Propionibacterium Acnes Brain Abscess in an Immunocompetent Man in the Absence of Prior Neurosurgery.

Propionibacterium acnes is a rare, but established, cause of intracranial abscesses. We describe a case of P. acnes brain abscess in an immunocompetent man without prior neurosurgery. A 49-year old man with mild psoriasis presented with a two-week history of gait changes, generalized weakness and a two-day history of headaches, aphasia and confusion. Imaging revealed a left thalamic mass and surgical biopsy suggested a pyogenic abscess. Cultures of biopsy samples of the abscess grew P. acnes alone. MRI and serial neurological exam showed marked clinical improvement with intravenous antibiotics. The significant reduction in the abscess was sustained on MRI obtained at six weeks after completion of antibiotic therapy. In conclusion, P. acnes must be considered as a differential diagnosis in individuals presenting with features suggestive of a brain abscess even in the absence of immunosuppression or previous neurosurgery.

[Pedicle screw fixation of thoracic spine fractures]. / Transpedikulárna stabilizácia zlomenín hrudnej chrbtice.

PURPOSE OF THE STUDY: Fractures of the thoracic spine involve injury at the levels of Th2 to Th10. Because of pedicle morphology, pedicle screw fixation is a demanding procedure. However, evidence on the reliability and efficiency of this technique has recently been provided by several studies. The aim of this study was to analyse a group of patients with thoracic spine fractures treated by pedicle screw fixation and to evaluate treatment outcomes. MATERIAL AND METHODS: A total number of 33 patients treated by pedicle screw fixation for thoracic spine fractures between January 2007 and December 2011 were enrolled in this retrospective study. The mean age was 39.7 ± 16.7 years. The evaluation included demographic data, mechanism of injury, associated injuries, neurological status, fracture type (AO classification), levels of the fractured vertebrae, injury-surgery interval, type and duration of surgery, type and length of pedicle screw fixation and complications. The position of pedicular screws in relation to the pedicle walls and correction of kyphotic deformity were assessed on post-operative CT scans. RESULT: Of the 33 patients, 24 had associated injuries (72.7%), 22 had thorax injury (66.7%) and 17 had neurological deficit (51.5%). The most frequent spinal fracture type was type B2, 15 (45.5%); followed by type C, nine (33.3%); and type B1, five (15.1%). The mean injury-to-surgery interval was 5.2 ± 4.3 days. The mean operative time was 210 ± 56 min. The most frequently used configuration of pedicle screw fixation involving two segments above and two below the fracture level was used in 20 cases (58.8%). The position of 149 out of 282 pedicle screws (52.8%) was evaluated on post-operative CT scans as follows: 98 % of the pedicle screws were placed in acceptable positions, 76% were placed completely within pedicle borders. The mean pre-operative Cobb angle was 18.7° ± 8.2°, the mean post-operative Cobb angle was 9.3 ± 3.4°. Six intraoperative and three post-operative complications occurred. During follow-up no instrumentation failure or apparent loss of correction was recorded. DISCUSSION: Early stabilisation of thoracic spine fractures reduces the risk of complications, shortens the hospital stay and allows for faster recovery of patients. Early thoracic spine stabilisation is most beneficial in patients with a high ISS (Injury Severity Score). In the case of small-sized pedicles there is the possibility of pedicle screw insertion via an extrapedicular or parapedicular trajectory. Recommended pedicle screw fixation is two levels above and two levels below the fracture level. CONCLUSIONS: Pedicle screw fixation of thoracic spine fractures is a safe therapeutic method with a low risk of complications. It facilitates effective reduction and stable fixation with a low risk of secondary displacement and implant failure. Key words:transpedicular stabilisation, thoracic spine, fracture, pedicle screws.

[Gunshot wounds of the spine and spinal cord.]. / Strelné poranenia chrbtice a miechy.

The authors summarize the existing findings on the treatment of gunshot wounds of the spine and spinal cord which in their country have become an important cause of mortality and morbidity. Their own experience prove the findings of the authors, i.e. that the seriousness of the initial neurological condition can be hardly influenced and an urgent surgical decompression does not improve statistical prospects of the correction in any type of neurological deficit either, with the exception of cauda ae-quina syndrome. They point out that occurrence of complications such as infections, liquor fistula or instability is from the statistical viewpoint significantly higher in patients operated on. They discuss the role of a routine antibiotic prophylaxis and corticotherapy.The stability of spine is usually not impaired by gunshot wounds and as a rule it does not reqiure stabilization by implants.Therefore they recommend to consider the occurrence of instability on a caseby-case basis. Key words: penetrating spinal injury, spinal injury.

