Six infants with obstetric brachial palsy, ranging from 4 to 7 months of age, were investigated. One was suspected of having extensive brachial plexus lesions and five were suspected of having a unilateral lesion of both roots C5 and C6. All were referred to our center to investigate the possibility for reconstructive surgery. In all infants, even at this age, transcranial magnetic stimulation resulted in motor evoked potentials (MEP) in the biceps (in one, in the brachioradial) muscles. Averaging could not be done because of the intraindividual variation in latency. The MEP was easier to recognize if evoked when the infant had the arm bent. In all five infants suspected of upper brachial plexus lesion with avulsion of both roots C5 and C6 and/or complete rupture of the upper trunk, proven in four, an MEP on the lesioned side could be evoked. Combined with earlier investigations showing (almost) normal EMG and somatosensory evoked potentials in infants with upper plexus lesion, this leads us to the conclusion that the paralysis of these infants cannot only be attributed to the peripheral axonal damage alone but that central plasticity must also play an important role. As this is a slow process, some infants might not yet be able to use the paralytic muscles. Some theoretic issues are discussed.
In 492 patients with a lumbosacral radicular syndrome caused by a lumbar intervertebral disc herniation or by a stenosis of the lumbar spinal canal, the situation 1 year after a root decompressing operation was compared with the situation before surgery. About 75% of the patients reported satisfactory improvement, while about 10% were not satisfied. The judgement of the physicians is somewhat more favourable: 80% and 5%, respectively. The best results are obtained in patients in whom the preoperative diagnosis of lumbar disc herniation is highly probable; the worst results are obtained in patients undergoing a second operation. Back pain, sometimes serious, persists after surgery in about 50% of the patients. Such persistent back pain occurs most frequently in patients with a lumbar canal stenosis; one-third even mention a postoperative increase in back pain. About 50% of the patients who were on sick leave before operation resumed work afterwards.
Two children are reported who had a bilateral carpal tunnel syndrome. In one patient mucopolysaccharidosis IS, in the second mucopolysaccharidosis IV was present.
textabstractChildren with untreated hydrocephalus show marked distension
of the veins of the skull and scalp. This is even more pronounced in
children with bifida aperta.
Such distension is usually relieved instantaneously when the
hydrocephalus is treated by a ventriculo-cardiac drainage. This drew
attention to the venous drainage of the cranial cavity and led to consideration
of the possibility that impeded venous drainage might be a
causalfactor in the origin of hydrocephalus.
Initially, we examined brains of hydrocephalic children regardless
of the cause of the hydrocephalus. After finding severe abnormalities
of the cranial venous system in children with spina bifida
aperta, however, we eventually confmed our investigations to these
cases. This limitation had the added advantage that we were dealing
with a group of hydrocephalic children with the same aetiology and
representing the single most common group available. Other forms of
hydrocephalus have heterogenous causes that are even less clearly
understood.
Five more cases were found described in the literature, two of which were well documented. There was one other case in which pericardial collection of cerebrospinal fluid was reported. In the case presented here and in the cases of STRENGER and DZENITIS symptoms of pericardial effusion developed with simultaneous good functioning of the shunt.
