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Query: UMLS:C0030552 (paresis)
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Clinical picture of congenital Toxoplasma gondii has been presented in 20 children. The infection was diagnosed in 18 children in the first and in 2 children in the sixth month of life. Clinical symptoms were observed in as many as 12 children. The most frequent symptoms were those concerning central nervous system, organ of vision in the form of hydrocephalus, spastic paresis, epilepsy, intracranial calcification, choroiditis, retinitis and vision impairment. The presented analysis indicates an urgent need of introduction of screening in pregnant women and infants and widespreading of prophylactic activity aiming at raising awareness of the existing threat of T. gondii infection.
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PMID:[Congenital toxoplasmosis in own studies]. 1689 52

Syringomyelia is often associated with hydrocephalus, especially in Chiari malformations, but it has never been described as a complication of posthemorrhagic hydrocephalus after preterm birth. We report on a premature infant who presented this exceptional association. He was born at 29 weeks of gestational age and suffered a grade 3 intraventricular hemorrhage. Progressive ventricular dilatation developed despite repeated lumbar punctures, and a ventricular reservoir had to be inserted for cerebrospinal fluid drainage. Two weeks later he presented a flaccid, areflexic paralysis of his left upper limb. Magnetic resonance imaging disclosed a remarkable tetraventricular hydrocephalus and a cervical hydrosyringomyelia expanding from the C(5) to T(1) segments. After shunt surgery, the cephalic perimeter stabilized, and the infant began to move his arm. On follow-up, a minimal paresis of the left hand persisted. This case highlights an unreported outcome of posthemorrhagic hydrocephalus. In this context, syringomyelia should be included in the differential diagnosis of any infant with who presents segmental signs of acute or progressive onset.
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PMID:Syringomyelia secondary to posthemorrhagic hydrocephalus in a preterm infant. 1827 58

The congenital retinocephalic facial vascular malformation syndrome is characterized by unilateral, nonhereditary retinal and cerebral arteriovenous malformations (AVMs) and is occasionally associated with orbital vascular changes. Typical signs are facial and oral mucosal vascular changes, rarely with changes of the maxilla or mandible. An AVM causes high blood flow because of direct connection (shunting) of major vessels without interposition of capillaries. Ocular complications include retinal and vitreous hemorrhages, edema, venous occlusion (risk of rubeosis iridis and secondary glaucoma). Neuroophthalmological changes comprise optic atrophy, papilledema, proptosis, pupillary changes, hemianopia, gaze paresis, nystagmus, cranial nerve palsies, strabismus, and amblyopia. Neurological complications include headache, subarachnoid hemorrhage, convulsions, cerebral hemorrhages, increased intracranial pressure, hydrocephalus, and stroke with hemiparesis. Threatening oral hemorrhages or epistaxis may rarely occur.
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PMID:[Congenital retinocephalic facial vascular malformation syndrome. Bonnet-Dechaume-Blanc syndrome or Wyburn-Mason syndrome]. 1915 63

The aneurysms of the Basilar Artery apex (ABA) are not very common. My personal experience derives from having performed surgery on a number of 3340 patients with cerebral aneurysms at the Department of Vascular Neurosurgery II in Bucharest between 1979 and 2010. In 234 (7%) of the aneurysms they were located in the posterior vasculature. In 146 patients, representing 4.37% of the total number of patients with cerebral aneurysms and 62.39% of those with aneurysms of posterior vasculature, the location was in the basilar artery apex. The mean age of the 146 patients with aneurysms of the basilar artery apex (ABA) was 45.2 years, varying between 34 and 71 years old. Most cases (69 -47.26%) were in the 41-50 years age group. Aneurysms were found in 68 males (46.57%) and 78 females (53.42%) suggesting a slight predominance in female patients. The main reason for hospitalization was subarachnoid haemorrhage. There were four reports of patients having three episodes of subarachnoid bleeding in the three months preceding the surgery. The mean time between the last subarachnoid bleeding and the hospital admission was 26 days, ranging between 1 and 62 days. On admission three patients were in a severe general and neurological state (Hunt IV and V, respectively). The diagnostic assessment for those patients started with computer tomography (CT) followed by brain angiogram for the four main vessels. The main challenges for the surgical treatment of such lesions are due to the complex vascular anatomy of the basilar artery apex, to the direct vicinity of these aneurysms with the base of the skull and with vital neural structures in the interpeduncular fossa as well as due to difficulties in gaining proximal control over them. The post-surgical evolution was excellent and good in 131 (89.72%) of patients, unsatisfactory in 8 patients (5.48%), while 8 patients (5.48%) died. Three of the 8 patients marked by an unsatisfactory evolution presented with right-side hemiballismus and paresis of the 3rd cranial nerve, while other three remained in a vegetative state. Post-operative hydrocephaly was reported in 10 patients (6.8%).
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PMID:Microsurgery for the aneurysms of the basilar artery apex. 2311 38

Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping. Preoperative functional mapping in vascular surgery is not routinely performed; however, in cases of high-grade arteriovenous malformations (AVMs), it could play a role in preoperative decision making. A 16-year-old male was suffering from a giant, right-sided insular, Spetzler-Martin Grade V AVM. This patient's history included 3 hemorrhagic strokes in the past 3 years, resulting in Medical Research Council Grade 2-3 (proximal) and 2-4 (distal) paresis of the left side of the body and hydrocephalus requiring a ventriculoperitoneal shunt. Preoperative TMS showed absent contralateral innervation of the remaining left-sided motor functions. Subsequently, the AVM was completely resected without any postoperative increase of the left-sided paresis. This case shows that TMS can support decision making in AVM treatment by mapping motor functions.
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PMID:Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient. 2486 24

Blake's pouch cyst (BPC), a rare cystic malformation in the posterior fossa, is believed to be caused by the congenital expansion of the posterior membranous area that normally regresses during embryogenesis. However, due to the wide spectrum of the onset pattern and age of patients, the natural history and the pathogenesis are poorly understood. The authors describe the case of a girl who admitted with headache and right abducens nerve paresis at the age of 3 years and 10 months. Magnetic resonance (MR) imaging demonstrated a tetraventricular hydrocephalus, an open aqueduct, and a posterior fossa cyst compatible with BPC. Multiple tumors were also noticed in the ventricular wall. Tumor biopsy and an endoscopic third ventriculostomy were performed. Intraoperative observation confirmed the BPC, and pathological diagnosis was pilomyxoid astrocytoma. In retrospect, MR imaging was performed twice in the past, at the age of 8 months and again at 22 months, and no anomaly was detected, suggesting that Blake's pouch was once regressed. Therefore, a BPC in this patient was certainly developed after her second or third year of life. The ventricular tumors may influence the cerebrospinal fluid (CSF) absorption, which triggered the re-expansion of BPC from the possible remnant of Blake's pouch. This is a rare but important report providing evidence that in addition to the classic congenital BPC in which the remnant of Blake's pouch remains persistent, there could be postnatal or secondary BPC, which develops after birth. Possible mechanisms include that the remnant of Blake's pouch, which originally disappears, may re-expand postnatally in association with unknown trigger or a change in CSF dynamics or absorption.
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PMID:Postnatal development of Blake's pouch cyst: a case report and new insight for its pathogenesis. 2490 10

Ventriculoperitoneal (VP) shunt surgery is probably the commonest surgical procedure in neurosurgery. Belying its technical simplicity is the myriad complications associated with it. Shunt malfunction is a common complication associated with this surgery, second only to shunt related infections, which may be associated with it. Sterile cerebrospinal fluid (CSF) eosinophilia (CE) has been reported with VP shunts, which may or may not be related to the dysfunction. Eosinophilia in the CSF has also been associated with a number of other conditions including parasitic infestations in the brain. This may be unrelated to the shunt surgery. We present a case of a child, operated earlier for hydrocephalus, who presented with sub-acute loss of vision and bilateral oculomotor paresis. CSF from a chamber tap revealed eosinophilia. The commonest presenting symptom of shunt malfunction is raised intracranial pressure. There are no reports in the literature of VP shunt malfunction presenting with bilateral oculomotor paresis and decreased visual acuity. The associated CE complicated the clinical picture, especially since the initial brain radiology was normal. We discuss the clinical differential diagnosis of this very interesting presentation, management dilemmas and outcome in this child. This rare clinical presentation was found to be the result of a shunt malfunction and not due to any rare parasitic infestation of the brain. Occam's razor dictates that the simplest explanation in a given situation is usually the most accurate, as is seen in this case.
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PMID:Occam's razor in the management of ventriculoperitoneal shunt dysfunction: Diagnosis and management of an unusual pediatric case. 2597 62

The influence of site of hemorrhage on presentation, clinical profile, hospital course, and outcome was examined in 225 patients with intracerebral hemorrhage in the NINDS Stroke Data Bank. Mode of presentation differed by hemorrhage site (coma at onset was most typical of pontine hemorrhage and headache with vomiting was most typical of cerebellar hemorrhage, whereas onset of focal deficit sometimes with headache was typical of lobar and and basal ganglionic hemorrhages). Distinct clinical profiles were found for cerebellar (ataxia, drowsiness, and horizontal gaze paresis), pontine (quadriparesis, coma, vertical and horizontal gaze paresis), and caudate hemorrhages (drowsiness and hemiparesis). Putaminal, thalamic, and lobar hemorrhages presented similarly with hemiparesis, sensory loss, and higher cortical function deficits. However, thalamic hemorrhages had more sensory loss, putaminal hemorrhages had more weakness, and lobar hemorrhages had more higher cortical function deficits. Hemorrhage volume was greatest for the lobar and putaminal hemorrhages and smallest for the pontine and cerebellar hemorrhages. Clot evacuations were performed for 28.9% of the lobar hemorrhages and 48.2% of the cerebellar hemorrhages. Few basal ganglionic hemorrhages or pontine hemorrhages had clot evacuations. Thirty-day survival was lowest for caudate hemorrhage (46.2%) and highest for cerebellar hemorrhage (81.5%). Hydrocephalus, intraventricular blood, larger size, and mass effect were adverse predictors of survival at most but not all hemorrhage sites. History of hypertension was the most prevalent risk factor for hemorrhage (64.0% of the patients). Other risk factors for hemorrhage included anticoagulants, platelet antiaggregating drugs, aneurysms, arteriovenous malformations, pregnancy, alcohol use, amyloid angiopathy, thrombocytopenia, renal and liver failure, and cocaine use. The most common medical complications were pneumonia (15.5%), urinary tract infection (15.0%), arrhythmias (8.4%), and seizures (8.0%).
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PMID:Influence of site on course of intracerebral hemorrhage. 2648 80

