Biomedical subjects
Publications and source records attributed to P L Silbert.
Cranial CT features of two patients with intracerebral hemorrhages in the setting of sepsis and disseminated intravascular coagulation are reported. Multiple predominantly subcortical hemorrhages were seen. This pattern of cerebral hemorrhage should raise suspicion of disseminated intravascular coagulation as an underlying cause.
OBJECTIVE: To report a case of cerebral neurocysticercosis, in which cranial magnetic resonance imaging (MRI) was performed at the time of probable death of the cysticercus. CLINICAL FEATURES: A 15-year-old Indian boy with a focal seizure disorder presented with a low-grade fever and an increase in seizure frequency. Cranial MRI scanning demonstrated a small, cortically based nodule surrounded by a low-intensity ring and extensive oedema. INTERVENTION AND OUTCOME: Carbamazepine therapy was continued (without steroids) and a further MRI scan after one month showed resolution of the oedema, and a subsequent cranial CT scan showed calcification of the cortically based nodule. Praziquantel therapy was administered. CONCLUSIONS: Diagnosis of neurocysticercosis must often rely upon clinical and distinctive radiological findings. Death of the cysticercus may provoke an inflammatory reaction that may result in an increase in seizure frequency.
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Five patients presented with symptoms related directly to pressure effects from their cavum septum pellucidum with persistent or intermittent obstructive hydrocephalus. The most characteristic presenting symptoms were intermittent postural headache and postural loss of consciousness. If cysts of the cavum septum pellucidum are symptomatic and stereotactic cyst puncture or fenestration are ineffective, ventriculoperitoneal shunting should be carried out before resorting to more radical excision of the cyst.
OBJECTIVE: To report a case of central and extrapontine myelinolysis with unusual behavioural manifestations that developed after slow (not more than 0.5 mmol sodium per litre per hour) correction of hyponatraemia. CLINICAL FEATURES: A 51-year-old Caucasian woman with hyponatraemia caused by psychogenic polydipsia experienced a delayed onset of behavioural changes with some ataxia, but no pyramidal signs, after correction of the hyponatraemia. INTERVENTION AND OUTCOME: The hyponatraemia was corrected with a combination of hypertonic saline and fluid restriction at the currently recommended rate of not more than 0.5 mmol of sodium per litre per hour. CONCLUSION: Central and extrapontine myelinolysis may develop after slow correction of hyponatraemia. Behavioural manifestations may be the most prominent clinical feature.
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Breath-holding spells can be a source of considerable parental anxiety and are a frequent cause of referral to paediatric services. This report is of a family of seven siblings all of whom have suffered breath-holding spells, including three who developed breath-holding spells within the neonatal period, with the other four developing them at 3-4 months of age. All of the children have on occasions exhibited convulsive activity at the termination of the episode. All had normal initial electroencephalogram's (EEG) and one had centrotemporal spikes on his EEG when repeated at age 6 years. Anticonvulsant therapy resulted in a reduced frequency of breath-holding spells. The epidemiology, pathophysiology and therapy of breath-holding spells is discussed with reference to this unique family. This report gives further credence to the notion that there often may be a familial predisposition to breath-holding spells.
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Facial paraesthesia due to perineural malignant infiltration is a well recognised complication of basal and squamous cell carcinomas of the head and neck. Perineural involvement was originally attributed to involvement of the perineural lymphatics; however subsequent studies have demonstrated conclusively that these lymphatics do not exist and that the invasion occurs along the line of least resistance. Previous studies on perineural spread of carcinomas of the head and neck have emphasised diagnostic biopsy of an involved nerve (e.g. the infraorbital, mental or major branches of the trigeminal nerve), or at times craniectomy with exploration of the gasserian ganglion. We suggest that in many cases the diagnosis can be obtained by biopsy of the anaesthetic skin alone, without recourse to more involved biopsy techniques. The following case report illustrates this point.
Ophthalmoplegia is a rarely observed sign in carbamazepine and other anticonvulsant overdoses. We present a patient who developed transient complete external ophthalmoplegia and asterixis with relative preservation of consciousness, in association with carbamazepine toxicity. Previously reported cases and proposed mechanisms are reviewed.
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There is a definite relationship between the vascular type of benign sexual headache and benign exertional headache. Forty five patients with benign vascular sexual headache were reviewed. Twenty seven (60%) experienced benign vascular sexual headache alone and eighteen (40%) had experienced both benign vascular sexual headache and benign exertional headache on at least one occasion. The mean age was 34.3 years with a male:female ratio of 5.4:1. Thirty patients with a history of benign vascular sexual headache were followed for an average of 74 months. A personal history of migraine was found in 47% of cases and a family history of migraine in 30%. Forty one per cent of patients with benign vascular sexual headache alone had recurrences after diagnosis, and stress and fatigue were considered major contributing factors to the initial and recurrent headache. Nine patients had experienced benign vascular sexual headache and benign exertional headache within 72 hours of each other on at least one occasion, often with a residual headache between the two. Four patients experienced their benign vascular sexual headache and benign exertional headache separated by months to years. The prognosis of benign vascular sexual headache and the clinical and possible pathophysiological relationships between benign vascular sexual headache and benign exertional headache are discussed. Knowledge of the interrelationships of these varieties of headache is valuable in the counselling of patients.
We have prospectively studied 45 patients undergoing scoliosis surgery (48 procedures) for evidence of postoperative acute radiculopathy. Posterior spinal fusion was performed in 42 patients (Cotrel Dubousset 28, Harrington rod with wires 9, Hartshill rectangles 5); anterior spinal fusion in 5 (Webb Morley) and an anterior release procedure in 5. Fourteen patients (29%) had sensory and/or motor signs of radiculopathy post-operatively, with moderate to severe symptoms in 10 and mild symptoms in 4. The radiculopathies were considered traumatic in 7 patients, in whom radiculopathy correlated with placement of a hook or passage of a sublaminal wire. In the remaining 7 patients, traction was considered the likely mechanism of injury; in these there was a significant association with the degree of postoperative correction of the scoliosis where it was substantially beyond the preoperatively demonstrated flexible range (p = 0.008). A system of intraoperative electromyographic monitoring for possible prevention of this complication is described. Radiculopathy is a common complication of scoliosis surgery.