Occipitocervical fixation in nontraumatic upper cervical spine instability.

Ten patients requiring occipitocervical fixation were reviewed: five were unstable secondary to rheumatoid arthritis, one had Klippel-Feil, and four had neoplastic disease. Patients with nonneoplastic disease improved, having decreased pain, decreased paresthesias, and increased ambulation. Patients with neoplastic disease improved significantly after the surgery, but eventually died from different tumors.

Fibrosing pseudotumor of the sella and parasellar area producing hypopituitarism and multiple cranial nerve palsies.

We present an unusual patient with a medical history of a fibrosing pseudotumor of the left orbit that had been stable for 8 years who presented with acute anterior hypophyseal failure. During the next 10-month period, sequential magnetic resonance scans showed a rapid growth of a plaque-like sellar and parasellar mass extending into the right cavernous sinus, right Meckel's cave, along the dural surfaces of the clivus, dens, and body of the second cervical vertebra. A transsphenoidal biopsy revealed sphenoid and intrasellar pseudotumor that invaded the adenohypophysis and had microscopic features identical to those of the previously excised orbital pseudotumor.

The value of panoramic radiographic examination in patients with leukemia before medical management.

Panoramic radiographs were completed for patients with leukemia before the start of medical management. The radiographs were taken as part of the patient admission evaluation. Patients were examined and followed throughout the course of their medical management.

Dural tear following traumatic spinal cord injury. A delayed complication.

Dural tears with leakage of cerebral spinal fluid into surrounding soft tissues can occur after traumatic spinal cord injury. An unusual case presented in a patient with traumatic paraplegia where the onset was delayed and clinical features were suggestive of autonomic dysfunction. The clinical features, pathophysiology and treatment of this interesting complication following traumatic spinal cord injury are discussed.

Magnetic resonance imaging of trauma to the thoracic and lumbar spine. The importance of the posterior longitudinal ligament.

Magnetic resonance imaging was used to evaluate 24 patients with injuries to the thoracic, thoracolumbar (T12-L1), or lumbar spine. Correlation of the magnetic resonance imaging findings to surgical therapy and outcome was evaluated, with particular attention to the longitudinal ligaments. The ability of the magnetic resonance imaging to detect the extent of trauma to the spinal cord parenchyma and to the anterior and posterior longitudinal ligaments was found to be important in guiding the surgical approach to these spine fractures.

Surgical treatment of the spontaneous spinal epidural abscess.

Seven cases of spontaneous epidural abscess are reviewed. Three patients had posterior abscesses and no evidence of vertebral body osteomyelitis. These patients had excellent outcomes with laminectomies and antibiotics.

Quantitative assessment of the effect of basal ganglia lesions on the stretch reflex in primates.

The effect of basal ganglia stereotactic lesions on motor tone in 3 primates was quantitated. The elastic and neurogenic forces generated with a controlled stretch of each animal's upper extremities were measured pre- and postlesion, and compared to previous studies. The techniques were sensitive to subtle changes in motor tone that were not clinically apparent.

Intrathecal application of drugs for muscle hypertonia.

The literature regarding the intrathecal use of morphine, baclofen, and midazolam to treat spasticity is reviewed. Nine patients with significant spasticity due to different etiologies were treated. Morphine and midazolam decreased spasticity but did not change the patient's functional status.

Osteonecrosis: study of the relationship of dental extractions in patients receiving radiotherapy.

Osteonecrosis is a severe complication of radiotherapy for cancer. Prevention of osteonecrosis is most important, as the condition may be chronic, progressive, and lead to pathologic fracture. The clinical experience, of 627 dental extractions at the Cancer Control Agency of British Columbia either before or after radiotherapy is presented.

Evaluations of combined premotor and supplementary motor cortex lesions on a visually guided arm movement.

The kinematics of a visually guided, multi-joint arm movement were examined before and after combined bilateral premotor and supplementary motor cortex lesions. Two rhesus monkeys were trained to move a manipulandum from a start zone to one of three equally spaced target zones and then return to the initial start zone. Various features of the movement trajectory including space error, time error, peak velocity and turnaround time were quantified and analyzed before and after the premotor and supplementary motor cortex ablations.

Intrathecal application of baclofen in the treatment of spasticity.

Baclofen, a derivative of g-aminobutyric acid (GABA) has been known for many years to be a useful drug in the treatment of spinal spasticity. However, when the spasticity is severe, the systemic administration has to be increased, often without therapeutic effects but frequently with central side-effects. Baclofen given intrathecally however, in microgram doses has been previously reported to be effective and safe.

Interactive computer graphic image analysis for functional neurosurgery.

This study deals with the use of microcomputer graphic analysis of preoperative magnetic resonance imaging (MRI) scans in functional neurosurgical procedures. Three patients (2 treated for thalamotomy and 1 for thalamic stimulation) had preadmission MRI scans which delineated the classic internal landmarks used in functional neurosurgery. These data were then manipulated and stored using a microcomputer-based graphic analysis system.

Intrathecal morphine during lumbar spine operation for postoperative pain control.

The analgesic requirements and bladder function of 5 patients who received 1 mg of intrathecal morphine during lumbar spine operation are compared to those of 10 control patients. No analgesics were used by the treatment group for the first 24 hours postoperatively. The test group subsequently required twice the amount of analgesics during the 2nd through 5th days after operation compared to controls.

Subependymoma in a 2 1/2-year-old boy. Case report.

Subependymomas are extremely rare tumors in the pediatric population and, when they occur, they are usually of a mixed type with elements of subependymoma and ependymoma. This report is of a 2 1/2-year-old male infant with a pure subependymoma of the fourth ventricle.

Barbiturate therapy in uncontrolled intracranial hypertension.

From July 1978 to September 1981, 27 patients from a group of 210 patients with severe head injuries developed uncontrolled intracranial hypertension despite intensive medical and surgical management. These 27 patients were considered appropriate candidates for barbiturate therapy. Abnormal posturing or flaccidity was present in 70% of the patients, and 41% had bilaterally fixed pupils.

Biochemical evidence of myocardial injury after severe head trauma.

Serum levels of creatine kinase (CK) and its myocardial isoenzyme (CK-MB) were measured and serial ECG recorded in 24 male and 6 female patients with severe head trauma. All patients were comatose, but no patient sustained a spinal or chest injury. Total CK activity was elevated in at least one sample in each patient.

Trigeminal neuralgia due to dolichoectasia: angiographic and CT findings in a patient with the EEC syndrome.

Ectrodactyly (lobster claw deformity), ectodermal dysplasia and clefting of the lip or palate, the EEC syndrome, is a rare genetic disorder involving both mesodermal and ectodermal derivatives. Cerebral arterial dolichoectasia, a pathological dilatation and elongation of intracranial vessels, was found in a patient with the EEC syndrome. Her hypertensive cardiovascular disease, mild dementia and trigeminal neuralgia were all related to her dolichoectasia.

Cerebellar nuclear stimulation in generalized penicillin epilepsy.

Comparison was made of the effectiveness of cerebellar cortical and nuclear stimulation in reducing paroxysmal activity induced in cats by parenteral penicillin administration. Vermal cortical and fastigial nuclear stimulation at high frequencies (100 Hz) were both effective in reducing the number and duration of paroxysmal events while the effects of dentate nucleus stimulation were found to be more variable. It was suggested that effective seizure inhibition appeared to be associated with increased fastigial output and resultant reticular excitation.