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Astrocytoma of the Brain and Spinal Cord

A Review of 176 Cases, 1940–1949

Laurence F. Levy and Arthur R. Elvidge

There were 11 astrocytomas of the spinal cord. The average age of the patients was 30 years; the eldest was 51 years old and the youngest 8 years. Nine were males and 2 were females. Three of the lesions were located predominantly in the cervicomedullary and cervical regions, 3 in the cervicothoracic, 4 in the thoracic and 1 in the thoracolumbar region. The average duration of symptoms in the 3 cervical and 4 thoracic cases, in which the predominant symptom was one of weakness or clumsiness of one or more limbs, was 6 months. The average duration of symptoms in 3

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Frederick W. L. Kerr

the C1 root by a distance of approximately 5 mm., and in this early stage there may not be any increase in intracranial pressure. But the C1 rootlets lie across the tonsil's path of displacement as it shifts downward and necessarily they will be stretched, either by direct engagement with the tonsil or indirectly by the wedge action of the tonsil between the dura mater and the cervical cord ( Fig. 2 ). An additional possibility is that the medulla and the tissues about the cervicomedullary junction are displaced downward to some extent also, thus stretching the

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Shedden Alexander and Frederick W. L. Kerr

pressure associated with elevation of cerebrospinal-fluid pressure around the spinal cord and that this observation had subsequently been confirmed and extended by several observers. 2, 3, 12 In the original and subsequent reports, the method used consisted of injection of saline into the spinal subarachnoid space, which had been isolated from the cranial compartment by a constricting ligature at the cervicomedullary junction 2, 3 or low cervical area. 12 Increasing the pressure of the cerebrospinal fluid by 50 to 100 mm. of mercury resulted in rises of blood pressure

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J. A. Taren, Ross Davis and E. C. Crosby

cord segment is at the lower margin of the cervicomedullary junction where the anteroposterior diameter of the cord increases rapidly, and the position of tracts varies with the size and position of the motor decussation ( Figs. 1 – 4 ). Fig. 1. Cross section of the normal human spinal cord from the obex to C-2. The position of the lateral spinothalamic tract and the motor decussation is at the level of the obex. Weil stain. Fig. 2. Cross section of the normal human spinal cord from the obex to C-2. The position of the lateral spinothalamic tract

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Abbott J. Krieger, Hubert L. Rosomoff, Abraham S. Kuperman and Lawrence H. Zingesser

operations, reported four operative mortalities from ventilatory failure. Necropsy in two patients demonstrated areas of softening and hemorrhage in the cervicomedullary region. In a later communication, 4 a similar danger was associated with decompression of atlanto-axial dislocations. Case Report A 50-year-old woman was admitted with a complaint of occipital pain of 2 years duration. The pain was increased by coughing and sneezing; and, associated with these maneuvers, she experienced momentary periods of apnea and tetraparesis. She noted dizziness when she

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Vascular insufficiency and differential distortion of brain and cord caused by cervicomedullary football injuries Richard C. Schneider Hank H. Gosch Horace Norrell Michael Jerva Loyal W. Combs Richard A. Smith October 1970 33 4 363 375 10.3171/jns.1970.33.4.0363 Paralysis of both arms from injury of the upper portion of the pyramidal decussation: “cruciate paralysis” Herbert S. Bell October 1970 33 4 376 380 10.3171/jns.1970.33.4.0376 Effects of local pressure on cortical electrical activity and cortical vessels in the dog Mitsuo Numoto R. M. Peardon

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Richard C. Schneider, Hank H. Gosch, Horace Norrell, Michael Jerva, Loyal W. Combs and Richard A. Smith

T raumatic lesions of the central nervous system are usually discussed under the separate headings of cranial or spinal injuries, with few reports appearing in the literature pertaining to the region of the cervicomedullary junction. This paper is concerned with serious or fatal football injuries due to vascular insufficiency to the brain stem and spinal cord and/or to the dynamic sequelae related to the differential distortion between the brain and spinal cord at the time of direct vertex impact. The football field is one of the few places where the actual

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Hank H. Gosch, Elwyn Gooding and Richard C. Schneider

to 30 ft lb. In one animal only were there smaller central lesions at the cervicothoracic junction below the level of the cut dentate ligaments. High-speed cinematography at the time of injury aided in the study of the mechanical factors involved at the cervicomedullary junction. The cervical spinal cord showed minimal motion in the cephalocaudal direction ( Fig. 2 ), in contrast to the marked movement of the cerebral hemispheres previously reported ( Fig. 3 ). 4, 16 At the time of impact the vertebral spaces were compressed and the foramen magnum telescoped

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Bilateral traumatic abducens palsy

A mechanism of injury suggested by the study of associated cervical spine fractures

Richard C. Schneider and Frank D. Johnson

, Williams & Wilkins , 1964 , ed 4 Rowbotham GF: Acute Injuries of the Head; Their Diagnosis, Treatment, Complications and Sequels. Baltimore, Williams & Wilkins, 1964, ed 4 8. Schneider RC , Gosch HH , Norrell H , et al : Vascular insufficiency and differential distortion of brain and cord caused by cervicomedullary football injuries. J Neurosurg 33 : 363 – 375 , 1970 Schneider RC, Gosch HH, Norrell H, et al: Vascular insufficiency and differential distortion of brain and cord caused by cervicomedullary football

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Robert C. Leaver and John D. Loeser

performed on four patients with Lhermitte's phenomenon did not reveal any abnormalities from the odontoid process to the sacrum. Whatever changes might have been present were not seen on indirect studies; we have not had cause to explore the cervicomedullary region of any patients who had sustained high velocity wounds of the brain. The EEG changes were compatible with the location and extent of the underlying brain injury and were unrelated to the presence of Lhermitte's phenomenon. Therefore, we are left with the conclusion that Lhermitte's phenomenon following high