Report of four cases
Richard C. Chan and Paul Steinbok
✓ The authors report four patients who suffered the delayed onset of Lhermitte's sign following head and/or neck trauma with no significant neurological deficits. The average onset from the time of the injury was 2½ months. In all patients, there was a full range of movement of the cervical spine with no tenderness and no neurological deficits. Myelography was performed in three of the four patients and was normal. The duration of Lhermitte's sign ranged from 4 months to 1 year (mean 8 months). Complete recovery occurred in all cases. The pathogenesis, differential diagnosis, and management of patients with Lhermitte's sign are discussed.
✓ The purpose of this report was to outline the various options currently used for treatment of spastic cerebral palsy (CP) and to discuss factors involved in selecting the appropriate treatment modalities for the individual child. In a review of the literature and his personal observations, the author presents an outline of treatment options and the criteria for using each. Therapeutic options include the following: physiotherapy; occupational therapy; oral spasmolytic and antidystonic drugs; botulinum toxin injections; orthopedic procedures; continuous infusion of intrathecal baclofen (ITB); selective dorsal rhizotomy (SDR); and selective peripheral neurotomy. The most commonly used neurosurgical procedures are ITB pump placement and SDR, and these are discussed in the most detail. The author's personal schema for assessment of the child to determine the nature of the hypertonia, the impact of the hypertonia, and the appropriate therapeutic intervention is presented. There are factors that help guide the optimal treatment modalities for the child with spastic CP. The treatment of these children is optimized in the setting of a multidisciplinary team.
Michael C. Boyd and Paul Steinbok
✓ Choroid plexus tumors are uncommon neoplasms of the central nervous system. A series of 11 cases from the Vancouver General and British Columbia Children's Hospitals, treated during the last 12 years, are reviewed. Some of the management problems commonly encountered with these tumors are discussed. Many of these tumors are associated with severe hydrocephalus at the time of diagnosis, and the perioperative management of this hydrocephalus remains a matter of some debate. The timing of and the necessity for shunting are major considerations. Large subdural fluid collections are often discovered in the postoperative period, and these occasionally cause symptoms of increased intracranial pressure. Reasons for this problem are suggested and possible steps for its prevention are proposed.
The similarity between papillary ependymomas and choroid plexus papillomas has sometimes caused difficulty in pathological diagnosis. Choroid plexus carcinomas, of which there were two in this series, also present a diagnostic challenge. Differential diagnosis affects the further treatment and prognosis for the patient.
Paul Steinbok and Kenneth Berry
✓ The authors report a case of inversion of part of the cerebral mantle into the frontal horn of the lateral ventricle following ventriculoperitoneal shunting for noncommunicating hydrocephalus. The abnormally positioned cerebral mantle continued to grow and caused no detectable neurological dysfunction.
Report of four cases in one family
Michael C. Boyd, Paul Steinbok, and Donald W. Paty
✓ Familial arteriovenous malformations (AVM's) are uncommon entities, with only seven reported cases in the English literature. Some have been associated with hereditary telangiectasia. A family in which AVM's were found in four male members of two generations is reported. In addition, one patient had a large cyst associated with his AVM without previous evidence of acute hemorrhage, which is an uncommon presentation. The family is discussed and a brief review of the literature is presented.
Christopher M. Bonfield, D. Douglas Cochrane, Ash Singhal, and Paul Steinbok
Sagittal craniosynostosis, the most common single suture craniosynostosis, is treated by numerous surgical techniques. Minimally invasive endoscopy-assisted procedures with postoperative helmeting are being used with reports of good cosmetic outcomes with decreased morbidity, shortened hospital stay, and less blood loss and transfusion. This procedure uses small skin incisions, which must be properly placed to provide safe access to the posterior sagittal and lambdoid sutures. However, the lambda is often hard to palpate through the skin due to the abnormal head shape. The authors describe their experience with the use of intraoperative, preincision ultrasound localization of the lambda in patients with scaphocephaly undergoing a minimally invasive procedure. This simple technique can also be applied to other operations where proper identification of the cranial sutures is necessary.
✓ A patient is reported who developed multiple basal-cell carcinomas of the skin, a breast carcinoma, an astrocytoma of the spinal cord, and a bronchial carcinoid tumor following multiple fluoroscopies during artificial pneumothorax treatment for pulmonary tuberculosis. A review of the literature revealed no previously documented cases of radiation-induced gliomas of the spinal cord.