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[Cerebral metastases and their revealing forms in a series of 156 cases. Contribution of cerebral scintigraphy to the diagnosis and indications for surgery].

This series of 156 cases of brain metastases collected over a period of 14 years may be divided up into 65 considered as multiple following further investigation and thus refused for surgery, and 91 considered as simple and operated on. Our conclusions are very similar to those presented recently to the French Society of Neurosurgery. Emphasis is however placed on the frequency of metastases which are the first sign of cancer and thus resemble a cerebral tumour. Postoperatively the primary tumour continues to develop for it is often not found. Even under these conditions, a single metastasis should lead to operation and it may be distinguished from multiple metastases by a brain scan together with angiography which often permit not only the diagnosis of malignant tumour but also its secondary nature. The scan was positive in 85% of our 78 cases including 20 gamma-encephalographies and 58 angioscans. The diagnosis of metastases was possible in only 57% where as other authors have accorded more specificity to this investigation.

Brain Neoplasms↗

Non-ketotic hyperglycinaemia in a neonate. A case report.

Non-ketotic hyperglycinaemia was diagnosed in a newborn infant presenting with lethargy, apnoea, hiccoughs and myoclonic seizures. The typical findings of raised cerebrospinal fluid:plasma glycine ratio, a burst suppression pattern on electro-encephalography, hypodense areas seen on computed tomography and lack of acidosis, ketosis and serum organic acid abnormality confirmed the diagnosis. Prenatal diagnosis by investigating the glycine cleavage enzyme system from a chorionic villus sample is not yet available.

Amino Acid Metabolism, Inborn Errors↗

[Study of a new anesthetic agent: etomidate (R 26490). Electroencephalographic aspects].

Etomidate or R 26490 is a new hypnotic agent produced by JANSSEN and al. in 1971. The first human experimentation was performed in 1972. The authors used Etomidate for 300 anaesthetics given for neuroradiological investigations. Two protocols were used for study: 25 anaesthetics were given with Etomidate as sole anaesthetic to outline its specific properties; 275 angiographies were performed with a combination of Etomidate and fentanyl. In protocol no. 1, the mean consumption was for 1,85 mg/kg/h, in protocol no. 2, the mean consumption was of 0,9 mg/kg/h. Pharmacological study of this drug defines it as a short acting hypnotic agent of low toxicity. Clinical observation shows cardiovascular and respiratory stability. However, frequent myoclonias were noted, when Etomidate was given as a sole anaesthetic. EEG recording and evoked response encephalography helped to outline some effects of Etomidate on central nervous system.

Adolescent↗

[Purulent meningitis in children in Yaounde (Cameroon). Survey of complications using echoencephalography].

Sixty-one infants aged 0 to 12 months with documented purulent meningitis underwent transfontanellar ultrasonography at the Yaounde Central Hospital. Twenty-eight (45.90%) infants had evidence of complications including communicating hydrocephalus (20 patients; 71.43%), ventriculitis (5; 17.86%), abscess with ventriculitis (2; 7.14%), and cerebral atrophy (1; 3.57%). An analysis of the main epidemiological, bacteriological and clinical parameters found no correlation between the presence of ultrasound evidence of complications and age, sex, or color of the CSF. Conversely, a close correlation was found with both the time elapsed between onset and initiation of treatment and the severity of clinical manifestations (coma, seizures). The authors, recommend routine ultrasound encephalography in infants with meningitis, improved information of parents, and close collaboration between pediatric radiologists and neurosurgeons.

Age Factors↗

[Prolactin-secreting adenomas. Radiologic signs].

The sellar and tomo-encephalographic changes in pituitary prolactin secreting adenomas are described on the base of 75 cases detected within a period of 2 years. In the diagnosis of smaller adenomas in which the sellar findings may be questionable, the value of fractionated encephalography is emphasized, and especially of frontal tomograms, in order to demonstrate a lateral bulging of the sellar diaphragm and a shift of the pituitary stalk to the opposite side.

Adenoma↗

[Effect of fractionated pneumoencephalography on intracranial pressure].

The major changes in clinical condition during and after encephalography may be explained by intracranial pressure variations. If neither intracranial hypertension nor CSF dynamic perturbations exist, minimal complications may be predicted, but in intracranial hypertension immediate deterioration may occur. Despite an apparently good level of tolerance, complications may develop if the compensation phenomena cannot occur: normal pressure hydrocephalus, craniosynostosis. In the cases with good clinical tolerance, minimal changes occur when air injection is administered at a slow rate and with a small volume.

Atrophy↗

Catamnestic study of cases with tardive decompensated hydrocephalus.

