1/155. Cerebral radionecrosis following the treatment of parotid tumours: a case report and review of the literature.radiotherapy is an accepted part of the treatment of malignant tumours of the parotid gland. The use of radiotherapy in benign parotid tumours, where spillage of tumour cells has occurred at operation, is more controversial. radiotherapy to the parotid bed is not without morbidity. Complications may arise as a result of radiation damage to neighbouring structures and there is also potential to induce malignant disease. A patient, whose postoperative radiotherapy following resection of a pleomorphic salivary gland adenoma was complicated by cerebral necrosis, is discussed. The literature pertaining to morbidity of radiotherapy for parotid tumours is reviewed.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
2/155. The care of students with insulin-treated diabetes mellitus living in university accommodation: scope for improvement?Concern has been expressed about the welfare of young adults with Type 1 diabetes mellitus who leave home to attend university or college for tertiary education. This has been highlighted by the local experience in Edinburgh of two male students with Type 1 diabetes, both of whom died from metabolic complications of diabetes during their first term at universities distant from their homes. One student died following the development of cerebral oedema secondary to diabetic ketoacidosis, which was probably precipitated by prolonged coma after an episode of severe hypoglycaemia. Another student, who was found 'dead in bed', had a history of previous severe hypoglycaemia. At a Fatal Accident Inquiry in Edinburgh, held following the death of the first student, recommendations were made to improve the care and personal safety of students with diabetes living in university accommodation. Despite the report being circulated to all Scottish universities, the second student died within three years of the inquiry. Further efforts to protect the welfare of students with Type 1 diabetes who are attending centres for tertiary education away from their home environment may require the more active participation by diabetes healthcare professionals.- - - - - - - - - - ranking = 28.372691878109keywords = person (Clic here for more details about this article) |
3/155. radiation-induced blood-brain barrier damage in astrocytoma: relation to elevated gelatinase B and urokinase.Successful management of brain tumors prolongs life, raising the risk of delayed injury secondary to the treatment. radiation therapy, a mainstay of brain tumor treatment, can damage the cerebral blood vessels. Acutely a breakdown of the blood-brain barrier (BBB) may be seen, but fibrosis complicates radiation injury in the chronic phase. matrix metalloproteinases (MMPs) and plasminogen activators are two matrix-degrading proteolytic enzymes, which are induced by radiation. They disrupt the basal lamina around cerebral capillaries and open the BBB. We report a patient with an astrocytoma managed by partial resection and external beam irradiation to maximal tolerable doses. The patient later developed malignant brain edema shortly after stereotactic radiosurgery. Tissue obtained during surgical debulking to control the edema showed very high levels of gelatinase B (92 kDa type IV collagenase) and urokinase-type plasminogen activator (uPA). Tumor cells were absent from the biopsy and subsequent autopsy specimens, but necrosis with fibrosis of the blood vessels was seen. If abnormal matrix enzyme function participates in the expression of radiation injury, then inhibitors to such enzymes may provide one strategy for controlling cerebrovascular damage after therapeutic brain radiation.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
4/155. 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 = 28.372691878109keywords = person (Clic here for more details about this article) |
5/155. A case of balamuthia mandrillaris meningoencephalitis.balamuthia mandrillaris is a newly described pathogen that causes granulomatous amebic encephalitis, an extremely rare clinical entity that usually occurs in immunosuppressed individuals. We report a case of pathologically proven Balamuthia encephalitis with unusual laboratory and radiologic findings. A 52-year-old woman with idiopathic seizures and a 2-year history of chronic neutropenia of unknown cause had a subacute illness with progressive lethargy, headaches, and coma and died 3 months after the onset of symptoms. Cerebrospinal fluid (CSF) glucose concentrations were extremely low or unmeasurable, a feature not previously described (to our knowledge). Cranial magnetic resonance imaging scans showed a single large temporal lobe nodule, followed 6 weeks later by the appearance of 18 ring-enhancing lesions in the cerebral hemispheres that disappeared after treatment with antibiotics and high-dose corticosteroids. The initial brain biopsy specimen and analysis of CSF samples did not demonstate amebae, but a second biopsy specimen and the postmortem pathologic examination showed Balamuthia trophozoites surrounded by widespread granulomatous inflammation and vasculitis. The patient's neutropenia and antibiotic use may have caused susceptibility to this organism. Amebic meningoencephalitis should be considered in cases of subacute meningoencephalitis with greatly depressed CSF glucose concentrations and multiple nodular lesions on cerebral imaging. Arch Neurol. 2000;57:1210-1212- - - - - - - - - - ranking = 11.22678350231keywords = illness, ill (Clic here for more details about this article) |
