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PubMed1988

Childhood central nervous system cysticercosis in Australia.

Cysticercosis of the central nervous system is seen infrequently in Australia. Most cases occur in adults, but two imported cases of neurocysticercosis in children are described. A 10-year-old Anglo-Indian girl presented with aseptic meningitis, raised intracranial pressure and a block to the flow of cerebrospinal fluid in the lumbar region. Laminectomy showed two cysticerci in the spinal subdural space. A three-year-old boy from Zimbabwe suffered a focal seizure. A granuloma that contained a degenerate cysticercus was found in the left parietal cortex. Serological examination of blood for cysticercosis was performed only in the second case and gave negative results. Examination of stools in both children gave negative results for the presence of parasites, cysts and ova.

Australia↗
PubMed1980

Experimental infection of mule deer with Parelaphostrongylus tenuis.

Six adult and three fawn mule deer (Odocoileus hemionus) were experimentally infected with a range of 75-100 infective larvae of Parelaphostrongylus tenuis. Five of the six adult deer developed clinical signs of neurologic disease that terminated in paralysis between 35 and 80 days. The sixth deer developed slight signs of neurologic disease for 10 days, but recovered. All three mule deer fawns developed neurologic disease. Adult meningeal worms were recovered from the subdural space of the spinal cord of two fawns. Eggs were observed on the cranial dura mater of one of these fawns, indicating that P. tenuis can complete its life cycle provided mule deer can survive the damage resulting from the infection. Neither eggs nor larvae of P. tenuis were recovered from the feces or lungs of infected mule deer. Clinical signs and histologic lesions observed in experimentally infected mule deer resembled those reported in infected moose (Alces alces americana). Two critical periods were apparent in mule deer infected with P. tenuis: nematode migration through the spinal neural parenchyma, and penetration of the adult nematodes into the cranial neural parenchyma. While most adult deer were unable to survive the first critical period, fawns survived the first but succumbed to infection during the second critical period.

Animals↗
PubMed2002

Cerebrospinal nematodiasis in a moose in Norway.

A case of cerebrospinal nematodiasis in a young adult moose (Alces alces) from Telemark county, southeastern Norway, is described. The moose was found by bird hunters during January, displaying signs of severe posterior paresis. It was killed and submitted for autopsy. The carcass was emaciated, and there were skin excoriations and subcutaneous edema over both metacarpi. Histopathologic examination revealed traumatic malacia throughout the spinal cord and meningeal accumulations of mononuclear inflammatory cells and eosinophils in brain and spinal cord. Two adult female nematodes were found in sections, respectively, of the subarachnoid and subdural spaces of the thoracic spinal cord. The nematode cross sections were similar with those of the two neurotropic Elaphostrongylus species, E. rangiferi and E. cervi. The moose originated from an area overlapping the grazing area of a large population of wild reindeer (Rangifer tarandus tarandus) living on the mountain plateau of Hardangervidda, suggesting the moose was infected with E. rangiferi from reindeer.

Animals↗
PubMedDate not supplied

Primary melanocytoma arising from the thoracic leptomeninges case.

Primary melanocytoma arising from the leptomeninges of the spinal cord is very rare. A surgical specimen of a thoracic meningeal tumor was resected from a 75-year-old woman complaining of gait disturbance was investigated. Magnetic resonance imaging and myelography showed a dumb-bell-type tumor in the subdural space at the 1st to 2nd thoracic vertebrae. The tumor was subtotally resected because of adhesion to the lamina and thoracic medulla. The localized, gelatinous black tumor showed a well-defined margin without dissemination or infiltration. The tumor had a thin capsule and was composed of solid proliferation of neoplastic melanocytes. Neither whorl formation nor foci of palisaded nuclei were observed. The neoplastic cells were of two major types: an epithelioid- or polygonal-shaped type and a spindle-shaped type, and had a large nucleus, a prominent nucleolus, coarse chromatin, and melanin-pigments in their cytoplasm. Only a few mitotic figures were observed. They were positive for HMB-45 and S-100 protein. This case was considered to be primary melanocytoma arising from the thoracic leptomeninges.

