Intrakranijska hipertenzija uzrokovana Lhermitte-Duclosovom bolešću: prikaz slučaja

A 24-year-old woman presented with symptoms of increased intracranial pressure. Computed tomography scanning showed a hypodense cerebellar mass. Magnetic resonance imaging (MRI) revealed a large lesion within the left cerebellar hemisphere and vermis that reduced the fourth ventricle and compressed the aqueduct with subsequent dilatation of the ventricular system. The case is described because of the rare occurrence of Lhermitte-Duclos disease in a central location. The preoperative diagnosis was verified by histologic findings obtained upon subtotal resection of the lesion. MRI provides an opportunity to improve the surgical approach and to evaluate long-term follow-up, thus reducing the probability for recurrence and complications. Therefore, MRI is considered the imaging method of choice to make the diagnosis of Lhermitte-Duclos disease.Mlada žena u dobi od 24 godine primljena je sa simptomima povišenog intrakranijskog tlaka. Kompjutorizirana tomografija pokazala je hipodenznu cerebelarnu masu. Prikaz pomoću magnetske rezonance otkrio je veće oštećenje unutar lijeve cerebelarne polutke i vermisa, koje je smanjilo četvrti ventrikul i pritisnulo akvedukt uz posljedičnu dilataciju ventrikularnog sustava. Slučaj se opisuje zbog rijetke pojave središnje lokalizirane Lhermitte-Duclosove bolesti. Učinjena je subtotalna resekcija lezije, a histološki su nalazi potvrdili prijeoperacijski postavljenu dijagnozu. Magnetska rezonanca pruža mogućnost poboljšanja kirurškog pristupa i procjenu dugotrajnog praćenja, smanjujući tako vjerojatnost ponovne pojave bolesti i komplikacija. Stoga se magnetska rezonanca smatra metodom izbora u postavljanju dijagnoze Lhermitte-Duclosove bolesti

Does mobile phone use cause brain tumors?

U današnje doba živimo u gustom moru polja elektromagnetskog zraèenja, za koje se procjenjuje da je 100 do 200 puta jaèe nego što je bilo prije sto godina. Dalekovodi, radari odašiljaèi, elektrièni vodovi, mobilni telefoni, televizori, digitalni satovi, CD/radioplejeri, raèunala i bežièni internet stvaraju elektromagnetska polja, a problem elektromagnetskog “zagaðenja” pogoršava upravo eksplozija bežiènih tehnologija. Tijekom rada, spomenuti ureðaji emitiraju elektromagnetsko zraèenje koje utjeèe na žive sustave. S obzirom na to da mobilne telefone za vrijeme razgovora prislanjamo na uho, dio njihovog zraèenja apsorbiraju tkiva glave, te postoji opravdana zabrinutost da njihovo korištenje utjeèe na razvoj tumora mozga i drugih fizioloških poremeæaja. U svijetu se progresivno poveæava broj korisnika i uèestalost korištenja mobilnih telefona, stoga je ovo pitanje od velikog javnozdravstvenog znaèaja. Mnogobrojne studije pokušale su ustanoviti utjeèe li korištenje mobilnih telefona na nastanak tumora mozga. Ovaj èlanak prikazuje problematiku vezanu uz štetne zdravstvene utjecaje uzrokovane korištenjem mobilnih telefona te komentira rezultate znaèajnijih studija iz tog podruèja.aWe live in a dense field of electromagnetic radiation today. It is estimated that this field is up to 200 times stronger than it was a 100 years ago. Power lines, radars, transmiters, electrical appliances, mobile phones, televisions, digital watches, CD/radio players, computers and wireless internet all produce electromagnetic fields, and the problem of electromagnetic “pollution” grows further with explosion of wireless technologies. These devices emit electromagnetic radiation that influences live organisms. When a mobile phone is used, it is held in a close proximity of head and a fraction of emited electromagnetic energy is absorbed by the user’s head. There is a concern that this electromagnetic radiation may cause brain tumors and other physiological disturbances. There is a growing number of new mobile phone users in the world making this concern a big publichealth issue. Many studies have tried to answer weather cell phone use causes brain tumors. This article examines the different aspects of mobile phone influence on genesis of brain tumors and comments the results of some of the important studies.elefo

Does mobile phone use cause brain tumors?

