Treatment strategy in a child with a retained bullet in the cerebellomedullary cistern.

A 6-year-old girl was admitted to our emergency room because of a gunshot wound in the posterior craniocervical junction. On admission, she was alert, but left hemiplegia and right hemiparesis were noted. Cranial CT scanning showed a retained bullet in the cerebellomedullary cistern without bone destruction. Moreover, fourth ventricle hemorrhage was observed. There were no signs of acute hydrocephalus. The patient underwent suboccipital craniectomy and C-1 laminectomy for bullet removal. Postoperatively, the patient experienced significant neurological improvement. To the best of the authors' knowledge, this is the first documented case of a patient with a retained bullet in the cerebellomedullary cistern. The management strategies in such a unique case are discussed.

A comparative study of thin-layer cross-sectional anatomic morphology and CT images of the basal cistern and its application in acute craniocerebral traumas.

AIM: To compare the cross-sectional morphologic features of successive thin-layers and CT images of the basal cistern and its application in the diagnosis and management of acute craniocerebral traumas. MATERIALS AND METHODS: Successive thin-layer cross-sectional images of the basal cistern were retrieved from the second Chinese visible human (CVH) data set and observed. A total of 40 healthy volunteers were subjected to 64-slice spiral CT scan of the head, and CT images of the basal cistern were compared with CVH images. A total of 413 patients with acute craniocerebral traumas were subjected to 64-slice spiral CT scan of the head, CT image changes of the basal cistern were observed. RESULTS: Thin-layer cross-sectional images retrieved from the CVH data set clearly displayed the sectional anatomic morphology, morphologic change pattern and important adjacent structures of the basal cistern. The quadrigeminal cistern was pateriform or sellaeform; the suprasellar cistern was hexagonal or pentagonal star-shaped; the ambient cistern encircled both sides of the brainstem like an arc band. CT images of the quadrigeminal and ambient cisterns were similar with their CVH images; however, the morphology of the suprasellar cistern changed substantially. In 413 patients with acute craniocerebral traumas, the basal cistern may be normal, or presented with narrowing, obliteration, shift, hematocele, and pneumatosis. Narrowing or obliteration of the basal cistern occurred mostly at the side of dominant intracranial lesions, and frequently occurred in patients with diffuse axonal injury or combination of SDH + CONT + ICH. CONCLUSIONS: Thin-layer cross-sectional images of the basal cistern retrieved from the CVH data set correspond satisfactorily to CT images of the basal cistern. Comparison of the two types of images can provide a sectional anatomic basis for the image identification of acute craniocerebral traumas. A careful observation on the initial CT images of the basal cistern for anatomic morphologic changes will help diagnose acute craniocerebral traumas early, improve the management, and appropriately predict the prognosis of the condition.

A role for serotonin in lipopolysaccharide-induced anorexia in rats.

Rats consistently reduce their food intake following injection of bacterial lipopolysaccharides (LPS). Because LPS increases CNS serotonin (5-HT) turnover, and because increases in CNS 5-HT turnover are associated with a decrease in food intake, we conducted a series of studies to examine 5-HT's potential role in LPS-induced anorexia. Chronic CNS 5-HT depletion by cisterna magna (CM) administration of 5,7-dihydroxytryptamine (5,7-DHT) failed to attenuate LPS-induced (100 microg/kg, ip) anorexia. In subsequent experiments, LPS was injected at lights out (hour 0) and [8-hydroxy-2-(di-n-propylamino)tetraline (8-OH-DPAT)] or N-CBZ-[(8beta)-1,6-dimethylergolin-8-yl]methylamine (metergoline) was injected at hour 5 - the time when LPS-treated rats become anorectic. Food intake was measured during the subsequent 2 h. In LPS-treated rats, 8-OH-DPAT (62.5, 125, or 250 microg/kg, sc) injection increased food intake. In a 2 x 2 factorial arrangement of LPS and 8-OH-DPAT, 125 microg/kg 8-OH-DPAT increased food intake significantly more in LPS-treated rats than in non-LPS-treated rats (significant LPS x 8-OH-DPAT interaction). In LPS-treated rats, 1 and 5 mg/kg metergoline significantly enhanced food intake. However, in a 2 x 2 arrangement of LPS and metergoline, 1 mg/kg metergoline failed to increase food intake in LPS and non-LPS-treated rats in two separate trials. The ability of the 5-HT(1A) receptor agonist 8-OH-DPAT to attenuate LPS-induced anorexia in rats supports a role of 5-HT in LPS-induced anorexia.

Intracranial penetrating injuries via the optic canal.

Two cases of intracranial penetration of a plastic or wooden chopstick via the optic canal are described. CT scans showed the chopsticks as linear hypodense structures in the suprasellar cistern contiguous with the optic canal. In one case, MR imaging was performed, which clearly depicted the foreign body and adjacent brain structures. Although they are extremely rare, transorbital intracranial penetrating injuries via the optic canal require physicians' awareness.

A new approach for multiple sampling of cisternal cerebrospinal fluid in rodents with minimal trauma and inflammation.

A new approach was developed to minimize inevitable damage to nervous and meningeal tissue due to implantation of a sampling tube allowing multiple withdrawal of cerebrospinal fluid (CSF) from the cisterna magna in adult rats. A tube was secured on the atlanto-occipital membrane. Thereafter, a hole was cut through the membrane, allowing flow of CSF from the cisterna magna to the tube. CSF could be sampled repeatedly for at least 1 week. There was no blood-brain barrier damage. The pressure in the cisterna magna remained normal as did the estimated rate of CSF formation. Very few blood cells contaminated the CSF. There was very little evidence of inflammation. The nervous tissue was undamaged as shown by exclusion of a dye-protein complex. The CSF concentrations of the cytosolic neuronal protein neuron-specific enolase (NSE), and of the astrocyte protein S-100 were very low. The pattern of amino acids remained within normal limits. Scanning electron microscopy revealed that clot and reactive changes were restricted to the vicinity of the connecting hole. We conclude that our approach to positioning a tube on the atlanto-occipital membrane and then connecting it to the cisterna magna reproducibly and reliably enables 'atraumatic' multiple sampling of CSF.

Evaluation of the integrity of the blood-brain barrier after meningeal trauma.

RATIONALE AND OBJECTIVES: The authors used magnetic resonance imaging (MRI) techniques to examine the effect of meningeal trauma produced by cisterna magna puncture on the integrity of the blood-cerebrospinal fluid barrier (BCB) in a rat model. METHODS: Intravenous gadolinium-DTPA (Gd-DTPA), a relaxation rate modifier which normally does not cross the BCB, was used as a probe to follow leakage of fluid across the BCB. After Gd-DTPA injection, cerebrospinal fluid (CSF) serial samples were obtained through the needle used to create the experimental trauma. These samples were subsequently examined in vitro by MRI to obtain their T1 relaxation rates and assayed by mass spectrometry for gadolinium and elemental iron concentrations. RESULTS: The iron levels reflected the severity of puncture-related subarachnoid hemorrhage. Rats with ongoing meningeal damage showed significantly higher CSF levels of gadolinium and significantly higher CSF T1 relaxation rates than controls at all samples times over 1 hour after the puncture. Blood in the CSF could not explain these changes because the CSF iron levels did not significantly differ from control levels. CONCLUSIONS: Intravenously administered Gd-DTPA can gain access to the subarachnoid space through minor defects in the BCB and cause significant increases in CSF T1 relaxation rates.