Chewing oscillopsia. A case of voluntary visual illusions of movement.

A 60-year-old man had a history of frontal headaches and chewing-related oscillopsia. Examination disclosed a retro-orbital epidermoid cyst that had eroded through the lateral orbital wall and under the temporalis muscle. The illusion of movement was due to mechanical displacement of the tumor mass and eye by contraction of the temporalis muscle. Removal of the cyst produced complete remission of the oscillopsia.

Glossopharyngeal neuralgia associated with syncope and seizures.

A case of glossopharyngeal neuralgia associated with seizures, syncope, bradycardia, and hypotension is presented. Intracranial section of the 9th cranial nerve and the upper filaments of the 10th cranial nerve resulted in the resolution of all symptoms. The literature is reviewed and the pathogenesis and treatment of the condition are discussed.

Traumatic subdural hygroma in adults.

The authors review 25 cases of post-traumatic subdural hygroma in adults and report the findings of computer tomography in 4 cases. There was marked diversity in the severity of injury and in chronicity. The site of the lesion was consistently delineated by angiography, but preoperative differentiation from subdural hematoma was possible only with computed tomography. The mortality was 28%. Good recovery occurred in 48%. The prognosis was best among younger patients with subacute or chronic lesions.

Triple fossa metastasis of prostate cancer.

The radiological appearance of prostate cancer metastasis to the central nervous system often mimics meningioma. The bony change of prostate cancer metastasis resembles the hyperostosis of meningioma because of its blastic rather than lytic nature. On computed tomographic (CT) scan, like meningioma, prostate cancer metastasis enhances homogeneously after the infusion of contrast material. Triple fossa (middle, temporal, and orbital fossae) involvement by a solitary mass without bony destruction is thought to be highly specific for meningiomas. We report a case demonstrating the CT findings typical for a triple fossa meningioma caused by prostate cancer metastasis.

Subacute diencephalic necrosis and dural arteriovenous malformation.

We report a case of congestive venous necrosis involving the diencephalon symmetrically, presumably precipitated by a dural arteriovenous malformation (AVM). The patient presented with a 1-month history of intermittent confusion and gait ataxia. The initial radiological work-up revealed a dural AVM. The patient's subsequent deterioration was accompanied by computed tomographic findings of diencephalic congestion. Pathological examination showed subacute necrosis of the diencephalon. We discuss the pathogenesis of this case of subacute diencephalic necorsis and its possible relationship to the entity of subacute diencephalic angioencephalopathy.

Traumatic hematomas of the posterior fossa. A clinicopathological spectrum.

Eight patients were found to have traumatic hematomas of the posterior fossa during a 6-year period. There were four patients with extradural hematomas, one patient with a subdural hematoma, and four patients with intracerebellar hematomas. In one patient, clinically significant hematomas were found both in the extradural space and in the cerebellum. Clinical or radiologic evidence of skull fracture was present in each case, and computed tomography scans were diagnostic of a posterior fossa hematoma in all cases. In six of the eight patients, there was clinical deterioration prior to surgical treatment, and in three cases, this was abrupt. All patients underwent suboccipital craniectomy. Six patients survived; four made a good recovery. Our experience indicates that early operation is usually indicated for these lesions.

Correction and monitoring of postoperative cerebral vasospasm.

There have been several case reports in which various hypertension-inducing regimens have been used in the treatment of postoperative cerebral vasospasm. Regimens have included the used of metaraminal bitarate, norepinephrine with intravascular volume expansion, and high-dose dopamine with mannitol and volume expansion. Clinical response has been very favorable. Our patient improved markedly after administration of dopamine and intravascular volume expansion. Little work has been done to document vasospasm as the cause of the ischemia or to demonstrate increased cerebral blood flow following treatment. We suggest that noninvasive Doppler flow velocity studies may be an ideal tool for the further assessment of these patients.

Solitary metastasis of systemic malignant lymphoma to the cerebellopontine angle.

Systemic malignant lymphoma rarely produces solitary metastasis to the brain. We report such a case in the cerebellopontine (CP) angle mimicking an acoustic neurinoma. CT scan showed a large, round mass in the CP angle which enhanced homogeneously following contrast infusion. The internal auditory meatus appeared to be eroded. The clinical, radiological, and pathological findings are presented.

The cubital tunnel in ulnar entrapment neuropathy.

Anteroposterior radiographs of the fully flexed and slightly externally rotated elbow were obtained in 122 cases of cubital tunnel syndrome (CUTS) and in 33 normal elbows. Medial trochlear lip osteophytes were not found in the studies of normal elbows but were noted in 20% of ulnar nerve entrapment cases. Medial incongruity between the trochlea and the olecranon greater than or equal to 5 mm was found in 29% of CUTS cases and in 6% of normal elbows. The presence of posttraumatic elbow-joint deformities seen on radiographs correlated significantly with the degree of clinical involvement. Depth and area measurements of ulnar nerve compression, performed using a line-art representation of the radiographs, showed a significant (P less than .0001) correlation between decrease in the area of the cubital tunnel and ulnar innervated muscle atrophy. These findings confirm the importance in this syndrome of both osteoarthritis and incongruity of the medial structures of the elbow joint.

Parapharyngeal fibrolipoma.

Although approximately 13% of lipomatous tumors occur in the head and neck, most of these are found in the immediate subcutaneous tissues, and lipomas of the deep head and neck tissues are rare. Lipomas consist of adipose tissue separated by fine fibrous trabeculae; if the amount of fibrous tissue is appreciable, the designation of fibrolipoma is used. We describe an unusual case of a parapharyngeal fibrolipoma with airway narrowing and ipsilateral compromise of the carotid artery and internal jugular vein blood flow. Diagnosis of deep head and neck lipomata is facilitated by utilizing computed tomographic analysis and angiography. The transcervical approach to the skull base which allows complete resection of this lesion is described.