Dermoid tumours occurring at the site of previous meningocele repair

Two cases of dermoid tumours following meningocele repair have been reported because of the rarity of the condition and paucity of literature. It should be stressed that a dermoid tumour should be considered in the differential diagnosis of neurological deterioration in patients with a repaired meningocele.     

Malignant fibrous histiocytoma originating at the site of a previous fronto-temporal craniotomy

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. MFH occurrence in the bones of the skull is extremely rare, and, to our knowledge, it has not been reported in a patient with a history of craniotomy. A 69 year old woman presented with a large mass in the left fronto-temporal bone. The patient's medical history included a left fronto-temporal craniotomy 8 years prior to the present admission for neck clipping of an aneurysm of the left middle cerebral artery. Following preoperative work up, the skull tumor was resected, and pathology showed that the mass was composed of spindle-shaped fibroblastic cells arranged in a storiform pattern, and of numerous multinucleated giant cells. A diagnosis of MFH was established. The patient died of intracranial hemorrhage from a subsequent tumor 22 months after resection of the first tumor.     

Intracranial meningioma at the site of a previous cranial fracture: case report and review of the literature

The authors present a case of post-traumatic intracranial meningioma, selected according to the criteria specified in the relevant literature. Assessment of the clinical characteristics of our patient and those reported in the literature seems to confirm that, in some cases, head trauma may be a factor contributing to the development of meningioma.

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Sommario Gli autori riportano un caso di meningioma intracranico post-traumatico. Il caso è stato selezionato in base agli specifici criteri riportati in letteratura. L'analisi delle caratteristiche cliniche del nostro paziente e di quelli riportati in letteratura ha permesso di confermare che il trauma cranico potrebbe essere un fattore predisponente all'evoluzione di un meningioma intracranico.

     

An ongoing, multi-faceted program for victims of terror attacks and their families

Victims of terror attacks, whether or not physically injured, sometimes suffer long-term posttraumatic symptoms, although the intensity of symptoms differs among individuals. Often, after discharge from the hospital, additional posttraumatic symptoms and emotional distress are evident, together with difficulty in readjusting to a normal life. This paper describes an ongoing multi-faceted program to empower victims and their families and assist them on the journey to recovery. The program is operated by the social work department in one of the main hospitals in Israel, in alliance with a voluntary non-profit organization in the U.S. One hundred seventeen victims of terror attacks who were previously hospitalized in the hospital for immediate care after attack were enrolled in the program, which is structured to offer comprehensive help in order to meet the psychological, material, and social needs of the participants and their families. Based on needs assessment, the participants are offered individual, family, and group therapies and community activities. Different elements of the project are described, and the need to further develop intervention models and to evaluate them is highlighted.     

Salivary cortisol and psychopathology in children bereaved by the september 11, 2001 terror attacks.

BACKGROUND: Studies suggest that stressful events increase risk for childhood anxiety and depression and hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This prospective longitudinal study evaluated relationships among severe psychosocial stress, psychiatric morbidity, and HPA axis function in children. METHODS: Forty-five children (mean age: 8.9 +/- 2.9 years) suffering parent death from September 11, 2001 terror attacks and 34 nonbereaved children (mean age: 9.3 +/- 2.5 years) were evaluated prospectively at 6-month intervals in this 2-year study. Assessments involved diagnostic interviews (Child Schedule for Affective Disorders and Schizophrenia [K-SADS]) for psychopathology and 3 days of baseline salivary cortisol and a salivary dexamethasone suppression test for HPA axis function. RESULTS: Bereaved children, but not nonbereaved children, had significantly increased rates of psychiatric disorders involving anxiety disorders, especially posttraumatic stress disorder (PTSD), after September 11, 2001 compared with retrospective assessments before September 11, 2001. Morning (AM) and 4:00 pm baseline cortisol were significantly and persistently higher for bereaved than nonbereaved children. Compared with bereaved children without psychopathology, bereaved children with PTSD had significantly lower 4:00 pm baseline cortisol and significantly greater 4:00 pm cortisol suppression. Children with generalized anxiety disorder had significantly less AM cortisol suppression than children without psychopathology. CONCLUSIONS: Children bereaved by sudden, unexpected parent death had persistent psychological dysfunction and HPA axis dysregulation in this study.     

