Volumetric analysis of cerebrospinal fluid and brain parenchyma in a patient with hydranencephaly and macrocephaly--case report.

The aim of this study was to perform for the first time the intracranial volumetric analysis of cerebrospinal fluid (CSF) and brain parenchyma in the supratentorial and infratentorial space in a 30-year-old female patient with hydranencephaly and macrocephaly. A head scan performed using a 3T magnetic resonance was followed by manual segmentation of the brain parenchyma and CSF on T2 coronal brain sections. The volume of CSF and brain parenchyma was measured separately for the supratentorial and infratentorial space. The total volume of the intracranial space was 3645.5 cm3. In the supratentorial space, the volume of CSF was 3375.2 cm3 and the volume of brain parenchyma was 80.3 cm3. In the infratentorial space, the volume of CSF was 101.3 cm3 and the volume of the brain parenchyma was 88.7 cm3. In the supratentorial space, there was severe malacia of almost all brain parenchyma with no visible remnants of the choroid plexuses. Infratentorial structures of the brainstem and cerebellum were hypoplastic but completely developed. Since our patient had no choroid plexuses in the supratentorial space and no obstruction between dural sinuses and CSF, development of hydrocephalus and macrocephaly cannot be explained by the classic hypothesis of CSF physiology with secretion, unidirectional circulation, and absorption as its basic postulates. However, the origin and turnover of the enormous amount of intracranial CSF volume, at least 10-fold larger than normal, and the mechanisms of macroencephaly development could be elucidated by the new hypothesis of CSF physiology recently published by our research team.

Ancient medicine--a review.

Different aspects of medicine and/or healing in several societies are presented. In the ancient times as well as today medicine has been closely related to magic, science and religion. Various ancient societies and cultures had developed different views of medicine. It was believed that a human being has two bodies: a visible body that belongs to the earth and an invisible body of heaven. In the earliest prehistoric days, a different kind of medicine was practiced in countries such as Egypt, Greece, Rome, Mesopotamia, India, Tibet, China, and others. In those countries, "medicine people" practiced medicine from the magic to modern physical practices. Medicine was magical and mythological, and diseases were attributed mostly to the supernatural forces. The foundation of modern medicine can be traced back to ancient Greeks. Tibetan culture, for instance, even today, combines spiritual and practical medicine. Chinese medicine developed as a concept of yin and yang, acupuncture and acupressure, and it has even been used in the modern medicine. During medieval Europe, major universities and medical schools were established. In the ancient time, before hospitals had developed, patients were treated mostly in temples.

[The risk of second seizure in children with benign childhood epilepsy with centrotemporal spikes without treatment--a prospective study]. / Rizik javljanja drugog napadaja u nelijecene djece s benignom parcijalnom epilepsijom s centrotemporalnim siljcima--prospektivno istrazivanje.

PURPOSE: To determine the rate of second seizure occurrence within and after six months of the first seizure in children with benign childhood epilepsy with centrotemporal spikes (BECTS) who did not undergo treatment after the first seizure. The results of this analysis may help elucidate the dilemma whether or not to treat the child after the first seizure. PATIENTS AND METHODS: Thirty-nine children with BECTS from our department (aged 3-11 years) were analyzed as candidates to be enrolled in a prospective multicenter randomized double-blind placebo controlled study on therapeutic efficacy of sulthiame. Thirty-four of 39 children were not treated after the first seizure. Four children were lost from the study, thus 30 children were included in final analysis. After the first seizure, the parents were instructed to apply diazepam rectal solution in case of second seizure, and were warned to observe the child, particularly during the first sleep and before awaking. RESULTS: Twenty of 30 (66.6%) children experienced second seizure within six months of the first one. Some of these children entered the group treated with sulthiame vs. placebo, and those who did not meet the criteria for sulthiame group were treated with carbamazepine. Ten of 30 (33.4%) children did not experience second seizure within six months of the first one. In only one of them, the second seizure occurred 14 months of the first one. The epileptic status did not appear as second seizure, irrespective of whether or not the children received rectal diazepam at seizure onset. CONCLUSIONS: In children with BECTS, a high incidence of second seizure was recorded within six months of the first seizure, whereas the rate of second seizure after six months of the first one was very low. The probability of the occurrence of epileptic status in children with BECTS could be neglected. These results may be viewed as a small contribution to clarifying the dilemma of whether or not, and when to treat children with BECTS. Because of the high incidence of second seizure, we decided to treat all children with BECTS after the first seizure.