Lateral medullary syndrome after neck injury

Several reported cases of brainstem stroke followed neck manipulation or trauma. We describe a 28-year-old man who had a lateral medullary syndrome after cervical hyperextension in an automobile accident. Angiography revealed complete occlusion of the left vertebral artery.

Bilateral rhinocerebral phycomycosis

A 51-year-old diabetic woman developed bilateral rhinoorbitocerebral phycomycosis. Successful treatment was accomplished by correction of the ketoacidosis, surgical debridement, and amphotericin B therapy. Rhinoorbitocerebral phycomycosis is a fulminant and frequently fatal disease most often seen in debilitated hosts. This survival suggests that aggressive therapy is indicated in patients with extensive fungal involvement.

Muscle hypertrophy after partial denervation: a human case

While undergoing long-term physiotherapy, a 41 year old woman with a chronic S1 radiculopathy developed progressive, painless enlargement of the weak calf. Gastrocnemius muscle biopsy disclosed changes of partial denervation and reinnervation, with small groups of type I and type II atrophic muscle fibres and abundant hypertrophic fibres of both types but mostly type II. It is postulated that, in addition to comprensatory work-induced type II muscle fibre hypertrophy, there was an element of (type I) stretched-induced hypertrophy of denervated fibres, a condition well recognised experimentally but not documented in man.

Recovery from acute subdural hematoma and uncal herniation due to ruptured intracranial aneurysm

A case of acute subdural hematoma due to a ruptured carotid aneurysm with decerebrate rigidity and complete recovery is reported.

The benign lateral medullary syndrome

Four young, otherwise healthy men developed the signs and symptoms of lateral medullary ischemia following extraordinary outdoor exercise. The syndrome was short-lived, with excellent long-term prognosis. We suggest that the designation "benign lateral medullary syndrome" is appropriate for this transient nonrecurring state.

Glioblastoma multiforme and the meningeal syndrome

Brain tumors rarely may produce acute steile meningitis (the meningeal syndrome) resulting from the spillage of blood, lipid products of tumor necrosis, or malignant cells into the cerebrospinal fluid (CSF). The frequency of the associated meningeal syndrome is a function of tumor type and of the tproximity of tumor necrosis to the ventricles. The meningeal syndromes of lipid-induced chemical inflammation are seen most commonly with epidermoids, craniopharyngiomas, and infarcted pituitary adenomas. I report a patient with the rare association of the meningeal syndrome with glioblastoma multiforme. The lipid irritants of glioblastomas and craniopharyngiomas are similar chemically and can be detected in the CSF. The anti-inflammatory and immunosuppressant properties of steroids provide a rational basis for their efficacy in treatment of the syndrome.

Sclerosing spinal pachymeningitis. A complication of intrathecal administration of Depo-Medrol for multiple sclerosis

Reported complications of intrathecal steroid therapy include aseptic meningitis, infectious meningitis, and arachnoiditis. We report a case of sclerosing spinal pachymeningitis complicating the attempted intrathecal administration of Depo-Medrol for multiple sclerosis. The lesion is characterised by concentric laminar proliferation of neomembranes within the subdural space of the entire spinal cord and cauda equina, resulting from repeated episodes of injury and repair to the spinal dura mater by Depo-Medrol. There is clinical and laboratory evidence that Depo-Medrol produces meningeal irritation and that the vehicle is the necrotising fraction.