Pediatric idiopathic intracranial hypertension: clinical and demographic features

Idiopathic intracranial hypertension (IIH) is a clinical condition characterized by elevated intracranial pressure and absence of clinical, laboratory or radiographic evidence of central nervous system infection, vascular malformation, intracranial space occupying lesion or hydrocephalus. In the last years the raising understanding of pediatric IIH, especially concerning its demographics and epidemiology, has brought up to a redefinition of diagnostic criteria and reevaluation of pathogenesis and treatment. The authors reviewed the records of nineteen consecutive children with newly diagnosed IIH in order to compare demographic characteristics, clinical pictures and ophthalmologic aspects as optic disc evaluation and visual field evaluation, as well as treatment modalities and follow up. Beside obesity and female gender, potential alternative risk factors remains to be investigated, which need a good collaboration between neuro-ophthalmologists and pediatric neurologists.     

Intracranial tumors simulating vascular lesions of the brain; a preliminary report

Occasionally in the presence of atypical symptoms it is difficult to distinguish between cerebrovascular disorders and intracranial tumors. Intracranial tumor should be suspected in cases of atypical symptoms of vascular lesion or even in typical cases in which the patient does not show expected improvement. In a group of eight cases the problem of differential diagnosis was not confined to those in which the patients were elderly. Furthermore, papilledema and elevated spinal fluid pressure were absent in all these cases. The absence of these signs, therefore, does not eliminate the possibility of an intracranial tumor.The electroencephalogram is an important adjunct in differential diagnosis. In this series, electroencephalograms lateralized the lesion correctly in every case and localized it in one. The importance of repeated electroencephalographic examination if wave patterns are normal in the first tracing was clearly illustrated in three instances.Ventriculography, which in six cases finally established the diagnosis, and the site of the lesion, should not be postponed unnecessarily.     

Experience using two CT-guided stereotactic biopsy methods

15 patients had intracranial CT-guided stereotactic biopsies. Biopsies were performed either with a Riechert-Mundinger stereotactic frame modified for use in the CT or by using the CT scan to establish the relationship of the intracranial lesion to identifiable bony landmarks, and subsequently performing the biopsy in a standard stereotactic frame. Both systems provided safe and accurate methods for obtaining intracranial tissue.     

Primary intracranial epidermoid carcinoma

The cytologic findings in the cerebrospinal fluid in a case of primary intracranial epidermoid carcinoma are presented. The presence of a few squamous cells showing hyaline cytoplasm compatible with keratinization suggested the possible nature of the tomographically observed lesion. These tumors may arise in congenital epidermoid cysts at the base of the brain. Because of their location and meningeal spread, such tumors may cause severe symptoms and death despite a minute size, as illustrated by this case.     

Ependymal cyst in a cynomolgus macaque (Macaca fascicularis)

Background A focal hypointense intracranial lesion was detected by magnetic resonance imaging in the right caudal occipital lobe of the cerebrum in an asymptomatic cynomolgus macaque (Macaca fascicularis). Results Following euthanasia, gross evaluation of the lesion revealed a 1 cm diameter, wedge‐shaped intracranial cavitation without apparent communication with the ventricles. Histologically, the lesion was lined by ciliated cuboidal to low columnar epithelium that showed immunopositivity for cytokeratin, S‐100, and GFAP. Conclusion Based upon the gross, histologic, and immunohistochemical findings, this lesion was classified as an ependymal cyst. In the human patients, ependymal cysts are benign, non‐infectious, non‐inflammatory lesions of the central nervous system that are believed to originate from aberrant migration of ependymal cells during development. To our knowledge, this is the first report of an ependymal cyst in a non‐rodent veterinary species and the first report of a benign intracranial cyst of any classification in a non‐human primate.     

Reactivity of the cerebral resistance and capacitance vessels and blood-brain water exchange in the experimental brain injury

In conclusion, an estimate of the intracranial volumetric effects produced in anesthetized dogs by histamine, acetylcholine and CO2 shows that, on a basis of equiactivity on CBF, the effects of histamine on the intracranial content are twice greater than those produced by acetylcholine and CO2. This difference may be explained by a greater activity of histamine on the intracranial capacitance vessels and/or by an increase in the fluid escape from blood to the brain produced by histamine. Data obtained after the production of an acute, cold induced brain lesion support the second possibility.     

Congenital malignant melanoma.

The diagnosis and management of a 3-day-old infant with an exophytic pigmented growth on her back and chest are discussed. At 3 days of age, the child underwent a complete surgical excision of this lesion with immediate coverage by partial-thickness skin grafts. Pathologically, the lesion proved to be a thoracolumbar congenital melanocytic nevus with multiple focal areas of malignant melanoma. The child is now 3 years past surgery and shows no evidence of recurrence or distant metastases. The importance of this case lies in the presence of overt malignant melanoma at birth within a giant congenital nevocytic nevus.     

