Georgios K. Matis

Erythropoietin in spinal cord injury

Spinal cord injury (SCI) is a devastating condition for individual patients and costly for health care systems requiring significant long-term expenditures. Cytokine erythropoietin (EPO) is a glycoprotein mediating cytoprotection in a variety of tissues, including spinal cord, through activation of multiple signaling pathways. It has been reported that EPO exerts its beneficial effects by apoptosis blockage, reduction of inflammation, and restoration of vascular integrity. Neuronal regeneration has been also suggested. In the present review, the pathophysiology of SCI and the properties of endogenous or exogenously administered EPO are briefly described. Moreover, an attempt to present the current traumatic, ischemic and inflammatory animal models that mimic SCI is made. Currently, a clearly effective pharmacological treatment is lacking. It is highlighted that administration of EPO or other recently generated EPO analogues such as asialo-EPO and carbamylated-EPO demonstrate exceptional preclinical characteristics, rendering the evaluation of these tissue-protective agents imperative in human clinical trials.

Spinal metastasis of glioblastoma multiforme: an uncommon suspect?

Study Design. Case report. Objective. To report a case and review the literature on glioblastoma multiforme (GBM) with drop-like metastasis to the spine. Summary of Background Data. GBM constitutes the most common adult malignant brain tumor with poor prognosis. Spinal metastases of this malignancy are quite rare and dissemination usually occurs late in the course of the disease. However, recent advances in cancer treatment prolongate survival and provide adequate time for these metastases to give clinical symptoms. Methods. We hereby present a case of a 57-year-old woman with a history of pineal GBM treated by stereotactic biopsy, chemotherapy, and radiotherapy, readmitted 38 months later due to gait disturbance, spastic paraparesis, edema of lower limbs, bilateral positive Babinski response, and loss of bladder control. A contrast-enhanced magnetic resonance imaging demonstrated an intramedullary lesion extending from C7 to T3 level. A T1 and T2 laminectomy was undertaken followed by extensive biopsy. Results. Histologic examination was consistent with GBM. No further treatment was given, and the patient died 2 months after the diagnosis of the spinal metastasis. Conclusion. Spinal metastases should be commonly suspected in patients with a history of intracranial GBM who complain about symptoms not explained by the primary lesion. Glioblastoma multiforme (GBM) was first described by Rudolph Virchow in 18631 and represents the most common and most malignant tumor of the cerebral hemispheres, usually arising between the ages of 40 and 60 years.2 The incidence in Europe and North America is 2 to 3 cases/100,000 per year, and 75% of the patients die within 18 months after diagnosis.1 It is an infiltrating malignancy that recurs locally and it may spread along compact fiber pathways such as corpus callosum, optic irradiation, anterior commisure, and fornix3 or via cerebrospinal fluid (CSF) pathways.4 However, when GBM is under apparent control, spinal metastases are clinically rarely detected.5,6 Although involvement of the spinal cord (SC) has been noted with increasing frequency in recent years,4 literature provides only a few well documented cases.

Silicone models as basic training and research aid in endovascular neurointervention-a single-center experience and review of the literature

The rapid development and wider use of neurointerventional procedures have increased the demand for a comprehensive training program for the trainees, in order to safely and efficiently perform these procedures. Artificial vascular models are one of the dynamic ways to train the new generation of neurointerventionists to acquire the basic skills of material handling, tool manipulation through the vasculature, and development of hand-eye coordination. Herein, the authors present their experience regarding a long-established training program and review the available literature on the advantages and disadvantages of vascular silicone model training. Additionally, they present the current research applications of silicone replicas in the neurointerventional arena.

Giuseppe Gradenigo: Much more than a syndrome! Historical vignette

Background: Giuseppe Gradenigo (1859–1926), a legendary figure of Otology, was born in Venice, Italy. He soon became a pupil to Adam Politzer and Samuel Leopold Schenk in Vienna, demonstrating genuine interest in the embryology, morphology, physiopathology, as well as the clinical manifestations of ear diseases. In this paper, the authors attempt to highlight the major landmarks during Gradenigos career and outline his contributions to neurosciences, which have been viewed as looking forward to the 20th century rather than awkward missteps at the end of the 19th. Methods: Several rare photographs along with many non-English, more than a century old articles have been meticulously selected to enrich this historical journey in time. Results: It was after Gradenigo that the well-known syndrome consisting of diplopia and facial pain due to a middle ear infection was named. However, Gradenigo was much more than a syndrome. Surprisingly, despite the fact that he is considered a pioneer of the Italian Otology of the late 19th and early 20th century, little is written of his life and his notable achievements in the English literature. Conclusions: Even though his name lives on nowadays only in the eponym “Gradenigos syndrome,” his accomplishments are much wider and cast him among the emblematic figures of science. His inherent tendency for discovering the underlying mechanisms of diseases and his vision of guaranteeing quality of services, professional proficiency, respect, and dedication toward the patients is in fact what constitutes his true legacy to the next generations.

