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Volker K. H. Sonntag and Bennett M. Stein

✓ A review of arteriopathic complications in three of seven patients receiving epsilon-aminocaproic acid (EACA) is presented. All seven patients with subarachnoid hemorrhage due to ruptured aneurysm were receiving EACA in the presurgical treatment period. Each of the three patients showed cerebral arteriographic changes resembling arteritis or intravascular thrombosis, and a deteriorating clinical course.

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R. Michael Scott, Volker K. H. Sonntag, Lloyd M. Wilcox, Lester S. Adelman and Thomas H. Rockel

✓ While recovering from tuberculous meningitis, a 5-year-old boy developed a profound visual deficit because of optochiasmatic arachnoiditis. Following micro-neurosurgical decompression of the optic nerves and chiasm, prompt visual recovery occurred.

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Daniel G. Nehls, Volker K. H. Sonntag, Alan R. Murphy, Peter C. Johnson and John D. Waggener

✓ Tumors of the cranial nerves are uncommon, and are usually schwannomas or neurofibromas. The authors describe a case of a fibroblastic tumor involving the sixth cranial nerve. Based upon electron microscopy and immunohistochemistry, the tumor was not of nerve-sheath origin, but was comprised of fibroblasts. Clinical, radiographic, and pathological material are presented, and the literature is discussed. This represents the third case report of a tumor of the abducens nerve, and the first report of a fibroma of a cranial or peripheral nerve.

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Suprascapular nerve entrapment

A summary of seven cases

Mark N. Hadley, Volker K. H. Sonntag and Hal W. Pittman

✓ The suprascapular nerve, formed from the upper trunk of the brachial plexus, can be entrapped at the suprascapular notch and result in significant patient morbidity. Seven patients with suprascapular nerve palsy are presented, and their evaluation, treatment, and outcome over a mean follow-up period of 24 months are described. Six of these patients were treated surgically and one medically; all experienced good results. In a review of the relevant literature, this entity is distinguished from other causes of shoulder pain, the typical presenting signs and symptoms are outlined, and the appropriate management of these patients is addressed.

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Pediatric spinal trauma

Review of 122 cases of spinal cord and vertebral column injuries

Mark N. Hadley, Joseph M. Zabramski, Carol M. Browner, Harold Rekate and Volker K. H. Sonntag

✓ A review of 122 pediatric cases of vertebral column and spinal cord injuries is presented. These relatively uncommon injuries can be characterized by four distinct injury patterns: fracture only, fracture with subluxation, subluxation only, and spinal cord injury without radiographic abnormality. The immature pediatric spine has several anatomical and biomechanical features that distinguish it from the mature adolescent spine and, accordingly, the frequency of the injury type, the level of spine injury, and the incidence of neurological compromise were found to vary with the age of the patient. Follow-up data were obtained in 93% of the cases (median duration 44 months). No patient was made worse by treatment, 89% of the patients with incomplete myelopathy on admission were improved on their last examination, and 20% of the patients with a complete myelopathy had evidence of significant recovery of function. The authors conclude that the outcome after pediatric spinal trauma is good.

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Conrad T. E. Pappas, Peter C. Johnson and Volker K. H. Sonntag

✓ Signet-ring cell lymphoma is a rare tumor described in the lymph nodes, skin, tonsils, thyroid, salivary gland, and ocular orbit. This is the first case report of a B-cell signet-ring cell lymphoma in the central nervous system with Dutcher and Russell bodies, signet-ring nuclei, intracisternal crystalline inclusions, and immunoglobulin M positivity. The patient is doing well 2 years after surgery and postoperative radiation therapy. No definitive prognostic characteristics have been elucidated. This disease entity can only be suspected on histological grounds and confirmed by immunocytochemical and ultrastructural studies.

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Curtis A. Dickman, Joseph M. Zabramski, Volker K. H. Sonntag and Stephen Coons

✓ A 30-year-old man presented with a subacute course of myelopathic signs and symptoms. Magnetic resonance imaging demonstrated an epidural mass lesion of the spinal canal at the cervicothoracic junction causing compression of the spinal cord. Laminectomy with resection of this lesion revealed a large varix with acute and chronic thrombus. Postoperatively, an improvement in neurological function occurred. Spinal epidural varicosities have been reported as an etiological factor in lumbar and sacral radiculopathies. This is the first reported case of spinal cord compression in association with spinal epidural varices. The diagnosis, pathophysiology, and management of this disorder are presented.

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Curtis A. Dickman, Mark N. Hadley, Carol Browner and Volker K. H. Sonntag

✓ Combination atlas-axis fractures occur relatively frequently and have a higher incidence of neurological morbidity than isolated C-1 or isolated C-2 injuries. Patients with combination C1–2 fracture-subluxation injuries should be studied with thin-section computerized tomography. Appropriate treatment is determined by the type of axis fracture present and includes surgical and nonsurgical strategies. An experience with 25 patients with combination C1–2 fractures is presented, and management and follow-up guidelines are reviewed.