Predictive value of assessment of disc-radicular conflict of the cervical segment by somatosensory evoked potentials.

Somatosensory evoked potentials (SSEP) of the n. medianus, with clinically significant neurological findings helps in diagnosing a number of different cervical spine lesions. SSEP of the n. medianus and neurological observations also aid in diagnosticis of the disc-radicular conflict. A final diagnosis is set by the computerised tomography (CT). The tested positive predictive value of assessment of disc-radicular conflict of the cervical spine by means of SSEP is 87%. The 95% confidence interval (CI) is 0.87 (0.81-0.93) (Tab. 3, Fig. 4, Ref. 23). Full Text (Free, PDF) www.bmj.sk.

An acute headache and hydrocephalus caused by the dermoid cyst.

We present a case report of a 41-year-old man with an acute headache and hydrocephalus caused by the dermoid cyst. The dermoid cyst of the third brain ventricle caused an acute hydrocephalus and an increased intracranial pressure (with neurological signs such as nausea, vomiting, oedema papilae n. optici) and, consequently, an acute intensive headache. Computed tomography scans demonstrated a mass in the third ventricle extending into the prepontine cistern, whereas any initially established cerebrospinal fluid ventriculoperitoneal shunt required further revision (Fig. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Clinical manifestations of vertebrobasilar dolichoectasia.

Vertebrobasilar dolichoectasia is defined as an increase in the length and diameter of the intracranial arteries. Clinical manifestations of dolichoectasiae result from compression of the cranial nerves and structures of the brain stem, turbulent flow causing tinnitus and vertigo, often with damages of small blood vessels of the brain. Dolichoectasia is an ishemic stroke risk factor. The role of dolichoectasia in occurrence of haemorrhagic stroke, aneurysm and arterial dissection and thrombosis is still not fully understood (Ref. 34).

Auditory evoked potentials (AEP)--an important help in early diagnosis of Schwannoma originating from vestibular nerve.

Early diagnosis of expansive formations enables efficient therapy and maximal reduction of remaining neurological damage. Schwannoma situated entirely within the inner auditory canal with free pontocerebellar angle is a rather rare event. Of significant diagnostical help are auditory evoked potentials (AEP), computerised tomography (CT) of the temporal bone pyramid with measuring the inner auditory canal diameter, and magnetic resonance (MRI). In this paper we present a case of a 56-year-old woman with gradually advancing noise in the right ear, weakening of hearing and occasional instability while walking. AEP register no evoked response at the right side, whereas at the left side the latencies and amplitudes of evoked acoustic responses are adequate. CT of the temporal bone pyramid shows a difference in the inner auditory canal diameters of 0.04 cm. MRI shows a Schwannoma tumorous formation in the inner auditory canal, situated entirely within the canal with free pontocerebellar angle (Fig. 3, Ref. 16). Full Text (Free, PDF) www.bmj.sk.

Cognitive impairment and epilepsy seizure caused by hypoparathyroidism.

We report a 46-years-old man with idiopathic hypoparathyroidism who presented with gradually cognitive impairment and generalized tonic clonic epilepsy. Computed tomography (CT) and magnetic resonance imaging (MRI) of brain showed calcification in the basal ganglia, thalamus and cerebral white matter. Calcium level was low and phosphor was increased in serum, but parathormon level was low. Following introduction of replacement therapy, cognitive functions improved as well. After treatment with calcium and vitamin D supplementation he showed clinical, cognitive impariment and laboratory improvements (Fig. 2, Ref. 13).

Tinnitus caused by vertebrobasilar dolichoectasia.

A 73-year old man presented with the tinnitus in the left ear for 11 months. Computer tomography (CT) showed an enlarged dolichoectasia of the left vertebral artery. Magnetic resonance imaging (MRI) of the brain shows dolichoectasia of the left vertebral artery and the initial part of the basilar artery. Multi-slices computer tomographic (MSCT) angiography showed an enlarged vertebrobasilar dolichoectasia of the left vertebral artery, which compressed the vestibulocochlear nerve. This study supports a vascular compression of cranial vestibulocochlear nerve and the brainstem as a cause of tinnitus, and demonstrates a MSCT angiography value as an excellent, non-invasive technique to demonstrate the compression (Fig. 1, Ref. 20). Full Text (Free, PDF) www.bmj.sk.

Somatosensory-evoked potentials and MRI in tuberculous spondylodiscitis.

Early diagnosis of spondylodiscitis is a condition of efficient conservative treatment. Somatosensory-evoked potentials with clinical examination results are used in assessing the diagnosis, as well as in monitoring the course of disease and healing. MRI clearly shows the inflammatory process, healing and scars. We report a 46-year-old woman suffering from non-specific interscapular pains. The evoked somatosensory potentials of the tibial nerveshow potential conductivity being slowed down through the thoracic spine, which is clearly evident from the prolonged latency and the decreased amplitude of the evoked response. The performed thoracic spine MRI shows spondylodiscitis at the Thl0-11 level. The subject is a nurse administering BCG therapy at a urology clinic, due to the fact of which this was deemed to have been a case of tuberculous spondylodiscitis. Due to the possibility of scattering the causative agent by needle, the biopsy was given up and antituberculous therapy was administered ex juvantibus. The disease was followed up by clinical examinations, somatosensory-evoked potentials and MRI up to fully successful and final recovery from spondylodiscitis. The above examinations are of great help in diagnosing the tuberculous spondylodiscitis and monitoring the recovery (Fig. 6, Ref. 16).

Neurocysticercosis--non-specific clinical and neuroradiological presentation.

Neurocysticercosis (cysticercosis cerebri) is a rare neurological diagnosis in Croatia. It is classically divided into four types: intraparenchymal, basilar cisternal, ventricular and diffuse. Computerized tomography (CT) and magnetic resonance imaging (MRI) established the diagnosis by demonstrating cysticercosis disseminated throughout the cerebral parenchyma. The authors emphasize the potential of the ELISA test to detect anticysticercosis antibodies in blood and cerebrospinal liquor (CSF). Diagnostics of neurocysticercosis is enabled jointly by clinical signs, neuroradiological, serum and liquor tests. We report the case of a 70-year old man with clinical and neuroradiological signs of cysticercosis cerebri. The neurological status is dominated by ataxia, corticospinal pathways damages and cognitive capacity impairments. CT of the brain shows calcificated and cystic lesions of various sizes. MRI of the brain enables the final diagnosis of the cysticercosis cerebri with multiple and multicentric lesions that indicate various stages of the cerebral cysticercosis (Fig. 2, Ref 20). Full Text (Free, PDF) www.bmj.sk.

Diagnostics of incomplete Brown-Sequard syndrome caused by meningococcal myelitis.

We are reviewing a 20-year old girl with the history of acute meningococcal sepsa with meningitis and thoracic myelitis resulting from an early embolia into the spinal cord, which is a very rare complication of meningococcemia. The ipsilateral loss of sensation indicates lesion of the posterior ascendent fiber tracts in the spinal cord, witout contralateral motoricity deficite, this indicating the incomplete Brown-Sequard syndrome. Somatosensory-evoked potentials (SSEP) of the n. tibialis show milder impediments of conductivity by the thoracic segment at left. Magnetic resonance (MRI) of the thoracic spine shows lesion of the posterior ascendent fiber tracts (Fig. 2, Ref. 17).