Alan H. Fruin

Choroid Plexus Papilloma of the Third Ventricle: Case Report and Review of the Literature

Choroid plexus papilloma (CPP) is a rare intraventricular neoplasm occurring primarily in the lateral ventricles of children and the 4th ventricle of adults. We describe the third reported case of a cystic CPP of the 3rd ventricle and review the pertinent literature. (Neurosurgery 12:217-220, 1983)

Role of routine emergency cervical radiography in head trauma

This review of 406 patients with head injury examines the role of emergency cervical radiography in head trauma and the frequency of associated cervical spine injury. Of 293 patients who had emergency cervical radiography (72 percent), 8 showed some abnormality, but only 5 (1.2 percent) were significant for cervical spine injury. All eight patients were, however, clinically suspected to have associated cervical spine injury before emergency cervical radiography. One hundred thirteen patients (28 percent) did not undergo emergency cervical radiography based on clinical evaluation, and none was subsequently found to have a missed cervical spine injury. There was no correlation between severity of head injury and the presence of associated cervical spine injury (p greater than 0.16). Head trauma is infrequently associated with cervical spine injury and when present is usually not clinically occult. Emergency cervical radiography is not efficacious and should not be routine in the emergency room management of head trauma. When associated cervical spine injury is clinically suspected, adequate cervical immobilization should be maintained and cervical radiography performed on a low priority basis. Head injury due to automobile and pedestrian or motorcycle and automobile accident may be more likely to be associated with cervical spine injury.

Caloric requirements in patients with severe head injuries

Indirect calorimetry was performed on 15 nonsteroid-treated, head-injured patients over 16 postinjury days. A search was made for a clinical marker that could be used to predict the caloric requirement in individual head-injured patients. Of all parameters reviewed, only motor activity correlated with the caloric needs of the patients (P less than 0.0001). Flaccid patients had a mean caloric expenditure of 108% of expected values, whereas patients with abnormal motor activity had a mean caloric expenditure of 191% of expected values.

cerebellar oligodendroglioma in a child

Oligodendrogliomas occur primarily in the cerebral hemispheres of adults. A rare case of an oligodendroglioma in the cerebellum of a child is presented. The tendency for oligodendroglioma to metastasize through the cerebrospinal fluid (CSF) is reviewed and emphasized. A recommendation for CSF cytology and possible spinal axis irradiation in the treatment of oligodendrogliomas is made.

Wallenberg's syndrome caused by direct brainstem injury.

A unique case of a shotgun wound producing a lateral medullary syndrome is reported. Evidence indicating direct brainstem injury and not vascular injury is presented. The long-term complications of this type of injury are stressed.

Diagnosis and treatment of complicated tubercular meningitis.

A 41‐year‐old woman was seen in no acute distress with an infected ventriculoperitoneal shunt. She underwent several revisions of the shunt but was readmitted to the hospital with nausea, vomiting, and neurologic sequelae. Results of spinal fluid analysis were white blood cells 68/mm3 (25% neutrophils), glucose less than 20 mg/dl, and protein 513 mg/dl. Cerebrospinal fluid, aerobic and anaerobic, and blood cultures were negative. Three weeks later the patient suffered a seizure and was prescribed antitubercular agents for a presumed diagnosis of tubercular meningitis. One week later, chest wound culture from her first visit suggested Mycobacterium tuberculosis, which was confirmed by DNA probe; cerebrospinal fluid culture eventually grew the organism. The patient fared well once she received antituberculosis agents. The time between first contact and treatment in the hospital delayed therapy.

Technical Application of Stereotactic Irradiation in Malignant Brain Tumors

This study reports the technical application of stereotactic interstitial brachytherapy for malignant gliomas in two groups of patients. Group I consisted of 2 patients who had undergone previous debulking brain surgery; group II were 3 patients who were not candidates for craniotomy because their tumors were surgically inaccessible. The stereotactic implantation technique in group I was somewhat complicated due to the irregular shape of the residual tumor masses. Sophisticated pre-implantation planning was necessary for adequate coverage of the entire tumor volume. In this series, inoperable tumors were also successfully implanted with excellent results.