Aged↗
PubMedDate not supplied

[Brain temperature during craniotomy in general anesthesia].

Mild hypothermia may occur spontaneously or, because of its putative neuroprotective effect, may be induced purposefully during neurosurgical procedures. Though the brain is the organ targeted for the purpose of neuroprotection, little is known about its temperature during general anaesthesia and craniotomy. The purpose of this study was to define the relations between core, skin and brain temperature during craniotomy and to compare two modes of inducing thermal insulation in patients during operative procedures. To achieve this we recorded core: rectal (Tre), oesophageal (Tes) and tympanic (Try) temperature, brain temperature in the subdural space (Tsd), and skin temperature on the thigh (Tfe), forehead (Tfr) and sternum (Tst) in 15 patients undergoing standard procedure for aneurysm clipping. In 13 patients the core temperature decreased, whereas skin temperature increased, after induction of general anaesthesia with isofluran. Nevertheless the mean body temperature remained unchanged, thus supporting the view that the cause of the resultant core hypothermia was heat redistribution between the thermal core and the periphery. Special thermofoil proved to be only as effective as a plain cotton blanket in preventing further heat loss during the later phases of the operation. Brain temperature was found to be the lowest core temperature throughout the procedure. It differed by as much as 0.1-1.2 degrees C from rectal temperature (mean 0.75 +/- 0.41 degree C) and reached the level of mild hypothermia (below 35 degrees C) even in those patients in whom rectal temperature indicated the state of normothermia. Furthermore tympanic and oesophageal temperature was on average 0.5 degree C higher than brain temperature. In conclusion, temperature measurements obtained in standard sites do not reflect brain temperature reliably during craniotomy and general anaesthesia. This indicates that the direct measurement of intracranial temperature is necessary for correct estimation of brain hypothermia.

Anesthesia, General↗
PubMed2000

[A case of hematoma in cisterna magna after mild head injury].

An 18-year-old man suffered severe neck pain, signs of meningeal irritation, and dysesthesia of his left breast and left arm after mild head injury incurred in a traffic accident. On the next day, magnetic resonance imaging(MRI) revealed a hematoma in the cisterna magna, and it extended into the posterior spinal subdural space. Eight days after admission, MRI demonstrated the hematoma on the right posterior aspect of the spinal cord at the level of craniovertebral junction. These MRI findings suggested a ruptured bridging dorsal vein from the spinal cord to the occipital or marginal sinus. The usefulness of MRI for diagnosis of localized hematoma around the craniovertebral junction and the mechanism of this hemorrhage are discussed.

Accidents, Traffic↗
PubMed1999

Management of chronic subdural haematoma: burr hole drainage, replacement with Hartmann's solution, and closed-system drainage.

Although the treatment of chronic subdural haematoma by burr hole drainage has been performed in the past with or without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. Cerebral infarction may also develop a few days after surgery because of the intracranial hypotension that occurs during the drainage procedure. In an attempt to minimise these complications and to prevent cerebral infarction and its attendant morbidity, we have developed a technique of treating chronic subdural haematoma-namely, performing burr hole drainage, irrigation and replacement of the haematoma with Hartmann's solution, and closed-system drainage of the subdural space with a silicone catheter. The blood pressure is closely monitored and maintained by the infusion of fluids throughout the procedure. An illustrative case using this technique is presented in this paper.

Journal Article↗
PubMedDate not supplied

Atypical parasitic migration and necrotizing sacral myelitis due to Serratospiculoides amaculata in a prairie falcon (Falco mexicanus).