Cerebral Strokes Associated with Pregnancy and the Puerperium

Thirty-one cases of ischaemic cerebral stroke occurring in association with childbirth were fully investigated. The pathological basis of non-haemorrhagic carotid territory strokes in pregnant or puerperal women proved to be similar to that in non-pregnant women of the same age group. Over 70% were due to occlusive cerebral arterial disease or ischaemic lesions unrelated to thrombosis of the intracranial venous system. Comparisons are made with some other reported series in which only a minority of the patients were investigated by angiography, but in which intracranial venous occlusion was assumed to be the primary lesion. It seems likely that many of these patients may also have suffered arterial rather than venous lesions.     

Intracranial hydatidosis. Report of a case diagnosed on cerebrospinal fluid cytology

BACKGROUND: Hydatidosis occurs due to infestation with the larval stage of the Echinococcus species. Humans are incidental hosts. Symptoms and signs in humans are a slowly growing mass lesion, especially in the central nervous system. Diagnosis depends on the appropriate presentation and history with corroborative radiology and serology. Microscopic detection of characteristic parasitic scolices and hooklets is confirmatory. CASE: A 10-year-old girl presented with complaints of headaches and convulsions for the preceding several months. Computed tomography findings showed asymmetric dilatation of the right lateral ventricle by an intraventricular, focally calcified mass. The radiologic suspicion was an intraventricular tuberculoma, hydatid cyst or choroid plexus papilloma. Cytologic examination of cerebrospinal fluid (CSF) smears revealed characteristic echinococcal components. CONCLUSION: Intracranial hydatid cyst is a fairly uncommon manifestation of an echinococcal infestation and shares clinicoradiologic features with several intracranial, space-occupying lesions. Cytologic examination of CSF samples may be employed to detect confirmatory evidence of a clinical/radiologic suspicion.     

Voxel-Based Sensitivity of Flat-Panel CT for the Detection of Intracranial Hemorrhage: Comparison to Multi-Detector CT

ObjectivesFlat-panel CT (FPCT) allows cross-sectional parenchymal, vascular and perfusion imaging within the angiography suite, which could greatly facilitate acute stroke management. We hypothesized that FPCT offers equal diagnostic accuracy compared to multi-detector CT (MDCT) as a primary tool to exclude intracranial hemorrhage.Methods22 patients with intracranial hematomas who had both MDCT and FPCT performed within 24 hours were retrospectively identified. Patients with visible change in hematoma size or configuration were excluded. Two raters independently segmented hemorrhagic lesions. Data sets and corresponding binary lesion maps were co-registered to compare hematoma volume. Diagnostic accuracy of FPCT to detect hemorrhage was calculated from voxel-wise analysis of lesion overlap compared to reference MDCT.ResultsMean hematoma size was similar between MDCT (16.2±8.9 ml) and FPCT (16.1±8.6 ml), with near perfect correlation of hematoma sizes between modalities (ρ = 0.95, p<0.001). Sensitivity and specificity of FPCT to detect hemorrhagic voxels was 61.6% and 99.8% for intraventricular hematomas and 67.7% and 99.5% for all other intracranial hematomas.ConclusionsIn this small sample containing predominantly cases with subarachnoid hemorrhage, FPCT based assessment of hemorrhagic volume in brain yields acceptable accuracy compared to reference MDCT, albeit with a limited sensitivity on a voxel level. Further assessment and improvement of FPCT is necessary before it can be applied as a primary imaging modality to exclude intracranial hemorrhage in acute stroke patients.     

Two L1-peptides are excellent tools for serological detection of HPV-associated cervical carcinoma lesions

A persistent high risk human papillomavirus (HR-HPV) infection causes cervical intraepithelial lesions and cervical carcinoma. There is evidence that detecting anti-L1 antibodies could be successfully used for discriminating between cervical lesion patients and women having normal cytology. It was found that peptides 18283 (55PNNNKILVPKVSGLQYRVFR74) and 18294 (284LYIKGSGSTANLASSNYFPT300) from the L1-surface exposed regions were specifically recognised by antibodies from the cervical lesion patient sera. These peptides were tested against 165 womens' normal cytology sera and 148 cervical lesion or cervical cancer patients' sera. Less than 3.6% of women's normal cytology sera recognised peptides 18283 or 18294; on the contrary, 91% to 96% of the cervical lesion (CIN I to CIN III) or cervical cancer patient sera recognised peptides 18283 and 18294. These data show that anti-peptide 18283 and 18294 antibodies in the patients' sera are strongly associated with the presence of HR-HPV associated cervical lesions, showing 92-97% sensitivity and 89-95% specificity in recognising precancerous and cervical cancer patients. These two peptides could be excellent tools for use in large-scale serological screening of women populations at risk of developing cervical carcinoma.     

