Neurology
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Fourteen children with Arnold-Chiari malformation had history of respiratory distress, apnea, vocal cord paralysis or inability to swallow. Postmortem examination in 12 disclosed vascular lesions in the tegmentum of the medulla oblongata. ⋯ It is suggested that the malformation results in changes in the vascular supply of the herniated portion of the brainstem. Stretching of the arteries may result in irreversible damage to the brainstem with subsequent life-threatening disturbance of respiratory function.
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We studied the delayed neurologic complications of left atrial myxoma in 2 patients and analyzed 47 previously published cases. Embolic cerebral infarctions may occur before surgical removal of the primary cardiac tumor, but aneurysm formation and hemorrhage may be delayed, whether or not there is evidence of neurologic disorder at the time of initial surgery. ⋯ Resultant aneurysms may show progressive enlargement, and treatment with doxorubicin failed to prevent aneurysm enlargement in one patient. Better guidelines are needed for clinical management in these patients.