The use of the term "meningeal meningiomatosis" for this condition is deprecated. So called arachnoidal sarcoma of the cerebellum. Its histogenesis and clinical comparison with classical medulloblastoma Japanese.
Three cases of cerebellar tumor named 'arachnoidal sarcoma of the cerebellum' or 'desmoplastic medulloblastoma' are reported. Histologically, this tumor was characterized by islands of cells surrounded by and delineated from the rest of the tumor cells.
In the island, there were no reticulin fibers, while the tumor tissue surrounding the islands demonstrated an elaborate network of reticulin fibers.
The tumor cells in the island were essentially identical with the cells of classical medulloblastoma by light as well as electron microscopy.
By electron microscopy it was seen that each group of the tumor cells was encircled and separated from the connective tissue element by a basement membrane.
These findings indicate that tumor called 'arachnoidal sarcoma of the cerebellum' or 'desmoplastic medulloblastoma' is of neuroectodermal origin.
This tumor is discussed from the clinical standpoint and compared with classical medulloblastoma. The authors did not find any difference between this tumor and the classical medulloblastoma in age distribution, location, tendency to encapsulation and in consistency.
The prognosis of both tumors is thought to be better in adults than children, and desmoplastic medulloblastoma seems to have a slightly more favorable prognosis than the classical medulloblastoma.
Die Behandlung der sackförmigen intrakraniellen Aneurysmen. Selbst die Entwicklung der cerebralen Angiographie, welche die genaue Diagnose dieser Erkrankung erst möglich machte, konnte die operative Behandlung zunächst nur wenig beeinflussen bzw.
Tönnis erfolgreich betrieben wurde, die Operation eines sackförmigen Aneurysmas als selten durchgeführtes Wagnis mit meist ungünstigem Ausgang für den Patienten.
Manche Stimmen Küttner hielten eine derartige operative Behandlung des sackförmigen Aneurysmas kaum jemals für möglich. Wenigen Beobachtungen über erfolgreich operierte Fälle stand die Skepsis der meisten Neurochirurgen gegenüber, auch die sackförmigen Aneurysmen zum Gegenstand der neurochirurgischen Behandlung werden zu lassen Dandy.
Diagnosis and management of Subarachnoid hemorrhage. Generally, the condition is treated under the heading of "spontaneous subarachnoid hemorrhage" and is defined as bleeding into the subarachnoid space due to causes other than trauma.
Subarachnoid hemorrhage is a symptom, and not a disease entity. It is due to the presence of blood in the subarachnoid space.
It results from blood escaping from pial vessels, from ruptured intracranial aneurysm, from massive cerebral hemorrhage that extended to the subarachnoid space, from ventricular hemorrhage and from vascular cerebral.
Jan Eur Neurol. The medulloblastoma and the so-called " arachnoidal cerebellar sarcoma": Rezidivierende Subarachnoidalblutung über 10 Jahre infolge eines Spongioblastoms.
Es wird über eine insgesamt 11mal rezidivierende Subarachnoidalblutung im Verlauf von 10 Jahren bei einem Patienten berichtet, bei dem sich während dieser Zeit diagnostisch keine Ursache der Subarachnoidalblutung fand.
Summary A patient is reported who had eleven recurrences of subarachnoid bleeding in the course of ten years during which entire period no cause was found on investigation for the subarachnoid bleeding.
At the autopsy a very vascular spongioblastoma about the size of a cherry was demonstrated, with a small cyst extending into the white matter of the left hemisphere.
The histological picture was of a spongioblastoma with a central angiomatous mass of convoluted vessels. Diagnosis and Management of Subarachnoid Hemorrhage.
This chapter discusses the clinical aspects of subarachnoid hemorrhage SAH. The clinical hallmark of SAH is a history of sudden, unusually severe headache.
A period of unresponsiveness longer than one hour occurs in almost half the patients, and focal signs develop at the same time of the headache or soon afterward in one-third of patients.
In patients in whom headache is the only symptom, it may be difficult to recognize the seriousness of the underlying condition.
Another problem is that in the group of patients whose headache came on within a split second, innocuous forms of headache outnumber subarachnoid hemorrhage by 10 to 1.
The chapter discusses epidemiological aspects for aneurismal subarachnoid hemorrhage, causes of subarachnoid hemorrhage, nonaneurysmal perimesencephahc hemorrhage, and others.
