1/10. Postpartum cerebellar herniation in von Hippel-Lindau syndrome.PURPOSE: To describe exacerbation during pregnancy of cerebellar hemangioblastoma in von Hippel-Lindau syndrome. METHOD: Case-report. A 21-year-old woman with von Hippel-Lindau syndrome was found on routine ocular examination to have severe papilledema 1 week after giving birth. RESULTS: Immediate magnetic resonance imaging disclosed a large cerebellar cyst from hemangioblastoma causing cerebellar tonsillar herniation. Immediate neurosurgical intervention was life saving. CONCLUSION: Worsening of intracranial hemangioblastoma during pregnancy in cases of von Hippel-Lindau syndrome should be realized and periodic neurologic and ophthalmologic observation is warranted.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/10. Auditory brainstem response and temporal bone pathology findings in a brain-dead infant.The criteria for assessing adult brain death have been already established, but those for infant brain death have not been yet established in japan. We report auditory brainstem response (ABR) and postmortem pathology of the temporal bone and brain of a brain-dead 9-month-old female. During the comatose state, her ABR showed only waves I and II bilaterally. autopsy revealed the presence of a left cerebellar astrocytoma, herniation and anoxic encephalopathy. The pathological examination of the temporal bone revealed the destruction of the inner ear particularly on the left side. In the auditory pathway of brain-dead patients, degeneration occurs first in the cerebrum, followed by the cochlear nerve. Thus, ABR is one of the useful means to assess brain death even in infants.- - - - - - - - - - ranking = 0.2keywords = herniation (Clic here for more details about this article) |
3/10. Posterior fossa decompression for life-threatening tonsillar herniation in patients with gliomatosis cerebri: report of three cases.OBJECTIVE AND IMPORTANCE: Gliomatosis cerebri (GC) is a rare type of primary brain tumor that diffusely infiltrates more than two lobes of the brain while the normal cerebral architecture is maintained. To the best of our knowledge, the association between an acquired tonsillar herniation and GC has never been reported. In this article, we describe three patients with progressive gliomatosis of the cerebellar hemispheres who subsequently showed signs and symptoms secondary to tonsillar herniation. Early recognition of this potentially life-threatening complication allowed us to recommend prompt surgical intervention. CLINICAL PRESENTATION: One patient with primary, or Type I, GC presented with suboccipital headaches, and two patients with secondary, or Type II, GC presented with the signs and symptoms of progressive myelopathy. Serial imaging studies demonstrated progressive involvement of the cerebellum, descent of the cerebellar tonsils through the foramen magnum, and cervicomedullary spinal cord compression. INTERVENTION: Once the tonsillar herniation was recognized, all three patients underwent posterior fossa decompression, a cervical laminectomy to the lowest level of the tonsillar herniation, and duraplasty. All three patients experienced immediate improvement in their conditions. CONCLUSION: Early recognition of tonsillar herniation, a possibly overlooked cause of death in patients with GC, allows for early surgical intervention as a potentially lifesaving procedure and significant improvement in the patient's condition.- - - - - - - - - - ranking = 1.8keywords = herniation (Clic here for more details about this article) |
4/10. Cowden disease with Lhermitte-Duclos disease: case report.BACKGROUND: We report a case and review the recent literature describing 36 patients with both Lhermitte-Duclos disease (LDD) and Cowden disease (CD). Lhermitte-Duclos disease, or dysplastic gangliocytoma, is a benign hamartomatous condition involving the cerebellum. The presenting symptoms are usually headaches, gait ataxia, and symptoms of lower cranial nerve involvement. Cowden disease is a rare autosomal dominant disease that usually presents with multiple mucocutaneous lesions. patients with CD are prone to multiple systemic malignancies, the most common of which is breast cancer. Recent studies have demonstrated an association between LDD and CD. methods: A 44-year-old woman with a previous history of breast cancer, multiple benign skin lesions, Hashimoto's thyroiditis, and chronic headaches presented with exacerbation of her headaches during the previous year. magnetic resonance imaging of the brain revealed a right cerebellar nonenhancing mass and an acquired tonsillar herniation. RESULTS: The patient underwent resection of the right cerebellar mass, posterior fossa decompression, C1 and C2 laminectomies, and a duraplasty. Pathologic examination confirmed LDD. The patient recovered well after surgery, with immediate improvement of her headaches. CONCLUSIONS: The association between LDD and CD has been under-recognized and under-reported. Recognition of this association has direct clinical relevance, because diligent monitoring of individuals with LDD and CD may lead to the early detection of systemic malignancies.- - - - - - - - - - ranking = 0.2keywords = herniation (Clic here for more details about this article) |
