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Epidermoid cysts in the central nervous system are rare tumours of controversial origin occurring mostly in the last adult age. We present here a series of four cases seen during the last five years. Their common clinical and histological features along with available literature have been discussed.
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The clinical characteristics of dysarthria in neurological disease are reviewed in relation to the site of the lesion, giving special attention to dysarthria as an early symptom and to paroxysmal dysarthria. Iatrogenic and toxic causes of speech disorder are enumerated and the principles of diagnosis and therapy summarized.
Sarcoidosis rarely involves the visual system posterior to the chiasm. A 55-year-old woman presented with fluctuating bilateral macular-sparing homonymous hemianopsia. The computed tomographic scan revealed an extensive contrast-enhancing density involving the tentorium, posterior falx, and adjacent medial occipital lobes and cerebellum. Spinal fluid studies revealed a mixed cellular response, and a biopsy of the meninges established the diagnosis of sarcoidosis. Ultimately, vision was lost, despite chronic steroid therapy. The presumed mechanism of visual loss is infiltration of the occipital lobes by meningeal granulomas, possibly with coexistent vascular occlusion.
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Responses of red nucleus neurons to stimulation of ipsilateral cerebellar nucleus interpositus were studied in cats after lesion of contralateral cerebellar nucleus interpositus within the period ranging from two weeks to one year and seven weeks. Recording of fast and slow mono- and polysynaptic EPSPs showed collateral sprouting of axons of interposito-rubral neurons to occur in various parts of soma-dendritic membrane of rubro-spinal neurons. Stimulation of ipsilateral cerebellar nucleus interpositus evoked antidromic activation in many red nucleus neurons, suggesting the sprouting of axon collaterals from rubro-spinal neurons onto the neurons of ipsilateral cerebellar n. interpositus projecting to the red nucleus.
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A case of venous thrombosis with pseudo-tumoral cerebellar infarction is reported. Cerebello-vestibular symptoms and intracranial hypertension had a progressive course over one and half month. CT showed an unilateral cerebellar lesion, with contrast medium enhancement and hydrocephaly. Thrombosis of the cerebellar superficial veins was found at surgical operation. A thrombosis of the transverse sinus was likely. No cause was discovered. This case, together with a published one, shows that a venous thrombosis may determine a cerebellar infarct.
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UNLABELLED: A rare case of cerebellar astrocytoma presenting with cerebellar hemorrhage is reported. On reviewing the literature, we could collect only four other cases of spontaneous hemorrhage in cerebellar astrocytomas. CASE: On April 5, 1984, a 15-year-old boy noted a sudden onset of headache, vomiting and vertigo and became lethargic and confused. He was admitted on the next day. General examinations, including bloodpressure, temperature and laboratory tests, were found to be normal upon admission. The patient was in somnolence with nystagmus and left dysdiadochokinesis. The result of the left nose to finger test was poor. Computerized tomography revealed a mass leison with calcification and hemorrhage in the paramedian part of the cerebellum. Fourty days after admission, suboccipital osteoplastic craniotomy was performed. A hematoma was found in the paramedian part of the cerebellum. A tumor mass with rich vascularity was completely removed together with the hematoma. Histologically this tissue was a low grade fibrillary astrocytoma accompanying calcification and hemosiderin suggesting tumoral hemorrhage. He regained his neurological functions satisfactorily and was discharged 2 months later.
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The mega cisterna magna is a congenital developmental malformation which in the majority of instances is symptomless and does not require further study or surgical treatment. However, differential diagnosis with other cerebellar diseases is often necessary especially in newborn infants. Ultrasonographic recognition of the mega cisterna magna in a newborn infant is reported. The reported case demonstrates the usefulness of the ultrasonographic technique in the study of the posterior cranial fossa abnormalities of newborn infants.