Sushma Ramraje

    2012-02-01

    Full Text Available Meningiomas are rare in children comprising less than 3% of paediatric brain tumours and only 1.5-1.8% of all intracranial neoplasms. Intraventricular meningiomas (IVM account for 0.5-5% of all meningiomas. They arise in the ventricles from arachnoid cap cells contained within the choroid plexus, the tela choroidea, or the velum interpositum. Paediatric tumours also show an association with neurofibromatosis type 2 and previous radiation exposure.We present two cases of intraventricular meningiomas, both in children. The age and site of the lesion in the two cases are uncommon. Excision of the lesions caused a total subsidence of the symptoms with no reported recurrences.

  7. [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.

  8. Meningioma - a review of 52 cases

    Directory of Open Access Journals (Sweden)

    E. Fynn

    2004-04-01

    Full Text Available Meningiomas are extra-axial neoplasms representing 15 - 20% of primary intracranial neoplasms. Incidence peaks in patients aged 40 - 60 years, and they more commonly affect women than men. Most meningiomas arise from arachnoidal cells on the inner surface of the dura and they thefore grow inward toward the brain to form bulky intradural tumour masses. Most meningiomas are benign, but ~6% are atypical or aggressive, and 1 - 2% are frankly malignant. Common locations for meningiomas include the cerebral convexity, parasagittal region, sphenoid wing, olfactory groove, tuberculum sella, posterior fossa, and cavernous sinus.

  9. Comportamiento de reubicación del alimento de Eucranium, escarabajo estercolero endémico de la Argentina y comparación con Scarabaeus (Pachysoma del sudoeste de África (Coleoptera: Scarabaeidae: Scarabaeinae Food relocation and nesting behavior of the Argentinian dung beetle genus Eucranium and comparison with the southwest African Scarabaeus (Pachysoma (Coleoptera: Scarabaeidae: Scarabaeinae

    Directory of Open Access Journals (Sweden)

    Federico C. Ocampo

    2005-07-01

    Full Text Available Se describe el comportamiento de reubicación del alimento del género sudamericano Eucranium Brullé basado en observaciones en su ambiente natural. La preferencia de alimento, el modo de transportarlo, preferencia de hábitat, y período de actividad en la superficie son discutidos para dos especies: E. arachnoides Brullé y E. planicolle Burmeister. La biología y comportamiento de relocación del alimento de Eucranium es comparado con la biología y comportamiento del subgénero del sudoeste de África Scarabaeus (Pachysoma MacLeay, el cual es similar morfológicamente. La convergencia adaptativa a los ambientes áridos de Eucranium y S. (Pachysoma son discutidas.The food relocation and nesting behavior of the South American genus Eucranium Brullé is described based on observations carried out under natural conditions. Food preference, food transportation, period of surface activity, and habitat preference are described for two species, E. arachnoides Brullé and E. planicolle Burmeister. The biology and food relocation behavior of Eucranium is compared with that of the morphologically similar South African subgenus Scarabaeus (Pachysoma MacLeay. The convergent adaptations to psamophilous habitats of Eucranium and S. (Pachysoma are discussed.

  10. 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.

  11. Macrophages and dendritic cells in the rat meninges and choroid plexus: three-dimensional localisation by environmental scanning electron microscopy and confocal microscopy.

    Science.gov (United States)

    McMenamin, Paul G; Wealthall, Rosamund J; Deverall, Marie; Cooper, Stephanie J; Griffin, Brendan

    2003-09-01

    The present investigation provides novel information on the topographical distribution of macrophages and dendritic cells (DCs) in normal meninges and choroid plexus of the rat central nervous system (CNS). Whole-mounts of meninges and choroid plexus of Lewis rats were incubated with various anti-leucocyte monoclonal antibodies and either visualised with gold-conjugated secondary antibody followed by silver enhancement and subsequent examination by environmental scanning electron microscopy or by the use of fluorochromes and confocal microscopy. Large numbers of MHC class II(+) putative DCs were identified on the internal or subarachnoid aspect of dural whole-mounts, on the surface of the cortex (pia/arachnoid) and on the surface of the choroid plexus. Occupation of these sites would allow DCs access to cerebrospinal fluid (CSF) and therefore allow antigens into the subarachnoid space and ventricles. By contrast, macrophages were less evident at sites exposed to CSF and were more frequently located within the connective tissue of the dura/arachnoid and choroid plexus stroma and also in a sub-pial location. The present data suggest that DC may be strategically located within the CNS to sample CSF-borne antigens. Furthermore, the data suggest that CNS tissue samples collected without careful removal of the meninges may inadvertently be contaminated by DCs and meningeal macrophages.

  12. [The meninges, an anatomical point of view].

    Science.gov (United States)

    Sakka, L; Chazal, J

    2005-03-01

    The meninges correspond to an anatomical concept. For the morphologist, the microscopic organization, the hypothetical presence of a subdural space, the nature of the interface between the deep meningeal layer and the nervous parenchyma in the perivascular spaces are the central issues. For the clinician, dynamic aspects of cerebrospinal fluid flow, secretion, and resorption are essential factors with practical consequences in terms of disease and patient management. Comparative anatomy, embryology, and organogenesis provide an interesting perspective for the descriptive and functional anatomy of the meninges. Usually considered as protective membranes, the meninges play a prominent role in the development and maintenance of the central nervous system. The meninges are in constant evolution, from their formation to senescence. The meninges present three layers in children and adults: the dura mater, the arachnoid and the pia mater. The cerebrospinal fluid is secreted by the choroid plexuses, flows through the ventricles and the subarachnoid space, and is absorbed by arachnoid granulations. Other sites of secretion and resorption are suggested by comparative anatomy and human embryology and organogenesis.

  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.

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

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    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.

  15. 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.

  16. Large/giant meningiomas of posterior third ventricular region: falcotentorial or velum interpositum?

    Science.gov (United States)

    Behari, Sanjay; Das, Kuntal Kanti; Kumar, Ashish; Mehrotra, Anant; Srivastava, Arun K; Sahu, Rabi N; Jaiswal, Awadhesh K

    2014-01-01

    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.

  17. 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.

  18. [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.

  19. Thin-section CT scan of the pituitary gland

    Energy Technology Data Exchange (ETDEWEB)

    Fukuda, T.; Inoue, Y.; Taniguchi, S. (Osaka City Univ. (Japan). Faculty of Medicine)

    1982-02-01

    Topographic anatomy of the pituitary fossa was studied by 2 mm thin-section CT scan (Somatom II). Nineteen with normal pituitary (control group) and 20 with suspected pituitary abnormality were selected. Plain and contrast CT were performed in all cases. Contrast CT was carried out immediately after the rapid infusion of 220 ml of 30% iodinated contrast medium. In all of control group but two, pituitary gland was detected as homogeneous density and its density was the same as the density of normal brain tissues, and was enhanced in degree of about 25 CT number. In 2 cases, small low density was visualized in the pituitary gland. Pituitary gland was differentiated from cavernous sinus was usually higher than the pituitary gland. In the abnormal group, microadenoma of the pituitary gland was diagnosed in 5 cases and 3 out of 5 cases was proved by surgery. All 3 microadenomas proved slightly dense by plain CT and enhanced higher than normal pituitary gland by contrast CT. Polytomograms showed no abnormality of the sella turcica in one of these 3 cases. Although 3 microadenomas were detected by the abnormal enhancement, we are not sure whether all microadenoma can be detected by CT alone. Arachnoid herniation into the pituitary fossa was diagnosed in 7 of the control group and 2 of the abnormal group. Four out of these 9 cases were verified by using Metrizamide CT. By plain thin-section CT, the diagnosis of arachnoid herniation seems to be possible without Metrizamide CT.

  20. CSF Flow in the Brain in the Context of Normal Pressure Hydrocephalus.

    Science.gov (United States)

    Bradley, W G

    2015-05-01

    CSF normally flows back and forth through the aqueduct during the cardiac cycle. During systole, the brain and intracranial vasculature expand and compress the lateral and third ventricles, forcing CSF craniocaudad. During diastole, they contract and flow through the aqueduct reverses. Hyperdynamic CSF flow through the aqueduct is seen when there is ventricular enlargement without cerebral atrophy. Therefore, patients presenting with clinical normal pressure hydrocephalus who have hyperdynamic CSF flow have been found to respond better to ventriculoperitoneal shunting than those with normal or decreased CSF flow. Patients with normal pressure hydrocephalus have also been found to have larger intracranial volumes than sex-matched controls, suggesting that they may have had benign external hydrocephalus as infants. While their arachnoidal granulations clearly have decreased CSF resorptive capacity, it now appears that this is fixed and that the arachnoidal granulations are not merely immature. Such patients appear to develop a parallel pathway for CSF to exit the ventricles through the extracellular space of the brain and the venous side of the glymphatic system. This pathway remains functional until late adulthood when the patient develops deep white matter ischemia, which is characterized histologically by myelin pallor (ie, loss of lipid). The attraction between the bare myelin protein and the CSF increases resistance to the extracellular outflow of CSF, causing it to back up, resulting in hydrocephalus. Thus idiopathic normal pressure hydrocephalus appears to be a "2 hit" disease: benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood.

  1. 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),

  2. Incidence of common variant and disease in young adult brain by using magnetic resonance imaging%正常青年人群脑磁共振检查中常见变异及病变发生率

    Institute of Scientific and Technical Information of China (English)

    吴站蓉; 平昭; 董大伟

    2012-01-01

    目的 观察对正常青年志愿者脑组织行MRI平扫检查检出常见变异及病变的发生率.方法 使用SIEMENS Trio Tim 3.0T MRI扫描仪对60例正常青年人行MRI平扫,T1WI、T2WI序列,必要时加扫FLAIR或DWI.结果 在男女各30例志愿者中发现蛛网膜下腔囊肿4例(男3例,女1例),发生部位分别为中颅凹2例,枕大池2例;透明隔囊肿1例;脱髓鞘改变4例(男3例,女1例).结论 蛛网膜下腔囊肿在正常人群中有一定发生率,通常男性多于女性,透明隔囊肿也有少量发生率,缺血性脱髓鞘改变在无神经系统临床表现正常青年人群中并不罕见.%Objective To study incidence of common variant and disease in normal young adult volunteer brain by MRI. Methods 60 normal young adults were examined by magnetic resonance general scan at SIEMENS Trio Tim 3.0T MRI (T1WI, T2WI). To scan FLAIR or DWI in needing. Results Among 60 normal young adults (male 30 cases, female 30 cases), intracranial arachnoid cysts was 4 cases, male 3 cases and female 1 case, location middle cranial fossa was 2 cases and posterior fossa was 2 cases; septi pellucidi was 1 case; demyelinating disease was 4 cases, male 3 cases and female 1 case. Conclusion Intracranial arachnoid cysts has any incidence; incidence of intracranial arachnoid cysts is male finding more than female; septi pellucidi has a little incidence; demyelinating disease is not rare in normal young adult volunteer brain.

  3. The use of low intensity laser radiation in the treatment of patients with closed traumatic brain injury consequences

    Directory of Open Access Journals (Sweden)

    Kolesov V.N.

    2016-06-01

    Full Text Available Objective: to determine the effectiveness of the use of low-intensity helium-neon laser radiation in patients with post-traumatic cerebral arachnoiditis. Material and Methods. We observed 164 patients with the effects of closed craniocerebral injuries of a various severity. Methods of percutaneous laser irradiation of blood in the projection of the common carotid artery at the level of IV cervical vertebra was carried out underthe supervision of the clinical evaluation of hemodynamic data survey methods. Results. Positive results of hemodynamic parameters of examination methods indicate regression of cerebral vasospasm and improving brain vascular reserve, which led to a decrease in cerebral and focal neurological symptoms. Conclusion. The method allows the use of this technique in these patients both in the hospital and at the outpatient stage.

  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. MR imaging of meningeal carcinomatosis by systemic malignancy%系统性恶性肿瘤所致脑膜癌病的磁共振成像表现

    Institute of Scientific and Technical Information of China (English)

    马林; 蔡幼铨; 梁丽; 郭行高; 于生元

    2001-01-01

    目的 探讨脑膜癌病的MRI表现特点,提高对脑膜癌病的影像学认识和诊断水平。方法 经确诊的脑膜癌病11例,MR常规扫描后均行钆喷替酸葡甲胺(Gd-DTPA)增强扫描,对其增强特点及病变类型进行了回顾性分析。结果 MR平扫均未见脑膜异常信号。增强扫描后9例显示软脑膜异常增强,表现为脑表面连续的、可延伸至脑沟内的细线状高信号,累及范围包括小脑、脑干及大脑表面,但未见明确的蛛网膜下腔异常增强。3例显示硬脑膜-蛛网膜异常增强,表现为大脑凸面或小脑幕等处连续的、较粗的弧线状高信号,该信号不延伸至脑沟内,3例均累及大脑凸面,其中1例同时累及小脑凸面和小脑幕。9例累及软脑膜者脑脊液均为异常,2例仅累及硬脑膜-蛛网膜者脑脊液均为正常。结论 MR增强扫描能很好地显示脑膜癌病,根据增强特点可以区分脑膜癌病的类型,结合临床对脑膜癌病能作出诊断并指导治疗。%Objective To investigate the 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 subarachnoid space was found. Abnormal dura-arachnoid enhancement was seen in 3 cases, showing

  6. Spontaneous development of bilateral subdural hematomas in an infant with benign infantile hydrocephalus: color Doppler assessment of vessels traversing extra-axial spaces

    Energy Technology Data Exchange (ETDEWEB)

    Amodio, John; Spektor, Vadim; Pramanik, Bidyut; Rivera, Rafael; Pinkney, Lynne; Fefferman, Nancy [New York University Medical Center, Department of Radiology, New York, NY (United States)

    2005-11-01

    We present an infant with macrocrania, who initially demonstrated prominent extra-axial fluid collections on sonography of the brain, compatible with benign infantile hydrocephalus (BIH). Because of increasing macrocrania, a follow-up sonogram of the brain was performed; it revealed progressive enlargement of the extra-axial spaces, which now had echogenic debris. Color Doppler US showed bridging veins traversing these extra-axial spaces, so it was initially thought that these spaces were subarachnoid in nature (positive cortical vein sign). However, an arachnoid membrane was identified superior to the cortex, and there was compression of true cortical vessels beneath this dural membrane. An MRI of the brain showed the extra-axial spaces to represent bilateral subdural hematomas. The pathogenesis of spontaneous development of the subdural hematomas, in the setting of BIH, is discussed. We also emphasize that visualizing traversing bridging veins through extra-axial spaces does not necessarily imply that these spaces are subarachnoid in origin. (orig.)

  7. 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

  8. Cystic lesions of the pineal region - MRI and pathology

    Energy Technology Data Exchange (ETDEWEB)

    Engel, U. [Department of Neuropathology, Benjamin-Franklin-Klinikum, Faculty of Medicine, Freie Universitaet Berlin, Hindenburgdamm 30, 12200 Berlin (Germany); Gottschalk, S.; Niehaus, L.; Lehmann, R. [Department of Neuroradiology, Institute of Radiological Diagnosis, Charite University Hospital, Berlin (Germany); May, C.; Vogel, S. [Neurosurgical Clinic, St. Gertraud' s Hospital, Berlin (Germany); Jaenisch, W. [Department of Neuropathology, Landesklinik Brandenburg (Germany)

    2000-06-01

    Pineal lesions are rare. Tumours in this location comprise 0.4-1% of intracranial tumours. They grow mainly as solid-mass lesions, and cystic tumours are not common. On MRI, a cystic configuration is associated usually with non-neoplastic pineal lesions rather than with a tumour, but analysis does not allow cystic pineal tumours to be distinguished from glial cysts with certainty. We compared neuroradiological and pathological data from 13 cystic pineal lesions, analysing preoperative MRI. Formalin-fixed, paraffin-embedded surgical specimens were stained routinely and immunocytochemically, using the streptavidin-biotin-complex method. Histology revealed six pineocytomas, four glial cysts, an arachnoid cyst, a low-grade astrocytoma and a teratoma. Signal characteristics of pineocytomas were similar in many respects to those of glial pineal cysts. Histomorphological analysis allowed unambiguous discrimination between pineocytomas and glial pineal cysts. (orig.)

  9. 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.

  10. Arrested Pneumatization of the Sphenoid Sinus on Large Field-of-View Cone Beam Computed Tomography Studies

    Directory of Open Access Journals (Sweden)

    Mehrnaz Tahmasbi-Arashlow

    2015-05-01

    Full Text Available Arrested pneumatization of the sphenoid sinus is a normal anatomical variant. The aim of this report is to define cone beam computed tomography (CBCT characteristics of arrested pneumatization of sphenoid sinus in an effort to help differentiate it from invasive or lytic skull base lesions. Two cases are presented with incidental findings. Both studies, acquired for other diagnostic purposes, demonstrated unique osseous patterns that were eventually deemed to be anatomic variations in the absence of clinical signs and symptoms although the pattern of bone loss and remodeling was diagnosed as pneumatization of the sphenoid sinus by a panel of medical and maxillofacial radiologists following contrasted advanced imaging. It is important to differentiate arrested pneumatization of the sphenoid sinus from lesions, such as arachnoid granulations, acoustic neuroma, glioma, metastatic lesions, meningioma, or chordoma, to prevent unnecessary biopsies or exploratory surgeries that would consequently reduce treatment costs and alleviate anxiety in patients.

  11. Efficacy and Toxicity of Intrathecal Liposomal Cytarabine in First-line Therapy of Childhood Acute Lymphoblastic Leukemia

    DEFF Research Database (Denmark)

    Levinsen, Mette; Harila-Saari, Arja; Grell, Kathrine

    2016-01-01

    We investigated efficacy and toxicity of replacing conventional triple (cytarabine, methotrexate, and hydrocortisone) intrathecal therapy (TIT) with liposomal cytarabine during maintenance therapy among 40 acute lymphoblastic leukemia patients. Twenty-eight of 29 patients in the TIT arm received...... TIT and 9/11 in the liposomal cytarabine arm received liposomal cytarabine. Arachnoiditis occurred in all initial 5 patients given liposomal cytarabine and intrathecal prednisolone succinate. Subsequently liposomal cytarabine was given with systemic dexamethasone. Neurotoxicity occurred at 6....../27 liposomal cytarabine administrations with concomitant dexamethasone (22%). More liposomal cytarabine-treated patients experienced neurotoxicity in relation to intrathecal therapy during at least 1 cycle compared with TIT-treated patients (6/9 [67%] vs. 3/28 [11%], P=0.002). Apart from intermittent lower...

  12. 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.)

  13. Gadolinium-DTPA enhanced MRI with CHESS method for lumbar disc herniation; Visualization of affected nerve roots

    Energy Technology Data Exchange (ETDEWEB)

    Aota, Yoichi; Kumano, Kiyoshi; Hirabayashi, Shigeru; Ogawa, Yutaka; Yoshikawa, Koki (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan))

    1993-11-01

    A total of 34 DTPA-enhanced magnetic resonance imaging (MRI) studies were made pre- and/or post-operatively by using chemical shift selective method in 31 patients with lumbar disc herniation. DTPA enhancement was seen in affected nerve roots in 7 of 15 preoperative cases and 6 of 12 postoperative cases with unfavorable course. When straight leg raising test revealed severe stimulation to the lower extremity nerve roots (less than 45degree), affected nerve roots were significantly enhanced with DTPA. All enhanced sites, except for one of arachnoid inflammation, was most remarkably compressed by herniation. Edema within the affected nerve root would be detected by DTPA-enhanced MRI. (N.K.).

  14. Oculoectodermal syndrome: twentieth described case with new manifestations*

    Science.gov (United States)

    Figueiras, Daniela de Almeida; Leal, Deborah Maria de Castro Barbosa; Kozmhinsky, Valter; Querino, Marina Coutinho Domingues; Regueira, Marina Genesia da Silva; Studart, Maria Gabriela de Morais

    2016-01-01

    Oculoectodermal syndrome is a rare disease characterized by the association of aplasia cutis congenita, epibulbar dermoids, and other abnormalities. This report describes the twentieth case of the disease. We report a 4-year-old female child who presented with the classical features of the syndrome: aplasia cutis congenita and epibulbar dermoids. Our case expands the clinical spectrum of the disease to include: diffuse hyperpigmentation (some following the Blaschko´s lines); hypopigmented skin areas on the trunk; arachnoid cyst on the right fronto-parietal border; rounded left side of the hippocampus; and dermoid cyst underlying the bulb-medullary transition. Our patient also reported infantile hemangioma on the right wrist and verrucous hemangioma on the left leg, the latter not previously described in the literature.

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

    Science.gov (United States)

    Mack, Julie; Squier, Waney; Eastman, James T

    2009-03-01

    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.

  16. Pediatric Suprasellar Tumors.

    Science.gov (United States)

    McCrea, Heather J; George, Emilie; Settler, Allison; Schwartz, Theodore H; Greenfield, Jeffrey P

    2016-10-01

    The various childhood suprasellar tumors, while pathologically distinct, present similar clinical and surgical challenges as a result of their common anatomic location. These lesions are in close proximity to or may invade the optic nerve and chiasm, pituitary gland and infundibulum, hypothalamus, and third ventricle, leading to presenting features including visual field loss, impairment in visual acuity, endocrine dysfunction, and hydrocephalus. Though many suprasellar lesions are relatively benign in pathology, treatment may be complicated by high surgical morbidity resulting from damage to the hypothalamic-pituitary axis. Here we review the most frequent pediatric lesions occurring in the suprasellar region: craniopharyngioma, chiasmatic glioma, germ cell tumor, Rathke cleft and arachnoid cysts, pituitary adenoma, and histiocytosis. This review outlines both common presenting features and differentiating aspects of these lesions. It also includes classic radiographic presentations and treatment considerations for each lesion.

  17. 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.

  18. 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.

  19. 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.

  20. [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.

  1. 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.)

  2. The metrizamide study in neuroradiologic diagnosis: The clinical utility and side effects of the metrizamide

    Energy Technology Data Exchange (ETDEWEB)

    Song, Kounn Sik; Choo, In Wook; Chang, Kee Hyun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1985-12-15

    The retrospective analysis on the clinical utility and side effects of the metrizamide myelography and metrizamide CT cisternography were made in 292 patients. Metrizamide CT proved valuable in the diagnosis of intraspinal neoplasms with total block in myelography, demonstrating the upper margin of the neoplasms in a large number (75%) of the cases with neoplasm. Metrizamide study also clearly showed the nature and extent of the congenital anomalies such as spinal dysraphism, the exact site of leakage in CSF rhinorrhoea, the extent of the syringomyelia, and arachnoid cyst. Metrizamide CT was also helpful in the diagnosis of spinal stenosis, spinal trauma and infectious disease of the spine. The most common side effects were transient minor meningeal irritations (headache, nausea, vomiting and dizziness) which persisted no more than 48 hours in most of the patients. Five patients developed major complications such as grand mal seizure, toxic psychosis or aspetic meningitis.

