Factors affecting the outcome of foetal hydrocephaly

In this study, the authors attempt to provide an account of the factors that affect the outcome of hydrocephaly in 26 foetuses. The hydrocephalus was related to a myelomeningocele in 35% of patients. Sixty-two percent of foetuses showed intra-uterine progression of their hydrocephalus and 50% were shunted postnatally. At a mean follow up of 2 years, the outcome was considered "fair" in 54% of patients. Our findings demonstrate that in foetal hydrocephaly a more favourable outcome is expected in patients with hydrocephalus which does not progress in utero, in whom the labour is not induced before 36 weeks of gestation, who are delivered vaginally weighing more than 2.5 kg and have a head circumference below the 95th centile and a CT cortical mantle thickness of 2 cm and more and who are treated by CSF shunting. The diagnosis of the foetal hydrocephaly at or before 28 weeks of gestation and the presence of a myelomeningocele did not affect the outcome significantly. Neurosurgeons are reminded to keep an open mind for infants with foetal hydrocephaly and to offer active treatment to patients with a potentially favourable outcome.

Orbito-cranial injury caused by penetrating metallic foreign bodies: report of two cases

Two cases of orbito-cranial injury caused by foreign bodies (FBs) penetrating the lateral wall and roof of the orbit are described. In the first patient, a long rusted nail acted as a missile and was only detected by X-rays and CT scan. The nail penetrated the orbit, the eyeball, the lateral orbital wall, and the temporal lobe of the brain. Lodged partly in the orbit and partly in the brain, this nail caused leakage of cerebrospinal fluid (CSF) through eye and led to orbital cellulitis and localized meningitis. The foreign body (FB) was removed through an extradural pterional approach with rapid resolution of orbital cellulitis and meningitis. In the second patient, large metallic FB, having penetrated the orbital roof was lodged intracranially above the chiasma. This was removed via frontal craniotomy. Mechanism of such injuries and appropriate surgical approaches are described as well.

Disparity between diastolic mitral flow characteristics and left ventricular mass in essential hypertension

Because left ventricular (LV) hypertrophy and aging have been associated with abnormal LV relaxation, this study evaluated the impact of LV mass on the filling patterns derived by Doppler in a large population aged > or =50 years. Results suggest that in essential hypertension the intrinsic myocardial composition is more important than cardiac hypertrophy in determining LV diastolic properties. This apparent discrepancy between LV mass and diastolic filling patterns highlights the difficulty in establishing the diagnosis of diastolic dysfunction in elderly hypertensives.

Receptor-specific in vivo desensitization by the G protein-coupled receptor kinase-5 in transgenic mice

Transgenic mice were generated with cardiac-specific overexpression of the G protein-coupled receptor kinase-5 (GRK5), a serine/threonine kinase most abundantly expressed in the heart compared with other tissues. Animals overexpressing GRK5 showed marked beta-adrenergic receptor desensitization in both the anesthetized and conscious state compared with nontransgenic control mice, while the contractile response to angiotensin II receptor stimulation was unchanged. In contrast, the angiotensin II-induced rise in contractility was significantly attenuated in transgenic mice overexpressing the beta-adrenergic receptor kinase-1, another member of the GRK family. These data suggest that myocardial overexpression of GRK5 results in selective uncoupling of G protein-coupled receptors and demonstrate that receptor specificity of the GRKs may be important in determining the physiological phenotype.

Subtentorial diverticulum of the third ventricle associated with a mural cavernous angioma in a child

The authors describe a case of a large subtentorial supracollicular diverticulum of the third ventricle associated with a cavernous angioma in its wall in a 6-year-old girl who presented with developmental delay and obstructive hydrocephalus. This is the first case in which such association has been diagnosed and successfully treated. The literature is reviewed, and the possible relationship between these two rare lesions is discussed.

Brain granulocytic sarcoma at the site of previous cerebral hemorrhage in a patient with acute myelogenous leukemia

An unusual case of granulocytic sarcoma developing at the site of a previous cerebral hemorrhage in a patient with acute myelogenous leukemia in complete hematological remission is presented. The pathogenesis of the tumor growth at this site and its relevance to the antecedent hemorrhage are discussed.

Computed tomographic evidence of an extensive thrombosis and infarction of the deep venous system

BACKGROUND

Massive bilateral infarcts due to deep venous system thrombosis are extremely rare and poorly documented. We present a case with computed tomographic evidence of both thrombosis and infarction of the whole deep venous system.

CASE DESCRIPTION

A previously healthy 30-year-old woman who had taken oral contraceptives for 3 years complained of recurrent headaches and transient visual obscuration. Three months later, she suddenly became comatose and was found to have papilledema. She rapidly worsened, became decerebrate, and died within 48 hours. Noncontrast computed tomographic scan showed the spontaneous hyperdensity of the thrombosed deep veins and a massive bilateral centrobasilar hypodensity suggestive of a deep venous system infarction.

CONCLUSIONS

This case shows that cerebral venous thrombosis can masquerade during 3 months as benign intracranial hypertension and then make a dramatic extension to the deep cerebral veins. It illustrates extensive thrombosis of the deep venous system as a possible cause of rapid coma and decerebration and stresses the importance of computed tomographic scan to show both the thrombosed veins and the venous infarct, which allows delineation of the deep venous system territory.

Lumbosacral plexus avulsion injury: clinical, myelographic and computerized tomographic features

A rare case of lumbosacral plexus avulsion studied with computerized tomography (CT) in a 5-year old Saudi involved in a vehicular accident with resultant left lower limb monoparesis is presented. Myelography and CT were superior to electromyographic findings in this case. Such cases should be closely followed and surgical exploration and decompression offered if any evidence of cauda equina compression develops.

Nasal encephalocoele. Treatment by trans-cranial operation

Results are described of 86 intracranial operations for the repair of nasal encephalocoele children at the Lahore Neurosurgical Centre in the last 13 years. These midline lesions at the base of the anterior cranial fossa have been considered in the past to be inoperable and even when operable, unpleasantly difficult. The intracranial approach has made it possible to treat this condition satisfactorily with comparatively few complications. Attempts at extra-cranial repair have met little success as they do not take into account the basic embryology and anatomy of the condition and fail to tackle the sac at the patent foramen caecum, the neck of the sac. This paper describes the embryology, anatomy, basic pathology and clinical features of the condition with characteristic X-rays showing the patent foramen caecum and outlines the operative repair.