Bulletin of the Los Angeles neurological societies最新文献

We have treated a selected series of patients with spinal epidural metastatic tumors by dorsal decompression according to principles we presumed would produce the most favorable therapeutic results. There was no operative mortality, and morbidity was minor. In the first postoperative week, improvement in motor function was apparent in 44% of cases. By 3 months postoperatively, 40% of the patients were independently ambulatory and an additional 28% were ambulatory with minimal assistance. This 68% composite compares favorably to the 30 to 40% results in several series of unselected cases. On the basis of this data, it is concluded that consideration of the tumor's histological type, biological history, the host's response, the extent of neurological deficit, the progression of neurological deficit, and dissemination of disease will aid in the definition of those cases with epidural metastases which may be expected to benefit from surgical decompression.

A case report of malignant external otitis is presented with particular emphasis on the neuropathological sequelae. The most striking finding was a mycotic aneurysm of the basilar artery with resultant thrombosis and brain stem infarction. Diffuse pachymeningitis was also present. The severity of the changes described in this case further point out the need for early recognition and adequate treatment of this potentially fatal disease complex.

A care is described of an astrocytoma grade 1 arising from the floor of the third ventricle, operated upon transcallosally. No disconnection symptoms were produced. Five years later the patient has above normal intelligence and is attending school at normal grade level in spite of a CT scan suggesting recurrence of the tumor.

The authors have recently reviewed the results of their consecutive cases of decompressive thoracic or lumbar laminectomy for spinal cord compression from epidural metastatic neoplasia at the City of Hope National Medical Center over the 15-year period, 1960-1974. This limited series tends to demonstrate the effect of case selection on results, as well as contrast the type of patient with paraparesis seen at a cancer treatment center with that seen at a community or county hospital.

An adult patient with literal alexia, agraphia, slight anomia, and dyscalculia due to a left hemisphere infarct showed lack of sequential skills while pattern recognition remained intact. Some words were recognized as patterns, but could not be read phonetically. Therapy concentrated on forming an association of the visual pattern of the complete word with the retained auditory pattern. In this way the patient learned to read several hundred words and short phrases, even as anomia worsened. The patterns learned could not be generalized to noun declension or verb conjugation, or broken into smaller words. This learning process is characteristic of right hemispheric skills which were utilized as left hemispheric functions deteriorated.

Large cerebellopontine angle tumors distort and displace the brain stem. Two cases are reported in which ipsilateral hemiparesis ensued postoperatively. Compression of the contralateral cerebral peduncle against the free edge of the tentorium cerebelli appears to be the mechanism leading to this mesencephalic dysfunction. Review of the literature failed to reveal a discussion of this mechanism of brain stem injury. Extension of tumor through the tentorial hiatus appears to make the mesencephalon particularly vulnerable. Incision of the tentorium prior to removal of a tumor when it invades the incisural hiatus may have merit.

A 47-year-old male with renal failure received a renal transplant which subsequently was rejected. After removal of the transplant the patient went into a catabolic state, and developed fever and hematochezia. The patient became septic, developed respiratory involvement. This is the eighth recorded case of central nervous system toxoplasmosis following renal transplantation.

A series of animals was studied to evaluate the effect of commonly used myoneural blockers (curare, succinylcholine, gallamine, and pancuronium) on intracranial physical dynamics. Of this group, only curare alters intracranial pressure. Histamine release secondary to curare administration results in bronchoconstriction with subsequent major alterations in pulmonary ventilation. Resultant hypercarbia along with a decreased cerebral vascular resistance affects intracranial dynamics by alterations in cerebral blood flow; changes in CSF flow patterns passively reflect the alterations in intracranial pressure. These changes can be blocked by prior treatment with antihistamines.

The adult or type 1 Chiari malformation is a hindbrain anomaly in which the cerebellar tonsils, but not the vermis, are chronically dispalced into the foramen magnum (1). Syringomyelia or syringobulbia are frequently associated with the anomaly (2-4). Seventeen cases of surgically verified adult Chiari malformations with or without a syrinx were recently diagnosed at the Neuropsychiatric Institute. University of California at Los Angeles. A review of these patients confirmed this anomaly has protean manifestations. Recognition of paroxysmal complaints induced by a variation of the Valslava maneuver, especially in the presence of nystagmus, might lead to early neurodiagnostic procedures and surgical intervention, with reduced morbidity.