Residents' hours and supervision.
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Humans↗
Biomedical subjects
M D Cusimano
Publications and source records attributed to M D Cusimano.
Cerebrospinal fluid fistula secondary to ecchordosis physaliphora.
A patient with a large ecchordosis physaliphora extending from the sphenoid sinus into the subarachnoid space of the prepontine cistern and resulting in a cerebrospinal fluid fistula is described. Ecchordoses are most commonly asymptomatic and found only incidently at autopsy. This case report adds to the scant literature on symptomatic ecchordoses. The previously reported cases of symptomatic ecchordoses and intradural chordomas are briefly reviewed. Differentiation of chordoma and symptomatic ecchordosis may be difficult; however, the intradural location and relatively benign behavior of the latter are useful points. A discussion concerning the remnants of the notochord which persist in the adult and their role in the genesis of chordoma and ecchordosis physaliphora is also provided.
Aged↗
Ventriculoperitoneal shunt malfunction during pregnancy.
Many women with cerebrospinal fluid shunts are now reaching reproductive age. Shunt malfunction may occur during pregnancy, and management requires a well-planned, combined neurosurgical and obstetrical approach. We present a case of ventriculoperitoneal shunt obstruction manifesting during the third trimester managed successfully in a conservative fashion. The literature on ventriculoperitoneal shunt malfunction during pregnancy is reviewed.
Adult↗
Transient cerebral ischemia.
Stroke is a major cause of disability and death in North America. About 30% to 40% of patients with stroke have had transient ischemic attacks (TIAs). The recognition and treatment of TIAs and possibly of asymptomatic stenoses of the carotid arteries may be beneficial in preventing stroke. We review the epidemiologic features, natural history, pathogenetic features, clinical presentation, methods of investigation and management of patients with TIAs.
Aged↗
An update on the cellular and molecular biology of brain tumors.
Patients with tumors of the central nervous system (CNS) remain difficult to treat despite recent advances in surgical, chemotherapeutic and radiotherapeutic techniques. A better understanding of the molecular and cellular biology of neoplasia is providing neuroscientists with a framework on which to devise novel therapies for these patients. It thus becomes imperative that neurologists and neurosurgeons be aware of these advances in basic science that may eventually have a positive impact on patient management. This paper reviews our present knowledge of the process of CNS oncogenesis and the roles that chemicals, viruses, oncogenes, growth inhibitor genes, and growth factors play in the process.
Brain Neoplasms↗
Hypertrophic brachial plexus neuritis: a pathological study of two cases.
Two patients with brachial plexus neuropathy had recurrent symptoms for years that culminated in the development of a painful lower cervical mass. On macroscopic examination the affected nerves had a fusiform segmental enlargement, suggestive of a nerve sheath tumor, that was excised. Histologically, marked endoneurial edema, florid focal chronic inflammation, extensive onion bulb formation, and perineurial sparing were seen. Electron microscopic studies on one patient revealed microvasculitis; frequent tubuloreticular inclusions in endothelial cells, histiocytes, and lymphocytes; and cylindrical confronting cisternae in lymphocytes. We conclude that some cases of recurrent brachial plexus neuropathy are due to a localized chronic inflammation that may be related to autoimmunity or to a viral infection.
Adult↗
Suprasellar craniopharyngioma associated with hyperprolactinemia, pituitary lactotroph hyperplasia, and microprolactinoma. Case report.
A case with the coexistence of a microprolactinoma and suprasellar craniopharyngioma lactotroph hyperplasia is presented. Loss of inhibitory hypothalamic dopaminergic input may have played a role in hyperprolactinemia and the proliferation of pituitary lactotrophs. This is believed to be the first published case of suprasellar craniopharyngioma with this association.
Brain Neoplasms↗
The carotid endarterectomy study.
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Aspirin↗
Management of pregnant women with cerebrospinal fluid shunts.
As more women with cerebrospinal fluid shunts reach child-bearing age, neurosurgeons, obstetricians and other health care providers will increasingly be called upon to care for them once they become pregnant. A review of the literature reveals that these patients may develop symptoms of shunt malfunction as uterine size increases. In most cases, symptoms can be managed conservatively during pregnancy and usually resolve following delivery. The presence of a CSF shunt per se, is not a contraindication to pregnancy and eventual fetal and maternal outcome has been excellent in the majority of cases. Labor and delivery should be allowed to progress naturally and interventions limited to those indicated for obstetrical reasons alone. Peripartum prophylactic antibiotics may be indicated and special care ought to be exercised if epidural analgesia or cesarian section is deemed necessary. Genetic investigations and counseling may be indicated in selected patients.
Adolescent↗