5/10. Fatal haemorrhage in medulloblastoma following ventricular drainage. Case report and review of the literature.Haemorrhage in medulloblastoma is reported to be very rare. The authors report a case of a 13-year-old boy who presented with headache, unsteadiness, diplopia and papilloedema due to posterior fossa medulloblastoma causing obstructive hydrocephalus. Six hours following placement of an external ventricular drain, he suddenly became comatose with respiratory arrest. The cause was marked upward herniation of the anterior vermis and downward herniation of the cerebellar tonsils due to massive spontaneous intratumoural haemorrhage extended into the ventricular system. This atypical clinical course of fatal haemorrhage in medulloblastoma after insertion of external ventricular drainage is reported and the literature discussed.- - - - - - - - - - ranking = 0.4keywords = herniation (Clic here for more details about this article) |
6/10. diagnosis of ascending transtentorial herniation by cranial computed tomography.The secondary effects of large infratentorial masses may include ascending transtentorial herniation. Rostral displacement of the superior vermis through the tentorial incisura can be accurately detected by cranial computed tomography. Signs of early or impending upward herniation are compression and slight posterior flattening of the quadrigeminal plate cistern. Progressively more severe herniation produces amputation of the peritcetal cerebrospinal fluid diamond, leading to a triangle or "squared off" appearance of the confluent quadrigeminal and superior cerebellar cisterns. When the disorder is severe, the herniated vermis plugs the incisura, completely effacing these cisterns and flattening the posterior third ventricle. Obstructive hydrocephalus may also occur with moderate or severe herniation.- - - - - - - - - - ranking = 1.6keywords = herniation (Clic here for more details about this article) |
7/10. Remote cerebral hemisphere symptoms from surgically treated patients with posterior fossa brain tumors; vascular factors: a basis for a theory concerning space sickness.Three case histories of patients with large tumors in the posterior fossa who were operated on in a sitting position subsequently developed 1 or more symptoms referable to the temporoparietooccipital regions of the brain 24 to 48 hours postoperatively. Initially, it was believed that such symptoms were due to a stimulation of the association pathways causing firing of remote association areas (See Ch. 4). Subsequent studies of the rotation of blood vessels of the brain in the developing embryo and a review of the anatomical location of the arteries supplying the temporoparietooccipital region led to the conclusion that some compromise of the posterior cerebral artery was responsible for the symptoms. The symptomatology in these brain tumor patients was not unlike that seen in the cosmonauts and astronauts in space flight, designated as "motion sickness" in the space literature. A suggestion was made as to clarification of the definitions. This author advocated that the term "motion sickness" be confined to those symptoms of dizziness, nausea, and vomiting, due to involvement of the peripheral end organ, the inner ear. "Space sickness" might include these symptoms but also might have the addition of disorientation or the inversion of image in space and formed or unformed hallucinations. These relate to the temporoparietooccipital area, the midtemporal, and the occipital regions. In such instances, there must be central involvement or a stimulation of this interpretive cortex of the brain. The remote symptoms from the supratentorial cotex were believed to be due to hypoxia related to the posterior cerebral artery compromise, resulting in delayed "luxury perfusion" and the development of local lactic acidosis. Transaxial transmission of force with an uncal tentorial herniation causing compression of the posterior cerebral artery was suggested as a mechanism responsible for the vascular compression.- - - - - - - - - - ranking = 0.2keywords = herniation (Clic here for more details about this article) |