OBJECTIVEPituitary adenomas (PAs) are benign neoplasms that are frequently encountered during workup for endocrinopathy, headache, or visual loss. Transsphenoidal surgery remains the first-line approach for PA resection. The authors retrospectively assessed complication rates associated with transsphenoidal PA resection from an institutional database.METHODSA retrospective analysis of 1153 consecutive transsphenoidal pituitary adenoma resections performed at the Keck Hospital of USC between November 1992 and March 2017 was conducted. Microscopic transsphenoidal resection was performed in 85.3% of cases, and endoscopic transsphenoidal resection was performed in 14.7%. Analysis of perioperative complications and patient and tumor risk factors was conducted.RESULTSThe overall median hospital stay was 3 days. There was 1 perioperative death (0.1%). Surgical complications included postoperative cerebrospinal fluid leak (2.6%), epistaxis (1.1%), postoperative hematoma (1.1%), meningitis (1.0%), cranial nerve paresis (0.8%), hydrocephalus (0.8%), vision loss (0.6%), stroke (0.3%), abdominal hematoma or infection (0.2%), carotid artery injury (0.1%), and vegetative state (0.2%). Perioperative medical complications included bacteremia/sepsis (0.5%), pneumonia (0.3%), myocardial infarction (0.3%), and deep venous thrombosis/pulmonary embolism (0.1%). Endocrine complications were the most frequent, including transient diabetes insipidus (4.3%), symptomatic hyponatremia (4.2%), new hypopituitarism (any axis) (3.6%), permanent diabetes insipidus (0.3%), and adrenal insufficiency (0.2%). There were no significant differences between microscopic and endoscopic approaches with regard to surgical complications (6.4% vs 8.8%, p = 0.247) or endocrine complications (11.4 vs 11.8%, p = 0.888). Risk factors for surgical complications included prior transsphenoidal surgery (11.4% vs 6.8%, p = 0.025), preoperative vision loss (10.3% vs 6.8%, p = 0.002), and presence of PA invasion on MRI (8.5% vs 4.4%, p = 0.007).CONCLUSIONSIn this single tertiary center study assessing complications associated with transsphenoidal PA resection, the rate of death or major disability was 0.26%. Risk factors for complications included prior surgical treatment and PA invasion. No differences in complication rates between endoscopic and microscopic surgery were observed. When performed at experienced pituitary centers, transsphenoidal surgery for PAs may be performed with a high degree of safety.
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PMID:Complications associated with microscopic and endoscopic transsphenoidal pituitary surgery: experience of 1153 consecutive cases treated at a single tertiary care pituitary center. 2999 59

We report diffusion tensor tractography (DTT) of the corticospinal tract (CST) in a patient with paresis of all four limbs following subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) after the rupture of an anterior communicating artery (ACoA) aneurysm rupture. The 73-year-old female was admitted to our emergency room in a semi-comatose mental state. After coil embolization-an acute SAH treatment-she was transferred to our rehabilitation department with motor weakness development, two weeks after SAH. Upon admission, she was alert but she complained of motor weakness (upper limbs: MRC 3/5, and lower limbs: MRC 1/5). Four weeks after onset, DTT showed that the bilateral CSTs failed to reach the cerebral cortex. The left CST demonstrated a wide spread of fibers within the corona radiata as well as significantly lower tract volume (TV) and higher fractional anisotropy (FA) as well as mean diffusivity (MD) compared to the controls. On the other hand, the right CST shifted to the posterior region at the corona radiata, and MD values of the right CST were significantly higher when compared to the controls. Changes in both CSTs were attributed to vasogenic edema and compression caused by untreated hydrocephalus. We demonstrate in this case, two different pathophysiological entitles, contributing to this patient's motor weakness after SAH.
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PMID:Injury of Corticospinal Tract in a Patient with Subarachnoid Hemorrhage as Determined by Diffusion Tensor Tractography: A Case Report. 3220 57


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