✓ Neurogenic pulmonary edema (NPE) is usually the result of head trauma. The authors describe the case of a 13-year-old girl, in whom NPE was associated with a colloid cyst of the third ventricle causing acute hydrocephalus. The mechanisms involved in the development of NPE are briefly discussed. The possible role of the colloid cyst in the distortion of the anatomical relationships in the vicinity of the hypothalamic nuclei is considered.
Gideon Findler and Shamay Cotev
Gideon Findler and Moshe Feinsod
✓ A patient with hydrocephalus due to aqueductal stenosis suffered facial pain which was relieved after the insertion of a ventriculoperitoneal shunt. The trigeminal somatosensory evoked response (TSER) of the affected side showed lower amplitudes and longer latencies as compared to the unaffected side. Following surgery, the waves regained higher amplitudes and shorter latencies. An episode of shunt malfunction was accompanied by recurrent facial pain and impairment of the TSER. Both improved after revision of the shunt. The possible etiology of facial pain in patients with hydrocephalus is discussed.
Gideon Findler and Moshe Feinsod
✓ Electrical stimulation of the upper and lower lips of normal subjects evoked a consistent response recorded from over the face area of the ipsi- and contralateral hemispheres. This response consisted of seven discrete waves. Peak latencies ranged from as early as 8 msec to 115 msec. Stimulation of the lower lip evoked a response of lower amplitude and reversed polarity, as compared to the upper lip stimulation response. The data support the validity of the trigeminal sensory evoked response in the evaluation of the trigeminal pathways. Previously reported methods are reviewed and compared.
Report of two cases
Gideon Findler and Sylvan Lavy
✓ Among the common side effects of diphenylhydantoin (DPH) overdose, the most frequently encountered neurological signs are those of cerebellar dysfunction. Very rarely, the toxic neurological manifestations of this drug are of cerebral origin. Two patients are presented who suffered progressive hemiparesis due to DPH overdose. Both had brain surgery before DPH treatment. It is assumed that patients with some cerebral damage are liable to manifest DPH toxicity as focal neurological signs.
Zvi Ram, Roberto Spiegelman, Gideon Findler and Moshe Hadani
✓ Sodium nitroprusside is commonly used for the induction of hypotension during neurosurgical procedures. Its toxicity stems from hemodynamic compromise as well as from its metabolites, especially the formation of cyanide. A patient is described who underwent craniotomy for hypertensive intracerebral hemorrhage. He gradually recovered following the operation, but needed continued administration of sodium nitroprusside for control of hypertension. On the 7th postoperative day, he deteriorated into coma with evidence of severe edema and herniation on the computerized tomography scan. Cessation of sodium nitroprusside and treatment for cyanide poisoning resulted in resolution of his symptoms within hours. The potential toxicity of sodium nitroprusside, measures to prevent toxicity, and therapeutic steps are discussed.
Moshe Hadani, Gideon Findler, Izhak Shared and Abraham Sahar
✓ A case of delayed onset of diabetes insipidus (DI), which developed 27 days after a closed head injury, is reported. The patient sustained only a minor neurological deficit and, except for antidiuretic hormone (ADH) insufficiency, hypothalamic function was intact. This selective damage of posterior pituitary function was total and permanent. Ischemia due to vascular injury may be the most likely etiology. Once the diagnosis of delayed posttraumatic DI is confirmed, the treatment of choice is DDAVP (desmopressin acetate). In contradistinction to DI immediately following minor head injury, most patients with a delayed onset of DI after trauma have permanent ADH deficiency.
Gideon Findler, Moshe Feinsod, Graciela Lijovetzky and Moshe Hadani
✓ A patient in whom transient global amnesia (TGA) led to the diagnosis of a metastasis of a transition-cell carcinoma of the bladder to the non-dominant hemisphere is described. In previously reported cases of TGA associated with brain tumors, the tumors involved either the dominant or both hemispheres. The etiology of TGA associated with a brain tumor is most likely vascular, as suggested by the sudden development and the transitory character of the event. In contrast to the “common” form of TGA (where both temporal lobes suffer temporary ischemia), in these patients only one side of the limbic system is affected, because a brain tumor has already compromised the other limbic area. Therefore, the dominance of the hemisphere with the tumor is of no consequence, as both hemispheres have been involved. It is concluded that the TGA in these patients is not due to, but is rather associated with, a unilateral brain tumor.
Gideon Findler, Amiram Aldor, Moshe Hadani, Abraham Sahar and Moshe Feinsod
✓ Children with rare coagulation disorders are at high risk from intracranial bleeding with even minor head injury. Treatment by transfusion of fresh frozen plasma is limited because of the large volumes required for restoring the missing coagulation factor. Furthermore, even when concentrates of such a factor are available, their use may prove ineffective due to circulating specific antibodies. Three patients with rare coagulation disorders are presented who suffered head injury complicated by intracranial hemorrhage.
Gideon Findler, Harold J. Hoffman, Hugh G. Thomson and Larry Becker
✓ A case is reported of aggressive cellular blue nevus of the scalp. Intracranial pigmentation in association with a melanocytic nevus of the scalp may indicate either benign coexisting melanosis, local extension, or invasive malignancy. The importance of accurate diagnosis is discussed, and the need to be prepared to carry the excision deep enough to include the dura is illustrated.