Biomedical subjects
Publications and source records attributed to G Dierssen.
A family is reported in which three members had an aneurysm at the junction of the posterior cerebral artery and the carotid artery. Two patients harbonred symmetrically placed bilateral aneurysm each. The cases suggest a hereditary basis for its causation.
In a group of 132 patients with malignant astrocytomas treated between 1971 and 1983, there were 3 patients who had received radiotherapy to the head several years before developing the glioma. The cases are described, and the evidence supporting the view that the gliomas might be radiation-induced is discussed.
A large densely calcified pilocytic astrocytoma of the brain stem is described. Calcification of a brain stem glioma is exceptional. Radiotherapy and long survival may contribute to this calcification.
The outcome of a series of 73 patients with spontaneous intraparenchymatous haematomas treated by surgical evacuation of the clot and decompressive craniectomy has been described. Comparing postoperative mortality of this series with another series of patients (54 cases) treated only with surgical removal of the clot without decompressive craniectomy a statistically significant improvement in the mortality rate after craniectomy could be observed in acute cases demanding surgical intervention for preservation of life in the first 24 hours. If signs of brain-stem suffering appear surgical mortality increases proportionally to the duration of this symptomatology. In these cases surgery, if it is to be useful, has to be performed as soon as possible. The morbidity of the surviving patients is not greater in this series with decompressive craniectomy than in series without decompression.
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3 cases of pyocephalus (ventricular empyema) in newborn children are described and 16 cases from the literature are analyzed. Half of the previously published cases of pyocephalus are secondary to cerebral abscesses. Neuroradiological findings and especially the necroscopic study of a case demonstrated the existence of membranous blockages inside the ventricles which may make the circulation of CSF impossible. Our treatment of choice consists of repeated punctures and evacuations of purulent content and topic as well as parenteral administration of antibiotics. Further CSF derivative measures are almost always necessary. By these means, we believe the high mortality of these cases could be lowered.
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A case of an aneurysm of the middle cerebral artery in a 17-month-old child has been presented and the literature on the problem reviewed. A total of 27 aneurysms in young children (under two years of age) has been found. The characteristics that define this group of patients are: a greater proportion of aneurysms of the middle cerebral artery and its branches and of the vertebrobasilar system; greater size of the aneurysms; and frequent pseudotumor syndromes. The surgical prognosis in this group of patients is excellent. The physical and pathophysiological characteristics of these aneurysms appearing in early childhood are described.
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