Biomedical subjects

R Alday

Publications and source records attributed to R Alday.

18 recordsLinked to original sources

PubMed2006

[Magnetic resonance in moderate and severe head injury: comparative study of CT and MR findings. Characteristics related to the presence and location of diffuse axonal injury in MR].

INTRODUCTION: Cranial CT has been the most extended evaluation means for patients suffering head trauma. However, it has low sensitivity in the identification of diffuse axonal injury and posterior fossa lesions. Cranial MR is a potentially more sensitive test but difficult to perform in these patients, a fact that has hampered its generalised use. OBJECTIVE: To compare the identification capability of traumatic intracranial lesions by both diagnostic tests in patients with moderate and severe head injury and to determine which radiological characteristics are associated with the presence of diffuse injury in MR and their clinical severity. MATERIAL AND METHODS: 100 patients suffering moderate or severe head injury to whom a MR had been performed in the first 30 days after trauma were included. All clinical variables related to prognosis were registered, as well as the data from the initial CT following Marshall et al., classification. The MR was blindly evaluated by two neuroradiologists that were not aware of the initial CT results or the clinical situation of the patient. All lesions were registered as well as the classification following the classification of lesions related to DAI described by Adams et al. CT and MR findings were compared evaluating the sensitivities of each test. Factors related to the presence of diffuse injury in MR were studied by univariate analysis using chi2 test and simple correlations. RESULTS: MR is more sensitive than CT for lesions in cerebral white matter, corpus callosum and brainstem. It also detects a greater number of cerebral contussions. The presence of diffuse axonal injury depends on the mechanism of the trauma, being more frequent in higher energy trauma, specially in traffic accidents. Among the radiological characteristics associated to DAI the most clearly related is intraventricular haemorrhage. The presence of a deeper injury and a higher score in the scales of Adams is associated with a lower score in the GCS and motor GCS, and so with a worse level of consciousness and bigger severity of injury, confirming Ommaya's model.

Adolescent↗

PubMed2005

A comparison of different grading scales for predicting outcome after subarachnoid haemorrhage.

BACKGROUND: Most scales used to assess prognosis after subarachnoid haemorrhage (SAH) are based on the level of consciousness of the patient. Based on information from a logistic regression model, Ogilvy et al. developed a new grading scheme (Massachussetts General Hospital (MGH) Scale) which applied a simple scoring method to each prognostic factor considered relevant such as level of consciousness, age, quantity of blood in the first CT scan and size of the aneurysm. The purpose of this study is to introduce a modified version of the MGH scale, built up using factors applicable to every patient suffering SAH, and compare this new scale to the World Federation of Neurological Surgeons scale (WFNS), the Glasgow Coma Scale (GCS) scale for SAH and the MGH scale. METHOD: A series of 442 patients consecutively admitted to Hospital 12 de Octubre between January 1990 and September 2001 with the diagnosis of spontaneous SAH were retrospectively reviewed. Outcome was assessed by means of the Glasgow Outcome Scale measured six months after hospital discharge. Differences between grades of the WFNS, the GCS scale for SAH, the MGH scale and the new scale were computed by chi2 statistics. ROC curves were plotted for the different scales and their areas compared. FINDINGS: Both WFNS and GCS scales fail to present significant differences between most of their grades, while the proposed scale shows a constant inter-grade significant difference in predicting outcome. The proposed scale presents a significantly higher prognostic efficacy in the whole series of patients suffering spontaneous SAH, patients with idiopathic subarachnoid haemorrhage (ISAH) and patients with confirmed aneurysmal SAH. The MGH scale is not applicable to some groups of patients suffering SAH. INTERPRETATION: Grading scales including additional factors to the level of consciousness show higher prognostic efficacy. The proposed modification of the MGH scale makes it applicable to every patient suffering SAH without losing its prediction capability.

Adult↗

PubMed2005

[Value of serial CT scanning and intracranial pressure monitoring for detecting new intracranial mass effect in severe head injury patients showing lesions type I-II in the initial CT scan].