Glioblastoma occurring at the site of a previous medulloblastoma following a 5‐year remission period

We describe a case of a 14‐year‐old boy who developed a cerebellar and brainstem glioblastoma 5 years after treatment for a medulloblastoma. The patient first presented in 2003 with 9 months of vomiting and a 9‐kg weight loss. A head MRI showed a heterogeneously enhancing posterior fossa mass with hydrocephalus. Gross total resection was performed and the tumor was consistent with a classic medulloblastoma. Postoperative chemotherapy and craniospinal radiation was administered. The patient remained tumor‐free until 2008, at which time he presented with right‐sided weakness and numbness, left eye pain, vomiting and weight loss. Imaging showed abnormalities within the posterior pons, medulla, inferior cerebellar peduncles, cerebellar hemispheres and cervicomedullary junction with expansion of the medulla and cervical spinal cord. Due to the location of the lesion, biopsy was felt to be too risky and was avoided. Despite receiving chemotherapy, his symptoms continued to worsen and he died 4 months later. Post mortem examination limited to the brain and spinal cord confirmed the radiographic extent of the tumor. Microscopic examination showed a highly cellular infiltrative glial neoplasm with extensive palisading necrosis. A diagnosis of glioblastoma was rendered. The question of whether the first and second tumors were related is of potential clinical and academic interest. The first tumor was synaptophysin‐positive and GFAP‐negative, consistent with medulloblastoma. The second tumor was synaptophysin‐negative and focally GFAP‐positive, consistent with glioblastoma. The glioblastoma displayed EGF receptor amplification, and interestingly, it also displayed MYCN amplification; both tumors showed low level PTEN deletion. The medulloblastoma displayed a signal pattern consistent with an isochromosome 17q, while the glioblastoma showed some cells with an isochromosome 17q signal pattern amid a background of cells with abundant chromosomal instability. The relationship between these two tumors, particularly with regard to various molecular events, is discussed.     

The impact of terrorism on children and adolescents: terror in the skies, terror on television

Terrorist attacks and their aftermath have had a powerful impact on children and their families. Media and television exposure of terrorist events throughout the world has increased during the past few years. There is increasing concern about the effects of this exposure on children who witness these violent images. To develop a proactive and strategic response to reactions of fear, clinicians, educators, and policy makers must understand the psychologic effects of media coverage of terrorism on children. Previous research has focused on media coverage of criminal violence and war. Recent studies have examined the effect of remote exposure of terrorist attacks and have shown a significant clinical impact on children and families.     

Post-trauma symptoms following indirect exposure to the September 11th terrorist attacks: The predictive role of dispositional coping

Few data prospectively address the role of coping in the development of PTSD. In the present study, 308 undergraduates were assessed for coping prior to the 9/11 WTC attack and for PTSD symptomatology at one and three-months post-9/11. Multiple regression analyses indicated that emotion-focused coping was predictive of increased symptomatology at Month 1 and Month 3, whereas problem-focused and avoidance-focused coping were not. Specifically, analyses predicting PTSD symptom factors (Intrusions, Avoidance, Dysphoria, and Hyperarousal) indicated that greater emotion-focused coping predicted increased Dysphoria symptoms at both time points and, among females, increased levels of Hyperarousal symptoms at Month 1. The role of coping style in the development of PTSD symptomatology and its clinical implications are discussed.     

Confronting the stigma of epilepsy

Stigma and resultant psychosocial issues are major hurdles that people with epilepsy confront in their daily life. People with epilepsy, particularly women, living in economically weak countries are often ill equipped to handle the stigma that they experience at multiple levels. This paper offers a systematic review of the research on stigma from sociology and social psychology and details how stigma linked to epilepsy or similar conditions can result in stereotyping, prejudice and discrimination. We also briefly discuss the strategies that are most commonly utilized to mitigate stigma. Neurologists and other health care providers, social workers, support groups and policy makers working with epilepsy need to have a deep understanding of the social and cultural perceptions of epilepsy and the related stigma. It is necessary that societies establish unique determinants of stigma and set up appropriate strategies to mitigate stigma and facilitate the complete inclusion of people with epilepsy as well as mitigating any existing discrimination.     