  3. 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.

  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. Pleuropulmonary paragonimiasis with migrated lesions cured by multiple therapies

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    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.

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

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

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    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.)

  8. Simulated pituitary apoplexy: report of an unusual case due to hemorrhage into hypothalamic astrocytoma.

    Science.gov (United States)

    Glew, W B

    1977-02-01

    An unusual case of acute bilateral loss of vision simulating pituitary apoplexy but due instead to a fatal hemorrhage into a hypothalamic glioma is reported. The clinician dealing with abrupt loss of vision must promptly rule out ocular and orbital causes and then proceed immediately to a consideration of the variety of intracranial lesions which may cause sudden visual loss. Uihlein and Rucker have listed them in descending order of frequency: pituitary adenoma, tumors of the optic nerve and chiasm, supraclinoid aneurysm, parasellar lesion, thrombosis of the carotid artery, hydrocephalus of the third ventricle, chiasmal arachnoiditis, fracture of the anterior cranial fossa, basofrontal tumor of the skull, and pseudotumor cerebri. Neurologic, ophthalmologic, and neuroradiologic evaluations should be obtained without delay and will usually define the lesion and point to the appropriate treatment.

  9. Metrizamide lumbar epidurography with Seldinger technique through the sacral notch and selective nerve root injection

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    Hatten, H.P. Jr.

    1981-01-01

    Lumbar epidurography serves as an important radiographic procedure in the evaluation of patients with equivocal myelography and confusing or non-diagnostic physical findings. It is particularly valuable in patients with a wide ventral epidural space secondary to previous surgery, arachnoiditis or on a congenital basis. Several techniques and various contrast agents have been employed for the procedure. A pure Seldinger technique with a caudal approach through the sacral hiatus and injection of metrizamide gives excellent visualization of the epidural space and nerve root sleeves. The proper concentration of metrizamide is crucial for optimal results. Lateral, AP, and AP oblique radiographs, occasionally combined with lateral, complex motion tomography, clearly demonstrate the root sleeves and ventral epidural space. CT scanning, with present technology, does not provide the necessary detail for evaluating the epidural space.

  10. [Two cases of spontaneous cerebrospinal fluid (CSF) otorrhea with meningitis].

    Science.gov (United States)

    Mada, Yusuke; Ueki, Yuji; Konno, Akiyoshi

    2012-09-01

    We report on two cases of spontaneous CSF otorrhea, which were considered to have been caused by enlarged arachnoid granulation with bone erosion of the posterior fossa. Both cases visited us complaining of severe headache, due to bacterial meningitis. In the first patient, a 68-year-old male, a high resolution CT scan showed a bony defect in the posterior fossa plate in the right temporal bone, where CSF leakage was confirmed during the operation. In the second patient, a 54-year-old female, a bony defect was located in the posterior fossa in the left temporal bone. In both cases, the bony defects were repaired by occlusion with the pedicled temporal muscles after the meningitis had been treated. CSF otorrhea disappeared after the surgery, and has not recurred during the postoperative observation period of 1 to 3 years.

  11. The role of the basal cisterns in the development of posterior fossa skull base meningiomas

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    Florian Ioan Stefan

    2016-09-01

    Full Text Available Meningiomas account for more than 30% of all intracranial brain tumors, with 25% of them originating somewhere along the skull base and about 20% of these located in the posterior fossa. The intimate relation of these tumors with neural and vascular structures make them difficult to treat, both surgically and nonsurgically. Their treatment is further hampered by the lack of definitive recommendations, which is partially due to the fact that there is no general accepted model of classification. The present report proposes a new concept of classification of posterior fossa skull base meningiomas, one that takes into account the intimate relation of these tumors with arachnoid structures, simplifies the overcrowded landscape of their systematization and can be extended to oher skull base locations.

  12. Alcohol dementia and thermal dysregulation: a case report and review of the literature.

    Science.gov (United States)

    Tanev, Kaloyan S; Roether, Melissa; Yang, Clifford

    Wernicke's encephalopathy and Korsakoff's psychosis in alcoholics are thought to be due to thiamine deficiency. When the process goes untreated, patients may develop alcohol-induced persisting dementia. We review the literature on thermal dysregulation and the place of thiamine treatment in Wernicke's encephalopathy, Korsakoff's psychosis, and alcohol-induced persisting dementia. We describe a patient with alcohol-induced persisting dementia who showed thermal dysregulation which responded to parenteral but not oral thiamine. Subsequently, he developed aspiration pneumonia with associated fever reaction and expired. We describe the neuroimaging findings--diffuse cortical atrophy, ventricular dilatation, atrophy of the corpus callosum, hypothalamus, and medulla, and a probable arachnoid cyst in the left temporal tip. We conclude that thermal dysregulation was likely related to dysfunction of temperature regulatory brain centers, that thermal dysregulation was stabilized with parenteral but not oral thiamine, and that parenteral thiamine may have a role even in chronic cases of alcohol-induced persisting dementia.

  13. Recurrent, symptomatic, late-onset, contralateral subdural effusion following decompressive craniectomy treated by cranial strapping.

    Science.gov (United States)

    Krishnan, Prasad; Roy Chowdhury, Siddhartha

    2015-01-01

    Subdural effusions following decompressive craniotomy for trauma are usually benign, ipsilateral to the craniotomy and resolve spontaneously. Far less common and more dangerous are contralateral subdural effusions causing external cerebral herniation. We report a case of recurrent contralateral effusion and highlight the management dilemmas. Arachnoid tear is probably the cause of these collections. Contralateral subdural effusions should be suspected in patients who have delayed neurological deterioration after an initial improvement particularly in the setting of increased "flap bulge" though they may also be found in patients who remain moribund after initial surgery. There are no clear-cut guidelines on their management due to their rarity. A variety of options like subduro-peritoneal shunt and drainage with simultaneous cranioplasty may be tried. In situations where resources or patient compliance is an issue, tapping the effusion followed by cranial strapping may be tried as was done in our case.

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

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    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.

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

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    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.

  16. Cardiac Arrest after Connecting Negative Pressure to the Subgaleal Drain during Craniotomy Closure

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    Monu Yadav

    2014-01-01

    Full Text Available A one-year-old child operated on for arachnoid cyst in right frontoparietotemporal region had sudden bradycardia followed by cardiac arrest leading to death after connecting negative pressure to the subgaleal drain during craniotomy closure. The surgical procedure was uneventful. It is a common practice to place epidural or subgaleal drains connected to a vacuum system towards the end of craniotomy to prevent accumulation of intracranial and extracranial blood. The phenomenon of bradycardia with hypotension is known to occur following negative pressure application to the epidural, epicranial, or subgaleal space after craniotomy closure. However cardiac arrest as a complication of negative pressure suction drain in neurosurgical patients is not described in the literature.

  17. Multiple spinal extradural meningeal cysts presenting as acute paraplegia. Case report and review of the literature.

    Science.gov (United States)

    Marbacher, Serge; Barth, Alain; Arnold, Marlene; Seiler, Rolf W

    2007-05-01

    Multiple spinal extradural meningeal cysts are rare. To the authors' knowledge, there have been only four reported cases in the world literature. The authors report a case of multiple spinal extradural meningeal cysts in a 31-year-old woman presenting with acute paraplegia. Magnetic resonance imaging of the thoracolumbar spine revealed multiple extradural cystic lesions extending from T-7 to T-8 and from T-12 to L-3. Intraoperative findings demonstrated a white, fibrous, and tense cyst filled with cerebrospinal fluid-like colorless fluid. Excision of the posterior wall of the symptomatic cyst was followed by immediate neurological improvement. The examination of the pathological specimen showed a thick duralike layer of collagen and an inner membrane of arachnoid that is often not found in these lesions. The final diagnosis was based on combined imaging, intraoperative, and histopathological findings. The authors review the literature and discuss the etiological, diagnostic, and therapeutic aspects of this lesion.

  18. Delleman Oorthuys syndrome

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    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. Epidermoid cysts of the velum interpositum.

    Science.gov (United States)

    Bahuleyan, Biji; Daniel, Roy T; Chacko, Geeta; Chacko, Ari G

    2008-10-01

    The cistern of the velum interpositum is a space located between the corpus callosum dorsally and the roof of the third ventricle ventrally. Lesions located within the velum interpositum are rare and include meningiomas, pilocytic astrocytomas, atypical teratoid/rhabdoid tumors and arachnoid cysts. Epidermoid cysts in this location have not been reported previously. We report the clinical and radiological features of two patients with epidermoid cysts located in the velum interpositum. The patients presented with gait difficulty and features of raised intracranial pressure and magnetic resonance imaging demonstrated large tumors in the velum interpositum with intensities suggestive of epidermoid cysts. There was ventral displacement of the internal cerebral veins and dorsal displacement of the corpus callosum in keeping with a mass in the velum interpositum. Tumors of the third ventricle displace the internal cerebral veins dorsally. A transcallosal approach was used in both patients to effectively excise the tumors.

  20. Intraparenchymal Angiomatous Meningioma: A Diagnostic Dilemma.

    Science.gov (United States)

    Bansal, Divya; Diwaker, Preeti; Gogoi, Priyanka; Nazir, Wazid; Tandon, Anupama

    2015-10-01

    Meningioma arises from the arachnoid cap cells of the cerebrum. Intraparenchymal meningiomas or meningiomas without dural attachment are rare. We report a case of 40-year-old male who presented with a history of headache, dizziness and gradual loss of vision since one year. Clinicoradiological diagnosis of a high grade glioma was considered. Tumour was excised and haematoxylin and eosin stained sections revealed a tumour comprised predominantly of variable sized blood vessels showing hyalinization in a background of plump spindle cells with oval vesicular nuclei. In view of these features angiomatous meningioma was suspected. However, to confirm the diagnosis, a panel of immunohistochemical markers including vimentin, EMA and GFAP was done and a final diagnosis of angiomatous meningioma was offered. Angiomatous meningioma is a rare variant of meningioma and even much rarer in the intraparenchymal location. Angiomatous meningioma should be considered in the differential diagnosis of highly vascular intraparenchymal brain tumours.

  1. [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.

  2. 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.

  3. 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.

  4. [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.

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

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    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.

  6. Intracranial neurenteric cyst traversing the brainstem

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    Jasmit Singh

    2015-01-01

    Full Text Available Neurenteric cysts (NECs, also called enterogenous cysts, are rare benign endodermal lesions of the central nervous system that probably result from separation failure of the notochord and upper gastrointestinal tract. Most frequently they are found in the lower cervical spine or the upper thoracic spine. Intracranial occurrence is rare and mostly confined to infratentorial compartment, in prepontine region [51%]. Other common locations are fourth ventricle and cerebellopontine angle. There are few reports of NEC in medulla or the cerebellum. Because of the rarity of the disease and common radiological findings, they are misinterpreted as arachnoid or simple cysts until the histopathological confirmation, unless suspected preoperatively. We herein report a rare yet interesting case of intracranial NEC traversing across the brainstem.

  7. Transglutaminase 2 expression is increased as a function of malignancy grade and negatively regulates cell growth in meningioma.

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    Yin-Cheng Huang

    Full Text Available Most meningiomas are benign, but some clinical-aggressive tumors exhibit brain invasion and cannot be resected without significant complications. To identify molecular markers for these clinically-aggressive meningiomas, we performed microarray analyses on 24 primary cultures from 21 meningiomas and 3 arachnoid membranes. Using this approach, increased transglutaminase 2 (TGM2 expression was observed, which was subsequently validated in an independent set of 82 meningiomas by immunohistochemistry. Importantly, the TGM2 expression level was associated with increasing WHO malignancy grade as well as meningioma recurrence. Inhibition of TGM2 function by siRNA or cystamine induced meningioma cell death, which was associated with reduced AKT phosphorylation and caspase-3 activation. Collectively, these findings suggest that TGM2 expression increases as a function of malignancy grade and tumor recurrence and that inhibition of TGM2 reduces meningioma cell growth.

  8. Giant calcified meningioma after radiation therapy; A case report

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    Zenke, Kiichiro; Fukumoto, Shinya; Ohta, Shinsuke; Sakaki, Saburo (Ehime Univ., Shigenobu (Japan). School of Medicine); Matsui, Seishi

    1993-09-01

    We presented a case of secondary giant meningioma with dense calcification (brain stone) after radiation therapy for primary ependymoma removed 25 years before. A 31-year-old man was referred to our hospital because of generalized convulsion. He had received extirpation of an ependymoma in the left frontoparietal region and postoperative radiation therapy 25 years before. Skull X-ray and CT revealed a giant brain stone in the left parietal region. It was totally removed en bloc. Photomicrograph of the specimen showed proliferation of arachnoid cell-like tumor cells in narrow spaces surrounded by marked calcified lesions which showed partial ossification. The etiology and therapy of this tumor were discussed. (author).

  9. 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.

  10. Patterns of contrast enhancement in the brain and meninges.

    Science.gov (United States)

    Smirniotopoulos, James G; Murphy, Frances M; Rushing, Elizabeth J; Rees, John H; Schroeder, Jason W

    2007-01-01

    Contrast material enhancement for cross-sectional imaging has been used since the mid 1970s for computed tomography and the mid 1980s for magnetic resonance imaging. Knowledge of the patterns and mechanisms of contrast enhancement facilitate radiologic differential diagnosis. Brain and spinal cord enhancement is related to both intravascular and extravascular contrast material. Extraaxial enhancing lesions include primary neoplasms (meningioma), granulomatous disease (sarcoid), and metastases (which often manifest as mass lesions). Linear pachymeningeal (dura-arachnoid) enhancement occurs after surgery and with spontaneous intracranial hypotension. Leptomeningeal (pia-arachnoid) enhancement is present in meningitis and meningoencephalitis. Superficial gyral enhancement is seen after reperfusion in cerebral ischemia, during the healing phase of cerebral infarction, and with encephalitis. Nodular subcortical lesions are typical for hematogenous dissemination and may be neoplastic (metastases) or infectious (septic emboli). Deeper lesions may form rings or affect the ventricular margins. Ring enhancement that is smooth and thin is typical of an organizing abscess, whereas thick irregular rings suggest a necrotic neoplasm. Some low-grade neoplasms are "fluid-secreting," and they may form heterogeneously enhancing lesions with an incomplete ring sign as well as the classic "cyst-with-nodule" morphology. Demyelinating lesions, including both classic multiple sclerosis and tumefactive demyelination, may also create an open ring or incomplete ring sign. Thick and irregular periventricular enhancement is typical for primary central nervous system lymphoma. Thin enhancement of the ventricular margin occurs with infectious ependymitis. Understanding the classic patterns of lesion enhancement--and the radiologic-pathologic mechanisms that produce them--can improve image assessment and differential diagnosis.

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

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    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

  12. 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.

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

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    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%.

  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. 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

  17. Amphetamine and environmentally induced hyperthermia differentially alter the expression of genes regulating vascular tone and angiogenesis in the meninges and associated vasculature.

    Science.gov (United States)

    Thomas, Monzy; George, Nysia I; Patterson, Tucker A; Bowyer, John F

    2009-10-01

    An amphetamine (AMPH) regimen that does not produce a prominent blood-brain barrier breakdown was shown to significantly alter the expression of genes regulating vascular tone, immune function, and angiogenesis in vasculature associated with arachnoid and pia membranes of the forebrain. Adult-male Sprague-Dawley rats were given either saline injections during environmentally-induced hyperthermia (EIH) or four doses of AMPH with 2 h between each dose (5, 7.5, 10, and 10 mg/kg d-AMPH, s.c.) that produced hyperthermia. Rats were sacrificed either 3 h or 1 day after dosing, and total RNA and protein was isolated from the meninges, arachnoid and pia membranes, and associated vasculature (MAV) that surround the forebrain. Vip, eNos, Drd1a, and Edn1 (genes regulating vascular tone) were increased by either EIH or AMPH to varying degrees in MAV, indicating that EIH and AMPH produce differential responses to enhance vasodilatation. AMPH, and EIH to a lesser extent, elicited a significant inflammatory response at 3 h as indicated by an increased MAV expression of cytokines Il1b, Il6, Ccl-2, Cxcl1, and Cxcl2. Also, genes related to heat shock/stress and disruption of vascular homeostasis such as Icam1 and Hsp72 were also observed. The increased expression of Ctgf and Timp1 and the decreased expression of Akt1, Anpep, and Mmp2 and Tek (genes involved in stimulating angiogenesis) from AMPH exposure suggest that angiogenesis was arrested or disrupted in MAV to a greater extent by AMPH compared to EIH. Alterations in vascular-related gene expression in the parietal cortex and striatum after AMPH were less in magnitude than in MAV, indicating less of a disruption of vascular homeostasis in these two regions. Changes in the levels of insulin-like growth factor binding proteins Igfbp1, 2, and 5 in MAV, compared to those in striatum and parietal cortex, imply an interaction between these regions to regulate the levels of insulin-like growth factor after AMPH damage. Thus, the

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

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    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. 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.

  20. 眼眶Ⅰ型神经纤维瘤颅眶骨异常的CT征%Cranio-Orbital Abnormalities in Orbital Neurofibromatosis Type Ⅰ

    Institute of Scientific and Technical Information of China (English)

    高文; 朱利民; 何彦津; 林婷婷; 张薇; 孙世振

    2010-01-01

    目的 探讨眼眶Ⅰ型神经纤维瘤(NF-1)颅眶骨异常的CT表现及机制.方法 2008年1月至2010年1月收治的7例眼眶NF-1患者中5例存在颅眶骨改变,分析该5例患者的临床资料和CT表现,全部病例均经手术病理和(或)临床证实.结果 5例眼眶NF-1中3例为颅眶沟通肿瘤(其中1例伴有上睑额部肿瘤),2例为上睑、颞、额部肿瘤.全部存在不同程度的颅眶骨异常,主要表现:蝶骨大翼缺失5例,眶上裂增大5例,眶壁骨质缺失1例,蝶鞍变形1例,颞骨变形1例.另外,4例患者相应部位蛛网膜囊肿.结论 眼眶NF-1大部分存在不同程度的颅眶骨异常,以蝶骨大翼缺失最为显著.其发生机制复杂,可能同时存在先天发育异常和继发性改变,有待临床研究.%Objective To review the possible manifestation and mechanism of Cranio-Orbital Changes in Orbital Neurofibromatosis Type Ⅰ (NF-1). Methods The CT imaging abnormalities of the orbit and cranium in 5 patients with Orbital NF-1 were reviewed retrospectively. Results Orbital and cranial abnormalities were documented in 5 patients including 3 cases of tumor in cranium-orbit and 2 cases of tumor in upper eyelid, tempora, and forehead. Five cases had defect of the greater sphenoid wings; 5 had expansion of the orbital foramen, the superior orbital fissure; 1 had epippium abnormality, 1 had temporal bone abnormality,1 had defect of wall of orbit. In addition, 4 cases of orbital and cranial abnormalities contiguous to the arachnoid cyst. Conclusions Patients with orbit NF-1, bony orbital and cranial changes occur frequently, and defects of the greater sphenoid wings can be explained by a congenital neuroectodermal and mesodermal maldevelopment hypothesis. In addition, the orbital NF-1 mass and arachnoid cyst is associated with orbital and cranial abnormalities.

  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. A CLINICAL AND EPIDEMIOLOGICAL STUDY OF MENINGEAL TUMORS

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    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.

  3. 先天性脊柱畸形和椎管内异常%Intraspinal Anomalies and Congenital Deformities of the Spine

    Institute of Scientific and Technical Information of China (English)

    王尚昆; 崔宽龙; 刘振堂

    1987-01-01

    Of 210 patients with congenital deformities of the spine, 21 (10%) were with congenital intraspinal anomalies, 15 of them with disste-matomyelia, 4 dermoid cyst, I neurenteric cyst and 1 arachnoid cyst. In most cases there were nervous functional disturbances. Therefore, a routine myelography, accurate diagnosis of in-traspiaal anomalies should be made before any correction of congenital spinal deformities. As for intraspinal anomalies.they should.be treated before the correction.%在210例先天性脊柱畸形中,有21例发现有椎管内异常.在这些异常中,以脊髓纵裂多见(15例),其他较少见的异常单独存在或与脊髓纵裂伴发,计有皮样囊肿4例(其中1例与脊髓纵裂并存),肠原性囊肿1例,蛛网膜囊肿1例,均经手术及病理证实.本文详细描述了椎管内异常的临床表现、X线检查、诊断、鉴别要点及治疗原则.

  4. 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).

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

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    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.

  6. 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.

  7. 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.

  8. 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.

  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. 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. CSF monoamine metabolites, cholinesterases and lactate in the adult hydrocephalus syndrome (normal pressure hydrocephalus) related to CSF hydrodynamic parameters.

    Science.gov (United States)

    Malm, J; Kristensen, B; Ekstedt, J; Adolfsson, R; Wester, P

    1991-03-01

    Monoamine metabolites, cholinesterases and lactic acid in lumbar cerebrospinal fluid (CSF) were investigated on patients with the adult hydrocephalus syndrome (idiopathic normal pressure syndrome; AHS, n = 15), Alzheimer's disease (AD, n = 14), multi-infarct dementia (MID, n = 13) and controls (n = 21). Patients had clinical and CSF hydrodynamic investigations. Monoamine concentrations were determined by reversed-phase liquid chromatography, cholinesterases and lactate were determined photometrically. In the AHS patients, CSF monoamine concentrations were not significantly different compared with controls, AD or MID patients. AHS and AD patients showed a similar reduction of CSF acetylcholinesterase activity compared with controls. Positive correlations were found in concentrations of CSF homovanillic acid, CSF 5-hydroxyindoleacetic acid and CSF lactic acid versus CSF outflow conductance (that is, resistance against CSF outflow) in the AHS patients. A similar pattern was observed in a subgroup of MID patients characterised by dilated ventricles and disturbed CSF hydrodynamics. These data suggest that a low CSF outflow conductance may facilitate the clearance of acidic substances from the arachnoid space at the probenecid sensitive active transport site. Alternative explanations would be that a pathologically low CSF outflow conductance is accompanied by an inverse caudorostral flow of CSF or a compromised trans-ependymal diffusion.

