Brain stem abscesses in childhood.

BACKGROUND: Solitary brain stem abscess is a rare condition with high mortality and morbidity. These lesions were considered to be invariably fatal before 1974 when advanced diagnostic tools were not available. Recently, the diagnosis and prognosis of brain stem abscesses have been modified by the introduction of modern radiological tools, and several patients with a favorable outcome have been reported since then. Because the pons is the most common site of the abscesses, involvement of the sixth and seventh nerves is frequent. The midbrain is the second most likely location, and medullary abscesses are distinctly rare. Treatment of a brain stem abscess includes medical therapy alone, open microsurgical intervention, or stereotactic aspiration. CASE REPORT: We report a case of a 7-year-old girl with a solitary brain stem abscess. Her neurological examination revealed involvement of the cranial nerves and pyramidal tracts. Microsurgical exposure and aspiration of the abscess resulted in rapid improvement in her neurological condition and radiological resolution of the lesion. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment, and we review the relevant literature.

Comparing open surgery with endoscopic releasing in the treatment of carpal tunnel syndrome.

AIM: The aim of this study is to retrospectively assess the complications and result of cases that underwent open surgery or endoscopic releasing for carpel tunnel syndrome. METHOD: A total of 50 cases of carpel tunnel syndrome, 30 of whom underwent endoscopic release using the biportal extrabursal technique described by Chow, and the other 20 that underwent open surgery were included in the study. Average age of the cases was 41 (24 - 62), 44 of them were females and 6 males. RESULTS: Follow-up examinations of the patients at the first and third month after operation revealed no limitation of activity in 40 (80 %) cases, minimal limitation in 4 (8 %), moderate limitation in 5 (10 %) and significant limitation in 1 (2 %). Among the group that underwent endoscopic release, as a major complication, the median nerve was almost totally cut in a patient undergoing endoscopic release. During the same operation setting perifascicular neurorrhaphy was done. Fourth and fifth digital nerve lesions occurred in three cases. Among the group that underwent open surgery fourth and fifth digital nerve injury occurred in one case, and in another case severe inflammation requiring reoperation occurred. CONCLUSION: Before intervention, cases of carpal tunnel syndrome should be examined well as regards which technique to use. Experience of the surgeon with the technique to be used should also be taken into consideration. Endoscopic carpal tunnel releasing, though a relatively easier procedure, leads to neurovascular injuries more frequently than open surgery; thus open surgery appears to be safer.

Carpal tunnel syndrome in carpet workers.

OBJECTIVE: Repetitive and forceful use of wrist and finger flexors is purported to be an occupational risk factor for carpal tunnel syndrome (CTS). While weaving carpet, wrist and finger flexors and extensors are used repetitively, with pinching movements and forced grasping. We aimed to investigate CTS frequency in hand-made carpet workers. METHODS: Seventy women from carpet workshops in the city center and 30 healthy unemployed women were evaluated by clinical examination and electrophysiology. The relationship between CTS development and employment duration, and work produced per year were also investigated. Our study is cross-sectional. RESULTS: CTS was present in 31 hands (22.1%) of workers and in four hands (6.7%) of the control group. The estimated relative risk of developing CTS was 3.3 times greater in carpet-workers than it was in controls. Considering all hands, we could not find any correlation between CTS development and employment duration (P = 0.977), or with work produced per year (P = 0.505); but these two were the prominent factors contributing to delayed median sensory latency (P = 0.013, P = 0.009, respectively). CONCLUSIONS: We could not find any correlation between CTS development and employment duration, or with work produced per year; but these two were the prominent factors contributing to delayed median sensory latency The results indicates that women working in the hand-made carpet industry have a higher risk of CTS development.

Surgical therapy for lumbar spinal stenosis: evaluation of 300 cases.

Although lumbar spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis, and treatment. In this article, we retrospectively analyzed the clinical, radiological, and surgical characteristics of 300 patients operated on in our clinics with the diagnosis of lumbar spinal stenosis. Surgical therapy and outcome are discussed with respect to the known facts. After clinical and radiological evaluation, 300 patients were diagnosed with lumbar spinal stenosis. All patients underwent laminectomy and bilateral foraminotomy at the stenotic level. Surgical outcomes were evaluated as very good, good, same, and poor according to the clinical findings. Ninety percent of the surgically treated patients demonstrated very good and good outcomes. Our conclusion in lumbar spinal stenosis diagnosed by objective clinical and radiological findings is that decompressive laminectomy and extensive foraminotomy without instrumentation allow a good outcome.

Acute ECG changes and chest pain induced by neck motion in patients with cervical hernia--a case report.

We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.

Traumatic occipital condyle fractures.

Trauma to the brain or calvaria may cause some cranial nerve damage. This may be transitory or permanent. Occipital condyle fracture (OCF) is a rarely encountered pathology not easily diagnosed by routine clinical and radiological evaluation and one of the causes of lower cranial nerve disability. Frequently, the hypoglossal nerve is involved. Here we present two cases of OCF caused by motor vehicle accidents. Both of the patients complained of dysphagia and voice disturbance. After detailed neurologic and radiologic evaluation, they were diagnosed with OCF. They were both treated conservatively. OCF as a cause of lower cranial nerve damage is rarely reported. Since it is hard to diagnose OCF by routine cranial and cervical evaluation, detailed radiological study in suspected cases is a must. Since one of our patients was admitted 6 years after the trauma, this article is also noteworthy as a report on radiological changes of the OCF.

