The effect of carotid stenting on rheological parameters, free radical production and platelet aggregation.

INTRODUCTION: Carotid artery stenting has become a possible treatment of significant carotid stenosis. The risk of stent occlusion and restenosis might be increased by abnormal rheological conditions amplified platelet aggregation and free radical production during the operation. AIMS: The aim of our study was to assess the changes in hemorheological parameters, platelet aggregation, and catalase activity after endovascular treatment of carotid stenosis. METHODS: 18 patients (11 men, ages 68 +/- 9 years and 7 women, ages 62 +/- 8 years) suffering from significant carotid stenosis and treated with carotid endovascular intervention were examined. Alteration in hemorheological parameters as well as epinephrine-, ADP-, and collagen-induced platelet aggregation were evaluated. Antioxidant reserve was characterized by the determination of catalase activity. The measurements were carried out directly before and after the procedure and 1, 2, 5 days and 1 month following the intervention. Preceding the operation the patients were administered a maximum dose (300 mg) of clopidogrel. RESULTS: Hematocrit, plasma fibrinogen concentration (PFC) and whole blood-, and plasma viscosity values (WBV and PV) significantly decreased immediately after stenting (p<0.001). By the fifth day following the intervention the PFC, WBV, PV, red blood cell (RBC) aggregation and ADP-induced platelet aggregation significantly increased (p<0.0001) compared to values measured postprocedurally. At 1 month follow-up these parameters, except whole blood viscosity, decreased significantly compared to measurements made on the 5th day. On the other hand, catalase activity showed significant elevation by the end of the first month. CONCLUSION: Hemorheological parameters and platelet aggregation showed specific changes following carotid stenting. Abnormal changes of the rheological conditions and increasing platelet activation are the most pronounced in the first week following stenting, which may lead to early stent occlusion. Oxidative stress production returned to baseline levels only by the end of the first month.

Regional gray matter reduction and theory of mind deficit in the early phase of schizophrenia: a voxel-based morphometric study.

OBJECTIVE: We tested the association between theory of mind (ToM) performance and structural changes in the brains of patients in the early course of schizophrenia. METHOD: Voxel-based morphometry (VBM) data of 18 patients with schizophrenia were compared with those of 21 controls. ToM skills were assessed by computerized faux pas (FP) tasks. RESULTS: Patients with schizophrenia performed significantly worse in FP tasks than healthy subjects. VBM revealed significantly reduced gray matter density in certain frontal, temporal and subcortical regions in patients with schizophrenia. Poor FP performance of schizophrenics correlated with gray matter reduction in the left orbitofrontal cortex and right temporal pole. CONCLUSION: Our data indicate an association between poor ToM performance and regional gray matter reduction in the left orbitofrontal cortex and right temporal pole shortly after the onset of schizophrenia.

Fast method for longitudinal relaxation time and water content mapping of the human brain on a clinical MR scanner.

BACKGROUND: Longitudinal relaxation time (T(1)) map generation from human brain slices renders possible the in vivo follow-up of the changes in T(1) values during the course of several pathologies such as stroke, multiple sclerosis, traumatic brain injury etc. T(1) values can be converted to water contents, thus brain oedema reducing therapy can be non-invasively evaluated. The purpose of the study was to work out a fast and simple MRI method to obtain T(1) and water maps of the human brain. METHOD: The T(1) values of Gadolinium solutions with different concentrations were determined by means of MRI methods at a clinical MR scanner operating at 1 Tesla. In order to validate these measurements, T(1) values of the same Gadolinium solutions were also quantified with a relaxometer operating at the same field strength. T(1) and water maps from the brains of healthy volunteers were obtained with an inversion prepared spoiled gradient echo sequence (turbo-FLASH). FINDINGS: The T(1) values of Gadolinium solutions measured with the relaxometer showed a strong correlation (r > 0.999) with those determined with MRI sequences on the whole body scanner. The fastest MRI method to produce T(1) and consequent water maps from human brain was the inversion prepared turbo-FLASH sequence. CONCLUSIONS: The implemented turbo-FLASH method can produce T(1) and water map of a single virtual brain slice within 2 minutes. However, brain tissue containing haemorrhage should be excluded from the measurement due to the large influence of excessive haemoglobin concentration on longitudinal relaxation. The proposed method is available on most of the MR scanners, thus T(1) and water mapping of human brain can be routinely performed.

