Malignant transformation of a lipomyelocele into a rhabdomyosarcoma?

SUMMARY

We report the unusual transformation of a lipomyelocele to a rhabdomyosarcoma in a 3-year-old boy. A lipomyelocele is not considered pre-malignant, but the possibility of developing such a tumor may represent another reason for close neurological follow-up in patients with spinal dysraphism.

Hereditary cerebral cavernous angiomas: presentation as idiopathic familial epilepsy

In cavernous angiomas of the brain, abnormally dilated blood vessels are tightly clustered together with no intervening neural parenchyma. Commonly recognised as a sporadic finding, these lesions may also be inherited in an autosomal dominant fashion. This disorder was recognised as a common entity with the advent of MRI. As lesions were often not detected on CT imaging, symptomatic patients presenting with seizures were mistakenly diagnosed with an idiopathic seizure disorder. Seizures are the commonest presenting symptom followed by haemorrhage and focal neurologic deficit. We present another cause of familial epilepsy that also emphasises the importance of MRI as the modality of choice in investigating seizures in children.

Herpes simplex encephalitis occurring after chemotherapy, surgery, and stereotactic radiotherapy for medulloblastoma

Reactivation of latent herpes simplex virus (HSV) in the trigeminal ganglion most commonly gives rise to recurrent herpes labialis and rarely to herpes simplex encephalitis. The mechanisms underlying reactivation of latent trigeminal HSV are complex. Here we report the case history of a 25-year-old woman who developed a fatal, bilateral necrotizing destructive temporal lobe lesion following surgical removal of a cerebellar medulloblastoma and combined radiotherapy and chemotherapy for recurrent tumor. Neuropathologic examination of the brain revealed minimal inflammatory changes, but immunohistochemistry was positive for HSV protein, and HSV deoxyribonucleic acid (DNA) was recovered from formalin-fixed paraffin-embedded brain tissue. The temporal proximity of the surgery, chemotherapy, and radiotherapy to the onset of disease suggests that these factors may have acted as triggers that precipitated conversion of latent HSV to overt HSV.

Self-inflicted head trauma using a captive bolt pistol: report of three cases

Three cases of self-inflicted head trauma using a captive-bolt pistol are described. This is a rarely reported phenomenon and presents with an unique pattern of brain injury.

Posterior plagiocephaly: proactive conservative management

The pathology, diagnosis and management of posterior plagiocephaly remains highly controversial. While the rationale for surgical management of true lambdoid synostosis is undisputed, opinions vary greatly on how to manage severe, unresolving, non-synostotic cases. We reviewed 39 cases of posterior plagiocephaly, 37 of which were treated conservatively. Of these, 34 patients had a significant improvement over the following year with sleep posture modification and/or physiotherapy. While only eight cases returned to complete normality, the remainder had deformities that were deemed mild by both mothers and surgeons, and did not merit surgery. Defining recalcitrant cases remains elusive as standard imaging is often unhelpful. While 3-D CT offers a much more accurate diagnosis of true lambdoid synostosis with bony union and allows objective assessment of the deformity, serial scans involve radiation doses that are difficult to justify. Clinical follow-up is the only reliable method at present.

Embolic bacterial aneurysm of the basilar artery: case report

A patient with basilar artery rupture caused by a septic embolus originating from a mitral valve vegetation is reported. The pathogenesis, investigation and management of infected cerebral aneurysms are reviewed.

