Biomedical subjects
Publications and source records attributed to A Lavano.
We present seven cases of tension pneumocephalus developing after burr hole evacuation of chronic subdural haematoma. After a careful review of the literature we discuss the physiopathology, the diagnosis and the treatment of this complication of chronic subdural haematoma surgery.
Three patients with cerebral tumor involving diencephalic midline structures (2 malignant gliomas, 1 craniopharyngioma) and no metabolic abnormalities developed disorientation in time and place or coma with triphasic waves (TW) seen on electroencephalograms. Serial EEG recordings showed persistence or disappearance of TW depending on poor or good outcome of the antiedema treatment. TW have been described with disorders affecting the brain diffusely, as metabolic encephalopathies, dementing processes, cerebral carcinomatosis and baclofen intoxication. The findings described here demonstrate that TW may occur in patients with brain tumor involving subcortical midline structures.
Two more patients with triphasic waves (TW) on their EEGs in the absence of metabolic disturbances are described. One patient had coma associated with cerebellar hematoma, the other had mild dementia associated with idiopathic calcifications of the basal ganglia and normal auditory brainstem responses, subcortical and cortical somatosensory evoked potentials. Neurologic examination failed to show asterixis in both patients. The literature on nonmetabolic causes of TW was also reviewed, and the clinical and anatomic reports of 10 patients have been analyzed: 7 patients had focal brainstem-diencephalic lesions (craniopharyngioma: 2 patients; thalamic gliomas: 3 patients; pontine stroke: 2 patients), and 3 patients suffered from diffuse subcortical or multifocal encephalopathies (Binswanger's encephalopathy: 1 patient; cerebral carcinomatosis: 1 patient; multifocal cerebral lymphoma: 1 patient). From the clinical point of view, patients with nonmetabolic diseases causing TW presented either disturbance of higher cerebral functions with no asterixis or sudden onset of coma. It is concluded that TW may result from focal brainstem/diencephalic lesions or from diffuse subcortical or multifocal encephalopathies in the absence of concomitant metabolic abnormalities. Nonmetabolic causes of TW should be suspected in patients presenting with neurologic disturbances not associated with asterixis.
A rare case of a meningioma of the posterior margin of the petrous temporal bone associated with cerebrospinal fluid rhinorrhea is presented. After a careful review of the literature, the possible pathogenesis of the fistulous tract is discussed.
Two cases of postoperative intracerebral haemorrhages remote from the site of the initial craniotomy for saccular aneurysms are reported and the other cases from the literature are reviewed. Lack of a good postoperative recovery and the appearance of neurological signs not related to the site of the operation may suggest this complication, which is associated with high mortality and disability rate. The possible pathogeness of those postoperative haemorrhages is discussed.
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Seven patients with spinal osteoid osteomas are reported and another 110 cases from the literature are reviewed. Among the patients spinal pain is the constant clinical complaint, while radicular pain and scoliosis are present in half of the patients. Whereas radiograms and tomograms of the spine are sometimes inadequate for diagnosis, bone scanning is positive in 100% of patients and is useful for directing spinal computed tomography at the exact level of the lesion. Complete removal of the tumoral nidus produces remission of pain in more than 95% of cases. The possibility of an erroneous diagnosis of a lumbar protruded disk and the necessity of a bone scan in young patients with spinal or radicular pain are emphasized.
A 52-year-old woman had a right temporal glioblastoma six months after an operation for a right internal carotid aneurysm. In the literature there are no reports of gliomas arising in the region of a preceding craniotomy for an aneurysm. The rare association of brain tumours with arterial aneurysms and the pathogenetic theories are discussed. The authors suppose that in their case there is a relationship between the vascular changes due to the aneurysm and the operation and the growth of the malignant glioma.
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A pseudohypertrophy of the calf can be rarely associated with neurogenic pathologies as S-1 radiculopathy, poliomyelitis, spinal muscular atrophy, traumatic lesions of peripheral nerves, intraspinal neurinoma. The causes of this particular phenomenon are unknown. The authors present the case of a 52-year-old man with an enlargement of the left calf suffering from a mild form of spinal paralytic poliomyelitis in the early childhood and episodes of severe left sciatica in the last four years. Electromyography demonstrated a pattern of denervation in both legs and an H-reflex absent when the left tibial nerve was stimulated. An open muscle biopsy of the left calf was performed. Light microscopic and ultrastructural examination of the muscle confirmed the presence of a pattern of "neurogenic type" pseudohypertrophy. Our results could be interesting for the understanding of the mechanism of neurogenic pseudohypertrophy. This case suggests that timing of stimulus or "dose" of denervation may be important factors in such a phenomenon.
In this study an interesting and not frequent case of non-traumatic chronic subdural haematoma after spinal anaesthesia is reported. After a careful review of the cases described in the literature, the Authors discussed the physiopathological mechanisms, emphasizing how the break of the bridge veins or of the subarachnoid granulations, the cerebral atrophy and the dehydration are factors which facilitate the appearance of this neurological complication. They suggest that a suitable post-operative rehydration is an important prevention factor.
Tubercular infection is a rare occurrence in the lower cervical spine. The isolated involvement of the posterior arch is particularly rare, and the very few cases in which it is reported at the thoracic or lumbar levels were principally observed in immunodepressive patients. It is the purpose of this study to describe two cases of tuberculosis of the lower cervical spine with neurological deficit: one expansive neoformation at the level of the arch of C7, with saving of the vertebral body and the discs, and a spondylodiscitis at C4-C5, treated conservatively, the healing process of which was followed by MRI.
We report a case of post-Paget telangiectatic osteosarcoma of the skull in a 75-year-old woman. Such a neoplasia is a rare variant of osteosarcoma, a tumor rare in the cranic bones. The patient was submitted for a careful analysis by the following procedures: technetium scintigram, X-rays, CT scan, and MRI. After the surgical procedure, pathological examination confirmed the diagnosis. Both radiological and pathological pattern of this tumor are discussed in relation to the differential diagnosis. Our report shows that benign lesions may represent a possible cause of diagnostic errors. They must be excluded by histological analysis.