11/15. Extramedullary hematopoiesis in a malignant meningioma.An unusual case of malignant intracranial meningioma is presented. The operative management was complicated by the abrupt development of fulminant brain edema and herniation. The tumor contained areas of extramedullary hematopoiesis, a finding not previously reported. Various pathogenetic mechanisms involved in intradural extramedullary hematopoiesis are discussed.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
12/15. Lumbosacral intradural tumours simulating disc disease.Twelve patients with symptoms and signs simulating lumbar disc disease were found to have intradural tumours in the lumbosacral area. Of the nine patients with a neurofibroma, two had previously had a laminectomy for an erroneous diagnosis of disc herniation and one had three separate tumours which were excised in two successive operations. One of the three patients with an ependymoma had a coccygectomy before the correct diagnosis was made. Only one patient who had an ependymoma showed radiographic abnormalities suggesting a neoplastic lesion, but eight of the ten cases in which the cerebrospinal fluid was analyzed had a protein content of 50 mg per 100 ml. myelography provided the correct diagnosis in all cases. Excision of the tumour resulted in full clinical recovery except for one patient with an ependymoma.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
13/15. Infradiaphragmatic spinal tumours demonstrated by transfemoral epidural venography.During the last few years transfemoral epidural venography has increasingly been used for diagnosing lumbar disc herniation. Occasionally this method may reveal an unexpected malignant tumour with the clinical symptoms of lumbar disc disease. Therefore it is of interest to be acquainted with the venographic signs of malignancy in this area. Moreover transfemoral epidural venography can be of help in the delineation of a tumour in the vertebral canal. If the double-catheter method is used, the anterior epidural venous plexus will, as a rule, be adequately shown up to the level of T10. Occasionally higher thoracic levels also are visualised. The procedure can easily be performed on an out-patient basis and is well tolerated by the patient. The complication rate is very low. The use of ioxaglate (Hexabrix) minimizes the post-injection reactions to the contrast medium.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
14/15. CPH and hemicrania continua: requirements of high indomethacin dosages--an ominous sign?Two female patients, one with chronic paroxysmal hemicrania and one with hemicrania continua, had a continuously high requirement of indomethacin, ie, > or = 225 mg per day, for 4 and 7 years, respectively. In the hemicrania continua patient, a right (symptomatic side) C7 root affection due to disc herniation was demonstrated. Removal of the disc relieved the arm pain completely, and reduced the head pain and indomethacin requirement considerably initially. The other patient suffered from the unremitting form of chronic paroxysmal hemicrania with right-sided attacks from the age of 16. indomethacin, 200 to 250 mg per day generally kept the headache at bay, but during exacerbations, especially during menstrual periods, the dosage transitorily had to be increased to 250 to 350 mg per day. A CT scan with contrast at aged 18 (1987) was negative. In 1992, she started having new symptoms, including numbness on the ipsilateral side of the face and arm and difficulty swallowing. An MR scan showed a meningioma originating in the roof of the cavernous sinus on the symptomatic side. The meningioma was surgically removed. The postoperative indomethacin requirement was reduced, but only transiently. patients with chronic paroxysmal hemicrania (CPH) and hemicrania continua (HC) with a continuously high indomethacin requirement may have grave additional disorders and should consequently be followed closely.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
15/15. Acute encephalopathy after initiation of cranial irradiation for meningeal leukaemia.Five patients experienced severe encephalopathy within hours of receiving their initial dose of cranial irradiation for the treatment of central-nervous-system leukaemia. Neurological findings included cranial-nerve palsies, seizures, ataxia, depressed consciousness, increased intracranial pressure, and signs of herniation. Symptoms developed within 3-30 hours of the first radiation treatment of 50-200 rad. Each patient had also received one or more injections of intrathecal chemotherapy before encephalopathy developed. The aetiology of this syndrome is uncertain but may involve transient cerebral oedema and/or an altered blood-brain barrier produced by the combination of intrathecal chemotherapy and cranial irradiation.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
| <- Previous | |