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We report the case of a 61-year-old woman, who developed progressive paraparesia over a period of 8 months. Conventional X-rays of the thoracic spine showed an intra-spinal calcified lesion at T10. On CT-scan and MRI, the lesion appeared anterior to the cord, thus making a posterior approach hazardous. Total resection of this calcified meningioma was achieved through a right transthoracic transcorporeal approach, under close monitoring of the somatosensory evoked potentials. Despite a delayed pseudomeningocele formation requiring an additional thoracotomy, outcome after 7 years is excellent with no residual neurological deficit. No recurrence was seen on a CT-scan performed two years after the surgery. Calcified anterior meningiomas of the spine are rare lesions. Surgical outcome has been unfavorable for a long time in relation with posterior or postero-lateral approaches. Although anterior transthoracic procedures are routinely performed for extradural spinal lesions, this approach is rarely used for intradural lesions. A calcified anterior spinal thoracic meningioma should be managed like the more frequent calcified thoracic disk hernia, despite the increased risk of cerebrospinal fluid effusion requiring subsequent repair.

The Central Nervous System is the site of a wide variety of inflammatory and infectious diseases. Some disease entities have been in the focus of interest in recent years and progress has been achieved in our understanding of some chosen domains. We will review recent progress in our knowledge about transmissible spongiformes encephalopathies and AIDS-associated lesions, and briefly discuss cerebral vasculitis, granulomatous diseases and the most frequent infections by parasites.

We present hereby some results indicating that there is a significant decrease in the release of NO by the retina immediately after branch-venous occlusion (BVO).Using an NO microprobe we measured (NO) in the preretinal vitreous of miniature pigs before and two hours aRer bvo. Conventional and electronic microscopy were performed on the affected retina.At the retinal surface (NO) was reduced to 25% of the previous value two hours after BVO, at the same time significative oedema of the inner retina was observed.Immediately after BVO there is a significative decrease in the amount of NO released by the affected retina, parallel to the first evidences of an oedema of the inner retinal layers.

Study of early hystological lesions after experimental branch venous occlusion (BVO) in miniature pigs.The retina was taken 1, 2, 4, 6 and 8 hours after BVO with green argon laser for examination with conventional and electronic microscopy.1 hour after occlusion an extracellular focal oedema is observable in the ganglion cells optic nerve fibers and cells of inner plexiform layer; 2 hours after occlusion there is also an extracellular oedema of the external plexiform layer as intracellular oedema of the inner nuclear layer, 4 hours after occlusion the extracellular oedema is more diffuse especially in the ganglion cells, inner nuclear and optic nerve fibers layers. Cytoplasmic vacuolisation, nuclear pycnosis and ruptured cell membrane layers are observed; 8 hours after occlusion both intra and extracellular oedema are observable throughout the inner retina.After BVO histological lesions are found within one hour only following the occlusion, apoptosis and cell necrosis are present as soon as 4 hours after experimental BVO.

A primary benign melanotic tumour was resected twice in the thoracic spinal cord of a 49-year-old woman. The patient had complained of low back pains, obstipation and mictional urgency for two years. She developed a partial Brown-Sequard's syndrome at th10-th12 level. The tumour showed the histological and immunohistochemical features of a meningeal melanocytoma. The following up was marked by tumoral seeding in the lumbosacral region and later in the cerebral hemispheres, which lead to death 4 years after the diagnosis. This is a survey of the clinical and morphological characteristics of meningeal melanocytoma and demonstrates the risk of secondary dissemination of this primary benign tumour.

The authors reports their experience of 5 cases of intra- and peri-aqueductal tumors. With the exception of 1 case, a subependymoma of the aqueduct discovered at autopsy in a 77 year old woman, the 4 other patients (2 females and 2 males) are relatively young (respectively 14, 23, 14 and 26) at the time when they presented with signs of chronically raised intracranial pressure due to a triventricular hydrocephalus. One patient presented with a partial Parinaud's sign, but the focal and long tract signs were conspicuously absent in the other patients. The diagnosis of a space occupying lesion in the tectum mesencephali or in the aqueduct could only be ascertained with the recent use of M.R.I. The radiological work-up of the cases suggest that theses lesions, presumably of glial origin, are very slowly growing tumors. Four patients have been treated for their symptomatic hydrocephalus, but no treatment of the tumor has been proposed, as the clinical state and the images remain remarkably stable. (Mean duration of follow up from the time of shunting = 3.7 years, extremes = 1.5-8 years). A review of the literature shows that not more than 48 cases of tumors of the aqueduct have been reported. Because of the small number of such observations, there are, until now, no precise informations on the management of such cases to decide if the patient will benefit of an open or stereotactic biopsy associated with radiotherapy or if one can rely on serial clinical and radiological examinations. Further information on the long term follow up is needed.

Full-contact, a sport which is becoming more and more popular in our society as a means of self-defence, is not without its hazards. We describe the case of a 32-year-old man who, shortly after an intensive practice match, presented symptoms consistent with cerebral damage which resulted in his death within three days. The main pathological findings were confined to the left internal carotid artery, which presented a dissecting aneurysm as a result of rupture of its intima with thrombosis of its lumen. The thrombus extended as far as the intracranial portion of the artery, resulting in massive cerebral infarction as cause of death. Furthermore, there were histological modifications of both main carotid arteries and their branches which suggested repeated microtraumatic events. The causal relation between the lesions observed and the practice of full-contact are discussed.

Twelve cases of ganglioneuroblastoma of the brain, tumour rarely observed in infants and young adults, are documented. The macroscopic, histologic and biological features of this tumour are discussed and compared with those of the literature. The author proposes an histogenetic hypothesis, which takes into consideration the possible association of an underlying dysplastic condition, comparable to that observed in cases of phakomatosis. Attention is drawn to the diagnostic difficulties, especially in that which concerns the diagnosis on frozen sections.

A very early case of D.S.H. (Hereditary Spongy Degeneration of the central nervous system) is described: clinical examination, C.A.T.-Scan (computerized axial tomography), biopsy and autopsy. The case presented in a 3 weeks old girl as a "colic of early infancy". During the fourth week, sudden worsening took place with attacks of dyspnea, cyanosis and frothy sputum. Ultrasound showed an echogenic thalamus. Examination by C.A.T.-Scan showed pale areas in the mid-brain and the central nuclei on both sides suggesting cerebral lesions of circulatory origin. Despite a normal lumbar puncture, cerebral biopsy was performed to exclude a potentially treatable viral condition (herpetic encephalitis?). Death took place 24 hours later. No inflammatory or spongy degenerative changes compatible with D.S.H. were found at biopsy. At autopsy however, despite superimposed recent ischemic lesions, microscopy and electron microscopy were characteristic of Hereditary Spongy Degeneration of the C.N.S. Six previous cases of D.S.H. are reported in the literature (explored by C.A.T.-Scan and confirmed histologically), this being the first report of hypodensities in the brain stem and central nuclei. In conclusion, this case shows once more that C.A.T.-Scan can be a useful tool in this still little known condition.