Fiberoptic intracranial pressure monitoring in rats.

An adaptation of a fiberoptic intracranial pressure monitoring system for clinical use is described. The method allows easy and reliable acute and chronic intracranial pressure registration in anesthetized as well as conscious rats. The disposable fiberoptic probes, originally designed for human use, can be re-used limitlessly. The fiberoptic method is compared with conventional monitoring procedures under different experimental conditions. The validity of intraparenchymal and epidural measurements is discussed. The importance of chronic intracranial pressure registration in conscious laboratory animals is stressed.

Intracerebral hemorrhage after lumbar myelography with iohexol: report of a case and review of the literature.

Intracranial hemorrhage is an uncommon complication of dural puncture. In most instances, hematomas are subdural; they may be unilateral or bilateral. Rarely are intraparenchymal cerebral hemorrhages related to dural puncture. This report describes a delayed occurrence of bilateral intraparenchymal hemorrhages in a 38-year-old woman 7 days after lumbar myelography with iohexol. A review of the literature is presented.

Pituitary abscess. Case report.

A case of pituitary abscess is reported in which the diagnosis was made during surgery. The difficulties in diagnosis and management of patients with this rare entity are stressed.

Familial oligodendroglioma. Case report.

A case of familial oligodendroglioma, occurring in a mother and her daughter, is presented.

Postsurgical follow-up by MRI of anterior cervical discectomy without fusion.

Postoperative magnetic resonance imaging (MRI) findings are described in selected patients with cervical radiculopathy and a cervical soft disc herniation, treated by anterior cervical discectomy (ACD) without fusion. Six months postoperatively, 45 patients underwent MRI examination using a 0.5 T superconductive unit. T1- and T2-weighted spin echo sequences were acquired on sagittal and axial planes. A low signal intensity on T2-weighted images was visualized at the ACD level in all patients. Five patients were found to have a slight kyphosis at the discectomy level. There was no residual disc material at any ACD level. In 5 patients, areas of diminished signal intensity on T1- and T2-weighted images on adjacent vertebrae was noticed, indicating sclerosis of the cortical bone adjacent to the ACD level. In 3 patients, cervical disc protrusions without impression on the dura were visualized postoperatively: 2 below and 1 above the ACD level. One patient developed a cervical disc herniation without complaints one level above the operated one. No patient developed infolding or degenerative swelling of the ligamenta flava and no intrinsic cord abnormalities were present. MRI provided useful information on pathology, allowing a non-invasive evaluation following ACD and enabling a better understanding of surgical consequences.

Failure of a modified posterior lumbar interbody fusion technique to produce adequate pain relief in isthmic spondylolytic grade 1 spondylolisthesis patients. A prospective study of 20 patients.

A modified posterior lumber interbody fusion procedure is described: this technique basically uses only two tricortical bone grafts and does not produce a distraction at the interspace while inserting the bone grafts. Twenty patients with intractable back and leg pain due to an isthmic spondylolysis and a grade 1 spondylolisthesis were operated using this technique and a prospective study with a mean follow-up of 41 months was conducted to evaluate the results. The final evaluation involved a questionnaire, a clinical examination, and a lumbar spine radiographic series. Fourty-five percent of the patients had good or excellent results whereas 55% had fair or poor results. The possible reasons for these unfavorable results are discussed.

Singlet oxygen induced cerebral vasospasm: an experimental study in rats.

A new experimental model is described which can be used as an alternative to study the effects of subarachnoid hemorrhage (SAH) in rats. Vasospasm of the basilar artery is induced photochemically after transpalatal illumination of intracisternally injected rose bengal in two different rat strains. Singlet oxygen, generated in the subarachnoid space, elicits vasospasm which has been demonstrated angiographically at 90 min and 24 h after photosensitisation. Sprague Dawley rats responded better than Wistar rats. Dilution of rose bengal in water was more vasospastic than dilution of rose bengal in artificial CSF. Since the action of singlet oxygen is similar to that of free radicals, this experiment gives an argument for the hypothesis that free radicals play a leading role in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage.

Transcranial Doppler sonography in subarachnoid hemorrhage.

Ten patients presenting a subarachnoid hemorrhage (SAH) due to rupture of a middle cerebral or an anterior communicating aneurysm are presented. Transcranial Doppler (TCD) values are obtained at different time intervals after SAH. The correlation of TCD values, vasospasm and clinical course is discussed.

Transcranial Doppler sonography.

A general review of the physical principles and the applications of transcranial Doppler (TCD) sonography is given. This new non-invasive technique is presented as an important diagnostic tool in neurology, neurosurgery and intensive care medicine. The applications are documented using our own patient material.

Atherosclerosis and cerebral ischemic attacks: intakes of cerebrography with xenon133 inhaled and platelet tests in the diagnosis, clinical and therapeutic monitoring; the preventive role of dipyridamole.

A study of patients to develop the significance of the role of the blood platelets in the recurrence of transient cerebral ischemic attacks in patients with cerebral atheromatous, develop the effectiveness of dipyridamole in the prophylactic therapeutic regimen. In the group treated with dipyridamole, a 76.3% clinical improvement was recorded (mean increases of 11.2 ml/min. and 11.4 ml/min. of the cerebral hemispheric flows), 15.8% of cases stabilized (mean increases of 1.7 ml/min. and 1.2 ml/min.) and 7.9% failures (mean decreases of 10.4 ml/min. and 14.3 ml/min.) of these same flows. The cerebrography with xenon133 inhaled as well as the platelet tests used, constitute unfailing means of diagnosing and monitoring the clinical development.

Craniostenosis: the importance of the anesthesiologist.

Based on the experience with 15 patients operated for craniostenosis in our hospital, guidelines were determined for the anesthetic and postoperative management with optimal maintenance of vital parameters. Subgaleal accumulation of blood may cause a spectacular drop of hemoglobin level during the first postoperative days. Since it is better to prevent than to cure, systematic anti-convulsive and antibiotic prophylaxis must be considered.

MR imaging of tuberculous spondylitis.

This case report describes a patient presenting with symptoms of progressive paresis of both legs. An X-ray of the thorax demonstrated an aspect consistent with miliary tuberculosis. Magnetic resonance imaging (MRI) of the thoracic spine revealed medullary compression. The patient underwent a laminectomy and the diagnosis of spinal epidural tuberculoma was made. The patient has been treated with isoniazid, rifampicin and pyrazinamide. After a period of six months, she made a complete recovery.

Oculomotor anomalies in sellar and parasellar pathology.

The authors report 19 cases where diplopia was the initial symptom of sellar pathology, Additionally, 5 cases with doubtful, diagnosis are discussed. Considering a series of 134 adenomata, the onset in 7 cases was intermittent diplopia with involvement of the third nerve.

Intracerebral temperature monitoring in severely head injured patients.

In a series of 6 severely head injured patients, intraventricular as well as rectal, bladder and jugular vein temperature is recorded. The relationship between these temperatures in different conditions is evaluated. Intracerebral temperature is 0.5 +/- 0.2 degrees C (mean +/- SD) higher than bladder temperature except in conditions such as brain death. It is concluded that rectal temperature is not representative and therefore not a good alternative to the measurement of brain temperature. More data on human intracerebral temperature are mandatory as well as prospective studies correlating intracerebral temperature with final outcome in head injury.