U današnje doba živimo u gustom moru polja elektromagnetskog zraèenja, za koje se procjenjuje da je 100 do 200 puta jaèe nego što je bilo prije sto godina. Dalekovodi, radari odašiljaèi, elektrièni vodovi, mobilni telefoni, televizori, digitalni satovi, CD/radioplejeri, raèunala i bežièni internet stvaraju elektromagnetska polja, a problem elektromagnetskog “zagaðenja” pogoršava upravo eksplozija bežiènih tehnologija. Tijekom rada, spomenuti ureðaji emitiraju elektromagnetsko zraèenje koje utjeèe na žive sustave. S obzirom na to da mobilne telefone za vrijeme razgovora prislanjamo na uho, dio njihovog zraèenja apsorbiraju tkiva glave, te postoji opravdana zabrinutost da njihovo korištenje utjeèe na razvoj tumora mozga i drugih fizioloških poremeæaja. U svijetu se progresivno poveæava broj korisnika i uèestalost korištenja mobilnih telefona, stoga je ovo pitanje od velikog javnozdravstvenog znaèaja. Mnogobrojne studije pokušale su ustanoviti utjeèe li korištenje mobilnih telefona na nastanak tumora mozga. Ovaj èlanak prikazuje problematiku vezanu uz štetne zdravstvene utjecaje uzrokovane korištenjem mobilnih telefona te komentira rezultate znaèajnijih studija iz tog podruèja.aWe live in a dense field of electromagnetic radiation today. It is estimated that this field is up to 200 times stronger than it was a 100 years ago. Power lines, radars, transmiters, electrical appliances, mobile phones, televisions, digital watches, CD/radio players, computers and wireless internet all produce electromagnetic fields, and the problem of electromagnetic “pollution” grows further with explosion of wireless technologies. These devices emit electromagnetic radiation that influences live organisms. When a mobile phone is used, it is held in a close proximity of head and a fraction of emited electromagnetic energy is absorbed by the user’s head. There is a concern that this electromagnetic radiation may cause brain tumors and other physiological disturbances. There is a growing number of new mobile phone users in the world making this concern a big publichealth issue. Many studies have tried to answer weather cell phone use causes brain tumors. This article examines the different aspects of mobile phone influence on genesis of brain tumors and comments the results of some of the important studies.elefo

Thoracic Intramedullary Sarcoidosis Mimicking an Intramedullary Tumor

Sarcoidosis is a chronic, systemic granulomatous reticulosis of unknown origin, characterized by formation of hard tubercles and noncaseating granulomas1. Since other infectious diseases such as berylliosis, mycobacterium and fungal infections may present with a noncaseating granulomas, histological diagnosis of sarcoidosis is made using the elimination method. Central nervous system manifestations of sarcoidosis may be present in 5–10% of the cases2–5 involving cranial nerves, leptomeninges and third ventricle respectively. Any part of the central nervous system can be affected. Involvement of spinal cord in sarcoidosis is extremely rare and presents with only 0.3–0.4% in patients with systemic sarcoidosis2. Intramedullary sarcoidosis is a rare first manifestation of the disease and it can mimic an intramedullary tumor, which is often manifested with symptoms that initiate from spinal cord compression, resulting in paraparesis, sensory disorders and sphincter dysfunction6–11. We present a case of intramedullary sarcoidosis that mimics a tumor of the thoracic spinal cord. Clinical features, neuroradiological, pathohistological findings, laboratory analysis and surgical treatment of such a rare entity are being discussed

Prednosti i nedostatci supraorbitalnog pristupa "ključanice" u liječenju intrakranijskih aneurizma

The fundamental tendency to be as minimally invasive as possible and to achieve a maximum of efficacy in the treatment of patients has existed since the beginning of surgery. In treating intracranial aneurysms the most widely used approach is pterional or frontotemporal approach described by Yasargil. The increasing knowledge of microsurgical anatomy, improved preoperative diagnostic techniques, and well adapted microsurgical instruments have led to the development of minimally invasive approaches. The supraorbital keyhole approach via an eyebrow incision is one of these minimally invasive procedures. Since it was first described by Perneczky it has raised debates on its advantages and disadvantages. The authors present their experience in using the supraorbital keyhole approach in treating intracranial aneurysms.Cilj ovoga istraživanja bila je procjena prednosti i nedostataka supraorbitalnog pristupa "ključanice" u neurokirurškom liječenju intrakranijskih aneurizmatskih tvorba. Supraorbitalni pristup "ključanice" predstavlja minimalno invazivni operacijski zahvat u liječenju intrakranijskih aneurizma. Od 2000. do 2003. godine 30 bolesnika s 30 intrakranijskih aneurizma operirano je supraorbitalnim pristupom "ključanice" na Klinici za neurokirurgiju, KB "Sestre milosrdnice". U većini slučajeva bolesnici su dobro podnijeli operacijski zahvat, a poslijeoperacijski oporavak je bio zadovoljavajući. Ukupni pobol iznosio je 16%, dok su zabilježena dva smrtna slučaja zbog komplikacija nevezanih za operacijski zahvat. Supraorbitalni pristup "ključanice" predstavlja razumnu opciju u neurokirurškom liječenju intrakranijskih aneurizma kod bolesnika pažljivo prijeoperacijski odabranih s obzirom na kliničku sliku, neurološki status i lokalizaciju aneurizmatske tvorbe

