Spinal subarachnoid hematoma of spontaneous origin and complicating anticoagulation. Report of four cases and review of the literature

Four cases of spinal subarachnoid hematoma are reported and three cases from the literature reviewed. Clinical presentation is characterized by a combination of back pain and meningismus and progressive compression of the spinal cord. Pathogenesis, diagnosis, and differential diagnosis are discussed. Information obtained from myelography was limited, and two patients underwent operation without it. Prognosis for functional recovery is poor unless decompression is performed at an early stage.

[The Glasgow coma scale]

The value of the Glasgow coma scale is definite and widely accepted. It is a help in teaching a difficult subject, in mutual understanding in a few words, and in comparison of cases. It uses accurate and practical observations. It is the best method of measuring the state of consciousness, provided observation of the diameter and light reaction of the pupils is added It avoids what Jamieson and Yelland feared in 1968. "It is tragic if the wardmaid assesses deterioration by recognizing that a patient is not as bright now as earlier while trained staff await the development of the next stage in their preconceived, rigid scale of deterioration."

Convergence-evoked eyelid nystagmus

We studied two patients with eyelid nystagmus induced by ocular convergence. The first patient, a 29-year-old man, had the signs of a cerebellar syndrome after sustaining severe craniocerebral injuries. The second patient, a 12-year-old girl, had a tumor of the anterior vermis cerebelli. After treatment with corticosteroids (Patient 1) and surgery (Patient 2), the eyelid nystagmus gradually disappeared. An alteration in the cerebellar system is the most likely cause of convergence-evoked nystagmus.

Benign ependymal cyst of the pons

Clinical presentation, radiological aspects, surgical treatment and histology of a case of an ependyma-lined cyst of the pons are depicted. Slight psychomotor retardation and long-standing neurological signs associated with a marked dolichocephalic skull and right aortic arch suggest a congenital anomaly. Differential diagnosis of cystic lesions in the posterior fossa is discussed.

Monocytes in inflammatory bowel disease: absolute monocyte counts

Using a cytochemical staining technique, peripheral blood monocytes have been precisely identified and enumerated in patients with inflammatory bowel disease and compared with healthy and disease control subjects. For ulcerative colitis there was a significant monocytosis, which was closely correlated with the total white cell count and with the activity of the disease. For patients with Crohn's disease, the peripheral blood monocyte count was also raised compared with that of the control groups, but the difference did not reach statistical significance. There was no correlation between the monocyte count in patients with Crohn's disease and the total white cell count or the disease activity. Some of the mechanisms that may influence the production and distribution of peripheral blood monocytes are discussed.

[The computerized tomography in findings posttraumatic hematoma (author's transl)]

The authors report two cases of posttraumatic hematoma in the orbit. The first patient presents an unilateral amaurosis through indirect trauma of the optic nerve. The computerized tomography reveals a hematoma of the optic nerve sheath, confirmed by surgery. The second patient presents a posttraumatic limitation of the ocular motility and the computerized tomography reveals a hematoma of two extraocular muscles.

[Computerized tomography in finding tumours in the orbit and in the base of the skull (author's transl)]

Two cases of tumours - a pleomorphic poorly differentiated malignant neoplasm and a juvenile angiofibroma - involving the orbit and extending to the base of the skull are reported. In both cases computerized tomography showed with great precision the localization and the extension of the tumours.

[Preventive antibiotic therapy in neurosurgery]

The swiss neurosurgeons were asked to give their own politics on prophylactic antibiotics. The results of this enquiry are given. Post-operative infections in the Neurosurgical Clinic of Geneva in a four-year period were at a satisfactorily low rate and demonstrated the importance of many factors of risk. Guide lines for a reasonable prophylaxis in three groups of operations are given, with a precise schedule for each group. It is suggested that ones own surgical technique be severely criticized before considering prophylactic antibiotics.

[Neurosurgery of chiasma syndromes (author's transl)]

The conditions for the success of surgical interventions within the chiasmal region are careful preparation of the patient, ideal general anesthesia, precise surgical technique especially improved by the use of the microscope and bipolar coagulation. The surgical results also depend on the age of the patient, on his general condition, on the volume of the tumoral lesion and on the extent and kind of implication of the vascular and nervous structures of this region. The lesions are classified into extraparenchymatous lesions, intraparenchymatous lesions, giant aneurysms and inflammatory lesions. The extensive extraparenchymatous lesions represent the most important group: they comprise the pituitary adenomas, the cranio-pharyngiomas, the meningiomas and finally rarer tumors like the chordomas, or other tumors of the sphenoid. In these regions the choice of access is extremely important: transphenoidal, subfrontal intracranial or mixed. Among the intraparenchymatous lesions one has to mention first of all the gliomas of the chiasm and then the ectopic pinealomas. The giant aneurysm in older persons is improved the symptomatology by ligation of the internal carotid. The inflammatory arachnoidal lesions of the chiasm (specific or nonspecific) generally profit from an intervention aiming to disconnect the adhesions. X-ray therapy represents very often an indispensable component of the surgical treatment of the tumoral lesions. Apart from death the complications are postoperative infection, aggravation of the neuro-ophthalmological symptoms, the neuro-psychological consequences and the endocrinological and hypothalamic complications. Early diagnosis represents the best means to diminish the importance of the complications. An alternative complication is the tumor recurrence.

Electro-clinical follow-up of shunted hydrocephalic children

In a survey of 29 hydrocephalic children treated by ventriculoatrial shunt (Holter valve) with a follow-up of 4 years, EEG records before the operation and at least once a year thereafter, the authors can support the view that an epileptogenic focus has developed around the place of insertion of the ventricular catheter in 19 cases, leading to epileptic seizures in 17 up to now. Thus the incidence of convulsions in this particular group of patients is 0.59 (17/29), the limits of confidence 95% being 0.39-0.76. The irritative abnormalities occur usually during the second year after the operation and the delay for the onset of clinical seizures is variable. The age at operation seems to influence the occurrence of the epileptogenic scar. The type of hydrocephalus and especially the presence of an associated cerebral focal lesion can be of importance in the development of clinical seizures.

Value of gas myelography in early management of acute cervical spinal cord injuries

Gas myelography was carried out in 22 patients with acute cervical spinal cord injuries in whom oily contrast media seemed contraindicated. The authors believe this technique makes a valuable contribution to the basic decision regarding the surgical versus medical treatment of a specific patient with a cervical cord injury. They emphasize the importance of visualizing cord compression due to disc herniation in these cases and conclude that gases are the optimal contrast agents for visualization of the entire circumference of the spinal cord.