Biomedical subjects
Publications and source records attributed to B P Brophy.
A case of a rare intracerebral tumour, namely a ganglioglioma, is reported to illustrate the CT and MRI features. The finding of focal thinning of the inner skull vault in association with an adjacent intracerebral mass lesion can aid in the diagnosis of intracerebral ganglioglioma.
A case of tenth and twelfth nerve compression secondary to a bony exostosis of the first cervical vertebra is described. This uncommon phenomenon serves to outline the importance of imaging the course of a cranial nerve when no intracranial abnormality is demonstrable on CT or MRI. The radiologic features of spinal osteochondromas are reviewed.
Lumbar disc prolapse managed surgically is occasionally complicated by a recurrent ipsilateral prolapse of the residual disc material at the same level, but only rarely by prolapse on the contralateral side at that level. We present a case of the latter, successfully managed by a second microdiscectomy, and review the frequency of such cases in previous series.
The administration of oestrogens is known to cause an increased risk of thrombosis in the cerebral arterial circulation. It has also been associated with cerebral venous thrombosis in patients on the contraceptive pill. We describe a case of cerebral venous thrombosis in a woman on post-menopausal hormonal therapy and discuss this with reference to the current literature.
Although cervical spondylosis is a common disorder, dysphagia induced by osteophyte formation is uncommon. Fewer than one hundred cases of cervical osteophyte induced dysphagia have been reported, with little attention to the diagnosis by barium swallow. The radiological features of two cases treated surgically with good results are described. Both cases complained of dysphagia while one had associated respiratory obstruction on forward flexion of his neck. The features on barium study of cervical osteophytes causing dysphagia include deformity at the level of osteophyte formation, in both AP and lateral projections. Tracheal aspiration due to deformity at the laryngeal inlet and interference with epiglottic retroversion may be present.
Nineteen patients with tic douloureux were treated with glycerol injection in the trigeminal cistern. Facial sensibility was measured with an electrical stimulator one day before and one day after the glycerol treatment. The thresholds for perception and pain, and the maximal pain tolerance rose by about 50% (p less than 0.01, 0.01, and 0.001, respectively). The hypaesthesia and hypalgesia were most marked just below the eye, whereas the mandibular division showed only slight sensory impairment. In 13 patients a follow-up sensimetry study was done 1-7 months after surgery. Thirteen patients became completely free of pain and one almost completely free from pain (74%). Two had no pain relief. Twelve patients had no subjective complaints of the treatment. Three reported on dysaesthesiae (16%) over the previously painful area. Seven patients (37%) had subjective sensations of diminished or altered sensibility: numbness and hypalgesia in the face. Corneal hypaesthesia was recorded in ten patients (53%). Glycerol has a non-specific neurotoxic effect which is equal for tactile and nociceptive fibres. Sensory impairment may be a conditio sine qua non for a good clinical result.
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Two cases of spinal epidural abscess following prolonged epidural anaesthesia are presented. The clinical features included fever, malaise, and signs of nerve root compression; backache was not marked. Prompt surgical drainage and appropriate antibiotics are required to avoid the costly sequelae of bladder and leg paralysis from spinal cord compression. Both infections were caused by bacterial contamination of catheter, and although this complication is uncommon, it emphasizes that strict asepsis is essential during continuous epidural anaesthesia.
Three cases of multiple cerebral nocardial abscess are presented. All were cured by a combination of chemotherapy and surgery, a unique experience. Early detection, appropriate chemotherapy, absence of underlying immune malfunction, and surgically remediable disease are good prognostic indices in cerebral nocardiosis. If other adverse prognostic factors are absent, however, multiple abscess formation does not preclude the possibility of cure. Accurate localisation of nocardia cerebral abscesses by computerised axial tomography is a great help in management if multiple lesions are present.
Thirty supraclavicular traction injuries of the brachial plexus are reported. Young motor cyclists are frequently involved. Recovery is slow and often incomplete. Myelography remains the most useful investigation for prognostic purposes. The management of intractable pain is discussed. An early assessment of prognosis is an important fact in planning and supervising the long-term management of these patients.
Chordomas are rare neoplasms arising from remnants of the embryologic notochord. Although typically midline in site, intracranial tumors may arise off the midline, and a significant proportion of these arise unilaterally in the petrous bone. Three examples of this entity are presented, all demonstrating typical radiologic features. Dendritic branches of the cranial end of the notochord ramifying in the skull base are thought to provide the embryologic basis for this tumor. The CT and MR features demonstrated are similar to those of the more common midline chordomas. CT demonstrates a well-defined extraaxial soft-tissue mass associated with foci of calcification and bone destruction and occurring at a site corresponding with the embryologic distribution of notochordal material. On MR, prolonged T1 and T2 relaxation times result in hypointensity on T1-weighted images and marked hyperintensity on T2-weighted images. Signal voids result from the foci of calcification while hemorrhage may also lead to inhomogeneity.