Cystic Encephalomalacia following Vasculopathy and Vasospasm of Proximal Intracranial Arteries Due to Pneumococcal Meningitis in a Infant.

Despite the availability of modern antibiotics, pneumococcal meningitis in both children and adults remains a severe disease-one known to frequently cause grave complications and residual disability. Although the appearance of arterial vasospasms in bacterial meningitis systematically has been investigated and reported on for adult patients, such research is lacking when it comes to infants. We report on a 4-week-old infant who, 6 days after onset of pneumococcal meningitis, suffered severe neurological deterioration with treatment-resistant seizures and coma. Generalized cortical and subcortical edema developed in conjunction with diminished cerebral blood flow, as depicted in magnetic resonance angiography and serial Doppler-sonographic examinations. The ischemia resulted in extensive cystic encephalomalacia. We propose that the degree of variation in cerebral blood flow in the acute phase was the result of an extensive arterial vasculopathy involving vasospasms. Awareness of this complication and prospective serial Doppler-sonographic examinations may improve our understanding of the connection between brain edema and vasculopathy. At present, however, no effective treatment appears available.

Cerebral Disorders of Calves.

Neurologic diseases of the cerebrum are relatively common in cattle. In calves, the primary cerebral disorders are polioencephalomalacia, meningitis, and sodium toxicity. Because diagnostic testing is not always readily available, the practitioner must often decide on a course of treatment based on knowledge of the likely disease, as well as his or her own clinical experience. This is particularly true with neurologic diseases in which the prognosis is often poor and euthanasia may be the most humane outcome. This article reviews the most common diseases affecting the cerebrum of calves with a focus on pathophysiology, diagnosis, and treatment.

The effect of hyperbaric oxygen on clinical outcome of patients after resection of meningiomas with conspicuous peritumoral brain edema.

OBJECTIVE: The goal of this study was to determine the effect of hyperbaric oxygen therapy on the clinical outcome of patients after resection of meningiomas with conspicuous peritumoral brain edema (PTBE). PATIENTS AND METHODS: 232 patients with intracranial meningiomas and conspicuous PTBE were allocated to the HBO2 Group or the Control Group (116 in each group). The Karnofsky Performance Score (KPS), the focal brain edema and the encephalomalacia in the operative region, as well as the number of patients with neurological deficits were compared statistically between the two groups at different times after the operation. RESULTS: On the third day after operation, the KPS and focal brain edema in the operative region between the HBO2 Group and the Control Group were not significantly different (p > 0.05), but 15 days after surgery, compared with the Control Group, the KPS of the HBO2 Group appeared obviously higher (p < 0.05), and the focal brain edema in the operative region was definitely smaller (p < 0.05). Six months after surgery, the volume of encephalomalacia in operative region and the number of patients with neurological deficits in the HBO2 Group were significantly less than those in the Control Group (p < 0.05). CONCLUSION: HBO2 therapy is effective in reducing edema formation and neurological deficits after resection of meningiomas with conspicuous PTBE.

Leukoencephalomalacia and laminar neuronal necrosis following smoke inhalation in a dog.

Acute respiratory and neurologic disease after smoke inhalation are well documented, but human patients may also develop delayed-onset neurologic symptoms associated with leukoencephalomalacia after exposure to smoke or carbon monoxide. In this case, a dog developed progressive neurologic signs 6 days after rescue from an apartment fire. At necropsy 9 days after smoke inhalation, leukoencephalomalacia of the central cerebral white matter was accompanied by laminar necrosis of cerebrocortical neurons. This is the first report of delayed posthypoxic leukoencephalopathy in a nonhuman animal.

Update on sulfur-related polioencephalomalacia.

Sulfur-related polioencephalomalacia is frequently associated with a high total sulfur intake by ruminants. The onset of clinical signs coincides with excessive ruminal sulfide production. Measurement of ruminal gas cap hydrogen sulfide makes it possible to identify cattle with potentially hazardous total sulfur intake. Evaluation of all potential sulfur sources is necessary to estimate total dietary sulfur concentration, which can lead to prevention strategies.

Neurotoxicity and secondary metabolic problems associated with low to moderate levels of exposure to excess dietary sulphur in ruminants: a review.

Problems associated with a low to moderate excess in dietary sulphur (S) intake in ruminants are being increasingly recognized. Comparing more recent reports with older data, there is an evident decrease in tolerance of cattle and sheep for even moderately elevated levels of dietary S, and an apparent drastic change in the clinical picture of chronic dietary S toxicoses. Outbreaks of polioencephalomalacia (PEM) in ruminants in association with excess dietary S have been reported in recent years throughout the world. Excessive levels of S-containing compounds in domestic ruminant animals' rations, and clinical problems associated with low to moderate levels of exposure to dietary S may be more common than previously thought. This review presents a comprehensive evaluation of the problems associated with excessive levels of S in ruminants' rations. Emphasis is placed on the recently increasing incidence of S-induced PEM. Secondary metabolic disorders associated with excessive intake of S are also discussed.

[Thalamic pain syndrome. Clinico-radiologic correlations and treatment by intermittent stimulation of the sensory nuclei of the thalamus]. / Le syndrome douloureux thalamique. Corrélations radiologico-cliniques et traitement par la stimulation intermittente des noyaux sensitifs du thalamus.

The thalamic pain syndrome is classically due to a softening of sensory thalamic nuclei. In a series of 10 patients treated between 1977 and 1984 by the intermittent stimulation of the nuclei ventroposterior thalami, the CT-Scan showed in 7 cases the thalamic lesions and in 3 cases a parietal one. The clinical manifestations of theses 2 groups can be individualised. The therapeutical results with long follow-up are moderate with 2 improvements of pain of more than 50%, 5 of less than 50% and 3 failures. The place of this technique is discussed.