Peripheral nervous system and spinal cord involvement in lymphoma

Nine-hundred-eighty-nine patients with diagnosis of lymphoma were studied. Forty-six cases (4.6%) had compressions of the spinal cord or roots. Forty-two patients (4.2%) had Herpes zoster virus infections, which in 6 cases were of disseminated type. The major predisposing factors for infection were: advanced stage of lymphoma, previous systemic chemotherapy and splenectomy. Toxic polyneuropathy secondary to chemotherapy was found in 39 patients (3.9%). In 14 cases, the polyneuropathic symptoms were the main complaint (Group 1), while in the remaining 25 cases the diagnosis was made during neurological consultations because of unrelated symptoms (Group 2). Both groups did not have significant differences in the total dose of chemotherapy received. The electrophysiological studies showed an axonal neuropathy in both groups. The discontinuation of chemotherapy was found to be a limiting factor in the appearance of neuropathic symptoms. Other less frequent forms of involvement were: compression of peripheral nerves or nerve plexi from lymphadenopathies (3 cases), radiation myelopathy (1 case), and Guillain-Barré Syndrome associated with Hodgkin's Lymphoma (1 case).     

Spinal cord involvement in Burkitt-type lymphoma: report of a case

Case report of Burkitt's type lymphoma with involvement of the spinal cord in a three years-old child. An epidural tumoral mass (T11-L1) was removed surgically (Fig. 2), and clinical conditions improved for a short period of time (1 and 1/2 months) after which symptoms reappeared. At this occasion a computerized tomography showed a tumoral mass occupying the spinal canal with high density at the L2 level. The patient died 6 months after the beginning of the disease. General considerations are made on Burkitt's lymphoma.     

Craniocerebral trauma

In cases of craniocerebral trauma there may be primary and secondary cerebral lesions.The principal goal of treatment is to minimize secondary cerebral trauma by optimized therapy. In the primary treatment phase monitoring of vital signs (blood pressure and respiration) is of crucial importance. CT diagnosis is followed by treatment of any increase in intracranial pressure by relief of hematomas, CSF drainage and appropriate intensive care measures.     

Craniocerebral gunshot injuries in preschoolers

Introduction  

Gunshot wounds (GSW) to the head are the most lethal form of trauma; unfortunately, the frequency of children being involved in such form of trauma is increasing at an alarming rate worldwide. We present our experience with four children from 2 to 3 years of age with craniocerebral GSW admitted to the neurosurgery service at a tertiary care hospital.     

Craniocerebral gunshot injuries in children

INTRODUCTION: Despite the worldwide increase in the incidence of gunshot injuries, there are few large published series on craniocerebral gunshot injuries in children. MATERIALS AND METHODS: The records of 30 consecutive children who were treated for craniocerebral gunshot injuries at the Red Cross War Memorial Children's Hospital from 1989 to 2002 were reviewed retrospectively. The circumstances of the injury, clinical status, CT findings, complications, and outcome were assessed. RESULTS: The median age was 7 years. Seventy-seven percent of the victims were boys. The majority of the children were injured in the crossfire of civilian violence. The initial management consisted of debridement under local anesthesia in 16 children and neurosurgical procedures under general anesthesia were performed in 14. Sixteen children sustained transhemispheric injuries, 5 bihemispheric injuries, 5 tangential injuries, and 4 transventricular injuries. All 3 children with a GCS <4 died within 72 h of admission. Three of the 7 children with GCS 4-7 died but there were no deaths in those children whose GCS was >7 post-resuscitation. Motor deficits, cranial nerve palsies, and visual field defects were very common. Early post-traumatic seizures were the commonest complication (18%). CONCLUSION: Children with higher post-resuscitation GCSs fared better than adults in terms of mortality but not necessarily morbidity. As in the case with adults, the GCS after resuscitation is a very good prognostic indicator of mortality.     

Craniocerebral missile injuries

Gun shot wounds to the brain are among the most devastating causes of morbidity and mortality in the civilian population. The majority of the victims will not survive and for a great number of survivors life becomes an uphill battle with permanent deficits and complications. While the fundamental surgical care of these patients is essentially unchanged, our scientific understanding of the pathophysiological changes and the post-injury care of the victims has been evolving. The purpose of this article is to provide an overview of the current clinical and laboratory advances in understanding and treating gun shot injuries to the brain.     

Argyll Robertson in a case of malignant lymphoma with ciliary involvement (author's transl)

The authors report a case malignant lymphoma associated with a pseudotabetic syndrome including ataxia, tendon areflexia and an Argyll Robertson pupil. Blood and CSF serological tests for syphilis were negative. Death occurred after 11 years of evolution. An autopsy revealed a malignant lymphoma with mediastinal and retroperitoneal tumor proliferation as well as infiltration of peripheral nerves, in particular the ciliary nerves and one ciliary ganglion examined. No lesion was found in the mesencephalon. The importance of this case lies in its contribution to the location of the pathological changes in the presence of an Argyll Robertson pupil.     

