[Unusual course of a planned lumbar microdiscectomy]. / Ungewöhnlicher Verlauf einer elektiv geplanten lumbalen Bandscheibenoperation.

We report the case of a 30-year-old female patient who underwent unilateral transverse sinus stenosis stenting due to a newly diagnosed idiopathic intracranial hypertension (Pseudotumor cerebri) with symptoms of papilledema, decreased visual acuity and headache. Resolution of the symptoms and improvement of magnetic resonance and ophthalmiologic findings could be documented.

[Beware of unconspicious cerebro spinal fluid]. / Gefahrenquelle unauffälliger Liquorstatus.

Nowadays with a lot of diagnostic facilities it is also difficult to find the right diagnose of herpes encephalitis. The aim of this case report was to give an overview about strategies of diagnostic and therapy of the herpes encephalitis.

Optic neuropathy and central retinal artery occlusion in non-Hodgkin lymphoma.

We report a patient with systemic large cell non-Hodgkin lymphoma in remission who presented with the rare combination of optic neuropathy and central retinal artery occlusion. Another unusual feature of this case is the lack of enhancement in the affected region on magnetic resonance imaging only hours after the first dose of steroids. Despite prompt treatment with steroids and radiotherapy, lymphomatous infiltration of the meninges developed 2 months later and was ultimately fatal.

Accuracy of MRI-guided stereotactic thalamic functional neurosurgery.

Our goal was to evaluate the accuracy of stereotactic technique using MRI in thalamic functional neurosurgery. A phantom study was designed to estimate errors due to MRI distortion. Stereotactic mechanical accuracy was assessed with the Suetens-Gybels-Vandermeulen (SGV) angiographic localiser. Three-dimensional MRI reconstructions of 86 therapeutic lesions were performed. Their co-ordinates were corrected from adjustments based on peroperative electrophysiological data and compared to those planned. MR image distortion (maximum: 1 mm) and chemical shift of petroleum oil-filled localiser rods (2.2 mm) induced an anterior target displacement of 2.6 mm (at a field strength of 1.5 T, frequency encoding bandwidth of 187.7 kHz, on T1-weighted images). The average absolute error of the stereotactic material was 0.7 mm for anteroposterior (AP), 0.5 mm for mediolateral (ML) and 0.8 mm for dorsoventral (DV) co-ordinates (maximal absolute errors: 1.6 mm, 2.2 mm and 1.7 mm, respectively; mean euclidean error: 1 mm). Three-dimensional MRI reconstructions showed an average absolute error of 0.8 mm, 0.9 mm and 1.9 mm in AP, ML and DV co-ordinates, respectively (maximal absolute errors: 2.4 mm, 2.7 mm and 5.7 mm, respectively; mean euclidean error: 2.3 mm). MRI distortion and chemical-shift errors must be determined by a phantom study and then compensated for. The most likely explanation for an average absolute error of 1.9 mm in the DV plane is displacement of the brain under the pressure of the penetrating electrode. When this displacement is corrected for by microelectrode recordings and stimulation data, MRI offers a high degree of accuracy and reliability for thalamic stereotaxy.

[Reversible posterior leukoencephalopathy: significance in everyday clinical practice]. / Reversible posteriore Leukoenzephalopathie: Bedeutung im klinischen Alltag.

Reversible posterior leukoencephalopathy (PLE) is a newly recognized syndrome with characteristic radiologic findings. The clinical picture resembles that of hypertensive encephalopathy. PLE is caused by uncontrolled hypertension as well as other neurotoxic conditions. We report on 3 patients with this syndrome. One patient also had transient hydrocephalus which may have been caused by PLE. Clinicians must be aware of this syndrome as its recognition obviates unnecessary diagnostic procedures. PLE is reversible by lowering elevated blood pressure and treating neurotoxic conditions such as uremia.

Intestinal non-rotation and pseudoobstruction in myotonic dystrophy: case report and review of the literature.

Myotonic dystrophy is an autosomal dominant inherited disease of the skeletal and cardiac musculature that involves the pharyngeal and gastrointestinal smooth and striated muscles, resulting in velopharyngeal insufficiency, Swallowing difficulties, gastrointestinal motility disorders and anal incontinence. Gastrointestinal symptoms are found in a large proportion of patients suffering from this disease and may herald the onset of muscular disorders, in rare cases they are even the predominant feature of the disorder. We report on a 31-years-old patient with formerly undiagnosed myotonic dystrophy in combination with a non-rotation of the intestinal tract, an association of disorders that to our knowledge never has been reported before. Our patient was admitted as an emergency with signs of an acute abdomen with ileus, associated with acute aspiration pneumonia. Surgical intervention was avoided once the diagnosis of myotonic dystrophy had been confirmed and the patient was treated successfully by conservative therapy. A review of the literature indicates that conservative treatment of motility disorders of the bowel in patients with myotonic dystrophy is to be recommended.