Biomedical subjects
Publications and source records attributed to H F Defesche.
The prognosis of patients subjected to operation for a solitary cerebral metastasis from a pulmonary carcinoma is unfavourable. The prognosis of a solitary cerebral metastasis from a mammary carcinoma that is removed appears to be better: a prolongation of life of acceptable duration and quality is frequently achieved.
This retrospective study from two hospitals is about a hundred patients who have been operated upon a spontaneous cerebral hematoma. By a spontaneous cerebral hematoma we mean a hematoma without a proven tumor, without aneurysm, without arteriovenous malformation, without preceding trauma, without aortical phlebitis and without pathology of the vessel-wall. In this study patients with coagulopathy, arterial hypertension and artherosclerosis are included. In order to comply with these conditions an angiography will have to take place pre-operatively as well as postoperatively. Moreover histological examination of the wall of the hematoma will have to be done. The etiology of the spontaneous cerebral hematoma is not clear in most cases. The indication to operate, the way of operating and the moment in which the operation takes place, vary strongly in medical literature. We operate when there is an aggravation of the clinical picture, persisting severe headache and neurological paresis which does not improve. As a rule we abide for one week before operating, if the clinical picture allows this. After the operation unconscious patients may recover and a hemiparesis may improve. The best way of diagnosing a cerebral hematoma is computerised tomography.
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Loss of cerebrospinal fluid through the nose is known complication of cranial fronto-basilar traumata. Such a fistula generally appears immediately or some time after the trauma; in some cases however the fistula appears a few months or years after. One of the causes of delayed fistula is the existence of leptomeningeal cyst. The clinical symptom of this fistula is often a meningitis. Detection of the fistula is performed through scinticisternography with radioactive media: in case of a leptomeningeal cyst there is a concentration of radioactivity in the fromto-basilar region. In a patient with meningitis and a known history of cranial trauma, even if the latter occurred many years before, it is wise to search for a possible cerbrospinal fluid fistula.
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The scintigraphic diagnosis of eight convexity leptomeningeal cysts is described; the cysts appear as a local collection of abnormal radioactivity, best seen at 48 hours. The correlation of the scintigraphic findings with clinical, radiological, and operative findings is discussed.
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