OBJECTIVE: To determine the incidence of pathological and intracranial pressure (ICP) changes during the acute posttraumatic period in severe head injury patients presenting with lesions Types I-II (TCDB classification) in the admission CT scan with the aim of defining the most appropriate strategy of sequential CT scanning and ICP monitoring for detecting new intra-cranial mass effect and improving the final outcome. MATERIAL AND METHODS: 56 patients (ages 15-80 years) consecutively admitted during a 2 years period were included. All had the initial CT scan < 24 hours after injury (mean interval = 150 min), several CT controls within the first days of the course and ICP monitoring after admission. Different epidemiological, clinical and radiological variables were recorded and deterioration defined as the development of sustained ICP over 20 mmHg requiring aggressive medical and/or surgical treatment was considered the dependent variable. Uni and multivariate analyses were made for determining the correlation between different parameters and the occurrence of deterioration and the final outcome as assessed with the GOS. RESULTS: The mean GCS score was 5 and 37% of the patients showed pupillary changes; 52.3% had peritraumatic hypotension-hypoxemia, 16.1% anemia and 12.3% coagulation changes. 50% of the patients showed petechial hemorrhages in the white matter or the brainstem, 66% SAH, 40% HIV, 39.3% brain contusion and 21.4% small extraaxial hematomas. 57.1% of the patients showed CT changes through the acute post-traumatic period consisting of new contusion (26.8% of the cases), growing of previous contusion (68.2%) or previous extraaxial hematoma (10.7%), and generalized brain swelling (10.7%). 64.9% of the patients made a favourable and 35.7% an unfavourable outcome. Overall, 27 (48.9%) patients developed deterioration, 21 (37.5%) with concurrent CT changes and 6 (10.7%) without new pathology as seen by the CT control. The remaining 29 (51.7%) patients in this series did not develop deterioration in spite that 11(19.6%) showed CT changes. The age, the initial score, the occurrence of peritraumatic hypotension-hypoxemia and coagulation disorders did not correlate with the risk of deterioration. By contrast, the presence of contusion at the initial CT scan (p= 0.01) and the occurrence of CT change (only generalized brain swelling, p= 0.003) significantly correlated with the risk of deterioration; in his turn deterioration increased by a factor of 10 (OR = 9.8) the risk of death and 7 out of the 8 patients who died developed intractable intracranial hypertension. The 8 (14.2%) patients requiring surgery showed simultaneous ICP deterioration and CT changes, but another 11 patients in a similar condition could be managed without surgery. With or without ICP deterioration, patients showing CT changes had a worse outcome than those without new pathologies, but the difference did not reach statistical significance, DISCUSSION AND CONCLUSIONS: Over 50% of the patients with initial Type I-II lesions developed new CT changes and nearly 50% showed intracranial hypertension during the acute posttraumatic period. Considering the high incidences of ICP and CT deterioration through the course, along with the absence of strong predictors and the discordances between CT and ICP changes (which were seen in 30.3% of the cases) we recommend ICP monitoring after admission in all patients and serial CT scanning at 2-4, 12, 24, 48 and 72 hours after injury with additional controls as indicated by clinical or ICP changes in all cases. Though it is clear that the presence of severe intra-cranial hypertension significantly increased the risk of death, the small size of the sample in this series prevented to assess to what extent the occurrence of new mass effect and/or raised ICP contributed to the development of moderate and severe disability in the survivors which were mainly due to the occurrence of diffuse axonal injury. Finally, demonstrating that sequential CT scanning and ICP monitoring improve the final outcome in this type of patients would require a prospective randomized trial which is impracticable for different reasons, among them the ethical ones.

Adolescent↗

PubMed2004

Meningiomas of the basal posterior fossa. Surgical experience in 80 cases.