  12. Effect of thrombin concentration on the adhesion strength and clinical application of fibrin glue-soaked sponge.

    Science.gov (United States)

    Campos, Francia; Fujio, Shingo; Sugata, Sei; Tokimura, Hiroshi; Hanaya, Ryosuke; Bohara, Manoj; Arita, Kazunori

    2013-01-01

    Fibrin glue-soaked gelatin sponge (FGGS) has been used for tissue sealing in neurosurgical practice, but too rapid clotting of fibrin glue occasionally prevents good fixation of FGGS. Dilution of thrombin may provide adequate manipulation time between mixing fibrinogen and thrombin on gelatin sponge and application into the tissue defects. The present study characterized the effect of thrombin dilution on the adhesion strength of FGGS and retrospectively assessed the clinical usage of the dilution for filling dead space or sealing arachnoid defect in 255 cases who underwent transsphenoidal surgery for the last 66 months. FGGS was prepared using three different concentrations of thrombin: 250 (standard), 50 (1:5 dilution), and 25 (1:10 dilution) units/ml, and incubated for three different periods (5, 20, and 60 seconds). FGGSs were applied over two adjacently positioned porcine skins placed on two metallic plates. The adhesion strength was evaluated by measuring maximum tensile strength during pulling out the sliding plate at a constant rate of displacement. The maximum adhesion strength was greater for FGGS with 1:10 diluted thrombin solution than for FGGS prepared with higher concentrations (p < 0.05). Adhesion strength did not decay for 20 seconds after the mixture. Only four of 255 cases (1.6%) required second reconstruction of sella floor due to the cerebrospinal fluid leakage. FGGS prepared with diluted thrombin solution can provide adequate adhesion strength for clinical use.

  13. Meningeal involvement by a transformed mycosis fungoides following Hodgkin's disease.

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    Beylot-Barry, M; Dubus, P; Vergier, B; Cogrel, O; Marit, G; Beylot, C; Merlio, J P

    1999-11-01

    A 58-year-old man had long-standing lesions of presumed large plaque parapsoriasis. Following treatment for nodal Hodgkin's disease (HD), these became more infiltrated, with a diagnosis of mycosis fungoides (MF). A few months later, nodules appeared on the right leg, which was lymphoedematous after inguinal irradiation for HD. Histopathological examination showed CD3+, CD30-, CD15- large pleomorphic lymphocytes, leading to the diagnosis of transformed MF. The cutaneous lesions were successfully treated with topical nitrogen mustard and interferon alfa-2b then methotrexate, but his general health worsened with depression and malaise, without specific neurological symptoms or extracutaneous spreading of the lymphoma. Cerebral computed tomographic scan revealed a cerebellar subdural collection, arachnoid cyst and quadriventricular hydrocephaly, initially considered to be non-specific. After a few weeks, clinical symptoms of intracranial hypertension appeared, and a cerebrospinal fluid (CSF) examination revealed meningeal involvement by the lymphoma. These cells were CD3-negative and the diagnosis was confirmed by polymerase chain reaction (PCR) study, which revealed an identical clonal rearrangement of the T-cell receptor gamma gene between cutaneous biopsies and the CSF. Repeated intrathecal injections of methotrexate and cranial irradiation were performed and the patient was still alive after 13 months. This case illustrates the possible meningeal involvement of MF that may be preceded by atypical and mild neurological or psychiatric symptoms, which may be dissociated from the evolution of the cutaneous lesions. Moreover, PCR study may be useful for both diagnosis and monitoring.

  14. Bengt Liliequist: life and accomplishments of a true renaissance man.

    Science.gov (United States)

    Connor, David E; Nanda, Anil

    2017-02-01

    In the 1970s, the membrane of Liliequist became the accepted name for a small band of arachnoid membrane separating the interpeduncular and chiasmatic cisterns, making it one of the most recent of the universally accepted medical eponyms. The story of its discovery, however, cannot be told without a thorough understanding of the man responsible and his contribution to the growth of a specialty. Bengt Liliequist lived during what many would consider the Golden Age of neuroradiology. With his colleagues at the Serafimer Hospital in Stockholm, he helped set the standard for appropriate imaging of the CNS and contributed to more accurate localization of intracerebral as well as spinal lesions. The pneumoencephalographic discovery of the membrane that was to bear his name serves merely as a starting point for a career that spanned five decades and included the defense of two separate doctoral theses, the last of which occurred after his 80th birthday. Although the recognition of neuroradiology as a subspecialty did not occur in his home country of Sweden until after his retirement, and technological progress saw the obsolescence of the procedure that he had mastered, Dr. Liliequist's accomplishments and his contributions to the current understanding of neuroanatomy merit our continued praise.

  15. 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.

  16. Lesions in Meckel's cave: variable presentation and pathology.

    Science.gov (United States)

    Beck, D W; Menezes, A H

    1987-11-01

    A series of 12 patients with mass lesions arising from Meckel's cave is presented. Patients' age on presentation ranged from 13 months to 71 years. Nine of the 12 patients had symptoms referable to the fifth cranial nerve, but only three complained of facial pain. The 12 patients presented eight different pathological entities, including meningioma, lipoma, schwannoma, malignant melanotic schwannoma, arachnoid cyst, neurofibroma, epidermoid tumor, and chordoma. Computerized tomography and magnetic resonance imaging were most useful in localizing the lesion to Meckel's cave. All 12 patients underwent a subtemporal approach to the lesion, and gross total removal was achieved in 11. Postoperative results were excellent with no increased neurological deficits seen 3 months postoperatively. Most patients had resolution of the cranial nerve deficits except for fifth nerve function, which was impaired in nine patients postoperatively. This series demonstrates that lesions in Meckel's cave can have a varied and unusual presentation, as well as an assortment of pathology. Total removal of lesions in this area resulted in relief of symptoms in most patients, with minimum morbidity.

  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.

  18. Leptomeningeal angiomatosis of the left occipital surface detected by CT scan. With special reference to Sturge-Weber disease

    Energy Technology Data Exchange (ETDEWEB)

    Niiro, Masaki; Mihara, Tadahiro; Maeda, Yoshiki; Awa, Hiroshi; Kadota, Koki; Asakura, Tetsuhiko (Kagoshima Univ. (Japan). Faculty of Medicine)

    1982-10-01

    A case of left occipital leptomeningeal angiomatosis was reported. The patient was a 12-year-old boy who had episodes of severe vascular type headache accompanied by transient right homonymous hemianopsia. CT scan showed localized superficial high density area in the left occipital pole. Remarkable enhancement of the lower and inner surface of the left occipital lobe was demonstrated. Angiography showed poor filling of the distal portion of the left posterior cerebral artery. Skull tomograms showed linear calcifications in the left occipital region. Brain scan showed increased RI uptake in the left occipital region. During operation, the surface of the left occipital lobe was covered by excessive, fine, vascular networks which extended over the arachnoid membrane. The abnormal vessels were cauterized by a CO/sub 2/ laser as throughly as possible. The occipital pole felt gritty. Histologically, the abnormal vessels had spread into the subarachnoid space and were predominantly veins with thin and enlarged walls. The abnormal vessels followed the leptomeninges in the sulci of the cerebral cortex. Underneath the abnormal vessels, in the external layers of the cerebral cortex, calcium deposits were scattered and gliosis and degeneration of the ganglion cells were observed. The lesion was comparable with leptomeningeal angiomatosis. Though the pathological findings of the specimen, CT findings, and brain scan findings were extremely similar to those of Sturge-Weber disease, in this case, the typical clinical and roentgenographic findings of Sturge-Weber disease were all absent.

  19. 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.

  20. [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.

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.)

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

    Directory of Open Access Journals (Sweden)

    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. 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.

  6. MRI of the postoperative lumbar spine: triple-dose gadodiamide and fat suppression

    Energy Technology Data Exchange (ETDEWEB)

    Wilmink, J.T. [Radiology Department, University Hospital Maastricht, Postbus 5800, NL-6202 AZ Maastricht (Netherlands); Hofman, P.A.M. [Radiology Department, University Hospital Maastricht, Postbus 5800, NL-6202 AZ Maastricht (Netherlands)

    1997-08-01

    In ten patients who had undergone lumbar laminectomy, visual assessment of epidural scar enhancement and diagnostic confidence was performed after 0.1 mmol/kg gadodiamide intravenously, again after a further 0.2 mmol/kg, and once more using a fat-suppression sequence. The single-dose contrast-enhanced T1-weighted images showed clear enhancement of epidural scar in eight cases, and clearly improved diagnostic confidence as regards scar and/or disc herniation in six. Triple-dose contrast-enhanced images showed further increase in epidural enhancement clearly in only two cases and marginally in six, with no significant increase in diagnostic confidence. Fat-suppression, performed in eight cases, showed a further clear increase in epidural enhancement in seven cases, but again no increase in diagnostic confidence. In one patient with arachnoiditis contrast enhancement and diagnostic confidence increased only slightly after each contrast injection, and again with the fat-suppression sequence. Increasing contrast medium dose was thus not useful following laminectomy when epidural scarring obscures a possible recurrent disc herniation. Use of fat suppression may, however, permit reduction of the dose of contrast medium necessary to provide adequate scar enhancement. (orig.). With 2 figs., 4 tabs.

  7. 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.

  8. Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins.

    Science.gov (United States)

    Baltsavias, Gerasimos; Parthasarathi, Venkatraman; Aydin, Emre; Al Schameri, Rahman A; Roth, Peter; Valavanis, Anton

    2015-04-01

    We reviewed the anatomy and embryology of the bridging and emissary veins aiming to elucidate aspects related to the cranial dural arteriovenous fistulae. Data from relevant articles on the anatomy and embryology of the bridging and emissary veins were identified using one electronic database, supplemented by data from selected reference texts. Persisting fetal pial-arachnoidal veins correspond to the adult bridging veins. Relevant embryologic descriptions are based on the classic scheme of five divisions of the brain (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon). Variation in their exact position and the number of bridging veins is the rule and certain locations, particularly that of the anterior cranial fossa and lower posterior cranial fossa are often neglected in prior descriptions. The distal segment of a bridging vein is part of the dural system and can be primarily involved in cranial dural arteriovenous lesions by constituting the actual site of the shunt. The veins in the lamina cribriformis exhibit a bridging-emissary vein pattern similar to the spinal configuration. The emissary veins connect the dural venous system with the extracranial venous system and are often involved in dural arteriovenous lesions. Cranial dural shunts may develop in three distinct areas of the cranial venous system: the dural sinuses and their interfaces with bridging veins and emissary veins. The exact site of the lesion may dictate the arterial feeders and original venous drainage pattern.

  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. Evaluation of surgical therapy for syringomyelia by means of magnetic resonance imaging

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    Abe, Toshiaki; Yatsuzuka, Hitoshi; Nishida, Shin; Suzuki, Takashi; Nakamura, Norio; Ida, Masahiro

    1988-12-01

    Magnetic resonance imaging (MRI) was performed to evaluate surgical therapy in 18 patients with syringomyelia. Fourteen patients had a Chiari I-syringomyelia complex, ten of whom underwent Gardner's operation - suboccipital craniectomy, upper cervical laminectomy, arachnoid dissection around the foramen Magendie, dural plasty, and plugging of the obex. Postoperative MRI studies revealed a collapse of the syringomyelic cavity in the 10 patients; and an enlargement of the cisterna magna, with an upward displacement of the cerebellar tonsiles, an increase in the size of the anterior-posterior diameter of the medulla, and a widering of the lower part of the fourth ventricle in 9 patients. These MR findings were comparable with clinical improvement and the cessation of neurologic deterioration in patients with syringomyelia. Using cine MR images, the flow of cerebral spinal fluid (CSF) was analyzed in 6 patients. The turbulent flow of CSF in the cisterna magna was not detected before surgery. There was an active flow inside the syrinx in all the preoperative patients, but it was much less active in the patients who had undergone Gardner's operation, although they had a residual syrinx inside the spinal cord. This suggested that the pulsatile flow inside the syrinx might be transmitted from the fourth ventricle through the patent central canal. (Namekawa, K).

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Complications associated with posterior lumbar interbody fusion using Bagby and Kuslich method for treatment of spondylolisthesis

    Institute of Scientific and Technical Information of China (English)

    陈亮; 唐天驷; 杨惠林

    2003-01-01

    Objective To analyze complications associated with posterior lumbar interbody fusion (PLIF) in which two Bagby and Kuslich (BAK) interbody fusion cages were implanted.Methods A total of 118 patients with spondylolytic spondylolisthesis underwent single-level PLIF using two BAK cages filled with morselized autogenous bone. The major clinical and radiographic complications were analyzed after a follow-up with an average time of 2 years and 9 months.Results Complications were divided into intraoperative and postoperative complications. Intraoperative complications mainly included dural tear (4 patients, 3.4%), nerve root injury (3 patients, 2.5%) and suboptimal cage position (9 patients, 7.5%). No death was caused by the operation. Postoperative complications chiefly consisted of cage retropulsion (3 patients, 2.5%), cage subsidence (4 patients, 3.4%), and postlaminectomy arachnoiditis (2 patients, 1.7%). Pseudarthrosis was noted radiographically with evidence of motion between adjacent vertebra on lateral flexion-extension films and luciencies around the cages (2 patient, 1.7%), continuous posterior cage migration (2 patients, 1.7%) or continuous cage subsidence (2 patients, 1.7%). Two patients died, one from a traffic accident and the other from metastatic cancer 1 year postoperatively.Conclusions The results of this study indicate that PLIF with BAK cages is an effective but also technically difficult procedure. The relatively high incidence of complications reminds us of the importance of surgical indications and proper manipulations.

  14. CT Diagnosis of Diastematomyelia:a Report of 17 Cases%脊髓纵裂的CT诊断价值(附17例报告)

    Institute of Scientific and Technical Information of China (English)

    程斌; 王尚昆; 王坤正; 孙仲箎; 李恭才

    1994-01-01

    The Diagnosis of 17 out of 39 cases of diastematomyelia was made by CT.The characteristic findings were:a septum bivalving spinal canal and the spinal cord or eauda equina,an asymmetric parting of arachnoid sac and the spinal cord,and the widining of the spinal canal.CT not only demonstrates the level of pathology,but also shows the natural contour of the spinal canal and outlines the shape of the septum.%1978~1992年共收治脊髓纵裂39例,其中17例术前行CT检查确诊.CT特征:椎管中央有纵行骨嵴将脊髓或马尾分隔,多数骨嵴两侧蛛网膜下间隙及脊髓不均称;该部椎管扩大;椎体及附件结构紊乱.CT不仅能准确诊断损害的平面,而且能显示椎管的自然状态和骨嵴的种类及轮廓.

  15. [Bacillus cereus sepsis and subarachnoid hemorrhage following consolidation chemotherapy for acute myelogenous leukemia].

    Science.gov (United States)

    Kawatani, Eri; Kishikawa, Yuki; Sankoda, Chikahiro; Kuwahara, Nobuo; Mori, Daisuke; Osoegawa, Kouichi; Matsuishi, Eijo; Gondo, Hisashi

    2009-04-01

    A 64-year-old man with acute myelogenous leukemia (FAB classification, M7) in remission received consolidation chemotherapy with mitoxantrone/cytosine arabinoside. WBC counts decreased to 0/microl on day 14, and fever (39.3 degrees C) and epigastralgia developed on day 15. Cefozopran was instituted for febrile neutropenia; however, on day 16, he was found to be in cardiac arrest. CT scan on day 16 revealed subarachnoid hemorrhage. Gram-positive rods were isolated from blood cultures on day 15, and were later identified as B.cereus. He recovered transiently, but eventually died on day 19. Postmortem examination demonstrated many colonies of B. cereus in the cerebrum, cerebellum, lung, and liver. Hepatocyte necrosis was also observed in the liver. Bacterial aneurysms or septic emboli were not identified in the arachnoid vessels, but necrosis of cerebral vessels was prominent, which was considered to be the cause of subarachnoid hemorrhage. Fatal subarachnoid hemorrhage has been reported to be associated with B. cereus sepsis, which developed at nadir following chemotherapy for leukemia patients. Because of the aggressive clinical course of B. cereus sepsis, including the risk for subarachnoid hemorrhage, early treatment with effective antibiotics for B. cereus sepsis would be important in the management of leukemia patients after chemotherapy.

  16. Epilepsy and ring chromosome 20: case report

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    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.

  17. 青少年首发精神分裂症患者脑结构异常及其相关因素研究%structural brain abnormalities and clinical features in childhood-onset schizophrenia

    Institute of Scientific and Technical Information of China (English)

    杨春林; 潘伟刚; 马俊芳; 李军

    2016-01-01

    Objective To investigate the clinical features and structural brain abnormalities in childhood-onset schizophrenia. Methods Retrospective analysis clinical features and brain CT images of 379 patients diagnosed with schizophrenia from January 2013 to April 2016. The patients were divided into 2 groups;with(n = 39)and without(n = 340)structural brain abnormalities. Socio-demographic and clinical data were compared between two groups. To observe the abnormality rate of structure CT and the types of structural brain abnormalities and analyze the clinical features in childhood-onset schizophrenia. Results The abnormality rate of structure CT scan was 10. 3% . There were 17 cases with ventricular dilatation,11 cases with broadening of cerebral sulci,7 cases with enlarged cisterna magna,4 cases with arachnoid cyst. Compared to without structural brain abnormalities,childhood-onset schizophrenia with structural brain abnormalities significantly had younger age,more fre-quent abnormal maternal pregnancy( P 0.05).结论 青少年首发精神分裂症脑结构异常检出率较高,并且脑结构异常者起病年龄更小、母孕期异常更多,青少年精神分裂症脑结构异常可能为其神经生物学基础.

  18. A case of spontaneous cerebrospinal fluid rhinorrhea: Accurate detection of the leak point by magnetic resonance cisternography

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    Teppei Matsubara

    2014-01-01

    Full Text Available Background: Spontaneous cerebrospinal fluid (CSF rhinorrhea is a rare entity. The accurate preoperative localization of the leak point is essential for planning surgical treatment, but is sometimes difficult. To localize the leak point, magnetic resonance cisternography (MRC is the method of choice, but its effectiveness remains unclear. Case Description: A 34-year-old mildly obese female experienced spontaneous CSF rhinorrhea after an attack of bronchial asthma. High-resolution computed tomography (CT failed to reveal the leak point, while MRC demonstrated an arachnoid herniation at the olfactory cleft. The patient underwent endoscopic endonasal repair of the CSF leak with success. There has been no recurrence of CSF rhinorrhea for 14 months after surgery followed by the administration of acetazolamide. Conclusion: We report a rare case of spontaneous CSF rhinorrhea associated with benign intracranial hypertension, in which the leak point was successfully detected by MRC. The CSF leak was completely repaired by minimally invasive endoscopic endonasal surgery. MRC may be a reliable method for detecting CSF leak points.

  19. 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 .

  20. Cauda Equina Syndrome Secondary to Leptomeningeal Carcinomatosis of Gastroesophageal Junction Cancer

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    Amal Alkhotani

    2016-04-01

    Full Text Available Leptomeningeal carcinomatosis (LMC is a diffuse or multifocal malignant infiltration of the pia matter and arachnoid membrane. The most commonly reported cancers associated with LMC are breast, lung, and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. We report a case of LMC secondary to gastroesophageal junction cancer present initially with cauda equina syndrome. A 51-year-old male patient with treated adenocarcinoma of the gastroesophageal junction presented with left leg pain, mild weakness, and saddle area numbness. Initial radiological examinations were unremarkable. Subsequently, he had worsening of his leg weakness, fecal incontinence, and urine retention. Two days later, he developed rapidly progressive cranial neuropathies including facial diplegia, sensorineural hearing loss, dysarthria, and dysphagia. MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord, and cauda equina extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. The patient died within 10 days from the second presentation. In cancer patients with cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered. To our knowledge, this is the first case of LMC secondary to gastroesophageal cancer presenting with cauda equina syndrome.

  1. Central nervous system tuberculosis: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kioumehr, F.; Dadsetan, M.R.; Rooholamini, S.A.; Au, A.

    1994-02-01

    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.)

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

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    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.

  3. 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.)

  4. Pseudo-cerebrospinal fluid rhinorrhea following traumatic cerebrospinal fluid rhinorrhea surgery: a case report

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Pseudo-cerebrospinal fluid rhinorrhea is very rarely reported. In 1994, our hospital admitted such a case, and we report it here. CASE REPORT On May 28, 1994, a 37-year-old man was readmitted to our hospital one-year following treatment for head injury and cerebrospinal fluid rhinorrhea. He had been suffering from a recurrence of rhinorrhea for three months at the time of his readmission. One year prior, the patient had been suffering from a recurrence of the rhinorrhea for three meters. He complained of headaches, dizziness and a right rhinorrhea. The fluid was positive for glucose. Skull-base film showed a traverse fracture of the right petrous bone. For three months, conservative treatment of the rhinorrhea continued, then he was first admitted to our hospital. After admission, a right temperal craniotomy was performed. During surgery, a traverse fracture of the petrous bone was found. In addition, the dura matter over the fracture line was torn, and the fibrotic brain tissue with arachnoid protruded into the fracture fissure. The dura adhering to the edge of the fracture fissure was explored and the bared internal carotid artery discovered. The fracture fissure was occluded with free-muscle and fascia lata grafts. Postoperative intravenous antibiotic therapy and cerebrospinal fluid drainage were carried on for 72 hours. Ten days after the operation the patient was discharged without any symptoms.

  5. Sincipital Encephaloceles: A Study of Associated Brain Malformations

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    Shashidhar Vedavyas Achar

    2016-01-01

    Full Text Available Objective: The aim of this study was to evaluate the associated intracranial malformations in patients with sincipital encephaloceles. Materials and Methods: A hospital-based cross-sectional study was conducted over 8 years from June 2007 to May 2015 on 28 patients. The patients were evaluated by either computed tomography or magnetic resonance imaging whichever was feasible. Encephaloceles were described with respect to their types, contents, and extensions. A note was made on the associated malformations with sincipital encephaloceles. Results: Fifty percent of the patients presented before the age of 3 years and both the sexes were affected equally. Nasofrontal encephalocele was the most common type seen in 13 patients (46.4%, and corpus callosal agenesis (12 patients was the most common associated malformation. Other malformations noted were arachnoid cyst (10 patients, hydrocephalus (7 patients, and agyria-pachygyria complex (2 patients. Conclusion: Capital Brain malformations are frequently encountered in children with sincipital encephaloceles. Detail radiological evaluation is necessary to plan treatment and also to prognosticate such rare malformations.

  6. 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.

