1/43. ECT in the presence of brain tumor and increased intracranial pressure: evaluation and reduction of risk.The presence of brain tumor and increased intracranial pressure has long been considered an absolute contraindication to electroconvulsive therapy. Recently, however, the American Psychiatric association Task Force Report questioned the absolute nature of this contraindication and recommended a detailed evaluation of the risk-benefit ratio and measures to decrease the risks involved in treatment of affected persons. After a careful review, electroconvulsive therapy was administered to a 61-year-old patient who had severe medication-resistant major depression and a left temporal anaplastic astrocytoma with brain edema. Special attention was given to reduce intracranial pressure and minimize neurologic side effects. A course of eight nondominant unilateral electroconvulsive therapy treatments improved the depression significantly, without serious complications at the 4-month follow-up examination. With appropriate modifications, electroconvulsive therapy may be considered a treatment option even in the presence of clinical evidence of increased intracranial pressure. Further studies are needed to assess and minimize risks of electroconvulsive therapy in association with brain tumor.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/43. Sudden death due to primary diffuse leptomeningeal gliomatosis.Tumors of the central nervous system are an unusual cause of sudden death. This report describes the sudden death of a presumed healthy 28-year-old woman from primary diffuse leptomeningeal gliomatosis. She presented to an emergency room with headache and vomiting, subsequently became unresponsive and was pronounced dead 14 h later. autopsy revealed a diffuse extensive infiltrate of well-differentiated astrocytoma in the leptomeninges of the brain and spinal cord without an underlying parenchymal tumor. Primary diffuse leptomeningeal gliomatosis is a rare tumor that arises within the leptomeninges from small neuroglial heterotopic rests that undergo neoplastic transformation. Grossly. this tumor can mimic leptomeningeal carcinomatosis, pachymeningitis, tuberculosis, sarcoidosis, and fungal infections. However, the histologic features of primary diffuse leptomeningeal gliomatosis should allow it to be readily distinguished from grossly similar conditions. The mechanism of death in this case is most likely tumor obstruction of cerebrospinal fluid outflow resulting in the usual complications seen with increased intracranial pressure. Although this tumor is aggressive and is associated with a rapidly progressive fatal course, it has not been previously associated with sudden death.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
3/43. Subependymal giant cell astrocytoma: clinical and neuroimaging features of four cases.The clinical history, neuroimaging features, treatments, and outcome of 4 patients with histologically verified subependymal giant cell astrocytomas (SEGA) were retrospectively reviewed. The average age at the time of surgery was 13.3 years. headache related to raised intracranial pressure was the first and only sign in 2 patients, with the remaining 2 being admitted because of sequential neuroimaging studies over several years revealing the growth of 'subependymal nodules' into intraventricular tumours. In each case the tumour was in the region of Monro's foramen and was associated with ventricular dilatation. On computed tomography (CT), multiple subependymal nodules were found in 3 patients, and these well circumscribed isodense SEGAs were markedly enhanced by contrast medium. On magnetic resonance imaging (MRI), which was obtained in 3 patients, 2 SEGAs were isointense with the cerebral cortex and one with the white matter on T1-weighted images, and on T2-weighted images, 2 were isointense with the cortex and one with the white matter. At surgery the tumours appeared to originate from the inferolateral wall of the lateral ventricle in the region of the head of the caudate nuclei. Total macroscopic removal was achieved in 3 patients, and subtotal removal in one patient. Follow up ranged from 4.6 to 13.2 years, and all patients have exhibited similar physical and mental conditions to preoperative. So far there has been no evidence of any recurrences. The diagnosis and the surgical indications for SEGA are discussed, with periodic monitoring with neuroimaging studies being recommended even for asymptomatic patients with 'subependymal nodules'.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
4/43. Subependymal giant-cell astrocytoma in tuberous sclerosis: endoscopic images and the implications for therapy.Supratentorial intraventricular tumors are not frequently encountered in childhood. One of the most frequent intraventricular glial tumors is the subependymal giant-cell astrocytoma, mostly associated with tuberous sclerosis. These tumors are diagnosed on computed tomography (CT) or magnetic resonance imaging (MRI) scans. They can occur isolated or multiple and operative resection is advised if these tumors cause symptoms, usually raised intracranial pressure due to obstructive hydrocephalus. However, the number of tumors can be much higher than seen on radiological examination making total resection of all tumors impossible. We demonstrate this with the endoscopic images derived during the endoscopic removal of a subependymal giant-cell astrocytoma obstructing a foramen of Monro in a 15-year-old boy with tuberous sclerosis.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
5/43. The use of chemotherapy to facilitate surgical resection in pleomorphic xanthoastrocytoma: experience in a single case.The use of noncytotoxic chemotherapy as an adjuvant treatment to permit resection of a pleomorphic xanthoastrocytoma (PXA) is described. A 6-year-old girl with a large right occipito-temporo-parietal lesion presented with signs and symptoms of raised intracranial pressure. An initial attempt at resection was halted because of excessive blood loss, and tumour embolisation was not feasible as no suitable vascular pedicle was identified. Two cycles of vincristine and carboplatin were given, and these decreased the vascularity of the tumour allowing subsequent complete macroscopic resection 9 weeks later. The use of chemotherapy to decrease the vascularity of the tumour by way of its antiangiogenic effects is discussed.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