[Stereotactic thalamotomy for Parkinsonian and others types of tremor. Experiences of thalamic multiunit burst activity by means of semimicroelectrode]. / Talamotomía estereotáxica de la enfermedad de Parkinson y otros tipos de temblor. Experiencias de la actividad multiunitaria burst en el tálamo basada en semimicroelectrodos.

INTRODUCTION: Better understanding of the basic mechanism of disorders of movement, together with improvements in surgery and electrophysiological techniques have led to a resurge of interest in the surgical treatment of patients with tremor. Ventrolateral thalamotomy has been considered to be an alternative neurosurgical treatment for disabled persons including those with drug-resistant Parkinson s disease and other types of tremor. PATIENTS AND METHODS: Thirty four of 47 patients had Parkinson s disease (n= 23), essential tremor (n= 4), multiple sclerosis (n= 5), olivopontocerebellar lesion (n= 1) and posttraumatic tremor (n= 1) and did not show satisfactory improvement after drug treatment. The lesions were made in the thalamic nucleus. In 26 patients simultaneous recordings were made of nerve activity in the thalamus and of burst activity. RESULTS: In 23% of the cases the appropriate site for the final lesion could not be determined in accordance with electrostimulation of the empirical objective. In these patients the objective was determined after observation of the electrophysiological activity localized to the burst activity seen during the operation. The patients were followed-up for 6-24 months (average 12 months); 88% of them had no tremor or moderate contralateral tremor. The patients were assessed on a modified Fahn scale. Average scoring fell from a preoperative evaluation of 73.8 points to 34.0 after three months; 30.7 after six months, 32.0 after 9 months, 37.1 after 12 months and 35.2 points after 18 months. CONCLUSION: Of 47 thalamotomies done, 13 (29%) were successful and 5 (10%) maintained their original state, but no cases became worse or had serious complications.

Talamotomía estereotáxica de la enfermedad de Parkinsony otros tipos de temblor. Experiencias de la actividad multiunitariaburst en el tálamo basada en semimicroelectrodos / Stereotactic thalamotomy for Parkinsonian and other types of tremor. Experience of thalamic multiunit burst activity by means of semimicroelectrode

Introducción. El mayor entendimiento del mecanismo fundamental en el trastorno de los movimientos acoplados con el perfeccionamiento en la cirugía y técnicas electrofisiológicas ha conducido al resurgimiento del interés en los tratamientos quirúrgicos en los pacientes con temblor. La talamotomía ventrolateral ha sido considerada como una alternativa en el tratamiento neuroquirúrgico para incapacitados, personas con enfermedad de Parkinson resistente a los fármacos y para otros tipos de temblor. Pacientes y métodos. Trenta y cuatro de 47 pacientes padecían enfermedad de Parkinson (n= 23), temblor esencial (n= 4), esclerosis múltiple (n= 5), olivopontocerebelosa (n= 1), o temblor postraumático (n= 1), los cuales no mejoraron ante la terapia de medicamentos. Las lesiones se realizaron en el núcleo del tálamo (Vim). El registro de la actividad neural se llevó a cabo en el tálamo; al mismo tiempo, se registró la actividad salva (burst) en 26 pacientes. Resultados. En el 23 por ciento de los casos no pudo determinarse cuál es el lugar apropiado para la lesión final de acuerdo con la electroestimulación del objetivo empírico. En estos pacientes el objetivo fue determinado tras la observación de la actividad electrofisiológica localizada en la actividad multiunitaria (burst) durante la operación. Los pacientes tuvieron un seguimiento de 6-24 meses (promedio 12 meses). El 88 por ciento de ellos ya no sufren, o sufren moderadamente, temblor contralateral.Los pacientes fueron evaluados con la escala modificada de Fahn. La puntuación promedio de la evaluación preoperativa declinó de 73,8 puntos a 34,0 a los tres meses, a 30,7 en seis meses, a 32,0 en nueve meses, a 37,1 en 12 meses y a 35,2 puntos a los 18 meses.Conclusión. De las 47 talamotomías, 13 (29 por ciento) han trascendido y 5 (10 por ciento) han mantenido, pero no se detectó empeoramiento ni complicaciones graves (AU)

Subluxation of a lumbar vertebra in a patient with Marfan syndrome. Case report.

