Neurosurgery
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A 23-year-old Hispanic woman whose mother had died of a brain hemorrhage developed signs and symptoms of a brain stem lesion. These gradually progressed over the next 30 years. Her computed tomographic and magnetic resonance imaging scans show features typical of a cavernous angioma in the brain stem. ⋯ The daughter's computed tomographic and magnetic resonance imaging scans likewise suggest cavernous angioma of the brain stem. There has been only one other report of familial cavernous angioma of the brain stem, and that also involved a Hispanic family. Hispanics have a known predisposition to familial cavernous angioma, and this diagnosis should be considered when more than one person in a family develops brain stem symptoms.
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Over the past 18 months we have encountered 11 cases of symptomatic lumbar synovial cysts. This experience occurred during a period during which some 1,800 lumbar computed tomographic scans were done. ⋯ This is a report and discussion of our 11 cases with a review of the literature. There is nothing distinctive in the physical findings or in the histories of our patients, but we have found, as have others, that high-resolution computed tomographic scanning and magnetic resonance imaging significantly enhance the diagnosis of such lesions.
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Conventional therapy for solitary brain metastases includes radiotherapy and surgical resection in selected cases. Often, however, the metastasis recurs and limits the quality of life and survival of the patient. Once the metastasis recurs, therapeutic options are limited. ⋯ The implants allowed long term survival in the two patients with recurrent metastatic breast carcinoma. Unfortunately, the patient with melanoma did not respond to the brachytherapy and died within 7 months of implantation. The approaches to treatment to metastatic brain tumors and the rationale for using brachytherapy are discussed.
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The evaluation of patients with symptoms recurrent after disc surgery is a difficult diagnostic problem. The most common causes are recurrent herniation and postoperative scarring; routine x-ray and myelographic differentiation between herniation and scarring is difficult or impossible. High resolution computed tomography (CT) has shown some results in the evaluation of postoperative patients, but the role of epidural fibrosis in failed back surgery syndrome (FBSS) is not clear. ⋯ We scanned 20 asymptomatic operated patients and 20 patients with recurrent sciatic nerve pain after disc surgery who did not have bony stenosis, recurrent disc herniation, or other causes of FBSS. Our observations showed no important differences in the fibrosis demonstrated by CT between symptomatic and asymptomatic patients. The degree and type of fibrosis are not related to recurrent symptoms.
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An unusual case of Type I Chiari malformation that became symptomatic after closed head injury is reported. The patient manifested transient upper extremity weakness, persistent lower cranial nerve dysfunction, and cerebellar signs that slowly resolved. Magnetic resonance images showed tonsillar ectopia but no displacement of the brain stem or syringomyelia. Type I Chiari malformation should be included in the differential diagnosis of patients who present with upper extremity weakness, lower cranial nerve palsies, or cerebellar signs after trauma.