1/16. Radicular compression by lumbar intraspinal epidural gas pseudocyst in association with lateral disc herniation. role of the posterior longitudinal ligament.Among unusual abnormalities of the lumbar spine reported since the introduction of Computed tomography (CT), the presence of gas lucency in the spinal canal, known as vacuum phenomenon, is often demonstrated. On the contrary, epidural gas pseudocyst compressing a nerve root in patients with a lateral disc herniation has rarely been reported. We report a case of a 44-year-old man who experienced violent low back pain and monolateral sciatica, exacerbated by orthostatic position, one week before admission. A lumbosacral spine CT showed the presence of vacuum phenomenon associated with a degenerated disc material and a capsulated epidural gas collection with evidence of root compression. A microsurgical interlaminar approach was carried out and, before the posterior longitudinal ligament was entered, a spherical "bubble" compressing the nerve roots was observed. The capsulated pseudocyst was dissected out, peeled off and excised en bloc. A large part of the posterior longitudinal ligament and the lateral disc herniation were removed. Postoperatively the patient was completely free of symptoms. The mechanism of exacerbation of pain was probably due to the increased radicular compression in the upright posture and, besides the presence of a lateral disc herniation, could be related to a pneumatic squeezing of gas from the intervertebral space into the well capsulated sac by the solicitated L4-L5 motion segment. Histological study of the wall of the pseudocyst showed the presence of fibrous tissue identical to the ligament. We conclude that, in case of a lumbar disc herniation, it is recommended to perform a complete microdiscectomy and an accurate removal of the involved portion of posterior longitudinal ligament in order to prevent pseudocystic formations.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/16. Medial meniscus anterior horn cyst: arthroscopic decompression.Meniscus cysts are mostly seen with meniscus tears, and arthroscopic decompression of cysts is gaining great importance in their treatment. In this study, we present a medial meniscus anterior horn cyst without an accompanying tear in the meniscus. A 33-year-old male patient was seen with pain and a palpable mass in his right knee. He complained that the severity of the pain had increased over the previous year. After the clinical and radiologic examinations, a painless, fixed soft tissue mass averaging 4 x 5 cm was located just medial to tuberositas tibia. The cyst was decompressed arthroscopically. In the 18th month of follow up, the mass had totally disappeared and the patient had no pain. Medial meniscus cysts are seen nine times fewer than lateral meniscus cysts. They are mostly accompanied with meniscal tears. Total meniscectomy with arthrotomy, isolated cyst excision, cyst excision, and partial meniscectomy with arthrotomy and arthroscopic partial meniscectomy with cyst decompression are treatment modalities. Arthroscopic meniscal cyst decompression is an important treatment choice and should always be taken into consideration with low morbidity, short recovery period, low recurrence rate, preservation of range of motion, and permission for early mobilization and rehabilitation of the joint.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/16. Intraventricular colloid cyst, hydrocephalus and neurogenic stunned myocardium.OBJECTIVE: To report the occurrence of neurogenic stunned myocardium in the context of a hydrocephalus due to a third ventricle colloid cyst. DESIGN: Case report. SETTING: Neurocritical care unit of a university hospital. PATIENT: The case of a 33-year-old woman with an intraventricular cerebral colloid cyst who developed hydrocephalus, cardiac arrest and survived is presented. Workup was consistent with neurogenic stunned myocardium in the context of acute hydrocephalus due to an intraventricular colloid cyst. RESULTS: The patient had decreased left ventricular ejection fraction, apex-sparing areas of hypokinesis and akinesis, wall motion abnormalities not matching a particular vascular territories, the peak troponin t level of 0.09 ng/ml and had normal coronary arteries at angiography. Seven days after the initial event the cardiac function recovered. Tumor resection was successfully performed. At 10 months after discharge, the only complaint was mild memory disturbance, she was completely functional with no evidence of seizures or of cardiac dysfunction. CONCLUSION: The sudden elevation of intracranial pressure, with the subsequent decreased cerebral perfusion pressure induces a vigorous cerebro-protective neuroendocrine system activation that can lead to the neurogenic stunned myocardium. Sudden death in patients with colloid cysts may be related to acute neurogenic cardiac dysfunction, and not necessarily cerebral herniation(s), as previously thought.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/16. diffusion-weighted MR imaging of the brain: value of differentiating between extraaxial cysts and epidermoid tumors.This study demonstrates the use of diffusion-weighted MR imaging in improving the specificity of the diagnosis of extraaxial brain tumors. Three surgically proved lesions (one arachnoid cyst and two epidermoid tumors) and two nonsurgically proved lesions (arachnoid and ependymal cysts) were evaluated with T1- and T2-weighted spin-echo studies followed by intravoxel incoherent motion (IVIM) MR imaging. The IVIM images of the lesions were displayed as an apparent diffusion coefficient (ADC) image obtained at 0.65 G/cm (maximum gradient b value = 100 sec/mm2) and compared with external oil and water phantoms. The ADC of arachnoid cysts was similar to stationary water whereas the ADC of epidermoid tumors was similar to brain parenchyma, indicating the solid nature and the slower diffusion rate of the epidermoid tumors. Cisternal CSF demonstrated uniformly high ADC, primarily because of bulk flow, which enhanced image contrast. Improved delineation of postsurgical changes was also possible. Our preliminary results show that diffusion-weighted MR imaging can be useful in distinguishing between arachnoid cysts and epidermoid tumors.