Pathophysiological mechanisms for vasospasm after subarachnoid haemorrhage (SAH) remain unclear and, so far, roles of cytokines in vasospasm have not been known. In the present study, we measured interleukin-1 alpha (IL-1 alpha), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumour necrosis factor-alpha (TNF-alpha) concentrations in the cerebrospinal fluid (CSF) of patients with subarachnoid haemorrhage (SAH). ELISA assay were performed on 21 CSF samples from 7 patients with SAH and on 4 sera samples. Both IL-6 and IL-8 were detected in all CSF samples, but IL-1 alpha, IL-1 beta, and TNF-alpha were not detected. IL-6 and IL-8 were also detected in sera, but at much lower concentrations. This study indicates that IL-6 and IL-8 may play roles as immunomodulators in patients with SAH. In addition, it has been reported that IL-6 inhibits prostaglandin I2 production and increases the mRNA level of c-sis gene, suggesting that IL-6 may play an important role in vasospasm as vasoconstrictor.
A 25-year-old male presented with an anterior sacral meningocele (ASM) manifesting as repeated urinary tract infections. Surgical correction was completed by simple ligation of the thecal sac next to the ostium via sacral laminectomy, and the thickened filum terminale was sectioned. A 22-year-old female presented with an ASM manifesting as transient difficulty in micturition. Subsequent to sacral laminectomy, the thickened filum terminale was sectioned. However, an aberrant nerve root over the ostium made simple ligation hazardous, so that transdural suture around the ostium was carried out. Complete obliteration was confirmed 5 months after the surgery. Magnetic resonance (MR) imaging could clearly demonstrate the involvement of neurologically important structures. Surgical strategy for ASM based on neurosurgical considerations is proposed, because of the frequent association of caudal spinal cord anomaly as well as presacral mass lesion. Intraoperative assistance systems such as endoscopy for cyst content examination and neurophysiological monitorings are recommended. Several months follow up with MR imaging is required to confirm successful surgical correction.
We report a case of intracerehral pneumatocele following a traumatic head i ゆ ry in addition to a review of pneumocephalus 仕oln the cases past 20 years . A 40 − year − o 重 d male was admitted to hospital because of a strong b弖 ow to his forehead received ln a vehicle accident . A CT scan performed on admissiQn showed a cerebral contusion in both frontal lobes accompanied by a $kull base fracture , However , intracerebral pneumocephalus was not detect − ed , About l month after the accident , CSF rhinorrehea was noted , but could not be halted by lumbar drainage , Forty イ ive days after the accident , MRI showed intracerebral pneumocephalus in his right frontal lobe . Seventy − four days after the accident , surgery fdr repa 三 ring the skull base fracture was perf { )rmed , During the surgery , it was noted that some parts of the right frontal contusion were adhered to the edge of the lacerated dura around the bone defect of the frontal sinus . The air cavity of the frontal lobe communicated with the 廿ontal sinus . After dissecting and cutting off the herniated brain , the air cavity of the frontaUQbe shrunk . Continuous in 且ammation , such as meningitis , may cause the partial destruction of the hernia も ed cortex , and provide a trajectory f6r intracerebral pneumocephalus from the paranasal sinus into the cortex . As for the cause of the delayed CSF rhinorrehea , we thought it oozed 角 〔 om the lateral ventricle through the intracerebral pneumocephalus , or 廿om the subarachnoid space at the丘 二 〇ntal lobe . (
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