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Henry T. Wycis

. “Air introduced by lumbar puncture for encephalomyelography visualized an almost complete block, with the caudal limit of the cisterna magna and one of the cerebellar tonsils displaced down the vertebral canal as far as the upper borders of the laminae of C-3 ( Fig. 3 ). Some air did enter the cranial cavity, indicating that the block was incomplete or inconstant, but even after prolonged maintenance of the sitting position, most of the air remained below the level of the foramen magnum.” Fig . 3. Left lateral projection of upper cervical canal after

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Axel Olsen and Gilbert Horrax

posterior fossa because of greater herniation of the cerebellar tonsils through the foramen magnum. However, in certain instances the spinal fluid findings may be of distinct diagnostic aid, and if the procedure is carried out in a hospital where immediate operative intervention can be instituted if necessary, the danger is at least greatly minimized. In two of our patients lumbar puncture contributed distinctly to the correct diagnosis. One of these cases is summarized here. In a third patient, a spinal puncture done elsewhere precipitated a train of symptoms which a

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Paul C. Bucy and Ben W. Lichtenstein

of the dura mater a typical Arnold-Chiari deformity was encountered. The medulla oblongata and the tonsils of the cerebellum were displaced into the upper portion of the cervical spinal canal ( Fig. 1 ). The right hypoglossal and spinal accessory nerves were found to be elongated and tense. The fourth ventricle and the space beneath the cerebellum on either side of the bulb was carefully explored. No tumor was found. The lower part of the fourth ventricle lay below the level of the foramen magnum. Blunt cannulae were inserted into the substance of the cerebellum

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A Contribution Related to Treatment

Olan R. Hyndman

injecting one or two cc. of phenolsulphonphthalein into a ventricle through the lateral aspect of the anterior fontanelle and attempting to recover it in the spinal fluid in one-half hour. Usually the ventricles are too large for ventriculography to be practicable. If an Arnold Chiari malformation should be present, and it may be associated with a meningocele, it is probably wiser not to attempt a repair. Young infants do not tolerate such major operations well and even a removal of the herniated cerebellar tonsils does not guarantee a correction of the hydrocephalus

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Raymond K. Thompson

as a space-consuming mass in the posterior fossa, elevates the cerebellar hemispheres and pushes the cerebellar tonsils into the foramen magnum. The partial obstruction of the cerebrospinal fluid flow results in back pressure throughout the ventricular system, with its consequent dilation and the development of an internal hydrocephalus. The clinical picture in the traumatic type is characterized by symptoms of an expanding lesion in the posterior fossa following cranio-cerebral trauma. The degree of trauma may be very mild, as is demonstrated in the case below

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Wallace B. Hamby

relieve compression the tentorium was incised laterally for 3 cm. The wound was closed. Postoperative Course The patient did not respond and had considerable respiratory difficulty. She expired suddenly 43 hours after operation. Autopsy Findings The cerebrum was markedly swollen, with flattened convolutions. The brain stem was compressed, with foraminal herniation of the cerebellar tonsils. In the left cerebellopontine angle was a 6×4×0.5 cm. meningioma displacing the cerebellum and brain stem backward and to the right. It arose from the dura and invaded

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Cerebral Swelling

Histopathology, Classification and Clinical Significance of Brain Edema

I. Mark Scheinker

belief that the lumbar and the ventricular pressures are not of necessity always equal. Hodgson reported a series of 49 cases of intracranial tumor in which he studied the ventricular and lumbar pressures. He concluded that partial block might result from herniation of the cerebellar tonsils, and that under such conditions the initial lumbar pressure might be lower than the pressure in the ventricles. The relation between the lumbar and the ventricular cerebrospinal fluid was studied by Smyth and Henderson in 39 patients, the majority of whom had intracranial tumor

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James C. Walker and Gilbert Horrax

ventricle which would require a supratentorial exposure, ventriculography was carried out under local anesthesia on April 24, 1936. The ventriculograms showed marked symmetrical dilatation of the lateral and 3rd ventricles, and, therefore, a posterior fossa exploration was immediately undertaken. The cisterna magna was large and the arachnoid was thickened and gray. The left cerebellar hemisphere was slightly larger than the right and the convolutions were slightly widened. Upon opening the cisterna, a large tumor was disclosed when the left tonsil was retracted. The

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Arthur Ecker

L ocalized increases of intracranial pressure commonly displace parts of the brain in relation to both the skull and its dural partitions. Examples are: 32 the herniation of cerebral substance into both base and vault of the skull, 3 especially the descent of the cerebellar tonsils through the foramen magnum; the downward herniation of the temporal lobe and brain stem through the tentorial notch (tentorial pressure cone; 12, 22 ) the shift of the medial aspect of a frontal lobe under the falx 2 and of the brain stem against the edge of the tentorial notch

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Hemangioblastoma of the Posterior Fossa (Lindau's Disease)

Report of Two Cases with Familial History

F. Keith Bradford

cerebellar folia appeared normal. Puncture of the right cerebellar hemisphere failed to reveal a cyst. When the cerebellar tonsils were separated, a reddish-brown tumor, 2 cm. in diameter, was exposed ( Fig. 2 ). It indented the tonsils and was attached to the dorsal surface of the caudal bulb and 1st cervical segment, predominantly to the right of the midline. An imposing group of vessels entered both superior and inferior poles of the tumor. These were clipped, coagulated and cut with scissors without mishap. Slight traction upon the tumor was made without alteration of