The discussion on practical management includes early rebleeding, prevention of rebleeding, prevention of secondary cerebral ischemia, intracerebral hematoma, and others.
Über ein umschriebenes Arachnoidealsarkom des Kleinhirns. B, lipos omalem N ysta tin, hyperbarer Sau-. Therapie in K omb ination mit häma topoe-.
Überlebe ns wahrscheinlichkeit erzielen. Pa tienten mit rhino zerebralen Z ygom y-. Die medikamen töse Therapie.
Med Lett Drugs Ther. An year-old woman with. N Engl J Med Bullock J, Warwar R Three patients with. Laryngol O t ol Rhinol Bord South Med J W eekly clinicopathological exer-.
A year-old woman with multi-. Successful treatment of rhinocer ebral zygomycosis. Br J Haematol W ar war R, Bullock J Rhino-orbital-cerebral mu-.
Die niedr ige Überlebenswahrschein-. Pa tienten eine Z ygo myk ose a uszuschlie-. D ie U rsache jeder letal verlau-. F azit für die Praxis. Die Zygom ykose der Nase und Nasenneben-.
V ergleich zur orbitalen Komplikation ähnli-. D ie V erdachts-. Therapie schliesst die Operation mit Resekti-. Klinik für Hals-, Nasen- und Ohrenheilkunde,.
Kopf- und Halschirurgie der Ruhr-Universität. Usually the detection of hyphae in tissue is unmistakable evidence of a deep mycosis requiring antimycotic treatment.
Micromorphology alone rarely allows a specific diagnosis, thus confusion is possible between Candida, Aspergillus, Alternaria and Fusarium species or several other fungal agents.
If broad, nearly non-septated hyphae are detected histologically mucormycosis can be suspected. Detection of hyphae in tissue is always a cause for concern because therapeutic consequences must follow.
Because therapeutic strategies may differ depending on the specific fungal agent, a suspected diagnosis should be supplemented by other methods, e.
Disseminated Rhizopus microsporus infection following allogeneic hematopoietic stem cell transplantation in a child with severe aplastic anemia.
Oct Transpl Infect Dis. Disseminated Rhizopus microsporus infections are uncommon in children and are resistant to echinocandin and azole antifungal agents.
We describe a child with severe aplastic anemia who developed disseminated R. The patient was treated successfully with hepatic drainage and amphotericin B deoxycholate.
Infections play a crucial role in organ transplantations as possible complications. Viruses, bacteria, fungi and parasites are potential agents.
The relevance of individual diseases depends on the organ transplanted. Morphology of the inflammatory reaction is given by the agent involved, but often several reactions can be caused by the same agent and different agents can also lead to the same reaction.
Histology therefore provides concrete identification of the causal agent only in some cases, such that additional microbiological diagnostics are necessary.
Results from these investigations should be transferred to the pathologist to distinguish between infection-associated changes and transplant rejection.
Three patients with mucormycosis of the paranasal sinuses were treated in the University ENT departments in Bochum and Essen in recent years.
All patients were immunocompromised for different reasons and had reduced resistance against microorganism infection.
They presented with symptoms of orbital complications of sinusitis. The difficulties of early diagnosis by imaging, histology, microbiology, or molecular biology and postoperative therapeutic options especially with amphotericin B, liposomal amphotericin B, and posaconazole are illustrated and discussed.
In recent years there have been major new developments in systemic antifungal drugs. For amphotericin B there are several lipid formulations recently developed.
These clearly reduce infusion and nephrotoxicity, allowing large doses to be administered safely. It remains less clear how much more effective are the lipid formulations as compared to amphotericin B desoxycholate.
For the triazoles, itraconazole has been reformulated into a solution which improves oral absorption and can also be given intravenously.
The clinical impact of this is still uncertain, Voriconazole and posaconazole are two new broad spectrum triazoles which will compete with itraconazole for activity in fluconazole resistant yeast and mycelial pathogens.
Finally, a new class, the echinocandins, is under Phase III study. Three competitors are highly active against Candida and some mycelial pathogens.
Their ultimate role has not been defined. All of these developments provide the clinician with an increasing array of choices to use in the expanding word of systemic mycoses.
Predisposing factors, diagnosis, therapy, complications and survival. Jan Rev Laryngol Otol Rhinol. Mucormycosis is the most acutely fatal fungal infection of the human being 5.
