Guidelines for the management of head injuries in remote and rural Alaska.

Numerous recommendations on the initial evaluation and treatment of the head injured patient have been proposed over the last several years. Most assume there is readily available access to computed tomography and neurosurgical specialists. Many clinicians in Alaska must evaluate and begin treatment of head injured patients in circumstances quite different from this.

Leptomeningeal carcinomatosis following craniofacial resection of an ethmoid tumor.

Leptomeningeal carcinomatosis (LMC) is a rare complication following treatment for head and neck cancer. In this paper, we report a case of LMC following surgery and localized radiation therapy for an ethmoid carcinoma, in which laceration of the dura during craniofacial resection may have provided an access for cancer cells into the cerebrospinal fluid (CSF). As a result, the patient developed LMC manifested as multiple spinal nerve root involvement.

Intradural extramedullary cysts of the spinal canal: clinical presentation, radiographic diagnosis, and surgical management.

Fourteen patients with intradural extramedullary cysts of the spinal canal are described. Histological classification included 11 arachnoid, 2 epithelial, and 1 ependymal cyst. There were 9 thoracic, 3 cervical, and 2 lumbar cysts.

Cerebral aneurysms associated with neurofibromatosis.

An uncommonly recognized complication of neurofibromatosis (NF) is an angiopathy of the intracranial and extracranial arteries. Most of the previously reported cases have presented as an occlusive process similar to Moyamoya disease. We present our experience over the past 3 years involving three patients with five cerebral aneurysms and associated NF.

Brain tumors occurring before 1 year of age: a retrospective reviews of 22 cases in an 11-year period (1977-1987).

Congenital brain tumors have been reported infrequently and their management remains ill defined. An 11-year review (1977-1987) of all children with brain tumors with the onset of symptoms before 1 year of age was completed. Twenty-two children with the following histological diagnoses were treated: astrocytoma (7 patients), primitive neuroectodermal tumor (6 patients), papilloma or carcinoma of the choroid plexus (3 patients), malignant teratoma (2 patients), dermoid tumor (2 patients), embryonal rhabdomyosarcoma (1 patient), and chloroma (1 patient).

Idiopathic and glucocorticoid-induced spinal epidural lipomatosis.

Pathological overgrowth of the epidural fat in the spine has been described and reported nearly exclusively in patients either with Cushing's syndrome or on chronic intake of glucocorticoids for a variety of clinical disorders. The authors report four patients with documented spinal lipomatosis (three pathologically and one radiologically). Only one of these patients received corticosteroids, and none had an underlying endocrinological abnormality.

Surgical experience with cerebral amyloid angiopathy.

Cerebral amyloid angiopathy can present as lobar intracerebral hemorrhage in an elderly person, presumably due to increased fragility of the vessels affected by amyloid deposition. For this reason, patients presenting with intracerebral hemorrhage and suspected of having cerebral amyloid angiopathy have often been treated nonsurgically. Since 1983 we have evaluated 11 patients with cerebral amyloid angiopathy (nine women and two men, mean age 73 years) who have undergone either intracerebral hematoma evacuation or brain biopsy.

Leukoencephalopathy in cerebral amyloid angiopathy: MR imaging in four cases.

We report four cases of biopsy proved cerebral amyloid angiopathy demonstrated by MR imaging. White matter signal hyperintensities on T2-weighted spin-echo pulse sequences were present in three patients. We believe the white matter lesions associated with cerebral amyloid angiopathy are not specific to this disorder but rather reflect hypoperfusion of distal white matter resulting from vascular disease.

Management of cervical spine injuries in patients with ankylosing spondylitis.

Eleven patients with ankylosing spondylitis and traumatic fracture/dislocation of the spine were identified in a retrospective review of all cases of cervical spine injury treated on the neurosurgical service over a 10-year period. Injury was most often secondary to minor trauma or a motor-vehicle accident, and the level of vertebral involvement was most frequently between C-5 and T-1. Neurological symptoms at presentation ranged from neck pain alone to complete loss of function distal to the level of injury.

MR imaging of basilar artery occlusion.

We studied six patients with basilar artery occlusion using magnetic resonance imaging. Two patients also had arteriography. All had signs consistent with pontine infarction; three had a "locked in" syndrome.

Magnetic resonance imaging and neurobehavioural outcome in traumatic brain injury.

Magnetic resonance (MR) imaging is a sensitive means of detecting haemorrhagic and nonhaemorrhagic forms of brain injury. This study correlates the neurobehavioural (NB) deficits in 49 adult patients with lesions detected by MR imaging. MR imaging was performed 2-19 days following trauma, analyzed for the injury type and graded for severity.

Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly.

We prospectively studied 30 older patients who had shunt surgery for symptomatic hydrocephalus and measured outcome using serial videotaping of gait, neuropsychological testing, and the Katz index of activities of daily living. Twenty-three patients improved and 7 did not. Using univariate analysis and the Fisher exact test, we found that the following variables were significantly related to outcome: (1) time B-waves present on 24-hour CSF pressure record; (2) anterior/posterior ratio on slice 4 of regional cerebral blood flow study; (3) duration of dementia prior to surgery; and (4) gait abnormality preceding dementia.

Symptomatic congenital hydrocephalus in the elderly simulating normal pressure hydrocephalus.

In a series of 30 older patients shunted for symptomatic hydrocephalus, we found 3 with a head circumference at or greater than the 98th percentile. In 2, we demonstrated deterioration over 6 and 12 months by serial videotaping of gait and neuropsychological testing. In the 3rd, serial lumbar punctures over a 6-month period gave temporary improvement.

Traumatic brain stem injury: MR imaging.

Eighty-seven patients with acute (n = 70) or chronic (n = 17) head injuries were prospectively studied with magnetic resonance (MR) imaging and computed tomography (CT) to characterize the frequency and nature of traumatic brain stem injury (BSI). Forty-eight traumatic lesions were identified in 36 patients. Of 36 patients, 35 had neurologic findings that corroborated the radiographic impression of BSI.

A randomized trial of aspirin or heparin in hospitalized patients with recent transient ischemic attacks. A pilot study.

In a randomized pilot study we compared the efficacy of temporary anticoagulation with intravenous heparin sodium to the efficacy of aspirin in preventing cerebral infarction in hospitalized patients with recent (less than 7 days) transient ischemic attacks (TIAs). Fifty-five patients (33 men, 22 women) aged 36-81 (mean 62.7) years met entry criteria and agreed to participate.

Nicardipine HCl: clinical experience in patients undergoing anaesthesia for intracranial aneurysm clipping.

Previous studies have reported haemodynamic interactions between dihydropyridine calcium antagonists and general anaesthesia. During anaesthesia for intracranial aneurysm surgery, we prospectively compared haemodynamic values obtained from 13 patients being treated with nicardipine HCl (0.15 mg.

Trauma to the corpus callosum: MR features.

The frequency, distribution, and appearance of corpus callosum injuries were evaluated with MR and CT in a prospective study of 78 patients with acute (n = 63) and chronic (n = 15) head injuries. Traumatic lesions of the corpus callosum were detected in 47% of patients. MR was significantly (p less than .

MR imaging of the corpus callosum: normal and pathologic findings and correlation with CT.

The MR appearance of the corpus callosum was investigated in 80 normal volunteers. Normal variations in appearance were recorded with regard to age, gender, and handedness. The MR studies of 47 patients with a wide spectrum of callosal disease were also reviewed.

Is duplex follow-up cost-effective in the first year after carotid endarterectomy?

Recent reports have suggested that duplex scanning is an ideal method to noninvasively assess the incidence of recurrent carotid stenosis. However, the timing and frequency of the follow-up studies are controversial. In the present study, 150 patients underwent 173 carotid endarterectomy procedures over a 2 year period.

Carotid endarterectomy in symptomatic elderly patients.

Fifty-three of 203 consecutive carotid endarterectomies (26%) performed on the Neurosurgical Service at the University of Iowa were in patients over 70 years of age (mean age, 73.4). This series included 38 men and 15 women.

Dose-escalation study of intravenous nicardipine in patients with aneurysmal subarachnoid hemorrhage.

A dose-escalation study of the calcium ion entry blocking drug nicardipine was performed using large dose infusions in 67 patients with recent aneurysmal subarachnoid hemorrhage (SAH). A safe, potentially therapeutic dose of the drug was determined. Patients admitted within 7 days of SAH from a documented cerebral aneurysm were entered into the study if no spasm was present on the initial angiogram.

Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma.

Forty patients with closed head trauma were evaluated prospectively with CT and intermediate-field-strength MR imaging to compare the diagnostic efficacies of the two techniques. Traumatic lesions were detected in 38 patients. The severity of injury, as determined by the Glascow Coma Scale, ranged from 3 to 14.

MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions.

The distribution and extent of traumatic lesions were prospectively evaluated with MR imaging in 40 patients with closed head injuries. Primary intraaxial lesions were classified according to their distinctive topographical distribution within the brain and were of four main types: (1) diffuse axonal injury (48.2%), (2) cortical contusion (43.