INTRODUCTION: Despite recent improvements in microsurgical and radiotherapy techniques, treatment of basal posterior fossa meningiomas still carries an elevated risk of morbidity. We present our results in a series of patients with this type of tumor and review the recent literature looking for the results obtained with different approaches and the new tendencies and algorithms proposed for managing these challenging lesions. MATERIAL AND METHODS: We analyzed retrospectively the clinical presentation and outcome of 80 patients consecutively operated between 1979 and 2003 for basal posterior fossa meningioma (foramen magnum tumors excluded). All patients had preoperative CT scans and the majority MRI studies. A total of 114 operations were performed including two-stage operations, reoperation for recurrence, CSF diversion, and XII-VII anastomosis. The most commonly used approaches were lateral suboccipital retrosigmoid, subtemporal-transtentorial, frontotemporal pterional and supra-infratentorial presigmoid. Thirteen patients received postoperative radiotherapy. RESULTS: There were 59 (73.7%) women and 21 men (mean age = 51.5 years; range = 18-78 yrs). Most common presenting symptoms were cranial nerve dysfunction, gait disturbances and intracranial hypertension. The mean duration of symptoms was 2.9 years. 70% of the tumors were over 3 cm in size. Fifty patients (62.5%) had a complete resection, 22 (27.5%) subtotal resection (> 90% tumor volume removed), and 8 (10%) only partial resection. Postoperative complications included hematoma, CSF leak, and infection. Fifty four (67.5%) patients developed new or increased cranial nerve deficits and 12.5% somatomotor, somatosensory or cerebellar deficits immediately after surgery with subsequent improvement in most cases. Following initial surgery 67 patients made a good recovery, 10 developed variable degrees of disability and 3 died. Eleven patients died later in the course for tumor recurrence with or without reoperation, malignant meningioma or unrelated causes. There were 9 recurrences in the subgroup of patients having complete resection initially (mean follow-up = 8.6 years). The majority of patients having initial subtotal or partial resections have been managed without reoperation during a mean follow-up period of 6.5 years (radiosurgery and/or observation). DISCUSSION AND CONCLUSION: Current microsurgical and radiotherapy techniques allow either a cure or an acceptable control of basal posterior fossa meningiomas. In patients with tumor invasion of the cavernous sinus, extracranial extension, violation of the arachnoidal membranes in front of the brainstem, or encasement and infiltration of major arteries, a subtotal excision seems preferable followed by observation and/ or radiosurgical treatment. Apart from the patients age and the clinical presentation (symptomatic or not), the size and secondary extensions of the tumor must be taken into account for planning treatment in the individual patient.

Adolescent↗

PubMed2004

[Spontaneous spinal cord herniation].

Spontaneous spinal cord herniation through a dural defect is an unusual condition. This entity has been probably underestimated before the introduction of MRI. We report a case of a 49-year-old man with a progressive Brown-Sequard syndrome. MRI and CT myelogram showed a ventrally displaced spinal cord at level T6-T7 and expansion of the posterior subarachnoid space. Through a laminectomy, a spinal cord herniation was identified and reduced. The anterior dural defect was repaired with a patch of lyophilized dura. The patient recovered muscle power but there was no improvement of the sensory disturbance. The diagnosis of spontaneous spinal cord herniation must be considered when progressive myelopathy occurs in middle-aged patients, without signs of spinal cord compression and typical radiological findings. Surgical treatment may halt the progressive deficits and even yield improvement in many cases.

Atrophy↗

PubMed2003

Posterior fossa subdural hematoma mimicking intracerebellar hemorrhage.

Subdural hematomas of the posterior fossa are very rare and most cases are related to head injury. The influence of anticoagulation in cases of spontaneous development is well known. Although diagnosis is easily achieved by CT sean, atypical forms may lead to the wrong diagnosis of cerebellar hematoma. We present a case of a posterior fossa acute subdural hematoma occurring in an anticoagulated patient who was preoperatively misdiagnosed as an intracerebellar hemorrhage.

Aged↗

PubMed2003

[The new residency program in neurological surgery in Spain].

