1/20. Hyperbaric chamber-related decompression illness in a patient with asymptomatic pulmonary sarcoidosis.An asymptomatic 46-yr-old male sustained an acute neurologic insult, appearing during the decompression phase of a 50-m dry hyperbaric chamber dive. The right hemisyndrome was most probably related to diving, since symptoms responded rapidly to the early commenced recompression therapy. Further diagnostics revealed a previously unknown pulmonary sarcoidosis with bilateral pulmonary opacities and pleural adhesions that might have predisposed to arterial gas embolism secondary to pulmonary barotrauma. This case may illustrate a potential risk of decompression illness even during dry chamber dives in patients suffering from asymptomatic pleuro-parenchymal pulmonary disease. The value of chest X-ray in the medical assessment of fitness to dive is therefore emphasized.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
2/20. Isolated cerebellar involvement in Rosai-Dorfman disease: case report.OBJECTIVE AND IMPORTANCE: Sinus histiocytosis or Rosai-Dorfman disease (RDD) is a rare but well-recognized disorder characterized by an unusual proliferation of histiocytic cells. Intracranial localization is a rare manifestation of RDD. Only three cases of localization in the posterior fossa have been reported in the literature. The present report describes the first case, to our knowledge, of cerebellar localization of RDD. CLINICAL PRESENTATION: A 67-year-old woman was admitted to our institution with a 5-month history of cerebellar ataxia. Her medical history was unremarkable. The patient was alert and cooperative. No cranial nerve deficits were evident; Romberg positivity to the left side was recorded. No cutaneous abnormalities, lymphadenopathy, or hepatosplenomegaly were revealed by physical examination. Routine hematological and biochemical studies were normal except for the erythrocyte sedimentation rate, which was elevated. Radiologically, the lesion appeared as a well-defined and avascular mass in the right cerebellar lobe. meningioma was considered the most likely diagnosis. TECHNIQUE: The patient underwent a suboccipital craniotomy with complete excision of the lesion. Microscopic examination of the operative specimen revealed the presence of a mixed cellular population with predominant mature histiocytes. A peculiar feature was the presence of lymphocytes and monocytes within the cytoplasm of histiocytes (emperipolesis). Immunohistochemical study of the histiocytes revealed strong positivity for S-100, CD-68 antigen, and vimentin. CONCLUSION: Involvement of the central nervous system in RDD appears to have a benign prognosis, especially in the absence of nodal diseases. Surgery is essential for diagnosis, and, when total removal is achieved, the outcome is generally good without risk of recurrence.- - - - - - - - - - ranking = 0.20461593743491keywords = physical (Clic here for more details about this article) |
3/20. Therapeutic effectiveness of acetazolamide in hindbrain hernia headache.A 43-year-old man had been suffering from exertional headache for 10 years. Sagittal sections on magnetic resonance imaging showed a Chiari type 1 malformation and a cerebellar arachnoid cyst. This syndrome, named hindbrain hernia headache, disappeared with oral acetazolamide. This treatment should be tried in patients with hindbrain hernia headache prior to considering surgical decompression of the foramen magnum.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
4/20. Cerebellar hemorrhage arising postoperatively as a complication of supratentorial surgery: a retrospective study.OBJECT: Postoperative cerebellar hemorrhage as a complication of supratentorial surgery is an increasingly recognized clinical entity. So far, it has remained unclear whether this complication constitutes an intraoperative or postoperative event. The observation of such cases prompted the authors to analyze retrospectively their series of supratentorial craniotomies. The aim of this study was to determine the incidence of cerebellar hemorrhage and its temporal relationship to supratentorial surgery. methods: The authors reviewed discharge notes and reports on postoperative computerized tomography (CT) scans for 1650 patients who had undergone supratentorial craniotomy between January 1998 and February 2001. The retrospective study led to the identification of 10 patients who had sustained cerebellar hemorrhage as a complication of supratentorial surgery. Because it was routine to perform CT scanning following craniotomy, an early CT scan obtained within the 1st postoperative hour (mean 24 minutes after wound closure) was available in eight of the 10 patients. In seven of these patients no hemorrhage was found immediately after surgery, and in only one patient was there the suspicion of cerebellar hemorrhage. In the whole series of 10 patients, cerebellar hemorrhage was detected during the later postoperative course, after a mean interval of 7 hours and 35 minutes (range 1 hour and 49 minutes-144 hours) following surgery. The incidence of cerebellar hemorrhage was 0.6% of all patients who underwent supratentorial surgery. Among patients suffering from epilepsy the incidence was 4.6%, and in those patients who underwent temporal lobe resection it was 12.9%. CONCLUSIONS: The authors have demonstrated that cerebellar hemorrhage as a complication of supratentorial surgery arises not as an intraoperative event, but as a postoperative event. Resective nontumorous temporal lobe procedures place patients at particular risk for this complication. Evidence suggests that the complication might be precipitated by postoperative suction drainage.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
