Abraham Sahar

Entrapped lumbar nerve root in pseudomeningocele after laminectomy: report of three cases.

The authors report three patients with symptomatic postlaminectomy pseudomeningocele. At operation a loop of a nerve root was found to be trapped within the dural defect. All three patients exhibited a delayed onset of radicular symptoms and signs after disc surgery. The pseudomeningocele was demonstrated computed tomography and myelography, but the entrapped root could be identified only at operation.

Intracranial hemorrhage in patients with hemophilia.

Intracranial hemorrhage (ICH) is a life-threatening complication of hemophilia. Seven of the 288 hemophiliacs living in Israel suffered eight episodes of ICH during the years 1972 to 1982. All episodes occurred in hemophilia A patients, with a higher incidence among patients with factor VIII inhibitor. Diagnosis was confirmed by computed tomographic scan in seven of the eight episodes. Four of the 7 patients died despite adequate factor replacement and supportive therapy, probably due to a conservative and hesitant neurosurgical approach. The correction of factor VIII to hemostatic level alone is inadequate in the majority of cases, and there is sudden deterioration in the patients condition and death. Operation is strongly recommended when no improvement is noted within a few hours.

Colonic Complications of Ventriculoperitoneal Shunts

Late perforation of the large bowel by the abdominal catheter of a ventriculoperitoneal (VP) shunt is extremely rare. Four of the five reported patients subsequently died. We report here three patients who presented with this complication and were treated successfully. Bowel perforation by a VP shunt catheter should be considered when a shunt infection is secondary to gram-negative enteric organisms. It can occur without evidence of peritonitis, and the abdominal catheter can be removed percutaneously, thus avoiding a laparotomy.

Effects of mannitol and furosemide on the rate of formation of cerebrospinal fluid.

Abstract The inhibitory effects of two different diuretic agents—mannitol and furosemide—on the rate of production of cerebrospinal fluid (CSF) were examined in cats by ventriculocisternal perfusion; each animal served as its own control. In 26 cats, mannitol effected as much as an 89% decrease in CSF formation as the serum osmolality was raised from 311 to 336 mosmol/liter by intravenous mannitol infused at rates from 2 to 10 mg/kg/min. The degree of decrease was a linear function of the rise in serum osmolality. Furosemide was shown to reduce CSF production by as much as 94% when intravenous doses of 0.87 to 20.3 mg/kg were used in 25 animals. The decrease was dependent on the natural logarithm of the dose. Intraventricular furosemide at concentrations of 0.06 to 0.24 mg/ml was very effective in 10 cats, without causing saluresis or diuresis. This effect was also linearly related to the natural logarithm of the concentration.

Trigeminal neurinoma with unusual presentation. Report of a case with trigeminal somatosensory-evoked response

A patient with trigeminal neurinoma, presenting unusual symptoms, is described. There was no trigeminal sensory or motor deficit. The only presenting symptoms were unilateral abducens nerve paresis and alternating hemiplegic episodes. The trigeminal somatosensory-evoked response was normal before surgery. After complete removal of the tumor from both the posterior and middle cranial fossae, severe trigeminal sensory deficit ensued, accompanied by impairment of the evoked response. Improvement of the trigeminal nerve function could be predicted by significant changes in a repeat trigeminal sensory-evoked response obtained 2 months after the operation.

Postoperative spinal epidural empyema : clinical and computed tomography features

Epidural empyema is a rare complication of elective spinal surgery. Four such cases are described. The clinical features of this postoperative complication were surprisingly vague and misleading. Fever was uncommon. Local inflammatory signs or rapid neurologic deterioration were absent. Computerized tomography proved useful in diagnosis and follow-up. Unlike spontaneous spinal epidural abscess, postoperative spinal epidural empyema had a benign course. Causative bacteria were miscellaneous. Surgical evacuation of the purulent collection and appropriate antibiotic therapy resulted in cure in all cases.

Intermittent priapism in spinal canal stenosis.

A case of spontaneous intermittent priapism in a patient with spinal canal stenosis is presented. Erection, as well as intermittent neurogenic claudication and urinary incontinence were provoked by physical exertion, mainly walking. The symptoms completely resolved after decompressive lumbar laminectomy.

Experimental progressive hydrocephalus in the young animal.

22 puppies with kaolin-induced hydrocephalus were repeatedly studied for 4 months in respect to their head size, ventricular size, pressure and cerebrospinal fluid (CSF) dynamics. The intraventricular pressure was markedly elevated during the first week and dropped towards the end of the first month of the hydrocephalic process. It then escalated and again returned to normal values after 3--4 months. Formation of CSF increased with age until it reached adult values of 0.049 ml/min at the age of 3 months. Absorption rates were very low initially. The absorptive capacity surpassed formation in the puppies which survived to the fourth month of the process. Ventricular size and rate of head enlargement correlated inversely with thickness of the skull. In the surviving puppies (4 out of 22) the hydrocephalic process seemed to have arrested.

Torsion Dystonia: a Case with Delayed Remission following Thalamotomy and Phenothiazine Therapy

Torsion dystonia in 13-year-old girl progressed to severe opisthotonus and dystonic posturing of the limbs, accompanied by severe psychic changes, cachexia and calcification around joints. Drug therapy was ineffective. Ventrolateral thalamotomy and chlorpromazine brought about a delayed but remarkable amelioration of all symptoms and signs, still present 4 years later.