A new Residency Program in Neurological Surgery has been recently elaborated by the "Comisión Nacional de Neurocirugía" following the requirement of the National Council of Specialities. This new Program, which will replace the one proposed in 1992, has been designed in a similar way as those applied in countries providing the best neurosurgical training. Changes included deal with the definition of the speciality, and the introduction of new rotations,a resident Log Book, a Tutor with a well defined profil and commitments, a structured planning of academic and clinical objectives, a rotation or training in research, and a planning for continuous evaluation of the progress of the resident. It is likely that an appropriate application of the new Program in Spanish neurosurgical units with accreditation for training will result in formation of highly competent neurosurgeons. However, there are new challenges for improving neurosurgical training and the development of our speciality in Spain, as those related with new legislation regulating resident working hours, or some political decisions changing the mechanisms for controlling the number of resident positions per year.

Curriculum↗

PubMed2002

[Arteriovenous malformation of the middle and posterior third section of the corpus callosum treated with embolization and surgery].

We are presenting the case of a 58 year-old woman with an arteriovenous malformation (AVM) of the middle and posterior thirds of the corpus callosum which had produced two episodes of bleeding before admission to our Department, when the patient was neurologically intact. The nidus was fed by the anterior and posterior pericallosal arteries draining through the left medial atrial vein to the vein of Galen, by parasagittal cortical veins to the superior sagittal sinus and by right temporal veins to the sphenoparietal sinus. The patient underwent embolization of the anterior and posterior feeders in two sessions separated by a week interval, and then the AVM was removed through a left paramedial parietooccipital craniotomy in a single stage. The patient showed transient mild short term memory deficit, but the final outcome was excellent.

Agenesis of Corpus Callosum↗

PubMed2002

[Idiopathic subarachnoid hemorrhage; comparison of different bleeding patterns and long-term outcome].

INTRODUCTION: Idiopathic subarachnoid haemorrhage (ISAH) represents approximately 15-30% of all subarachnoid haemorrhages. On the basis of the diagnostic CT and depending on the location of the subarachnoid bleeding, patients with ISAH may be classified into three groups: a) Patients with normal CT and diagnosis made by lumbar puncture (ISAHNCT); b) patients with a pure perimesencephalic pattern (ISAHPM) and c) patients with a bleeding pattern resembling that of aneurismatic rupture (ISAHA). This classification could permit the establishment of differences in the management and prognosis. OBJECTIVES: To describe the clinical and radiological characteristics of these three classes of patients and analyse their medium and long term outcome and moreover, compare these with those observed in patients suffering aneurysmal subarachnoid haemorrhage (ASAH). MATERIAL AND METHODS: A series of 122 patients consecutively admitted to Hospital 12 de Octubre Madrid between 1990 and 2000 with the diagnosis of ISAH were retrospectively reviewed. Patients were considered to have suffered ISAH when the first complete four vessel angiography did not show the presence of any aneurysm or vascular lesion responsible for the bleeding. Patients were classified depending on the pattern of bleeding into ISAHNCT, ISAHPM as described by Van Gijn et al., and ISAHA. The angiography study was repeated when: a) the first study was incomplete or had poor quality, b) vasospasm was present, c) in those patients who had an aneurysmal pattern of bleeding in the initial CT. Different clinical and radiological characteristics were recorded as well as complications that occurred during the hospital stay. Final outcome was evaluated by means of the Glasgow Outcome Score (GOS). With the purpose of comparing these clinical and radiological characteristics and the outcome of patients with ISAH with those suffering aneurysmal subarachnoid haemorrhage (ASAH), 294 patients diagnosed with ASAH during the same study period were also reviewed. RESULTS: 27% of patients admitted to our hospital with the diagnosis of non-traumatic subarachnoid hemorrhaged were diagnosed as ISAH. Of these, 41% presented with a ISAHA pattern, 39% ISAHPM and 20% ISAHNCT. The average age was similar in the different subgroups of SAH, being around 55 years. There was a greater frequency of male patients in the ISAHNCT and ISAHPM groups. In comparison with ASAH, ISAH characterises by patients presenting with less frequency a bad clinical grade and also loss of consciousness at stroke. There are fewer complications in patients with ISAH than ASAH, with a frequency of rebleeding and ischemia much less (5 and 6% respectively). Within the ISAH group, patients with ISAHA pattern of bleeding present more complications. Outcome is excellent for patients with ISAHNCT and ISAHPM, and rather worse for patients with ISAHA (median followup 5.8 years). CONCLUSIONS: This study confirms that the frequency of ISAH in our environment reaches the higher limit of that shown previously in the literature, replicating the results previously published by our group. Patients with ISAH have a better prognosis and a smaller risk of complications than patients with ASAH, the prognosis of patients with ISAHCTN and ISAHPM being particularly good. Patients with ISAHA present initially with a severe clinical situation, probably related to the bigger amount of bleeding, as well as a higher frequency of systemic complications, cerebral ischemia and hydrocephalus. However, if the absence of vascular lesions is confirmed, the long term prognosis is similar to that of the other subgroups of ISAH.