5/20. Cerebellar infarction in the young.BACKGROUND AND PURPOSE: Ischemic cerebrovascular disease in children and young adults usually affects the anterior circulation. SUMMARY OF REPORT: We describe two cases of cerebellar infarction in the territory of vertebral artery supply, associated with physical exertion, in a young adult and in a child. review of 31 previous cases of cerebellar infarction occurring in the first 2 decades of life demonstrated a mostly obscure causation; where a likely cause was found, trauma was most frequent. In 12 of the 31 patients, a vertebral artery (usually the left) was occluded. patients were sometimes predisposed to such occlusions by subluxation between the first and second cervical vertebrae, allowing abnormal neck movements that can cause arterial injury and thromboembolism. Some of these cerebellar infarcts, like those of our patients, have followed physical exertion. CONCLUSIONS: Cerebellar infarction can be life-threatening, but half of the patients, including ours, have had complete or near-complete recovery.- - - - - - - - - - ranking = 0.40923187486983keywords = physical (Clic here for more details about this article) |
6/20. CACNA1A mutations causing episodic and progressive ataxia alter channel trafficking and kinetics.BACKGROUND: CACNA1A encodes CaV2.1, the pore-forming subunit of P/Q-type voltage-gated calcium channel complexes. Mutations in CACNA1A cause a wide range of neurologic disturbances variably associated with cerebellar degeneration. Functional studies to date focus on electrophysiologic defects that do not adequately explain the phenotypic findings. OBJECTIVE: To investigate whether some missense mutations might interfere with protein folding and trafficking, eventually leading to protein aggregation and neuronal injury. methods: The authors studied the functional consequences of two pore missense mutations, C287Y and G293R, in two families with EA2, one newly discovered and the other previously reported. Both mutations caused episodic and interictal ataxia. The biophysical properties of mutant and wild type calcium channels were examined by whole-cell patch-clamp recordings in transfected COS-7 cells. The plasma membrane targeting was visualized by confocal fluorescence imaging on CaV2.1 tagged with green fluorescent protein. RESULTS: The mutant channels exhibited a marked reduction in current expression and deficiencies in plasma membrane targeting. CONCLUSIONS: In addition to altered channel function, the deficiency in protein misfolding and trafficking associated with the C287Y and G293R mutants may contribute to the slowly progressive cerebellar ataxia.- - - - - - - - - - ranking = 0.20461593743491keywords = physical (Clic here for more details about this article) |
7/20. Positional nystagmus and vertigo due to a solitary brachium conjunctivum plaque.The authors describe two patients suffering from demyelinating central nervous system disease who developed intense vertigo and downbeat nystagmus upon tilting their heads relative to gravity. brain MRI revealed in both cases a single, small active lesion in the right brachium conjunctivum. The disruption of otolithic signals carried in brachium conjunctivum fibres connecting the fastigial nucleus with the vestibular nuclei is thought to be causatively involved, in agreement with a recently formulated model simulating central positional nystagmus. Insufficient otolithic information results in erroneous adjustment of the Listing's plane in off-vertical head positions, thus producing nystagmic eye movements.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
8/20. brain injury following neuroleptic malignant syndrome: case report and review of the literature.OBJECTIVE: To report a case of brain injury following neuroleptic malignant syndrome (NMS) and review the literature for similar documented cases. CASE REPORT: A 30-year old woman presented to the ER with psychotic features and was treated with several anti-psychotics. Subsequently, she developed neurological symptoms and was diagnosed with neuroleptic malignant syndrome. Following a prolonged course in an acute care facility, she was admitted to a rehabilitation ward, where cognitive and physical examinations revealed significant findings. These included marked dysarthria, difficulties comprehending commands, attention problems, as well as abnormalities in her muscle tone, power, reflexes, gait, co-ordination and sensory function. CONCLUSION: literature reviews reveal few documented cases of brain injury following neuroleptic malignant syndrome. A further exploration of the effects of NMS on the brain is warranted to elicit whether cerebellar damage is indeed common following neuroleptic malignant syndrome. Such research could eventually lead to therapeutic interventions aimed at preventing permanent brain injury in persons with NMS.- - - - - - - - - - ranking = 0.20461593743491keywords = physical (Clic here for more details about this article) |
9/20. Cerebellar degeneration in neuroleptic malignant syndrome: neuropathologic findings and review of the literature concerning heat-related nervous system injury.A selective subtotal cerebellar neuronal degeneration was found in a patient who died 4 1/2 months after suffering neuroleptic malignant syndrome (NMS), a rare, potentially fatal disorder associated with neuroleptic medications. It is suggested that the cerebellar neuronal degeneration in this case was due to hyperpyrexia, a cardinal clinical feature of NMS. Similar pathologic findings appear not to have been previously reported in NMS but have been described in heat-induced central nervous system (CNS) injury. The findings imply that a cerebellar syndrome might be encountered in patients who survive NMS complicated by a particularly high febrile course.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
10/20. Chronic paleocerebellar stimulation for the treatment of neuromuscular disorders. Four case report.4 patients suffering severe neuromuscular diseases were subjected to a subtentorial implantation of electrodes over the anterior cerebellar lobe surface. Chronic stimulation was applied for 90 min to 7 h daily, with a rate of 20--180 Hz, 6--10 V and a schedule of 15 min "on", 15 min "off". Some improvement was observed in 3 patients treated with high frequency stimulation. 1 patient suffered seizures after three months of chronic stimulation. In 2 cases, posterior fossa explorations were necessary for revision of the stimulation apparatus and marked meningeal proliferation surrounding the electrodes was observed. light and electron microscopic examination of the biopsies showed loss of purkinje cells and gliofibrillar reaction. Effectiveness and side effects of chronic stimulation of the cerebellum are discussed.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
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