Craniocerebral aspergillosis in immunocompetent hosts: surgical perspective

Craniocerebral aspergillosis is a rare but dangerous variety of central nervous system infections. Surgery is being widely recognized as the cornerstone of management. Due to the rarity of the disease, difficulty and delay in diagnosis and poor outcome, there is very little in the literature regarding the various surgical strategies that may be adopted in these patients. Early aggressive surgery followed by chemotherapy offers the best chances. Surgical planning would depend upon the type and location of the disease process as well as the condition of the patient. Perioperative care holds immense importance and knowledge of possible complications is essential. Aspergillosis of the central nervous system is difficult to diagnose and equally difficult to treat. Surgery remains the cornerstone of management followed by systemic antifungal medications. Results are better in immunocompetent patients as compared to those who are immunocompromised.     

Peripheral nervous system involvement as presenting symptom of systemic B‐cell lymphoma

Peripheral nervous system involvement has been reported in systemic B or T cell lymphoma and may result from intraneural localization of lymphoma resulting in meningo‐radiculopathy or mononeuropathies, or manifest as a sensory‐motor polyneuropathy sometimes mimicking chronic inflammatory demyelinating polyneuropathy. We report two patients with a previously unknown NHL presenting in both with a stepwise progressive asymmetric multiradiculoneuropathy initially misdiagnosed as inflammatory radiculopathy. A 58‐year‐old man presented with a 2 year history of stepwise progressive peroneal sensory loss, impotence, and lower limb painful asymmetric neuropathy. Lumbosacral MRI was normal. Electrophysiological studies were consistent with an axonal multiradiculoneuropathy while CSF examinations repeatedly showed increased protein levels (80–91 mg/dl) with slightly increased white cells (<10 mm³) but no malignant cell. The patient repeatedly failed to respond to steroids although he consistently deteriorated at their suspension. An MRI performed 2 years later when multiple cranial nerve palsies appeared showed bilateral T1 and T2 hyperintensities in the brain and cervical spinal cord. An extensive investigation for neoplasm was negative. The patient died from an intracranial hemorrhage during anticoagulant therapy for deep vein thrombosis. Autoptic studies revealed a widespread non‐Hodgkin's type B lymphoma with massive systemic and neural involvement including cauda equina and spinal cord. A 54‐year‐old man presented with a 1 year history of impotence, urinary incontinence, progressive asymmetric painful distal sensorimotor impairment at four limbs and prominent weight loss. Four previous CSF examinations revealed increased protein levels (80–100 mg/dl), and slightly but inconsistently increased white cells (1–11/mm³) but no malinant cells. Steroids were repeatedly ineffective although the patient consistently deteriorated whenever steroids were discontinued. On admission electrophysiological studies showed an axonal asymmetric polyradiculoneuropathy. Brain and spinal MRI was normal while bone marrow biopsy and aspiration disclosed a B cell lymphoma.     

Craniocerebral injury resulting from transorbital stick penetration in children

Objects: Two children were admitted to hospital for treatment of craniocerebral injury with transorbital penetration. Methods: One child aged 6 years and 6 months had poked a chopstick in his orbit. There was no report of either a palpebral or an ocular wound. He had subsequently developed a meningeal syndrome with a cerebral abscess managed by needle aspiration biopsy and intravenous antibiotics. The other child, aged 4, had fallen onto a metal rod. He presented with a palpebral wound, motor disorders and coma, all due to a frontal intracerebral hematoma. There was an improvement in outcome without complications of an infectious nature or motor sequelae. Conclusions: Such head injuries are rare. Clinical, radiological and ophthalmological investigations must be performed, including computed tomography (CT) scan or cerebral magnetic resonance imaging (MRI) with antibiotic treatment for suspected microorganisms. Received: 7 September 1999     

重型颅脑损伤患者早期肠内营养支持治疗的临床分析

目的探讨早期肠内营养对重型颅脑损伤患者救治的效果。方法将我院2006年8月至2007年4月收治的58例入选病例随机分为治疗组和对照组，治疗组27例早期应用肠内营养乳剂治疗，对照组31例按传统方法鼻饲流质，其余治疗两组无差异。分析两组病人的营养指标、并发症及预后情况。结果治疗组27例病人中，除1例因发生较重的并发症而暂时中断肠内营养外，其余病例均顺利接受了早期肠内营养，其营养指标及预后均明显优于对照组（P〈0.05），且并发症明显减少。结论肠内营养方便、经济、并发症少，可以提供患者所需要的营养素，增强免疫，减少感染；绝大多数病人能顺利接受早期肠内营养支持治疗；早期胃肠内营养在重型颅脑损伤病人的治疗中非常重要，可明显降低致残率和死亡率，应高度重视。     

不同程度的颅脑创伤对CEC的影响

目的研究颅脑创伤的严重程度与血液循环内皮细胞﹙CEC﹚含量的关系。方法在家兔上制成不同严重程度颅脑创伤模型,采用Percoll密度梯度法测定家兔颈内静脉血中的CEC,应用BH-2型光学显微镜﹑JEM-1000SX型透射电镜观察脑组织的病理改变。结果动物致伤后颈内静脉血中的CEC显著升高,在同一时相点对照组﹑轻伤组﹑重伤组两两间有显著差异(P<0.05或P<0.01),伤情愈重,病理损伤愈明显。结论创伤可致CEC升高,受伤早期CEC升高在一定程度上可反映伤情的轻重。