Profile of the perpetrator of the Nice terror attack that took place on 14th July 2016: A terrorist whose modus operandi may have been imitated in other European attacks

The perpetrator of the Nice terrorist attack was a 31-year-old Tunisian with a history of domestic violence. Up until shortly before the mass murder, he is deemed to have had no particular interest in religion. He led an unbridled sex life with both women and men, drank alcohol, ate pork and took toxic substances. His profile, one that is difficult to class among the recent typologies of radicalised persons, shows that Islamic terrorists can be diverse in terms of their backgrounds. This wide-ranging diversity must be integrated into the detection and prevention of this type of terrorism. As successive apparent imitations seem to suggest, the Nice terror attack may have played a role in subsequent attacks on European soil, particularly due to the easily accessible modus operandi involved in the attacks, as well as for its destructive capabilities.     

Not so close but still extremely loud: Recollection of the world trade center terror attack and previous hurricanes moderates the association between exposure to hurricane sandy and posttraumatic Stress Symptoms

Background

The present study examined whether recollections of the World Trade Center (WTC) terror attack and previous hurricanes moderated the relationship between exposure to Hurricane Sandy and related posttraumatic stress disorder (PTSD) symptoms.

Methods

An online sample of 1000 participants from affected areas completed self-report questionnaires a month after Hurricane Sandy hit the East Coast of the United States. Participants reported their exposure to Hurricane Sandy, their PTSD symptoms, and recollections of the WTC terror attack and previous hurricanes elicited due to Hurricane Sandy.

Results

Exposure to Hurricane Sandy was related to PTSD symptoms among those with high level of recollections of the WTC terror attack and past hurricanes, but not among those with low level of recollections.

Conclusions

The aftermath of exposure to Hurricane Sandy is related not only to exposure, but also to its interaction with recollections of past traumas. These findings have theoretical and practical implications for practitioners and health policy makers in evaluating and interpreting the impact of past memories on future natural disasters. This may help in intervention plans of social and psychological services.     

Growing burr hole: enlarging pseudomeningocele at the site of a craniostomy

Background Growing skull fractures and other enlarging skull defects are rare postoperative occurrences. We report here on a 10-month-old girl who presented with an enlarging burr hole and pseudomeningocele after an endoscopic third ventriculocisternostomy.Methods Evaluation of an enlarging subcutaneous mass at the site of the burr hole included computed tomography scans and magnetic resonance imaging, which revealed a pseudomeningocele. The patient underwent repair of the lesion, including dural closure and cranioplasty.Conclusions Growing skull fractures or other enlarging bone defects may occur after burr hole placement, particularly in infants who require larger access sites for endoscopy.     

Weight reduction at the work site: a promise partially fulfilled

Three consecutive studies of weight reduction at the work site were conducted with 172 female union members, who participated in 16-week behavioral group programs. There was no significant difference in weight loss over the three studies, but attrition decreased from 57.5% to 33.8% and weight loss maintenance improved. Groups that met three to four times weekly had less attrition than those which met once a week, but had no more weight loss. These behavioral weight reduction programs were as effective as self-help and commercial groups, and lay leaders produced results equivalent to those produced by professional therapists at one-third the cost.     

Multifocal motor neuropathy: pathologic alterations at the site of conduction block