  7. Magnetic resonance imaging in complex partial seizures

    Energy Technology Data Exchange (ETDEWEB)

    Furune, Sunao; Negoro, Tamiko; Maehara, Mitsuo; Nomura, Kazushi; Miura, Kiyokuni; Takahashi, Izumi; Watanabe, Kazuyoshi (Nagoya Univ. (Japan). Faculty of Medicine)

    1989-09-01

    Magnetic resonance imaging (MRI) and computed tomography (CT) were performed on 45 patients with intractable complex partial seizures. MRI was performed with a superconducting whole-body scanner operating at 0.5 tesla (T) and 1.5 T. In patients with temporal lobe epilepsy, 8 of 24 patients had abnormal CT, but 16 or 24 patients showed abnormal MRI. 1.5 T MRI detected more abnormality than 0.5 T MRI when CT was normal. In patients with frontal lobe epilepsy, 5 of 7 patients had normal CT and MRI. In 2 other patients, MRI demonstrated an arachnoid cyst and increased signal intensity area on the T2-weighted images which were not detected by CT. In patients with occipital lobe epilepsy, 5 of 6 patients show abnormal CT and MRI. In patients with tuberous sclerosis, MRI revealed some increased signal intensity areas on the T2-weighted images in the occipital and temporal lobe, which were not detected by CT. Most surface EEG foci corresponded with the side of MRI abnormality. These data indicate that MRI is more informative than CT in complex partial seizures. MRI is the imaging technique of choice in the diagnosis of complex partial seizures. (author).

  8. [Cryptococcal meningitis in a patient with a ventriculoperitoneal shunt and monitoring for pulmonary sarcoidosis].

    Science.gov (United States)

    Baallal, H; El Asri, A C; Eljebbouri, B; Akhaddar, A; Gazzaz, M; El Mostarchid, B; Boucetta, M

    2013-02-01

    The fungus Cryptococcus neoformans can cause common opportunistic infection in acquired immune deficiency syndrome (AIDS) patients. But other conditions can be associated with sarcoidosis. Meningoencephalitis is the most common manifestation of this disease. One of the most important neurological complications is the development of intracranial hypertension (ICH), which may result in high morbidity and mortality. We report the case of a patient harboring a ventriculoperitoneal shunt, and having contracted a cryptococcal meningitis as a risk factor for pulmonary sarcoidosis. Brain MRI showed arachnoiditis, with a mass in contact with the right frontal horn. Indian ink staining of the cerebrospinal fluid (CSF) showed positivity that was confirmed by the identification of Cryptococcus neoformans after culture. The evolution was favorable under medical treatment with removal of material. The relationship between sarcoidosis and cryptococcosis, described in the literature is not coincidental but is a rare complication of sarcoidosis of potential severity (40% of mortality). Sarcoidosis is a common systemic disease that may increase host susceptibility to CNS cryptococcal infection without any other signs or symptoms of host immunosuppression. The diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.

  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. 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.

  11. Fungal Infections Associated with Contaminated Steroid Injections.

    Science.gov (United States)

    Kauffman, Carol A; Malani, Anurag N

    2016-04-01

    In mid-September 2012, the largest healthcare-associated outbreak in U.S. history began. Before it was over, 751 patients were reported with fungal meningitis, stroke, spinal or paraspinal infection, or peripheral osteoarticular infection, and 64 (8.5%) died. Most patients had undergone epidural injection, and a few osteoarticular injection, of methylprednisolone acetate that had been manufactured at the New England Compounding Center (NECC). The offending pathogen in most cases was Exserohilum rostratum, a brown-black soil organism that previously was a rare cause of human infection. Three lots of methylprednisolone were contaminated with mold at NECC; the mold from unopened bottles of methylprednisolone was identical by whole-genome sequencing to the mold that was isolated from ill patients. Early cases manifested as meningitis, some patients suffered posterior circulation strokes, and later cases were more likely to present with localized infection at the injection site, including epidural abscess or phlegmon, vertebral diskitis or osteomyelitis, and arachnoiditis with intradural involvement of nerve roots. Many patients with spinal or paraspinal infection required surgical intervention. Recommendations for treatment evolved over the first few weeks of the outbreak. Initially, combination therapy with liposomal amphotericin B and voriconazole was recommended for all patients; later, combination therapy was recommended only for those who were most ill, and voriconazole monotherapy was recommended for most patients. Among those patients who continued antifungal therapy for at least 6 months, outcomes for most appeared to be successful, although a few patients remain on therapy.

  12. 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.

  13. Exacerbation of preexisting neurological deficits by neuraxial anesthesia: report of 7 cases.

    Science.gov (United States)

    Aldrete, J Antonio; Reza-Medina, Marisela; Daud, Olga; Lalin-Iglesias, Silvia; Chiodetti, Gustavo; Guevara, Uriah; Wikinski, Jaime A; Torrieri, Alberto

    2005-06-01

    We undertook this case series to determine if preexisting neurological disease is exacerbated by either spinal or epidural anesthesia. In the website of the Arachnoiditis Foundation, we posted an offer to advise anesthesiologists in cases of neurological problems after either of these techniques was used. Contacts were made first by way of the Internet, confirmed by telephone, and maintained by fax, e-mail, or by special mail. Patients here described were cared for and observed by one of the authors, in a hospital, in Argentina or in Mexico. A total of 7 adult, ASA physical status I and II patients, including 3 men and 4 women, with subtle symptoms of neurological disease before anesthesia, are described. Two patients had continuous lumbar epidural anesthesia, 3 had spinals; in 2 more, attempted epidural blocks led to accidental dural puncture and were converted to subarachnoid anesthetics. All patients accepted neuraxial anesthesia without informing the anesthesiologists that they had mild neurological symptoms before surgery. Because anesthesiologists did not specifically inquire about subclinical neurological symptoms or prior neurological disease, anesthesiologists are advised to carefully inquire about prior neurological disease whether neuraxial anesthesia techniques are considered.

  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. 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.)

  16. Central nervous system tuberculosis.

    Science.gov (United States)

    Torres, Carlos; Riascos, Roy; Figueroa, Ramon; Gupta, Rakesh K

    2014-06-01

    Tuberculosis (TB) has shown a resurgence in nonendemic populations in recent years and accounts for 8 million deaths annually in the world. Central nervous system involvement is one of the most serious forms of this infection, acting as a prominent cause of morbidity and mortality in developing countries. The rising number of cases in developed countries is mostly attributed to factors such as the pandemic of acquired immunodeficiency syndrome and increased migration in a globalized world. Mycobacterium TB is responsible for almost all cases of tubercular infection in the central nervous system. It can manifest in a variety of forms as tuberculous meningitis, tuberculoma, and tubercular abscess. Spinal infection may result in spondylitis, arachnoiditis, and/or focal intramedullary tuberculomas. Timely diagnosis of central nervous system TB is paramount for the early institution of appropriate therapy, because delayed treatment is associated with severe morbidity and mortality. It is therefore important that physicians and radiologists understand the characteristic patterns, distribution, and imaging manifestations of TB in the central nervous system. Magnetic resonance imaging is considered the imaging modality of choice for the study of patients with suspected TB. Advanced imaging techniques including magnetic resonance perfusion and diffusion tensor imaging may be of value in the objective assessment of therapy and to guide the physician in the modulation of therapy in these patients.

  17. 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.

  18. SPECT and PET Imaging of Meningiomas

    Directory of Open Access Journals (Sweden)

    Varvara Valotassiou

    2012-01-01

    Full Text Available Meningiomas arise from the meningothelial cells of the arachnoid membranes. They are the most common primary intracranial neoplasms and represent about 20% of all intracranial tumors. They are usually diagnosed after the third decade of life and they are more frequent in women than in men. According to the World Health Organization (WHO criteria, meningiomas can be classified into grade I meningiomas, which are benign, grade II (atypical and grade III (anaplastic meningiomas, which have a much more aggressive clinical behaviour. Computed Tomography (CT and Magnetic Resonance Imaging (MRI are routinely used in the diagnostic workup of patients with meningiomas. Molecular Nuclear Medicine Imaging with Single Photon Emission Computed Tomography (SPECT and Positron Emission Tomography (PET could provide complementary information to CT and MRI. Various SPECT and PET tracers may provide information about cellular processes and biological characteristics of meningiomas. Therefore, SPECT and PET imaging could be used for the preoperative noninvasive diagnosis and differential diagnosis of meningiomas, prediction of tumor grade and tumor recurrence, response to treatment, target volume delineation for radiation therapy planning, and distinction between residual or recurrent tumour from scar tissue.

  19. 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.

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

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    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.

  1. 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.

  2. da Vinci robot-assisted keyhole neurosurgery: a cadaver study on feasibility and safety.

    Science.gov (United States)

    Marcus, Hani J; Hughes-Hallett, Archie; Cundy, Thomas P; Yang, Guang-Zhong; Darzi, Ara; Nandi, Dipankar

    2015-04-01

    The goal of this cadaver study was to evaluate the feasibility and safety of da Vinci robot-assisted keyhole neurosurgery. Several keyhole craniotomies were fashioned including supraorbital subfrontal, retrosigmoid and supracerebellar infratentorial. In each case, a simple durotomy was performed, and the flap was retracted. The da Vinci surgical system was then used to perform arachnoid dissection towards the deep-seated intracranial cisterns. It was not possible to simultaneously pass the 12-mm endoscope and instruments through the keyhole craniotomy in any of the approaches performed, limiting visualization. The articulated instruments provided greater dexterity than existing tools, but the instrument arms could not be placed in parallel through the keyhole craniotomy and, therefore, could not be advanced to the deep cisterns without significant clashing. The da Vinci console offered considerable ergonomic advantages over the existing operating room arrangement, allowing the operating surgeon to remain non-sterile and seated comfortably throughout the procedure. However, the lack of haptic feedback was a notable limitation. In conclusion, while robotic platforms have the potential to greatly enhance the performance of transcranial approaches, there is strong justification for research into next-generation robots, better suited to keyhole neurosurgery.

  3. Pathophysiology of acute meningitis caused by Streptococcus pneumoniae and adjunctive therapy approaches

    Directory of Open Access Journals (Sweden)

    Tatiana Barichello

    2012-05-01

    Full Text Available Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting piamater, arachnoid and the subarachnoid space. The intense inflammatory host's response is potentially fatal and contributes to the neurological sequelae. Streptococcus pneumoniae colonizes the nasopharynx, followed by bacteremia, microbial invasion and blood-brain barrier traversal. S. pneumoniae is recognized by antigen-presenting cells through the binding of Toll-like receptors inducing the activation of factor nuclear kappa B or mitogen-activated protein kinase pathways and subsequent up-regulation of lymphocyte populations and expression of numerous proteins involved in inflammation and immune response. Many brain cells can produce cytokines, chemokines and others pro-inflammatory molecules in response to bacteria stimuli, as consequence, polymorphonuclear are attracted, activated and released in large amounts of superoxide anion and nitric oxide, leading to the peroxynitrite formation, generating oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage, blood-brain barrier breakdown contributing to cell injury during pneumococcal meningitis.

  4. Risk factors for early post-operative neurological deterioration in dogs undergoing a cervical dorsal laminectomy or hemilaminectomy: 100 cases (2002-2014).

    Science.gov (United States)

    Taylor-Brown, F E; Cardy, T J A; Liebel, F X; Garosi, L; Kenny, P J; Volk, H A; De Decker, S

    2015-12-01

    Early post-operative neurological deterioration is a well-known complication following dorsal cervical laminectomies and hemilaminectomies in dogs. This study aimed to evaluate potential risk factors for early post-operative neurological deterioration following these surgical procedures. Medical records of 100 dogs that had undergone a cervical dorsal laminectomy or hemilaminectomy between 2002 and 2014 were assessed retrospectively. Assessed variables included signalment, bodyweight, duration of clinical signs, neurological status before surgery, diagnosis, surgical site, type and extent of surgery and duration of procedure. Outcome measures were neurological status immediately following surgery and duration of hospitalisation. Univariate statistical analysis was performed to identify variables to be included in a multivariate model. Diagnoses included osseous associated cervical spondylomyelopathy (OACSM; n = 41), acute intervertebral disk extrusion (IVDE; 31), meningioma (11), spinal arachnoid diverticulum (10) and vertebral arch anomalies (7). Overall 54% (95% CI 45.25-64.75) of dogs were neurologically worse 48 h post-operatively. Multivariate statistical analysis identified four factors significantly related to early post-operative neurological outcome. Diagnoses of OACSM or meningioma were considered the strongest variables to predict early post-operative neurological deterioration, followed by higher (more severely affected) neurological grade before surgery and longer surgery time. This information can aid in the management of expectations of clinical staff and owners with dogs undergoing these surgical procedures.

  5. [Lewis-Sumner syndrome presenting unilateral quadriceps amyotrophy as an initial symptom].

    Science.gov (United States)

    Fujiyama, J; Aita, T; Itoh, K; Hamano, T; Kumano, T; Kinomoto, K; Fujii, A; Yasokawa, T; Kuriyama, M

    2000-11-01

    We report a 55-year-old man with a chief complaint of wasting and weakness of the left quadriceps muscle. At age 54, he noticed difficulty in running and weakness in the left thigh, which gradually progressed. On the first admission to our hospital, based on the nerve conduction studies (NCS), the muscle biopsy findings showing neurologenic changes, and no abnormality of spinal MRI, we diagnosed as unilateral quadriceps amyotrophy, which resulted from an atypical form of spinal progressive muscular atrophy. One year later, he showed the bilateral hand weakness, conduction blocks on the right median and ulnar nerves by NCS, and the presence of serum anti-GM 1 antibody. From these findings, Lewis-Sumner syndrome was diagnosed. The therapy of high-dose intravenous immunoglobulin moderately improved his symptoms. The clinical symptoms of quadriceps amyotrophy is produced by various disorders including spinal progressive muscular atrophy, spinal extradural arachnoid cyst, rimmed vacuole myopathy, Becker dystrophy, limb-girdle dystrophy, and focal myositis. However, there have been no reports of a case of Lewis-Sumner syndrome. It is important to consider Lewis-Sumner syndrome in the differential diagnosis of quadriceps amyotrophy.

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

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    Ricardo Coentre

    2016-05-01

    Full Text Available 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.

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

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    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.

  8. Evidence of pathological conditions in the Florisbad cranium.

    Science.gov (United States)

    Curnoe, Darren; Brink, James

    2010-11-01

    Palaeopathological studies of the middle Pleistocene cranium from Florisbad (Free State, South Africa) document the presence of extensive cortical lesions and areas of thinning, a widened medullary cavity with destruction of the diploë, orbital roof lesions, a benign ectocranial neoplasm, and evidence for alveolar destruction, resorption, and antemortem tooth loss. Differential diagnosis suggests one or more possible aetiologies, including a haematological disorder, metabolic condition(s), Paget's disease of bone, or non-specific infection perhaps following trauma. Moreover, if not directly associated with those on the external vault, orbital lesions alone could have been caused by infection or an indeterminable factor such as pressure from an enlarged organ. Multiple parasagittal lesions on the internal vault cortex probably represent expansile lesions left by enlarged arachnoid granulations. A multifactorial model of pathogenesis may be most appropriate to account for dentoalveolar lesions and antemortem tooth loss. Additionally, there are clear indications of diagenetic alteration deep within the vault, as well as multiple signs of degeneration on the cranium. These complicate the assessment of pathological alterations and identification of their possible aetiology. The Florisbad cranium is the latest specimen to join the growing sample of Pleistocene hominin remains with non-fatal and non-trivial pathological disorders adding to understanding of early human ecology and lifestyle.

  9. 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.)

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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)

  19. Diseases of the nervous system among miners of the Far North and questions of prophylaxis

    Energy Technology Data Exchange (ETDEWEB)

    Ignat' eva, A.G.

    1982-10-01

    In the Far North and arctic regions of the USSR mine workers experience effects on the organism of extreme meteorologic factors (low temperature, shortened daylight and permafrost) in addition to professional hazards of vibration and noise. Diets may be deficient in water-soluble vitamins necessary for normal functioning of the nervous system. For 4 years 3,575 miners of the Far North and Arctic were observed. At times, noise and vibration are more intense in areas of permafrost. Temperature of mine air in winter is -20 to -40/sup 0/C, in summer -4 to -15/sup 0/C. As miners adapt to work in cold climates, their resistance weakens. Data showed only 1% of miners developed vibrational disease. Major neuropathology was damage to the peripheral nervous system caused by osteochondrosis, particularly of the spine with or without inflammation of spinal nerve roots. Other neurological diseases (vascular pathology of brain, diffuse neuritis, cerebral arachnoiditis) were observed in miners of different professional groups. Preventive treatment is recommended: observation of hygienic norms of work; rational rearrangement of work regimens of sick miners; periodic work on related tasks; hospital rest; twice yearly study units on physical therapy, massage, conditioning; use of preventive measures. (5 refs.)

  20. 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

  1. MRI analysis for different routing meningeal metastasis%不同途径脑膜转移瘤的MRI分析

    Institute of Scientific and Technical Information of China (English)

    张贵祥; 徐朝霞; 韩月东; 刘艳丽; 刘满生; 常英娟; 赵海涛

    2001-01-01

    目的 回顾性分析经手术及病理证实的59例不同途径脑膜转移瘤的MRI表现及诊断作用。方法 59例病人,男42例,女17例;年龄17~65岁。其中血源性脑膜转移24例,邻近肿瘤直接侵犯脑膜29例,颅内肿瘤经脑脊液播散6 例。59例脑膜转移均经平扫及注射钆喷替酸葡甲胺(Gd-DTPA)后扫描。结果 血源性脑膜转移主要表现为硬脑膜-蛛网膜或软脑膜-蛛网膜的增厚或结节,肿瘤直接侵犯脑膜均表现为肿瘤向远端延伸的由粗变细的类似“靶征”或“鼠尾征”,经脑脊液播散的脑膜转移均为沿脑蛛网膜下腔或室管膜下大小不等的结节灶。MRI平扫阳性:结节型12例,线状增厚型11例,混合型6例。增强扫描均有较明显的强化。结论 MRI是检出脑膜转移瘤的重要方法,疑有脑膜转移时应行增强MRI扫描。%Objective To retrospectively analyze MRI appearances of meningeal metastasis from different routs in 59 patients proved by operation or pathology. Methods Fifty-nine patients including 42 males and 17 females, aged 17-65 years, were studied. 24 hematogenous, 29 direct invasion, and 6 CSF dissemination metastatic cases were examined with and without enhancement MR examination. Results Hematogenous metastasis showed diffuse thickening or nodular pattern in the dural-arachnoid or pia-arachnoid. Invasion from adjacent intra- or extra-axial tumor demonstrated meningeal thickening and off towards periphery just like “tail of mouse” or “target signs”. CSF dissemination of intra-axial tumor showed subarachnoid space or subependymal diffuse thickening and nodular pattern. Positive of MRI plain scan were as follows: nodular pattern 12 cases, linar thickening pattern 11 cases, and mixed pattern 6 cases. All metastasis showed marked enhancement. Conclusion MRI was an important tool for detecting meningeal metastasis and post-contrast MR scan must be performed in

  2. 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。

  3. 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

  4. 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.

  5. 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。

  6. Evidence of connections between cerebrospinal fluid and nasal lymphatic vessels in humans, non-human primates and other mammalian species

    Directory of Open Access Journals (Sweden)

    Armstrong Dianna

    2004-12-01

    Full Text Available Abstract Background The parenchyma of the brain does not contain lymphatics. Consequently, it has been assumed that arachnoid projections into the cranial venous system are responsible for cerebrospinal fluid (CSF absorption. However, recent quantitative and qualitative evidence in sheep suggest that nasal lymphatics have the major role in CSF transport. Nonetheless, the applicability of this concept to other species, especially to humans has never been clarified. The purpose of this study was to compare the CSF and nasal lymph associations in human and non-human primates with those observed in other mammalian species. Methods Studies were performed in sheep, pigs, rabbits, rats, mice, monkeys and humans. Immediately after sacrifice (or up to 7 hours after death in humans, yellow Microfil was injected into the CSF compartment. The heads were cut in a sagittal plane. Results In the seven species examined, Microfil was observed primarily in the subarachnoid space around the olfactory bulbs and cribriform plate. The contrast agent followed the olfactory nerves and entered extensive lymphatic networks in the submucosa associated with the olfactory and respiratory epithelium. This is the first direct evidence of the association between the CSF and nasal lymph compartments in humans. Conclusions The fact that the pattern of Microfil distribution was similar in all species tested, suggested that CSF absorption into nasal lymphatics is a characteristic feature of all mammals including humans. It is tempting to speculate that some disorders of the CSF system (hydrocephalus and idiopathic intracranial hypertension for example may relate either directly or indirectly to a lymphatic CSF absorption deficit.

  7. 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.

  8. Disseminated oligodendroglial-like leptomeningeal tumors: preliminary diagnostic and therapeutic results for a novel tumor entity [corrected].

    Science.gov (United States)

    Preuss, Matthias; Christiansen, Holger; Merkenschlager, Andreas; Hirsch, Franz Wolfgang; Kiess, Wieland; Müller, Wolf; Kästner, Stefanie; Henssler, Andreas; Pekrun, Arnulf; Hauch, Holger; Nathrath, Michaela; Meixensberger, Jürgen; Pietsch, Torsten; Kuchelmeister, Klaus

    2015-08-01

    Pediatric tumors of the central nervous system composed of oligoid tumor cells showing diffuse leptomeningeal spread without a primary mass lesion seem to represent a novel tumor entity. The terms "diffuse leptomeningeal glioneural tumor" or-preferably-"disseminated oligodendroglial-like leptomeningeal tumor of childhood" (DOGLT) were proposed. Four patients were identified with clinico-neuropathologic findings compatible with DOGLT and a mean follow-up time of 54 months was determined. Seven different biopsies obtained from the four patients were histologically evaluated. Clinical course, diagnostic measures, histopathologic and radiologic features and treatment suggestions were recorded, on the basis of which diagnostic and therapeutic algorithm was proposed. Patients with DOGLT presented with hydrocephalus as first symptom, requiring neurosurgical therapy. Open arachnoid biopsy was necessary to confirm diagnosis. The oligoid cells in a desmoplastic or focally myxoid matrix showed OLIG2-, MAP2-, S-100 and rare HuC/HuD protein-immunopositivity. IDH1 (R132H)- and CD99-immunohistochemistry was negative in all patients. None of the evaluable biopsies of three patients showed chromosome 1p/19q deletion, neither as isolated nor combined allelic loss. Chemotherapy according to the SIOP-LGG 2004 standard induction and consolidation protocol resulted in complete response and partial response, respectively, in 50 % of the patients. However, after discontinuation of chemotherapy, two patients experienced tumor progression and one of them succumbed to the disease after 19 months. Radiological criteria as well as preliminary treatment results are presented after observation of four clinical cases. Prognosis and long-term clinical courses remain to be observed.