Aneurysm, Ruptured↗

PubMed2001

Prognostic factors on hospital admission after spontaneous subarachnoid haemorrhage.

BACKGROUND AND OBJECTIVE: Factors related to prognosis after subarachnoid haemorrhage (SAH) have been mainly extracted from surgical series, and only few authors have considered these factors in total management or population series. Though the level of consciousness is a major determinant of outcome after subarachnoid haemorrhage, there is not a consensus about which classification should be used to define it. The objective of this study was twofold. Firstly to find which factors recorded on hospital admission relate to outcome determining their relative importance in a non-selected series of patients suffering from aneurysmal SAH admitted to our centre, and secondly to assess the validity of the WFNS clinical scale for predicting the final result. METHODS: A series of 294 patients consecutively admitted to Hospital 12 de Octubre Madrid between January 1990 and June 2000 with the diagnosis of aneurysmal SAH were retrospectively reviewed. All factors possibly related to prognosis were recorded on hospital admission. Outcome was measured by means of the Glasgow Outcome Scale measured one month after hospital discharge. Relationship between factors and outcome was evaluated by univariate and logistic regression multivariate analysis. RESULTS: Although several factors, appeared related to prognosis in the univariate analysis, only the age. the level of consciousness defined by the WFNS scale and the presence of global brain hypodensity on the initial CT scan had a significant prognostic influence in the logistic regression model. Global brain hypodensity was strongly related to mortality. Since a number of factors associated with poor outcome in the univariate analysis are related to age, their influence could be explained by the difficulty of recovery of the ageing brain. The WFNS grading scale failed to predict significant differences in outcome between some of its grades. CONCLUSIONS: Age and clinical grade on admission are the most important factors influencing the final outcome of patients suffering aneurysmal SAH. A reappraisal of the WFNS grading scale should be considered as no significant differences in outcome were found between some of its grades.

Adolescent↗

PubMed2001

[Meningioma of the olfactory groove: review of a series of 27 cases].

OBJECTIVE: To describe our experience with olfactory groove meningiomas, analysing their clinical and radiological form of presentation and their surgical treatment. METHODS: The clinical records of 27 patients diagnosed of olfactory groove meningioma, extracted from the series of meningiomas operated on in our department since 1973, were retrospectively reviewed. Demographical data, the clinical presentation and duration of the symptoms before diagnosis were collected. Several radiological characteristics were also reviewed such as the tumour size, associated brain edema, type of contrast enhancement, presence of endostosis and invasion of the cranial base. The surgical resection grade, the histological type and the presence of recurrences in the follow-up were also analysed. RESULTS: The average age at presentation was 59 years. Average duration of symptoms prior to diagnosis was 39 months. The most frequent symptom at presentation was higher function impairment (52%), The average maximum tumoral diameter was 6.2 cm. 61% of the patients presented moderate or severe brain edema, which was quite frequently bilateral (74%). Radiological endostosis was present in 37% of the cases, but there were no signs of bone invasion in any case. The approach used was the basal frontal, uni or bilateral. In all cases the grade of resection was Simpson II. The majority of the cases presented a typical histology. Over 80% of the cases presented a good recovery at discharge. None of the patients presented with a tumoral recurrence after an average radiological follow-up of 74 months. CONCLUSIONS: The olfactory groove is an infrequent location for intracranial meningiomas, accounting for only 4.5% of all meningiomas in our experience. These tumours reach a big size due to the delay in diagnosis. Drilling of the cranial base does not seem necessary for preventing tumoral recurrence.

