Spontaneous cerebellar hemorrhage in children and adolescents

Spontaneous cerebellar hemorrhage is infrequently reported in children, although this disorder account for roughly 10% of nontraumatic intracranial hemorrhages in adults. We studied three cases that demonstrated the clinical features, radiological findings, pathological features, and outcome in this condition. A review of the literature uncovered 21 additional cases. The most commonly encountered cause of hemorrhage found in 62% of the cases was a vascular abnormality. Of the 24 patients, 15 underwent surgery and 14 of these survived. No patient survived without surgery. Computerized tomography has increased the diagnostic yield while decreasing diagnostic morbidity, and early surgical intervention provided dramatic improvement in many patients. The diagnosis of spontaneous cerebellar hemorrhage must always be considered in the examination of a patient with symptoms and signs suggesting an acute onset of a posterior fossa mass lesion.     

Delayed onset of hand tremor related to cerebellar hemorrhage

Spontaneous hematomas are rare and can present with acute or chronic symptoms. Our patient presented with deep vein thrombosis of the lower extremity associated with a spontaneous pelvic hematoma. This lesion was radiologically and clinically indistinguishable from a soft-tissue neoplasm. The case of a spontaneous pelvic neoplasm in an otherwise healthy young man is presented and the literature reviewed regarding issues of differential diagnosis and clinical management.     

Usefulness of aspiration surgery for elderly patients with hypertensive cerebellar hemorrhage

Synthesis of 1-[11C]methylpiperidin-4-yl propionate ([11C]PMP), an in vivo substrate for acetylcholinesterase, is reported. An improved preparation of 4-piperidinyl propionate (PHP), the immediate precursor for radiolabeling, was accomplished in three steps from 4-hydroxypiperidine by (a) protection of the amine as the benzyl carbamate, (b) acylation with propionyl chloride, and (c) deprotection of the carbamate by catalytic hydrogenation. The final product was obtained in an overall 82% yield. Reaction of the free base form of PHP with [11C]methyl trifluoromethanesulfonate at room temperature in N,N-dimethylformamide, followed by high performance liquid chromatography (HPLC) purification, provided [11C]PMP in 57% radiochemical yield, > 99% radiochemical purity, and > 1500 Ci/mmol at the end of synthesis. The total synthesis time from end-of-bombardment was 35 min. [11C]PMP can thus be reliably prepared for routine clinical studies of acetylcholinesterase in human brain using positron emission tomography.     

减重步行训练对小脑出血患者步行功能的影响

目的:探讨减重步行训练在小脑出血患者步行功能康复方面的影响.方法:随机选择10例小脑出血患者在康复过程中使用减重步行训练系统(BWSTT)进行步行功能训练,定期进行Fugl-Meyer下肢运动功能评分,Barthel指数评分及10m步行时间评定,并且同时随机选择另外10例小脑出血患者,经传统康复训练后的以上三组数据分别进行对比分析.结果:减重步行训练6周和传统步态训练6周后患者在步行参数、平衡功能及生活自理评定方面具有统计学意义(P＜0.05).两种康复训练方法比较,减重步行训练组比较下肢功能评分及其它二项指数均大于传统步态训练组(P＜0.05),差异有统计学意义(P<0.05).结论:减重步行训练对于小脑出血患者在恢复步行能力、纠正步态、改善平衡、减轻肌肉痉挛及改善心肺功能方面较传统康复训练有较大优势.     

Paraneoplastic cerebellar degeneration

Paraneoplastic cerebellar degeneration (PCD) is a rare manifestation of cancer, characterized clinically by subacute progressive ataxia, dysarthria and nystagmus. The pathological hallmark of PCD is a severe, diffuse loss of Purkinje cells. PCD occurs most frequently in association with small cell carcinoma of the lung and adenocarcinoma of the ovary, but it has also developed in patients with carcinoma of the breast, malignant lymphoma, and various cancers. Autoantibodies against cerebellar Purkinje cells have been frequently observed in the serum or cerebrospinal fluid (CSF) from patients with PCD. The cause of PCD is unknown, but the presence of these autoantibodies in some patients suggests that the pathogenesis may be immune mediated. The potential role of the autoantibody in the pathogenesis of PCD is discussed.     

Tuberculous cerebellar abscess

We report uncultured rod-shaped magnetotactic bacteria from natural waters that biomineralize magnetic crystals in two different size ranges. Electron spectroscopic imaging of whole bacteria deposited over formvar-coated grids permitted a better visualization and measurement of the magnetosomes. All magnetosomes of individual bacteria could be observed by this technique. The magnetosomes formed one large chain, composed of three to four columns of crystals, disposed in parallel to the main axis of the bacteria. The magnetosomes ranged from 19 to 136 nm in length and 14 to 112 nm width. Smaller magnetosomes (less than 80 nm in length) localized mostly in extremities of the bacterial body while larger preferentially localized in the middle part of the cell. Electron spectroscopic diffraction and X-ray microanalysis indicate that both types of magnetosomes contain magnetite (Fe3O4). In projection, most magnetosomes seem to present pseudo-hexagonal morphologies described for magnetite. As the aspect ratios for smaller and larger magnetosomes are different, we suggest that different levels of control on biomineralization of magnetosomes may exist.     