8/10. hydrocephalus and infratentorial tumors. incidence, clinical picture, and treatment.One may consider that the child with hydrocephalus complicating a primary brain tumor has two distinctly different diseases: 1) a neoplasm, and 2) hydrocephalus. The hydrocephalus may be obstructive, communicating, or (in the case of choroid plexus papilloma) hypersecretory. This paper presents the incidence, symptomatology, and management of hydrocephalus associated with infratentorial brain tumors in 156 children and with pineal tumors in 21 children, all treated by the first author during the period 1967 to 1979. medulloblastoma was the most commonly encountered tumor. Of 117 children with cerebellar-fourth ventricle tumors, 110 had hydrocephalus, whereas 11 of 34 with brain-stem tumors and all 21 with pineal tumors presented with hydrocephalus. Of the total 143 patients with hydrocephalus, shunts were inserted before craniotomy in 123, with the interval between shunt insertion and craniotomy for tumor removal ranging from 1 to 21 days. Eighteen of these children required shunt revisions after craniotomy; 36 of 80 patients followed for 6 months or more had their shunts permanently removed, but it was necessary to reinsert the shunt from 5 days to 13 months later in 30% of these patients. Only 25 patients remained permanently shunt-free. It is considered that the placement of shunts before craniotomy is justified by the extraordinarily high incidence of papilledema and visual impairment associated with hydrocephalus. "Upward herniation" and dissemination of neoplastic cells through the shunting system are theoretical contraindications to precraniotomy shunt insertion, although the former is rare (3%), and there is no statistical evidence to support the latter.- - - - - - - - - - ranking = 0.2keywords = herniation (Clic here for more details about this article) |
9/10. motion sickness: part III--a clinical study based on surgery of posterior fossa tumors.Three patients who had large, benign cerebellar tumors were operated upon in the sitting position and developed symptoms referable to the temporoparieto-occipital region of the brain 24-48 h postoperatively. They consisted of dizziness, nausea, vomiting, formed and unformed hallucinations, and inversion of image or disorientation in space, some of which were experienced by some of the astronauts and cosmonauts during space flight. Such findings are not due to stimulation of the cerebellum, the site of the lesion, but must come from the cerebral hemisphere. The symptoms were believed to be caused by "the luxury perfusion" of Lassen with the development of local lactic acidosis secondary to vascular insufficiency to the brain in the distribution of the posterior cerebral artery thus stimulating the temporoparieto-occipital region. This theory is suggested to some degree by the work of Endo et al. using CT scans, which showed the shifting of increased blood flow from the frontal region to the temporoparieto-occipital region following removal of a benign posterior fossa tumor. The mechanism for the compression of the posterior cerebral artery may be due to uncal herniation at the tentorium. The authors believe that it might be well to consider further testing in a vertical or oblique plane rather than only in a centrifugal horizontal one. This method would tend to cause uncal herniation more readily. Monitoring of such effects could be done with the colored CT scan.- - - - - - - - - - ranking = 0.4keywords = herniation (Clic here for more details about this article) |
10/10. infarction of the territory supplied by the contralateral superior cerebellar artery in a case of descending transtentorial herniation.infarction of the territory supplied by the contralateral superior cerebellar artery in cases of descending transtentorial herniation has not been reported. The authors experienced a primitive neuroectodermal tumor in a patient whose consciousness deteriorated transiently due to descending transtentorial herniation. On the magnetic resonance imaging taken 8 days after the herniation, lesions thought to be infarction of territories supplied by the ipsilateral posterior cerebral artery and the contralateral superior cerebellar artery were noted. The possible mechanism of this peculiar pattern of infarction is discussed.- - - - - - - - - - ranking = 1.4keywords = herniation (Clic here for more details about this article) |
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