Dennis J. Rivet

Acute meningoencephalitis caused by adenovirus serotype 26

Adenoviridae are rare causes of meningoencephalitis in both immunocompetent and immunocompromised hosts. In this article the authors report a case of adenoviral meningoencephalitis caused by serotype 26 and its identification, not described previously, in cerebrospinal fluid (CSF) by PCR and brain tissue by immunohistochemical staining.

Single-institution experience with matrix coils in the treatment of intracranial aneurysms: comparison with same-center outcomes with the use of platinum coils.

BACKGROUND AND PURPOSE: This study was undertaken to analyze the outcomes and treatment-related complications of the polyglycolic/polylactic acid (PGLA)-coated Matrix platinum coils in the treatment of intracranial aneurysms and compare these results with those derived from the same single-institutional experience with use of uncoated, bare platinum coils. MATERIALS AND METHODS: In this study, we compared 2 groups of patients in a retrospective fashion. The first group consisted of 70 consecutive patients who underwent 82 aneurysm treatments with Matrix coils during the 14-month period of study, from January 2003 to February 2004. We compared this cohort with 70 consecutive patients who underwent a total of 80 aneurysm treatments with bare platinum coils in the 12 months immediately preceding the use of PGLA-coated coils, from January through December 2002. We then recorded the treatment characteristics, angiographic outcomes, and any complications. RESULTS: There were similar baseline demographic characteristics between the 2 study groups except in age, anatomic location, and length of follow-up. The overall recurrence rate of aneurysms was 41% among the Matrix-treated group and 32% among the patients treated with bare platinum. Among the 42 patients treated with 100% Matrix, the rate of recurrence was 31%. Of the recurrences, 21% of the Matrix group, 19% of the 100% Matrix group, and 9% of the bare platinum group required retreatment. The overall rate of complications was 10% in the Matrix-treated group and 7% in the bare platinum group. There was not a statistically significant difference in the rate of recurrence of aneurysms or complications between the 2 groups. CONCLUSIONS: On the basis of our single-center experience, there is insufficient evidence to support the use of Matrix coils over bare platinum coils, given their disadvantages.

Distance of the motor cortex from the coronal suture as a function of age.

Objective: This study was performed to investigate whether the distance from the motor cortex to the coronal suture changes with age. Methods: We performed a retrospective review of the charts of pediatric patients who had undergone frontoparietal implantation of subdural grids for long-term video-EEG monitoring during an evaluation for seizure surgery from 1995 to 2001. Cortical mapping was performed in 17 patients to localize the motor cortex. On postimplantation lateral skull radiographs, the coronal suture was identified at its medial aspect, and the anterior-posterior distance was measured to the electrodes overlying motor cortex. Results: Ages ranged from 10 months to 14.6 years with a mean of 8.6 years. The mean distance from the coronal suture to the motor cortex was 31.5 mm (±7 mm). The location of the motor cortex correlated significantly with age (rs = 0.84, p < 0.0005) and increased at a rate of 1.5 mm per year. All patients aged <6 years had distances of <3 cm from the coronal suture to the motor cortex. Conclusions: The distance from the coronal suture to the motor cortex increases with patient age. This variability has implications for determining the location of eloquent structures based on this anatomical landmark.

A Seven-Week-Old Infant with Fever, CSF Pleocytosis and Intraspinal Mass

Dennis J. Rivet II: This 7-week-old male infant was born via cesarean section at 36 weeks estimated gestational age and noted to have an imperforate anus shortly after birth. This was surgically addressed and treated with serial dilations. At the age of 3 weeks he was hospitalized for fever and a spinal tap revealed a nucleated cell count of 1,035 with 57% neutrophils, a protein level of 123 mg/dl and a glucose level of 58 mg/dl. Cultures of CSF and blood were negative. He received a 7-day course of cefotaxime. He again presented with fever, diarrhea and decreased oral intake at the age of 6 weeks. A repeat lumbar puncture showed a nucleated cell count of 3,105 with 86% neutrophils, protein of 200 mg/dl and glucose of 30 mg/dl. All cultures of CSF, blood and urine remained negative. On physical examination he was a well-nourished, well-developed alert and active male infant. The head circumference was 39.5 cm (90th percentile), weight 5.16 kg (75th percentile). The anterior fontanelle was soft and flat. He had a strong cry. His pupils were equal and reactive to light with normal extraocular movements. The remaining cranial nerves appeared to be intact. He had normal bulk and tone to all his extremities and could bear weight briefly. He appeared to have normal sensation in his legs and feet. Reflexes in his upper and lower extremities were equal and symmetric without clonus. His urinary stream and rectal tone were normal. Examination of his back revealed no dimple or tuft of hair. A left-sided hydrocele was present. Additional preoperative blood analysis included the following: complete blood count: white blood cells, 6.8/ mm3; red blood cells, 2.70/mm3; hemoglobin, 8.6 g/dl; hematocrit, 25.3%; neutrophils, 37%; eosinophils, 3%; lymphocytes, 47%; monocytes, 12%; MCV, 93.7 fl; MCH, 31.9 pg; MCHC, 34.0; red blood cell distribution width, 15.4; platelet count, 444 ! 103/mm3; ·-fetoprotein, 73.0; ß-hCG ! 5.0 mIU/ml. Chemistry: sodium, 136 mmol/l; potassium, 4.6 mmol/l; glucose, 100 mg/dl; calcium, 5.09 mg/dl.