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.
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.
✓ 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.
Report of two cases
Paul Steinbok, Clarisse L. Dolman, and Ken Kaan
✓ Two cases of pineocytoma are reported in patients whose initial symptoms resembled a subarachnoid hemorrhage. The underlying tumor became obvious only later in the disease. Several episodes of subarachnoid bleeding occurred. These are the first documented cases of pineocytoma with this type of clinical presentation.
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.