Lumbar spondyloptosis after severe polytrauma: a case report.

A rare case of thoracolumbar spondyloptosis after a severe polytraumatic event is presented. Spondyloptosis accounts for a minor proportion of all spine trauma cases and is usually accompanied by complete neurological deficit. A 48-year-old man suffered severe polytrauma after having been hit by a truck at the work place. Radiographic scanning revealed multiple traumatic injuries and spondyloptosis at the L1/L2 level in coronal plane. However, despite extensive injuries, ASIA score was estimated as D. The patient underwent urgent multidisciplinary surgery due to severe head injuries. The next surgery was performed to stabilize the thoracolumbar segment and to preserve neurological functions. The surgery included implantation of transpedicular titanium screws via posterior approach. Good postoperative recovery was achieved during early postoperative rehabilitation at our Department, which was estimated as ASIA score D. In conclusion, prompt operative treatment to achieve neural integrity and early rehabilitation should be considered as the gold standard in such complicated injuries. Postoperative recovery largely depends on the quality of rehabilitation, which leads to improvement of patient self-care and normal social and psychological functions. In our case, the good preoperative neurological status of the patient also contributed to better postoperative outcome.

Complications of pulmonary AVMs in a patient with Rendu-Osler-Weber disease.

Rendu-Osler-Weber disease, also called hereditary hemorrhagic telangiectasia (HHT), is a rare, genetically determined complex disease with a spectrum of associated manifestations which extend beyond the typical pathology of arteriovenosus malformations (AVMs). Our subject, a 54-year-old male patient with a long history of HHT has a typical mucocutaneous telangiectasias and bleeding from the nose, but the most important manifestations of the disease are those related to pulmonary AVMs. A variety of complications, such as hypoxemia, polycythemia, cyanosis, clubbing fingers and brain abscesses, have developed over time as a consequence of a-v shunt in the pulmonary AVMs. A large pulmonary AVM necessitated a surgical intervention when the patient was in his thirties, and two more surgeries followed later, due to brain abscesses. Despite intensive manifestations of the disease and episodes of life threatening complications, the patient has adjusted well to his chronic medical condition and lives a near-normal life.

[Efficiency of pharmacological treatment of chronic post-traumatic headaches]. / Ucinkovitost farmakoloskog lijecenja kronicne posttraumatske glavobolje.

BACKGROUND: Chronic post-traumatic headache (CPH) is a complex clinical entity. The clinical features of CPH are variable and may resemble those of primary headaches (migraine, tension-type headache or cluster headache), as well as of cervicogenic headache. Therefore, the treatment must be individualized according to the headache type. There were few studies addressing the effectiveness of pharmacological treatment in patients with CPH. AIM: The aim of the present study was to analyze the efficiency of pharmacological treatment with analgesic drugs and concomitant psychotropic drugs in outpatients with CPH. METHODS: We studied 59 outpatients with CPH (39 males and 20 females, mean age 36+/-13 years) who were taking analgetic monotherapy for their headache (simple analgesics, NSAIDs, atypic analgesics and triptans in subjects with migraine) and in case of comorbid psychic disorders some of them were taking psychotropic drugs. The efficiency of drug therapy was evaluated by the outcome scale based on the patients' headache diaries (outcome graded as improved, unchanged or worsened). RESULTS: Most of the study patients reported that their CPH was unchanged. The improvement was greater in the subgroup of cervico-occipital headache sufferers, but it was not statistically significant when compared to other subgroups. Post-traumatic migraine was the type of headache most refractory to drug therapy. The patients who took analgesics without psychotropic drugs had a reliably (p<0.05) better improvement of their headache. CONCLUSION: Analgesic drug monotherapy did not produce favorable therapeutic response in patients with CPH. Appropriate psychopharmacotherapy should be prescribed to CPH patients with psychiatric comorbidity.

Brain abscess due to Aggregatibacter aphrophilus and Bacteroides uniformis.

OBJECTIVE: The aim of this report was to describe the occurrence of a bacterial brain abscess in a healthy individual, without any predisposing condition. CASE REPORT: A thirteen-year old boy was admitted to the Department of Neurosurgery after the onset of vomiting, headache and dizziness. A neurological deficit was detected during the physical examination so urgent magnetic resonance imaging of the brain was performed, revealing an intrahemispheric, right positioned solitary expansive mass with ring enhancement. Purulent material was obtained during osteoplastic craniotomy with total extirpation of the brain abscess. Aggregatibacter aphrophilus and Bacteroides uniformis were isolated. The patient's general condition improved and the neurological deficit subsided as a result of the prompt recognition and treatment of this life threatening condition. CONCLUSION: To achieve a favourable clinical outcome, prompt recognition and surgical treatment of a brain abscess are of primary importance,followed by administration of appropriate antimicrobial therapy. To our best knowledge, this is the first report of this combination of microorganisms as the cause of a brain abscess.

Six years of following up a glomus jugulare tumor - a case report.

This case report followed up a patient for six years after she had been successfully treated by embolization and gamma knife surgery, while a complete surgical resection was contraindicated because of the high risk of possible mortality outcome. A development of internal hydrocephalus in a subacute postoperative period as a probable postoperative complication related to gamma knife surgery was noted.