Shoshana Matz

Successful non‐neurotoxic therapy (without radiation) of a multifocal primary brain lymphoma with a methotrexate, vincristine, and BCNU protocol (DEMOB)

A 3.5‐year‐old boy with a multifocal primary lymphoma of the brain was treated successfully without neurotoxicity with a treatment regimen that did not include radiation. The protocol of Dexacort (dexamethasone), methotrexate, Oncovin (vincristine), and BCNU (carmustine) (DEMOB), which was developed with the use of MTX pharmocokinetic studies, was given over 7.5 months, and resulted in tumor disappearance on computerized tomography scans and marked improvement in clinical status. The patient remains in good health 3 years after diagnosis (March 1985).

Experience with intraoperative CT scanning in brain tumors

Abstract Intraoperative CT scanning was used in 10 patients suffering from malignant brain tumors. Follow-up CT scans performed postoperatively indicated that extensive resection of the tumor was achieved in all of the patients. It is suggested that this technique might also be employed in other types of invasive brain tumors.

Methotrexate-Induced Leukoencephalopathy is Treatable with High-Dose Folinic Acid: A Case Report and Analysis of the Literature

An episode of leukoencephalopathy is reported in a 13-year-old girl who, after standard radiotherapy for a posterior fossa medulloblastoma, received 8 treatments with a protocol containing a 4-hour infusion of 500 mg/m2 methotrexate and 12 mg intrathecal methotrexate. The leukoencephalopathy, documented clinically and by CT and EEG, cleared after 2350 mg of leucovorin (citrovorum factor, folinic acid) was given in addition to the 135 mg given as part of the therapy. A review of the literature suggests that leukoencephalopathy may be prevented by high doses of leucovorin and can be treated by high doses, if lower doses were used initially. When high dose leucovorin was not used, residual neurological damage is not unusual.

Nasal Visual Field Loss by Intracranial Lesions of the Optic Nerve Pathways

Five patients developed nasal visual field defects as a result of involvement of the intracranial portion of the optic nerves. The cause in each patient, respectively, was as follows: (1) dolichoectatic carotid arteries, (2) optochiasmatic arachnoiditis, (3) meningioma of the olfactory groove, (4) pituitary apoplexy, and (5) pituitary chromophobe adenoma. The common factor in these cases was probably impaired circulation in the prechiasmal arterial anastomotic network. The nasal visual field loss present in these cases was characterized by a pattern similar to that seen in glaucoma but with impairment of visual acuity. The superior nasal visual field was usually normal and the lower temporal visual field often defective.

Congenital vascular malformation of spinal cord simulating diastematomyelia.

Diastematomyelia is usually caused by a midline bony, cartilaginous or fibrous spur. A case is presented with splitting of the spinal cord by a large arteriovenous malformation at the thoracolumbar junction. A hairy skin patch, kyphoscoliosis, vertebral anomalies and an arachnoidal cyst were found adjacent to the vascular and neural malformations.

Cervical myelopathy caused by narrowing of the cervical spinal canal. The value of x-ray examination of the cervical spinal column in extension

In order to determine the minimal diameter of the cervical spinal canal, the canal diameter was measured in radiographs taken in the neutral position and in extension in 100 control patients and in 11 patients with signs of myelopathy of undetermined cause. It was found that: 1. In the myelopathic group the average canal diameter was significantly smaller than that in the control group. 2. Even in normal persons the canal narrows in extension. The importance of this narrowing is amplified when the canal is narrow to begin with or when there is cervical spondylosis or cervical disc protrusion. Stress is laid upon the importance of carrying out lateral x-ray studies of the cervical spinal column in extension when the suspected cause of a myelopathy is pressure upon the spinal cord.