An adult, wild-caught, female prairie falcon (Falco mexicanus) was presented with the chief complaint of anorexia. Radiographic findings included increased densities within the air sacs, and coelomic endoscopy revealed numerous slender worms within the air sacs and on the serosal surfaces of the ovary, oviduct, liver, proventriculus, and ventriculus. The bird seemed to improve for a short period of time with antiparasitic therapy (ivermectin and fenbendazole) and supportive care. Twenty-one days after initial presentation, the bird became recumbent with increasing pelvic limb neurologic deficits and was euthanized. On histopathologic examination, mature nematodes and larvated eggs identified as Serratospiculoides amaculata were found within the subdural space of the distal thoracolumbar and synsacral spinal cord and within the coelomic cavity. This case suggests that S. amaculata can cause clinically significant lesions in its falconiform host with potentially fatal results.

Animals↗
PubMed1992

[A patient with epilepsy presenting developmental regression after seizures--consideration of the mechanism from the findings of CT-scan and SPECT].

We report a 6-month-old female infant with frequent brief seizures who subsequently showed developmental regression. CT-scans right after her seizures revealed enlargement of bilateral subdural space more on the right side with an evidence to suggest destruction of the blood brain barrier in enhanced CT-scan, CT-scan, one month after the onset, showed diffuse brain atrophy. 123I-SPECT, which was performed 11 days after cessation of her seizures, still showed diffuse hypoperfusion predominantly in the right temporal area, and it returned to normal 3 months after the onset. We discussed the mechanisms of developmental regression in this case from the neuroradiological findings.

Child, Preschool↗
PubMed1992

[Spinal endoscopy in the detection of problems caused by continuous spinal anesthesia].

Continuous spinal anaesthesia has a number of advantages, but there are a number of drawbacks as well: difficulties in threading the catheter, distribution of the local anaesthetics and the development of cauda equina syndrome. Spinaloscopy was done to visualize the fate of catheters during and after their insertion, as well as the distribution of local anaesthetics injected through these fine-bore catheters. METHOD. The studies were conducted in preserved and fresh cadavers donated to the Anatomic Institute for Medical Studies. The spinal column from T12 to S1, together with the back musculature (in order to preserve the normal curvature of the spine) were removed from the cadaver. Spinaloscopy was done with a 4 mm endoscope with a 0 degree optic (Storz, Tutlingen, FRG). All observations were made from the lumbosacral region of the dissected preparation. In this fashion, it was possible to observe the insertion of the spinal needle used to introduce the catheter into the subdural space. The distribution of local anaesthetics injected through a 22-gauge spinal needle or a 28-gauge catheter was shown by injecting 0.5% hyperbaric bupivacaine colored with a small amount of 1% methylene blue. Pictures were taken 15, 30 and 45 s after beginning the injection. RESULTS. Difficulty in threading the catheter: our observations indicate that the difficulty in inserting microbore catheters is most likely due to inserting the needle too far. It is impossible for the catheter to bend and be inserted into the subarachnoid space. In many cases the catheter encountered the anterior wall of the spinal canal and would slide along various structures. Distribution of the drug: the injection is better dispersed with a 22-gauge needle and it completely fills the subarachnoid space. The local anaesthetics injected through the 28-gauge nylon catheter (Kendall Healthcare, Mansfield, Mass.) are distributed in the dependent portions of the spinal canal. If high doses and a high concentration are injected, the distribution pattern may result in an overconcentration in some parts of the subarachnoid space. Possibility of trauma: the catheter stretches around the roots, the potential for trauma is that untoward stress may be applied to the root, either during full insertion of the catheter or during its withdrawal. CONCLUSION. Spinaloscopy was done in a non-fixated anatomic spinal column preparation with a 4 mm 0 degree endoscope (Storz, Tuttlingen, FRG). Based on our observations, we conclude: The catheter should only be inserted 2 cm into the subarachnoid space. This may decrease the risk of malpositioning. After the tip of the catheter has reached the subarachnoid space, the stylet should be with drawn 2 or 3 cm to minimize the risk of nerve injury and/or bleeding.

Anesthesia, Spinal↗
PubMedDate not supplied

[Anesthesia of the brain stem after a retrobulbar block. Description of 2 cases].

