Spontaneous Cervical Epidural Hematoma.

BACKGROUND: A 65-year-old woman was admitted to the emergency department for sudden onset of neck pain and dysesthesia of both upper limbs. The pain occurred spontaneously, without any history of recent trauma. Rapidly after her admission, she developed tetraparesia. The patient had a past medical history of long standing hypertension correctly controlled as confirmed at admission. Neurological examination confirmed the tetraparetic status with a sensory level at Th3. Moreover, a saddle anesthesia with impaired bladder control was observed. Cranial nerve examination and consciousness of the patient remained normal. Laboratory coagulation tests and platelets count were all within normal limits.

Tumour response and safety of cetuximab in a window pre-operative study in patients with squamous cell carcinoma of the head and neck.

BACKGROUND: To investigate the safety and activity of cetuximab in the pre-operative treatment of squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Cetuximab was administered for 2 weeks before surgery to 33 treatment-naïve patients selected for primary surgical treatment. Tumour biopsies, 2-[fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography ((18)FDG-PET) and imaging were carried out at baseline and before surgery. The primary aim of the study was safety and the secondary aims included metabolical, radiological and pathological tumour response. Five untreated patients were included as controls. RESULTS: Cetuximab given 24 h before surgery was safe. Ninety percent of patients had (18)FDG-PET partial response (EORTC guideline) in the cetuximab group versus 0% in the control group. Delta maximal standardized uptake values (ΔSUVmax) were correlated with tumour cellularity on the surgical specimens (P < 0.0001). For patients with ΔSUVmax less than -25% or less than -50%, Ki67 was significantly decreased by cetuximab (P = 0.01 and 0.003). Cetuximab induced down-regulation of pEGFR (P = 0.0004) and pERK (P = 0.003). CONCLUSIONS: Short-course pre-operative administration of cetuximab is safe and shows a high rate of (18)FDG-PET response. (18)FDG-PET response was correlated with residual tumour cellularity suggesting that (18)FDG-PET deserves further investigation as a potential early marker of cetuximab activity in SCCHN.

Heart rate variability analysis as an index of emotion regulation processes: interest of the Analgesia Nociception Index (ANI).

Autonomic Nervous System (ANS) variations are strongly influence by emotion regulation processes. Indeed, emotional stimuli are at the origin of an activation of the ANS and the way an individual pass from a state of alert in the case of emotional situation to a state of calm is closely coupled with the ANS flexibility. We have previously described and developed an Analgesia Nociception Index (ANI) for real time pain measurement during surgical procedure under general anesthesia. This index, based on heart rate variability analysis, constitutes a measure of parasympathetic tone and can be used in several other environments. In this paper, we hypothesized that such an index could be used as a tool to investigate the processes of emotional regulation of a human subject. To test this hypothesis, we analyzed ANI's response to a negative emotional stimulus. This analysis showed that the index decreases during the emotion induction phase and returns to its baseline after 2 minutes. This result confirms that ANI could be a good indicator of parasympathetic changes in emotional situation.

Gliomatosis cerebri, imaging findings of 12 cases.

BACKGROUND AND PURPOSE: We report 12 cases of Gliomatosis cerebri (GC), a rare brain neoplasm, to define its semeiologic criteria. Literature was reviewed to clarify its physiopathology. PATIENTS AND METHODS: From 1997 to 2008, 12 histologically proven cases with GC were retrospectively reviewed. Of the 12 patients, nine were male. The mean age was of 54 years. Were performed CT-Scan (n=6), MRI (n=12), diffusion and perfusion weighted images (n=12 and n=4), MR Spectroscopy (n=3), a FDG and a Methionin PET-Scan (n=2 and n=3 respectively). RESULTS: Primary diagnosis was missed in six cases. Most frequent clinical signs were seizure and mental changes. Imaging criteria were: area of high signal intensity on FLAIR and T2-weighted images, involving three or more contiguous lobes with conserved architecture. Frequently a bilateral widespread invasion with involvment of the corpus callosum or the anterior white commissure or both was observed. At diagnosis and in the classical form (type I) of GC, no significant contrast enhancement and decreased rCBV were observed. Focal enhancement and increased rCBV were observed in the focal mass in type II GC. MR Spectroscopy showed an increase of the Cho/Cr ratio and a decrease in the NAA/Cr one. FDG PET showed in type I a decreased avidity for the FDG whereas in type II a increased avidity was observed. MET-PET showed an increased avidity for the tracer in a GC type II and a slight avidity in a GC type I. CONCLUSION: GC is a rare brain entity. Primary diagnosis is often missed. The imaging findings of GC I, a WHO grade III tumor, should be known and include classical MRI but also PWI, MRS and scintigraphic findings.