Adult↗

PubMed2000

Spinal cord ependymoma presenting with acute paraplegia due to tumoral bleeding.

Acute paraplegia is a rare presentation for a spinal cord ependymoma Among spinal cord tumors ependymomas are most commonly associated with subarachnoid hemorrhage and there is evidence that some have had intratumoral hemorrhage, but most of these bleedings pass without symptoms. In this report, a case of spinal cord ependymoma debutting with acute neurological deterioration due to tumoral bleeding is presented. We discuss the clinical and neuroradiological findings and review the literature related to this unusual presentation.

Adult↗

PubMed1999

Risk factors predicting recurrence in patients operated on for intracranial meningioma. A multivariate analysis.

The authors undertook a follow-up study of 286 patients who underwent surgical treatment for intracranial meningioma between 1973 and 1994, in order to analyse clinical, radiological, topographic, histopathological and therapeutic factors significantly influencing tumour recurrence. All patients were followed by using either computed tomography (CT) or magnetic resonance from 3 months to 17 years since first surgery (mean follow-up: 4.1 years). Forty-four (15.4%) recurrences were detected during this time period. Overall recurrence rates were 14%, 37% and 61% at 5, 10 and 15 years, respectively. Factors significantly associated with tumour relapse in bivariate analysis were: tumour location at petroclival and parasagittal (middle third) regions, incomplete surgical resection (assessed by Simpson's classification), atypical and malignant histological types (WHO classification), presence of nucleolar prominence, presence of more than 2 mitosis per 10 high-power fields, and heterogeneous tumour contrast enhancement on the CT scan. The multivariate analysis using the Cox's proportional hazards model identified the following risk factors for recurrence: incomplete surgical resection (Relative risk: 2.2; 95% Confidence interval: 1.33-3.64), non conventional histological type (RR: 2.13; 95%CI: 1-4.53), heterogeneous contrast enhancement on the CT scan (RR: 2.25; 95%CI: 1.1-4.72) and presence of more than 2 mitosis per 10 high-power fields (RR: 2.28; 95%CI: 0.99-5.27). Patients without any of these features showed low recurrence rates (4% and 18% at 5 and 10 years), and thus, they need less clinical and radiological controls through the follow-up than patients with some of these risk factors.

Adolescent↗

PubMed1997

Sequential computerized tomography changes and related final outcome in severe head injury patients.

The authors analysed the serial computerized tomography (CT) findings in a large series of severely head injured patients in order to assess the variability in gross intracranial pathology through the acute posttraumatic period and determine the most common patterns of CT change. A second aim was to compare the prognostic significance of the different CT diagnostic categories used in the study (Traumatic Coma Data Bank CT pathological classification) when gleaned either from the initial (postadmission) or the control CT scans, and determine the extent to which having a second CT scan provides more prognostic information than only one scan. 92 patients (13.3% of the total population) died soon after injury. Of the 587 who survived long enough to have at least one control CT scan 23.6% developed new diffuse brain swelling, and 20.9% new focal mass lesions most of which had to be evacuated. The relative risk for requiring a delayed operation as related to the diagnostic category established by using the initial CT scans was by decreasing order: diffuse injury IV (30.7%), diffuse injury III (30.5%), non evacuated mass (20%), evacuated mass (20.2%), diffuse injury II (12.1%), and diffuse injury I (8.6%). Overall, 51.2% of the patients developed significant CT changes (for worse or better) occurring either spontaneously or following surgery, and their final outcomes were more closely related to the control than to the initial CT diagnoses. In fact, the final outcome was more accurately predicted by using the control CT scans (81.2% of the cases) than by using the initial CT scans (71.5% of the cases only). Since the majority of relevant CT changes developed within 48 hours after injury a pathological categorization made by using an early control CT scan seems to be most useful for prognostic purposes. Prognosis associated with the CT pathological categories used in the study was similar independently of the moment of the acute posttraumatic period at which diagnoses were made.

