Brucellar spinal epidural abscesses. Analysis of eleven cases.

Brucellar spinal epidural abscesses (BSEA) are rare and very few series of them have been reported. In order to evaluate the clinical characteristics, management and outcome of this entity, the clinical records and current status of a series of 11 patients have been retrospectively reviewed. A series of 11 patients treated for BSEA in our Service during a period of 12 years (1989-2000) have been retrospectively studied. Spinal epidural abscesses (SEA) were diagnosed by MRI, CT or at surgery. Brucellar aetiology of SEA was considered when seroagglutination tests were positive at a titre of 1/160 or higher, and/or Brucella spp. were isolated in the blood or sample cultures. Ten of the 11 cases were treated with rifampicin plus doxycycline and in the remaining patient streptomycin was added because of a poor initial response. Six patients underwent surgical decompression and debridement of the SEA. Outcome was excellent in nine cases and good in two. There was no mortality and only one patient recovered incompletely from preadmission neurological deficits. Although BSEA is considered to be an unusual complication of spondylitis, our findings show that in some cases it can follow direct haematogenous spread to the extradural space. Surgical treatment must be undertaken when major neurological deficits are present. If antibiotic treatment is chosen as the initial therapy, the possibility of sudden neurological deterioration must be taken into account. Contrary to the high morbi-mortality rates reported in pyogenic or tuberculous SEA, BSEA has a good prognosis with early diagnosis and appropriate management.

[Anterior cervical interbody fusion with treathed cylindrical bone versus bak-cace: a comparative study]. / Estudio camparativo de la artrodesis cervical con injerto óseo roscado e implante de titanio.

The authors conducted a prospective and randomized study in 44 consecutive patients requiring cervical interbody fusion following anterior cervical discectomy to compare the efficacy of heterologous threaded cylindrical bone (Unilab Surgibone) versus titanium implant (Bak-C; Spine-Tech, Minneapolis ). The patients were evaluated between two and five years postoperatively and the objectives of the study were to assess the potential differences in implant shifting, interespace collapse, angulation, maintenance of cervical alignment and lordosis, and clinical and radiographic fusion success rates between the two fusion substrates. Clinical results were satisfactory with both types of implant. However the threaded cylindrical titanium implant was found to be superior to the heterologous threaded cylindrical bone as an interbody substrate after single -and multiple- level anterior cervical decompression procedures with respect to maintenance of cervical interspace height, interspace angulation and radiographic fusion success rates.

Delayed pneumocephalus in shunted patients. Report of three cases and review of the literature.

Delayed pneumocephalus is a very rare complication of CSF shunt systems with only 37 cases so far reported. We report three additional cases with different mechanisms of production, clinical presentations and managements. While the first patient was treated with closure of the site of air entrance and shunt externalization, in the second case, modification of the shunt was enough to solve the pneumocephalus, even when a skull base fistula was suspected. The third one died during treatment from complications. The literature is reviewed with respect to the aetiology, clinical presentation, radiological findings and management of this problem.

Inadvertent intraspinal placement of a Foley catheter in severe craniofacial injury with associated atlanto-occipital dislocation: case report.

A case of fatal, inadvertent, intraspinal placement of a Foley urinary catheter is presented. The patient suffered a severe craniofacial injury with life-threatening epistaxis requiring emergent tamponade with two Foley catheters plus gauze packing. There was an associated atlanto-occipital dislocation. The mechanism of production is discussed, and guidelines to avoid this complication are outlined.

Focal dystonia secondary to cavernous angioma of the basal ganglia: case report and review of the literature.

The case of a young woman with focal dystonia of the hand due to a cavernous angioma of the basal ganglia is presented. The lesion involved the anterior third of the lentiform nucleus and a large portion of white matter anterior to this nucleus and lateral to the head of the caudate, as shown by magnetic resonance imaging; it was completely removed through a computed tomography-assisted stereotactic craniotomy by microsurgical technique, resulting in the cure of the patient. These facts support the pathophysiological hypothesis of a disruption of the striatopallidothalamic projection to the premotor cortex as the cause of symptomatic dystonia. A review of the reported cases of cavernous angiomas of the deep cerebral gray nuclei shows that this is the first case of cavernous angioma associated with movement disorder.