  9. Primatology in southern Brazil: a transdisciplinary approach to the conservation of the brown-howler-monkey Alouatta guariba clamitans (Primates, Atelidae

    Directory of Open Access Journals (Sweden)

    Leandro Jerusalinsky

    2010-12-01

    Full Text Available Human interventions in natural environments are the main cause of biodiversity loss worldwide. The situation is not different in southern Brazil, home of five primate species. Although some earlier studies exist, studies on the primates of this region began to be consistently carried out in the 1980s and have continued since then. In addition to important initiatives to study and protect the highly endangered Leontopithecus caissara Lorrini & Persson, 1990 and Brachyteles arachnoides E. Geoffroy, 1806, other species, including locally threatened ones, have been the focus of research, management, and protection initiatives. Since 1993, the urban monkeys program (PMU, Programa Macacos Urbanos has surveyed the distribution and assessed threats to populations of Alouatta guariba clamitans (Cabrera, 1940 in Porto Alegre and vicinity. PMU has developed conservation strategies on four fronts: (1 scientific research on biology and ecology, providing basic knowledge to support all other activities of the group; (2 conservation education, which emphasizes educational presentations and long-term projects in schools near howler populations, based on the flagship species approach; (3 management, analyzing conflicts involving howlers and human communities, focusing on mitigating these problems and on appropriate relocation of injured or at-risk individuals; and finally, (4 Public Policies aimed at reducing and/or preventing the impact of urban expansion, contributing to create protected areas and to strengthen environmental laws. These different approaches have contributed to protect howler monkey populations over the short term, indicating that working collectively and acting on diversified and interrelated fronts are essential to achieve conservation goals. The synergistic results of these approaches and their relationship to the prospects for primatology in southern Brazil are presented in this review.

  10. 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.

  11. Signet Cell in the Brain: A Case Report of Leptomeningeal Carcinomatosis as the Presenting Feature of Gastric Signet Cell Cancer

    Science.gov (United States)

    Khan, Muhammad Talha; Idrisov, Evgeny A; Maqsood, Aadil; Asad-Ur-Rahman, FNU; Abusaada, Khalid

    2017-01-01

    Malignant infiltration of pia and arachnoid mater, referred to as leptomeningeal carcinomatosis (LMC), is a rare complication of gastric carcinoma. The most common underlying malignancy in patients with LMC are leukemia, breast cancer, lymphoma, and lung cancer. We report a case of gastric adenocarcinoma that presented with LMC in the absence of overt gastrointestinal signs or symptoms. A 56-year-old Hispanic woman presented to the hospital with a three-week history of intermittent headaches and visual blurring. An initial brain imaging showed infarction in the distribution of right posterior inferior cerebellar artery (PICA) along with communicating hydrocephalus. She underwent ventriculoperitoneal (VP) shunt placement with improvement in her symptoms. Two months later she presented again with deterioration in her mental status. Imaging studies and cerebrospinal fluid (CSF) analysis confirmed the diagnosis of LMC. Further studies determined the primary tumor to be signet ring cell gastric adenocarcinoma. However, she did not have any preceding gastrointestinal symptoms. In light of the poor prognosis, the patient's family proceeded with comfort care measures. Our case portrays a rare presentation of gastric adenocarcinoma with LMC without other distant organ metastatic involvement. It also illustrates the occult nature of gastric carcinoma and signifies the importance of neurologic assessment of patients, with or at risk of gastric carcinoma. ​It also raises a theoretical concern for VP shunt as a potential conduit of malignant cells from the abdomen to the central nervous system, which may serve as an important susbtrate for future research.

  12. 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.

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

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    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

  14. MRI diagnosis and differential diagnosis of pineal region tumors%松果体区肿瘤的MRI诊断与鉴别诊断

    Institute of Scientific and Technical Information of China (English)

    岑家定

    2013-01-01

    Objective To discuss the MRI diagnosis and differential diagnosis of pineal region tumors. Methods Retrospected and analysed 28 cases of pineal region tumors diagnosed with MRI data. Results 8 cases of germ cell tumor, glioma with teratoma in 5 cases, 2 cases of meningioma, 4 cases of choriocarcinoma, neuroblastoma, pinealoblastoma, arachnoid cyst and skin itching cyst in 1 cases. The diagnostic results showed that only rely on the MRI signal was difficult to accurately diagnose,combined with clinical data was still needed. Conclusion MRI examination could accurately display the pineal region tumor morphology and location, diagnosis and differential diagnosis could be combined with the source to determine the tumor tissue, effectively improved the accuracy diagnosis and differential diagnosis.%  目的探讨松果体区肿瘤的MRI诊断与鉴别诊断。方法回顾分析28例松果体区肿瘤患者MRI诊断资料。结果生殖细胞瘤8例,胶质瘤及畸胎瘤各5例,脑膜瘤2例,绒毛膜癌4例,神经母细胞瘤、松果体母细胞瘤、蛛网膜囊肿及皮痒囊肿各1例。诊断结果显示,仅依靠MRI信号难以准确诊断,还需结合临床资料,有助于准确诊断。结论 MRI检查能够准确显示松果体区肿瘤的形态以及位置,诊断与鉴别诊断可以结合肿瘤的组织学来源确定,有效提高诊断以及鉴别诊断的准确性。

  15. Cannabidiol reduces host immune response and prevents cognitive impairments in Wistar rats submitted to pneumococcal meningitis.

    Science.gov (United States)

    Barichello, Tatiana; Ceretta, Renan A; Generoso, Jaqueline S; Moreira, Ana Paula; Simões, Lutiana R; Comim, Clarissa M; Quevedo, João; Vilela, Márcia Carvalho; Zuardi, Antonio Waldo; Crippa, José A; Teixeira, Antônio Lucio

    2012-12-15

    Pneumococcal meningitis is a life-threatening disease characterized by an acute infection affecting the pia matter, arachnoid and subarachnoid space. The intense inflammatory response is associated with a significant mortality rate and neurologic sequelae, such as, seizures, sensory-motor deficits and impairment of learning and memory. The aim of this study was to evaluate the effects of acute and extended administration of cannabidiol on pro-inflammatory cytokines and behavioral parameters in adult Wistar rats submitted to pneumococcal meningitis. Male Wistar rats underwent a cisterna magna tap and received either 10μl of sterile saline as a placebo or an equivalent volume of S. pneumoniae suspension. Rats subjected to meningitis were treated by intraperitoneal injection with cannabidiol (2.5, 5, or 10mg/kg once or daily for 9 days after meningitis induction) or a placebo. Six hours after meningitis induction, the rats that received one dose were killed and the hippocampus and frontal cortex were obtained to assess cytokines/chemokine and brain-derived neurotrophic factor levels. On the 10th day, the rats were submitted to the inhibitory avoidance task. After the task, the animals were killed and samples from the hippocampus and frontal cortex were obtained. The extended administration of cannabidiol at different doses reduced the TNF-α level in frontal cortex. Prolonged treatment with canabidiol, 10mg/kg, prevented memory impairment in rats with pneumococcal meningitis. Although descriptive, our results demonstrate that cannabidiol has anti-inflammatory effects in pneumococcal meningitis and prevents cognitive sequel.

  16. A visual description of the dissection of the cerebral surface vasculature and associated meninges and the choroid plexus from rat brain.

    Science.gov (United States)

    Bowyer, John F; Thomas, Monzy; Patterson, Tucker A; George, Nysia I; Runnells, Jeffrey A; Levi, Mark S

    2012-11-14

    This video presentation was created to show a method of harvesting the two most important highly vascular structures, not residing within the brain proper, that support forebrain function. They are the cerebral surface (superficial) vasculature along with associated meninges (MAV) and the choroid plexus which are necessary for cerebral blood flow and cerebrospinal fluid (CSF) homeostasis. The tissue harvested is suitable for biochemical and physiological analysis, and the MAV has been shown to be sensitive to damage produced by amphetamine and hyperthermia. As well, the major and minor cerebral vasculatures harvested in MAV are of potentially high interest when investigating concussive types of head trauma. The MAV dissected in this presentation consists of the pial and some of the arachnoid membrane (less dura) of the meninges and the major and minor cerebral surface vasculature. The choroid plexus dissected is the structure that resides in the lateral ventricles as described by Oldfield and McKinley. The methods used for harvesting these two tissues also facilitate the harvesting of regional cortical tissue devoid of meninges and larger cerebral surface vasculature, and is compatible with harvesting other brain tissues such as striatum, hypothalamus, hippocampus, etc. The dissection of the two tissues takes from 5 to 10 min total. The gene expression levels for the dissected MAV and choroid plexus, as shown and described in this presentation can be found at GSE23093 (MAV) and GSE29733 (choroid plexus) at the NCBI GEO repository. This data has been, and is being, used to help further understand the functioning of the MAV and choroid plexus and how neurotoxic events such as severe hyperthermia and AMPH adversely affect their function.

  17. Ex vivo and in vivo diffusion of ropivacaine through spinal meninges: influence of absorption enhancers.

    Science.gov (United States)

    Brandhonneur, Nolwenn; Dollo, Gilles; Ratajczak-Enselme, Maja; Deniau, Anne Laure; Chevanne, François; Estèbe, Jean Pierre; Legrand, Alain; Le Corre, Pascal

    2011-02-14

    Following epidural administration, cerebrospinal fluid bioavailability of local anesthetics is low, one major limiting factor being diffusion across the arachnoid mater barrier. The aim of this study was to evaluate the influence of absorption enhancers on the meningeal permeability of epidurally administered ropivacaine. Five enhancers known for their ability to increase drug permeability via transcellular and/or paracellular pathways, i.e. palmitoyl carnitine, ethylenediaminetetraacetic acid, sodium caprate, dodecylphosphocholine and pentylglycerol, were tested ex vivo on fresh specimen of meninges removed from cervical to lumbar level of rabbit spine following laminectomy and placed in diffusion chambers. Among them, sodium caprate lead to the best permeability improvement for both marker and drug (440% and 112% for mannitol and ropivacaine, respectively) and was therefore selected for in vivo study in a sheep model using microdialysis technique to evaluate epidural and intrathecal ropivacaine concentrations following epidural administration. Resulting dialysate and plasma concentrations were used to calculate pharmacokinetic parameters. Following sodium caprate pre-treatment, ropivacaine intrathecal maximal concentration (Cmax) was 1.6 times higher (78 ± 16 μg ml(-1) vs 129 ± 26 μg ml(-1), p<0.05) but the influence of the absorption enhancer was only effective the first 30 min following ropivacaine injection, as seen with the significantly increase of intrathecal AUC(0-30 min) (1629 ± 437 μg min ml(-1) vs 2477 ± 559 μg min ml(-1), p<0.05) resulting in a bioavailable fraction 130% higher 30 min after ropivavaine administration. Co-administration of local anesthetics with sodium caprate seems to allow a transient and reversible improvement of transmeningeal passage into intrathecal space.

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

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    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

  19. Aquaporin-4 expression in post-traumatic syringomyelia.

    Science.gov (United States)

    Hemley, Sarah J; Bilston, Lynne E; Cheng, Shaokoon; Chan, Jing Ning; Stoodley, Marcus A

    2013-08-15

    Aquaporin-4 (AQP4) is an astroglial water channel protein that plays an important role in the transmembrane movement of water within the central nervous system. AQP4 has been implicated in numerous pathological conditions involving abnormal fluid accumulation, including spinal cord edema following traumatic injury. AQP4 has not been studied in post-traumatic syringomyelia, a condition that cannot be completely explained by current theories of cerebrospinal fluid dynamics. Alterations of AQP4 expression or function may contribute to the fluid imbalance leading to syrinx formation or enlargement. The aim of this study was to examine AQP4 expression levels and distribution in an animal model of post-traumatic syringomyelia. Immunofluorescence and western blotting were used to assess AQP4 and glial fibrillary acidic protein (GFAP) expression in an excitotoxic amino acid/arachnoiditis model of post-traumatic syringomyelia in Sprague-Dawley rats. At all time-points, GFAP-positive astrocytes were observed in tissue surrounding syrinx cavities, although western blot analysis demonstrated an overall decrease in GFAP expression, except at the latest stage investigated. AQP4 expression was significantly higher at the level of syrinx at three and six weeks following the initial syrinx induction surgery. Significant increases in AQP4 expression also were observed in the upper cervical cord, rostral to the syrinx except in the acute stage of the condition at the three-day time-point. Immunostaining showed that AQP4 was expressed around all syrinx cavities, most notably adjacent to a mature syrinx (six- and 12-week time-point). This suggests a relationship between AQP4 and fluid accumulation in post-traumatic syringomyelia. However, whether this is a causal relationship or occurs in response to an increase in fluid needs to be established.

  20. 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.

  1. Longitudinal measurements of syrinx size in a rat model of posttraumatic syringomyelia.

    Science.gov (United States)

    Najafi, Elmira; Bilston, Lynne E; Song, Xin; Bongers, Andre; Stoodley, Marcus A; Cheng, Shaokoon; Hemley, Sarah J

    2016-06-01

    OBJECTIVE Syringomyelia pathophysiology is commonly studied using rodent models. However, in vivo studies of posttraumatic syringomyelia have been limited by the size of animals and lack of reliable noninvasive evaluation techniques. Imaging the rat spinal cord is particularly challenging because the spinal cord diameter is approximately 1-3 mm, and pathological lesions within the spinal cord parenchyma are even smaller. The standard technique has been histological evaluation, but this has its limitations. The aim of the present study was to determine whether syrinx size could be reliably measured using a preclinical high-field MRI animal system in a rat model of posttraumatic syringomyelia. METHODS The authors used an existing rat model of posttraumatic syringomyelia, which was created using a controlled pneumatic compression device to produce the initial spinal cord injury, followed by a subarachnoid injection of kaolin to produce arachnoiditis. T2-weighted MRI was performed on each animal using a 9.4-T scanner at 7, 10, and 13 weeks after injury. Animals were killed and syrinx sizes were calculated from in vivo MRI and histological studies. RESULTS MRI measurements of syrinx volume and length were closely correlated to histological measurements across all time points (Pearson product moment correlation coefficient r = ± 0.93 and 0.79, respectively). CONCLUSIONS This study demonstrates that high-field T2-weighted MRI can be used to measure syrinx size, and data correlate well with syrinx size measured using histological methods. Preclinical MRI may be a valuable noninvasive technique for tracking syrinx formation and enlargement in animal models of syringomyelia.

  2. 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

  3. The efficacy of intraoperative ultrasonography-assisted microinvasive cisterna magna reconstruction for Chiari malformation typeⅠwith syringomyelia

    Directory of Open Access Journals (Sweden)

    LI Peng-chao

    2012-08-01

    Full Text Available 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 typeⅠwith 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 × 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 method, the curative effect was divided into 3 groups, improved, stable and worsen. MRI were reviewed at the same time, and the result was divided into syrinx disappeared, reduced, no change and expanded. Results The operation was successful in all patients. Postoperative complications included cerebellum hemorrhage (n = 1, cerebral infarction (n = 1, hydrocephalus (n = 1, subcutaneous dropsy (n = 2 and were recovered after specific treatment. All patients were followed up for 6 months to 12 months after operation. Thirty-six cases were improved, 55 cases were stable, and 2 cases got worse. The MRI showed that the syringomyelia shrinked or disappeared in 90 cases, no change in 3 cases and no expansion. Eighty cases were followed up for 30 months to 36 months after operation, 12 stable cases improved, 1 stable case got worse, while the others remained unchanged. The MRI showed no change was compared with previous follow-up imaging. Conclusion Microinvasive cisterna magna reconstruction is a surgical procedure with mininal injury, quick recovery, stable effect, fewer complications, and high security. Intraoperative ultrasonography provides reliable data and is easy to perform.

  4. Antigen-specific immune reactions to ischemic stroke

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    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.

  5. Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study

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    Shruti V Sangani

    2015-01-01

    Full Text Available CNS Tuberculosis can manifest as meningitis, arachnoiditis and a tuberculoma. The rupture of a tubercle into the subarachnoid space leads to Tuberculosis Meningitis (TBME; the resulting hypersensitivity reaction can lead to an elevation of the intracranial pressure and hydrocephalus. While bedside optic nerve sheath diameter (ONSD ultrasonography (USG can be a sensitive screening test for elevated intracranial pressure in adult head injury, little is known regarding ONSD measurements in Tuberculosis Meningitis. Objectives: The aim of this study was to determine whether patients with TBME had dilation of the optic nerve sheath, as detected by ocular USG performed in the emergency department (ED. Materials and Methods: We conducted a prospective, observational study on adult ED patients with suspected TBME. Patients underwent USG measurements of the optic nerve followed by MRI. The ONSD was measured 3 mm behind the globe in each eye. MRI evidence of basilar meningeal enhancement and any degree of hydrocephalus was suggestive of TBME. Those patients without evidence of hydrocephalus subsequently underwent a lumbar puncture to confirm the diagnosis. Exclusion criteria were age less than 18 and obvious ocular pathology. In total, the optic nerve sheath diameters of 25 adults with confirmed TBME were measured. These measurements were compared with 120 control patients. Results: The upper limit of normal ONSD was 4.37 mm in control group. Those patients with TBME had a mean ONSD of 5.81 mm (SD 0.42. These results confirm that patients with tuberculosis meningitis have an ONSD in excess of the control data (P < 0.001. Conclusion: The evaluation of the ONSD is a simple non-invasive and potentially useful tool in the assessment of adults suspected of having TBME.

  6. [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.

  7. CSF ADENOSINE DEAMINASE (ADA ACTIVITY IN PATIENTS WITH MENINGITIS

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    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.

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

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    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)

  9. Intravital imaging of a massive lymphocyte response in the cortical dura of mice after peripheral infection by trypanosomes.

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    Jonathan A Coles

    2015-04-01

    Full Text Available Peripheral infection by Trypanosoma brucei, the protozoan responsible for sleeping sickness, activates lymphocytes, and, at later stages, causes meningoencephalitis. We have videoed the cortical meninges and superficial parenchyma of C56BL/6 reporter mice infected with T.b.brucei. By use of a two-photon microscope to image through the thinned skull, the integrity of the tissues was maintained. We observed a 47-fold increase in CD2+ T cells in the meninges by 12 days post infection (dpi. CD11c+ dendritic cells also increased, and extravascular trypanosomes, made visible either by expression of a fluorescent protein, or by intravenous injection of furamidine, appeared. The likelihood that invasion will spread from the meninges to the parenchyma will depend strongly on whether the trypanosomes are below the arachnoid membrane, or above it, in the dura. Making use of optical signals from the skull bone, blood vessels and dural cells, we conclude that up to 40 dpi, the extravascular trypanosomes were essentially confined to the dura, as were the great majority of the T cells. Inhibition of T cell activation by intraperitoneal injection of abatacept reduced the numbers of meningeal T cells at 12 dpi and their mean speed fell from 11.64 ± 0.34 μm/min (mean ± SEM to 5.2 ± 1.2 μm/min (p = 0.007. The T cells occasionally made contact lasting tens of minutes with dendritic cells, indicative of antigen presentation. The population and motility of the trypanosomes tended to decline after about 30 dpi. We suggest that the lymphocyte infiltration of the meninges may later contribute to encephalitis, but have no evidence that the dural trypanosomes invade the parenchyma.

  10. 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.

  11. 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

  12. A new methodology of viewing extra-axial fluid and cortical abnormalities in children with autism via transcranial ultrasonography

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    James Jeffrey Bradstreet

    2014-01-01

    Full Text Available Background: Autism spectrum disorders (ASDs are developmental conditions of uncertain etiology which have now affected more than 1% of the school-age population of children in many developed nations. Transcranial ultrasonography (TUS via the temporal bone appeared to be a potential window of investigation to determine the presence of both cortical abnormalities and increased extra-axial fluid (EAF. Methods: TUS was accomplished using a linear probe (10-5 MHz. Parents volunteered ASD subjects (N = 23; males 18, females 5 for evaluations (mean = 7.46 years + 3.97 years, and 15 neurotypical siblings were also examined (mean = 7.15 years + 4.49 years. Childhood Autism Rating Scale (CARS2® scores were obtained and the ASD score mean was 48.08 + 6.79 (Severe. Results: Comparisons of the extra-axial spaces indicated increases in the ASD subjects. For EAF we scored based on the gyral summit distances between the arachnoid membrane and the cortical pia layer (subarachnoid space: 1 0.10 cm. All of the neurotypical siblings scored 1, whereas the ASD mean score was 3.41 + 0.67. We also defined cortical dysplasia as the following: hypoechoic lesions within the substance of the cortex, or disturbed layering within the grey matter. For cortical dysplasia we scored: 1 none observed, 2 rare hypoechogenic lesions and/or mildly atypical cortical layering patterns, 3 more common, but separated areas of cortical hypoechogenic lesions, 4 very common or confluent areas of cortical hypoechogenicity. Again all of the neurotypical siblings scored 1, while the ASD subjects’ mean score was 2.79 + 0.93. Conclusions: TUS may be a useful screening technique for children at potential risk of ASDs which, if confirmed with repeated studies and high resolution MRI, provides rapid, noninvasive qualification of EAF and cortical lesions.

  13. Human epidermal growth factor receptor 2/neu protein expression in meningiomas: An immunohistochemical study

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    Ramesh Babu Telugu

    2016-01-01

    Full Text Available Background: Meningiomas are common slow-growing primary central nervous system tumors that arise from the meningothelial cells of the arachnoid and spinal cord. Human epidermal growth factor receptor 2 (HER2 or HER2/neu (also known as c-erbB2 is a 185-kD transmembrane glycoprotein with tyrosine kinase activity expressed in meningiomas and various other tumors. It can be used in targeted therapy for HER2/neu positive meningiomas. Aim: To correlate the expression of HER2/neu protein in meningiomas with gender, location, histological subtypes, and grade. Materials and Methods: It was 3½ years prospective (March 2010–October 2011 and retrospective (May 2008–February 2010 study of histopathologically diagnosed intracranial and intraspinal meningiomas. Clinical details of all the cases were noted from the computerized hospital information system. Immunohistochemistry for HER2/neu protein was performed along with scoring. Statistical analysis was done using Chi-square test to look for any association of HER2/neu with gender, location, grade, and various histological subtypes of meningiomas at 5% level of significance. Results: A total of 100 cases of meningiomas were found during the study period. Of which, 80 were Grade I, 18 were Grade II, and 2 were Grade III meningiomas as per the World Health Organization 2007 criteria. The female-male ratio was 1.9:1 and the mean age was 47.8 years. HER2/neu protein was expressed in 75% of Grade I and 72.2% of Grade II and none of Grade III meningiomas. About 72.7% brain invasive meningiomas showed HER2/neu immunopositivity. Conclusion: HER2/neu protein was expressed in 73% of meningiomas. Statistically significant difference of HER2/neu expression was not seen between females and males of Grade I and Grade II/III meningiomas, intracranial and spinal tumors, Grade I and Grade II/III cases, and various histological subtypes of meningiomas.

  14. Recombinant canine distemper virus strain Snyder Hill expressing green or red fluorescent proteins causes meningoencephalitis in the ferret.