One hundred patients with decompensated hydrocephalus (60 operated, 40 nonoperated) were studied both retrospectively and prospectively at 3 moments of the disease course. The indicators were clinical: neurologic, psychic and social, and paraclinical: results of pneumoencephalography, encephalography, radioisotope cisternography. The effects of surgical treatment (ventriculocardiac derivation) and of medical treatment were evaluated at short and long term. In surgical treatment, favourable short-term outcome (headache, gait and micturition disorders, improved consciousness, psychomotor activity, social behaviour) was found in 88% of the patients; long-term favourable outcome was present in 60% of the patients and implied only the psychic and social indicators. In medical treatment the favourable short-term outcome was nonsignificant and the long-term outcome was favourable in only 32% of the patients. In the remaining cases evaluated as unfavourable, the cognitive disorders increased progressively. The predictors for favourable therapeutic outcome were: early diagnosis, early surgical intervention, the clinical form of hydrocephalus, the sequelae and short-term effects of surgical treatment.

Adult↗

Health effects of pesticides in the flower-bulb culture in Holland.

In a comprehensive project the health risk for workers using pesticides in the flower-bulb culture was addressed in several studies regarding biological monitoring, occupational hygiene and health effects. With respect to biological monitoring, methods were developed for the analysis of metabolites in urine of captan, pirimicarb, zineb and maneb and the soil fumigant dichloropropene. For dichloropropene in a field study a clear relationship was found between the external personal exposure and the excretion of two metabolites (mercapturic acids) in urine. The application technique distinctly influenced the extent of exposure. For the other substances preliminary measurements were performed in the urine of exposed workers; for captan and pirimicarb the methods are promising for further studies of the uptake of these substances under working conditions. In an occupational hygiene study, the dermal exposure due to different application techniques used in crop protection and bulb disinfection was investigated. This resulted in method specific exposure values (grams/field area of bulbs) that showed large differences between the techniques. These exposure values in combination with information on the type of techniques used, the treated area and the frequency of application were used to calculate a personal exposure index (grams/working life); this is an estimate of the potential (external) exposure of individual workers. In an effect study 137 workers who applied pesticides for more than 10 years (average 20 years) in at least bulb disinfection and crop protection (the most important area's of exposure for the growers) were compared to 73 controls. Tests for autonomic and peripheral nerve functions including the distribution of conduction velocities and refractory periods, were applied as well as computerized neurobehavioral tests and electro-encephalography. Significant effects were found on peripheral nerve function parameters, on measures of attention and perceptual coding and on the amount of beta-activity in the EEG; the data suggest that for the majority of subjects these effects are small. No effects were found on liver and renal function and no difference in the prevalence of symptoms that might be ascribed to the usage of pesticides. In a number of exposed workers a cutaneous allergy to pesticides was found. Based on this study, measures are recommended to diminish effectively the exposure to pesticides in this culture.

Acetylcysteine↗

[Neuro-surgical exophthalmias (retrospective study of 27 cases at the C.H.U. of Dakar)].

The report covers 27 cases of neuro-surgical exophthalmia treated at Dakar U.H.C. between 1970 and 1987. Unilateral forms are the most common (25 cases), usually discovered at the bulging stage. Exploration was undertaken by the usual means of X-ray without contrast, echography, arteriography, and fractioned, gaseous encephalography employed together in varying degrees. The main etiologies are tumours (70%), largely benign, and specific and non-specific inflammation (18.5%). Surgery was prescribed in 18 cases, including 11 orbitotomies--8 frontal and 3 fronto-temporal. Malformation syndromes, and above all very advanced pathologies challenged surgical skill in 9 of the cases. Generally speaking, post operational results are favourable, but 3 deaths are reported and one relapse. Tomodensitometry, modern anaesthetic and revival techniques, and the important collaboration between the ophthalmologist and the neuro-surgeon are all factors in successfully mastering neuro-surgical protrusions.

Adolescent↗

[Significance of computed tomography in therapeutic diagnosis of brain tumors (author's transl)].

Because of its noninvasive property of direct imaging of the size and shape of the lesion, CT scan is significant not only for the diagnosis of the brain tumors, but also for the assessment of its chronological and/or therapeutic change in size. Contrary to the conventional cerebral angiography and contrast encephalography, CT scan is feasible to detect the tumor repeatedly at short intervals. From March 1976 to October 1977, 197 cases of brain tumors were examined by CT, 6 tumors (1 pineal tumor, 2 cerebellar vermian tumors and 3 supratentorial tumors) of which were radiated after the initial CT scan and re-examined by CT at every 400-1,000 rads radiation, and their grade of radiosensitivity could be evaluated. Immediately after the radiation of 400 rads for five days to the large pineal tumor of a 16-year-old boy, CT exactly showed the markedly diminished size of the tumor, and the tumor disappeared on CT after the 4,000 rads radiation. Cerebellar vermian tumors suspected of medulloblastoma were also diminished in size on CT after the 600 rads radiation. One supratentorial tumor was radiosensitive and disappeared at the end of radiation therapy. Other supratentorial tumors were not changed on CT during the radiation. Procedures for the therapeutic diagnosis, when combined with CT, can easily indicate whether the tumor is radiosensitive or not, without any invasive examination and/or operation.

