Neurochirurgie
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Brain metastases are common events in adult patients with solid tumors. The choice of the optimal therapy is still challenging and controversial. Whole brain radiotherapy (WBRT) is a standard practice in most patients with an excellent palliative effect. ⋯ Although brain metastases of solid tumors occur in the presence of progressive widespread disease, chemotherapy has played a limited role in their treatment. Poor drug penetration across the normal blood-brain barrier of chemotherapy agents is not a limiting factor because of the neovascularization in the tumor. The few prospective studies that have addressed this issue, especially in lung and breast tumors, are reviewed.
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The hydatic cyst is a pathology observed in developing countries. Multiple cerebral localizations with a cardiac origin are exceptional and are sometimes diagnosed only after onset of complications. We present the case of a 22-year-old male student: the diagnosis of multiple cerebral hydatic cysts caused by rupture of a cardiac hydatic cyst was established after an episode of ischemia of the limbs with cerebral hemorrhage induced by heparin. ⋯ After surgical removal of the cardiac cyst, the patient has been lost to follow-up. Cerebral hydatidosis of cardiac origin is highly exceptional and, due to nonspecific symptomatology, may go undiagnosed. In general, prognosis is good in case of a cerebral localization but the cardiac localization is associated with high mortality.
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Sarcoidosis is a systemic granulomatous disease of unknown etiology. The frequency of neurologic manifestations varies from 5 to 15% of cases. Systemic manifestations of sarcoidosis are often present and the diagnosis is still based on histopathological studies. ⋯ The prognosis is often good and 55% of patients reported have had a complete recovery. In case of failure, immunosuppressive and radiation therapy can be used. Surgery is indicated to establish tissue diagnosis, in the presence of increased intracranial pressure, or to remove brain tumor.
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Civilian Gunshot Wounds (GSWs) to the head are important causes of mortality. The severity of GSWs is related to several factors. Patients with GSWs tend to do very well or very poor depending on these factors. ⋯ The manuscript describes the clinical experience of penetrating missile injuries in a Turkish civilian practice. Mortality and/or poor outcome are relatively high in spite of the cases wounded by low-velocity weapons. We should emphasize that following stabilization of vital signs, all patients with GCS scores of 3 to 5 should be evaluated immediately with CT and treated conservatively. If it is appropriate the patients with a GCS score higher than 8 should undergo surgery. Patients with GCS scores of 6 to 8 should be followed closely and treated with surgery when necessary even if they have poor prognosis.