An atypical meningioma demystified and advanced magnetic resonance imaging techniques

A 40-year-old male presented with visuospatial processing disturbances. Family history was free. Conventional and advanced magnetic resonance imaging (MRI) studies were performed. On T2 and fluid attenuation inversion recovery images, an increased signal intensity extra-axial lesion was demonstrated. Post-contrast scans depicted homogeneous intense contrast medium enhancement. T2* star sequence was negative for hemorrhagic or calcification foci. Diffusion-weighted imaging findings were indicative of malignant behavior and magnetic resonance venography confirmed superior sagittal sinus infiltration. Increased cerebral blood volume values were observed and peri-lesional oedema on perfusion-weighted imaging was also demonstrated. The signal intensity-time curve depicted the characteristic meningioma pattern. Spectroscopy showed increased choline and alanine levels, but decreased N-acetyl-aspartate levels. Conventional MRI is adequate for typical types of meningiomas. However, the more atypical ones, in which even the histopathologic specimen may demonstrate characteristics of typical meningioma, could be easier diagnosed with advanced MRI techniques.

Organizational issues in stroke treatment: The Swiss paradigm - Stroke units

Stroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society. In this sense, prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease. Herein the authors present the new guidelines recently adopted by the Swiss Stroke Society concerning the establishment of stroke units. Standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the Swiss stroke management system. Coordinated multidisciplinary care provided by specialized medical, nursing and therapy staff is of utmost importance for achieving a significant dependency and death reduction. It is believed that the implementation of these guidelines in the stroke care system would be beneficial not only for the stroke patients, but also for the health system.

Spontaneous externalization of peritoneal catheter through the abdominal wall in a patient with hydrocephalus: a case report

Since 1905, the abdominal cavity has been used for absorption of cerebrospinal fluid in patients with hydrocephalus. We report a case of a 33-year-old female, in which a spontaneous extrusion of the peritoneal catheter of a ventriculo-peritoneal shunt through the intact abdominal wall occurred. We suggest that the rather hard peritoneal catheter eroded the abdominal wall, caused local inflammation, and then extruded through the skin. Additionally, the intestinal peristaltic movements, the omental activity and the intraabdominal pressure could play an adjuvant part, pressing direct the foreign body from the peritoneal cavity toward the skin.

Metal external ventricular drainage catheters in the treatment of persistent ventriculitis - an old story made new: technical note and preliminary results.

AIM Conventional ventricular catheters have proven to be ineffective in the drainage of the cerebrospinal fluid in the long run in terms of infection rates. Consequently, the development and clinical evaluation of new catheters is urgently needed. MATERIAL AND METHODS We implanted a ventricular needle made of stainless steel in 3 neurosurgical patients in whom multiple conventional (silicon) ventricular catheters had been previously implanted. All of them developed persistent ventriculitis during the first 30 days post-admission. The infection did not respond to antibiotics neither intravenously nor intrathecally via conventional catheters. After the implantation of the needle, colistin mesilate sodium was administered (150,000 IU/day for 21 days) intrathecally, cerebrospinal fluid white blood cells were measured and cerebrospinal fluid cultures were obtained. RESULTS Within 15 days after the implantation of the metal catheter, a significant decrease of the cerebrospinal fluid white blood cell count was noted and all cultures were negative. No operation related complications were observed. CONCLUSION Our technique of a metal catheter implantation is safe and requires fewer reoperations. Moreover, it is cost-effective since metal catheters can be used for longer periods of time, can be reused in other patients, and are of low cost.

Ocular melanoma: keep your eyes open for late brain metastases

Background: The most frequent intraocular malignant tumor is choroidal melanoma (CM). Although brain metastasis is a common feature of other types of cancers, metastasis of CM to the brain is a rare entity. Case Description: The authors report a case of a 28-year-old woman presenting with a single brain metastasis, 10 years after the treatment of a CM. She underwent a total en-bloc resection of the lesion, and the diagnosis was confirmed histopathologically. The patient concomitantly received whole-brain irradiation therapy combined with chemotherapy, with a survival period of 24 months. Conclusion: The present case report draws attention to the necessity of a close and lifelong follow-up of patients treated for this malignancy. The international literature is also reviewed.

Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia

A case of an iatrogenic spinal arteriovenous fistula with progressive paraplegia in a young woman is reported. The fistula was eventually created after repetitive lumbar punctures performed in the process of spinal anaesthesia. Her symptoms were progressed to paraplegia over a period of 2 years. The digital subtraction angiography demonstrated a single-hole fistula, involving the anterior spinal artery and vein. The lesion was occluded by embolization with immediate improvement. The potential mechanism is discussed.