Free Radical-Induced Tandem Base Damage in DNA Oligomers

A new tandem base lesion has been identified in two DNA oligomers, namely d(GpT) and d(CpGpTpA), exposed to X-irradiation in deoxygenated aqueous solution. In this lesion the C6 carbon atom of thymine is hydroxylated and a covalent link is formed between the C5 carbon atom of thymine and the C8 carbon atom of the adjacent guanine base. In addition, further evidence in the form of mass spectrometric data is presented confirming the structures of previously reported tandem base lesions that are produced by ionizing radiation in the presence of oxygen. New data is presented on the prevalence of a previously reported tandem base lesion in which the methyl carbon atom of thymine is covalently linked to the C8 carbon atom of the adjacent guanine base. The free radical-initiated processes by which tandem base damages are generated are discussed. To date four different radiation-induced tandem base lesion have been identified. The evidence suggests that tandem base damage is a significant component of free radical-induced DNA damage.     

Epethelial Presence of Trueperella pyogenes Predicts Site-Level Presence of Cranial Abscess Disease in White-Tailed Deer (Odocoileus virginianus)

Cranial/intracranial abscess disease is an emerging source of significant mortality for male white-tailed deer (Odocoileus virginianus). Most cases of cranial/intracranial abscess disease are associated with infection by the opportunistic pathogen Trueperella pyogenes although the relationship between the prevalence of the bacteria and occurrence of disease is speculative. We examined 5,612 hunter-harvested deer from 29 sites across all physiographic provinces in Georgia for evidence of cranial abscess disease and sampled the forehead, lingual, and nasal surfaces from 692 deer. We used polymerase chain reaction (PCR) to determine presence of T. pyogenes from these samples. We found T. pyogenes prevalence at a site was a predictor for the occurrence of cranial abscess disease. Prevalence of T. pyogenes did not differ between samples from the nose or tongue although prevalence along the forehead was greater for males than females (p = 0.04), particularly at sites with high occurrence of this disease. Socio-sexual behaviors, bacterial prevalence, or physiological characteristics may predispose male deer to intracranial/cranial abscess disease. Determination of factors that affect T. pyogenes prevalence among sites may help explain the occurrence of this disease among populations.     

Clinical Aspects of Thyroid Cancer

Confusion still prevails regarding the selection of patients with thyroid nodules for surgical treatment. Classical features of malignancy do not apply to growths of the thyroid gland. Duration, size, presence of calcification, scintiscanning and response to thyroid feeding are not, in themselves, reliable indicators of the absence or presence of malignancy. In 78 personal thyroidectomies there was a 60% overall neoplasm rate and a 25% malignancy rate. Operation is indicated for the thyroid lesion which is solitary, cold, unresponsive to thyroid feeding or accompanied by obvious evidence of malignancy. Recent experience indicates that thyroid surgery has a low morbidity and negligible mortality. Surgical treatment of the common forms of thyroid cancer yields excellent results if it is complete and is expertly done.     

An autopsy case of epignathus (immature teratoma of the soft palate) with intracranial extension but without brain invasion: case report and literature review

Background

Epignathus is a rare congenital orofacial teratoma infrequently associated with intracranial extension. Intracranial extension of an epignathus indicates a poor prognosis; however, only a small number of such cases have been reported. While there have been some studies reporting cases of epignathus expanding directly into the cranium, others have reported no communication between an epignathus and an intracranial tumor.

Case presentation

A fetus at gestational week 27 was suspected of having an epignathus with intracranial tumor as shown by ultrasonographic and magnetic resonance imaging. The fetus was stillborn and an autopsy was performed. An epignathus measuring 12?×?6?×?6?cm and weighing 270?g protruded from the mouth, with its base on the soft palate. An intracranial tumor weighing 14?g was located at the middle intracranial fossa and connected to the epignathus through the right side of the sella turcica. The intracranial tumor was encapsulated, and there was no invasion into the brain. Histologically, both the epignathus and intracranial tumor were immature teratomas, with neural and pulmonary components that were especially immature as compared to those of the internal organs and brain tissues of the fetus.

Conclusion

There have been several reports of epignathus and intracranial tumors that did not communicate; therefore, careful evaluation is needed when a fetus is suspected of having an epignathus extending into an intracranial lesion. Our case supports the findings that an epignathus can directly expand into the cranium. Moreover, this is a rare case of an epignathus in which the intracranial lesion was encapsulated and did not invade the brain. These rare but important findings will provide additional, potential therapeutic strategies for gynecologists, neurosurgeons, and pathologists.