Adolescent↗

[The examination pattern at an x-ray department over a 25 year period].

The pattern of examinations at the x-ray department of Buskerud sentralsykehus has changed over the last 25 years. Heart- lung- and skeleton examinations remain unchanged, and represent 71 to 79% of the total number, but there has been a marked charge in other examinations. Through the years there has been a marked decline in the number of "classical" contrast medium examinations of gallbladder/gall-paths, gastroduodenal examinations and intravenous pyelography. Air-encephalography has disappeared, and arthrography is about to disappear as an x-ray examination. New methods, such as computer-tomography and ultrasonography and non-radiological examinations, such as gastroscopy and arthroscopy, seem to be the main reason for this change, but other factors, such as change in disease patterns and therapeutic procedures may also have contributed.

Norway↗

[Magnetoencephalography--current trends].

The review deals with the method of magnet-encephalography. The physical principles and the most important technical conditions to put into practice this method are mentioned. Comparing with the electroencephalography this method shows various advantages, what leads to its intensive use for the localisation of components of evoked potentials, for the magnet-encephalographic record of the brain activity of the human fetus, and for the localisation of epileptic foci in therapy resistant epileptics.

Brain Damage, Chronic↗

Effects of clonidine, yohimbine and eserine on the quantified EEG of rats.

The effects of three different classes of drugs were analyzed on the EEG of rats on two cortical derivations (parieto-occipital and fronto-occipital) and one deep structure, the locus coeruleus. Clonidine, an alpha 2-agonist (0, 0.10, 0.30 and 0.50 mg/kg, i.p.), yohimbine, an alpha 2-antagonist (0, 2, 4 and 8 mg/kg, i.p.) and eserine, an anticholinesterase (0, 0.10, 0.30 and 0.50 mg/kg, i.p.), affected the EEG in different significant ways. Clonidine significantly decreased frequency in the theta-band (3.7-7.5 Hz) and increased it in the alpha-band (7.6-13.5 Hz). A general significant increase in power was also observed. For yohimbine, there was a significant dose-dependent increase of power, particularly in the theta-, alpha- and beta-bandwidth. Moreover, its effects on EEG varied in accordance to the derivations analyzed. Finally, eserine significantly decreased power in the high frequency bandwidths. A synchronization, as a function of dose, with a peak at 5-6 Hz was observed shortly after its administration. The results are discussed in terms of the potentiality of the technique of quantitative pharmaco-electro-encephalography and drug interaction studies in the analysis of psychoactive substances.

Animals↗

Principles of the 2-deoxyglucose method for the determination of the local cerebral glucose utilization.

Sokoloff and co-workers developed the 2-deoxy-D-[1-14C]glucose (2DG) method in order to study the local cerebral glucose utilization (LCGU) of discrete brain regions in vivo. Energy metabolism of the adult mammalian brain is almost entirely dependent on glucose. The majority of the glucose taken up by the brain is needed for the maintenance of the membrane potentials and the electrical activity. The functional activity could thus be shown to be closely linked to energy metabolism. Consequently, examination of the energy metabolism by measuring the cerebral metabolic rate for glucose can provide information concerning functional activity in all of the neuroanatomically defined regions of the brain. Studying the fate of experimentally injected 2-deoxy-D-[1-14C]glucose, a radioactive labeled analogue of glucose, and, subsequently, employing quantitative autoradiographic techniques, it is possible to estimate the levels of the local cerebral glucose utilization in specific regions of the brain. According to Sokoloff (1982) the LCGU represents a "metabolic encephalography".

Animals↗

[Correlations between anatomy and computerized tomography findings in transtentorial cerebral herniation].

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

Brain↗

[Studies of a full night's sleep in patients with absences].

Clinical electro-encephalography and especially the simultaneous recording of EEG values and other physiological parameters can greatly contribute to investigations into the neurophysiological aspects of sleep disturbances in patients suffering from attacks. In the case of absences peak potentials have been found in all phases of sleep, with a reduction in the pattern-like arrangement of the peak potentials and an increase in the irregular spike-and-wave complexes. During the dream phase, however, the peak potentials of these patients were primarily in the form of "patterns" comparable to the situation when they were awake. This evidence of epileptic activity throughout all sleep phases of patients suffering from absences makes it necessary to give anticonvulsive drugs in three doses distributed evenly over the entire day.

Child↗

Anatomy-computerized tomography correlations in transtentorial brain herniation.

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal plane was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

Autopsy↗