The pathologic changes of nerves in multifocal motor neuropathy (MMN), a rare neuropathy with selective focal conduction block of motor fibers in mixed nerves, remain essentially unstudied. Fascicular nerve biopsy of 8 forearm or arm nerves in 7 patients with typical MMN was undertaken for diagnostic reasons at the site of the conduction block. Abnormalities were seen in 7 of 8 nerves, including a varying degree of multifocal fiber degeneration and loss, an altered fiber size distribution with fewer large fibers, an increased frequency of remyelinated fiber profiles, and frequent and prominent regenerating fiber clusters. Small epineurial perivascular inflammatory infiltrates were observed in 2 nerves. We did not observe overt segmental demyelination or onion bulb formation. We hypothesize that an antibody-mediated attack directed against components of axolemma at nodes of Ranvier could cause conduction block, transitory paranodal demyelination and remyelination, and axonal degeneration and regeneration. Alternatively, the antibody attack could be directed at components of paranodal myelin. We favor the first hypothesis because in nerves studied by us, axonal pathological alteration predominated over myelin pathology. Irrespective of which mechanism is involved, we conclude that the unequivocal multifocal fiber degeneration and loss and regenerative clusters at sites of conduction block explains the observed clinical muscle weakness and atrophy and alterations of motor unit potentials. The occurrence of conduction block and multifocal fiber degeneration and regeneration at the same sites suggests that the processes of conduction block and fiber degeneration and regeneration are linked. Finding discrete multifocal fiber degeneration may also provide an explanation for why the functional abnormalities remain unchanged over long periods of time at discrete proximal to distal levels of nerve and may emphasize a need for early intervention (assuming that efficacious treatment is available).     

Pain coping strategies: French adaptation of the coping strategies questionnaire (CSQ-F)

BACKGROUND: Many studies have shown that the strategies used to cope with chronic pain play a very important role in the adjustment to the pathology and to its effects (emotional distress, physical and psychosocial impairment, and quality of life). Among the methods assessing coping with pain, the most widely used instrument at present is the coping strategies questionnaire (CSQ) developed by Rosenstiel and Keefe, [Pain 17 (1983) 33-44]. This questionnaire is composed of 48 items distributed in eight subscales each including six items: diverting attention, reinterpreting pain sensations, coping self-statements, ignoring pain sensations, praying and hoping, catastrophizing, increasing activity level, and increasing pain behaviour. Most studies examining the factor structure of the CSQ have used the scores of its eight prior theoretically derived scales rather than the 48 items. Three studies, Tuttle et al. [Rehab Psychol 36 (1991) 179-187], Swartzmann et al. [Pain 54 (1994) 311-316; Robinson et al. [Clin J Pain 13 (1997) 43-49] have examined the factor structure of the CSQ from the 48 original items on the questionnaire and have yielded five or six factors. A structural confirmatory analysis showed the superiority of the six-factor model [Clin J Pain 13 (1997) 156-162]: distraction, catastrophizing, ignoring pain sensations, distancing from pain, coping self-statements and praying. The present study aimed at measuring the internal consistency and the construct validity of the French version of the CSQ. METHOD: The CSQ was translated into French with the forward and backward translation procedure. To evaluate internal consistency, Cronbach's alphas were computed. Construct validity of the questionnaire was estimated through confirmatory factor analysis (CFA) in a sample of 330 chronic pain patients (71% of women): 40.3% suffered from low back pain, 33.6% from headaches and 26.1% from neuropathic pain. The three factor structures previously proposed in the literature were tested using the LISREL 8.3 structural equation-modelling program developed by J?reskog and S?rbom, [Lisrel 8: user's reference guide, Chicago: Scientific Software International, 1993]. RESULTS: The CFA performed on the three models of factor structures of the CSQ previously reported confirms the best fit of the six-factor model by Robinson et al. [Clin J Pain 13 (1997) 43-49] in our sample. However, the coping self-statements factor, whose internal consistency was too weak in our analysis (Cronbach's alpha=0.57), was eliminated. We therefore retained only five factors in our sample. The French version of the CSQ (CSQ-F) is composed of 21 items belonging to five factors: distraction, catastrophizing, ignoring pain sensations, reinterpreting pain sensations, and praying. CONCLUSIONS: The present study indicates that the internal consistency and the construct validity of the French version of the CSQ were adequate, and contributes to demonstrate the stability of the factor structure of the CSQ across samples. The 21-item French adaptation of the CSQ (CSQ-F) appears to be a very interesting tool because it facilitates the use of this questionnaire, not only for research but also in the clinical assessment of the patients suffering from chronic pain.     

