Cerebral cladosporiosis

Two cases of cerebral abscess caused by Cladosporium bantianum are described. One patient was a 50-year-old man who presented after experiencing symptoms for five years, while the other was a 6-month-old child. In both patients the fungus was identified in the material submitted for histopathological examination, and in 1 case it was cultured. Although no antifungal therapy was administered, the child has improved and is doing well ten months after the operation.

Primary rhabdomyosarcoma of the cerebellum

A case of primary rhabdomyosarcoma of the cerebellum is reported. This is a very rare form of primary tumour in the brain and probably arises from the ectomesenchyme of the neural crest.

Ultrastructural observations in experimental hydrocephalus in the rabbit

Changes in the ependyma and periventricular brain tissues of the lateral, 3rd and 4th ventricles and the cervical spinal canal were studied electron-microscopically in young rabbits on the 9th day after injecting kaolin into the cisterna magna. The ependyma of the lateral ventricle overlying the white matter was notably stretched causing increased egress of CSF and disorganisation of the normal architecture of the white matter and capillaries. The neurons and glial cells close to the white matter showed edematous changes. The changes in the ependymal lining and the underlying grey matter were less severe in the dorsal part of the 3rd and the 4th ventricle. The ventral part of the 3rd ventricle was the least affected. The height and the arrangement of the ependymal cells, the surrounding grey matter with narrow interstitial spaces and the absorbing tanycytes seemed to be factors which were responsible for the minimal changes in these regions. The changes appeared to be reversible if the CSF pressure was relieved at this stage. The spinal canal remained unaffected in the majority of our hydrocephalic animals, which could probably be attributed to the type of animal and the degree of hydrocephalus.

Transitory block of the arachnoid granulations following subarachnoid haemorrhage. A postmortem study

The arachnoid granulations of the superior sagittal sinus were examined for blockage by erythrocytes in 43 cases of subarachnoid haemorrhage. Ten cases had survived for more than two weeks after the haemorrhage. Among 33 cases with acute haemorrhage, 17 had evidence of blocking of the granulations. The severity of the block varied from complete clogging of nearly all granulations to slight filling of a few of them. Cases with some days' survival showed evidence of phagocytosis of the entrapped erythrocytes by macrophages. Several of the cases with old haemorrhage had groups of haemosiderin macrophages in the granulations but none showed fibrosis (except for one single villus). It is concluded that clogging of the arachnoid granulations may contribute to the raised intracranial pressure in some cases of acute subarachnoid haemorrhage. However, the observations do not support the hypothesis that the haemorrhage may lead to fibrosis or scarring of the granulations with chronic impairment of the cerebrospinal fluid resorption and subsequent hydrocephalus.

Spontaneous rupture of the third ventricle in obstructive hydrocephalus: a radiographic diagnosis

Two cases of posterior fossa tumours with spontaneous rupture of the third ventricle are presented. In the first case there was dramatic relief of symptoms of raised intracranial tension. Rupture of the supra-pineal recess was demonstrated by Conray ventriculography in both cases.

Brain abscess and congenital heart disease

The clinical features and management of 18 patients with congenital heart disease and a brain abscess are reviewed. Except for one patient all had cyanosis. All abscesses were large, containing at least 50-60 ml of pus, and mostly unilocular. Bilocular and multilocular abscesses were also encountered. The organisms cultured from the pus had little relation to the mortality. Tapping may be the final investigation, and is also the treatment of choice. The high mortality (50%) is attributed to the delay in referral of these patients to a neurosurgical unit.

A follow-up study of 91 patients operated on for focal epilepsy

Ninety-one patients operated on for focal epilepsy between 1952 and 1973 have been followed regularly. Nontumoral lesions were found in 68 patients, and tumors in 23. Of the 50 patients without tumor who have been followed for more than 2 years, 30% were seizure-free, 50% improved, while only 20% did not benefit from the operation. There was no operative mortality. Ventricular asymmetry in the pneumoencephalogram was associated with a better prognosis than when there was no or symmetrical enlargement. The time between the onset of seizures and the operation did not affect the prognosis, but early operation is important to achieve better and quicker rehabilitation. There was a positive correlation between the postoperative ECoG and EEG and the clinical results.

On the pathology of experimental hydrocephalus

Acute hydrocephalus was produced in newborn rabbits by injection of kaolin into the cisterna magna. The light microscopic changes which occurred in the ependyma and periventricular brain tissue were studied. Some animals also received intraventricular injection of Evans blue albumin (EBA) at various times after the kaolin injection to study the permeability of the ependyma. There was a progressive dilatation of the lateral ventricles from the second day after the kaolin injection. Marked hydrocephalus was seen after 2 weeks. The white matter of the cerebral hemispheres showed increasing reduction in volume with the degree of hydrocephalus. Neither destruction of brain tissue nor macrophage response or inflammation were seen. The ependyma adapted remarkably well to the increased intraventricular pressure by extensive flattening and stretching. No convincing breaks or ruptures were seen. There was a patchy spongy zone beneath the ependyma, probably indicating oedema of the periventricular white matter due to transventricular absorption of the cerebrospinal fluid (CSF). Denudement of the ependymal lining is not necessary for the concept of transventricular flow of CSF. No difference was seen in the penetration of EBA into the periventricular tissue between hydrocephalic and control animals. The reduction of the cerebral mantle thickness was probably caused by simple pressure atrophy. This indicates that the morphological changes may to a large extent be reversible if the hydrocephalus is properly treated within reasonable time. The role of morphological changes in the pathophysiology of hydrocephalus if briefly commented upon in relation to certain aspects of human hydrocephalus.