Search

Schilder's disease, or myelinoclastic diffuse sclerosis, is a rare disorder characterised by an inflammatory white matter plaque of demyelination. Clinical signs and symptoms might be atypical for early multiple sclerosis and at imaging the lesion is easily taken for a brain tumour. Regardless of the use of Poser's criteria for clinical diagnosis of Schilder's disease proposed in 1986, diagnostic difficulties are still present, as evidenced by the many reported cases in the English literature revised (Pubmed indexed, period 1998-2008). It clearly emerges that neuroradiological features, observable in additional magnetic resonance sequences are crucial, besides the consideration of Poser's criteria, in differentiating between demyelinating lesions and brain tumours. A 29-year-old female patient is presented, where a careful evaluation of both the clinical and radiological features, which might have been at a first glance misleadingly suggestive for a brain tumour, allowed non-invasive diagnosis of Schilder's disease.

In patients with ischemic stroke, endovascular treatment results in a higher rate of recanalization of the affected cerebral artery than systemic intravenous thrombolytic therapy. However, comparison of the clinical efficacy of the two approaches is needed.We randomly assigned 362 patients with acute ischemic stroke, within 4.5 hours after onset, to endovascular therapy (intraarterial thrombolysis with recombinant tissue plasminogen activator [t-PA], mechanical clot disruption or retrieval, or a combination of these approaches) or intravenous t-PA. Treatments were to be given as soon as possible after randomization. The primary outcome was survival free of disability (defined as a modified Rankin score of 0 or 1 on a scale of 0 to 6, with 0 indicating no symptoms, 1 no clinically significant disability despite symptoms, and 6 death) at 3 months.A total of 181 patients were assigned to receive endovascular therapy, and 181 intravenous t-PA. The median time from stroke onset to the start of treatment was 3.75 hours for endovascular therapy and 2.75 hours for intravenous t-PA (P0.001). At 3 months, 55 patients in the endovascular-therapy group (30.4%) and 63 in the intravenous t-PA group (34.8%) were alive without disability (odds ratio adjusted for age, sex, stroke severity, and atrial fibrillation status at baseline, 0.71; 95% confidence interval, 0.44 to 1.14; P=0.16). Fatal or nonfatal symptomatic intracranial hemorrhage within 7 days occurred in 6% of the patients in each group, and there were no significant differences between groups in the rates of other serious adverse events or the case fatality rate.The results of this trial in patients with acute ischemic stroke indicate that endovascular therapy is not superior to standard treatment with intravenous t-PA. (Funded by the Italian Medicines Agency, ClinicalTrials.gov number, NCT00640367.).

In this paper we review the clinical and morphological results of intracranial aneurysms treated with Guglielmi Detachable Coils.We report our experience in 100 patients with intracranial aneurysms treated with GDC. Since February 1993 we have treated 70 females and 30 males, with a mean age of 57 years old, for a total of 118 intracranial aneurysms. Sixty-five patients had a recent history of ruptured aneurysm, 10 suffered from a previous subarachnoid hemorrhage and 25 patients had never bled. In the choice of treatment for subarachnoid aneurysm, in accordance with our neurosurgeons, we have not applied a protocol, rather we have followed guidelines in relation to: age, neurological clinical conditions, systemic disease and location of aneurysm. Morphological aspect of immediate aneurysm occlusion was: 60% more or less complete occlusion, 30% loose packing with 10% failures.The clinical outcome at follow-up (1 month-3 years) was: 72 patients without neurological deficits, 19 patients improved pre-existing neurological deficits, 3 patients worsened for procedural complications; 6 patients died (1 patient unrelated).