[Treatment of fractures of the lower cervical spine (C3-C7)]. / Liecba zlomenín dolnej casti krcnej chrbtice (C3-C7).

Spinal surgery dealing with reparation of injury consequences by stabilisation implantates is a relatively new surgical branch. The experience and results at individual departments in Slovakia in this field differ significantly as to their qualitative degree. The Trauma Surgery Department IVZ in Bratislava and the National Rehabilitation Center in Kovácová cooperate since 1989 in a mutual spinal programme. 177 out of 189 patients survived after undergoing a surgical treatment due to the injury of the lower cervical spine performed from 1988 to 1994. 68 patients (Frankel A, B, C) were included into the spinal programme. The authors present the therapeutical results evaluated according to morphologic, neurologic, functional and subjective criteria. The most frequently used stabilizing method is the so-called method of Caspar and the technique of Morscher, the latter being less frequently applied. Both methods are fully secure, causing minimal blood loss, perfectly stable as to the angle and axis. Both techniques enable a sufficient approach to the decompression of the spinal cord. Since they do not demand any additional external rigid fixation, they are excellently tolerated by patients and only minimally restrict movement. (Tab. 2, Fig. 4, Ref. 8.)

Predominantly extraaxial astroblastoma: imaging and proton MR spectroscopy features.

The CT, angiographic, MR, and proton MR spectroscopy findings in a case of astroblastoma, a rare neoplasm of glial cell origin, are presented. Of particular interest is the predominantly extraaxial location of the tumor. CT and MR demonstrated a complex mass consisting of a solid nodule and a peripheral septated cystic component. The extraaxial nature of the mass was suggested on MR.

Normal imaging anatomy of the suprasellar cistern and floor of the third ventricle.

This article discusses the gross, functional, and imaging anatomy of the suprasellar cistern and its contents as well as the structures that form its borders, among the most important being the floor of the third ventricle and associated structures. Specific structures discussed include the optic chiasm and optic tracts, the anterior third ventricle, the tuber cinereum, the pituitary stalk (infundibulum), the choroidal fissure, the lamina terminalis, the gyrus rectus, the uncus, and the cerebral peduncles.

MRI of hemorrhagic choroid plexus cyst.

An unusual case of hemorrhage within a cyst in the choroid plexus of the lateral ventricle is presented. Choroid plexus cysts are commonly found incidentally on imaging studies, particularly MRI, where their characteristic appearance produces little diagnostic difficulty. In this case, high signal intensity of the cyst contents on T1-weighted images and apparent hemosiderin deposition in the cyst wall, not previously described, represented a dramatic change from a study 10 weeks previously and allowed a presumptive diagnosis of hemorrhage into the cyst, a presumption further supported by the changes in signal 20 weeks later.

Diagnostic imaging in puerperal febrile morbidity.

This retrospective study was conducted to assess the value of imaging in patients with refractory puerperal febrile morbidity. During a 36-month period, 31 patients were referred for ultrasound and/or computed tomography or magnetic resonance imaging because of postpartum fever unresponsive to broad-spectrum antibiotic therapy of at least 72 hours' duration. Hematomas were identified in 11 women. Abscesses were diagnosed in seven patients, ovarian venous thrombosis in two, vesicouterine fistula in one, small-bowel obstruction in one, and a subcutaneous seroma in one. Twenty-one women had endomyometritis, 13 of whom also had other extrauterine abnormalities (abscess in six, hematoma in four, and ovarian venous thrombosis, vesicouterine fistula, and small-bowel obstruction in one each). Retained placental tissue was found in two women with endomyometritis. Only two subjects had negative imaging studies. In most patients, imaging led to definitive diagnosis and specific therapeutic measures resulting in resolution of the febrile morbidity. Our experience suggests that these imaging techniques may be helpful in evaluating puerperal fever.

Ovarian vein thrombosis with atypical presentation: role of sonography and duplex Doppler.

Ovarian vein thrombosis was diagnosed in two patients, one postoperatively and one postpartum, with mild, atypical presentations, using sonography and duplex Doppler. Demonstration of the dilated ovarian vein with internal thrombus, without demonstrable flow by Doppler, was diagnostic. We propose that sonography with duplex Doppler be the initial screening examination in at-risk patients with typical or atypical presentations.