    Science.gov (United States)

    Ludlow, M; Nguyen, D T; Silin, D; Lyubomska, O; de Vries, R D; von Messling, V; McQuaid, S; De Swart, R L; Duprex, W P

    2012-07-01

    The propensity of canine distemper virus (CDV) to spread to the central nervous system is one of the primary features of distemper. Therefore, we developed a reverse genetics system based on the neurovirulent Snyder Hill (SH) strain of CDV (CDV(SH)) and show that this virus rapidly circumvents the blood-brain and blood-cerebrospinal fluid (CSF) barriers to spread into the subarachnoid space to induce dramatic viral meningoencephalitis. The use of recombinant CDV(SH) (rCDV(SH)) expressing enhanced green fluorescent protein (EGFP) or red fluorescent protein (dTomato) facilitated the sensitive pathological assessment of routes of virus spread in vivo. Infection of ferrets with these viruses led to the full spectrum of clinical signs typically associated with distemper in dogs during a rapid, fatal disease course of approximately 2 weeks. Comparison with the ferret-adapted CDV(5804P) and the prototypic wild-type CDV(R252) showed that hematogenous infection of the choroid plexus is not a significant route of virus spread into the CSF. Instead, viral spread into the subarachnoid space in rCDV(SH)-infected animals was triggered by infection of vascular endothelial cells and the hematogenous spread of virus-infected leukocytes from meningeal blood vessels into the subarachnoid space. This resulted in widespread infection of cells of the pia and arachnoid mater of the leptomeninges over large areas of the cerebral hemispheres. The ability to sensitively assess the in vivo spread of a neurovirulent strain of CDV provides a novel model system to study the mechanisms of virus spread into the CSF and the pathogenesis of acute viral meningitis.

  15. Horner's syndrome and brachial paresis as a complication of lumbar sympathetic block: a case report Síndrome de Horner e paresia braquial como complicação de bloqueio simpático lombar: relato de caso

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    Pa. Maranhão-Filho

    1995-12-01

    Full Text Available An unusual case of Homer's syndrome secondary to a sympathetic block in a patient with chronic adhesive arachnoiditis (CAA is described. The patient, a 40-year-old white woman, presented with spastic paraplegia, hyperreflexia, bilateral Babinski sigh, superficial and deep sensitive hypoaesthesia at the T4 level, in addition to bladder and rectal dysfunction since she was 32. At age of 38 she complained of excessive daily sweating below the T4 level, mostly at night. A 4mL 0.5% bupivacaine lumbar sympathetic block was performed. Within 15 min aright brachial paresis and an ipsilateral Horner's syndrome were noted. Speculatively, an abnormal cephalic spread of the anaesthesic due to a putative erratic space secondary to the CAA may justify the clinical picture even using a relatively small amount of anaesthesic (4 mL.Os autores descrevem o caso de uma mulher branca de 40 anos de idade, com paraplegia espástica, hiperreflexia, sinal de Babinski bilateral, hipoestesia superficial e profunda em T4, além de incontinência fecal e urinária, desde os 32 anos decorrente de aracnoidite crônica adesiva (CAA. Aos 38 anos passou apresentar sudorese excessiva com limite superior em T4, diária, com intensificação noturna. Um bloqueio simpático lombar foi efetuado com 4mL de bupivacaina 0.5%. Quinze minutos depois a paciente apresentou monoparesia braquial direita e síndrome de Horner ipsolateral. Devido provavelmente a um espaço peridural estreito e errático, secundário à CAA, pode-se justificar o quadro clínico como secundário à ascenção cranial do anestésico, mesmo utilizado em reduzida quantidade (4mL.

  16. Collision Tumor Composed of Meningioma and Cavernoma

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    Weigel, Jens; Neher, Markus; Schrey, Michael; Wünsch, Peter H.; Steiner, Hans-Herbert

    2017-01-01

    A true collision tumor is a rare entity composed of two histologically distinct neoplasms coinciding in the same organ. This paper reports a unique case of cerebral collision tumor consisting of two benign components. On the first hand, meningioma which is usually a benign lesion arising from the meningothelial cell in the arachnoidal membrane. On the other, cerebral cavernoma which is a well-circumscribed, benign vascular hamartoma within the brain. To our knowledge, there is no previously documented case of cerebral collision tumor consisting of two benign components. A 56-year-old Caucasian male suffered in 2002 from an atypical meningioma WHO II° located in the left lateral ventricle. Three years after the tumor extirpation, the patient suffered from a hematoma in the fourth ventricle due to a recurrently haemorrhaged cavernoma. In 2008, a recurrence of the tumor in the left lateral ventricle was discovered. Additionally, another tumor located in the quadrigeminal lamina was detected. After surgical resection of the tumor in the left lateral ventricle, the pathological examination confirmed the diagnosis of a collision tumor consisting of components of a meningioma WHO II° and a cavernoma. Postoperatively, no adjuvant treatment was needed and no tumor recurrence is discovered up to the present. A possible explanation for the collision of those two different tumors may be migration of tumor cells mediated by the cerebrospinal fluid. After 5-years of follow-up, there is no sign of any tumor recurrence; therefore, surgical tumor removal without adjuvant therapy seems to be the treatment of choice. PMID:28061500

  17. 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

  18. Pathogenesis of cerebral malformations in human fetuses with meningomyelocele

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    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

  19. Intrathecal Acetyl-L-Carnitine Protects Tissue and Improves Function after a Mild Contusive Spinal Cord Injury in Rats.

    Science.gov (United States)

    Ewan, Eric E; Hagg, Theo

    2016-02-01

    Primary and secondary ischemia after spinal cord injury (SCI) contributes to tissue and axon degeneration, which may result from decreased energy substrate availability for cellular and axonal mitochondrial adenosine triphosphate (ATP) production. Therefore, providing spinal tissue with an alternative energy substrate during ischemia may be neuroprotective after SCI. To assess this, rats received a mild contusive SCI (120 kdyn, Infinite Horizons impactor) at thoracic level 9 (T9), which causes loss of ∼ 80% of the ascending sensory dorsal column axonal projections to the gracile nucleus. Immediately afterwards, the energy substrate acetyl-L-carnitine (ALC; 1 mg/day) or phosphate-buffered saline (PBS) was infused intrathecally (sub-arachnoid) for 6 days via an L5/6 catheter attached to a subcutaneous Alzet pump. ALC treatment improved overground locomotor function (Basso-Beattie-Breshnahan [BBB] score 18 vs. 13) at 6 days, total spared epicenter (71% vs. 57%) and penumbra white matter (90% vs. 85%), ventral penumbra microvessels (108% vs. 79%), and penumbra motor neurons (42% vs. 15%) at 15 days post-SCI, compared with PBS treatment. However, the ascending sensory projections (anterogradely traced with cholera toxin B from the sciatic nerves) and dorsal column white matter and perfused blood vessels were not protected. Furthermore, grid walking, a task we have shown to be dependent on dorsal column function, was not improved. Thus, mitochondrial substrate replacement may only be efficacious in areas of lesser or temporary ischemia, such as the ventral spinal cord and injury penumbra in this study. The current data also support our previous evidence that microvessel loss is central to secondary tissue degeneration.

  20. Tuberculose meningo-encefalica na infância: estudo anatomo-patologico de 10 casos Tuberculosis of the central nervous system in the childhood: anatomo-pathological study of ten cases

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    Ligia M. Barbosa Coutinho

    1976-06-01

    Full Text Available Estudo anátomo-patológico de 10 casos de tuberculose do SNC em crianças, com idade inferior a 10 anos. São enfatizadas as alterações macro e microscópicas produzidas pela tuberculose nas meninges, parênquima nervoso e vasos. Os achados clínicos e patológicos são discutidos e correlacionados com a literatura. Os autores concluem que: 1 a lesão, em crianças com tuberculose do SNC, é geralmente uma meningoencefalite proliferativa; 2 o parênquima nervoso pode ser afetado por propagação contígua do processo tuberculoso ou por alterações circulatórias secundárias a lesões arteriais; 3 por causa da localização dos vasos endocranianos no espaço sub-aracnóideo, eles são geralmente lesados pelo processo inflamatório, que determina uma endarterite obliterante, a qual pode ser observada por angiografia carotídea.The anatomo-pathological study of ten cases of tuberculosis of the central nervous system (CNS in children under 10 years old is reported. The emphasis is given to the macroscopic and microscopic changes produced by the tuberculosis in the meninges, in the nervous parenchyma and in the vessels. The clinical and pathological findings are discussed and correlated with the literature. The authors concluded that: 1 the lesion in children with tuberculosis of the CNS is generally a proliferative meningoencephalitis; 2 the nervous parenchyma may be affected by the contiguous propagation of the tuberculous process or by the circulatory changes secondary to the arterial lesions; 3 because of the localization of the endocranial vessels in the sub-arachnoidal space they are generally injured by the inflammatory process, which can determine an obliterating endarteritis, which can be observed by a carotid angiography.

  1. 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

  2. Humphrey Ridley (1653-1708): 17th century evolution in neuroanatomy and selective cerebrovascular injections for cadaver dissection.

    Science.gov (United States)

    Thakur, Jai Deep; Sonig, Ashish; Chittiboina, Prashant; Khan, Imad Saeed; Wadhwa, Rishi; Nanda, Anil

    2012-08-01

    Humphrey Ridley, M.D. (1653-1708), is a relatively unknown historical figure, belonging to the postmedieval era of neuroanatomical discovery. He was born in the market town of Mansfield, 14 miles from the county of Nottinghamshire, England. After studying at Merton College, Oxford, he pursued medicine at Leiden University in the Netherlands. In 1688, he was incorporated as an M.D. at Cambridge. Ridley authored the first original treatise in English language on neuroanatomy, The Anatomy of the Brain Containing its Mechanisms and Physiology: Together with Some New Discoveries and Corrections of Ancient and Modern Authors upon that Subject. Ridley described the venous anatomy of the eponymous circular sinus in connection with the parasellar compartment. His methods were novel, unique, and effective. To appreciate the venous anatomy, he preferred to perform his anatomical dissections on recently executed criminals who had been hanged. These cadavers had considerable venous engorgement, which made the skull base venous anatomy clearer. To enhance the appearance of the cerebral vasculature further, he used tinged wax and quicksilver in the injections. He set up experimental models to answer questions definitively, in proving that the arachnoid mater is a separate meningeal layer. The first description of the subarachnoid cisterns, blood-brain barrier, and the fifth cranial nerve ganglion with its branches are also attributed to Ridley. This historical vignette revisits Ridley's life and academic work that influenced neuroscience and neurosurgical understanding in its infancy. It is unfortunate that most of his novel contributions have gone unnoticed and uncited. The authors hope that this article will inform the neurosurgical community of Ridley's contributions to the field of neurosurgery.

  3. Membrane-plate transition in leaves as an influence on dietary selectivity and tooth form.

    Science.gov (United States)

    Talebi, Mauricio G; Sala, Enrico A; Carvalho, Barbara; Villani, Giovanna M; Lucas, Peter W; van Casteren, Adam

    2016-09-01

    Primates need accurate sensory signals about food quality to forage efficiently. Current evidence suggests that they target leaf foods based on color at long-range, reinforcing this with post-ingestive sensations relating to leaf toughness evoked during chewing. Selection against tough leaves effectively selects against high fiber content, which in turn gives a greater opportunity of acquiring protein. Here we consider a novel intermediate mechanical factor that could aid a folivore: leaves may transform mechanically from membranes (sheets that cannot maintain their shape under gravitational loads and thus 'flop') early on in development into plates (that can maintain their shape) as they mature. This transformation can be detected visually. Mechanical tests on two species of leaf eaten by southern muriqui monkeys (Brachyteles arachnoides) in Southern Atlantic Forest, Brazil, support a membrane-to-plate shift in turgid leaves during their development. A measure of this mechanical transition, termed lambda (λ), was found to correlate with both leaf color and toughness, thus supporting a potential role in leaf selection. Muriquis appear to select membranous leaves, but they also eat leaves that are plate-like. We attribute this to the degree of cresting of their molar teeth. A dietary choice restricted to membranous leaves might typify the type of 'fallback' leaf that even frugivorous primates will target because membranes of low toughness are relatively easily chewed. This may be relevant to the diets of hominins because these lack the bladed postcanine teeth seen in mammals with a specialized folivorous diet. We suggest that mammals with such dental adaptations can consume tougher leaf 'plates' than others.

  4. 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.

  5. [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.

  6. [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.

  7. 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)

  8. 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.

  9. Endoscopic transsphenoidal treatment of empty sella turcica syndrome using a silastic coil.

    Science.gov (United States)

    Rudnik, A; Zawadzki, T; Gałuszka-Ignasiak, B; Larysz, D; Bazowski, P; Zdeb, M

    2006-12-01

    An empty sella turcica is due to the presence of an arachnoid diverticulum with its fluid content in the sella turcica, exerting pressure on the pituitary gland. In most cases this condition has an asymptomatic course, and is discovered by accident. Some patients, however, develop empty sella turcica syndrome with headaches, mild dishormonose, dysopsia and, rarely, spontaneous rhinorrhoea. Surgical treatment of empty sella turcica consists of filling the sella, through the transsphenoid route, with tissues collected from the patient or with artificial material. The aim of this report is to present our own experience of endoscopic extradural sella elevation using a silicone spiral, in 4 patients with primary empty sella turcica syndrome. The main indication for surgery was progressing dysopsia. The microinvasive endoscopic transsphenoidal method has been used, based upon the Jho technique with our own modifications. For the elevation of the sella, we used a coiled section of a Pudenz valve intraventricular silicone drain, adjusting its size to the dimensions of the operated sella. Both the implantation of the helix, and the postoperative course were uncomplicated for all surgically treated patients. The follow-up of several months confirmed improvement of the dysopsia in all surgically treated patients. MR examinations confirmed the correct location of the silicone spiral placed in the sella. It seems that the good results achieved are due to a correct indication for surgical treatment. The follow-up period ranges from 12 to 30 months and, so far, the clinical improvement is stable and satisfying both for the patients who underwent treatment and for the neurosurgeons.

  10. 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.

  11. Magnetic resonance imaging-based diagnosis of middle cranial fossa tumors%中颅窝区脑外肿瘤的MRI表现

    Institute of Scientific and Technical Information of China (English)

    段刚; 彭旭红

    2009-01-01

    Objective To analyze the magnetic resonance imaging (MRI) features of middle cranial fossa tumors. Methods Thirty-one patients with surgically and pathologically confirmed middle cranial fussa tumors were enrolled in this study, including 13 with trigeminal neurinornas, 6 with meningiomas, 3 with arachnoid cysts, 3 with dermoid cysts, 2 with osteoblastomas, 2 with chordomas, and 2 with epidermoid cysts. All the patients underwent plain and enhanced MR scanning and the imaging data were retrospectively analyzed. Results Different types of middle cranial fossa tumors had distinctly different MRI appearances. Trigeminal neuromas displayed hypo- and iso-intense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI), and 9 of the 13 patients presented with shell-shaped enhancement after Gd-DTPA injection. Meningioma showed hypo-and iso-intense signals on T1WI and hypo-, iso- and hyper-intense signals on T2WI, with relatively homogeneous enhancement after Gd-DTPA injection. Osteoblastoma exhibited shell-shaped bony encapsulation of the tumor, and chordomas grew along the middle and posterior cranial fussae with close lateral association with the clivus. Arachnoid cysts and epidermoid cysts showed hypointense signals on TIWI and hyperintense signals on T2WI with slight enhancement of the cyst wall after Gd-DTPA injection. The arachnoid cysts grew expansively, and epidermoid cysts were characterized by high invasiveness in any possible directions. Dermoid cysts presented with hyperintense signals on T1WI and T2WI with popcorn-like appearance in some cases. Conclusion The middle fossa tumors present characteristic MRI features, which, in combination with clinical examinations, help derive an accurate diagnosis.%目的 探讨中颅窝区脑外肿瘤的MRI特点,提高其诊断准确率. 方法 经手术病理证实的31例中颅窝区脑外肿瘤(包括三叉神经鞘瘤13例,脑膜瘤6例,蛛网膜囊肿3例,皮样囊肿3

  12. 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

  13. 脊膜脊髓结核23例核磁共振影像分析%Analysis on 23 cases of spinal meningeal tuberculosis by magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    王东坡; 吕岩; 周新华; 贺伟; 吕平欣

    2015-01-01

    and spinal meningeal tuberculosis compared to 25 patients with spinal cord meningeal metastatic carcinoma.All patients were admitted in our hospital from Jun.2011 to Oct.2014.There were 12 males and 11 females with a median age of 26 (range 16-50) years in the spinal cord meningeal tuberculosis group,and 18 males and 7 females with a median age 56 (range 44-78) years in the spinal cord meningeal metastatic carcinoma group.All patients underwent MR plain and contrastenhanced scanning.The enumeration data were compared with the x2 test and the measurement data were compared with t test.The difference was considered statistically significant when the P value was < 0.05.Results Of the 23 cases,16 were spinal meningeal tuberculosis and 7 were spinal cord tuberculosis.The MR imaging features were as follows:(1) Spinal meningeal tuberculosis:Irregular and linear strip and hummocky thickening (thickness < 5 mm) of the meninges (dura,arachnoid and pia mater),with the average length of involvement of 7 vertebral segments.Enhancement was present in all cases by contrastenhanced scanning,including clustering or moniliform enhancement in 5 cases.Subarachnoid irregular stenosis was seen in all cases,partial occlusion in 5,abnormal heterogeneous signal in 20,rough cerebrospinal fluid (CSF)-spinal interface in 10,and formation of secondary arachnoid cyst in 15.(2) Spinal cord meningeal tuberculosis:of the 7 cases,4 showed ring enhancement and 3 showed small plaque with heterogeneous enhancement.(3)There were 20 cases of meningeal metastatic carcinoma and 5 cases of meningeal metastatic carcinoma with spinal cord metastasis.Nodular thickening was present in 8 cases,plaque thickening in 10,and nodular and plaque thickening in 7.Continuous thickening involving 3 vertebral bodies was seen in 19 cases.Multiple localized thickening was present in 6 cases,with obvious enhancement in the meninges and heterogeneous enhancement in the spinal cord.Conclusions The MR imaging features of

  14. Clinical value of prenatal ultrasound diagnosis of fetal central nervous system abnormalities%产前超声诊断胎儿神经系统畸形的临床价值

    Institute of Scientific and Technical Information of China (English)

    韩磊; 沈亚梅; 彭建美; 管湘平; 王珍芳; 邹荣莉

    2016-01-01

    Objective To evaluate the clinical value of prenatal routine ultrasound examination in screening of fetal central nervous system abnormalities.Methods Ultrasound imaging features of 27 cases of abnormalities in central nervous system confirmed by autopsy or follow-up were analyzed retrospectively.Results Among these cases, there were 11 cases of spine bifida and meningomyelocele, 3 cases of Dandy-Walker syndrome ( DWS) , 3 cases of cephalocele, 3 cases of hydrocephalus, 1 case of anencephaly, 2 cases of holoprosencephaly, 2 cases of agenesis of corpus callosum, 1 cases of choroid plexus cysts, and 1 case of arachnoid cyst.The accuracy, misdiagnosis rate and missed diagnosis rate of prenatal ultrasound examination was 88.90%, 7.40%and 7.40%, respectively.Conclusion Prenatal ultrasound examination has high diagnostic accuracy for fetal central nervous system malformations, and it has very important clinical value.%目的 探讨产前常规超声检查在胎儿神经系统畸形筛查方面的临床应用价值.方法 对27例经随访及引产证实的中枢神经系统畸形胎儿进行回顾性分析.结果 27例畸形儿中,其中脊柱裂和脊髓脊膜膨出11例,Dandy-Walker畸形3例,脑脊膜膨出3例,脑积水3例,无脑儿1例,全前脑2例,胼胝体发育不全2例,脉络丛囊肿1例,蛛网膜囊肿1例,产前超声诊断准确率为88.90%,误诊率7.40%,漏诊率7.40%.结论 产前超声检查对胎儿中枢神经系统畸形诊断准确率高,具有十分重要的临床应用价值.

  15. 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.

  16. Value of lateral ventricle and cerebellum plane scanning in diagnosis of fetal midline structure abnormalities%侧脑室及小脑平面对胎儿神经系统中线结构畸形的诊断价值

    Institute of Scientific and Technical Information of China (English)

    符忠蓬; 林如; 戴蓓蓓; 谢梦; 黄晓微; 任芸芸; 严英榴; 孙莉; 孔凡斌; 赵蔚; 姚英; 胡雁来; 曹丽

    2015-01-01

    Objective:To evaluate the value of the lateral ventricle and cerebellum plane scanning in the diagnosis of fetal central nerve system (CNS) midline structure abnormalities. Methods:Ultrasound imaging features of 97 fetuses with fetal CNS midline structure abnormalities from 3 921 abnormal fetuses were analyzed retrospectively. Results: Among the 97 fetuses, there were 9 cases of encephalocele, 7 cases of anencephaly, 4 cases of meningocele, 11 cases of transparent septum widened, 16 cases of complete agenesis of the corpus callosum (ACC), 15 cases of partial ACC, 15 cases of holoprosencephaly, 4 cases of arachnoid cyst, 10 cases of Dandy-Walker malformation, 4 cases of malformation Arnold-Chiari typeⅡ, and 2 cases of vein of Galen aneurysm malformation. Conclusion: The lateral ventricle and cerebellum plane scanning is a safe, liable, practical and quick method to diagnose the fetal CNS midline structure abnormalities.%目的:探讨在产前常规超声检查中,侧脑室及小脑平面对胎儿中枢神经系统中线结构畸形的诊断价值。方法:从复旦大学附属妇产科医院3921例畸形胎儿中选出97例中枢神经系统中线结构畸形胎儿,对其声像图特征进行回顾性分析。结果:产前超声诊断胎儿中枢神经系统中线结构畸形97例,其中脑膜脑膨出9例、无脑儿7例、脑膜膨出4例、透明隔腔增宽11例、完全型胼胝体缺失(ACC)16例、部分型ACC 15例、全前脑15例、蛛网膜下腔囊肿4例、Dandy-Walker畸形10例、Arnold-Chiari畸形Ⅱ型4例、Galen静脉瘤2例。结论:胎儿侧脑室平面及小脑平面的超声检查安全有效、方便快捷,是胎儿中枢神经系统畸形筛查最常用的切面,对胎儿中枢神经系统中线结构畸形检出率高。

  17. 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.

  18. 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.

  19. 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.

