The effects of clenbuterol on cerebral vasospasm in an experimental rat model of subarachnoid hemorrhage.

OBJECTIVE: To investigate the possible therapeutic effects of clenbuterol on cerebral vasospasm after subarachnoid hemorrhage (SAH) in rats. METHODS: Eighteen male albino Wistar rats, each weighing 200-250 g, were randomized into three groups; Group 1 (Control group) (n = 6) having no SAH and no treatment; Group 2 (Sham group) (n = 6) having only SAH and Group 3 (Experimental group) (n = 6) having SAH treated with clenbuterol. Group 2 has been accepted as sham group to the experimental group. Experimental SAH was induced using a modified rat double hemorrhage model. Clenbuterol was administered twice daily in 12-hour intervals for three days at a dose of 0,1 mg/kg/day. The luminal diameter of the basilar artery was measured on each section with an optic micrometer by an experienced pathologist blinded to the groups. RESULTS: Mean basilar artery diameters were found to be different between the three groups (p < 0.001). Mean value of Group 2 was significantly lower than that of Group 1 (p < 0.001). While mean value of Group 3 was significantly greater than that of Group 2 (p = 0.001), Groups1 and 3 were found to be similar (p = 0242). CONCLUSION: Clenbuterol has favorable effects in the treatment of rat cerebral vasospasm (CVS). Further investigations are needed to evaluate both molecular effects and to find out effective treatment dose of clenbuterol on CVS.

Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy.

BACKGROUND: Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously silent vertebral hemangiomas. However, the occurrence is rare with only 26 cases reported in the English medical literature. CASE DESCRIPTION: A 22-year-old woman in her 36th week of gestation presented with acute onset of upper back pain and progressive paraplegia. Imaging studies revealed a T4 vertebral hemangioma, which involved the vertebral body, pedincules, transverse, and spinous process with a focal extradural extension of soft tissue component. She underwent emergent cesarean delivery and endovascular embolization, respectively. Her symptoms and neurologic deficits improved quickly. Her complaints restarted 2 years after embolization. Surgical treatment which consists of intraoperative vertebraplasty and segmental fixation was performed. The patient's postoperative recovery was excellent. CONCLUSION: According to literature review and our patient's outcome, pregnancy may induce neurologic symptoms and signs in silent spinal hemangiomas. The way of management is decided by whether the neurologic deficits depend on the deformity caused by hemangioma or some other factors including vascular insufficiency.

The influence of cervical spinal cord stimulation on induced epileptic discharges in rats.

Spinal cord stimulation (SCS), also known as dorsal column stimulation, is a novel technique used widely in pain surgery. However, its effect on other pathologies such as epileptic disorders is unknown. The aim of this study is to evaluate the influence of electrical epidural stimulation of the upper cervical region on epileptic cortical discharges. The long term goal is to elucidate and evaluate a therapeutic central nervous system (CNS) electrical stimulation methodology to treat epilepsy. Twelve Wistar female rats were randomly divided into two groups. In group 1 (six rats under general anesthesia), C2-3 laminectomies were performed and epidural electrodes were placed to perform SCS. To induce epileptic discharges, 1 ml (200 IU) penicillin G was microinjected into the left somatomotor cortex via left stereotactic parietal craniotomies, 0.01 to 0.1 mA at 2 Hz was used to stimulate the spinal cord. In group 2 (the control group, six rats under general anesthesia), C2-3 laminectomies were performed without electrode placement and epileptic discharges were induced with penicillin G microinjections, as described above. Both groups were monitored with digital electroencencephalography (EEG) for 70 min in seven stages and recordings analyzed with power spectral analysis. Spinal cord stimulation decreased penicillin-induced median values of epileptic discharges. Epileptic wave frequencies decreased significantly with increasing intensities of SCS. The results of this study suggest that SCS used for drug resistant epilepsies may be a viable alternative treatment modal.

Postoperative mutism after removal of an anterior falcine meningioma.

Postoperative mutism is rare. We present a 65-year-old man who had transient mutism after resection of anterior falx meningioma. Mild left hemiparesis and palmomental reflex on the right were the only abnormal signs on neurological examination. CT scan and MRI demonstrated a mass at the anterior one-third portion of the falx just superior to the corpus callosum. The mass enhanced homogenously with administration of gadolinium DTPA. The patient underwent surgical resection of the lesion and adjacent falx cerebri. The operation was uneventful. On the second postoperative day he became mute. He could follow verbal commands, and write and read. Postoperative CT scan revealed a hypodense area in the right frontal lobe including a part of the anterior cingulate cortex and the anterior part of the corpus callosum. Histopathological examination revealed a mixed meningioma. Ten days postoperatively, he began to say simple words, and three weeks later he could talk normally. We consider that lesion of the supplementary motor area (SMA) may be responsible for postoperative mutism.

Intracerebellar granulocytic sarcoma complicating acute myelogenous leukemia: a case report and review of the literature.

Granulocytic sarcoma is a solid mass composed of premature precursors of granulocytic series cells in an extramedullary region. Intraparenchymal central nervous system localization without skull or meningeal invasion is extremely rare. Although different theories have been proposed to explain the mechanism of this unusual disorder, its exact mechanism is still unclear. Some degree of improvement can be achieved after surgery and radiotherapy but its prognosis is poor and most patients die within months. Nine cases of purely intraparenchymal granulocytic sarcomas have been reported in the literature. Here, we report the tenth case and review the current literature.

Inflammation as a risk factor for carotid intimal-medial thickening, a measure of subclinical atherosclerosis in haemodialysis patients: the role of chlamydia and cytomegalovirus infection.

OBJECTIVES: Atherosclerotic vascular disease is the most frequent complication seen in haemodialysis (HD) patients. Evidence suggests that inflammation may play a role in the pathogenesis and progression of atherosclerosis. Our aim was to evaluate the causative role of inflammation in atherosclerosis among HD patients. METHODS: Intima-media thickness (IMT) in carotid arteries was determined in 54 HD patients and 52 controls. Plasma levels of lipids, glucose, albumin and several acute phase proteins, and immunoglobulin G titres against chlamydia and cytomegalovirus were measured in all subjects. RESULTS: Mean carotid IMT was significantly greater in HD patients than in controls (0.75 mm vs 0.56 mm, P < 0.005). While plasma levels of C-reactive protein (CRP), serum amyloid A (SAA), lipoprotein (a) Lp(a), fibrinogen and ferritin were higher in HD patients, albumin levels were lower. In HD patients, carotid IMT was correlated positively with CRP (R = 0.29, P = 0.019), SAA (R = 0.69, P < 0.001), Lp(a) (R = 0.42, P = 0.001), fibrinogen (R = 0.57, P < 0.001) and chlamydia pneumonia immunoglobulin G titres (R = 0.50, P < 0.001), and negatively with albumin levels (R = -0.33, P = 0.02); there was no relationship between carotid IMT and hypertension, plasma lipid levels and cytomegalovirus. In multivariate regression analysis, these variables still showed a significant relationship with IMT (R(2) = 0.694 and P < 0.001). CONCLUSION: We conclude that atherosclerotic changes are more common in HD patients than in controls, and that inflammatory processes may play a role in the pathogenesis of atherosclerosis.