Prednosti i nedostatci supraorbitalnog pristupa "ključanice" u liječenju intrakranijskih aneurizma

The fundamental tendency to be as minimally invasive as possible and to achieve a maximum of efficacy in the treatment of patients has existed since the beginning of surgery. In treating intracranial aneurysms the most widely used approach is pterional or frontotemporal approach described by Yasargil. The increasing knowledge of microsurgical anatomy, improved preoperative diagnostic techniques, and well adapted microsurgical instruments have led to the development of minimally invasive approaches. The supraorbital keyhole approach via an eyebrow incision is one of these minimally invasive procedures. Since it was first described by Perneczky it has raised debates on its advantages and disadvantages. The authors present their experience in using the supraorbital keyhole approach in treating intracranial aneurysms.Cilj ovoga istraživanja bila je procjena prednosti i nedostataka supraorbitalnog pristupa "ključanice" u neurokirurškom liječenju intrakranijskih aneurizmatskih tvorba. Supraorbitalni pristup "ključanice" predstavlja minimalno invazivni operacijski zahvat u liječenju intrakranijskih aneurizma. Od 2000. do 2003. godine 30 bolesnika s 30 intrakranijskih aneurizma operirano je supraorbitalnim pristupom "ključanice" na Klinici za neurokirurgiju, KB "Sestre milosrdnice". U većini slučajeva bolesnici su dobro podnijeli operacijski zahvat, a poslijeoperacijski oporavak je bio zadovoljavajući. Ukupni pobol iznosio je 16%, dok su zabilježena dva smrtna slučaja zbog komplikacija nevezanih za operacijski zahvat. Supraorbitalni pristup "ključanice" predstavlja razumnu opciju u neurokirurškom liječenju intrakranijskih aneurizma kod bolesnika pažljivo prijeoperacijski odabranih s obzirom na kliničku sliku, neurološki status i lokalizaciju aneurizmatske tvorbe

Brain metastases from lung cancer show increased expression of DVL1, DVL3 and beta-catenin and down-regulation of E-cadherin

The susceptibility of brain to secondary formation from lung cancer primaries is a well-known phenomenon. In contrast, the molecular basis for invasion and metastasis to the brain is largely unknown. In the present study, 31 brain metastases that originated from primary lung carcinomas were analyzed regarding over expression of Dishevelled-1 (DVL1), Dishevelled-3 (DVL3), E-cadherin (CDH1) and beta-catenin (CTNNB1). Protein expressions and localizations were analyzed by immunohistochemistry. Genetic alterations of E-cadherin were tested by polymerase chain reaction (PCR)/loss of heterozygosity (LOH). Heteroduplex was used to investigate mutations in beta-catenin. DVL1 and DVL3 showed over expression in brain metastasis in 87.1% and 90.3% of samples respectively. Nuclear staining was observed in 54.8% of cases for DVL1 and 53.3% for DVL3. The main effector of the Wnt signaling, beta-catenin, was up-regulated in 56%, and transferred to the nucleus in 36% of metastases. When DVL1 and DVL3 were up-regulated the number of cases with nuclear beta-catenin significantly increased (p=0.0001). Down-regulation of E-cadherin was observed in 80% of samples. Genetic analysis showed 36% of samples with LOH of the CDH1. In comparison to other lung cancer pathologies, the diagnoses adenocarcinoma and small cell lung cancer (SCLC) were significantly associated to CDH1 LOH (p=0.001). Microsatellite instability was detected in one metastasis from adenocarcinoma. Exon 3 of beta-catenin was not targeted. Altered expression of Dishevelled-1, Dishevelled-3, E-cadherin and beta-catenin were present in brain metastases which indicates that Wnt signaling is important and may contribute to better understanding of genetic profile conditioning lung cancer metastasis to the brain