Substitution of 11C-methionine PET by perfusion MRI during the follow-up of treated high-grade gliomas: preliminary results in clinical practice.

PURPOSE: Our aim was to compare perfusion magnetic resonance imaging (MRI) and positron emission tomography (PET) using carbon-11 labelled methionine (MET) in gliomas and their value in differentiating tumour recurrence from necrosis. MATERIALS AND METHODS: We retrospectively reviewed 28 patients with a high-grade glioma. A total of 33MR perfusions and MET-PET were ultimately analysable for comparison between the relative cerebral blood volume (rCBV) and MET-PET examinations. Intra- and interobserver reproducibility was assessed and diagnostic value of rCBV compared to MET-PET and histology was assessed by the area under the receiver operating characteristic (ROC) curve. RESULTS: ROC curve analysis showed that rCBV had at least equal performances in differentiating tumour recurrence and necrosis than MET-PET. Cut-off value of rCBV for differentiating tumour from necrosis was 182% with a sensitivity of 81.5% and a specificity of 100%. CONCLUSION: In clinical practice, perfusion MRI could replace MET-PET for differentiating necrosis from tumour recurrence.

Paucisymptomatic brainstem lesions revealing CNS schistosomiasis.

We describe clinical and magnetic resonance (MR) features in a 69-year-old, Caucasian woman presenting with an unusual meningeal onset of cerebral schistosomiasis. Magnetic resonance work-up demonstrated supra- and infratentorial lesions with prominent brainstem involvement contrasting with the paucisymptomatic clinical presentation. Because of a recent stay in Uganda, including swimming in Lake Victoria, a diagnosis of neuroschistosomiasis was suggested. Serological tests and rectal biopsy confirmed the putative diagnosis. The patient was successfully treated with praziquantel at a dose of 50 mg/kg/day for 15 days. Brain MRI abnormalities improved dramatically within two months.

Use of tiapride on stuttering in children and adolescents.

Reported here is the therapeutic efficacy of Tiapride with 10 10- to 17-yr.-old patients afflicted with severe stuttering problems. During the 20-wk. open, controlled study (baseline, low dose of Tiapride, high dose of Tiapride, follow-up observation without medication) the stuttering in various speech situations decreased markedly. No substantial change in different parameters of acoustic analysis and psychopathological characteristics accompanied the reduction in stuttering when group data were compared although positive effects concerning these variables could be seen in some cases. Several conclusions based on these results are presented. One assumed effect of the medication is improvement of central nervous regulatory mechanisms of speech motor coordination. Further, the value of the medication Tiapride in comprehensive stuttering therapy is discussed.

Stuttering in childhood: a five-year longitudinal study in progress.

The actual state of research in childhood stuttering is presented and certain points open to criticism are discussed. We want to find answers to some of the open questions by means of a longitudinal study that starts at an early stage. In this study the prognostic validity of various dimensions of behaviour can be determined with regard to the development of stuttering. Thus, the conditions for the development of a valid and reliable instrument for early diagnosis are created that enable the specialist to estimate the probability of chronicity and to determine whether to treat or not to treat childhood stuttering. Furthermore, the study aims to develop a screening procedure which is easy to use for the persons in the child's surroundings (parents, teachers, physicians) so that stuttering children can be referred to a specialist at an earlier stage.

[Stuttering in childhood: etiology and follow-up. Initial results of a 5-year longitudinal study]. / Kindliches Stottern: Atiologie und Verlaufsbedingungen. Erste Ergebnisse einer fünfjährigen Längsschnittstudie.

For about 15 months a multifactorial longitudinal study on the development of stuttering in preschool children has been conducted at the Phoniatric Outpatient Department of the University of Ulm. The main subject of the study is to determine valid indicators to estimate the risk of future chronicity or remission of stuttering and to find out whether and how it is possible to differentiate normal developmental dysfluencies from chronic abnormal dysfluencies. Preliminary results are presented and discussed.

Idiopathic arterial calcification of infancy with unusual clinical presentations in sisters.

Two cases of idiopathic arterial calcification of infancy that occurred in sisters are reported. One patient died at age 14 months after a protracted course characterized by the nephrotic syndrome, blood chemistry abnormalities, hypertension, seizures, and a microangiopathic hemolytic anemia. Her sister died at age 3 weeks after a precipitous illness that initially was misinterpreted at autopsy as Reye's syndrome.