Hendrik J. Svien

Swan-neck deformity following extensive cervical laminectomy. A review of twenty-one cases.

Twenty-one patients, thirteen to sixty-two years old, were treated for cervical swan-neck deformity after extensive laminectomy (with or without foraminotomy), performed for cervical-disc syndrome in nine, spondylosis in six, syringomyelia in three, cord tumor in two, and old fracture-dislocation with nerveroot compression in one. Spontaneous fusion occurred in one patient after prolonged bracing. In the other twenty, the results of surgical stabilization (three posterior and seventeen anterior fusions) were excellent in nine, good in one, fair in four, and poor in six. It was concluded that bracing after extensive laminectomy is indicated, and may prevent this complication; that early recognition and anterior fusion are essential to prevent fixed severe deformity; and that fusion must extend the full length of the laminectomy.

Ependymoma of the brain; pathologic aspects.

STORCH’ is credited by Scherer as being the first to describe clearly, in 1899, a brain tumor whose general structure differed from that of both the main groups known until then, glioma and sarcoma. In a child aged six years he found a partially cystic tumor of the parietal lobe characterized by a curious papillary perivascular structure, its cells forming “crowns of rays” around the vessels, and in other places he noted tubular structures with a lumen resembling the central canal of the nervous system. There is little doubt that what Storch described is what we call “ependymoma” today. He even described dark corpuscles in the cytoplasm of the tumor cells, which in all probability correspond to the “blepharoplasts” considered by Mallory2 as very important for the diagnosis. The literature prior to 1924 contains numerous reports of tumors classified as “ependymal gliomas.” Bailey,3 in 1924, analyzed critically the reports of tumors in this varied group and identified only five cases which he could accept as cases of true ependymomas, that is, tumors originating from ependymal cells. The next year he4 divided the tumors of this group into ependymomas and ependymoblastomas on a histogenetic basis. This subdivision has been used by most neuropathologists since. In 1931, Kernohan, Woltman and Adson; divided the ependymomas, on histologic and architectural grounds, into epithelial, myxopapillary and cellular

Craniosynostosis involving the sagittal suture only: Guilt by association?

Summary The clinical findings in 42 cases of craniosynostosis are summarized. Eighteen patients had craniosynostosis involving only the sagittal suture. Ten of the 18 did not have surgical treatment, while 5 had inadequate and 3 had adequate surgical procedures. We believe that patients with craniosynostosis involving the sagittal suture alone have been given an unwarrantedly poor prognosis in regard to development, and we question advocation of craniectomy for cosmetic reasons alone.

A STUDY OF CEREBRAL PROTEIN AND POLYSACCHARIDE IN THE DOG. III. "ALBUMIN" CHANGES IN EXPERIMENTAL CEREBRAL EDEMA.

I N PREVIOUS COMMUNICATIONS1.2 we reported on the normal cerebral protein and polysaccharide in dog brain. An increase in the relative concentration of albumin in cerebral edema was first noted by Kaps% in 1954. Sperl and associates4 developed a technic, using intracerebral implantation of psyllium seed, for consistentlv producing cerebral edema in the dog. Utilizing this technic, we have confirmed the finding of Kaps in experimental cerebral edema and are reporting an extension of this as a quantitative measure of cerebral edema.

Occlusion of the third ventricle by tortuous, bulbous, calcified basilar artery

A married man, 59 years old, registered at the Mayo Clinic on February 12, 1957, because of marked mental disorientation. He apparently had been in reasonably good health until December 1956, when he suffered what was called a “stroke.” He felt ill, lay down on the ground, and vomited. He was not paralyzed after this episode, however. At this time, hypertension was discovered. Attempts at treatment with drugs failed because of lack of cooperation on the part of the patient. A month before his admission, edema of the legs developed and became progressive to a rather marked degree. Examination by the patient’s local physician disclosed auricular fibrillation. The patient was hospitalized in his home city two weeks before admission to the clinic, and digitalis and diuretic agents rid him of much of the edema. Apparently, the patient had experienced no neurologic symptoms until about mid-December of 1956. A t that time, it was noted that he was becoming confused. He became disoriented for several hours and then seemingly recovered orientation completely. However, in the ensuing three or four weeks, he had repeated episodes of confusion. The patient was confused as to time and place and was unable