Congenital infiltrating lipomatosis of the face with cerebral abnormalities.

The aim of this study was to describe a possible variant of encephalo-craniocutaneous lipomatosis syndrome. Three cases of congenital infiltrating lipomatosis of the face, associated with cutaneous, subcutaneous, and cerebral abnormalities, are presented. This neurocutaneous syndrome appears very similar to encephalo-craniocutaneous lipomatosis syndrome but lacks the typical eye lesions.

Chiasmatic glioblastoma of childhood. A case report.

A 6-year-old girl presented with visual deterioration that had progressively worsened over 2 months. MR imaging revealed a sellar, para- and suprasellar lesion. Subtotal tumor resection was performed. Histopathological diagnosis was glioblastoma of the optic chiasma. Chiasmatic glioblastoma is rare in adults and extremely uncommon in children. Surgical resection implies a risk of severe endocrinologic and ophthalmologic complications.

Bilateral median nerve compression at the level of Struthers' ligament. Case report.

Struthers' ligament syndrome is a rare cause of median nerve entrapment. Bilateral compression of the median nerve is even more rare. It presents with pain, sensory disturbance, and/or motor function loss at the median nerve's dermatomal area. The authors present the case of a 21-year-old woman with bilateral median nerve compression caused by Struthers' ligament. She underwent surgical decompression of the nerve on both sides. To the authors' knowledge, this case is the first reported bilateral compression of the median nerve caused by Struthers' ligament. The presentation and symptomatology of Struthers' ligament syndrome must be differentiated from median nerve compression arising from other causes.

Fronto-orbitonasal intradiploic meningioma in a child.

Intradiploic meningioma, which may be classified as a subgroup of intraosseous meningioma, is a rarely encountered disorder. To date, less than 10 cases have been reported. Here, we report a case of fronto-orbitonasal intradiploic meningioma. A 12-year-old female with exophthalmos and diplopia was operated on for a cranial intradiploic mass lesion. Histopathological evaluation of the specimen confirmed the diagnosis of intradiploic psammomatous meningioma. Her exophthalmos did not change, but the diplopia disappeared. This case is unique in that it is an extensive case of intradiploic meningioma of the orbital roof and frontal base in a child. Intradiploic meningiomas generally are of psammomatous type. Especially tumors adjacent to the orbita cause exophthalmos; cases located on the other side of the calvarium may not cause any symptom or sign other than headache or sometimes a mass on the scalp. Treatment, as with meningiomas located in the intracranial cavity, is total resection of the lesion.

[Cranial gunshot injuries and treatment approaches]. / Kranyal atesli silah yaralanmalari ve tedavi yaklasimlari.

21 patients with gunshot wounds were retrospectively evaluated. They were 19 male and 2 female, age range was 9-24. All of the patients underwent a plain x-ray and computed tomography evaluation. 9 patients had intracerebral hematoma, 4 had subdural hematoma, 1 had epidural hematoma and 1 had intraventricular hematoma. 9 patients were observed to have bullet in the cranium. All the patients with glasgow coma scale 3-5 at the admittance died. 15 patients underwent surgical treatment. 3 patients had cerebrospinal fluid fistula postoperatively and underwent reoperation. Extensivity of the lacerated brain, localization of the lesion and the glasgow coma scale at the admittance affect the outcome in gunshot wounds.

An unusual fatal complication of low basilar trunk aneurysm surgery: isolated prepontine tension pneumocephalus.

OBJECTIVE: A case of postoperative tension pneumocephalus after low basilar trunk aneurysm clipping is presented. To our knowledge, this is the first case of isolated prepontine tension pneumocephalus. BACKGROUND: A 63-year-old woman was admitted for repair of a basilar aneurysm that had caused a subarachnoid hemorrhage. She was cooperative and partially oriented. According to Hunt & Hess classification, she was considered Grade III. METHOD: The aneurysm was clipped, using a right lateral suboccipital craniectomy with the patient in the sitting position. In the early postoperative period, she had no new neurological deficit. However, 2 hours later the patient became lethargic and unresponsive to verbal commands. Emergency CT scan revealed an isolated prepontine tension pneumocephalus with prominent posterior displacement of the pons. She was immediately taken back to surgery. Upon incision of the dura mater, air could be heard escaping under pressure from the posterior fossa cavity. The clip was in its proper position and all arteries were patent. Spontaneous respiration and pupil reflexes returned soon after surgery, but she remained unconscious and died 3 days later. CONCLUSION: We believe that this death was directly attributable to the tension pneumocephalus and the distortion of the pons. Postoperative prepontine tension pneumocephalus, although this is an extremely rare condition, should be considered if a patient deteriorates after basilar aneurysm surgery in the sitting position.

Clinical and therapeutic properties of Cushing's disease in childhood.

Cushing's disease (CD) in adolescence and childhood is a rare pathology and has some different clinical and therapeutic characteristics than in adults. We report 3 cases treated surgically, with the diagnosis of CD. Their common complaints were short stature and obesity. Endocrinological investigations and radiological evaluation pointed out the diagnosis of CD for all children. They were operated on by the transsphenoidal route, and adenoma resection was performed. Histopathologic and immunohistochemical examination of the tissue specimens confirmed the diagnosis of CD. Long-term follow-up demonstrated weight loss and increase in height.