A successful excision of a giant cerebral mycotic anuerysm in a young girl with endocarditis is presented. The clinical pictures can be confused with a cerebral abscess. C.T. Scan and angiography are essential in the diagnosis. Rupture of the aneurysm is associated with high mortality and morbidity which can be averted by prompt neurosurgical treatment.
The author describes a posterolateral extradural approach for total excision of small to moderate symptomatic lateral thoracic meningoceles. Its advantages over the classical laminectomy, intradural repair, and thoracotomy excision are discussed.
Central nervous system involvement in melioidosis is rare. We describe a 48 year old woman who developed septicaemia and a brain abscess due to Pseudomonas pseudomallei. Since there is a continuing practical problem in bacteriological confirmation of the aetiological agent, diagnosis of melioidosis has to be made on clinical suspicion.
Thirty four patients with cryptococcal meningitis seen in the University of Malaya medical centre since 1980 were reviewed. Eleven patients had bilateral papilloedema and visual impairment but eventually survived. Seven patients had intensive aggressive measures, including shunting to reduce intracranial hypertension irrespective of ventricular size shown in CT scan, and showed substantial improvement in vision. It is concluded that papilloedema and visual failure in cryptococcal meningitis reflects raised intracranial pressure and that this should be treated vigorously.
Over the last 8 years, 22 consecutive cases of subarachnoid haemorrhage were found to have no obvious cause on angiography. The age, neurological status and CT-scan appearance in 16 cases were studied together with the completeness and quality of the angiogram. Limited angiography was done in cases with advanced age, poor neurology or severe hypertension. There is a need for more repeat angiographic studies in the presence of vasospasm whether focal or generalised, as indicated by the fact that only 5 out of the 17 cases with vasospasm had repeated satisfactory studies.
Paraventricular calcification not previously reported in systemic lupus erythematosus was seen in cranial computed tomograms of two patients with this disorder.
Neuroblastoma is the most common malignant tumour in infancy originating in about 70% of cases in the adrenal gland. Haemorrhage and necrosis is often seen in neuroblastoma but cyst formation is uncommon. Fistulous communication between an adrenal cystic neuroblastoma and the large bowel has never to our knowledge been reported before.
A rare case of hepatic hydatidosis in non-endemic Malaysia is reported. It is important that clinicians treating the occasional patient be familiar with current diagnostic and therapeutic modalities.
Spontaneous hemorrhage into the lateral part of the pons with sequelae compatible with survival has been documented previously. The author describes an unusual case with spontaneous hemorrhage into the lateral pons, with intraneural extension into the right trigeminal nerve root. Radiological features were of an expanding mass of the cerebellopontine angle. The patient was treated surgically with success.
Anterior sacral meningocele is a rare congenital meningeal cyst herniating through a bony defect in the sacrum. Since its description by Bryant in 1837, only 154 cases have been reported in the world literature. The application of ultrasound and C.T. scan following myelography is discussed.
Two cases of late second trimester extrauterine pregnancy are presented--intraabdominal pregnancy in one and an ampullary pregnancy in another. In the former the diagnosis was made only after attempts at induction of labour for fetal death with prostaglandins failed and in the latter only at laparotomy. The diagnostic and surgical problems encountered are discussed.
We describe a case of cervical cord compression due to ossified posterior longitudinal ligament in association with diffuse idiopathic skeletal hyperostosis, in a young female. Characteristic CT findings are described.
Two cases of longstanding foreign bodies in the larynx and lower laryngo-pharynx were accurately localised by direct coronal3 and limited axial CT scans of the neck. The relationship of the foreign bodies with the surrounding structures and associated changes are demonstrated clearly.
An unusual case of syringomyelia secondary to a cauda equina meningioma involving the conus medullaris is described. The tumour was totally removed with decompression of an adjacent cyst and syrinx resulting in resolution of the symptoms and radiological appearance.
A 37 year old female who presented with a history of foreign body ingestion ten months previously was found on examination to have a retropharyngeal swelling. An initial differential of foreign body granuloma or retropharyngeal tuberculous abscess was considered. The usefulness of the lateral neck radiograph in demonstrating retropharyngeal pathology and the supplementary role of the computed tomography scan in confirming and elucidating the identity of the radio-opacity is highlighted. This presentation is a timely reminder of the need for a simple inexpensive lateral neck radiograph in situations of doubt as to persisting foreign body impaction.
An 8-year old boy presented with a right neck swelling which appeared only intermittently. The swelling was well demonstrated by the Valsalva manoeuvre. The differential diagnosis include a laryngocele, a superior mediastinum tumour or cyst and a venous aneurysm. Plain radiography, computerized tomography, ultrasonography and venography were performed. A diagnosis of venous aneurysm was confirmed. Ultrasonography was the best modality for imaging of this rare condition. It is non-invasive and it will also delineate the extent of the lesion. The treatment is expectant. Surgery is reserved for cosmesis and symptomatic aneurysms.