Pseudotumor cerebri: risk factors, clinical course, prognostic criteria.

UNLABELLED: Eighty-five patients with the diagnosis of pseudotumor cerebri were retro- and prospectively studied. For clinical evaluation, the following criteria were used: neurological--headache, ophthalmological--visual acuity, visual field, ophthalmoscopy and psychic--memory. Each patient was assigned 2 categories of results expressed by: neuropsychic and ophthalmological scores which were statistically processed. The following conclusions related to the aim of our paper can be drawn: I. RISK FACTORS: pregnancy (8% of cases), obesity (15%), generalized infections or located in the pelvic region+operated on (6%), hormonal treatment (cortisol (12%), estrogens (6%)); II. The clinical course was significantly favourable for: headache (51% of cases), defects of visual acuity (54%) and papilledema (63%). The long-lasting effects of the treatment applied showed: recovery (for the 2 parameters) in 27% of patients and improvement with sequelae for one and/or the other parameter in 73% of the cases; III. Among the more significant prognostic criteria were the ophthalmological symptoms and signs at onset of the disease. The ophthalmological sequelae (visual acuity, visual field defects, chronic papilledema and optic atrophy) are important factors in the prognosis of the disease and represent predictors for the surgical management.

Time-related variations of some biochemical parameters in patients with short- or long-lasting post-traumatic coma.

The variation in time of some blood biochemical parameters was investigated in 100 patients with acute head injury and coma of variable duration, in parallel with the clinical course. The purpose of this study was to establish possible correlations between the severity of the trauma (assessed according to the coma classification proposed by C. Arseni) and the variation of the parameters studied. The results show complex correlations between the biochemical events in the patient and the degree of brain function impairment initially and after some time. Long lasting coma (over 14 days) is associated with complex biochemical alterations representing an additional element for defining the clinical condition.

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.

Giant sacro-coccygeal teratoma. Case report.

A case is presented, of a giant teratoma in the sacro-coccygeal region, in a two-year old child. Surgery was performed in two successive stages, one month apart, under CT-scan control. Exeresis of the teratoma was complete. The authors stress the very large volume of the tumor, that extended in the pre-sacral area, and the fact that complete exeresis was mandatory. Eight months after surgery the postoperative evolution was satisfactory. The importance of CT-scans for the postoperative control is stressed, in cases of teratomas extending in the pre-sacral retroperitoneal area.

Cerebral abscesses secondary to otorhinolaryngological infections. A study of 386 cases.

A study is presented, of adjacent cerebral abscesses secondary to otorhinolaryngological infections. A total of 386 patients were included. According to frequency, and in relation to the adjacent septic focus the cerebral abscesses were classified as: otogenic--334 cases (86.5%); rhinogenic--47 cases (12.2%); tonsillary--5 cases (1.3%). These abscesses had similar characteristics: they occurred with the highest frequency in the second and the third decade of life, had a higher incidence in males, the otorhinolaryngologic infection had a chronic course with frequent recidives, propagation of the infection from the original focus occurred by continuity or through the venous system, and the clinical picture was marked by symptoms of local and general infection, by meningeal manifestation, and frequently by altered consciousness (somnolence, confusion). Surgical treatment, next to other therapeutic measures (administration of antibiotics, anti-inflammatory drugs, and intensive care) was aimed at improving the vital prognosis. The postoperative mortality was 23.8%. It was also aimed at increasing the functional recovery rate. Neuropsychical sequellae were noted in 54.9% of all cases. After surgery for the cerebral abscess attempts were made at removing the septic focus, preventing any additional risk of cerebral seeding.

Orbital, sphenoidal ridge and spinal meningiomas occurring in one patient.

From the more than 1500 intracranial meningiomas, 600 spinal meningiomas and 400 orbital tumours operated on in our clinic between 1935-1980 we are reporting the case of a patient with multiple meningiomas which gradually developed in three different regions - right orbital, the left sphenoidal ridge and the upper thoracic region. We have not found any comparable case with these features in the medical literature. From the clinical, radiological and scintigraphic findings we established the coexistence and the gradual development of these multiple meningiomas in three different regions. The correlation of the clinical and paraclinical findings offered us the presumptive diagnosis of multiple orbito-cranial and spinal meningiomas before the last two operations.

Investigations on the presence of papova virus in certain forms of human cancer. Note 2. Brain tumors.

Two serially transmissible tumors (metastatic lymphosarcomas) were induced in the hamster by inoculation of human brain tumor material--tissue homogenate from a malignized fibroma or DNA extracted from a meningioma. SV40 V antigen was made evident by indirect immunofluorescence in 4 out of 18 human tumors, while SV40 T antigen could only be demonstrated in the tumors experimentally induced in hamsters. Antibodies to SV40 T antigen were detected in 12 out of 60 patients with different tumors, in 1 out of 40 blood donors and in 7 out of 18 hamsters carrying experimentally induced tumors.

Subarachnoid empyemas. Considerations in connection with 55 cases.

The authors present data concerning the nosologic frame of the subarachnoid empyemas. Aspects such as incidence, predominance in males (65.4% of all cases), involvement of subjects in their II-nd--IV-th decade, and the complex pathogeny of this affection are discussed. From the bacteriologic viewpoint the predominance of the monomicrobial flora is stressed, mainly staphylococcus strains (24.4% of all cases). The clinical picture consists in a severe infectious syndrome, intracranial hypertension syndrome (27.2% of all cases), neurologic syndrome (motor deficit in 81.8% of the cases, focal attacks in 43.6% of all patients), meningeal syndrome (83.6% of all cases), and psychical disturbances (in 89% of the patients). Of the para-clinical investigations performed cerebral angiography provided conclusive data in 88.5% of all cases. Surgical treatment was applied in 50 of the patients using various methods with an overall death-rate of 26%. The early diagnosis is stressed, as well as the necessity to apply surgical therapy using the bone-flap method, and full surgical cure of the primary infectious focus.

Cerebral abscesses of unknown origin. General report.

The authors present the etio-pathogenic, anatomo-pathological, clinical, and therapeutic aspects of cerebral abscesses of unknown origin. Prognostic and neuropsychical problems are also outlined, which may be related to performance of surgical interventions. A personal series of 108 cases is presented in detail. Cerebral abscesses of unknown origin represent 13.3% of a total of 810 cerebral abscesses hospitalized in the Neurosurgical Clinic from Bucharest between 1936 and 1979. The significant number of this type of cerebral suppuration is stressed, and the authors discuss the diagnostic and the therapeutic difficulties of this affection. On the other hand the authors mention the high number of postoperative neuropsychical sequellae (70%). The overall mortality rate of the group was 29.7%.