Foreign body reaction of the brain Enzyme‐histochemical study in dogs

THE CELLULAR REACTIONS in cerebral damage have been reported sporadically in the medical literature since the beginning of this century. Improved histologic techniques, such as Cajal’s gold sublimate and Hortega’s silver carbonate impregnation methods, accelerated this type of investigation, but there still are unsettled problems regarding the role of individual cellular components and, particularly, regarding the origin of compound granular corpuscles. In 1927, Del Rio-Hortega and Penfieldl extensively reviewed the world literature and described their own experiment on cerebral cicatrix formation. They concluded that compound granular corpuscles originated from rnicroglia and that astrocytes had no phagocytic activity. This conclusion was supported by Carmichael.2 After studying wounds produced during ventriculography in human brains, Baggenstoss and co-worker9 suggested that most compound granular corpuscles arose from endothelial cells associated with capillaries, from adventitial cells of larger vessels, and from mononuclear cells of the circulating blood. Rand and Courville4~5 studied human brains which had sustained various types of mechanical injuries. However, there are only few reports regarding cerebral parenchymatous reaction to foreign bodies. FarrarG implanted sterile “elder marrow” into the cortex of rabbits. He reported that the first period was characterized by engorgement of surrounding blood vessels and gradual accumulation of leukocytes in the “meshes” of the foreign body. The second period consisted of progressive changes in mesodermal and glial elements; in the third period, there was termination of the mesodermal proliferation and simultaneous regressive changes in the glia. Similar findings were obtained by Morgenthaler,? and both authors657 described progressive alteration in capillaries, beginning at six hours and becoming marked at seven days. Hassins described the cerebral reaction to an intracerebrally placed cotton pledget. Rubinstein and Smith9 investigated the dehydrogenases in reactive macrophages in necrotic brain tissue, and Osterberg and Wattenberglo studied this aspect in reactive gliosis. While we were investigating, by enzymehistochemical techniques,ll an experimental cerebral edema similar to that occurring in human brain abscess or brain tumor, we found significant enzyme activities in the tissue immediately surrounding implanted sterile psyllium seeds. The histologic changes were similar to those observed surrounding a brain abscess in human beings (Fig. 1). This granulomatous area showed enzyme activities which were significantly different from those in a purely edematous area.ll This paper compares the changes in the edematous area with those in the granulomatous capsular area immediately surrounding the implanted psyllium seeds.

EVALUATION OF RESULTS OF RADIATION TREATMENT OF PITUITARY CHROMOPHOBE ADENOMAS PRODUCING VISUAL IMPAIRMENT.

In the early years of the twentieth century, treatment of pituitary tumors was placed on a sound basis by the pioneer work of Beclere (1) and other workers in the field of radiotherapy, and by Cushing (2) and others in surgery. Since those early days there has been (to quote Dyke and Davidoff (3)) …“some tendency on the part of radiotherapeutists and neurological surgeons to show preference for their own type of therapy.” In the nearly half century since this pioneer work, the “tendency” still seems to exist, probably because even to this date no sound objective method of evaluating treatment has found general acceptance and usage. Emphasizing this point are two editorial comments from the most recent Yearbook of Radiology (4): (a). “The chronicity and variability in progression of chromophobe adenomas make evaluation of any treatment difficult…” (b) “One of the difficulties in evaluating the results of treatment of pituitary adenomas is the inability to find something to measure….” Also, as Paterson (5) ...

Paraparesis following abdominal crush injury in children

Case 1 . A 22-month-old boy was knocked down by a car backing from a driveway. The rear tire ran partially over his body, stopped, and, reversing direction, pulled clear. Immediate paraparesis was recognized, and the attending physician referred the patient directly to the Mayo Clinic. Initial examination seven hours after the injury revealed superficial contusions of the right arm and the trunk and a slightly distended abdomen with hypoactive bowel sounds but without localized tenderness. Sensory appreciation was moderately diminished below the thoracic tenth dermatome on the right and below the first lumbar dermatome on the left. Only a trace movement of reflex withdrawal of either foot could be elicited. The stretch reflexes were slightly hyperactive in the right leg and of normal amplitude in the left. The anal sphincter was flaccid, and Babinski’s reflex was more readily provoked on the right than on the left. Roentgenograms of the chest, abdomen, pelvis, hips, and lumbodorsal spine were negative. The bladder contained 150 ml. of clear urine upon catheterization. Diagnostic peritoneal puncture excluded active intra-abdominal bleeding. Lumbar puncture yielded clear cerebrospinal fluid containing 100 mg. of protein per 100 ml. and 3,640 erythrocytes, 2 lymphocytes, and 2 neutrophils per cubic millimeter. The opening cerebrospinal fluid pressure was 10 cm. of water, and flow dynamics were normal with jugular compression. The patient was kept a t bed rest, an indwelling catheter was inserted, and nothing was given orally in deference to the incomplete paralytic ileus. Serial hemoglobin determinations were done to warn against occult hemorrhage, and the urinary output and neurological status were closely followed. Three days later he had improved so that a minimum residue diet was given; successful voiding made further catheter drainage unnecessary. Bedside physiotherapy to maintain the full range of joint motion was started.