Trials. 2006 Jan 18;7:2.

Links

Prophylactic antibiotic for prevention of posttraumatic meningitis after traumatic pneumocephalus:

design and rationale of a placebo-controlled randomized multicenter trial [ISRCTN71132784].

Eftekhar B, Ghodsi M, Hadadi A, Taghipoor M, Sigarchi SZ, Rahimi-Movaghar V, Kazemzadeh ES, Esmaeeli B, Nejat F, Yalda A, Ketabchi E.

Sina Trauma and Surgery Research Center and Department of Neurosurgery, Sina Hospital, Tehran University, Iran. eftekhar[at]sina.tums.ac.ir

BACKGROUND: The purpose of this study is to compare the efficacy of prophylactic antibiotic for prevention of meningitis in acute traumatic pneumocephalus patients. METHODS: In this prospective, randomized controlled clinical trial, 200 selected head injury patients with traumatic pneumocephalus are randomly assigned to receive intravenous antibiotics (2 grams Ceftriaxone twice a day), oral antibiotics (Azithromycin) or placebo for at least 7 days after trauma. The patients will be followed for one month posttrauma. CONCLUSION: The authors hope that this study helps clarifying the effectiveness and indications of antibiotics in prevention of meningitis in traumatic pneumocephalus after head injury and in specific subgroup of these patients.

PMID: 16542035 [PubMed]

1: J Neurosurg. 2006 Mar;104(3 Suppl):210-1.

Links

Posterior spinal cord herniation into an extradural thoracic arachnoid cyst: surgical treatment. Case report and review of the literature.

Nejat F, Cigarchi SZ, Kazmi SS.

Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. nejat[at]sina.tums.ac.ir

The authors describe the case of a 2-year-old boy who experienced progressive spastic paraparesis for several months. Magnetic resonance imaging revealed an extensive extradural arachnoid cyst at the T3-L1 levels and posterior spinal cord herniation at T3-4. Surgical release of the neck of the hernia and total resection of the arachnoid cyst were performed. The patient had good clinical recovery several weeks after surgical decompression. This case highlights an exceedingly rare type of spinal cord herniation in a pediatric age group, and focuses on the abnormalities of the dorsal dura mater, together with imaging and intraoperative findings.

PMID: 16572642 [PubMed - indexed for MEDLINE]


doi:10.1136/jnnp.2003.027912
J. Neurol. Neurosurg. Psychiatry 2005;76;143-144
F Nejat, S Zabihyan Sigarchi and M IzadYar
trauma
Congenital dumbbell neuroblastoma mimicking birth

Stiff person syndrome with eye movement abnormality, myasthenia gravis, and thymoma Stiff person syndrome (SPS) is a rare disorder of the central nervous system characterised by progressive fluctuating rigidity and painful spasms of the body musculature. We describe a patient with SPS with positive glutamic acid decarboxylase (GAD) antibodies who developed diplopia. Thymoma was detected by computed tomography (CT), and after thymectomy his symptoms improved. One month after thymectomy, he tested positive for antiacetylcholine receptor (AchR) antibodies.
Case report A 45 year old man presented with a four week history of back pain and stiffness of his trunk causing difficulty in bending forward and turning over while lying down, which he attributed to a minor injury sustained while playing squash. He later developed asymmetrical stiffness of the legs and difficulty walking. His past medical history was notable for an episode of dysphagia (two weeks’ duration) associated with heartburn six months ago; a gastroenterological evaluation and an endoscopy at that time were normal. He recovered spontaneously and there was no recurrence. On examination his mental status, speech, and cranial nerves were normal. He had exaggerated lumbar lordosis. Neurological examination showed normal bulk with increased tone of the flexors and extensors of the knee and ankles. Power and coordination were normal, deep tendon reflexes were
brisk, but he had flexor plantar responses. There was no evidence of fatigable muscle weakness. Sensory examination was normal. A chest radiograph and magnetic resonance imaging (MRI) of the brain and the spinal cord were normal. He was anti-GAD antibody positive at 3.4 U/ml (radioimmunoassay; normal 0–1 U/ml). Full blood count, vitamin B12, folate, thyroid function tests, liver function tests, urea, electrolytes, glucose, cortisol, immunoglobulins, and electrophoresis were normal. Antinuclear antibody and smooth muscle, mitochondrial, parietal cell, gliadin, reticulin, microsomal, thyroid peroxidase and antineutrophil cytoplasmic antibodies were negative. Cerebrospinal fluid (CSF) examination revealed 9 lymphocytes/ mm3. CSF protein and glucose were normal at 0.31 g/l and 3.1 mmol/l, respectively and oligoclonal bands were absent. The spasms were controlled with diazepam, but his symptoms recurred on reducing the dose. A diagnosis of SPS was made. Treatment with intravenous immunoglobulins (400 mg/kg per day for five days) was not beneficial. He later improved on baclofen 20 mg/day and clonazepam 0.5 mg at bedtime.
Four months after the onset of stiffness, he developed diplopia. Visual acuity was 6/4 in both eyes. He had variable alternatingesotropia of up to 10 prism dioptres at distance and esophoria at near. Eye movement examination showed bilateral mild abduction deficit, variability of horizontal and vertical saccades with a tendency to be slow, and slight endpoint nystagmus. There was no ptosis or weakness after sustained upgaze for one minute. Eye movement recordings, obtained with a high resolution video pupil tracker (EyeLink, Sensomotoric Instruments, Berlin, Germany; sample rate 250 Hz) confirmed the clinical findings (fig 1, top panel). Anti-AChR antibodies were negative. The neurological findings were unchanged. Motor and sensory nerve conduction studies and ulnar and radial repetitive nerve stimulation were normal. Concentric needle electromyography (EMG) showed sporadic fasciculation potentials in the tibialis anterior. Single fibre EMG from 34 potential pairs from the orbicularis oculi revealed only one site with definitely abnormal jitter. A chest CT scan revealed a thymic mass. Histological examination confirmed thymoma with minimal involvement of the perithymic fat. His symptoms improved over a month after thymectomy. One year from the onset of symptoms, one month after thymectomy, he tested positive for anti-AChR antibodies (44610210M/l) radioimmunoassay in the same laboratory, normal 0–5610210 M/l) and remained positive for anti-GAD antibodies (2.0 U/ml). His eye movements improved significantly after thymectomy as evidenced by eye movement recordings that showed less variability ofsaccadic velocity (fig 1, bottom panel). Eighteen months after the onset of symptoms he is off medications and back to his normalroutine. He has mild intermittent stiffness of his back, precipitated by anxiety. Occasional mild diplopia at far distance persists.

