A prospective study for the treatment of cerebellar haemorrhage was conducted in a non-selected group of 33 patients. All patients with cerebellar haemorrhage arriving at the Department of Neurosurgery at Homburg/Saar have been included in this study, also those in bad condition, with high risk factors, and the aged. All of them required intensive care respectively intensive supervision. The following management protocol has been established. I. Cases with small haemorrhage, in good clinical condition, without hydrocephalus and/or occlusion of the basal cisterns: intensive supervision, operative intervention only if they deteriorate into one of the following groups. II. Cases with hydrocephalus-even if not yet pronounced-but without occluded basal cisterns and without major tonsillar herniation: pressure monitored ventricular drainage, which opens at 15 mm Hg and thus prevents higher CSF pressure developing. III. a): Cases with large haematoma, occluded basal cisterns and/or tonsillar herniation, but without severe general risk factors, as a first step: pressure monitored ventricular drainage; as a second step, if they do not improve soon after the normalization of the ventricular pressure: open surgical evacuation of the haematoma, which also decompresses the posterior fossa. If present and possible, causative vascular malformations may be dealt with at the same session. III. b): Same intracranial situation, but patients with severe general risk factors: pressure monitored ventricular drainage only. IV. Cases with causative aneurysm or angioma, who initially had been treated conservatively or by ventricular drainage: secondary operation of the vascular malformation after stabilization of the general conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
More than 200 intraventricular haematomas (IVH) have been treated in the Homburg Neurosurgical University Clinic since computed tomography was available and facilitated the diagnosis. Among 200 consecutive cases, which are analysed and presented in this publication, there were 71 patients with subarachnoid haemorrhage (SAH)--58 of whom with angiographically and/or pathologically verified aneurysms--, and 21 cases with intraventricular angiomas. IVH without concomitant intracerebral haematoma (ICH) and without evidence of SAH is highly suggestive of intraventricular angioma. In our experience panangiography [if available digital subtraction angiography (DAS)] should be done as soon as possible in all cases of IVH. It is a precondition for early diagnosis and operative elimination of the source of bleeding, because the retrospective analysis of our material shows that rebleeding is by far the highest single risk factor in cases with IVH caused by aneurysms or angiomas. We therefore recommend early microsurgical occlusion of the aneurysms and exstirpation or intravascular embolisation of the angioma. The best survival rate (76%) was achieved in IVH cases caused by angiomas. In aneurysms with IVH the survival rate was 35%, in IVH caused by other diseases 37%. The worst prognosis occurs in SAH with IVH without proven aneurysm or angioma. The survival rate of this group was only 8%.
Among 110 patients (45 men, 65 women), aged 15 to 66, with clinical and/or biological diagnosis of multiple sclerosis (MS), severe to moderate corpus callosum (CC) atrophy was observed in 67 (60%) patients. Correlation between CC atrophy, brain atrophy, duration and severity of clinical symptoms, and high signal white matter areas, was carried out in 90 patients. Mean age was 46 years for patients with severe CC atrophy, and 33 years for those without atrophy. Mean duration of the disease was 14 years in patients with severe atrophy, and 5 years in patients without atrophy. Severity of clinical symptoms is more pronounced in patients with severe CC atrophy. Numerous or large white matter high signal areas are observed in patients with severe CC atrophy on T2-weighted images. CC atrophy appears earlier than brain atrophy in the course of MS.
Up to 5 years ago, the radiological diagnosis of leukodystrophy was based on computed tomography (CT). More recently, magnetic resonance imaging (MRI) has been used to study pathology of the white matter with great success. The abnormalities in eight patients with different types of leukodystrophy are described, using high-field MRI. CT and MRI show comparable sensitivity in detecting the pathological changes of leukodystrophy. MRI seems to be superior in visualizing the extent of the lesions, their precise anatomical location and any involvement of the brain stem and cerebellum. Differential diagnosis among the three types of leukodystrophy by MRI is difficult but may be attempted by some features. Specific diagnosis can be achieved only by laboratory examination or histology. The role of MRI should be to suggest the proper biochemical test at an earlier stage.
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