Double compartment hydrocephalus in an adult.

A case of double-compartment hydrocephalus in an adult is presented. Although this entity is infrequently noted in children, it is diagnosed even more rarely in the adult population. A discussion of the spectrum of abnormal cerebrospinal fluid dynamics of the 4th ventricle and treatment options are presented.

T2-ganglionectomy via limited costotransversectomy for minor causalgia.

T2-ganglionectomy via limited costotransversectomy is a safe and effective method to produce sympathetic denervation of the upper extremity. It provides prompt and lasting relief of the complex array of symptoms associated with minor causalgia. Four patients with minor causalgia treated by this procedure are presented. All patients were seen by multiple physicians before a correct diagnosis was made. Pain and trophic changes resolved in all cases. No instances of Horner's syndrome or pneumothorax were encountered. Preoperative response to temporary stellate ganglion block is essential to both diagnosis and treatment. Consideration of early surgical intervention should be given in cases involving significant disability. A fundamental problem surrounding the appropriate management of minor causalgia has been and continues to be accurate recognition of the diagnosis.

Pachymeningeal gadolinium enhancement of the lumbar region secondary to neuraxis hypotension.

STUDY DESIGN: A case of diffuse pachymeningeal gadolinium enhancement of the lumbar region secondary to neuraxis hypotension is presented. OBJECTIVE: To report a case of diffuse pachymeningeal gadolinium enhancement of the lumbar region and to show the importance of considering neuraxis hypotension in the differential diagnosis of this type of enhancement so as to avoid excessive invasive and noninvasive diagnostic testing. SUMMARY OF BACKGROUND DATA: Diffuse pachymeningeal gadolinium enhancement of the lumbar region secondary to neuraxis hypotension has not been reported previously. METHODS: A case of diffuse pachymeningeal gadolinium enhancement of the lumbar region is presented in the context of clinical signs and symptoms replete with a history of cerebrospinal fluid diversion that strongly suggest neuraxis hypotension. RESULTS: The patient's clinical presentation and history of shunting implicated neuraxis hypotension as a cause of the diffuse dural enhancement. CONCLUSION: Proper attribution of the dural gadolinium enhancement to neuraxis hypotension helped avoid a dural biopsy with its potential attendant morbidity. It is important to consider neuraxis hypotension in the differential diagnosis of diffuse pachymeningeal enhancement occurring anywhere in the central neuraxis to avoid unnecessary diagnostic testing with its attendant morbidity and cost.

Air ventriculogram serendipitously discovered after epidural anesthesia.

An air ventriculogram was discovered in the context of a minor head trauma evaluation. Its correct attribution to an antecedent epidural anesthesia rather than trauma precluded an unnecessary workup. The relationship between epidural anesthesia and pneumocephalus is emphasized. The development of air ventriculography as a diagnostic tool is discussed as well.

Intrathecal administration of morphine for pain of malignant origin.

Intrathecally administered morphine is a safe and effective method of providing analgesia, with the indicated constraints. Unencumbered by pain and the soporific effect of systemic narcotics, many, if not most, patients are able to lead productive lives. Neuroablative procedures are, in many instances, either delayed or eliminated entirely. As the number of support personnel familiar with the management of implantable systems increases, this avenue of treatment should become widely available.

Intraoperative monitoring of brainstem auditory evoked potentials following emergency evacuation of a cerebellar vascular malformation.

This case report highlights the use and value of monitoring the auditory brainstem response during emergency neurosurgery. The prompt on-line changes in the auditory brainstem response after evacuation of a cerebellar arteriovenous malformation provided objective evidence of improved brainstem function, which aided in the management of this patient's disorder.