6/155. High-altitude cerebral edema (HACE): the Denver/Front Range experience.High-altitude cerebral edema (HACE) is a potentially fatal metabolic encephalopathy associated with a time-dependent exposure to the hypobaric hypoxia of altitude. Symptoms commonly are headache, ataxia, and confusion progressing to stupor and coma. HACE is often preceded by symptoms of acute mountain sickness and coupled, in its severe form, with high-altitude pulmonary edema. Although HACE is mostly seen at altitudes above that of the Denver/Front Range visitor-skier locations, we report our observations over a 13-year period of skier-visitor HACE patients. It is believed that this is a form of vasogenic edema, and it is responsive to expeditious treatment with a successful outcome.- - - - - - - - - - ranking = 2434.5863514119keywords = sickness (Clic here for more details about this article) |
7/155. Calcifying epithelial odontogenic tumor with intracranial extension: report of a case and review of the literature.The calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasm, possibly of stratum intermedium origin and occurring predominantly in the mandible of adults. The treatment varies, depending on its size, location, and histology. A case of an advanced CEOT arising in the maxilla with intracranial extension is reported. The report is supplemented by a review of the literature.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
8/155. A huge frontal meningioma associated with intraoperative massive bleeding and severe brain swelling--case report.A 58 year old female presented with progressive memory disturbance and personality change. Magnetic resonance (MR) imaging disclosed a huge mass lesion accompanied by prominent oedema in the right frontal lobe. Cerebral angiogram demonstrated a vascular-rich tumour and a major drainer through diploic vein. A right frontotemporal craniotomy was performed. We encountered massive bleeding from diploic vein and dura mater immediately at the craniotomy. We were also faced with severe brain swelling at the dural incision. The tumour was solid, highly vascularised, and fairly well demarcated. We performed total removal of the tumour as quickly as possible in order to reduce the intracranial hypertension and avoid the impending brain herniation. The patient had an uneventful recovery and was asymptomatic at 10 months follow-up.- - - - - - - - - - ranking = 28.372691878109keywords = person (Clic here for more details about this article) |
9/155. Ventriculomegaly and pericerebral CSF collection in the fetus: early stage of benign external hydrocephalus?BACKGROUND AND PURPOSE: Mild ventricular dilatation or an asymmetric aspect of the atrium with prominent subrachnoid spaces is a challenging clinical condition in utero that requires prenatal MRI to rule out a destructive lesion or brain malformation. We report five cases that demonstrated benign external hydrocephalus postnatally, together with the prenatal MRI to define prenatal criteria of so-called benign external hydrocephalus. methods AND RESULTS: The prenatal MR images of five cases showing typical features of external hydrocephalus postnatally were reviewed. All cases showed in utero mild ventricular dilatation at the level of the atrium with enlargement of the subarachnoid spaces homo-, contra- or bilaterally, and predominantly in the parietooccipital areas. The head circumference was normal in all cases with no family history of macrocephaly. MRI did not demonstrate either abnormal signal within brain parenchyma or loss of the normal layering of the developing brain. CONCLUSION: Posterior mild ventricular dilatation and prominent subarachnoid spaces in a posterior distribution can be considered an early stage of benign external hydrocephalus that is nicely illustrated by MRI.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
10/155. Proton magnetic resonance spectroscopy of choroid plexus tumors in children.A variety of lesions may present as intraventricular masses in children. We report quantitative proton magnetic resonance spectroscopy (MRS) of two intraventricular tumors of the choroid plexus: choroid plexus carcinoma (CPC) and choroid plexus papilloma (CPP). Both lesions were characterized by high levels of choline-containing compounds and a complete absence of creatine and the neuronal/axonal marker N-acetyl aspartate. The CPC showed higher levels of choline compared to the CPP, and it also had elevated lactate. These preliminary results, if confirmed in a larger cohort of patients, indicate that proton MRS may have a role in the presurgical diagnosis of choroid plexus tumors in children, which may also have important implications for therapy and prognosis.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
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