Sewing needle injuries of the brain.
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Biomedical subjects
Publications and source records attributed to O Barlas.
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Two cases of aqueductal stenosis presenting with fluctuating hearing loss, tinnitus, and vertigo are presented. Audiovestibulometric assessment of both cases disclosed the characteristic pattern of disorder of the membranous inner ear. Non-tumoral aqueductal stenosis was demonstrated by computerized tomography in one case and by positive contrast ventriculography in the other. Shunting procedures of the cerebrospinal fluid resulted in resolution of inner ear dysfunction in both patients.
A 50-year-old woman was first examined in the emergency room because of inadequate ventilation, rapidly developing respiratory paralysis, and papilledema. Multiple cranial nerve palsies and tetraparesis were present. Carotid angiogram demonstrated bilateral ventricular dilatation. Facilities for computerized tomography and vertebral angiography were not available. Ventriculograms revealed a filling defect of the fourth ventricle without displacement of the midline structures. Immediate exploration of the posterior fossa through a suboccipital craniectomy permitted microsurgical excision of a meningioma of the lower clivus. Spontaneous respirations returned postoperatively and a complete return of neurological functions ensued. The pertinent literature is reviewed.
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We report a case of a 35-year-old man with nocardiosis infection involving soft tissue and the central nervous system who had received a cadaveric donor kidney. The patient was admitted with fever, malaise and right shoulder pain. Soft tissue abscess was seen on ultrasound examination. It was presumed due to gram (+) microorganisms, so 4 g day (IV) ampicillin/sulbactam was started empirically once the abscess was drained. Nocardia asteroides was found in the pus specimen. On the second day in hospital, severe headache, ataxia and signs of meningeal irritation appeared. The cranial CT showed two intracranial abscesses in the frontal lobe and cerebellum. We assumed Nocardia asteroides was the infective agent for the cerebral abscesses, so antibiotic therapy was switched to trimethoprim-sulphamethox-asole (3x160/800 mg/d). Nausea and vomiting occurred on the fifth day of therapy, improving after drainage from the frontal abscess. However, these complaints recurred five days later. CT showed cerebellar abscess had become bigger. The patient's complaints improved after the second surgical drainage. N. asteroides was again grown in the aspiration fluids of both cerebral abscesses. Complete regression of the abscesses was seen in the CT after two months. Co-trimoxazole was continued for six months then withdrawn. Graft dysfunction was not observed. Early medical and surgical interventions may be life-saving in this potentially lethal disease.
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