Aydin Paşaoğlu

Intradural disc herniations pathogenesis, clinical picture, diagnosis and treatment.

SummaryThe relatively rare occurrence and uncertainty about pathogenesis of intradurally displaced disc herniations stimulated an anatomico-pathological study into intradural disc herniations. The relation between the ventral dura and posterior longitudinal ligament in the cervical, thoracic, lumbar and sacral regions were examined macroscopically and microscopically, and ventral and dorsal durai thickness was compared in 20 adult autopsies on patients who died from various causes; in addition, 20 late abortions and newborn cadavers were investigated in the same way.In this study, a total of 40 autopsies has shown that the ventral dura is most frequently and firmly attached to the posterior longitudinal ligament at the L4–L5 level and these adhesions may be congenital. In the adult cadavers dorsal dura was found to be thicker than the ventral dura in the lumbar and lower cervical interspaces.Three personal clinical cases of intradurally herniated disc prolapse are shortly described and the diagnosis and management of this pathology discussed.

Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase

During the last three years, seven patients with severe intraventricular hemorrhage admitted to our clinic were treated with direct intraventricular infusion of urokinase. In each case, hemorrhage extended into the entire ventricular cavity and cast formation as well as an expansion of third and fourth ventricles were found. On the average, both the third and fourth ventricles became clear on the third day and the lateral ventricle on the ninth day after hemorrhage. Five of the seven patients showed good recovery or only moderate disability, and two died. Infection, convulsion, rebleeding, and peripheral or secondary hemorrhage due to the side effects of urokinase was not encountered during therapy.We conclude that this procedure can be applied effectively and safely in severe intraventricular hemorrhage.

Acute spontaneous subdural hematoma of arterial origin : A report of five cases

Acute spontaneous subdural hematoma of arterial origin is very rare. We report five patients who presented with a history of sudden onset of severe headache and vomiting and who developed progressive neurologic deficits, three becoming comatose. The symptomatologic onset was indistinguishable from other cerebrovascular disorders; none of the patients had a history of head trauma. In all our patients, the source of bleeding was identified at operation as a cortical artery located near the Sylvian region. Comparable cases in the literature are reviewed and the etiologic possibilities are discussed.

Cranioplasty with bone flaps preserved under the scalp

Cranial bone defects in 27 patients were repaired with bone flaps preserved under the scalp. Head trauma (thirteen patients), cerebrovascular disorder (five patients), postoperative brain swelling (seven patients), and cerebral infective disease (two patients) accounted for the cranial defects. The bone flaps are reimplanted after 14–98 days. The follow-up period was 6 to 26 months. We have encountered no complications releated to this technique in 27 consecutive cases.

Traumatic extradural haematomas in pediatric age group

SummaryA series of 75 children with traumatic extradural haematomas operated on at our Department between 1982 and 1988 were analysed in detail. The overall mortality rate was 17%. CT scan constituted a valuable tool for an early and correct diagnosis, and the mortality rate declined to 9% in the post-CT era. The outcome was found to be predominantly affected by the preoperative neurological status, by the duration of the time interval between onset of coma and surgical intervention, and mainly by the presence of associated brain lesions.

Histopathology of experimental spinal cord trauma: comparison of treatment with TRH, naloxone and dexamethasone

SummaryThe results of treatment with thyrotropin-releasing hormone (TRH), naloxone and dexamethasone treatments albino rats with experimental spinal cord injury were compared. All the animals were made paraplegic by the application clip method of Rivlin and Tator. Treatment was administered i.p. as bolus injections in two doses, at 45 and 120 min after the injury. Animals were allocated randomly to four experimental groups: (1) TRH (0.6 mg per dose), (2) naloxone (0.8 mg per dose), (3) dexamethasone (0.6 mg per dose), and (4) control (saline). TRH-treated rats showed significantly better histopathological scores than either naloxone or dexamethasone-treated ones (Kruskal Wallis: 24.058P<0.001).

An Experimental Evaluation of Response to Contrast Media: Pantopaque, Iopamidol, and Iohexol in the Subarachnoid Space

Myelography in dogs was performed with Pantopaque, iopamidol and iohexol. The effects of these agents were evaluated by histologic study of the brain, spinal cord, and meninges four months after the procedure. Retained Pantopaque was always accompanied by some degree of arachnoidal reaction, mild in the cervical cord segment and severe in the most caudal part of the cul-de-sac. No apparent protection against Pantopaque arachnoiditis was provided by either intrathecal or intramuscular methylprednisolone. We found no histologic evidence of arachnoiditis in animals examined with iopamidol and iohexol.

Endogenous neuropeptides in patients with acute traumatic head injury II: Changes in the levels of cerebrospinal fluid substance P, serotonin and lipid peroxidation products in patients with head trauma

The cerebrospinal fluid (CSF) levels of substance P (SP), serotonin (5-HT) and lipid peroxidation (LPx) products were measured in patients with traumatic head injury and then compared to the levels obtained from control subjects. CSF samples were collected from 45 patients (31 male, 14 female, aged 19.2 +/- 17.79) within 24 h of the head trauma and the control CSF samples were obtained from 25 healthy subjects (23 male, 2 female, aged 51.44 +/- 17.6 years) having minor surgical operations under spinal anaesthesia. CSF SP and 5-HT levels in patients with head trauma were significantly lower than the levels in controls (P < 0.005, P < 0.001, respectively). On the other hand, the CSF Lpx products were significantly increased in patients with head trauma (P < 0.001). No significant correlation was found between the CSF changes and the admission Glasgow Coma Scale scores of the patients. This study constitutes the second part of our work on endogenous neuropeptides in patients with traumatic head injury and it emphasizes the role of SP, 5-HT and lipid peroxidation as additional endogenous factors in traumatic head injuries.

Cerebellopontine angle germinoma. A case report

A case of ectopic germinoma in the cerebellopontine angle with peripheral facial palsy and complete hearing loss on the left side is presented. The diagnosis was confirmed histopathologically. The unusual location of the tumor is stressed, and current management recommendations are reviewed.

Subperiosteal intraorbital haematoma following minor head trauma

SummarySubperiosteal haematoma of the orbit following minor head trauma is extremely rare. A 5-year-old girl is presented with bilateral proptosis, chemosis, extraocular palsy, and progressive visual loss after minor head trauma. She had no evidence of fracture or abnormality of coagulation. The intraorbital haematoma resulted most probably from the oozings of a subgaleal haemorrhage which entered the subperiosteal space and then dissected over the supraorbital ridge into the orbit.