Background and Objective. Studies on decompressive craniectomy (DCE) after a malignant middle cerebral artery (MCA) stroke in selected population show an increased probability of survival without increasing the number of very severely disabled. Cerebral infarct volume (CIV) as a triage criterion for performing surgery has not been discussed in literature. The aim of this study was to investigate the value of CIV and initial National Institutes of Health Stroke Scale (NIHHS) and Glasgow Coma Scale (GCS) scores as possible triage criteria in the surgical treatment of patients with “malignant” MCA stroke. Material and Methods. According to the study protocol, 28 patients with a malignant MCA stroke were included and analyzed prospectively. The patients were randomly divided either into the DCE plus best medical treatment (BMT) group or BMT alone group. CIV and NIHHS and GCS scores were measured at time of enrollment in every case. Clinical outcome was evaluated 1 year after the treatment. Results. Six patients survived: 5 in the DCE group (none of them was older than 60 years) and 1 in the BMT group (P=0.03/0.06). Among survivors, none had a cerebral infarct volume of more than 390 cm3 (P=0.05). All survivors in the DCE group had favorable outcomes. There was no significant difference in the NIHSS and GCS scores between the groups and survivors/nonsurvivors (P>0.05). Conclusions. Decompressive surgery in the selected patients is likely to increase the probability of survival with a favorable outcome without increasing the number of severely disabled survivors. Patients with CIV of more than 390 cm3 may be bad candidates for DCE, and the prognosis is likely to be bad regardless the treatment strategy. The initial NIHHS and GCS scores did not prove any prognostic value in outcome.
No improvement in this Mn-induced movement disorder occurs after cessation of methcathinone abuse despite improvement of Mn blood levels and/or MRI abnormalities. Ultrastructural abnormalities in a former user confirm structural damage to white matter is associated with the disorder. Methcathinone/Mn toxicity is an important, disabling and permanent medical sequel of intravenous drug abuse in the former Soviet Union.
Summary
Metastatic tumours in the brain occur more frequently than primary neoplasms. Despite the generally dismal prognosis, neurosurgical resection is indicated in certain patients and can yield prolonged survival. Here we describe an 82-year-old male with a history of neurosurgical resection of a single brain metastasis 6 years ago. Tumour immunophenotype disclosed lung adenocarcinoma with low proliferation fraction. However, the primary tumour remained occult then. At present, 3 new brain metastases were identified by computed tomography. Repeated resection was performed in 2 stages, resulting in removal of 2 metastases. Lung mass was now evident as well. The final diagnosis was lung adenocarcinoma with metachronous brain metastases, stage IV. In conclusion, prolonged survival, in this case 6 years, can be reached even in patients with metastatic cancer by successful selective application of neurosurgical treatment. The biological properties of the tumour including low proliferation also contributed to longer survival and demonstrated surgery as a successful treatment option.
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