Cervical root compression by a traumatic pseudoaneurysm of the vertebral artery: case report

We report the case of a patient with cervical monoradiculopathy secondary to a pseudoaneurysm of the vertebral artery caused by a knife wound to the neck.     

Presternal bronchogenic sinus with predunculated lymphoid aggregate

Congenital cranial, cervical, and upper thoracic sinuses are rare conditions that historically have been classified according to their location and/or pathology. However, published reports of bronchogenic or branchial anomalies are on the increase, and the traditional defining characteristics--location and histopathology--are proving to be less reliable. We describe the pathologic and clinical findings of a congenital presternal pedunculated lesion with a sinus, and review the literature to describe its proper classification.     

Genes, proteins, and neurotoxins involved in Parkinson's disease

Parkinson's disease (PD) is a common neurodegenerative disorder. The etiology of PD is likely due to combinations of environmental and genetic factors. In addition to the loss of neurons, including dopaminergic neurons in the substantia nigra pars compacta, a further morphologic hallmark of PD is the presence of Lewy bodies and Lewy neurites. The formation of these proteinaceous inclusions involves interaction of several proteins, including alpha-synuclein, synphilin-1, parkin and UCH-L1. Animal models allow to get insight into the mechanisms of several symptoms of PD, allow investigating new therapeutic strategies and, in addition, provide an indispensable tool for basic research. In animals PD does not arise spontaneously, thus, characteristic and specific functional changes have to be mimicked by application of neurotoxic agents or by genetic manipulations. In this review we will focus on genes and gene loci involved in PD, the functions of proteins involved in the formation of cytoplasmatic inclusions, their interactions, and their possible role in PD. In addition, we will review the current animal models of PD.     

Trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave: case report

OBJECTIVE AND IMPORTANCE: Trigeminal neuralgia is often the result of vascular compression at the root entry zone of the trigeminal nerve. We report a case of trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave. Endovascular closure of the fistula resulted in elimination of the patient's pain at the gasserian ganglion level. CLINICAL PRESENTATION: A 77-year-old woman was referred for treatment of trigeminal neuralgia after failed conservative treatment, including multiple gasserian ganglion blocks. Magnetic resonance imaging of the brain suggested a vascular lesion, and cerebral angiography demonstrated a dural arteriovenous fistula in Meckel's cave. INTERVENTION: Endovascular coil embolization was performed, with obliteration of the dural arteriovenous fistula and resolution of facial pain but with decreased sensation in the face. CONCLUSION: Trigeminal neuralgia may be associated with complex vascular lesions around the base of the brain and along the course of the trigeminal nerve. The evaluation of patients with trigeminal neuralgia should include high-quality, thin-section, magnetic resonance imaging scans, to exclude the possibility of vascular lesions and other structural lesions. In particular, patients who are being evaluated for surgical treatment of trigeminal neuralgia should undergo magnetic resonance imaging, with a focus on the course of the trigeminal nerve.     

Guglielmi detachable coil extraction: suction generated by pusher-wire withdrawal after coil detachment within an intracranial aneurysm

We present a case of Guglielmi detachable coil extraction into a microcatheter after coil detachment during embolization of a superior hypophyseal artery aneurysm; extraction was a result of the suction generated during pusher-wire withdrawal. Experimental simulations using many coil and microcatheter combinations were used to identify factors that contribute to the likelihood of this phenomenon.     

Management of vascular perforations that occur during neurointerventional procedures

This article describes a number of treatment strategies for the management of perforations that occur during neurointerventional procedures. During the past 5 years, we have performed over 1200 endovascular procedures to treat vascular disorders involving the brain and spinal cord (400 cerebral arteriovenous malformations, 230 tumors, 197 carotid cavernous fistulas, 183 aneurysms, 130 dural fistulas, 80 spinal arteriovenous malformations, 18 vein of Galen aneurysms, and 20 cases of vasospasm). Fifteen patients (1.1%) sustained a vascular perforation as a direct result of these procedures. Among these 15 patients, indications for endovascular treatment were six symptomatic arteriovenous malformations, two spinal cord arteriovenous malformations, two cavernous sinus dural fistulas, one transverse sinus fistula, one case of vasospasm following subarachnoid hemorrhage, one direct carotid cavernous fistula, one vein of Galen malformation, and one ruptured basilar artery aneurysm. The vascular perforations were grouped into three probable mechanisms: mechanical perforation of a normal vessel (six patients), mechanical disruption of a dysplastic vessel or aneurysm (five patients), and fluid overinjection (four patients). Treatment of the perforations included immediate reversal of anticoagulants (12 patients) and direct closure of the perforation site with coils (five patients). In addition, closure of the intravascular compartment adjacent to the perforation was achieved with coils (six patients), liquid adhesives (four patients), balloons (two patients), or particles (two patients). In two patients a detachable balloon was placed transiently across the perforation site for several minutes, deflated, and removed when no further extravasation was noted. Five patients were started on anticonvulsant therapy, two of whom have had a new onset seizure related to the perforation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of carotid-cavernous fistulas associated with Ehlers-Danlos syndrome

Four patients with Ehlers-Danlos syndrome presented spontaneously with symptomatic direct carotid-cavernous fistulas. Two had previously (2 and 15 years, respectively) had contralateral carotid-cavernous fistulas that were treated with carotid occlusion procedures. The patients' ages at presentation ranged from 19 to 49 years, with a mean of 32 years. All four patients underwent attempted embolization procedures. Two patients had transarterial embolization, one with balloons and liquid adhesives, one with platinum coils and a balloon; the carotid artery was preserved in one and sacrificed in one other. In one patient, who underwent direct puncture of the carotid artery, a massive hematoma causing airway compromise required intubation and emergent surgical repair. The fistula spontaneously closed during this event. In the fourth patient, two transvenous embolizations resulted in markedly decreased flow, but diversion of residual flow to cortical veins produced a fatal pontine hemorrhage. The vascular fragility associated with Ehlers-Danlos syndrome can produce spontaneous direct carotid-cavernous fistulas and makes both diagnostic and therapeutic procedures more difficult.     

Neuromuscular,autonomic and central cholinergic hyperactivity associated with thymoma and acetylcholine receptor-binding antibody

Summary Two cases of a neuromuscular hyperactivity syndrome associated with a proliferative thymoma and high serum titres of acetylcholine receptor (AChR) antibody with no signs of myasthenia are reported. The clinical and electrodiagnostic findings indicated generalized cholinergic hyperactivity at the neuromuscular junction and in the autonomic and central nervous system, resulting in generalized myokymia, excessive sweating and intermittent psychotic behaviour. The association with thymoma and raised AChR antibody suggests that this syndrome represents a unique type of autoimmune disease, in which antibodies against the AChR facilitate rather than inhibit cholinergic action. This conclusion is supported by the remission of symptoms after thymectomy and with immunosuppressive therapy in one case.     

Codeine and its alternates for pain and cough relief. I. Codeine, exclusive of its antitussive action

This report—the first of a series on codeine and its alternates for pain and cough relief—presents a detailed evaluation of experimental and clinical data concerning the analgesic action of codeine (the antitussive action will be assessed separately). The authors discuss the pharmacology of the drug, including side-effects and toxicity; effects on the respiratory, circulatory, digestive and urinary systems; tolerance, dependence and liability to abuse; metabolic effects; and mechanism of action.