THE French Ophthalmologist Darier was the first to make the experiment (1896) of utilizing the hormone of the suprarenal gland for the purposes of ophthalmology.His most important discovery, subsequently confirmed by general observations, was an enlargement of the pupil (sympa- thetic excitation) while reducing the eye pressure.Not until 20-30 455
The goal of this article is to present the clinical and histopathological features of two rare cases of ganglioglioma occurring in the cervicothoracic and thoracolumbar spinal cord.A 4-year-old female patient presented with tetraparesis, whereas a 54-year-old woman showed paraparesis of both feet.Both tumors could be removed totally by microsurgical techniques. Light microscopically, the tumors in both cases showed basically identical histological features and were diagnosed as benign gangliogliomas. Postoperatively, the two patients did not show improvement. Tumor recurrence was not noted at follow-up examinations within 11 and 24 months after surgery, respectively.Ganglioglioma must be considered in the differential diagnosis of tumors affecting the spinal cord. In cases of suspected spinal ganglioglioma showing no sharp delineation from the surrounding tissue, a subtotal tumor removal should be considered to prevent severe neurological deficits.
The functional anatomy of motor recovery was studied by assessing motor function quantitatively in 23 patients following capsular or striatocapsular stroke. While selective basal ganglia lesions (caudate and/or putamen exclusively) did not affect voluntary movements of the extremities, lesions of the anterior (plus caudate/putamen) or posterior limb of the internal capsule led to an initially severe motor impairment followed by excellent recovery, hand function included. In contrast, lesions of the posterior limb of the internal capsule in combination with damage to lateral thalamus compromised motor outcome. In experimental tracing of the topography of the internal capsule in macaque monkeys, we found axons of primary motor cortex passing through the middle third of the posterior limb of the internal capsule. Axons of premotor cortex (dorsolateral and post-arcuate area 6) passed through the capsular genu, and those of supplementary motor area (mesial area 6) through the anterior limb. Small capsular lesion can therefore disrupt the output of functionally and anatomically distinct motor areas selectively. The clinically similar motor deficits with a similar course of functional restitution following disruption of these different descending motor pathways indicate a parallel operation of cortical motor areas. They may have the further capability of substituting each other functionally in the process of recovery from hemiparesis.
Retrospective analysis of routine computed tomography investigations.To investigate whether the extent of clinical symptoms in patients undergoing surgery for cervical spinal myelopathy depends on the transsectional area of the cervical spinal canal.Forty-five patients underwent surgery using different techniques to enlarge the width of the spinal canal. For clinical evaluation before and after surgery, a modified score of the Japanese Orthopedic Association was used (mean follow-up period, 19.6, 9.1 months). The cross-sectional area of the spinal canal in computed tomography scans (C4-C6) was quantified 1 day before and 1 week after surgery using pixel-dependent area calculation software for three different density ranges given in Hounsfield units.After surgery, a significant enlargement of the cervical spinal canal of 78.2 +/- 55.9% could be achieved. The Japanese Orthopedic Association score increased significantly by 3.7 +/- 2.2 points from a median preoperative score of 10 to a score of 14 after surgery. Patients with a preoperative Japanese Orthopedic Association score > or = 10 achieved a significantly better outcome after surgery. Conversely, no patient with a postoperative area larger than 1.6 cm2 achieved a score of less than 12 Japanese Orthopedic Association-points. No significant linear correlation, however, was found between the postoperative transsectional area and the postoperative Japanese Orthopedic Association score of all patients.The preoperative clinical presentation of the patient was found to be the only prognostic hint for improvement after surgery. Preoperative area measurements of the spinal canal cannot be used as a prognostic tool for surgical outcome. Further, the postoperative measurements do not correlate with the clinical outcome. These data, however, which refer to C4 to C6, provide evidence that every surgical procedure to enlarge the cervical spinal canal should result in an area of 1.6 cm or more.