Although relatively uncommon, its morbidity makes it an extremely important disease for the Otolaryngologist-Head and Neck Surgeon.
A review of 11 cases of rhinocerebral mucormycosis nine female and two male patients admitted from to at Hospital das Clinicas, University of Sao Paulo was undertaken.
The age range was from eight months to 49 years with a median age of 31 years. In the current study, we present and discuss the predisposing factors, the methods of diagnosis, the treatment given the complications observed and the survival of the disease.
The survival rate for paranasal sinus mucormycosis in this study was All deaths occured within the first month after diagnosis and institution of treatment.
All the patients that died presented with diabetic ketoacidosis. Hemiplegia as a neurological complication of the disease was seen in The authors intend to add some more information to the limited literature on paranasal sinus mucormycosis.
Evolution of the Disease and Treatment Options. Rhinocerebral mucormycosis is recognized as a potentially aggressive and commonly fatal fungal infection.
The classic presentation is involvement of nasal mucosa with invasion of the paranasal sinuses and orbit. Mucormycosis is most commonly seen in association with diabetic ketoacidosis, but disease demographics have changed with the onset of AIDS and the advent of powerful immunosuppressive drugs.
Treatment includes aggressive debridement, systemic antifungal therapy, and control of underlying comorbid factors. Although surgical intervention remains essential, advances in medical therapy have permitted a more limited surgical approach to minimize functional loss without compromising survival.
We present the UCLA experience with rhinocerebral mucormycosis from to , with emphasis on the evolution of disease presentation and alternative treatment options.
Well-recognized risk factors for zygomycosis include diabetic ketoacidosis, immunocompromise, and deferoxamine therapy for iron or aluminum overload, usually in patients undergoing kidney dialysis.
We report a case of fatal nasal-orbital-cerebral zygomycosis in an year-old man with known myelodysplasia and well-controlled diabetes.
He was not receiving deferoxamine. Despite radical surgery and amphotericin B therapy, he died; primary hemochromatosis with gross iron overload was found post mortem.
Experimental evidence suggests iron overload without deferoxamine therapy may be a risk factor for zygomycosis; the findings in this case would support this hypothesis.
Mucormycosis in patients with haematological malignancies: A retrospective clinical study of 37 cases.
A retrospective study of 37 patients with haematological malignancy 21 acute myeloid leukaemia, 11 acute lymphoid leukaemia, two lymphoma, two hairy cell leukaemia, one Hodgkin's disease and histologically documented mucormycosis was conducted to evaluate the clinical characteristics and ascertain the factors which influenced the outcome from mycotic infection.
Patients were admitted to 18 haematology divisions in tertiary care or university hospitals in Italy between and Fever, thoracic pain, dyspnoea and cough were the most frequent presenting symptoms.
Only three patients were asymptomatic. When performed, thoracic and cranial CT scan were the most useful diagnostic investigations.
Nine patients were cured by antifungal therapy plus, in five cases, radical surgery procedures. An analysis of factors influencing outcome demonstrated that the resolution of chemotherapy-induced neutropenia and prolonged treatment with amphotericin B and, if feasible, radical surgical debridement treatment, were significantly correlated with recovery from infection.
Mucormycosis, a rare filamentous fungal infection that occurs most frequently in neutropenic acute leukaemia patients, is characterized by a high mortality rate.
Extensive and aggressive diagnostic and therapeutic procedures are essential to improve the prognosis in these patients. Rhinocerebral zygomycosis is usually an aggressive, fulminant and, at times, fatal disease most often affecting poorly controlled diabetics of all ages.
We report the case of a month-old white boy, a previously undiagnosed diabetic. He came to our hospital with recurrent epistaxis, decreasing consciousness, and a small visible infection at the inner canthus of the left eye.
Initial evaluation revealed that the patient was in diabetic ketoacidosis. Despite aggressive medical and surgical treatment, his condition deteriorated rapidly, including the development of diabetes insipidus, and he died 4 days after admission.
At autopsy, he was found to have fungal cerebritis Rhizopus with multiple areas of infarction and massive cerebral edema.
Three patients with presumed rhino-orbital-cerebral mucormycosis. We describe a case of successful treatment of rhinocerebral mucormycosis in a patient with multiple myeloma.