Intraspinal tumours in children--clinical presentation

Intraspinal tumours in children are rare, the estimated average ratio of spinal to intracranial tumour in the paediatric population is 1:10. We reviewed our experience of paediatric spinal tumours over the period 1992-96. Nineteen patients presented during this time, 12 males and 7 females with the mean age of 7.8 years. The main presenting symptoms were pain, limb weakness, ataxia, sensory disturbance and spinal curvature abnormalities with a mean duration of 10 months. There was a wide variety of tumour types. All underwent a laminectomy with 8 having total tumour excision, 5 partial excision, and 6 had biopsies only. Five patients had extradural lesions and fourteen were intra-dural, four of which were extramedullary and six were intramedullary tumours. There were no major complications of surgery and only one patient had a CSF leak which was repaired. The average hospital stay was 15 days. Seven patients underwent radiotherapy and four had chemotherapy. Four patients are disease free and seven are symptom free after a mean follow-up of 2 years. Four patients died in this series with extensive diffuse tumours.

Titanium mesh and bone dust calvarial patch during cranioplasty

A technique of filling calvarial defects using bone dust reinforced with titanium Micro Mesh (Leibinger) was investigated using plain x-ray films and computed tomography (CT) in seven consecutive patients (age range, 7-21 years). The aim of our study was to assess whether, in the presence of the titanium, bone dust harvested with a power burr promotes persistent ossification that is comparable with adjacent bone. The mesh was localized by standard skull plain x-ray films, and orthogonal CT scans were obtained at between 9 and 18 months post-operatively. An ultrahigh-resolution algorithm was used to detect neoossification on either side of the Micro Mesh (1-mm collimation, 330-mA and 120 KV(p) at the center of 400 HU, and window width of 2000 Hu). The mesh induced minimal streak artifact. Virtually no new bone formation was seen. It appears that bone dust was completely reabsorbed in this patient group even in the presence of semi-rigid fixation.

Acute near-fatal parainfectious cerebellar swelling with favourable outcome

The clinical course, neuro-imaging features and neuropathologic findings in a child with para-infectious acute cerebellar swelling are described. Reversible transtentorial and transforaminal herniations occurred and required emergency posterior fossa decompression with external ventricular drainage. Neuropathologic examination of a cerebellar biopsy demonstrated a subacute pathogen-free cerebellitis. Following neurosurgical intervention and steroid therapy, symptoms and signs resolved and the patient is well 3 years later. Acute para-infectious cerebellar swelling is potentially fatal unless recognised and treated early in its evolution.

"Tethered cord syndrome"--recent clinical experience

Thirty-three consecutive patients treated surgically for "tethered cord syndrome" over a 3-three year period were reviewed. The main presenting complaints were back and leg pain, progressive lower limb and spinal deformity, and neurological deficits. Untethering of the cord was achieved in 32 patients, in whom the filum terminale was divided in 17. There were no serious complications; one patient had a CSF leak which required surgical repair. The mean postoperative follow-up was 15 months and 20 of the patients reported improvement, the rest were unchanged. There was no neurological deterioration in any of the patients. Our series suggests that cord release in patients with "tethered cord syndrome" improves or arrests the progression of neurological deterioration.

Cloverleaf skull anomaly with extreme orbitostenosis

A neonate presented with cloverleaf skull anomaly and severe proptosis requiring urgent cranioplasty to attain eyelid closure. Despite this, she experienced exposure keratitis and corneal perforations. A ventriculoperitoneal shunt was performed subsequently to relieve hydrocephalus, but respiratory problems eventually led to her death at 6 months. This case highlights the complexity of the problems encountered in the cloverleaf skull anomaly, and a brief review discussing its management is included. Despite improvements in treatment of this condition, the overall prognosis remains poor.

The Dandy-Walker syndrome--a 10-year experience of its management and outcome

Hydroephalus of childhood may be associated with intracranial haemorrhage, infection, aqueductal stenosis, Arnold-Chiari malformation (spina bifida), tumours or more uncommonly with the Dandy-Walker syndrome (DWS). We present our experience with the management of this condition over a 10-year period. Twelve children with a definite diagnosis of DWS are reviewed with regard to the age at diagnosis, investigations, treatment, associated problems and overall outcome. Two patients died; there was a high incidence of mental retardation (65%) and associated problems. All but one child had ventriculo-peritoneal shunting and two had cysto-peritoneal shunts in addition to their V-P shunts. There were no familial cases; one child had a chromosomal abnormality. Although the long-term outcome is dismal in most cases, about 35% of the children have a reasonable outcome and hence the condition warrants energetic treatment.