Unilateral cerebellar aplasia

Thirty physicians who immigrated together from South America to Israel were followed during their first two years in Israel. Success in the medical requalifying examination and finding work as physicians correlated directly with permanency in Israel, and, inversely, returning to country of origin was associated with being unqualified and unemployed. Age, sex, marital status, religion and previous professional status were not associated with permanency in Israel.     

Rhombencephalosynapsis: cerebellar embryogenesis

We describe two infants in whom rhombencephalosynapsis was diagnosed with MR imaging in vivo. In contrast to Dandy-Walker malformation, the vermian maldevelopment in this anomaly is characterized by an absence of the anterior vermis and a deficiency of the posterior vermis. The cerebellar hemispheres are fused. In an attempt to identify the pathogenesis of these anatomic manifestations, we question the traditional concept of the embryologic development of the cerebellar primordium.     

Spinal intradural cerebellar ectopia

We present a case of multilocular cystic nephroma with an unusual localization treated by a nephron-sparing procedure. A 21-year-old white woman presented with a history of hematuria and right lumbar pain. Imaging techniques revealed a multilocular cystic mass originating from the renal parenchyma but mainly involving the renal pelvis. The lesion was localized almost entirely within the renal pelvis at surgery and was treated by excision. Pathologic analysis was consistent with multilocular cystic nephroma. The patient remains free of recurrence with 10 years of follow-up. We conclude that multilocular cystic nephroma may present as a cystic lesion localized within the renal pelvis, and we advocate simple excision of these lesions.     

Hypertensive crisis and nursing counseling

A hypertensive crisis is a serious complication that can happen to all patients with a history of hypertension. Unfortunately, it is a process that has not been much studied in the area of primary care. This study, using a sample of 700 hypertensive patients over a six year period, has the objective of trying to establish the incidence of crisis annually, the period of the most frequent attacks, and the effects the nursing consultations had upon these parameters. Nursing interventions included preventative methods such as trying to reduce the time between episodes by reinforcing good health habits through educational methods.     

Hypertensive derailment in marital crisis

A 34-year-old man was admitted because of headache with neck pain, hypertension and tachycardia. The symptoms started 10 days prior to presentation. In the past the patient was treated because of different vegetative symptoms, which were interpreted in relation to excessive private problems. Despite suggestive clinical presentation, the diagnosis phaeochromocytoma was confirmed late. Following removal of the tumor, blood pressure came into the normal range. The operation also abolished all vegetative symptoms and lead to stabilisation of the psychosocial situation.     

Perceptual timing in cerebellar degeneration

This study examined time perception in 12 patients with cerebellar degeneration (CD) and in 13 normal controls (NC). We used a time bisection procedure with four interval conditions (100-900 msec; 8-32 sec; 100-600 msec; 100-325 msec). Each subject's bisection point, discrimination ability (the Weber ratio) and precision (the inverse of the proportion of unexplained variance) was calculated for each condition. CD patients' performance on the 100-900 msec time bisection condition suggested a possible time discrimination deficit, which was confirmed with intervals in the range of 100-600 msec. Time discrimination was normal on the 100-325 msec condition and impaired on the 8-32 sec bisection task. However, when discriminating long intervals, CD patients also showed a precision deficit, which points to impaired sustained attention and/or decision processes. Our findings corroborate the view that cerebellar timing processes are not limited to the motor system but are also used in perceptual computations.     

Transient "cerebellar" mutism

The term "cerebellar mutism" refers to a specific disorder in which a complete but transient loss of speech, followed by dysarthria, occurs following resection of intrinsic posterior cranial fossa tumors or cerebellar hemorrhages, or upon trauma. Although it is well known that the lack of long-tract findings and cranial nerve (CN) involvement is the rule, the pathophysiology of cerebellar mutism has not been clearly elucidated. A review of the relevant literature disclosed 93 patients with this condition, the majority of these being in the pediatric age group. The neuropathological findings were as follows: 57 primitive neuroectodermal tumors (PNET), 19 astrocytomas, 10 ependymomas, 5 vascular malformations, 1 metastatic tumor, and 1 traumatic injury. The interval before the onset of mutism ranged from 0 to 168 h (mean 40.9 h). The mutism lasted from 1 to 168 days (mean 37.6 days). Subsequent dysarthria was present in 75 (80%) of the 93 patients. In this article, some specific recent illustrative reports are presented, and the concept of the role of the cerebellum in language and cognition is discussed. With these data as our point of departure, various hypotheses that have been advanced to explain the pathogenesis of this transient speech disorder are analyzed. The findings of the study suggest that the cause of the cerebellar mutism is the ischemia caused by vasospasm, as it usually developed after a latent period.     

Positional vertigo with cerebellar astrocytoma

The autopsy finding on an infant with severe combined immunodeficiency was marked thymic mast cell hyperplasia. The clinical immune status showed a deficit in T (thymus derived) lymphocytes and low immunoglobulin levels. The autopsy showed the histologic pattern designated thymic alymphoplasia and a marked lack of development of the reticuloendothelial organs. The mast cell hyperplasia may be the result of an antigenic stimulus early in embryonic life and/or the result of mast cell differentiation at the expense of normal thymic lymphoid development caused by a genetic defect.