G. C. Andrioli

Extracranial Posterior Inferior Cerebellar Artery Aneurysm Causing Isolated Intraventricular Hemorrhage: A Case Report

The authors report the unusual case of an aneurysm arising on an extracranial loop of the left posterior inferior cerebellar artery (PICA). The computed tomographic scan showed an isolated hemorrhage in the lateral ventricles, and the lesion was recognized 1.5 cm below the foramen magnum at the level of the atlas. The literature concerning peripheral PICA aneurysms is reviewed and the clinical and radiological features of these lesions are discussed. A tendency for subarachnoid bleeding from distal PICA aneurysm ruptures to spread into the ventricular system is suggested. The diagnosis of distal PICA aneurysm should also be considered in cases of isolated intraventricular hemorrhage without obvious parenchymal or subarachnoid hemorrhage. The need for four-vessel angiography when studying patients suffering from a subarachnoid hemorrhage is stressed.

Severe head injury in children: early prognosis and outcome.

The outcome is reported in 62 children with severe head injuries following a road traffic accident. All patients were comatose for at least 6 h; all patients were graded using the Glasgow Coma Score (GCS) or the Children Coma Score (CCS). Fifty-four patients were comatose immediately after injury, 8 after a lucid interval. Thirty patients had isolated head injuries and 32 had associated injuries, either long bone fractures or rupture of an abdominal organ. Additional information concerning main brainstem reflexes, posture and respiration was included in the study. The overall mortality was 32%. The goal of the study was to identify those clinical features available soon after injury which are important indicators of treatment and outcome.

Subarachnoid haemorrhage of unknown aetiology.

SummaryOne hundred and forty consecutive subarachnoid haemorrhages (SAH) which presented either an intracranial vascular malformation (102 cases: aneurysm 80 cases, AVH 22 cases) or remained of “unknown aetiology” (38 cases) were studied. SAH caused by other factors (neoplasms, thrombo-embolisms, systemic diseases etc.) were excluded. The 38 cases with bleeding of “unknown aetiology” have been studied by complete cerebral angiography, pneumoencephalogram or CT scan, and have been followed for two years.The most important clinical factors in the three groups have been compared by a statistical method to verify the hypothesis that SAH of “unknown aetiology” is caused by vascular micromalformations which are angiographically not evident either because of their small size or because of their “spontaneous” recovery after bleeding due to thrombosis and disappearance of the malformation.From the data collected it may be concluded that SAH of “unknown aetiology” is a benign lesion, typically occurring in middle age, but with no clear characteristics that enable identification of the anatomical substratum from it originates.

Cerebellopontine angle osteoma causing trigeminal neuralgia: case report.

A case of cerebellopontine angle petrous bone osteoma manifesting as homolateral trigeminal neuralgia and causing a mild brain stem compression is presented. The literature concerning osteomas and particularly those affecting the temporal bone is reviewed. This is the second report of an osteoma located on the inner surface of the petrous bone and causing intracranial complications. Moreover, we discuss the intracranial tumors presenting with trigeminal neuralgia or atypical facial pain.

Chronic extradural haematomas

SummaryWe report 17 cases of chronic extradural haematoma out a total of 411 epidural haematomas treated at the Neurosurgical Department of Padua from 1954 to 1980.The definition, the variations in the presentation, and the CT scan features of chronic epidural haematomas are discussed.

Brain stem abscess treated successfully by medical therapy.

A case of a solitary brain stem abscess in a 55-year-old man is presented. The computed tomographic scan and clinical picture allowed the presumptive diagnosis to be made. The abscess resolved completely after treatment with chloramphenicol, vancomycin, and ceftazidime administered intravenously. Medical therapy should be considered as an effective treatment of a brain stem abscess, provided the antibiotic therapy is administered under close clinical and computed tomographic monitoring.

Primary brain stem haematomas. Diagnosis and treatment

SummaryCase histories are reported of 18 patients in whom the diagnosis of primary brain stem haematoma5 and brain stem haemorrhage13 was made by computed tomography (CT).The possibility of an early diagnosis of brain stem haematoma, and the differential diagnosis of brain stem haemorrhage by a combination of clinical and tomodensitometric criteria is emphasized.It is concluded that CT is a highly reliable method for the diagnosis, location, and management of brain stem haematoma.

Brain metastasis from endometrial carcinoma. Report of two cases.

The authors report two cases of surgically treated brain metastases from endometrial cancer which are quite unusual occurrences. In one of them the brain lesion was the presenting symptom of malignancy while in the other the metastasis was discovered after the primary tumor had been treated. Both the brain lesions were scarcely differentiated adenocarcinomas which closely resembled the uterine primaries histologically.The authors review the four cases reported in the literature and discuss the clinical features and the treatment of this disease. The analysis of cases shows that the metastatic potential of endometrial cancer is extremely variable and unpredictable but less severe than that observed in ovarian or cervical tumors.The authors suggest that the erratic behaviour of endometrial cancer may justify an aggressive (though necessarily palliative) approach to brain metastases even in the presence of circumscribed metastatic involvement.

Concurrent Primary Intracranial Tumours of Different Histogenesis

The occurrence of intracranial tumours of diverse histogenesis can be considered occasional. In a careful survey of the literature we have encountered 63 cases of concurrent intracranial tumours: we report five personal observations, too. This review raises the question as to whether the conjoint occurrence of two intracranial tumours is purely coincidental. The statistical analysis of the cases of concurrent intracranial tumours, and the comparison between the frequency found for each different tumour when it is solitary and when it is coincident in a same patient, suggests that a casual connection can be found between tumours of diverse histogenesis.

Epidural haematoma at the vertex.

SummaryWe report 14 cases of vertex epidural haematomas among 478 cases of epidural haematomas that were hospitalized in the Neurosurgical Department of the University Hospital of Padova during the period 1953–1980.We discuss the clinical, diagnostic, and prognostic features. The mortality rate was 50%. In this type of traumatic haematoma prompt surgical treatment is not always followed by good recovery.