1/34. pulmonary edema after resection of a fourth ventricle tumor: possible evidence for a medulla-mediated mechanism.A well-recognized fact is that some patients may have development of pulmonary edema in association with disorders of the central nervous system. The origin of this phenomenon, known as neurogenic pulmonary edema, is unclear but may result, in part, from select pulmonary venoconstriction modulated by autonomic outflow from the medulla oblongata. We describe a 21-year-old man who had development of pulmonary edema in association with surgical resection of a brain tumor that was close to the medulla. Other than the possibility of medullary dysfunction, which could have occurred after surgical manipulation, no other risk factor for pulmonary edema was identified. Of note, the patient's blood pressure remained normal throughout the perioperative period, and no fluid overload or primary cardiac dysfunction was evident. This case supports the theory that the medulla is an important anatomic site of origin for neurogenic pulmonary edema and that alterations in medullary function can induce pulmonary edema in humans, independent of systemic hypertension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/34. color Doppler image of central retinal artery of eyes with an intraconal mass.PURPOSE: Retinal ischemia secondary to hypoperfusion of the central retinal artery is recognized as one factor that may contribute to the development of loss of vision in eyes with intraorbital tumors. We study intraorbital tumors which produce motility disturbances and visual problems by color Doppler imaging to evaluate this factor. methods: We examined the central retinal artery velocities of 3 patients with disc edema caused by intraconal masses (2 cavernous hemangiomas and 1 presumed optic nerve glioma) via color Doppler imaging. RESULTS: The time-velocity waveform demonstrated abnormally high vascular resistance in the central retinal artery of all affected eyes in the primary position compared with the normal waveform seen in the other eyes. We compared the pulsatility index of eyes with an intraconal mass and contralateral, control eyes using Student's t test for paired samples and significant differences were noted between both groups (p< 0.01). CONCLUSIONS: Intraconal tumors could produce increased pressure in the optic nerve sheath and the optic nerve tissue which could be associated with impaired retinal and optic nerve blood flow and the subsequent amaurosis encountered with intraorbital tumors.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/34. A distinctive glioneuronal tumor of the adult cerebrum with neuropil-like (including "rosetted") islands: report of 4 cases.Four examples of a novel glioneuronal neoplasm are presented. All tumors affected adults (including two males and two females aged 25-40 years) as supratentorial, cerebral hemispheric masses with associated seizure activity and, in one case, symptoms of raised intracranial pressure and progressive hemiparesis. CT scans in two cases revealed hypodense masses without calcification. MRI scans at presentation demonstrated, in all cases, solid T1-hypointense and T2-hyperintense tumors with mass effect in one instance but no edema or contrast enhancement. Only one was relatively circumscribed on neuroradiologic study. All were infiltrative in their histologic growth pattern and predominantly glial in appearance, being composed mainly of fibrillary, gemistocytic, or protoplasmic astroglial elements of WHO grade II to III. Their distinguishing feature was their content of sharply delimited, neuropil-like islands of intense synaptophysin reactivity inhabited and rimmed in rosetted fashion by cells demonstrating strong nuclear immunolabeling for the neuronal antigens NeuN and Hu. These cells included small, oligodendrocyte-like ("neurocytic") elements as well as larger, more pleomorphic forms. Two cases contained, in addition, well-differentiated neurons of medium to ganglion-cell size. Proliferative activity was observed principally within the glial compartment; two cases contained mitotic figures and exhibited relatively elevated MIB-1 indices (6.8% and 8.2%). One of the latter progressed and proved fatal at 30 months following subtotal resection and radiotherapy. The three other patients are alive at intervals of 14 to 83 months, two tumor-free and one with extensive disease associated with the appearance of enhancement on MRI. This glioneuronal tumor variant may pursue an unfavorable clinical course.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/34. rCBF in impending brain death.Regional cerebral blood flow (rCBF) was measured in three patients after relief of elevated intracranial pressure and restoration of normal cerebral perfusion pressure. Two patients, studied within 4 hours after closed head injury were found to have marked impairment of cortical blood flow and elevation of cerebrovascular resistance. We suggest that this picture is indicative of impending brain death, and may be the result of a long period of severe cerebral ischemia. The third patient, who had a shorter period of intracranial hypertension occurring during anaesthetic induction, responded to reduction of ICP quite differently with a transient relative hyperaemia. The physiopathological explanations for these two different types of flow response and their possible clinical significance are discussed.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/34. 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 = 1keywords = pressure (Clic here for more details about this article) |
6/34. 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 = 1keywords = pressure (Clic here for more details about this article) |
7/34. Rapid neurological deterioration associated with minor head trauma in chronic hydrocephalus.CASE REPORT: An 8-year-old developmentally normal boy (status: post third ventriculostomy and resection of posterior fossa low-grade glioma 4 years earlier and with known history of ventriculomegaly/arrested hydrocephalus) presented to the emergency room with vomiting and lethargy after a minor head trauma. Computed tomography scan of the head revealed no acute changes since previous studies. However, the patient's neurological status rapidly declined in the emergency room, where an emergency ventriculostomy demonstrated increased intracranial pressure. The patient's clinical condition improved over 24 h: he underwent placement of a ventriculoperitoneal shunt without complications and was discharged intact. DISCUSSION: The pathogenesis of rapid neurological decline associated with minor head trauma in chronic hydrocephalus is reviewed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/34. A knot in the catheter--an unusual cause of ventriculo-peritoneal shunt blockage.A 25-year-old woman, who was 25 weeks pregnant, underwent insertion of a VP shunt for hydrocephalus, secondary to a bithalamic glioma. Two months later, she represented with symptoms of raised intracranial pressure and MR scan revealed increased ventricular size. On exploration of the shunt, manometry with saline confirmed blockage of the catheter distal to the valve. On re-opening the abdominal wound, the peritoneal catheter was found to be knotted, 2 cm from the end. This segment of the catheter was replaced, with resolution of symptoms, post-operatively.The present case illustrates that a knot in the peritoneal catheter is an extremely rare cause of shunt malfunction. Possible mechanisms underlying it are discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/34. Twin and triple peaks papilledema.PURPOSE: To describe 2 adult patients who presented with papilledema after band atrophy (i.e., twin and triple peaks papilledema). DESIGN: Retrospective small case series. PARTICIPANTS: Two outpatients. methods: Observations made on 2 patients whose cases were reviewed in the neuro-ophthalmology clinic. RESULTS: The first patient had a pituitary tumor presenting with papilledema, causing a triple peaks clinical sign. color photographs, optical coherence tomograms, and magnetic resonance images are shown. The second patient developed twin peaks papilledema due to a chiasmal glioma causing secondary raised intracranial pressure. CONCLUSION: Twin peaks papilledema is a rare clinical sign that may develop in adults as well as in children. The first report and optical coherence tomography features of triple peaks papilledema illustrate a new clinical sign.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/34. radiation-induced osteosarcoma 16 years after surgery and radiation for glioma--case report.A 35-year-old man developed osteosarcoma of the left parietal and occipital bones 16 years after radiotherapy for glioma in the right occipital lobe. radiotherapy of the primary neoplasm used 50 Gy administered to a localized field through two lateral ports. The secondary neoplasm arose contralateral to the primary lesion but within the irradiated field. The tumor had a multilocular cyst with considerable intracranial extension, and symptoms of elevated intracranial pressure were prominent early in the course. After a short-lived initial remission following surgical intervention and chemotherapy, the patient deteriorated because of tumor recurrence and died 18 months after the diagnosis. radiation-induced osteosarcoma is a well-known but rare complication of radiotherapy for brain neoplasms with a poor prognosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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