"Benign" shaken baby syndrome: case report

The authors report an infant with clinical and neuroimaging findings of shaken baby syndrome. The pitfalls encountered in the assessment on the cause of the bilateral frontal and interhemispheric subdural hematomas in this child are also briefly discussed. We have called this condition "benign" shaken baby syndrome and emphasize that not always acute subdural hematomas are of non-accidental nature

Regression of syringomyelia and tonsillar herniation after posterior fossa arachnoid cyst excision: case report and literature review

Antecedentes. Algunos trabajos han descrito la existencia de quistes aracnoideos de fosa posterior que producían siringomielia al obstruir la circulación de liquido cefalorraquídeo (LCR) por bloqueo del agujero magno ocasionado por el propio quiste. Rara vez la siringomielia asociada a quiste aracnoideo de fosa posterior es producida por malformación de Chiari adquirida. Objetivos. Publicar el caso de un hombre de 38 años con hidrocefalia y siringomielia, en el que se encontró descenso de las amígdalas cerebelosas por la presión ejercida por un quiste aracnoideo retrocerebeloso. Tras tratar primero la hidrocefalia mediante ventriculostomía neuroendoscópica, el paciente fue operado de descompresión del agujero magno y extirpación de las membranas del quiste que condujeron a la resolución tanto del Chiari como de la siringomielia. Discusión. En la mayoría de los casos publicados la siringomielia se debía a la obstrucción de LCR en el agujero magno ocasionada por el propio quiste aracnoideo. Hemos encontrado solamente un caso previo en el que el quiste de fosa posterior era causante del descenso de las amígdalas cerebelosas y éste, a su vez, producía la siringomielia. Conclusiones. Los quistes aracnoideos de fosa posterior pueden producir descenso de las amígdalas y siringomielia. En nuestra opinión, el manejo de estos pacientes debe de encaminarse no sólo a descomprimir el agujero magno, sino también a comunicar las paredes del quiste ya que éste parece ser el principal responsable del complejo cuadro de siringomielia en estos casos

Sporadic intracranial haemangioblastomas: surgical outcome in a single institution series

International audienceBACKGROUND: Haemangioblastomas are benign vascular tumours that may appear sporadically or in von Hippel-Lindau disease. Despite their higher incidence, sporadic haemangioblastomas have been less studied than syndromic ones. In this article, we evaluate the specific features, outcome and quality of life of patients with intracranial sporadic haemangioblastomas (ISHs) operated on in our institution. METHODS: Between 1998 and 2010, 38 patients harbouring 38 ISHs were operated on in our department. Their clinical, biological, radiological and surgical features were retrospectively reviewed. All patients were contacted for a quality-of-life (QOL) survey assessed by the Short Form 36 questionnaire (SF36). The mean duration of follow-up was 40 months (13-108 months). RESULTS: ISH represented 0.9 % of primary intracranial neoplasms treated in our centre during this period. Patients comprised 23 men and 15 women with a mean age of 47 years. None had polycythaemia. Cerebellar locations accounted for 79 % of ISHs, and brainstem ISH with involvement of the floor of the fourth ventricle represented 11 % of ISHs. At last follow-up, two patients harbouring solid medulla oblongata haemangioblastoma had died following severe bulbar syndrome and five patients had died of unrelated causes. One patient had multiple surgeries for three recurrences. Tumoral control was achieved in all cases at last follow-up. Results of the SF-36 questionnaire were as follows: median physical functioning score 100 (range 0-100), median physical problems score 100 (range 0-100), median bodily pain score 100 (range 45-100), median social functioning score 100 (range 25-100), median general mental health score 84 (range 40-92), median emotional problems score 100 (range 0-100), median vitality score 70 (range 35-80) and median general health perceptions score 70 (range 35-100). Mean QOL scores were similar to the general healthy population. CONCLUSION: Surgery of ISH provides good QOL and tumoral control except for those located in the medulla oblongata. We recommend considering a careful multimodal therapeutic approach, including radiosurgery for these specific locations

Käytännön kosteikkosuunnittelu

Maatalouden vesiensuojelua edistetään monin tavoin. Ravinteita ja eroosioainesta sisältäviä valumavesiä pyritään puhdistamaan erilaisissa kosteikoissa. Tämä opas on kirjoitettu avuksi pienimuotoisten kosteikkojen perustamiseen. Oppaassa esitetään käytännönläheisesti kosteikon toteuttamisen eri vaiheet paikan valinnasta suunnitteluun ja rakentamiseen. Vuonna 2010 julkaistun painoksen tiedot on saatettu ajantasalle. Julkaisu on toteutettu osana Tehoa maatalouden vesiensuojeluun (TEHO) -hanketta ja päivitetty TEHO Plus -hankkeen toimesta. Oppaan toivotaan lisäävän kiinnostusta kosteikkojen suunnitteluun ja edelleen niiden rakentamiseen

Imaging of trigeminal neuralgia

Trigeminal neuralgia is one of the most frequent neuropathy of the cranial nerves, whose prevalence has been reported between 0.03% and 0.3% in the general population. This condition is a communal manifestation of several possible etiologies. The classical type of trigeminal neuralgia is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, with no cause other than a neurovascular compression. Secondary trigeminal neuralgia is the term used to group a large amount of different diseases, which are alike in developing the symptoms of trigeminal neuralgia, due to an insult to the V CN which triggers the complex pathogenesis of pain. These conditions include inflammatory diseases, infections, neoplasms, autoimmune diseases, vascular diseases other than neurovascular conflict, and treatment-related disorders. Generally, the possible mechanisms which lead to the development of neuralgia include nerve distortion/compression by an external mass or damage to the nerve fibers due to an acute or chronic insult. The radiological investigation plays a pivotal role in the diagnosis of trigeminal neuralgia, and MRI constitutes the gold imaging standard in most cases. The trigeminal nerve is a mixed sensory-motor nerve which can be divided anatomically into five segments: brainstem segment, cisternal segment, Meckel’s cave segment, cavernous sinus segment, and extracranial segment. In this paragraph, an anatomy-based imaging approach is proposed to investigate the many causes of trigeminal neuralgia, highlighting the importance of choosing the appropriate sequences and parameters, in the light of a target-suited protocol