     

高龄（80-89 岁）非ST 段抬高心肌梗死早期 介入治疗的疗效观察

目的:研究调查高龄(80-89岁)非ST段抬高心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者行早期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的有效性。方法:回顾分析2008年8月-2009年10月期间我院住院的66例80-89岁NSTEMI患者,冠状动脉造影检查后45例行PCI术,5例因为左主干病变或者严重的三支病变行冠脉搭桥(CABG)术,其余16例做保守治疗。发病到行介入治疗时间<72h。结果:45例行PCI术中42例成功,再血管化的成功率为63.6%,失败的3例PCI术病人中2例因导丝或球囊未能通过病变,1例为顽固性室速。共植入支架80枚,术后梗死相关动脉血流均达到TIMI2-3级。术后死亡2例(心源性休克、颅内出血各1例),死亡率为4.8%。住院期间出血并发症较高,有4(9.5%)例(穿刺部位血肿2例,消化道、颅内出血各1例)。住院期间无再发心肌梗死,偶发心绞痛2例。结论:穿刺尽管高龄(80-89岁)非ST段抬高心肌梗死冠脉早期介入主要出血事件较多,但可改善住院期间的预后。     

Value of computed tomography in patients with stroke: Oxfordshire Community Stroke Project.

The usefulness of computed tomography (CT) was assessed in 325 consecutive patients with a "clinically definite first stroke" from a community stroke register. CT detected five "non-stroke" lesions (two cerebral gliomas, one cerebral metastasis, and two subdural haematomas), a frequency of 1.5%. Five patients were identified with cerebellar haemorrhage, but only one survived long enough to have a CT scan. CT was useful in excluding intracranial haemorrhage as the cause of the stroke in four patients receiving anticoagulants and seven receiving antiplatelet treatment; it showed intracranial haemorrhage in one patient taking aspirin. Forty six patients were in atrial fibrillation at the time of their stroke; four had intracranial haemorrhages and three had haemorrhagic cerebral infarcts. Nineteen patients with presumed ischaemic minor stroke were considered suitable for carotid endarterectomy; CT showed small haemorrhages in two. The CT scan provides very useful information in a minority (up to 28%) of patients with first stroke, who can be selected on quite simple criteria: (a) doubt (usually because of an inadequate history) whether the patient has stroke or a treatable intracranial lesion; (b) the possibility of cerebellar haemorrhage or infarction; (c) the exclusion of intracranial haemorrhage in patients who either are already taking or likely to need antihaemostatic drugs or are being considered for carotid endarterectomy; (d) if the patient deteriorates in a fashion atypical of stroke.     

Craniofacial dermoids

Thirty-two patients with nasal dermal sinuses and cysts were treated during the 10-year period from 1978 to 1987. These patients presented with midline cysts (N = 18) or sinus ostia (N = 14). Only 6 of the 32 patients manifested intracranial extension (19 percent). All the patients with intracranial extension exhibited an intracranial mass on preoperative CT scans. Ten patients with no CT evidence of intracranial mass were noted to have only a fibrous cord extending to the base of the foramen cecum. In 4 of these 10 patients, craniotomy confirmed that there was no intracranial extension of the dermoid. Four other patients presented with sinus ostia at the base of the columella. None of these 4 patients had intracranial extension. Clinical examination and preoperative CT scans provide most of the information needed to determine the nature, course, and extent of these lesions.     

Cranial computed tomography in infants and children.

Cranial computed tomography has been performed in adults for the past 2 years but relatively few children have undergone this procedure. The specific uses in children are in detecting intracranial mass lesions and identifying the character of the lesion, and evaluating congenital cranial diseases such as cerebral dysplasia, tuberous sclerosis and leukodystrophies. This safe, rapid, noninvasive technique will soon replace or supplement standard neuroradiologic techniques in infants and children.     

Lumbar Puncture in the Presence of Raised Intracranial Pressure

Study of 30 patients with raised intracranial pressure whose condition worsened after lumbar puncture emphasizes the danger of carrying this out in the presence of raised intracranial pressure. In half the cases deterioration was immediate and dramatic, and in the other half it occurred within 12 hours. Probably a tentorial or cerebellar pressure cone, or both, had formed before lumbar puncture, and the procedure made this worse and caused the clinical deterioration.A history of progressive headache associated with mental changes, and the development and progression of localizing neurological signs were the two features suggestive of varied intracranial pressure found most constantly in this series. A good quality plain x-ray film is important in the diagnosis of this condition.