[Epidermoid cyst in the posterior fossa].
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The diagnosis of multiple sclerosis is still a clinical one, and depends on the occurrence of neurological symptoms due to lesions at two or more necessarily distinct sites in the white matter of the central nervous system. Up to now there exists no specific laboratory test for the diagnosis of multiple sclerosis. The cerebrospinal fluid-profile strongly supporting the diagnosis of multiple sclerosis consists of: cell count slightly elevated, total protein concentration normal or slightly elevated, in the electrophoresis distinct immunreaction without disturbance of the blood-brain-barrier, i.e. significant increase of gammaglobulins and IgG, oligoclonal pattern of the gammaglobulin subfractions. Newly developed diagnosistic possibilities are based on the determination of myelin basic protein, determination of the different glycerophosphatides and on the measurement of the activity of lipid hydrolyzing enzymes. Disturbances of lipid metabolism play an important role in the course of demyelination. Therapy of multiple sclerosis by steroids and immunsuppression will be discussed.
Primary intracranial germinomas are classically known as midline lesions, occurring most commonly in the pineal and suprasellar regions, and will usually present with symptoms related to increased intracranial pressure or hypothalmic dysfunction. Involvement of both the pineal and the suprasellar region in the same patient (double midline lesions) is relatively rare (7%). Dissemination of germinoma to both cerebellopontine angles, in addition to the double midline lesions, with the initial clinical presentation of lower cranial nerve involvement has not been previously reported. We encountered such an unusual case, which prompted this report and review of the literature.
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The activity of total, Mg++ dependent and Na+/K+ ATPase as well as the content of cAMP and cGMP in homogenates of human brain tumors have been investigated. Results are compared to values obtained from normal cortices. Na+/K+ ATPase and cAMP are decreased with a close relationship with the degree of malignancy, while Mg++ dependent activity is lower than in normal cortex but with no differences between the various tumors, and cGMP is unaffected. We conclude with a discussion on the metabolism of brain tumors and the suggestion of Na+/K+ ATPase activity as a marker of the malignancy of neoplastic growth.
Sixty-five patients underwent craniotomy for brain tumors; of these 35 had glioblastoma multiforme (GM). The GM cases, as a group, showed significantly higher serum titers for herpesvirus type 1 (HSV-1) neutralizing antibodies (NT) than the non-glioblastoma cases. Both the GM group and the pituitary adenoma group had high levels of HSV-1 serum antibodies with the enzyme-linked immunosorbent assay (ELISA). These data, combined with other evidence, lead us to speculate that HSV-1 infections may be associated with certain brain tumors in humans. However, coincidental causes for these elevated HSV-1 titers must be ruled out.
The nervous system is the most common site for the development of solid neoplasms in children. The most frequent oncotype is the pilocytic astrocytoma, followed by the medulloblastoma. Primitive undifferentiated neuroectodermal tumors occur primarily in childhood; problems of pathogenesis of these neoplasms are discussed, as well as their relationship with central nervous system development.
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Three patients harboring glioblastoma were treated by fractionated intracavitary radiation using remote afterloading system. For this therapy, a special intracranial applicator was designed and used. Radiation schedule was planned to deliver 3000 rads to the margin of the tumor in 3 fractions over 10 days. The advantages of this treatment are that complete elimination of all unnecessary radiation exposure is possible, and that placing a radioactive source in the tumor provides maximal delivery of radiation to the tumor with relative sparing of surrounding normal brain. The method of treatment is presented and discussed with the reports of the clinical cases.
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CT Scan has greatly helped preoperative diagnosis in brain tumors. CT Scan alterations are found in about 95% of brain tumors and the most modern instruments can pick-up even small alterations, locate them precisely and, in 80% to 90% of the cases can give their exact extension. But precise CT-scan diagnosis in brain tumors can be done in only 80% of the cases when in a supratentorial site; about 90% in infratentorial localizations. Differential diagnosis difficulties occur with metastasis, abscesses, infarction, meningiomas, and vessel malformations. Angiography does not always solve these diagnostic problems left uncovered by CT Scan and not infrequently surgical proof is necessary.
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