1/29. diffusion-weighted MR imaging of Carmofur-induced leukoencephalopathy.Carmofur (1-hexylcarbamyl-5-fluorouracil), a derivative of 5-fluorouracil (5-FU), has been widely used in japan as a postoperative adjuvant chemotherapy agent for colorectal and breast cancer. Periventricular hyperintensity on T2-weighted MR images in carmofur-induced leukoencephalopathy confront the physician with a broad range of differential diagnoses. We describe two cases of carmofur-induced leukoencephalopathy in which diffusion-weighted MR imaging revealed periventricular hyperintensity. We compared their findings with those of age-related periventricular hyperintensity in five patients and found discrepancies in signal intensity of periventricular areas. Our results suggest that diffusion-weighted MR imaging may be useful to differentiate carmofur-induced leukoencephalopathy from age-related periventricular hyperintensity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/29. Incidental pediatric intraparenchymal xanthogranuloma: case report and review of the literature.Juvenile xanthogranuloma (JXG) is a specialized form of non-Langerhans cell histiocyte proliferation that occurs in children. The majority of cases present as a solitary cutaneous lesion with a predilection for the head and neck region; however, isolated lesions occasionally have been identified in the central nervous system. The cutaneous forms of JXG usually follow a benign course. Other physicians have reported surgery as the first line of treatment in symptomatic patients with accessible lesions. Adjuvant therapies may be indicated for multicentric or surgically inaccessible lesions. The authors describe an unusual case of isolated intraparenchymal JXG in an asymptomatic child with no cutaneous manifestations and provide a review of the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/29. Intrathecal baclofen overdose followed by withdrawal: clinical and EEG features.Intrathecal baclofen therapy is increasingly used to alleviate medically intractable spasticity in children with cerebral palsy, spinal cord injuries, and generalized dystonia. Complications like overdose or withdrawal can occur and could be the result of pump malfunction (device-related) or refilling and programming mistakes (human errors). This report describes a case, with emphasis on electroencephalographic changes, of a 12-year old male on long-term intrathecal baclofen therapy who had sequential occurrence of both acute inadvertent baclofen overdose followed by withdrawal symptoms. During baclofen intoxication, electroencephalography documented periodic generalized epileptiform discharges, occasionally followed by intermittent electro-decremental responses on a background of diffuse delta slowing (1-2 Hz). During withdrawal, mild generalized slowing during wakefulness was observed along with the appearance of high-amplitude, sharply contoured delta activity resembling frontal intermittent rhythmic delta activity in sleep. To our knowledge, this temporal profile of electroencephalographic features during baclofen intoxication followed by withdrawal has not been described before in pediatric patients. It is important for treating physicians to recognize the evolution of this electroencephalographic pattern in order to avoid misinterpretation of diagnosis and prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/29. Prolonged unconsciousness in a patient with End-stage Renal disease.patients with End-stage Renal disease being immunocompromised; are prone to a variety of infections, sometimes, rare ones, more than the general population. This fact should alert the physicians to be more vigilant and have a broader scope when considering the etiology of infections in such patients. We report the case of a 65-year-old man who had a very stormy hospital stay secondary to cerebral nocardiosis with multiple brain abscesses, prolonged unconsciousness and neurological deficits. However, the patient was treated successfully, surgically and chemotherapeutically. He was discharged home in a good condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/29. Evaluation of acute vertigo: unusual lesions imitating vestibular neuritis.The acute onset of vertigo is a common clinical problem presenting to primary care physicians or otologists for evaluation. Usually the underlying disease process is benign and self-limited in nature. In the absence of hearing loss or additional neurologic findings, a common initial diagnosis is vestibular neuritis. The patient is treated symptomatically and observed for spontaneous resolution. However, other more serious disease processes may mimic the presentation of vestibular neuritis and be misdiagnosed. Five cases of serious central nervous system disorders that were similar to vestibular neuritis in their initial presentation are reviewed to illustrate this point. Each patient presented with the acute onset of continuous vertigo without associated hearing loss. The correct diagnosis