Biomedical subjects
Publications and source records attributed to G Findler.
A case of spontaneous intermittent priapism in a patient with spinal canal stenosis is presented. Erection, as well as intermittent neurogenic claudication and urinary incontinence were provoked by physical exertion, mainly walking. The symptoms completely resolved after decompressive lumbar laminectomy.
Visual hallucinations were the presenting symptom in three patients with pituitary adenoma. One patient reported only simple unformed hallucinations, which are a well-documented phenomenon occurring in lesions compressing the optic nerves and chiasm. The other two patients, however, experienced complex formed visual hallucinations believed to be of the release type. No evidence of seizure activity responsible for the hallucinations was found; the mechanism producing them is discussed with correlation to operative findings and electrophysiological studies.
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Adenoid cystic carcinoma of the breast is a rare neoplasm that usually has a benign biological behavior. A patient who was operated upon for removal of this tumor developed metastases to the lungs and brain 12 years after mastectomy. This is probably the first report in the literature of brain metastasis from adenoid cystic carcinoma of the breast. Radiological and histological evidence of both primary breast tumor and the metastasis to the brain are presented.
Anatomic reports have demonstrated that the sympathetic fibers leave the carotid plexus to join the abducens nerve in the posterior part of the cavernous sinus. A lesion in this area may cause both an abducens nerve palsy and ipsilateral Horner's syndrome. This article details two additional cases of this uncommon occurrence.
Intracranial hemorrhage (ICH) is a life-threatening complication of hemophilia. Seven of the 288 hemophiliacs living in Israel suffered eight episodes of ICH during the years 1972 to 1982. All episodes occurred in hemophilia A patients, with a higher incidence among patients with factor VIII inhibitor. Diagnosis was confirmed by computed tomographic scan in seven of the eight episodes. Four of the 7 patients died despite adequate factor replacement and supportive therapy, probably due to a conservative and hesitant neurosurgical approach. The correction of factor VIII to hemostatic level alone is inadequate in the majority of cases, and there is sudden deterioration in the patient's condition and death. Operation is strongly recommended when no improvement is noted within a few hours.
The authors report three patients with symptomatic postlaminectomy pseudomeningocele. At operation a loop of a nerve root was found to be trapped within the dural defect. All three patients exhibited a delayed onset of radicular symptoms and signs after disc surgery. The pseudomeningocele was demonstrated computed tomography and myelography, but the entrapped root could be identified only at operation.
The management of four patients with dysphagia due to esophageal compression by anterior cervical osteophytes is described, and the literature is reviewed. Treatment of this condition is simple and without complication. Surgical removal of the bony ridges using the anterior cervical approach leads to complete recovery.
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Manifest or occult spinal dysraphism in the absence of neurological symptoms is likely to remain undetected. Therefore, accurate and early diagnosis of such underlying anomalies is of prime importance for early surgical intervention in order to avoid late irreparable damage. During a period of just over 1 year, 17 such cases of spinal congenital anomalies were diagnosed by myelography with metrizamide and computed tomography-myelography. There were 16 cases of tethered cord, six with myelomeningocele, two with diastematomyelia, two with a split spinal cord, three with a lipoma, and the remaining three with vertebral anomalies. Scoliosis was present in 60%, weakness of both legs in 45%, and asymmetry of the feet in 25%. Some of these patients were initially brought to the orthopedic department for corrective surgery before undergoing a complete neurological evaluation; thus the radiologist was acting as the link between patient and neurosurgeon. Clinical experience has shown that surgical treatment can be successful and can thereby obviate further progression of neurological symptoms.
A case of a cystic meningioma recurring in its cystic form, two years after the initial removal, is presented. Regarded as a true cystic meningioma, the possible aetiology of the cyst formation is suggested. As the cyst wall itself may give rise to tumour cells, it is recommended that the initial operation should be directed at total removal of the tumour mass and cyst wall, thus reducing the possibility of a tumour recurrence. A CT finding of a hypodense lesion in a patient, operated on previously for a cystic meningioma suggests a recurrence of the tumour. However, other non-neoplastic changes should be considered.
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Spinal intradural ependymal cysts are extremely rare. The case presented is the sixth reported in the literature. The symptoms are consistent clinically and radiologically with a spinal intradural space-occupying lesion. The cyst wall is lined with both ciliated and nonciliated cells, resting directly on connective tissue. The exact embryonal origin of these cysts is obscure.
A case of delayed onset of diabetes insipidus (DI), which developed 27 days after a closed head injury, is reported. The patient sustained only a minor neurological deficit and, except for antidiuretic hormone (ADH) insufficiency, hypothalamic function was intact. This selective damage of posterior pituitary function was total and permanent. Ischemia due to vascular injury may be the most likely etiology. Once the diagnosis of delayed posttraumatic DI is confirmed, the treatment of choice is DDAVP (desmopressin acetate). In contradistinction to DI immediately following minor head injury, most patients with a delayed onset of DI after trauma have permanent ADH deficiency.
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Our experience in the use of computerized tomography (CT) in the evaluation and treatment of combat-related penetrating missile injuries of the head in 12 cases is summarized. Advantages observed in the use of CT include accurate delineation of in-driven bony and metallic fragments, the relation of hematomas to the missile tract and detection of brain abscesses. The availability of a CT scanner for use in military medicine may further reduce the mortality and morbidity due to combat-related cranial missile injuries.
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A patient with trigeminal neurinoma, presenting unusual symptoms, is described. There was no trigeminal sensory or motor deficit. The only presenting symptoms were unilateral abducens nerve paresis and alternating hemiplegic episodes. The trigeminal somatosensory-evoked response was normal before surgery. After complete removal of the tumor from both the posterior and middle cranial fossae, severe trigeminal sensory deficit ensued, accompanied by impairment of the evoked response. Improvement of the trigeminal nerve function could be predicted by significant changes in a repeat trigeminal sensory-evoked response obtained 2 months after the operation.