Adolescent↗

PubMed1996

Brain oedema in patients with intracranial meningioma. Correlation between clinical, radiological, and histological factors and the presence and intensity of oedema.

The authors analysed the correlation between different clinical, radiological, and pathological variables and the presence and intensity of brain oedema associated to intracranial meningioma in 400 consecutive patients studied by computerized tomography (CT). The following factors did not show significant correlation with brain oedema development: the age and sex of the patient, the occurrence of focal deficits, the presence of skull changes (endostosis, exostosis, osteolysis), the occurrence of tumour calcification, the density of the tumour on plain CT scan, the presence of a cystic component, the pathological subtype of meningioma (both conventional and non-conventional), and the presence of histological features of tumour aggressiveness, such as an increased vascularization, high cellularity, high mitotic index, pleomorphism, necrosis, and brain infiltration. Factors showing a statistically significant correlation with the presence and intensity of brain oedema at the bivariate analysis were: the presence of symptoms (p < 0.001), the duration of the clinical history (p < 0.05), the location and size of the tumour (p < 0.001), the type (heterogeneous vs homogeneous), and intensity of tumour contrast enhancement (p < 0.001), the presence of irregular tumour margins (p < 0.001), and the existence of focal low density intratumoural areas (p < 0.001). The multivariate analysis using only clinical parameters showed that the group of variables with the highest power for predicting the presence of brain oedema (concordance level of 76.8%) included: the presence of symptoms, the occurrence of seizures (focal or generalized), the presence of an intracranial hypertension syndrome, and the age of the patient. The multivariate analysis using only anatomico-radiological parameters showed that the model which included the size of the tumour, the intensity of contrast enhancement, the tumour margins, and meningioma location, predicted the presence of brain oedema in 80.8% of the cases. Though the results of the present study do not definitively support any of the major physiopathological theories proposed to explain brain oedema formation in patients with intracranial meningioma, some findings could favour the so-called hydrodynamic theory.

Adolescent↗

PubMed1991

Evaluation of brain SPECT in the diagnosis and prognosis of the normal pressure hydrocephalus syndrome.

From January 1989 to September 1990 fourteen patients with the Normal Pressure Hydrocephalus (NPH) syndrome were diagnosed in our Service. All patients were studied by CT-Scan, Radionuclide Cisternography and brain Single Photon Emission Computed Tomography (SPECT). In this series, the predictive value of the brain SPECT was assessed. A statistically significant relationship between SPECT patterns and clinical outcome was found. The patients who showed a Dementia Alzheimer Type (DAT) pattern on SPECT had worse results. The results are discussed and compared with those reported by other authors.

Aged↗

PubMed1989

Spinal intrathecal empyema due to Actinomyces israelii.

The authors report a case of a spinal intrathecal empyema caused by Actinomyces israelii in a patient who had been diagnosed, four years previously, of a left petrous apex abscess due to an unknown microorganism. The clinical course is outlined and the possibility of both lesions being related is discussed.

Actinomycosis↗

PubMedDate not supplied

Arachnoiditis ossificans. Diagnosis with helical computed tomography.

Arachnoiditis ossificans (AO) is a rare entity in which ossification of the leptomeninges occurs. This report illustrates a patient with AO of the cervical and dorsal spine, diagnosed by helical computed tomography with multiplanar reconstruction. It demonstrates the value of computed tomography in diagnosing calcified plaques and the utility of multiplanar reconstruction in giving an exact anatomic reference to neurosurgeon.

Aged↗