Leptomeningeal cyst associated with hemiplegia and skull defect of traumatic origin

Cooperstock, Moses

doi:10.1016/s0022-3476(46)80035-0

Cited by 9 publications

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“…Convulsions, aphasia, and pyramidal tract signs have been described. Although known for nearly 100 years (Quain, 1855), few cases have been described (Schwartz, 1941;Cooperstock, 1946;Taveras and Ransohoff, 1953;Gruber, 1969), and this may be attributed to difficulties in diagnosis. Cysts are generally recognized by the bone changes they cause.…”

Section: Discussionmentioning

confidence: 99%

Leptomeningeal cysts diagnosed by isotope cisternography

Front

Minderhoud

Beks

et al. 1973

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY The diagnosis of leptomeningeal cysts by isotope cisternography is described in four cases. The cysts are visualized as abnormal local collections of the radiopharmaceutical, best demonstrated 48 hours after lumbar injection. The investigation makes it possible to diagnose the cyst at an early stage, before severe clinical symptoms and changes in the bones of the skull develop. Cases of leptomeningeal cysts in various areas of the brain are described.Isotope cisternography provides a visual assessment of flow dynamics of the cerebrospinal fluid (CSF) and has proved very valuable in the diagnosis of disturbances of CSF flow and absorption. It has recently been found to be useful also in the diagnosis of local abnormalities in CSF spaces (James et al., 1971;. In this paper four cases will be described in which leptomeningeal cysts were diagnosed by isotope cisternography. METHODSRadioiodinated human serum albumin (RIHSA) is used. Routinely 100 ,t Ci are injected into the lumbar theca. The RIHSA must be freshly prepared and of high specific activity (1 mg albumin/100 u Ci). The thyroid gland is blocked by administering three drops of Lugol's solution daily for nine days, starting one day before the investigation. Each study is performed with both a scintillation gamma camera (Pho Gamma III, Nuclear Chicago) and a rectilinear scanner (Pho Dot, Nuclear Chicago). There are several reasons for this: a preliminary study with the gamma camera gives a quick general orientation, and suggests whether it is necessary to use views and positions other than the routine anterior and lateral ones; and the rectilinear scanner gives somewhat better resolution in the plane of the collimator than does the gamma camera. Every patient is studied at 4, 24, and 48 hours after injection. CASE 1A 24 year old man suffered a head injury in a car accident. On examination he was subcomatose and had a mild right hemiparesis. Plain radiographs of the skull showed a depressed fracture of the left temporal bone, and at operation the dura mater was found to be torn and the depressed bone fragments penetrating the brain. The bone and the necrotic brain tissue surrounding it were excised and the dural defect was repaired. The postoperative course was uneventful: examination at discharge from hospital after 14 days showed a spastic right hemiparesis and aphasia. Three months later the patient had an epileptic attack starting on the right side of his body, and this was followed by many more attacks. Nine months later the bone defect ( Fig. 1) was covered with acrylic. Frequent epileptic attacks still continued despite high dosage, sometimes to toxic levels, of antiepileptic drugs. In the course of time the patient became apathetic and unable to walk, and eventually bedridden. He was readmitted two years after the accident, and RIHSA cisternography (Fig. 2) was carried out in a search for posttraumatic non-resorptive hydrocephalus. A large abnormal collection of the radiopharmaceutical was seen in the left temporoparietal region, which was thou...

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Section: Discussionmentioning

confidence: 99%