Improving the imaging report in patients with acute intracerebral hemorrhage.
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Adult↗
Biomedical subjects
C A Muszynski
Publications and source records attributed to C A Muszynski.
Conservative management of extra-axial hematomas diagnosed by CT.
Our purpose was to assess the role of serial CT in recently traumatized patients with clinically stable extra-axial intracranial hematomas (EACH) and a midline shift of less than 0.5 cm. A retrospective review of 91 imaging studies in 41 patients (with 45 EACH) was done to assess the time between trauma and CT; the presence and type of skull fracture; the volume, type, and location of the EACH; the presence of associated edema and/or contusion. Over a 19-day follow-up, 11% of the dense EACH increased in volume and 27% decreased. An adjacent skull fracture was seen most frequently in patients with a decrease in EACH volume. Clinical data remain the key to determining the need for neurosurgical intervention in patients with EACH. Follow-up CT afforded no data which altered the medical management of these patients. However, it may be said to have alerted the clinician to an increase in the size of the EACH in 11% of cases, which could mandate close observation of this group.
Adolescent↗
Sympathetic storms in a child with a midbrain glioma: a variant of diencephalic seizures.
The authors report the unusual case of a 7-year-old child, one of the youngest reported to date, who developed repeated episodes of sympathetic hyperactivity after surgical resection of a midbrain glioma. These paroxysmal events were similar to previously described diencephalic seizures. However, there was no evidence of epileptogenic activity on electroencephalography, and radiologic imaging did not reveal hydrocephalus or intraparenchymal hemorrhage. In this report, clinical features are described of this patient, along with the novel use of clonidine--a sympathetic blocking agent--in his treatment, published reports are reviewed on diencephalic seizures, and steps are recommended in the treatment of a patient who presents in this manner. The authors believe that diencephalic seizures can present with a spectrum of autonomic features, and treatment should be tailored with the appropriate pharmacologic blockade.
Anticonvulsants↗
Infantile cerebral aneurysms with visual pathway compression.
Intracranial aneurysms are rare in infancy. The commonest presentation is intracranial hemorrhage, but signs of mass effect are more frequent than in adults. We report 2 infants with cerebral aneurysms, one presenting with macrocephaly and another with strabismus. Both had visual loss and optic disc pallor; MRI revealed a suprasellar mass and anterior visual pathway compression. In both cases, the preoperative diagnosis was craniopharyngioma. It is essential to recognize that, although exceedingly uncommon, cerebral aneurysms do occur in infants and have features that differ from those in adults.
Calcinosis↗
Intraparenchymal clear cell meningioma of the brainstem in a 2-year-old child. Case report and literature review.
We report an unusual case of an intraparenchymal clear cell meningioma of the brainstem, occurring in a 22-month-old girl. She presented with bulbar dysfunction and a right hemiparesis due to an intrinsic tumor of the medulla, which was confirmed by radiologic imaging to be focal and with an exophytic component. At surgery, a partial resection was achieved and no dural attachment was found. Pathologic examination revealed a clear cell meningioma. In reviewing the literature, there have been fewer than 20 reported cases of clear cell meningioma, none of which were intraparenchymal, involved the brainstem or occurred in such a young patient. The pathologic findings, treatment options and present understanding of this tumor are discussed.
Adolescent↗
Coagulation of herniated cerebellar tonsils for cerebrospinal fluid pathway restoration.
In the past, many different surgical techniques have been proposed for treatment of the Chiari type I malformation. Despite the different technical considerations, in general, the treatment objectives have shared certain features: to prevent/ameliorate tonsillar crowding and to restore normal circulation of cerebrospinal fluid at the foramen magnum. We report a simple technique of coagulation of the herniated cerebellar tonsils in situ to decompress adjacent neural structures and to achieve the above-mentioned goals. When compared to the method of tonsillar resection, the procedure described herein affords the following two advantages: it is relatively less time-consuming and is more hemostatic. These two features minimize inflammation-mediated morbidity which may occur during the postoperative period.
Adolescent↗
Scalp hibernoma: case report and literature review.
Hibernomas are uncommon, benign neoplasms derived from the remnants of fetal brown adipose tissue. A review of the world literature revealed 105 cases, with the interscapular location the most common. Typically, hibernomas are asymptomatic and slow-growing. Adequate treatment usually consists of simple excision. We describe the second documented case of a scalp hibernoma.
Humans↗
Prenatal sonographic detection of basilar aneurysm.
Retrospective reviews document the infrequency of intracranial aneurysms in the first decade of life, with an even greater rarity in the first 2 years. Intracranial aneurysms are not known to be associated with trisomy 18. An infant is reported who was diagnosed at 32 weeks gestation as having trisomy 18. Prenatal ultrasonography identified a large cystic lesion in the posterior cerebral circulation. This small-for-gestational-age infant was born at term by dates, but renal maturation suggested a gestational age of 35-36 weeks. He survived 5 days. This is the first report of prenatal sonographic imaging of a basilar artery aneurysm confirmed by autopsy.
Adult↗
Effects of ventricular drainage and dural closure on cerebrospinal fluid leaks after posterior fossa tumor surgery.
In a retrospective study of 50 consecutive children with posterior fossa tumors treated at Texas Children's Hospital, Houston, Tex., in 1989-1992, we evaluated perioperative factors which might influence the development of postoperative cerebrospinal fluid leaks. Factors analyzed included the presence of preoperative hydrocephalus, the institution of cerebrospinal fluid diversion, and the method of dural closure. No statistically significant impact on subsequent cerebrospinal fluid leakage was demonstrated.
Adolescent↗
DFMO reduces cortical infarct volume after middle cerebral artery occlusion in the rat.
Ornithine decarboxylase (ODC), a key enzyme in polyamine biosynthesis, is induced in ischemic tissue and may mediate vasogenic edema and delayed neuronal death. We determined the effects of alpha-difluoromethylornithine (DFMO), a specific inhibitor of ODC, on infarct size and ODC activity in a rat model of transient focal ischemia. DFMO blocked the ischemia-induced increase in ODC and significantly reduced infarct volumes by 57-45%, depending upon the treatment regimen. These studies suggest that polyamine metabolism plays a role in the development of cerebral infarction after focal ischemia and that DFMO may be useful in limiting injury after a stroke.
Animals↗
A guide to the venous drainage of the anterior Sylvian fissure.
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Brain↗