  20. Carcinomatose das meninges: dados clínico-patológicos de 3 casos Carcinomatosis of the meninges: a report of three cases

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    Aristides Cheto de Queiroz

    1974-12-01

    Full Text Available Foram estudados 3 casos de carcinomatose das meninges, autopsiados no serviço de Anatomia Patológica do Hospital Prof. Edgard Santos. O quadro neurológico apresentado era proeminente e representado por sinto- matologia decorrente do envolvimento meníngeo e encefálico, razão pela qual foram considerados como portadores de meningite tuberculosa e encefalomielite. O aspecto de maior interesse neste estudo foi a discrepância entre o quadro clínico e os dados anátomo-patológicos do exame do encéfalo. A sintomatologia clínica foi proeminente, enquanto as lesões anatômicas foram apenas discretas ou moderadas e representadas por espessamento e granulosidade das meninges, com infiltração difusa do espaço subaracnoideano pela neoplasia. Nos casos 1 e 3 a neoplasia estava representada por adenocarcinoma, cujos focos primitivos foram localizados no pulmão e vesícula biliar, respectivamente. O caso 2 era um carcinoma indiferenciado do estômago, com envolvimento difuso do espaço subaracnoideano e subdural, havendo neste último extensa hemorragia recente. Os critérios diagnósticos e a maneira de disseminação desta condição são discutidos.A diffuse involvement of the meninges by carcinoma is described in three cases characterizing the so called "meningeal carcinomatosis". The neurologic symptoms were those of the chronic meningitis or encephalomyelitis, with changes in the spinal fluid. The morphologic features were identical in the three cases and represented by slight to moderate thickening of the meninges by diffuse infiltration of tumor cells and few foci of inflamatory reaction. The cases 1 and 3 were represented by well differentiated adenocarcinoma with primary site in the lung and gallbladder, respectively. In case 2 the tumor was a poorly differentiated carcinoma of stomach with diffuse involvement of the arachnoid and dura mater associated with recent hemorrhage. An interesting point was the lack of correlation between

  1. Microsurgical anatomic study of the parasellar region and its related structures%中颅窝鞍旁区相关结构的外科显微解剖研究

    Institute of Scientific and Technical Information of China (English)

    邵君飞; 傅震; 张岩松; 王海秋; 姚建社

    2009-01-01

    Objective To study the surgical microanatomy of the parasellar region and its Related Structures. Methods The microsurgical dissections were performed on 38 cadaveric heads with the aid of an operating microscope to observe and measure the dura, nerves and vessels in the sphenopetroclival region, and to learn the relationships among the dura, nerves and vessels with histochemical technique. Results In middle cranial fossa, cranial nerves Ⅲ, Ⅳ and Ⅵ, which were enwrapped by arachnoid and dura, entered between the dura of middle cranial fossa. The Meckel's cave, the trigeminal ganglion and its three branchs, just like a glove, were embedded between the dura of middle cranial fossa , and ICA and some venous structures traveled among them. Cavernous sinus and those structures were located in a cave made up of two floors of the middle cranial fossa dura, namely dura mater space. Conclusions We suggest a new constructive conception about this region which is the surgical anatomy based by the parasellar region approach.%目的 提供中颅窝鞍旁区相关解剖学依据,为鞍旁区手术提供帮助.方法 对38例成人尸颅进行手术巨微解剖,测量鞍旁区的硬膜关系、神经与血管走行及相邻结构的关系,并进行组织学观察.结果 在中颅窝,动眼神经、滑车神经、展神经包裹着蛛网膜与硬脑膜深入中颅窝硬膜之间,Meckel腔、三叉神经节及其三个分支包裹着后颅窝蛛网膜与硬脑膜像三指手套深入中颅窝硬膜之间,颈内动脉及颅内、外静脉亦穿行于中颅窝硬膜间;上述结构与海绵窦在中颅窝鞍旁两层硬膜形成一个腔,即硬膜间腔.结论 提出鞍区形态学特点,为中颅窝鞍旁区手术提供解剖学依据.

  2. 原发性颅骨内溶骨性脑膜瘤3例报告并文献复习%Primary intraosseous osteolytic meningomas of the skull: report of three cases and review of the literatures

    Institute of Scientific and Technical Information of China (English)

    曹磊; 张小军; 王守森; 陈宏颉; 高进喜; 王如密

    2011-01-01

    Objective To explore the pathogenesis, diagnosis and treatment of the primary intraosseous osteolytic meningomas of the skull (PIOMS).Method The clinical data of 3 patients with PIOMS, who were treated in our department from March, 2005 to June,2010, were analyzed retrospectively and the literatures related to PIOMS were reviewed.Results Three PIOMS were located respectively in tuberculum sellea, parietoccipital bone and sphenoid wing.All the tumors were of osteolytic characteristics on the images and resected by surgery.The pathohistological examination showed that 3 meningomas were psammomatous, mixed and fibrous ones respectively.The meningoma recurred in 1 patient 23 months after the surgery.Conclusions PIOMS possibly originate from the misplaced intraosseous arachnoid granulation cells.It is difficult to make a definite diagnosis of PIOMS preoperatively, which depends on histopathological examination.Intraoperative pathological examination is helpful to guiding the operation.The maximal resection of the tumors and involved bones is the key to prevention of PIOMS recurrence.%目的 探讨原发性颅骨内溶骨性脑膜瘤的诊断和治疗方法.方法 同顾性分析2005年3月至2010年6月收治的3例经病理学证实为原发性颅骨内溶骨性脑膜瘤患者的临床资料,并结合相关文献进行分析.结果 3例患者的肿瘤分别位于鞍结节、顶枕骨和蝶窦大翼内,影像学表现均呈溶骨性破坏,均行手术切除肿瘤.术后病理学结果分别为砂样体型、混合型和纤维型脑膜瘤,周围骨质均受累.1例术后23月复发;另2例随访6月至5年,未见复发.结论 原发性颅骨内溶骨性脑膜瘤术前明确诊断有一定难度,确诊依赖于病理学检查;术中冰冻切片病理学检查对决定手术方案有指导价值;最大程度切除肿瘤及受累骨质是治疗的关键.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. Paraplegia and intracranial hypertension following epidural anesthesia: report of four cases Paraplegia e hipertensão craniana após anestesia epidural: relato de 4 casos

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    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. Assessing ventricular size: is subjective evaluation accurate enough? New MRI-based normative standards for 19-year-olds

    Energy Technology Data Exchange (ETDEWEB)

    Aukland, Stein Magnus [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Institute of Surgical Sciences, Section for Radiology, Bergen (Norway); Odberg, Morten Duus [University of Bergen, Institute of Clinical Medicine, Section for Paediatrics, Bergen (Norway); Gunny, Roxanna; Chong, W.K. [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Eide, Geir Egil [Haukeland University Hospital, Centre for Clinical Research, Bergen (Norway); University of Bergen, Department of Public Health and Primary Health Care, Bergen (Norway); Rosendahl, Karen [University of Bergen, Institute of Surgical Sciences, Section for Radiology, Bergen (Norway); Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom)

    2008-12-15

    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

  9. 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

  10. 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

  11. Ocean acidification has little effect on developmental thermal windows of echinoderms from Antarctica to the tropics.

    Science.gov (United States)

    Karelitz, Sam E; Uthicke, Sven; Foo, Shawna A; Barker, Mike F; Byrne, Maria; Pecorino, Danilo; Lamare, Miles D

    2017-02-01

    As the ocean warms, thermal tolerance of developmental stages may be a key driver of changes in the geographical distributions and abundance of marine invertebrates. Additional stressors such as ocean acidification may influence developmental thermal windows and are therefore important considerations for predicting distributions of species under climate change scenarios. The effects of reduced seawater pH on the thermal windows of fertilization, embryology and larval morphology were examined using five echinoderm species: two polar (Sterechinus neumayeri and Odontaster validus), two temperate (Fellaster zelandiae and Patiriella regularis) and one tropical (Arachnoides placenta). Responses were examined across 12-13 temperatures ranging from -1.1 °C to 5.7 °C (S. neumayeri), -0.5 °C to 10.7 °C (O. validus), 5.8 °C to 27 °C (F. zelandiae), 6.0 °C to 27.1 °C (P. regularis) and 13.9 °C to 34.8 °C (A. placenta) under present-day and near-future (2100+) ocean acidification conditions (-0.3 pH units) and for three important early developmental stages 1) fertilization, 2) embryo (prehatching) and 3) larval development. Thermal windows for fertilization were broad and were not influenced by a pH decrease. Embryological development was less thermotolerant. For O. validus, P. regularis and A. placenta, low pH reduced normal development, albeit with no effect on thermal windows. Larval development in all five species was affected by both temperature and pH; however, thermal tolerance was not reduced by pH. Results of this study suggest that in terms of fertilization and development, temperature will remain as the most important factor influencing species' latitudinal distributions as the ocean continues to warm and decrease in pH, and that there is little evidence of a synergistic effect of temperature and ocean acidification on the thermal control of species ranges.

  12. 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.

  13. 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

  14. Neuralgia do trigêmeo bilateral por cisticerco racemoso unilateral no ângulo-ponto cerebelar: relato de caso Unusual cause for bilateral trigeminal neuralgia: unilateral racemous cysticercus of cerebellopontine angle. Case report

    Directory of Open Access Journals (Sweden)

    PAULO HENRIQUE AGUIAR

    2000-12-01

    Full Text Available Descrevemos o caso de uma paciente de 42 anos portadora de cisticerco racemoso na região do ângulo ponto-cerebelar (APC direito com trigeminalgia bilateral mais intensa no lado ipsilateral à localização do parasita. O cisticerco foi totalmente removido por meio de craniotomia suboccipital. No primeiro dia pós-operatório houve desaparecimento bilateral da dor. Duas hipóteses fisiopatológicas foram aventadas para explicar a sintomatologia: lesões que ultrapassam os limites da cisterna do APC poderão através da cisterna pré-pontina alcançar a cisterna do APC atingindo o trigêmeo contralateral; lesões com grande efeito de massa poderão provocar rotação do tronco cerebral e deslocamento e tração de estruturas ipsi e contralaterais, provocando compressão arteriovenosa sobre o trigêmeo contralateral na porção superior da cisterna do APC. Salientamos a necessidade de exames de imagem ante qualquer algia craniofacial e observamos que, em lesões na região do APC, a cisticercose não pode ser esquecida.We report the case of a 42-year-old woman with a racemous cystecercus in the right cerebellopontine angle (CPA, who presented with bilateral trigeminal neuralgia. The parasite was completly removed via a right suboccipital craniotomy. On the first postoperative day, the patient indicated that the pain disappeared. The neuralgia was caused by two probable mechanisms: a distortion of the brain stem and compression of the nerve against an arterial loop at the entry zone or arachnoiditis caused by the parasite in the both CPA cisternae. This case demonstrates the advisability of obtaining imaging studies in all patients with trigeminal neuralgia before starting any management. We must always remind that the cysticercus may be a differential diagnosis of CPA lesions.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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 .

  1. 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。

  2. Microsurgical treatment of medial sphenoid ridge meningiomas%内侧型蝶骨嵴脑膜瘤的显微外科治疗

    Institute of Scientific and Technical Information of China (English)

    林恩; 许海雄; 方旭生; 郭骅

    2010-01-01

    Objective To discuss the microsurgical techniques and clinical efficacy of excision of medial sphenoid ridge meningiomas.Methods Eighteen patients with medial sphenoid ridge meningioma treated by microsurgical techniques were analyzed.Results Total removal(Grade Ⅰ,Ⅱ of Simpson system)was done in 12 cases and subtotal remove was in 6,without hemjplegia and mortality.Conclusions The dural attachment of the lesion should be dissected along the sphenoid wing first,in order to minimize blood loss and to facilitate orientating and exposing the supraclinoidal segment of ICA,and then the engulfing tumor should be dissected proximally to distally.Microsurgical techniques,identification and preservation of the important artery and cranial nerves during operation could be obtained.Because of the presence of interfacing arachnoid membrane in most of the cases,tumor should be removed with a vigorous attempt in the initial operation.%目的 探讨治疗内侧型蝶骨嵴脑膜瘤的显微神经外科的技巧和临床效果.方法 回顾性分析1993年至2008年应用显微神经外科技术治疗18例内侧型蝶骨嵴脑膜瘤患者的临床资料.结果 手术全切除(Simpson Ⅰ、Ⅱ级)12例,次全切除6例.术后无偏瘫及死亡.2例发生动眼神经麻痹;有8例视力改善.结论 尽早离断肿瘤基底并沿颈内动脉床突上段由近向远分离切除包绕的肿瘤是该术式技巧.充分利用显微技术辨别肿瘤与周围血管、神经的关系,注意保护穿通动脉,是手术成功的关键.

  3. 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

  4. 视交叉池的显微观察及测量与视神经和视交叉的保护%Correlations of morphological observation and measurement of the chiasmatic cistern with the protection of optic nerves and optic chiasm

    Institute of Scientific and Technical Information of China (English)

    丁继固; 陈小武; 钱月楼

    2004-01-01

    背景:有关视交叉池的显微观测指标不完善. 目的:探讨视交叉池的境界、池内各结构测值、特征及临床意义. 设计:抽样调查. 地点及对象:在咸宁学院医学院手术显微镜室观测制备好的视交叉池,男 16例,女 4例,估计年龄 30~ 60岁. 干预:在手术显微镜下剔除额叶,保留其额叶下面的软脑膜、蛛网膜及鞍区周围的结构,观察、测量视交叉池的境界及池内各结构的相互关系及相关值. 主要观察指标:视交叉池境界、池内各结构的相互关系、特征及相关值. 结果:视交叉池是由视神经之间、视交叉和鞍膈上面相互延伸的蛛网膜所围成.在池内,视神经颅内段左右侧长度为( 9.89± 2.63) mm ,厚度为( 2.96± 0.82) mm .视交叉前后径为( 10.87± 1.63) mm ,左右径为( 13.38± 1.52) mm,厚度为( 4.68± 0.72) mm;视交叉正常型 10例,占 50% ;前置型 7例,占 35%;后置型 3例,占 15%.垂体柄长度为( 5.98 ± 2.7) mm, 前后径为( 1.59± 0.42) mm ,左右径为( 1.96± 0.44) mm.纤维网直径小于 0.06 mm. 结论:视交叉池内结构以视交叉中心,前续视神经,后邻垂体柄,下隔鞍膈邻脑垂体等;池内各结构借纤维网和缠结在纤维网上的小血管彼此牵连;故使池内结构显得非常复杂.在鞍区手术中应重点保护好视神经和视交叉及池内血管等.%BACKGROUND:The accurate data about the microstructure of chiasmatic cistern are still not available. OBJECTIVE:To explore the boundary,microstructure,characteristics and clinical significance of chiasmatic cistern. DESIGN:Sample survey. SETTING and PARTICIPANTS:The study was carried out at the Operation Microsscope Room of Medical College of Xinning College.Chiasmatic cistern sample was collected from 16 males and 4 females with their ages ranged from 30 to 60 years old. INTERVENTIONS:Frontal lobe was eliminated with operation microscope,while the soft meninges under frontal lobe,arachnoid and sphenoid saddle

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

    Directory of Open Access Journals (Sweden)

    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

  6. 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

  7. 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

  8. Microsurgical treatment of spinal cord congenital tumors%椎管内先天性肿瘤的显微外科治疗

    Institute of Scientific and Technical Information of China (English)

    黄忻涛; 万大海; 王宏勤; 马宁; 薛乃照; 赵学明; 郝解贺; 王振宇

    2016-01-01

    Objective:To characterize the microsurgical treatment of spinal cord congenital tumors and explore the experiences of pa-tients who have undergone the treatment. Methods:The clinical data of 50 patients with spinal cord congenital tumors (from August 2010 to August 2015) were analyzed retrospectively. The characteristics of different types of tumor and surgical techniques were dis-cussed. Results:The age of patients with spinal cord congenital tumors is relatively young. Most tumors are located in the lumbar and sacral regions. In the 50 cases, total tumor removal was achieved in 11 cases, subtotal in 9, partial in 29, and cyst fistulation in 1. We al-so found 10 cases of epidermoid cyst, 8 cases of dermoid cyst, 13 cases of mature teratoma, 9 cases of lipoma (2 of angiolipoma), 4 cases of intestinal cyst, 3 cases of arachnoid cyst, 1 case of glial ependymal cyst, 1 case of hamartoma, and 1 case without pathological diagnosis. The postoperative complications included 1 case of meningitis and 1 case of incision infection. Of the 50 cases, 39 have been followed up from 3 months to 2 years. Recurrence was observed in 3 cases. Conclusion:Spinal cord congenital tumors could be revealed and removed satisfactorily with fewer surgical complications through microsurgical treatment.%目的:探讨椎管内先天性肿瘤的特点及显微外科治疗体会。方法:回顾性分析山西医科大学第一医院2010年8月至2015年8月50例椎管内先天性肿瘤患者的临床资料,对不同类型肿瘤的特点、术中技巧等问题进行探讨。结果:椎管内先天性肿瘤患者发病年龄较轻,大部分位于腰骶部。50例患者中,肿瘤全切11例,近全切9例,大部分切除29例,囊肿造瘘1例。病检表皮样囊肿10例、皮样囊肿8例、成熟畸胎瘤13例、脂肪瘤9例(血管脂肪瘤2例)、肠源性囊肿4例、蛛网膜囊肿3例、胶质室管膜囊肿1例、错构瘤1例、未获得病理诊断1例。手术并

  9. 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

  10. 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

  11. 大鼠慢性乙醇中毒脑组织微管相关蛋白Tau的表达与外伤性蛛网膜下腔出血致死机制的关系%Relationship between the expression of Tau protein and mechanism of traumatic subarachnoid haemorrhage in chronic alcoholic rat brain

    Institute of Scientific and Technical Information of China (English)

    魏来; 雷怀成; 于晓军; 赖小平; 钱红; 徐小虎; 朱方成

    2012-01-01

    目的:观察大鼠慢性乙醇中毒后轻微伤脑组织微管相关蛋白(Tau蛋白)的表达,探讨酗酒与外伤性蛛网膜下腔出血(TSAH)死亡机制的相关性.方法:雄性SD大鼠随机分为饮水打击组、饮酒组、饮酒打击组,饮酒组(52%v/v北京红星二锅头)连续灌胃4周,打击组予脑震荡性打击,各组大鼠脑组织行H-E染色、免疫组织化学显色,并用图像分析系统对检测结果进行分析.结果:随着饮酒时间延长,大鼠逐渐出现慢性乙醇中毒改变,TSAH发生率和死亡率增高,脑干周围多见TSAH,神经元变性、坏死,神经纤维疏松水肿,神经骨架纤维崩解;脑干、小脑、海马、额叶等部位Tau IOD值增高.结论:慢性乙醇中毒脑组织在轻微损伤的情况下可引起脑神经纤维细胞骨架的形态结构破坏,脑白质萎缩、神经突起数量减少,推测慢性乙醇中毒后轻微的外伤可能参与了TSAH病理生理过程.%Objective:To explore the correlation of chronic alcoholism and the mechanism of death associated with traumatic sub-arachnoid haemorrhage (TSAH), and to observe the Tau protein expression in the brain after chronic alcoholism in rats. Methods: Male SD rats were randomly divided into three groups: the chronic water group with strike, the chronic alcoholism group, and the chronic alcoholism group with strike. Four weeks later, the rats were sacrificed and sagittal sections of the brain were prepared for routine paraffin serial sections, H-E and Tau protein immunohistochemical staining. The pathological changes were analyzed by computer image analysis system. Results: With the drinking time extending, the rats showed a gradual change in chronic alcoholism. In the chronic alcoholism group with strike, the neurons and glial cells were in a high degree of hydropic degeneration; with the perivitelline space expanding, more nucleus pyknosis dissolved and disappeared. The nerve fibers were loose and swollen, and cell gap was

  12. 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

  13. 急性硬膜下血肿短时自动消散现象及相关分析%Short-term auto-dissipation phenomena and related analysis of acute subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    李强; 赵佃林

    2012-01-01

    目的 剖析外伤性急性硬脑膜下血肿短时自动消散现象的伤因、病理及其相关因素.方法 对2006年2月~2012年1月我院12例短时自动消散急性硬脑膜下血肿的临床特点、动态CT扫描结果、治疗方法及预后效果进行分析.结果 12例患者均采取非手术治疗,头颅CT显示血肿均在3 d内消失,4例患者伤后5 h以内血肿完全吸收,5~24 h以内血肿吸收患者3例,第2天血肿吸收患者3例,第3天血肿吸收患者2例,吸收时间最短为4 h,中线结构恢复,脑室、脑池清楚,出院后无神经系统功能障碍.结论 急性硬脑膜下血肿短时自动消散是血液的重新分布,不但跟血肿形态、部位、密度和血肿量有关,而且受蛛网膜破裂、适当的高颅压、脑萎缩和伴有硬膜破裂的颅骨骨折等相关因素影响.%Objective To analyze the cause of injury, pathology and relevant factors of the phenomenon of traumatic acute subdural hematoma short term automatic lift. Methods 12 patients with traumatic acute subdural hematoma short term automatic lift were analysed on clinical characteristics, dynamic CT scans, treatment and prognosis effect. Results 12 patients were adopted in the nonoperative treatment, the CT scan showed the hematoma disappeared within 3 days, 4 patients within 5 h after injury had hematoma absorption, 3 cases within 5-24 hours after injury had hematoma absoiplion, 3 cases had hematoma absorption on the next day, 2 cases had hematoma absorption on the third day, the shortest time of absorption were 4 h, the midline structures were recovered, the vutricle and cisternal were cleared. All patients had no autonomic nervous system after hospital. Conclusion The acute subdural hematoma short-term automatic lift is a redistribution of blood, not only with the hematoma shape, location, density, and hematoma volume, but also by the arachnoid rupture, high in-tracranial pressure, cerebral atrophy and associated subdural rupture of

  14. 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

  15. Radical surgical treatment of pineal region tumors: report of 158 cases%松果体区肿瘤的手术治疗(附158例报告)

    Institute of Scientific and Technical Information of China (English)

    漆松涛; 樊俊; 张喜安; 方陆雄; 邱炳辉; 潘军

    2013-01-01

    Objective To investigate surgical strategies and key techniques of pineal region tumors.Methods The records of 158 patients with pineal region tumors surgically removed by occipital transtentorial approach,including their clinical data,surgical methods and follow-up results,were retrospectively reviewed.Results A gross total tumor removal was accomplished in 137 patients (86.7%),subtotal in 19 (12.0%),and partial in 2 (1.3%).The histological diagnosis was germ cell tumor in 52.5%,pineal parenchymal tumor in 11.4%,glioma in 18.4% and miscellaneous in 17.7%.The mortality and permanent morbidity were 1.9% and 18.4%,respectively.Early or delayed hydrocephalus occurred in 19 cases.Conclusions Radical surgery plays an important role in the management of pineal region tumors.Reasonable approach selection,developed knowledge about arachnoid membranes and deep veins in pineal region,and skilled microsurgical techniques are critical to achieve a safe tumor removal.%目的 探讨松果体区肿瘤的手术治疗策略和技术要点.方法 对采用枕部经小脑幕入路切除的158例松果体区肿瘤患者进行回顾性研究,总结分析其临床资料、手术方法及术后随访结果.结果 肿瘤全切除137例,次全切除19例,部分切除2例.病理证实生殖细胞肿瘤83例,松果体实质肿瘤18例,神经上皮肿瘤29例,其他类型肿瘤28例.术后死亡3例(1.9%),出现同向偏盲、眼球运动障碍等永久性并发症29例(18.4%).19例出现早期或迟发性脑积水.结论 手术切除是松果体区肿瘤的必要治疗手段,合理的手术入路、对松果体区蛛网膜及深静脉系统的深入了解以及娴熟的显微操作技巧,是保障手术安全有效的关键因素.

