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Nassir Mansour, Ruth-Mary deSouza, Christian Sikorski, Madelyn Kahana, and David Frim

in the setting of focal brain lesions of nontraumatic origin. In such a situation, pentobarbital may be a suitable agent to control an acute ICP crisis for a limited time period. We describe our experience with the use of pentobarbital as an adjunct for ICP control in 3 pediatric patients undergoing 6 operations for nontraumatic focal lesions. Special consideration was made regarding temperature control, cardiovascular stability, urine output, and infection both during and after treatment. Methods Three patients ( Table 1 ) presented to our institution with

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Chang Z. Zhu and Roland N. Auer

I nsulin has been demonstrated to be beneficial in both global 14, 25, 28, 31, 35 and focal 10, 12, 20, 22 models of cerebral ischemia and even in ischemic paraplegia of the spine. 15 The relationship between insulin-related hypoglycemia and the neuroprotective effect of insulin, however, differs in these two models of ischemia. In animals with global ischemia the neuroprotection remains active even if glucose is co-administered with the insulin to maintain the same blood sugar level present in untreated control animals. 13 The same species of animal

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Douglas B. Moreland, Franz E. Glasauer, James G. Egnatchik, Reid R. Heffner, and George J. Alker Jr.

T he diagnosis of focal cortical dysplasia has been rare and elusive since this entity was originally described in 1971. 7 With only a dozen clearly documented cases, most of them reported prior to computerized tomography (CT) scanning, its radiographic presentation has not been adequately described. Mental retardation and intractable seizures are early symptoms and are associated with abnormal electroencephalographic (EEG) findings and CT scan changes similar to those of neoplasia. Although gross pathological changes are occasionally seen, the diagnosis is

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Richard Leblanc

W ilder Penfield's career began with the search for the cause of focal epilepsy. 1 This led him to Madrid, in 1924, to the laboratory of Pío del Río Hortega (1882–1945) to learn how to use the silver and gold techniques that he and Santiago Ramón y Cajal (1852–1934) had developed to stain neurons, glia, and their projections. Río Hortega quickly put Penfield to work on a project that led to the discovery of the oligodendrocyte. 2 Building on this success, Penfield and Río Hortega performed an experiment that characterized the structure of posttraumatic

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Richard Leblanc

W ilder Penfield's career began with the search for the cause of focal epilepsy. 1 This led him to Madrid, in 1924, to the laboratory of Pío del Río Hortega (1882–1945) to learn how to use the silver and gold techniques that he and Santiago Ramón y Cajal (1852–1934) had developed to stain neurons, glia, and their projections. Río Hortega quickly put Penfield to work on a project that led to the discovery of the oligodendrocyte. 2 Building on this success, Penfield and Río Hortega performed an experiment that characterized the structure of posttraumatic

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Mathias Kunz, Philipp Karschnia, Ingo Borggraefe, Soheyl Noachtar, Joerg-Christian Tonn, and Christian Vollmar

E pilepsy surgery is a well-proven and powerful treatment option in drug-resistant focal epilepsy. 1 , 2 After careful presurgical evaluation and patient selection, most patients achieve postsurgical improvement in seizure burden, 3 – 5 cognition, 6 quality of life, 7 and social outcomes. 8 The boundary of the surgical target depends on the location and extent of the epileptogenic zone (EZ) but may be limited by adjacent eloquent structures. A detailed presurgical evaluation is therefore indispensable and includes noninvasive and invasive video

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Selvadurai Sivalingam, Guy Corkill, William G. Ellis, and John R. Claiche

concerns a patient who at the age of 9 years underwent three consecutive craniotomies for apparent cerebral infarction of the brain. This disease process, initially a diagnostic and therapeutic dilemma, was subsequently diagnosed as focal cerebral necrosis with eosinophilia, and was controlled eventually by the use of small doses of radiation. Even though there was clinical evidence of systemic involvement, extensive search revealed no further histological evidence of dissemination. Case Report This 9-year-old boy presented to his family doctor with a several

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Yanfang Shi and Huancong Zuo

E pileptic syndromes characterized by focal inhibitory motor seizures (ictal paralysis) are rare. 10 This ictal paralysis is best documented with ictal video EEG recordings, which usually reveal hemiparesis or hemiplegia during the ictal EEG pattern without loss of consciousness. The most common foci, patterns of progression, and salient electrophysiological characteristics of ictal paralysis are still uncertain owing to the rarity of this seizure syndrome. We describe a patient with focal inhibitory motor seizures who was evaluated using invasive EEG

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Bertrand C. Liang, Allan F. Thornton Jr., Howard M. Sandler, and Harry S. Greenberg

tumor recurrence. Ninety percent of recurrences were located within 2 cm of the original tumor margin, with the other 10% outside the 2-cm margin but detectable by CT scanning. Based on these observations, they suggested that focal irradiation might be appropriate. At the University of Michigan, three-dimensional treatment planning has been used since 1985 in an attempt to spare normal brain during irradiation. This has emphasized the consistent delivery of radiation to three-dimensionally defined volumes of brain parenchyma using multiple cross-firing fields

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Fausto Iannotti, Julian T. Hoff, and Gerald P. Schielke

increase in cellular water content has little effect on intracranial pressure (ICP) at first, because brain parenchyma is compliant and the insult is focal. Hours to days later, when the blood-brain barrier opens and protein-rich fluid extravasates into the ischemic area, water accumulates and the brain swells. Then ICP, measured from the ventricles, rises as edema continues to form. 10, 13, 22, 24, 32 Intracranial pressure, measured directly from brain tissue, may increase within the ischemic area as soon as cellular water content begins to rise. 10 That tissue