Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis [ISRCTN31053647]

Background: The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis

Is skull fracture necessary for developing an intradiploic pseudomeningocele as a complication of head injury in adulthood?

We report the case of an adult with a posttraumatic intradiploic pseudomeningocele which caused an expanded osteolytic skull lesion. Local pain and swelling, the only symptoms of the lesion, regressed after surgery. Intradiploic pseudomeningocele must be distinguished from intradiploic leptomeningeal cyst, which is of traumatic origin or arachnoid cyst and epidermoid cyst, which are of congenital origin. We also discuss the development of intradiploic pseudomeningoceleafter head trauma without skull fracture in adulthood and suggest a possible mechanism

Intradural lumbar disc herniation: report of two cases

Intradural lumbar disc herniation (ILDH) is a rare pathology. The pathogenesis of ILDH is not known with certainty. Adhesions between the ventral wall of the dura and the posterior longitudinal ligament (PLL) could act as a preconditioning factor. Diagnosis of ILDH is difficult and seldom suspected preoperatively. Prompt surgery is necessary because the neurologic prognosis appears to be closely linked to preoperative duration of neurologic symptoms. Despite preoperatively significant neurological deficits, the prognosis following surgery is good. We report on two new cases of ILDH of high lumbar locations L1-2 and L2-3 with difficult differential diagnoses, and the possible pathogenic factors are discussed

Growing skull fracture of the orbital roof - Case report

Growing skull fractures are rare complications of head trauma and very rarely arise in the skull base. The clinical and radiological finding and treatment of a growing fracture of the orbital roof in a 5-year-old boy are reported, and the relevant literature is reviewed. The clinical picture was eyelid swelling. Computed tomography (CT) scan was excellent for demonstrating the bony defect in the orbital roof. Frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing skull fracture of the orbital roof should be considered in the differential diagnosis in cases of persistent ocular symptoms. Craniotomy with excision of gliotic brain and granulation tissue, dural repair and cranioplasty is the treatment of choice

Growing skull fracture of the orbital roof - Report of two cases and review of the literature

In this report, the authors describe two cases of growing fracture of the orbital roof. The aim is to draw attention to this rare complication and discuss the role of three-dimensional computed tomography in radiological findings and surgical planning. Relevant literature is also reviewed

Anterior cervical foraminotomy for unilateral spondylotic radiculopathy

Anterior cervical foraminotomy (ACF) was developed under the concept of functional spine surgery, which directly eliminates compressive pathological factors while preserving functional anatomic features. The authors reviewed their results to determine the efficacy of the approach for unilateral cervical spondylotic radiculopathy (CSR). Nineteen patients were treated with the ACF with a follow-up from 12 to 36 months. There were 10 men and 9 women (mean age 49.8). Fourteen patients had a single ACE and 5 had procedures at adjacent levels. The procedure involves microsurgical removal of the lateral portion of the uncinate process to identify the nerve root. Seventeen patients (89.5%) were symptom-free or clearly improved, one (5.3%) was unchanged and one patient (5.3%) was worse in the visual analogue scale (VAS) score for radicular pain. One patient had developed contralateral foraminal stenosis at the level of the surgery and had undergone anterior discectomy and fusion. ACF provided good or excellent outcomes, with minimal morbidities, for patients with CSR. The advantages of ACF include direct decompression of the nerve root, and the preservation of the intervertebral disc and the motion segment. Thus, fusion-related sequelae, including graft-related complications, graft site complications and the adjacent level disease are avoided. The ACF procedure appears to be a good alternative for carefully selected patients with unilateral CSR

Postoperative intraradicular lumbar disc herniation: A case report

An unusual case is presented in which a fragment of herniated lumbar disc was found within the sheath of the right S-1 nerve root. Diagnosis of intradural and intraradicular lumbar disc herniation is difficult, so that it is rarely suspected preoperatively. Surgical treatment results in a satisfactory clinical outcome

Clivus fractures: clinical presentations and courses

Fractures in the clivus region are usually associated with blunt head trauma. They may cause many cranial nerve deficits and vascular complications. The mortality rate is high because of brainstem trauma or vertebrobasilar occlusion. The diagnosis of clivus fracture (CF) is difficult with routine cranial radiography due to the presence of dense petrous temporal bones. Because of this, few cases have been described in the past. In this study, we report nine cases of CF observed and treated in our department during the last 5 years. Computed tomographic (CT) scanning revealed CF in nine of 2500 patients with head trauma (0.36%). The patients ranged in age from 17 to 68 years (mean 38.3). Five patients had had motor vehicle accidents, three were injured in falls, and one was a pedestrian injured by a motor vehicle. Five patients had longitudinal fractures and four had transverse fractures. Cranial nerve deficits were recorded in all patients. Deficits of cranial nerves VI and VII were the most frequently observed (six patients, 66.6%). We review the literature to highlight the differences in clinical presentation and the course in cranial nerve deficits. The diagnosis of CF is made by high-resolution, fine-cut CT using standard and bone window settings. Its presence should alert clinicians to the potential complications

Extradural hematoma of the posterior cranial fossa

Fourteen cases of an extradural hematoma of the posterior fossa (EDHPF), are presented and the clinical and radiological findings are described. The onset of symptoms was acute in 10 patients and subacute in the other 4. Hematomas occurred in the younger age groups with a clear male predominance. Nine cases had suffered a blow to the head. A fracture of the occipital bone was seen in 86 % of the patients. The bleeder could be identified in 10 cases, and in 6 of these the source was a bleeding transverse sinus. The overall mortality was 14.2 %, but only patients with an acute course died (20 %). All subacute cases survived. This study revealed that the most important factors influencing mortality were late diagnosis and late treatment. Coexisting intracranial lesions had no influence on mortality According to the literature, there has been a certain decrease in mortality in the acute and subacute course patients since the introduction of computed tomography (CT) scanning. Emphasis is placed on the importance of occipital soft-tissue swelling and occipital fracture as clues to the possible presence of extradural hematomas, and of using the CT in all such patients even if no clinical symptoms are present