  16. 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.

  17. Ventral extradural spinal meningeal cyst causing cord compression: neurosurgical treatment Cisto meníngeo extradural ventral do canal espinhal causando compressão medular: tratamento neurocirúrgico

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    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. [Oral contraception and circulatory risks].

    Science.gov (United States)

    Wingrave, S J

    1984-10-01

    The longterm prospective study of health effects of oral contraceptives (OCs) conducted by the Royal College of General Practitioners compared 23,000 OC users with 23,000 controls matched for age and marital status. As of 1981, 55 deaths attributable to circulatory problems had occurred in ever-users of OCs, ciompared to 10 in controls, giving a relative risk of 4.2 for OC users. No relation was found between duration of use and mortality risk among users, although mortality risks were greater at all durations of use than for nonusers. Parity was related to mortality risk among users but not among controls. The most significant factors affecting the relation between pill use and circulatory risk were age and smoking. Among users who smoked, the risk ratios were 3.4 for those aged 25-34, 4.2 for those aged 35-44, 7.4 for those aged 45 and over, and 5.1 for the entire group. Among nonsmoking pill users, the ratios were 1.6 for those aged 25-34, 3.3 for those aged 35-44, 4.6 for those 45 and over, and 3.2 for the total sample. Among smokers, the rates of excess deaths were 1 in 10,000 for users aged 15-34, 1 in 2000 for those aged 35-44, and 1 in550 for those aged 45 and over. Among nonsmokers, the rates were 1 in 50,000 users for those aged 25-34, 1 in 6700 for those aged 35-44, and 1 in 2500 for those aged 45 and over. The majority of deaths were attributed to ischemic cardiac problems and to sub-arachnoid hemorrhages, and risks appeared to be elevated in former as well as current users. The total incidence of circulatory effects in former users appears to be elevated only for cerebrovascular disorders, but the suggestion of residual effects requires further study before conclusions can be drawn. Smokers who developed cardiovascular or cerebrovascular problems were at 2-3 times greater risk of dying than were other women. The percentages of fatal cases of ischemic heart and cerebrovascular diseases were 22.8% among ever-users who smoked, 10.9% among controls who

  19. 分析脊髓空洞症分流术治疗的临床疗效%Clinical Analysis of Treatment of Syringomyelia Shunt

    Institute of Scientific and Technical Information of China (English)

    于传宝

    2015-01-01

    目的:分析通过分流手术治疗脊髓空洞症的患者的临床资料,研究分流手术的临床效果。方法选取我院2012年1月~2014年12月收治的40例脊髓空洞症患者,在进行详细的检查后对其进行分流手术,并在术后3年内进行跟踪随访,确定患者的康复效果。24例为外伤后脊髓空洞症,16例为蛛网膜炎导致的脊髓空洞症。结果28例患者经治疗有明显改善,临床症状基本消失;10例患者较术前有所改善,但症状依旧存在;1例患者的临床症状无明显变化;1例患者加重,治疗有效率达95%。结论通过分流手术治疗脊髓空洞症的患者在手术后神经功能得到明显的改善,空洞复发率低。可见分流手术是目前临床上治疗脊髓空洞症的有效途径。%Objective To analyze the clinical data of shunting operation through the treatment of syringomyelia patients,clinical study on the efect of shunt operation. Methods40 patients with syringomyelia patients in our hospital in January 2012 to December 2014 were enrolment,in a detailed examination after the shunt operation,and in postoperative 3 years folow-up,determine the rehabilitation effect of patients. 24 cases of post-traumatic syringomyelia,16 cases of syringomyelia caused as arachnoiditis.Results 28 patients were treated and had obvious improvement,clinical symptoms disappeared; 10 patients with preoperative symptoms improved,but stil exist, no significant changes in the clinical symptoms of 1 patients; 1 patients were increased,the efective rate was 95%.ConclusionThrough the shunting operation treatment of syringomyelia patients improved obviously in neural function after operation,empty low recurrence rate. Visible shunting operation is an efective way to the current clinical treatment of syringomyelia,is worth the clinical promotion.

  20. Pulsed laser-induced liquid jet: evolution from shock/bubble interaction to neurosurgical application

    Science.gov (United States)

    Nakagawa, A.; Kumabe, T.; Ogawa, Y.; Hirano, T.; Kawaguchi, T.; Ohtani, K.; Nakano, T.; Sato, C.; Yamada, M.; Washio, T.; Arafune, T.; Teppei, T.; Atsushi, K.; Satomi, S.; Takayama, K.; Tominaga, T.

    2016-11-01

    fine perforating vessel involvement, and cerebrovascular disease (1 arteriovenous malformation and 2 intracerebral hemorrhages) in 3 patients. Precise dissection and mass reduction of the tumor were obtained in all tumor cases except for one chordoma with significant fibrosis. Small arteries down to 100 μ m were preserved, allowing subsequent microsurgical devascularization. Veins were also preserved occasionally. The arachnoid membrane and the tumor capsule were resistant to the LILJ except for one case with prolonged exposure. No complications related to use of the LILJ system were observed. No disturbance of the surgical field by splashing, aerosol, or dissemination of pathological tissue occurred with placement of the optimal suction system. The Ho:YAG LILJ system enhances the advantages of commercialized pressure-driven continuous liquid jet instrumentation in terms of small vessel preservation and accessibility in confined spaces for minimally invasive neurosurgery, and solves some of the drawbacks involved with excessive liquid use and size.

  1. 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

  2. Clinical efficacy of microvascular decompression plus intraoperative monitoring of abnormal muscle response in the treatment of hemifacial spasm%微血管减压术辅以异常肌反应电生理监测治疗面肌痉挛

    Institute of Scientific and Technical Information of China (English)

    高俊; 李宽正; 郭毅; 窦万臣; 李永宁; 王任直

    2011-01-01

    目的 探讨显微血管减压手术中,辅以异常肌反应电生理监测治疗面肌痉挛的临床应用价值.方法 北京协和医院于2009至2010年对47例原发性面肌痉挛患者均采用显微血管减压手术,手术过程中间断电刺激患侧面神经颧支,记录同侧口轮匝肌肌电位的变化情况.手术后随诊5~22个月.结果 47例患者在手术开始时,均可在痉挛侧记录到异常肌反应信号.在手术过程中的不同阶段里,42例患者痉挛侧异常肌反应信号消失(其中4、9及29例患者的异常肌反应信号分别于剪开硬膜时、分离蛛网膜时、垫开责任血管时消失);全部42例患者术后未再发作面肌痉挛.5例患者异常肌反应波形在手术结束时仍未消失;随访中发现其中2例患者的面肌痉挛症状完全消失,3例患者痉挛程度较术前明显缓解.结论 显微血管减压手术中辅以异常肌反应电生理监测,可帮助判定责任血管,提高手术的疗效.%Objective To explore the clinical efficacy of microvascular decompression plus intraoperative monitoring of abnormal muscle response in the treatment of hemifacial spasm.Methods Between 2009 and 2010,a total of 47 patients underwent microvascular decompression for hemifacial spasm.There were 15 males and 32 females with an age range 23 -70 years old.During operations,intermittent electrical pulses were applied to stimulate the zygomatic branch of facial nerve at the spasm side.And evoked potentials were monitored in orbicularis oris.All patients were followed up for 5 - 22 months.Results The abnormal muscle responses were recorded pre-operatively in all 47 patients at the spasm side.In 42 patients,the abnormal muscle responses disappeared at the different stages of operations (4 while opening dura,9 while dissecting arachnoid membrane and 29 while separating responsible vessels).All 42 patients were cured during the follow-up period.In the remaining 5 patients,the abnormal muscle

  3. Application of EMG monitoring to microvascular decompression for hemifacial spasm%肌电图监测在面肌痉挛微血管减压术中的应用

    Institute of Scientific and Technical Information of China (English)

    黄进; 吴祥奎; 张岩松; 邵君飞

    2016-01-01

    目的:探讨面肌肌电图监测在面肌痉挛微血管减压术(MVD)中的应用价值。方法回顾性分析MVD治疗的72例面肌痉挛患者的临床资料,术中仔细辨别并处理责任血管,通过实时记录面肌的肌电反应了解减压效果。结果60例有明确责任血管压迫,6例单纯性蛛网膜粘连或增厚,6例存在隐匿性责任血管。术后异常肌电图波形完全消失54例,基本消失16例,无明显变化2例。术后临床症状完全消失57例,部分消失14例,无改善1例;总有效率为98.6%(71/72)。结论面肌肌电图监测可实时了解术中减压效果,对面肌痉挛的MVD,尤其是隐匿性责任血管所致面肌痉挛具有重要的指导作用。%Objective To explore the applied value of intraoperative electromyography (EMG) monitoring to microvascular decompression for hemifacial spasm. Methods The clinical data of 72 patients with hemifacial spasm, who underwent microvascular decompression under intraoperative EMG monitoring, were analyzed retrospectively. The real-time recording of EMG response of facial muscles was performed by the needle electrode put into the ipsilateral orbicularis oculi muscle, orbicularis oris muscle and masseter. Intraoperative careful identification and treatment of vessels responsible for hemifacial spasm in order to understand the effect of decompression and objectively evaluate the prognoses of the patients. Results The blood vessels responsible for the hemifacial spasm were definitely determined in 60 patients. The arachnoid adhesion or thickening was found in 6 patients. The occult blood vessels probably were the vessels responsible for the hemifacial spasm in 6 patients. The abnormal EMG waveforms completely disappeared in 54 patients, almost disappeared in 16 and were unchanged in 2 after the decompression. The clinical symptoms disappeared completely in 57 patients, partly in 14 and were unchanged in 1 after the decompression. The

  4. Congenital encephalocele in children%小儿先天性脑膨出

    Institute of Scientific and Technical Information of China (English)

    金惠明; 孙莲萍; 杨波

    2008-01-01

    目的 总结小儿先天性脑膨出的临床特点和诊治经验.方法 回顾分析1997年5月至2006年5月经外科手术及影像学证实48例先天性脑膨出.结果 本组男28例,女20例,年龄1d~15岁.CT和MRI是主要诊断手段.脑膨出位于枕后36例,前颅窝2例,顶部4例,颅底6例.脑膨出合并颅内畸形有灰质异位、胼胝体发育不全、透明隔缺如、脑积水、Chiari畸形、Dandy-Walker畸形和枕大池蛛网膜囊肿.48例中3例末行手术.4例合并脑积水分别于脑膨出修补前及同时做脑室腹腔分流术,2例脑膨出修补术后急性脑积水及时做脑室腹腔分流术,颅底脑膨出中有3例行经鼻内镜下脑膨出切除修补术.结论 脑膨出为先天性疾病.MRI是首选的诊断方法,推荐MRI检查同时作MR血管造影,明确硬膜静脉窦是否随膨出物突出,以利手术.%Objective To summerize the clinical characteristics and experiences of congenital encephalocele in children. Methods From May 1997 to May 2006, 48 cases of congenital encephalocele confirmed by surgical procedures and imageological studies were retrospectively analyzed. Results In this series, 28 cases were boys, 20 cases were girls, the age ranged from 1 day to 15 years. CT and MRI were the main means of diagnosis. The encephaloceles were located in occiput in 36, anterior cranium in 2, parietal region in 4 and basilar region in 6. Concomitan intracranial anomalies included gray matter heterotopia, callosal agenesis, septum pellucidum absence, hydrocephalus, Chiari malformation, Dandy-Walker syndrome and arachnoid cyst of cisterna magna. 3 of 48 cases did not undergo surgery. 4 cases with hydrocephalus received V-P shunts before or at the same time of encephalocele repair. 2 cases were put V-P shunts in time because of acute hydrocephalus after repair of encephalocele. Via nasendoscopy, 3 cases of basicranial encephaloceles underwent resection and repair. Conclusions Encephalocele is a congenital disease

  5. 外伤性硬膜下积液研究进展%Research progress of traumatic subdural effusion

    Institute of Scientific and Technical Information of China (English)

    何森; 黎明

    2016-01-01

    pressure factors,prevention and treatment of epilepsy,maintaining homeostasis,reasonable use of dehydrating agent,improving cerebral blood circulation and so on.The operative treatment includes the fontanelle before percutaneous centesis,drilling drainage surgery,waist big pool puncture indwelling tube continuous drainage surgery,subdural cavity-peritoneal shunt,arachnoid colostomy and temporal muscle filling operation,envelope resection craniotomy,ventricle mirror surgery and so on.

  6. The effects of intrathecal administration of betamethasone over the dogs' spinal cord and meninges Efeitos determinados na medula e nas meninges pela administração subaracnóidea de betametasona em cães

    Directory of Open Access Journals (Sweden)

    Guilherme Antonio Moreira de Barros

    2007-10-01

    Full Text Available PURPOSE: To determinate the potential clinical and histological changes due the injection of betamethasone, when administered into the canine intrathecal space. METHODS: Twenty one animals were included in a random and blind manner in the study. After general anesthesia, intrathecal puncture was performed and 1 ml of the random solution was injected. The G1 dogs received 0.9% saline solution, the G2 dogs received 1.75 mg betamethasone and the G3 dogs received 3.5 mg of betamethasone. The animals were clinically evaluated for 21 days and then sacrificed. The lumbar and sacral portions of the spinal cord were removed for light microscopy histological analyses. RESULTS: No clinical changes were observed in any of the animals included in this study. No histological changes were observed in G1 animals. Inflammatory infiltration was observed in two dogs, one in G2, another in G3. Hemorrhage and necrosis were also seen in the G2 dog which inflammatory infiltration was detected. In other two dogs, one from G2 and another from G3, there was discreet fibrosis and thickness of the arachnoid layer which was focal in one and diffuse in the other. CONCLUSION: Intrathecal administration of betamethasone caused histological changes in the spinal cord and meninges in some of the dogs involved in this study.OBJETIVO: Determinar possíveis alterações clínicas e histológicas determinadas pela administração da betametasona no espaço subaracnóideo de cães. MÉTODOS: Vinte e um cães foram incluídos no estudo de forma aleatória e encoberta. Depois de anestesiados, os cães foram submetidos a punção subaracóidea com injeção de 1 ml da solução sorteada. Os animais receberam solução salina 0,9% em G1, betametasona na dose de 1,75 mg em G2 e betametasona na dose de 3,5 mg em G3. Todos os animais foram mantidos em observação clínica por 21 dias, sendo posteriormente sacrificados. Porções da medula espinhal e sacral foram removidas para an

  7. Lesões neurológicas na blastomicose sul-americana estudo anatomopatológico de 14 casos

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    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

  8. Pulsed laser-induced liquid jet: evolution from shock/bubble interaction to neurosurgical application

    Science.gov (United States)

    Nakagawa, A.; Kumabe, T.; Ogawa, Y.; Hirano, T.; Kawaguchi, T.; Ohtani, K.; Nakano, T.; Sato, C.; Yamada, M.; Washio, T.; Arafune, T.; Teppei, T.; Atsushi, K.; Satomi, S.; Takayama, K.; Tominaga, T.

    2017-01-01

    fine perforating vessel involvement, and cerebrovascular disease (1 arteriovenous malformation and 2 intracerebral hemorrhages) in 3 patients. Precise dissection and mass reduction of the tumor were obtained in all tumor cases except for one chordoma with significant fibrosis. Small arteries down to 100 μ m were preserved, allowing subsequent microsurgical devascularization. Veins were also preserved occasionally. The arachnoid membrane and the tumor capsule were resistant to the LILJ except for one case with prolonged exposure. No complications related to use of the LILJ system were observed. No disturbance of the surgical field by splashing, aerosol, or dissemination of pathological tissue occurred with placement of the optimal suction system. The Ho:YAG LILJ system enhances the advantages of commercialized pressure-driven continuous liquid jet instrumentation in terms of small vessel preservation and accessibility in confined spaces for minimally invasive neurosurgery, and solves some of the drawbacks involved with excessive liquid use and size.

  9. 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

  10. 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

  11. The superiority of 3D-CISS sequence in displaying the cisternal segment of posterior nerves and their pathological changes%3D-CISS MRI序列对脑池段后组脑神经及其病变显示的优势

    Institute of Scientific and Technical Information of China (English)

    梁长虎; 柳澄; 李坤成; 武乐斌; 庞琦; 乌大尉; 王海燕; 于富华

    2009-01-01

    目的 通过脑池段后组脑神经3D-CISS序列与3D-TSE序列成像质量的比较,评估3D-CISS序列对脑池段后组脑神经及其病变显示的作用.方法 对45例正常体检者和12例患有各种后组脑神经异常症状的病人进行3D-CISS序列、3D-TSE序列扫描,对后组腑神经成像进行评分.结果 舌咽、迷走、副神经及舌下神经在3D-CISS、3D-TSE序列的显示率依次为:100%、57.1%;100%、52.3%;100%、41.1%;91.0%、59.3%.应用3D-CISS序列:对8例血管性神经痛病人显示了责任血管压迫点,对3例后组脑神经微小肿瘤进行了显示,对1例蛛网膜囊肿病人显示了压迫点.结论 对于被脑脊液围绕的后组脑神经显示成像,3D-CISS序列是较好的选择.%Objective To evaluate the efficacy of 3D-CISS on image quality of posterior nerves surrounded by CSF when compared with that of 3D-TSE. Method A total of 45 volunteers and 12 patients with abnormality of posterior cranial nerves were examined using 3D-CISS and 3D-TSE sequences respectively. The image quality were graded for glossopharyngeal nerve、vagus nerve、accessory nerve、 hypoglossal nerves (CN Ⅸ、Ⅹ、Ⅺ、Ⅻ) and their related arteries. Results The identification rates for cisternal segment of posterior nerves were as follows: glossopharyngeal nerve (100% in 3D-CISS and 57.1% in 31)-TSE)、vagus nerve(100% in 3D-CISS and 52.3% in 3I)-TSE)、accessory nerve(100% in 3D-CISS and 41.1% in 3D-TSE)、hypoglossal nerves(91.0% in 3D-CISS and 59.3% in 3D-TSE);12 patients with pathological changes in posterior nerves were all displayed well, among them 8 were pressed by artery, 1 by arachnoid cyst,3 caused by tumors. Conclusions 3D-CISS sequence is preferable when imaging posterior cranial nerves surrounded by CSF.

  12. In normal rat, intraventricularly administered insulin-like growth factor-1 is rapidly cleared from CSF with limited distribution into brain

    Directory of Open Access Journals (Sweden)

    Gorevic Peter D

    2005-07-01

    Full Text Available Abstract Background Putatively active drugs are often intraventricularly administered to gain direct access to brain and circumvent the blood-brain barrier. A few studies on the normal central nervous system (CNS have shown, however, that the distribution of materials after intraventricular injections is much more limited than presumed and their exit from cerebrospinal fluid (CSF is more rapid than generally believed. In this study, we report the intracranial distribution and the clearance from CSF and adjacent CNS tissue of radiolabeled insulin-like growth factor-1 after injection into one lateral ventricle of the normal rat brain. Methods Under barbiturate anesthesia, 125I-labeled insulin-like growth factor-1 (IGF-1 was injected into one lateral ventricle of normal Sprague-Dawley rats. The subsequent distribution of IGF-1 through the cerebrospinal fluid (CSF system and into brain, cerebral blood vessels, and systemic blood was measured over time by gamma counting and quantitative autoradiography (QAR. Results Within 5 min of infusion, IGF-1 had spread from the infused lateral ventricle into and through the third and fourth ventricles. At this time, 25% of the infused IGF-1 had disappeared from the CSF-brain-meningeal system; the half time of this loss was 12 min. The plasma concentration of cleared IGF-1 was, however, very low from 2 to 9 min and only began to rise markedly after 20 min. This delay between loss and gain plus the lack of radiotracer in the cortical subarachnoid space suggested that much of the IGF-1 was cleared into blood via the cranial and/or spinal nerve roots and their associated lymphatic systems rather than periventricular tissue and arachnoid villi. Less than 10% of the injected radioactivity remained in the CSF-brain system after 180 min. The CSF and arteries and arterioles within the subarachnoid cisterns were labeled with IGF-1 within 10 min. Between 60 and 180 min, most of the radioactivity within the cranium was

  13. 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

  14. 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.

  15. Clinical diagnosis and therapy of opsoclonus-myoclonus syndrome%眼球阵挛-肌阵挛综合征的临床诊治分析

    Institute of Scientific and Technical Information of China (English)

    熊晖; 彭镜; 张月华; 包新华; 姜玉武; 秦炯

    2008-01-01

    Objective Clinical manifestations of opsoclonus-myoclonns syndrome(OMS) in children were snummarized and analyzed and the clinical features and therapeutic approaches to OMS were investigated in order to improve its diagnosis and management.Methods Clinical information on features and management of 6 cases with OMS inpatients being followed up from 2006 to 2007 were collected and analyzed.Results Among the 6 cases,one was male and the other five were female.The age at the onset ranged from 12 to 26 months (average 21.0 months). Four of them had history of prior infection.The symptoms were opsoclonus,myoclonns,ataxia,sleep disturbances and behavioural problems in the 6 cases.Urinary DL-3-methoxy-4-hydroxy-acid amygdalin (VMA) was positive in 1 case. Abdominal B-mode ultrasound showed a mild hepatomegaly in 4 cases.The EEG showed abnormal findings such as slow background activity in 3 cases.Epileptiform discharges were found in none of the patients.MRI showed a high signal in medial longtitudinal fasciculus and tectospinal tract on T2-weighted image in 1 case.Computerized tomagraphy found L3-4 arachnoid cysts in 1 case and was normal in the others.Adrenocorticotropic hormone (ACTH) was given to all these patients and was effective in all during acute stage.In 2 cases the disease relapsed during follow-up stage.Conclusion OMS is a rare neurological condition with opsoclonus,myoclonus,ataxia,sleep disturbances and behavioral problems,which might relapse easily and is associated with adverse neurological outcome.ACTH therapy is effective in management of OMS.%目的 总结眼球阵挛.肌阵挛综合征(OMS)的临床特征及治疗经验,以提高诊疗水平.方法 对北京大学第一医院儿科2006至2007年收治的6例OMS患儿的临床、实验室资料及治疗情况进行分析.结果 6例中男1例,女5例,发病年龄12~26个月(平均21个月),其中4例病前有前驱感染史.就诊时主要症状为眼球阵挛、肌阵挛、共济失调

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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 subarachnoi