Legal issues in the practice of neurology and neurosurgery.
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Biomedical subjects
Publications and source records attributed to L P Ivan.
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We report a case of choroid plexus papilloma arising from the right lateral ventricle in a 4-month-old infant. Because of intermittent vomiting, abdominal pain, and diarrhea, the child was initially treated with intravenous rehydration, which aggravated the symptoms, and a bulging fontanel developed. Before a planned lumbar puncture, cranial ultrasound was performed, which disclosed a choroid plexus papilloma. The tumor was removed surgically, and the child made an uneventful recovery. We discuss the diagnostic value of cranial ultrasound compared to computed tomographic (CT) scan and angiography.
Modern, very sensitive, and noninvasive devices (strain-gauges, accelerometers, etc) detect deformations and motions in the order of a few microns. The observation that the rise in intracranial pressure produces measurable suture strain suggests that noninvasive determination of mechanical parameters in the intracranial cavity, such as density, velocity, pressure, energy, and their time rates, is clearly possible. Based on the above premise, and utilizing the concept of representative elementary volume (REV), this paper presents the conceptual part of a theory that defines the mechanical behavior of the brain and skull under various conditions. The systematic review of brain tissue mechanics leads to a continuum model of a mixed stress-displacement boundary value type, which defines the dynamics of the visco-elastic brain tissue in mathematical terms.
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The case of an 8-year-old boy with spontaneous spinal epidural haematoma and complete post-operative recovery is described. A review of the literature with particular emphasis on the paediatric age-group is given. The clinical presentation and aetiology are discussed.
A single and perhaps unique case of a venous malformation over the quadrigeminal plate causing acute obstructive hydrocephalus is reported. The lesion was well demonstrated by means of CAT scan but cerebral angiography failed to reveal the vascular nature of this lesion. Complete thrombosis of the lesion was achieved by surgical intervention and the resolution of the lesion was demonstrated by CAT scan. The patient remains asymptomatic and neurologically intact six months after the operation.
A case of a primary intracranial embryonal carcinoma, the first with ultrastructural study, is reported. The tumor was associated with precocious puberty in a 6 1/2-year-old female. Characteristic embryoid bodies were present. At the ultrastructural level three cell types were noted: undifferentiated, differentiated, and intermediate types. The undifferentiated showed scanty cytoplasmic organelles and numerous free polysomes, while the differentiated cells contained well-developed mitochondria, Golgi apparatus, rough endoplasmic reticulum, and some contained secretory granules. The intermediate cells possessed dilated and irregularly-shaped mitochondria but still retained large numbers of free polysomes. The authors suggest that intracranial germ cell tumors be named in conformity with germ cell tumors in other sites, and that terms such as "ectopic pinealoma" and "atypical teratoma of the pineal" be used no longer.
Spontaneous spinal epidural hematoma was confirmed by myelography in an 8-year-old boy. The hematoma was removed more than 21 hours after the onset of paraplegia, and there was no evidence of vascular malformation. The patient made a complete recovery.
Two patients with arteriovenous malformations draining into the deep venous system of the brain are presented. Both were diagnosed in infancy. One of the patients required a ventriculo-peritoneal shunt to control his obstructive hydrocephalus. Six months later, the AVM was surgically attacked in an attempt to control the progressive heart failure. The other, treated without a shunt, required digitalis to control the progressive heart failure. The clinical presentation and the characteristics of arteriovenous malformations of the vein of Galen and treatment are discussed.
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Ten cases of subdural hematoma and one case of spinal epidural hematoma encountered in patients who were receiving anticoagulant therapy are discussed.This surprisingly large number of complications was observed within three years in a single hospital and represents 36.6% of all chronic and subacute subdural hematomas seen during the same period. The cases are analyzed and the conclusion reached that the causal relationship between anticoagulant therapy and hemorrhage cannot be denied.Suggestions are made as to how to decrease the danger of such complications.
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