The outcome of a series of 73 patients with spontaneous intraparenchymatous haematomas treated by surgical evacuation of the clot and decompressive craniectomy has been described. Comparing postoperative mortality of this series with another series of patients (54 cases) treated only with surgical removal of the clot without decompressive craniectomy a statistically significant improvement in the mortality rate after craniectomy could be observed in acute cases demanding surgical intervention for preservation of life in the first 24 hours. If signs of brain-stem suffering appear surgical mortality increases proportionally to the duration of this symptomatology. In these cases surgery, if it is to be useful, has to be performed as soon as possible. The morbidity of the surviving patients is not greater in this series with decompressive craniectomy than in series without decompression.
After chemothalamectomy for advanced parkinsonism, one of our patients developed dyskinetic symptoms which suggested the diagnosis of hemiballism. These symptoms persisted after a second lesion had been placed slightly deeper than the first. The patient died 5 months after the operation from causes which had no evident connection with the neurological disease. It seemed that the history of this case, together with the report of the autopsy findings, might give useful information on the morbid anatomy of hemiballism.A 35-year-old white man was admitted in June, 1957, with a past history of operation for cleft palate and of bronchiectasis.The actual illness started in 1946 with slight tremor of the left thumb and involved the whole extremity soon afterwards. The other arm became gradually affected by tremor and rigidity 6 months later. Four years later an attack of "severe flu"increased the severity of the Parkinson syndrome. Rigidity increased and became generalized; the arms attained a rigid flexed posture. In 1955, flexion deformities in the hands and progressive speech disturbances appeared, and the clinical pic¬ ture showed a steady progress of the disease.
ExaminationClinical Findings.-The patient was a well-de¬ veloped and well-nourished man of erect posture. His neck was flexed and the head tilted slightly to the right, with some tremor. The face was markedly mask-like, with a staring expression. He had a slightly shuffling gait with no associated movements of the arms, and slight tendency for retropulsion could be observed. The speech was stuttering, the voice low, and micrographism was exhibited.Cranial Nerves.-The examination was negative, except for blepharospasm and lack of convergence of eyes.Upper Limbs.-Marked tremor was present bi¬ laterally. Bradykinesia, more pronounced on the left side, was noted. Both hands exhibited dystonic deformities which were not completely fixed. Both
In a group of 132 patients with malignant astrocytomas treated between 1971 and 1983, there were 3 patients who had received radiotherapy to the head several years before developing the glioma. The cases are described, and the evidence supporting the view that the gliomas might be radiation-induced is discussed.
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