Primary leptomeningeal melanoma: an unusually aggressive tumor in childhood

Primary malignant melanoma of the leptomeninges of the central nervous system is a rare and aggressive tumor in children. We report our experience from 1964 to 1990 with this tumor in eight children. The mean age at diagnosis was 4.9 years (range, 1.3 to 13 yr). Five children presented with signs and symptoms of raised intracranial pressure from hydrocephalus secondary to tumoral obliteration of the basal cisterns, but the time from the initial symptomatology to diagnosis was frequently delayed. Three patients in this series had hairy nevi in association with their leptomeningeal melanoma. Cerebrospinal fluid (CSF) analysis typically showed raised opening pressures, decreased glucose, and increased protein concentrations. Malignant melanoma cells were found in the CSF in three patients. Confirmatory radiographic examinations included air encephalography, myelography, and computed tomographic and magnetic resonance scanning. Four patients were treated with lumboperitoneal shunts, and one patient was treated with a ventriculoperitoneal shunt for hydrocephalus. Two patients underwent craniotomies and subtotal excisions of their tumors. In seven patients, a definitive diagnosis of leptomeningeal melanoma was made by pathological examination of tissues sent at surgery or at post mortem. In one case, the diagnosis was established by a detailed cytological analysis of the CSF. Four children died of fulminant disease and tumor spread before treatment could be instituted. The four children who received treatment had a combination of radiation therapy and chemotherapy. One child received intrathecal methotrexate. The two children with the longest survivals (2 and 3 yr, respectively) received cisplatinum and dimethyltriazenoimidazole carboxamide in addition to craniospinal irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)

A qualitative comparison of the reactions of retinal ganglion cell axons to optic nerve crush in neonatal and adult mice

The reaction of ganglion cell axons in the mouse retina to optic nerve crush was studied in adult and neonatal albino mice 10-85 days after operation, using silver-stained retinal whole mounts and sagittal sections of retina and optic nerve. In both adult and neonatal animals the majority of neural cells and axons degenerated; surviving neurons had small cell bodies. Degeneration was more marked in neonatal neurons compared to adult neurons. In the adult study, two populations of axonal sprouts growing from the ends of the severed ganglion cell axons were identified. One population, representing the large majority of fibres grew for up to 20 days after operation in the myelinated retinal stump of the optic nerve and then degenerated. A smaller number of axons grew for the whole duration of the study, initially in the inner plexiform area juxtaposed to the non-myelinated optic nerve head and peri-papillary region of the retina, but later invaded the entire retina. In the neonate, no evidence of axonal regeneration was seen, although transient axonal collateral sprouting of surviving ganglion cells occurred.

A quantitative comparison of the reactions of retinal ganglion cells to optic nerve crush in neonatal and adult mice

The response of neurons and glia of the ganglion cell layer of the retina to optic nerve crush was studied in adult and neonatal albino mice between 10-85 days post-lesion (dpl). The numbers of ganglion cells and glia surviving optic nerve transection were quantified using Nissl-stained retinal whole mounts. Large- and intermediate-sized ganglion cells were more sensitive to axotomy in the optic nerve than small-sized cells. About 80% of the former cells degenerated by 10 dpl in adult mice whilst 90-100% were affected in neonates. 40-60% of the small-sized ganglion cells survived in adults whilst in neonates, although a similar number escaped the effects of axotomy at 10 dpl, by 30 dpl only less than 10% remained. These aspects were reflected in the changes in the relative frequency distribution with time of ganglion cells in normal and lesioned mice. No significant alterations in glial cells in the ganglion cell and fibre layers of the retina were recorded at any time of lesioning the optic nerve.