The Authors report two cases of central nervous system complications after retrobulbar block. These complications have a 0.044% incidence in 4500 subsequent cases of retrobulbar blockade studied from 1981 to 1990. The Authors attribute the respiratory arrest and coma to direct access of the anesthetic to the central nervous system along the subdural space in the optic nerve sheath.

Brain Stem↗
PubMed2004

Non-accidental fatal head injury in small children--a clinico-pathological correlation.

Non-accidental head injury leading to massive intracranial trauma has been identified as a leading cause of death in small children. In a typical case, a child usually below the age of one year is violently shaken, leading to rupture of the connecting veins between the dura mater and the brain substance with variable degrees of bleeding into the subdural space resulting in increased intracranial pressure. The accompanying venous thrombosis affecting the vessels of the brain substance leads to cerebral hypoxia and cellular death. In this study conducted throughout the year 1999, all children below the age of 3 years who were admitted to Hospital Kuala Lumpur and had died due to non-accidental injuries were included. Postmortems, including histopathological studies, were conducted to determine the most likely mechanisms of the injuries. Ten cases were identified for the whole year. In 2 cases, both below one year of age, the features presented showed evidence of violent shaking of the infants. In 6 other cases whose average age was 13 (range 4-24) months, there were evidences of direct trauma and violent shaking. In the last two cases, aged 24 and 33 months respectively, there was only evidence of direct trauma on the heads without being shaken. This study shows that death due to intracranial trauma caused by shaking with or without direct impact is the most frequent cause of mortality in abused children. Death due to direct impact between the head and another object is a less frequent occurrence.

Autopsy↗
PubMed2005

Self-inflicted penetrating head injury in a patient with manic-depressive disorder.

A 32-year-old Caucasian male with a history of repeated self-injury drilled a hole in his skull using a power tool and subsequently introduced intracerebrally a binding wire from a sketch pad. An emergency craniotomy was performed around the site of cranial injury, and the foreign body was carefully extracted. The wire was located partially in the subdural space and partially in the right hemisphere of the brain. The patient made an excellent recovery and was referred to a psychiatrist for further treatment. This is a rare case of unusual and complex repetitive self-destructive behavior without apparent suicidal intent. The pertinent literature is reviewed and the surgical and psychiatric implications of such injuries are discussed.

Adult↗
PubMed1992

[Clival chordoma in an infant; case report and review of the literature].

Skull base chordoma in infants is a very rare entity in spite of its congenital origin; only 11 clinical cases can be found in the literature so far. Here we report such a case and review the literature. The case is that of a 3.5-year old boy suffering from left abducent nerve palsy for 5 months. CT scan revealed an isodense mass lesion with bone destruction involving the clivus and left petrous apex, and was homogeneously enhanced on post-contrast study. MRI disclosed the clival tumor as a long T1 and long T2 mass. Angiogram showed no tumor stain. The tumor was preoperatively diagnosed as clival chordoma, and was partially removed via left transpetrosal-transtentorial approach. The tumor was found to extend into the subdural space through Dorrello's canal and compress the abducent nerve. Histological examination with H & E, PAS, mucicarmine, and reticulin stainings led us to a diagnosis of "typical chordoma". Electron microscopy demonstrated the mitochondria-endoplasmic reticulum complexes (MERC), glycogen granules, and vacuoles in the tumor cells. Postoperative irradiation (total dose 55 Gy) was performed. At present, 30 months after the operation, no evidence of tumor regrowth nor hypothalamus-pituitary deficiency is recognizable and the patient is free from left abducent nerve palsy. It is concluded that skull base chordoma in infants should be postoperatively irradiated in an appropriate manner.

Child, Preschool↗
PubMed2005

[Intracranial hemorrhage in term newborn].