 Titre du document / Document title

Posterior spinal cord herniation into an extradural thoracic arachnoid cyst : surgical treatment

Auteur(s) / Author(s)

NEJAT Farideh ; SAMIRA ZABIHYAN CIGARCHI ; SYED SHUJA KAZMI ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, IRAN, REPUBLIQUE ISLAMIQUE D'
⁽²⁾ Department of Neurosurgery, Mashad University of Medical Science, Mashad, IRAN, REPUBLIQUE ISLAMIQUE D'

Résumé / Abstract

The authors describe the case of a 2-year-old boy who experienced progressive spastic paraparesis for several months. Magnetic resonance imaging revealed an extensive extradural arachnoid cyst at the T3-L1 levels and posterior spinal cord hemiation at T3-4. Surgical release of the neck of the hernia and total resection of the arachnoid cyst were performed. The patient had good clinical recovery several weeks after surgical decompression. This case highlights an exceedingly rare type of spinal cord herniation in a pediatric age group, and focuses on the abnormalities of the dorsal dura mater, together with imaging and intraoperative findings.

Revue / Journal Title

Source / Source

2006, vol. 104, n^o3, pp. 210-211 [2 page(s) (article)] (8 ref.)

Langue / Language

Anglais

Editeur / Publisher

American Association of Neurological Surgeons, Charlottesville, VA, ETATS-UNIS (2004) (Revue)

Mots-clés d'auteur / Author Keywords

extradural arachnoid cyst ; spinal cord herniation ; paraplegia ; pediatric neurosurgery ;

Localisation / Location

INIST-CNRS, Cote INIST : 6023 S2, 35400015341820.0120

Copyright 2006 INIST-CNRS. All rights reserved

Toute reproduction ou diffusion même partielle, par quelque procédé ou sur tout support que ce soit, ne pourra être faite sans l'accord préalable écrit de l'INIST-CNRS.
No part of these records may be reproduced of distributed, in any form or by any means, without the prior written permission of INIST-CNRS.

Nº notice refdoc (ud4) : 17559020

 


Study protocol Open Access Prophylactic antibiotic for prevention of posttraumatic meningitis after traumatic pneumocephalus: design and rationale of a placebo-controlled randomized multicenter trial [ISRCTN71132784]

Behzad Eftekhar*1, Mohammad Ghodsi1, Azar Hadadi2, Mousa Taghipoor3,
Samira Zabihyan Sigarchi4, Vafa Rahimi-Movaghar5,
Ehsan Sherafat Kazemzadeh3, Babak Esmaeeli7, Farideh Nejat8,
Alireza Yalda6 and Ebrahim Ketabchi1

Address: 1Sina Trauma and Surgery Research Center and Department of Neurosurgery, Sina Hospital, Tehran University, Iran, 2Department of
Infectious Diseases, Sina Hospital, Tehran University, Iran, 3Department of Neurosurgery, Namazi Hospital, Shiraz University, Iran, 4Department
of Neurosurgery, Ghaem Hospital, Mashad University, Iran, 5Department of Neurosurgery, Khatam-ol-anbia Hospital, Zahedan University, Iran,
6Department of Infectious Diseases, Imam Hospital, Tehran University, Iran, 7Department of Neurosurgery, Hospital, Shahrood, Iran and
8Department of Neurosurgery, Children's Hospital Medical Center, Tehran University, Iran
Email: Behzad Eftekhar* - eftekhar[at]sina.tums.ac.ir; Mohammad Ghodsi - ghodsism[at]sina.tums.ac.ir; Azar Hadadi - Hadadiaz[at]sina.tums.ac.ir;
Mousa Taghipoor - taghiporm[at]sums.ac.ir; Samira Zabihyan Sigarchi - zabihyan[at]yahoo.com; Vafa Rahimi-Movaghar - v_rahimi[at]yahoo.com;
Ehsan Sherafat Kazemzadeh - sherafate[at]sums.ac.ir; Babak Esmaeeli - esmailibabak[at]yahoo.com; Farideh Nejat - Nejat[at]sina.tums.ac.ir;
Alireza Yalda - AlirezaYalda[at]yahoo.com; Ebrahim Ketabchi - ebrahimketabchi[at]yahoo.com
* Corresponding author