Malignant brain stem hyperthermia caused by brain stem hemorrhage

BACKGROUND

We report two cases of brain stem hemorrhage characterized by severe hyperthermia, rhabdomyolysis, acute renal failure, and a rapidly fatal course.

METHODS

A 55-year-old man and a 65-year-old man were admitted with coma-producing brain stem hemorrhage accompanied by hyperthermia. Both underwent ventricular drainage.

RESULTS

Within 1 day of onset, both patients developed hyperthermia of over 41 degrees C, increased serum creatine phosphokinase (CPK) level indicating rhabdomyolysis, and acute renal failure. One patient died on the second day and the other on the third day after onset despite supportive treatment.

CONCLUSIONS

These cases of brain stem hemorrhage with fulminant hyperthermia should be distinguished from those with simple hyperthermia. They may represent a kind of malignant hyperthermia, in which case dantrolene sodium might be beneficial. Monitoring serum CPK levels would be of help in making the diagnosis early in the course.

Intradural, purely extramedullary hemangioblastoma of the spinal cord--case report

An unusual, purely extramedullary hemangioblastoma of the spinal cord occurred in a 59-year-old female. Myelography revealed a filling defect at the Th6 level, and computed tomographic myelography demonstrated an extramedullary intradural isodense mass at the same level. The mass was homogeneously enhanced on postcontrast computed tomographic scans. T1-weighted magnetic resonance imaging showed an isointense mass, homogeneously enhanced by contrast medium. The tumor was removed en bloc.

Retroflexion of holoprosencephaly: report of two cases

Two cases of retroflexed holoprosencephaly are presented. Reports of nine cases of retroflexion were available in the literature. Case analysis indicates that retroflexion results from subdural fluid collection. The incidence of retroflexion in holoprosencephaly was apparently higher than that of ordinary subdural hygromas. Possible explanations for this high incidence are given. The clinical significance and management of retroflexion are touched upon.

Rebleeding from vertebral artery dissection after proximal clipping. Case report

The authors present the case of a patient with vertebral artery dissection that rebled after being treated by proximal clipping. This is the second report of such a case. The results indicated that proximal clipping is not free from the risk of rebleeding, and a better alternative surgical technique should always be sought when treating vertebral artery dissections.

Secondary malignant lymphoma of the central nervous system with delayed high uptake on 123I-IMP single-photon emission computerized tomography. Case report

A case of secondary central nervous system (CNS) lymphoma with high uptake in the delayed image of N-isopropyl-[123I]-p-iodoamphetamine (125I-IMP) single-photon emission computerized tomography (SPECT) is presented. Previous to this report, only six cases of brain tumor with high uptake on the delayed 123I-IMP SPECT scan have been reported, two of which were CNS malignant lymphomas. Of 19 brain tumors examined with 123I-IMP SPECT at Kameda General Hospital, this case was the only one that showed high uptake in the delayed image. These data imply that 123I-IMP SPECT, which has now become rather obsolete as a tumor-imaging method, can be useful in diagnosing CNS malignant lymphoma.

Avellis syndrome after minor head trauma: report of two cases

Avellis syndrome is a rare condition that usually occurs in association with infarction of the medulla oblongata or mass lesions around the jugular foramen; this syndrome has rarely been reported after trauma. Two cases of Avellis syndrome that occurred following minor head trauma are presented. The mechanism by which Avellis syndrome is produced is briefly discussed. The relative resistance to damage of the spinal accessory nerve was thought to play an important role in producing the peripheral type of Avellis syndrome. The outcome was favorable in both cases.

Postradiation astrocytoma. Report of two cases

The authors describe two cases of malignant astrocytomas associated with previous radiation therapy in childhood for intracranial germinoma and craniopharyngioma. In both patients, there was no recurrence at the primary tumor site. Because of a geometric coincidence between the tumor location and the radiation field, radiotherapy was strongly implicated as a cause of these two astrocytomas.