Velika aneurizma vrška bazilarne arterije predstavljena kao mezencefalični tumor i uzrok jednostranog opstrukcijskog hidrocefalusa: prikaz slučaja i tehnička napomena

Cerebral ventricular system is a sporadic location of intracranial aneurysms including those of basilar artery tip. Treatment of such aneurysms remains challenging regardless of endovascular or microsurgical techniques applied. Basilar tip aneurysm presenting as third ventricular mass is rarely associated with obstructive hydrocephalus, mimicking midbrain expansive process and urging precise diagnostics and prompt treatment. Hence, the management of such patients may be delicate, having an uncertain outcome. We report on a case of a patient with unilateral hydrocephalus caused by large basilar tip aneurysm mimicking a midbrain tumor. We also discuss different operative strategies influencing the outcome, including our own endovascular treatment technical modification. A 62-year-old female patient presented with slightly decreased cognition, minor gait disturbances and urinary incontinence. Computed brain tomography revealed a third ventricle mass with unilateral ventricular dilatation, indicating hypertensive obstructive hydrocephalus. Magnetic resonance and digital subtraction angiography identified the third ventricular mass as a large saccular basilar tip aneurysm. The patient was selected for endovascular treatment followed by cerebrospinal fluid derivation. After aneurysm endovascular occlusion and temporary external ventricular drainage, the symptoms diminished and ventricular dilatation decreased. On post-procedure day 10, the hydrocephalus was relieved and external drainage removed. The patient recovered fully and was discharged without neurological deficit. In conclusion, large basilar tip aneurysms associated with obstructive hydrocephalus are rare and best treated by a combination of endovascular obliteration and cerebrospinal fluid ventricular diversion. The possibility of such an aneurysm should always be considered on the differential diagnosis of cerebral ventricular growths.Intrakranijske su aneurizme smještene unutar ventrikulskog sustava rijetke, uključujući one vrška bazilarne arterije. Njihovo je liječenje izrazito zahtjevno, neovisno o primijenjenoj endovaskularnoj ili mikrokirurškoj tehnici. Aneurizme bazilarnoga vrška koje se očituju kao ventrikulska ekspanzivna tvorba u području mezencefalona rijetko su povezane s razvitkom opstrukcijskoga hidrocefalusa, što zahtijeva preciznu dijagnostiku i žurno aktivno liječenje. Postupak je liječenja u ovakvih bolesnika iznimno složen, a ishod neizvjestan. U ovom radu opisujemo slučaj bolesnice s jednostranim hidrocefalusom uzrokovanim velikom aneurizmom bazilarnoga vrška, koja se diferencijalno dijagnostički očitovala kao mezencefalični tumor. Također raspravljamo o različitim mogućnostima operacijskog liječenja od utjecaja na ishod, uključujući i vlastitu tehničku modifikaciju endovaskularnog zahvata. Bolesnica u dobi od 62 godine zaprimljena je zbog blago sniženih kognitivnih sposobnosti, manjeg poremećaja u hodu i urinarne inkontinencije. Kompjutorska tomografija mozga upućivala je na ekspanzivnu tvorbu područja treće klijetke s jednostranim proširenjem postranične klijetke i posljedičnim hipertenzivnim hidrocefalusom. Magnetna rezonancija i digitalna suptrakcijska angiografija razotkrile su ekspanzivnu tvorbu kao veliku sakularnu aneurizmu bazilarnoga vrška. Bolesnica je podvrgnuta endovaskularnom liječenju sa susljednom derivacijom cerebrospinalnoga likvora. Simptomi i proširenje postranične klijetke su se umanjili nakon učinjene endovaskularne okluzije i privremene izvanjske ventrikulske drenaže. Desetog dana od operacije hidrocefalus se u cijelosti povukao pa je izvanjska drenaža uklonjena. Bolesnica se je u potpunosti oporavila te je otpuštena bez neurološkog ispada. Zaključujemo kako su aneurizme bazilarnoga vrška udružene s opstrukcijskim hidrocefalusom rijetke i kako ih je najpovoljnije liječiti kombinacijom endovaskularnog postupka i likvorske ventrikulske derivacije. Na mogućnost nastanka ovakve aneurizme treba uvijek pomisliti u diferencijalnoj dijagnostici cerebralnih ventrikulskih tvorba