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/16. Clinical correlates of septum pellucidum cavities: an unusual association with psychosis.Cavities in the septum pellucidum are widely regarded as incidental findings of little clinical importance. The prevalence of such cava on computerized tomography in a mixed sample of 22000 neurological and psychiatric patients is found to be 0.15%. A statistical association between this anomaly and a referral diagnosis of functional psychosis is reported, and 6 cases are described. These cases were male and characterized by an early history of developmental delay, with lifelong disturbances of emotion and behaviour prior to the onset in early adulthood of an atypical schizophrenia-like psychosis with disorders of speech and movement. It is suggested that septal cavities may signal an underlying abnormality of function relevant to the pathogenesis of these illnesses.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/16. Benign symptomatic glial cysts of the pineal gland: a report of seven cases and review of the literature.Seven cases of clinically symptomatic benign glial cyst of the pineal gland are reported. The cysts' size ranged from 1.0-4.5 cm in diameter. They were characterised by a golden or, less frequently, brown-reddish proteinaceous or haemorrhagic fluid content. The cyst wall, up to 2 mm thick, consisted of clusters of normal pineal parenchymal cells, often compressed and distorted, surrounded by reactive gliotic tissue which sometimes contained Rosenthal fibres. The presenting clinical features included headache (6/7), signs of raised intracranial pressure, partial or complete Parinaud's syndrome (5/7), cerebellar deficits (2/7), corticospinal and corticopontine fibre (2/7) or sensory (1/7) deficits, and emotional disturbances (2/7). CT and MRI (in 2/7 cases) scans showed a hypodense or nonhomogeneous lesion in the region of the pineal gland, with or without contrast enhancement. Surgical excision resulted in complete clearance of the symptoms in 5/7 patients. The previous literature is reviewed and the clinicopathological correlations and the possible pathogenetic mechanisms are discussed. The need to distinguish this benign lesion from other mass lesions of the pineal region, in particular from pinealocytoma, is stressed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/16. Paradoxic vocal cord syndrome with surgical cure.Paradoxic vocal cord motion (PVCM) can cause wheezing, stridor, weak or absent voice, and ineffective cough. We have described a patient who had a posterior fossa arachnoid cyst, which was thought to be causing PVCM by compressing the brain stem. The PVCM and all symptoms resolved after surgical treatment of the arachnoid cyst.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/16. Defective maturation of granulocytes, retinal cysts and multiple skeletal malformations in a mentally retarded girl.A case of congenital malformations of the extremities (deformed thumbs and great toes, dislocation of the hips, limitation of motion of the joints of the lower extremities), bilateral microphthalmia, bilateral retinal cysts, cerebral atrophy epilepsy, severe physical and mental retardation and monolobed neutrophil granulocytes is reported. A similar clinical picture has not previously been described. We assume that the patient suffers from a sublethal genetic disorder.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/16. M-mode ultrasonic localization and identification of fluid-containing pulmonary cysts.Successful ultrasonic localization of pleural fluid has been well documented in recent reports. The ability of ultrasound to detect and identify fluid within a parenchymal lesion has not been defined. We examined nine patients with cystic lesions and air-fluid levels noted on the chest roentgenogram. In all nine patients, an echo-free space that corresponded anatomically to the level of fluid noted on the x-ray film could be recorded in the M-mode presentation. The combined thickness of the wall of the chest and the overlying lung as judged by ultrasound ranged from 2 to 8 cm, with a mean of 4 cm. The following two characteristics appeared to distinguish parenchymal from pleural fluid: (1) similar characteristics of motion of the proximal and distal interfaces of the sonolucent space; or (2) the ultrasonographic pattern of overlying lung proximal to the loculation of fluid. Ultrasonograms in eight (89 percent) of nine patients demonstrated one or both of these characteristics. These findings indicate that ultrasound can detect fluid within a parenchymal structure and may be used to differentiate intraparenchymal loculations from those in the pleural space.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/16. Evaluation of computerized tomography, cinelaryngoscopy, and laryngography in determining the extent of laryngeal disease.A prospective study of over 100 cases comparing computerized tomography (CT) and correlating these studies with photographic motion picture studies of the larynx, conventional tomography and contrast laryngography has been performed. The authors give illustrative examples of cases in which the CT scan has been documented as providing equal and often times greater information concerning not only tumors, but also cystic lesions and traumatic lesions. With the newer technology, the reduced radiation (which is less than one half that of conventional tomography), and the decreased expense (now comparable to that of laryngography alone), eliminates the need for conventional laryngography and tomography examinations. The incorporation of motion picture documentation of the lesions allowing future comparative studies between the original lesion and the CT are recommended for a more accurate retrospective classification and assessment of therapeutic results.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
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