6/43. Bilateral thalamic tumors in children.INTRODUCTION: The actual incidence of thalamic tumors is not known, but the frequency of the bilateral tumoral involvement of both thalami is even less defined. CASE REPORT: In the present paper we report 4 new pediatric cases of primary bilateral thalamic tumors (PBTTs) observed in the Pediatric neurosurgery Section at the Catholic University Medical School, rome. neuroimaging studies could not detect the presence of abnormal neoplastic tissue at the level of the midline basal subependymal region of the third ventricle, in the midbrain, and in the pineal gland in any of these 4 patients, thus apparently excluding the diffusion of a firstly unilateral thalamic tumor to the contralateral thalamus. In all of the patients, the lesions appeared as large symmetrical masses on both sides of the third ventricle, a feature that seems to further exclude the contralateral growth of a previously unilateral tumor. PBTTs appear to remain confined to the thalamic nuclei for a long time, and, unlike the unilateral form, the border between gray and white matter may not be violated for a relatively long time. Unlike in adults, PBTTs do not present with dementia in children. signs and symptoms of increased intracranial pressure (3 cases) and movement disorders (tremor, 2 cases) were the presenting clinical manifestations in our 4 patients. CONCLUSIONS: The diffuse and bilateral involvement of both thalami makes surgical therapy barely feasible, even at the present time. Today, the main role of surgery is still to obtain a histological diagnosis. Generally, PBTTs are low-grade astrocytomas (grade II in the WHO classification), but limited anaplastic areas may be found in some patients, so that grade III and IV astrocytomas may be expected in a significant proportion of cases.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
7/43. Funduscopic appearance of papilledema with optic tract atrophy.In a child with a hypothalamic glioma, elevated intracranial pressure and retrograde optic tract atrophy produced distinctive patterns of papilledema and disc pallor in each eye. On the side of the tract lesion, the disc was swollen nasally and was pale temporally. In the contralateral fundus, the swollen optic disc was bisected horizontally by a pale atrophic band. These funduscopic signs exemplify a rare instance in neuro-ophthalmologic diagnosis wherein specific lateralizing and localizing information can be deduced solely from the appearance of papilledema.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
8/43. Acute increase in intracranial pressure revealed by transcranial Doppler sonography.Increased pulsatility of blood flow in the basal cerebral arteries recorded with the use of transcranial Doppler sonography (TCD) corresponds to increased intracranial pressure (ICP) to near the level of the diastolic arterial blood pressure. We describe the case of a 39-year-old woman who developed acute reduction in consciousness, anisocoria, gaze deviation, and right-sided hemiparesis 2 days after resection of a relapsed astrocytoma. MRI revealed only a moderate enlargement of the ventricles, but TCD revealed highly pulsatile waveforms of all basal cerebral arteries, showing a biphasic pattern with diastolic backflow. This pattern was interpreted as a massive increase in ICP with imminent danger of cerebral circulatory arrest corresponding to acute malresorptive hydrocephalus. External cerebrospinal fluid drainage was immediately undertaken, revealing excessive ICP of more than 50 cm H(2)O. Twenty-four hours after this intervention, both the ICP and the Doppler waveforms had returned to normal. This case illustrates the usefulness of TCD for diagnosing a critical but potentially reversible acute increase in ICP with imminent cerebral circulatory arrest.- - - - - - - - - - ranking = 0.85714285714286keywords = pressure (Clic here for more details about this article) |
9/43. Intractable vomiting as an early clinical symptom of cerebrospinal fluid seeding to the fourth ventricle in patients with high-grade astrocytoma.OBJECT: cerebrospinal fluid (CSF) seeing of high-grade astrocytoma is common, but the early clinical symptoms are not well characterized. Here, we report five patients with disseminated high-grade astrocytoma in the fourth ventricle region who presented with intractable vomiting prior to the detection of the metastatic deposits with enhancement. patients AND methods: From 1994 to 2000, 133 patients of high-grade astrocytoma were treated in our institute and were followed up until December 2002. Follow-up magnetic resonance (MR) imaging was performed in all patients every 2-3 months. The CSF seeding was defined as leptomeningeal enhancement. signs and symptoms of CSF seeding were checked at the monthly outpatient examination. RESULTS: Among them, 5 patients aged from 27 to 58 years (mean 43.8 years) with one anaplastic astrocytoma and four glioblastomas showed intractable vomiting without signs of high intracranial pressure as evaluated by MR imaging or ocular fundus examination prior to the detection of the fourth ventricle dissemination. fourth ventricle dissemination appeared 1-3 months after vomiting in five patients. One patient with glioblastoma received gamma knife radiotherapy for a fourth ventricle lesion appearing as a high intensity area on T2-weighted imaging before the appearance of the enhanced nodule, and this lesion was cured. Four patients died of progression of the fourth ventricle lesion. CONCLUSION: Intractable vomiting may be an early clinical symptom of CSF seeding to the fourth ventricle in patients with high-grade astrocytoma. Early detection and immediate radiotherapy for this lesion are recommended to control fourth ventricle dissemination.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
10/43. Anaplastic pleomorphic xanthoastrocytomas. review of the literature with reference to malignancy potential.Malignancy potential of pleomorphic xanthoastrocytomas (PXAs) has rather been an underestimated reality. We report the case of a 13-year-old boy who presented with signs of increased intracranial pressure. The child had been epileptic since the age of 2. Computed tomography and magnetic resonance scans revealed a huge left frontal mass. At surgery, a subtotal excision was accomplished. Histopathological diagnosis was anaplastic PXA (grade III; WHO, 2000). The tumor showed an increased mitotic index and minimal endothelial proliferation. The patient died 3.5 months later due to a fatal intracranial hemorrhage. A review of the entire PXA literature revealed 15 well-documented cases of PXA with subsequent malignant transformation and 11 cases of primary anaplastic PXA. The prognosis was grim for both subsets of patients. Anaplastic PXAs clearly represent the transition between the original PXA concept and lipidized giant-cell glioblastoma.- - - - - - - - - - ranking = 0.14285714285714keywords = pressure (Clic here for more details about this article) |
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