Journal of neurosurgery
-
Journal of neurosurgery · Oct 1983
"The common devotion"--Cushing's legacy and medical ethics today. The 1983 Harvey Cushing oration.
The author examines the principles that have been specific to the profession of medicine. He iterates Harvey Cushing's exhortation to reaffirm adherence to traditional medical ethics which are at times strained in dealing with major congenital defects, maintenance of ancillary support, technological possibilities, and terminal illness. Moral considerations must be examined and respected, and remain the personal responsibility of the profession. The best decisions involve the patient's interests and the freedom to choose.
-
Journal of neurosurgery · Oct 1983
Differential diagnosis between ventriculitis and fourth ventricle cyst in neurocysticercosis.
The fourth ventricle is frequently affected in patients with cysticercosis of the central nervous system, due either to a large cyst occluding the cavity or to granular ependymitis (ventriculitis) as a consequence of diffuse inflammation within the intraventricular and subarachnoid spaces. In some cases, the differential diagnosis between these two forms of neurocysticercosis is difficult to make, even after special radiological procedures. It is important to establish the correct diagnosis, since a surgical approach is beneficial only when the fourth ventricle is obstructed by a large cyst. ⋯ Patients with a large cyst occluding the fourth ventricle had a short evolution of signs and symptoms, Bruns' syndrome, and discrete or no inflammatory reaction in the cerebrospinal fluid (CSF). Patients with ventriculitis generally had a longer duration of signs and symptoms, Parinaud's syndrome, a consistently positive complement fixation test to cysticerci, and more cells and proteins in the CSF. The clinical picture and ancillary studies can give the precise diagnosis in most patients before surgical exploration is performed.