Excitatory amino acid transmitters

Amino acid neurotransmitters and their pathways in the mammalian central nervous system

Intracranial Pressure IV

Objective: To compare the pathogenesis, clinical presentation, therapy, and prognosis of primary central nervous system lymphoma in immunocompetent persons with these characteristics of the disease...

Primary Central Nervous System Lymphoma

✓ The Chiari malformation is a condition characterized by herniation of the posterior fossa contents below the level of the foramen magnum, and is categorized into three types based on the degree of herniation. The authors review their surgical experience between 1975 and 1985 with 50 patients afflicted with symptomatic Chiari malformations. Any patient with associated myelomeningocele, tethered spinal cord, lipoma, or diastematomyelia was excluded from this series. Forty-one patients had Chiari I malformations, seven were classified as having Chiari II, and two as having Chiari III. The presentation of pediatric and adult patients was identical. Treatment was directed at the posterior fossa pathology. Seven patients with accompanying ventral bone compression underwent transoral decompression of the cervicomedullary junction, 42 had posterior decompressive procedures, and six received ventriculoperitoneal shunts. The posterior decompression included opening the outlet foramina of the fourth ventricle, occ...

Symptomatic Chiari malformations. An analysis of presentation, management, and long-term outcome.

The clinical, radiographic, and pathological findings in 155 patients with symptomatic Rathke's cleft cysts are discussed. Eight patients were treated by the authors and 147 were collected in a review of the literature. This lesion occurred more often in female than male patients by a 2:1 margin, and the mean age at presentation was 38 years. The average patient had been symptomatic for nearly 3 years at the time of treatment, with the most common symptoms and signs being pituitary dysfunction, visual disturbances, and headaches. Affected children generally were pituitary dwarfs. The sella was enlarged in 80% of cases, and the cyst was situated in both an intrasellar and a suprasellar location in 71%. Computerized tomography revealed a low-density cystic mass with capsular enhancement in one-half of the cases. A variable appearance was seen with magnetic resonance imaging. Partial excision and drainage of the cyst by the transsphenoidal approach is the recommended treatment, as the recurrence rate is low. Most symptoms and signs improved or resolved following surgery with the exception of hypopituitarism and diabetes insipidus. The cyst lining was usually composed of ciliated cuboidal or columnar epithelium. Theories as to the origin of Rathke's cleft cysts are also discussed.

Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts.

Forty-five of 185 (24%) infants and children with hydrocephalus treated by ventriculoperitoneal (VP) shunt procedures developed intra-abdominal complications. The occurrence of a previously unrecognized inguinal hernia was noted in 31 patients (16.8%). The mean interval from VP shunt to hernia occurrence was 6.8 months. Seventy-five percent had bilateral findings and 20% were incarcerated. Perforation of the colon occurred in five patients and of the bladder in two. Intra-abdominal cerebrospinal fluid (CSF) cyst was noted in three cases, catheter disconnection in two, knotted catheter in one, and intestinal obstruction due to volvulus around a shunt in one. There was only one death. Abdominal x-ray was often diagnostic; demonstrating the VP-shunt catheter in the scrotum in six patients with otherwise unrecognized inguinal hernia, and in instances of knotted shunt, shunt disconnection, bladder perforation, CSF cysts, and intestinal obstruction. In addition, contrast studies in instances of shunt dysfunction documented bowel perforation and CSF cyst formation. These data indicate that intra-abdominal complications are not uncommon following VP-shunt operations. Close observation for development of previously unrecognized inguinal hernia and other intra-abdominal complications is advised following VP-shunt operations in infants with hydrocephalus.

Intra-Abdominal Complications Following Ventriculoperitoneal Shunt Procedures

The authors have presented 81 children with intraspinal tumors, all less than 16 years of age. The clinical features indicated that gait disturbance, pain, and sphincter disturbance are the most prominent complaints. Reflex changes, paralysis, and sensory impairment are the most frequent physical findings. Cerebrospinal fluid protein was recorded in 47 patients and was abnormal in 34. Spine radiography was abnormal in 58% of the patients. Seventy of the patients had myelography, and it was diagnostic in 67. Surgery was performed on 79 patients, with a 2.5% operative mortality (30 days postsurgery). Of the 49 patients who are alive, 91.5% are able to walk. Mean follow-up period was 8.5 years. The authors document the benign course of the intramedullary astrocytomas and suggest an approach to their treatment. They encourage an aggressive approach to metastatic intraspinal tumors. The latrogenic origin of some epidermoid tumors is noted. The importance of early diagnosis and treatment of the intraspinal tumors in children is emphasized.

Intraspinal tumors in children. A review of 81 cases.

The neurological complications secondary to embolism from atrial myxoma are reviewed. A patient with intracranial and skeletal metastases is described to emphasise the malignant potentiality of this tumour. A classification of atrial myxoma metastases is presented.

https://jnnp.bmj.com/content/jnnp/41/12/1119.full.pdf

Atrial myxoma: a review of the neurological complications, metastases, and recurrences

HIS paper is concerned with antibiotic penetration of the brain in patients having non-inflamed meninges. It establishes the amount of antibiotic penetration of actual extravascular cerebral tissue. Such information may be useful in the antibiotic prophylaxis of basilar fractures, prophylaxis in routine craniotomy, or in the management of open cranial-cerebral wounds. Such data might also be pertinent to the therapy of established brain parenchymal infection in which the meninges are not necessarily involved, in particular, brain abscesses. There are many studies in the literature on cerebral spinal fluid levels of antibiotics in the non-infected central nervous system following systemic injection. Most antibiotics are recovered in the cerebrospinal fluid in little, or very small, amounts after the usual, or even increased, systemic doses. In the most carefully done studies, it has been concluded that the blood-brain barrier and cerebrospinal fluid barrier are not the same. 2 It can then be expected that actual drug penetration of the cerebrospinal fluid would differ from drug penetration of the extravascular cerebral tissue. With particular reference to antibiotics, it should be noted that the single other study on antibiotic penetration of cerebral tissue, which was conducted in 1954, attempted to correlate brain levels and cerebrospinal fluid levels and found this discrepancy in penetration of the two media. 1~ Five antibiotics were chosen for this study: 1) chloramphenicol, 2) cephalothin, 3) ampicillin, 4) penicillin G, and 5) cephaloridine. Chloramphenicol is a well-established drug and penetrates many tissues with

Robert L. Campbell

Papers

Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts.

Intra-Abdominal Complications Following Ventriculoperitoneal Shunt Procedures

Intraspinal tumors in children. A review of 81 cases.

Atrial myxoma: a review of the neurological complications, metastases, and recurrences

Antibiotic Penetration of the Brain: A Comparative Study