was established only after further evaluation was pursued. Recommendations for the initial and subsequent evaluation of these patients are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/29. Rhinocerebral mucormycosis: a report of eleven cases.Rhinocerebral mucormycosis (RCM) is a rare, fulminant fungal infection that usually occurs in diabetic or immunocompromised patients. The mortality rate has been reduced recently with the advent of amphotericin b combined with aggressive surgery. Eleven RCM patients have been treated over the past five years at Srinagarind Hospital. Eight had underlying diabetes, five had renal failure and three of them had both. In eight patients, the diagnosis was established by KOH preparation before histological confirmation. Only two cases revealed positive cultures for rhizopus spp and cunninghamella spp. All patients underwent surgical treatments (extensive debridement, 8 cases; sphenoidectomy, 7 cases; ethmoidectomy 8 cases; maxillectomy 5 cases and orbital exenteration, 6 cases). amphotericin b was administered to all patients as soon as the diagnosis of RCM was made. Only three patients survived. early diagnosis and cooperation among ophthalmologist, otolaryngologist and physician are the most important factors for the survival of patients with mucormycosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/29. Determination of brain death via pulsatile echoencephalography.For cerebral death to occur there must be many levels of cerebral function destroyed. Cortical and subcortical irreversible damage is evident by unresponsiveness to any stimuli. brain stem and basal ganglia damage is indicated by absence of spontaneous respirations, cephalic reflexes, and thus cerebral circulation. All elements of the criteria for cerebral death must be met. The decision should be made by the attending physician in consultation with his peers. The life support mechanisms should be discontinued after the diagnosis of cerebral death has been made. Absence of pulsatile echoes means absence of cerebral circulation and cerebral function, or a definitive diagnosis of cerebral death. It is a final parameter in the criteria and allows definite measures to be taken. But it behooves one to remember that this phenomenon of cerebral death makes organ donation and transplantation possible. It has not been created in order to supply the needs for organ transplant!- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/29. Updates on the diagnosis and management of posttraumatic hydrocephalus.Posttraumatic hydrocephalus is a vital subject for the practitioner caring for patients with traumatic encephalopathy, as a large number of brain trauma patients develop ventricular enlargement. The managing physician should understand which ventriculomegalic patients are suffering from hydrocephalus, which have cerebral atrophy and which stand a reasonable chance of improvement on surgical placement of a ventricular shunt. This paper highlights this decision process in two patients, and offers the physician a practical overview of posttraumatic hydrocephalus and its management.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/29. A brief neurobehavioral exam useful for early detection of postoperative complications in neurosurgical patients.This article describes data from 11 patients evaluated before and after neurosurgical intervention for treatment of brain tumor, subdural hematoma and hydrocephalus. The Neurobehavioral Cognitive Status Examination (NCSE) was administered pre- and postoperatively. Improvement was documented by the NCSE in 6 of the 11 patients. In the remaining five patients, there was evidence of deterioration in cognitive functioning. After clinical and diagnostic re-evaluation by the physician, four patients had repeat operations. Follow-up evaluation after the second operation was useful in determining treatable and non-treatable causes of progressive cognitive deterioration. In these patients use of the NCSE may have expedited effective diagnostic evaluation and subsequently improved patient care. Such instruments have clinical utility since they are easily administered, pragmatic, and objectify subtle changes in cognitive functioning which may be early signs of increased intracranial pressure or complications of surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/29. Ethical and legal aspects of the emergency management of brain death and organ retrieval.patients brought to an emergency room with profound brain damage can be determined to be unsalvageable but usually cannot be declared brain dead. Most such patients should be admitted to the hospital for physiologic support and formal brain death determination. There are ethical and legal justifications, discussed in this article, for physicians to encourage the families of such patients to consent for them to be organ and tissue donors.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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