Marfan syndrome is a hereditary disorder of the connective tissue that, in its most classic form, includes cardiovascular, ocular, and skeletal features. The neurological problems associated with the disease are mainly caused by intracranial vascular abnormalities and spinal meningeal defects, but other neurological manifestations are rarely present. Scoliosis, a skeletal manifestation of the syndrome, occurs frequently, but its onset, natural history, and radiological characteristics differ from those of the idiopathic form. Scoliosis in a patient with Marfan syndrome seldom accompanies other spinal deformities. In this article the authors describe the case of a patient with Marfan syndrome and scoliosis in whom lumbar subluxation occurred. This rare deformity, diagnosed on three-dimensional computerized tomography scanning, has not been reported previously in association with Marfan syndrome. Its development can be explained in terms of the theory of progressive rotatory dislocation. The morphological characteristics, clinical features, and surgical treatment of the deformity are presented.

[MRI guided stereotactic thalamotomy for the treatment of the neurogenic pain]. / Talamotomía estereotáxica por resonancia magnética para el tratamiento del dolor neural.

INTRODUCTION: Medial thalamotomy is one of the first stereotactic operations to have been used for neurogenic pain, has a low complication rate and no risk of the development of iatrogenic neurogenic pain. It represents selective local relief for all types of pain, without causing somatosensorial deficit. PATIENTS AND METHODS: We did 39 posteromedial thalamotomies in patients with persistent intractable pain due to various disorders. The pain was assessed pre- and postoperatively on the VAS (Visual Analogic Scale). RESULTS: Half of the patients operated on had relief of pain after thalamotomy. In 84% (n = 39) of our cases this relief occurred on the second day, in 70% (n = 35) after three months, in 63% (n = 27) after six months, in 64% (n = 25) after nine months, in 62% (n = 23) of the patients after 12 months, and in 62% (n = 22) after 24 months. Three patients had temporary complications and one a permanent complication, but this did not make him an invalid. CONCLUSION: Posteromedial stereotactic thalamotomy under MR guidance can provide safe, effective treatment for persistent, intractable pain.

Biportal endoscopic removal of a primary intraventricular hematoma: case report.

Primary intraventricular hematomas account for approximately 6% of all intracerebral hematomas. If the clot blocks cerebrospinal fluid (CSF) pathways, surgical intervention, which may be of different types, can be life-saving. In the case reported here, after careful preoperative planning the use of two rigid endoscopes permitted the removal of most of the intraventricular clot and restoration of CSF circulation by creation of a 3rd ventriculostomy within the same procedure and no later treatment was necessary. Repeated CT scans proved that only a small portion of the intraventricular clot remained in the ventricular system. The ventricular size normalised, and the patency of the artificial hole in the floor of the 3rd ventricle was demonstrated both by the rapidly improving clinical picture of the patient and by flow-sensitive MRI studies. For individuals who suffer primary intraventricular hemorrhage and later develop occlusive hydrocephalus, endoscopic removal of the clot and 3rd ventriculostomy might offer a more adequate treatment option than external ventricular drainage.

[Hydranencephaly. (Severe cerebral malformations in three newborn infants)]. / Hydranencephalia (a súlyos agyi elváltozásról három újszülött kapcsán).

Three neonatal cases of hydranencephaly are reported. Clinical and radiological characteristics of this disease are also described. Factors which can have any role in the development of hydranencephaly are reviewed. The importance of intrauterine ultrasonography and the quick, early diagnosis is emphasized. Therapeutic approaches are also discussed.

Occlusive hydrocephalus complicating tuberous sclerosis: report of two cases.

Two patients-6 and 14 years old-with tuberous sclerosis are presented. Both developed a subependymal giant cell astrocytoma from nodules located near to the foramen of Monro. They caused obstruction of the cerebrospinal fluid pathways. Signs of raised intracranial pressure were detected in both patients, and one of them had also developed infantile spasm-Blitz-Nick-Salaam seizures. Cutaneous stigmata being characteristic for this entity were observed in both cases, but their mental development was unaffected. Diagnosis was based on computed tomography. Angiography did not reveal pathological vessels. The tumours were completely excised through transcallosal exposure in both cases. The patients have been symptom-free during the follow-up time of 1 and 2 years. Although the incidence of malignant transformation of tuberous sclerosis is less than 15% the disease generally has a poor prognosis which can be ascribed to sudden increase of intracranial pressure caused by obstruction of cerebrospinal fluid pathways by paraventricular tumours. However, regular follow-up of paraventricular nodules and maintenance of patency of cerebrospinal fluid pathways by microsurgical methods in patients suffering from mild cerebral disorders offers a better chance of survival.