AIM: Surgery for gliomas located inside or in proximity of motor cortex or tracts requires cortical and subcortical mapping to locate motor function; direct electrical stimulation of brain cortex or subcortical pathways allows identification and preservation of motor function. In this study we evaluated the effect which subcortical motor mapping had on postoperative morbidity and extent of resection in a series of patients with gliomas involving motor areas or pathways. METHODS: One hundred and forty-six patients were included in the study. Intraoperative findings of primary motor cortex or subcortical tracts were reported, together with incidence of new postoperative deficits at short (1 week) and long term (1 month) examination. The relationship between intraoperative identification of subcortical motor tracts and extent of resection was reported. RESULTS: The motor strip was found in 133 patients (91%) and subcortical motor tracts in 91 patients (62.3%). New immediate postoperative motor deficits were documented in 59.3% of patients in whom a subcortical motor tract was identified intra-operatively and in 10.9% of those in whom subcortical tracts were not observed; permanent deficits were observed in 6.5% and 3.5%, respectively. A total resection was achieved in 94.4% of patients with high-grade gliomas and in 46.1% of those with low-grade gliomas.

Surgery is currently the treatment of choice for acutely ruptured aneurysms, representing an efficient option both in the short and long term. We believe that the endovascular option may be of help in high surgical-risk cases.

Introduction . The aim of our study was to analyze the effect of various levels of light availability in the fruit microenvironment (induced by summer pruning) on some fruit quality traits. Materials and methods . Two levels of summer pruning were set: removal of either 30% or 60% of the canopy leaf area. These treatments were compared with the control (unpruned vines). Two canopy layers (upper and lower) were identified in each treatment and in the control vines. At harvest, yield per cane and per shoot was recorded in the two canopy layers; fruit fresh weight, flesh firmness, total soluble solid content and total titratable acidity were measured. Fruit Total Antioxidant Capacity (TAC) and Total Polyphenols (TPH) were determined at kiwifruit harvest and post-harvest (60 days after storage at 1 °C) in relation to their position within the canopy (layer) and to the pruning treatment applied. Results . Removing 60% of the canopy leaf area induced higher titratable acidity and flesh firmness of kiwifruits at harvest; it reduced fruit weight and crop yield, but increased TAC and TPH compared with kiwifruits of control. Removing 30% leaf area did not reduce mean fruit weight and crop yield; it increased TAC and TPH at harvest by 20%. Post-harvest TAC and TPH evolution did not differ among treatments. Discussion and conclusion . Pergola-trained kiwifruit vines showed good performances in terms of crop yield and fruit quality when summer pruning reduced the Leaf Area Index (LAI) to 3. More intense pruning resulted in a significant increase in fruit TAC, but reduced fruit weight and crop yield, and delayed softening of pulp.

Objective Subcortical stimulation can be used to identify functional language tracts during resection of gliomas located close to or within language areas or pathways. The objective of the present study was to investigate the feasibility of the routine use of subcortical stimulation for identification of language tracts in a large series of patients with gliomas and to determine the influence that subcortical language tract identification exerted on the extent of surgery and on the appearance of immediate and definitive postoperative deficits. Methods Subcortical stimulation for language tract identification was systematically used during surgical removal of 88 gliomas (44 high-grade and 44 low-grade gliomas) involving language pathways. Procedures were performed during asleep/awake craniotomy. Subcortical stimulation was continuously alternated with surgical resection in a back-and-forth fashion. Language performances were tested by neuropsychological language evaluation preoperatively and at 3, 30, and 90 days after surgery. Results Language tracts were identified in 59% of patients, with differences according to tumor location but not according to histological grade. Language tract identification influenced the ability to reach a complete tumor removal in low-grade gliomas, in which tracts were documented inside the peripheral mass of the tumor. Identification of language tracts was associated with a higher occurrence of transient postoperative deficits (67.3% of cases), but a low occurrence of definitive morbidity (2.3% of cases). A pattern of typical language disturbances related to the phonological and semantic system can be identified according to tumor location, with preservation being important for the maintenance of language integrity. Conclusion Our study supports the routine use of subcortical stimulation for language tract identification as a reliable tool for guiding surgical removal of gliomas in or in close proximity to language areas or pathways.