BACKGROUND: The improvements in perinatal care during last decade have changed clinical presentation of intracranial hemorrhage (ICH) among full-term newborns. New imaging techniques allow for diagnosis of ICH even in asymptomatic babies. AIM: Analysis of prevalence and risk factors of ICH among full-term newborns requiring intensive care. MATERIAL AND METHOD: 397 full-term newborns hospitalized in tertiary Neonatal Intensive Care Unit were analyzed. Detailed neurological evaluation, head ultrasound and/or cerebrospinal fluid were done. RESULTS: ICH was diagnosed in 40 newborns. The most common clinical presentation was subarachnoid hemorrhage (n = 24). Multifocal bleeding was more frequent (28/40) than bleeding only to one brain compartment (12/40). In the first week of life bleeding to different compartments was observed, but in the 2nd week of life there was no bleeding to posterior fossa. Eleven newborns died due to ICH (parenchymal and subarachnoid ICH). Significant, independent ICH risk factors were: delivery complications (OR: 10.4: 95% CI: 3.7-29.6), scull bone fractures (OR: 44.4: 95% CI: 4-495), nuchal cord (OR: 6.4: 95% CI: 2.2-18.8), hemorrhagic diathesis (OR: 4.5: 95% CI: 1.2-17.5). CONCLUSIONS: Significant risk factors of ICH among full-term newborns requiring intensive care are: mechanical (scull bone fractures, labor complications) trauma, nuchal cord, hemorrhagic diathesis. In such cases the detailed neurological evaluation and imaging techniques should be used to exclude bleeding. Multifocal bleeding is the most common form of ICH. Because subarachnoid and subdural space are not easy visible by head ultrasound, the CT or MRI scans are recommended in babies with ICH.

Female↗
PubMed1990

Value of CT and NMR imaging in diagnosing of chordomas.

Chordomas usually occur in the axial skeleton and they arise from the remnants of notochord. Their growth is slow and they often give metastases. Such cases are mainly observed among people above 40 years of age. Most frequently chordomas are situated in sacral bone (50%), in spheno-occipital region of the skull base (35%), and in the cervical, dorsal and lumbar spine (15%). Very rarely chordomas are found within sella, paranasal sinuses and nasopharynx, and in the forms of ectopic foci in the pons and spinal canal. Such tumour situated within spine destroys vertebral bodies and arches and can bulge into subdural space causing impression of the dural sac. Despite osteolytic destruction, chordomas cause visible reactive sclerotization and characteristic granular calcifications or ossifications. Intracranial chordomas destroy bony base of skull, specially clivus, pyramids and sphenoid sinuses.

Adolescent↗
PubMed1991

Transtemporal approaches to the skull base.

Transtemporal approaches to lesions of the posterior fossa and/or temporal bone afford direct access with minimal manipulation of the subdural spaces. In most instances, the primary concern is the preservation of seventh nerve integrity or restoration of seventh nerve function in the event of loss of facial nerve integrity. The transtemporal approaches afford the surgeon the ability to trace the seventh nerve from normal to diseased regions and so increased the possibility of anatomical preservation. In addition, the availability of the seventh nerve for transposition or rerouting makes nerve grafting easier in the event of seventh nerve sacrifice. Limitation of the craniectomy site within the temporal bone without violating the deep cervical musculature avoids the complication of severe postoperative headaches so frequently seen in suboccipital resections. Thorough knowledge of the temporal bone anatomy and intracranial structures is mandatory prior to utilization of this procedure.

Cochlea↗
PubMed1991

Presentation of rhinosinugenic intracranial abscesses.

Intracranial abscesses secondary to rhinosinugenic disease are uncommon and the incidence is poorly documented. It is generally believed that individuals at risk of developing this complication can be identified by presenting clinical features. A ten year retrospective Scottish national survey 1976-1985 of intracranial abscesses was carried out. Clinical and or radiological evidence of nasal/paranasal aetiology in abscesses localised to the frontal lobe, extradural or subdural spaces allowed 23 surgery or autopsy confirmed abscesses to be classified as rhinosinugenic. 12 abscesses occurred in individuals aged 0-19 years, two in patients with risk factors for intracranial spread, 8 of 11 adults had similar predisposing features (p less than 0.01). This is a rare complication and individuals at risk in the first two decades of life can seldom be identified prospectively on clinical grounds.

Adult↗