Partners in adversity V: Support,personality and coping behaviour at the time of crisis

This paper presents further results from a study of married women in Edinburgh who had just suffered an adverse experience: either their husband's non-fatal myocardial infartion, their husband's death or their own arrival in a Women's Aid refuge for battered women. Interviews were carried out 4–6 weeks following the adverse experience and, where possible, again approximately 3 months later. Symptoms were assessed using the 30-item General Health Questionnaire and criterion-based measures of depression and anxiety derived from it. The extent and nature of crisis support from household members and from groups of people outside the household, and also of failures in expected support, was measured at first interview. A modified version of Tyrer and Alexander's (1979) personality schedule was administered at the follow-up interview, and the resulting personality data were then reduced to six factors using principal components analysis. An interviewer assessment of how well the subject was coping was made at both interviews. The vast majority of the sample received extensive practical and emotional support from family and friends, and perhaps because such positive support was so prevalent, variations in it seemed to have little effect on symptoms. However, subjects who were unexpectedly let down or criticised by friends or family tended to show higher symptom levels, although, surprisingly, this was less true for the bereaved wives than for the others. The six personality factors that emerged were labellednervousness (similar to neuroticism)impulsivity, social withdrawal, helplessness, inferiority andaggressiveness. There was evidence that subjects high on nervousness remained symptomatic longer following the adverse experience. The aggressiveness factor showed a curvilinear trend with high and low aggressives showing higher symptom levels than middle aggressives. However, for the coronary wives the trend was linear with low aggressives having high symptoms. Subjects low on impulsivity were more affected by being let down by friends and family. The interviewer-assessed coping measure was linearly related to nervousness and showed a curvilinear relationship with aggressiveness.     

Psychopathological description of hyperventilation-induced panic attacks: a comparison with spontaneous panic attacks

Our aim was to describe the clinical features of hyperventilation-induced panic attacks (HPA) in panic disorder patients - DSM-IV - and to compare them with their spontaneous panic attacks and with spontaneous panic attacks in panic disorder (PD) patients not sensible to the hyperventilation challenge test. We reexamined 88 previously studied PD patients when they were submitted to a hyperventilation challenge test. They were induced to hyperventilate (30 breaths/min) for 4 min and anxiety scales were applied before and after the test. A total of 51.1% (n = 45) PD patients had a panic attack after hyperventilating - HPA (chi(2) = 13.11, d.f. = 1, p = 0.017). The clinical symptoms of the most severe panic attack were recorded by the HPA patient and by the PD patients not sensible to this test (non-HPA; n = 43, 48.9%) in a diary during a 1-week period and then compared. The HPA group had more respiratory symptoms (chi(2) = 15.26, d.f. = 1, p < 0.001), fulfilling the criteria for the respiratory PD subtype (75.6%), the disorder started later (Mann-Whitney, p < 0.001), had a higher familial prevalence of PD (chi(2) = 19.45, d.f. = 1, p = 0.036), and had more previous depressive episodes (chi(2) = 18.74, d.f. = 1, p < 0.001). The HPA group had similar symptomatology in spontaneous attacks and HPA. The HPA group may be regarded as a subgroup of the respiratory panic disorder subtype with diagnostic and therapeutic implications.     

Caring and coping: the dementia caregivers

Objectives: Caring for a family member with Alzheimer's disease is associated with increased burden and depression. Effective coping with the hardships and demands of caring may help to sustain the caregiver and lessen the effect of the stressors. The objective of this study was to examine caregivers’ coping styles and the relationship with reported levels of burden and depression.

Method: A cross-sectional correlation study was employed. One hundred and seventy-two caregivers of patients suffering from Alzheimer's type dementia participated in the study. All patients were recruited from neurology clinics. The Greek versions of four measuring instruments used were: the Memory and Behaviour Problem Checklist, the Burden Interview, the Centre for Epidemiological studies-Depression scale and the Ways of Coping Questionnaire.

Results: Positive coping is negatively correlated with burden (r?=??0.20) and wishful thinking strategies were related positively (r?=?0.16). The relation between depression and positive coping strategies is highly significant (p?p?

Conclusion: Positive coping approaches need to be developed by caregivers so as to continue their caring role.