Bernd Haubitz

Combined orbito-frontal injuries

Our experiences in 55 patients suffering from orbitofrontal injuries are discussed. The prognosis is determined by the severity of the brain injuries and the cerebral complications. The relation of fronto-basal, orbital, and maxillofacial fractures to lesions of the brain tissue and contents of the orbita is best demonstrated in high-resolution CT scan. Surgery is usually possible in one interdisciplinary operating session. Penetrating injuries with CSF leakage primarily require operative therapy; indirect, open, frontobasal fractures should be covered secondarily within two weeks following trauma. A debridement of the paranasal sinuses is necessary if drainage is obstructed or infection is imminent. We found no improvement of visual function in eight patients following transethmoidal optic nerve decompression; the visus recovered only in one patient after removal of a bone fragment impressing on the eyeball. Typical complications are systematic or central nervous system infections; less frequent are traumatic cavernoussinus fistulas and pneumato- or encephaloceles.

Cavernous angioma of the geniculate ganglion

Intracranial extraaxial cavernous angiomas are rare vascular malformations. Their occurrence at the geniculate ganglion of the facial nerve within the temporal bone is exceptional. The authors describe a 35-year-old man who developed a slowly progressing facial palsy. Initial cranial MR imaging showed no pathological findings, but 2 years later another MR examination detected a small tumor located at the geniculate ganglion of the facial nerve. The tumor was removed via a subtemporal approach. Histological examination revealed a cavernous angioma. Even small cavernomas located at the geniculate ganglion of the facial nerve may result in facial palsy. Isolated facial palsy in a young person should be monitored closely using imaging studies even if the initial imaging study is negative. Early decompression of the facial nerve may help to preserve its function.

Chronic cerebrovascular insufficiency on the xenon CT scan

Several investigators have describedCT-negative low flow areas in TIA and stroke patients in the chronic phase. The emission tomographic SPECT image they employed has, in contrast to the xenon CT method, no direct relation to the x-ray transmission CT scan. The aim of our study was to study the phenomenon ofCT-negative low flow areas using the xenon CT method, a method especially well suited for such cases. 57 xenon CT examinations were performed in 40 TIA patients, and 56 xenon CT examinations in 32 stroke patients. Flow data from brain tissue which appeared to be anatomically intact in a slice 5 cm above the canthomeatal plane were analyzed. In the TIA group, the flow in the gray matter was found to be significantly lower on the clinically affected side: symptomatic side, 61.8 ± 14.7 ml/100 g/min; asymptomatic side, 66.4 ± 15.8 ml/100 g/min (p < 0.001).In the stroke group, the flow in the white matter was also affected; symptomatic side, 31.2 ± 9.8 ml/100 g/min; asymptomatic side, 35.3 ± 11.1 ml/100 g/min (p < 0.01). Gray matter: symptomatic side, 56.1 ± 11.4 ml/100 g/min; asymptomatic side, 66.0 ± 11.0 ml/100 g/min (p < 0.001).The findings indicate that the appearance ofCT-negative low flow areas in TIA and stroke patients during the chronic phase is the rule rather than the exception. Flow adaptation to anatomic changes not discernible by CT can be differentiated from clinically relevant flow impairment only by testing the cerebrovascular reserve.

Progressive multifocal cerebral infarction in a young kidney transplant recipient due to thrombotic microangiopathy

BackgroundRenal transplant recipients frequently experience neurological complications. Whereas ischemic stroke, cerebral haemorrhage or hypertensive encephalopathy often result from vascular alterations prior to transplantation, other cerebral diseases like CNS infections, primary brain tumors and drug induced neurotoxicity may develop as consequences of the required post-transplant immunosuppressive treatment.Case presentationHere we report on an unusual clinical course of a young kidney transplant recipient with a cluster of fulminant necrotic brain lesions within a period of two months due to thrombotic microangiopathy.ConclusionCerebral ischemia in organ transplant recipients should prompt one to consider thrombotic microangiopathy.

CLIPPERS Syndrome: An Entity to be Faced in Neurosurgery

BACKGROUND Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory disorder of the central nervous system; it has only recently been defined and to date has received only limited attention. Its cause is as yet unknown. The pathologic characteristics are infiltration of T lymphocytes into the perivascular spaces of the pons, responsiveness to immunotherapy, and gadolinium-enhancing punctiform lesions in the brainstem seen on magnetic resonance imaging (MRI). CASE DESCRIPTION We report here on the clinical, MRI, and brain biopsy findings in a 68-year-old man who presented with dysphagia, numbness and paresthesia on the right side of his face, as well as progressive gait ataxia. Brain and spinal MRI showed lesions in the pons and in the cervical spinal cord. The pontine lesion became progressively larger extending to the middle cerebellar peduncle and a tumor was suspected. After repeated biopsy, the histopathologic diagnosis confirmed CLIPPERS. CONCLUSIONS CLIPPERS syndrome may become manifest with a progressive tumor-like pontine lesion. This report adds clinical and radiologic aspects to the limited number of CLIPPERS cases reported to date, and underlines the importance of considering CLIPPERS in the differential diagnosis of tumor-like pontine processes.

Effects of 33% stable xenon/O2 mixture on somatosensory evoked potentials

The influences of 30% stable xenon/O2 mixture on somatosensory evoked potentials were investigated in 8 patients with and without Diamox application. Changes of the amplitude of the primary cortical response occurred frequently and correlated well with the psychotropical effect of xenon. They usually normalized within 2 to 3 minutes after ending xenon inhalation. There were no significant changes of the latency of the N20.