Cerebellopontine epidermoid presenting with trigeminal neuralgia for 10 years: a case report

Trigeminal neuralgia, also called tic douloureux, is a common and potentially disabling pain syndrome, which affects the trigeminal or fifth cranial nerve. The precise pathophysiology of Trigeminal neuralgia remains obscure. The disorder causes extreme, sporadic, sudden burning or shock-like face pain that lasts from few seconds to minutes and can be physically and mentally incapacitating. More than one nerve branch can be affected by the disorder. A 55-year-old female presented with pain over the left side of face for 10 years uncontrolled with carbamazepine. On examination the positive findings were reduced sensation by 25% over the left side of face with House and Brackman grade II facial nerve palsy. The corneal reflex was absent on left side. Magnetic resonance imaging showed left cerebellopontine angle (CPA) mass suggestive of an epidermoid involving the Vth nerve and Gasserian ganglion and extending into the middle cranial fossa. She underwent left suboccipital craniectomy and near total excision of the tumor with decompression of the Vth nerve which was fully engulfed by the tumor. Postoperative the VII nerve palsy increased to grade III and she had 50% loss of sensation over left side. She had no further attacks of pain and hence tapered off the carbamazepine. TN caused by cerebellopontine angle epidermoids is uncommon and should be kept in view in all cases presenting with TN. The aim of surgery for epidermoids is to decompress the cranial nerves and brain stem and not total removal with its attendant morbidity and mortality

On type Ia supernovae and the formation of single low-mass white dwarfs

There is still considerable debate over the progenitors of type Ia supernovae (SNe Ia). Likewise, it is not agreed how single white dwarfs with masses less than ~0.5 Msun can be formed in the field, even though they are known to exist. We consider whether single low-mass white dwarfs (LMWDs) could have been formed in binary systems where their companions have exploded as a SN Ia. In this model, the observed single LMWDs are the remnants of giant-branch donor stars whose envelopes have been stripped off by the supernova explosion. We investigate the likely remnants of SNe Ia, including the effects of the explosion on the envelope of the donor star. We also use evolutionary arguments to examine alternative formation channels for single LMWDs. In addition, we calculate the expected kinematics of the potential remnants of SNe Ia. SN Ia in systems with giant-branch donor stars can naturally explain the production of single LMWDs. It seems difficult for any other formation mechanism to account for the observations, especially for those single LMWDs with masses less than ~0.4 Msun. Independent of those results, we find that the kinematics of one potentially useful population containing single LMWDs is consistent with our model. Studying remnant white-dwarf kinematics seems to be a promising way to investigate SN Ia progenitors. The existence of single LMWDs appears to constitute evidence for the production of SNe Ia in binary systems with a red-giant donor star. Other single white dwarfs with higher space velocities support a second, probably dominant, population of SN Ia progenitors which contained main-sequence or subgiant donor stars at the time of explosion. The runaway stars LP400-22 and US 708 suggest the possibility of a third formation channnel for some SNe Ia in systems where the donor stars are hot subdwarfs.Comment: Accepted for publication in Astronomy & Astrophysic

Suprasellar cysts: clinical presentation, surgical indications, and optimal surgical treatment

<p>Abstract</p> <p>Background</p> <p>To describe the clinical presentation of suprasellar cysts (SSCs) and surgical indications, and compare the treatment methods of endoscopic ventriculocystostomy (VC) and ventriculocystocisternotomy (VCC).</p> <p>Methods</p> <p>We retrospectively reviewed the records of 73 consecutive patients with SSC who were treated between June 2002 and September 2009. Twenty-two patients were treated with VC and 51 with VCC. Outcome was assessed by clinical examination and magnetic resonance imaging.</p> <p>Results</p> <p>The patients were divided into five groups based on age at presentation: age less than 1 year (n = 6), 1-5 years (n = 36), 6-10 years (n = 15), 11-20 years (n = 11), and 21-53 years (n = 5). The main clinical presentations were macrocrania (100%), motor deficits (50%), and gaze disturbance (33.3%) in the age less than 1 year group; macrocrania (75%), motor deficits (63.9%), and gaze disturbance (27.8%) in the 1-5 years group; macrocrania (46.7%), symptoms of raised intracranial pressure (ICP) (40.0%), endocrine dysfunction (40%), and seizures (33.3%) in the 6-10 years group; symptoms of raised ICP (54.5%), endocrine dysfunction (54.5%), and reduced visual field or acuity (36.4%) in the 11-20 years group; and symptoms of raised ICP (80.0%) and reduced visual field or acuity (40.0%) in the 21-53 years group. The overall success rate of endoscopic fenestration was 90.4%. A Kaplan-Meier curve for long-term efficacy of the two treatment modalities showed better results for VCC than for VC (p = 0.008).</p> <p>Conclusions</p> <p>Different age groups with SSCs have different main clinical presentations. VCC appears to be more efficacious than VC.</p

Structural analysis of the factors pertaining to attitudes toward and consciousness of organ donation : Comparison between Japanese and Americans

The purpose of this study is to analyze the background factors relating to opinions on organ donation through factorial and structural comparisons between Japanese and Americans. The data were obtained from responses to a questionnaire (371 Japanese and 41 Americans). The main findings are as follows: 1. Most of the factors, ‘a will for organ donation depending on a recipient’, ‘view of remains’, ‘understanding of brain death’ and so on showed significant differences between Japanese and Americans. 2. Japanese had a better understanding of brain death. On the other hand, the ratio of Americans who were willing to donate an organ was higher than that of Japanese. 3. It was revealed that “the approval of organ donation for the third person, not only for one's family” had an impact for having donor card showing the approval for organ donation. Furthermore, as underlying factors generating differences on organ transplant opinions, differences were found among Japanese between “approval of organ transplant” and the attitude assuming that oneself or a member of one's family was the person concerned with organ transplantation. There were also differences between Japanese and Americans on ideas about a view for life and death such as soul existence or view of remains. The argument for transplantation in Japan should consider these structural differences