Biomedical subjects
Publications and source records attributed to M Cerisoli.
A case of left extracranial internal carotid artery occlusion, associated with ipsilateral parietal glioblastoma, is reported. The clinical and radiological aspects are discussed. The Authors stress the usefulness of a complete investigation in patients with symptoms of cerebrovascular insufficiency.
The Authors report the results obtained by long-term clinical and radiological evaluation of patients who had undergone cervical multiple bilateral laminectomy to relieve the compression exerted on the cord by different diseases (spondylarthrosis, syringohydromyelia, intramedullary and extramedullary tumours, leptomeningeal cysts and extradural tumours). 98 patients were reviewed, the follow-up ranging from 8 to 24 years (mean 14 years). The results demonstrate that the most severe post-laminectomy changes are recorded in patients with intramedullary lesions and when middle-low cervical spine levels (C4-C7) are affected. The significance of spinal deformities such as kyphosis, spondylolisthesis and swan-neck is also discussed.
The Authors discuss the incidence, the etiology, the pathology and the pathophysiology of congenital hydrocephalus. Furthermore, the problems of intrauterine surgical procedures are in particular discussed. On the light of the experimental and clinical results the Authors believe that the shunting fetal procedures should be considered anything but experimental and, therefore, subject to rigorous limitations. The results of the postnatal surgical procedures in congenital hydrocephalus are also discussed. Owing to the fact that early treatment of hydrocephalus in newborns seems to obtain the most satisfactory results, particular regard is reserved to that diagnostic techniques which could allow to recognize the right and early moment for surgical intervention, such as transfontanelle Doppler ultrasound examination.
The Authors describe an experimental model (rat) performed in order to evaluate the cerebrovascular changes which occur following the venous outflow impedance increase. This increase was obtained by bilateral occlusion of the external jugular veins at the neck. The rat was chosen because its intracranial and extracranial circulation is very similar to the human one, thus allowing the recording of blood flow velocity changes in the common carotid artery by means of a noninvasive technique such as Doppler ultrasound. Ligature of both the external jugular veins, performed on 35 rats, produced a decrease of common carotid artery blood flow velocity in 2/3 of the animals. The remaining 1/3 presented increased common carotid velocity. These changes were recorded within 15 minutes after ligation of the veins. On the contrary, the epidural pressure, measured in 6 cases, showed a constant increase. The results demonstrate that the different patterns of CBF and EDP do not permit univocal interpretation of the cerebrovascular reactivity control mechanisms, that is, myogenic, metabolic or neurogenic.
An original device for the epidural pressure measurement in the rat is presented. The reliability of epidural pressure as an index of intracranial pressure is discussed and several possible causes of error are examined. The device has been tested under conditions both of transient and prolonged cerebral blood volume increase, obtained by venous outflow obstruction.
The mega cisterna magna is a congenital developmental malformation which in the majority of instances is symptomless and does not require further study or surgical treatment. However, differential diagnosis with other cerebellar diseases is often necessary especially in newborn infants. Ultrasonographic recognition of the mega cisterna magna in a newborn infant is reported. The reported case demonstrates the usefulness of the ultrasonographic technique in the study of the posterior cranial fossa abnormalities of newborn infants.
The problem of multiple primary gliomas is discussed starting from a personal report concerning with a case of coexisting cerebral and intramedullary gliomas. Pathological examination allows the Authors to differentiate the cerebral from the medullary tumor by means of the principles of the new WHO classification of brain tumors. In this way it is possible to support the hypothesis of multicentricity. In diagnosing multiple or multifocal tumors the clinical criteria are preferred to the pathological observations. It is felt that in this way a more correct diagnostic and therapeutic approach to the multicentric tumors may yield good results. The theoretical basis for multicentric growth conclude the work.
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A case of unusual Neuro-Behçet syndrome is reported. Four years of follow-up revealed at beginning later the occurrence of acute meningoencephalitis caractherized by two convulsive fits. CSF examination revealed high albumin and cells contents. CT examination of the head was negative. Incomplete clinical improvement was obtained by using steroids. Differential diagnosis is finally discussed.
The authors report on a case of sacral agenesis evaluated by Computed Tomography (CT) of the spine. Sacral agenesis is an exceedingly rare, nongenetic, developmental anomaly which consists in an absence of the entire sacrococcygeal complex. Although maternal diabetes appears to be the most important etiologic factor, the significant teratogenetic effects related to maternal diabetes are not yet completely understood. Only few cases have been reported in neurological and neurosurgical literature because most authors believe that the neurological deficits associated with sacral agenesis are static and, therefore, myelography and surgical approach are useless. However, sacral agenesis can be surgically treated when dural sac stenosis is evident in presence of progressive neurological deficits. The usefulness of CT in depicting nervous anomalies which may favorably respond to surgical treatment is emphasized, in particular when compared with contrast myelography. CT scan seems able to replace contrast myelography in delineating the intraspinal nervous anomalies, thus avoiding the myelographic risks.
The authors evaluate the effectiveness of combination groups of antiedema pharmacological agents on experimental transient bilateral cerebral ischemia. The results show that dexamethasone and furosemide appear to be the most useful combination group. However, the improvement of post-ischemic vascular re-perfusion is not different when these antiedema agents are employed simultaneously or when they are administrated alone. The experimental model allows the authors to evaluate various modalities of the injection of the dye and drugs. Better filling of the cerebral hemisphere in which the antiedema agents were injected through the common carotid artery is always recorded. Therefore, the authors conclude that the best way to obtain homogeneous post-ischemic vascular re-perfusion is to inject half of drugs through the left common carotid artery and half through the right common carotid artery.
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The authors describe an experimental model of transient (15 min). unilateral, cerebral ischemia followed by 60 min of reperfusion in anesthetized rats. Zones of non perfusion are recorded and referred to as the "no-reflow phenomenon". The authors believe that vascular changes which interfere with postischemic reperfusion are due to ischemia-induced swelling of perivascular glia. The effects of the intracarotid injection of dexamethasone, furosemide and escina are evaluated in the attempt to show the importance of brain edema in ischemic cerebral damage.
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The authors performed follow-up examinations on 84 patients who had undergone cervical laminectomy in order to relieve the pressure caused by tumors, malformations, leptomeningeal cysts and spondylarthrosis. In an attempt to quantify the post-laminectomy cervical spine changes on plain X-ray films, the authors used an original radiological grading. A clinical evaluation was made and graded either as improved, unchanged and worsened. The authors found significant clinico-radiological correlations and concluded that a neuromuscular imbalance may determine the most severe post-laminectomy cervical spine changes.
The Authors report on 150 cases of patients suffering from Parkinson's disease. The patients represent 8.3% of total parkinsonian patients and are selected on the basis of clinical and laboratory criteria that allow the diagnosis of "angiopathic parkinsonism" as an autonomous entity. Cerebral blood flow alterations in Parkinson's disease and associated dementing symptoms are also discussed. In conclusion, the Authors emphasize the usefulness of recognizing the "angiopathic parkinsonism" in view of therapeutical implications.