Cerebral manifestation of an actinomycosis infection. A case report.

Affection of the CNS by actinomycosis is a rare but treatable manifestation of an infection with actinomyces israeli. Neurological involvement includes a meningeal, granulomatous and also pseudotumoral form. We report the case of a patient suffering from an intracerebral actinomycosis abscess. The source of infection was the upper jaw. After a right frontal craniotomy the intracerebral abscess was removed. Postoperatively the patient received initially a combined antiedemateous and antibiotic therapy with 12 mg dexamethasone and 6 g cefotaxime and 3 g amoxicilline. After 4 weeks of treatment with improving neurological deficits dexamthasone therapy was reduced followed by an exclusive antibiotic therapy for another 4 weeks. During this time the patient recovered completely.

Cysteinyl-leukotriene levels in intracerebral hemorrhage: an edema-promoting factor?

In 12 operatively (stereotactic aspiration and recombinant tissue-type plasminogen activator, rTPA) and 5 conservatively treated patients with spontaneous intracerebral hemorrhage the amounts of cysteinyl-leukotriene (cys-LT) released by blood-brain cell contact were measured by the urinary excretion of their metabolites during treatment. The mean cys-LT release before treatment was 14.51 +/- 1.13 pg/mg creatinine/ml hematoma volume. The urinary cys-LT excretion at the end of the measurements was significantly lower in the operatively treated group than in the patients with conservative therapy (p < 0.05). We also found a significant correlation between the perifocal edema volume and the amount of cys-LT measured in patients' urine (p < 0.01). In an additional animal experiment using dissociated rat brain cells plasmin was excluded as an activator for cerebral cys-LT formation, which emphasizes that rTPA did not influence cys-LT formation.

Technical note: external cerebrospinal fluid (CSF) drainage by percutaneous needle punction in newborn children.

External drainage of CSF in children is indicated in acute hydrocephalus e.g. after intraventricular bleeding or infection. In these cases the drainage has to remain in place until physiological CSF circulation is restored or an internal shunt can be inserted. External drainage is mostly performed using a silicon catheter connected to a plastic bag. An external CSF drainage left for several days in situ bears an increasing risk of bacterial infection. In these cases a metal needle minimizes the risk of ventriculitis. For prevention of accompanying infection we implanted a Cytocan port needle with a 20 G diameter in 7 infants. The needle is easily inserted with low risk of complications. By its plastic top angulated at 90 degrees to the needle the system can be fixed to the skin very safely by suture or tape. With this system neither an implantation related intracerebral haemorrhage nor an accompanying ventriculitis was encountered. In two cases a pre-existing ventriculitis was cured by this needle drainage and antibiotic treatment. In five cases an acute hydrocephalus after intraventricular haemorrhage was drained by the port needle system.

Levels of immunoreactive cysteinyl-leukotrienes in CSF after subarachnoid haemorrhage correlate with blood flow-velocity in TCD.

Lipid peroxidation and enhanced arachidonic acid metabolism is activated after blood-brain cell contact. Previous studies have indicated that cysteinyl-leukotrienes (cys-LT) have the capacity to constrict arterial vessels in vivo and in vitro suggesting their involvement in the pathogenesis of cerebral vasospasm. The purpose of this study was to measure the amount of cyst-LT in the cerebro-spinal fluid (CSF) in correlation with transcranial Doppler findings (TCD) in patients with aneurysmal subarachnoid haemorrhage (SAH). In all patients early surgery was performed. In the first cisternal CSF-sample which was already collected intra-operatively an initial peak of cys-LT was detected, followed by decreasing amounts of cys-LT during the next 5 days. The CSF-levels of immunoreactive cys-LT were significantly higher in those patients who showed signs of vasospasm on transcranial Doppler sonography (TCD) (p < 0.001). Normalization of TCD values was accompanied by decreasing levels of CSF-cys-LT. We found a significant correlation between the amounts of immunoreactive cys-LT in cerebrospinal fluid and cerebral vasospasm measured by TCD.