Extradural hemangioma mimicking a dumbbell nerve sheath tumor in the thoracolumbar spine: Case report.

BACKGROUND: Extradural hemangiomas are rare, have varied and challenging clinical presentations, and require special considerations from the management point of view. CASE DESCRIPTION: A 70-year-old female presented with back pain that was ultimately attributed to a thoracolumbar extra-dural "dumbbell" hemangioma. Following surgical resection, the patient did well. CONCLUSION: Extradural hemangiomas may present as spinal extradural soft tissue masses that must be differentiated from dumbbell neurofibroma.

Sudden severe chest pain: thoracic dural arteriovenous fistula aneurysm rupture with intracranial subarachnoid haemorrhage.

Spinal perimedullary arteriovenous fistula (AVF) or dural arteriovenous fistula (DAVF) presenting as intracranial subarachnoid haemorrhage (SAH) is uncommon. A total of 16 cases have been reported to date. A majority of the reports described cervical spinal DAVF, while two other case reports described intracranial SAH secondary to lumbar and thoracic DAVF, respectively. We report a 61-year-old Chinese man with intracranial SAH secondary to thoracic DAVF aneurysm, who presented with sudden, severe chest pain, initially suggestive of aortic dissection/acute myocardial infarction. However, a careful examination of the history and physical signs, followed by appropriate and timely investigations enabled effective treatment to be administered promptly with a good outcome. This serves to illustrate the importance of investigating the entire cerebrospinal system when neurological symptoms and clinical signs suggest extracranial primary pathology.

A case of mistaken identity: intracranial foreign body reaction after AVM embolisation mimicking a glioma.

Intracranial foreign body granulomas are exceedingly rare. We present the case of an intracranial foreign body granuloma found in a 72-year-old male 10 years after he underwent a successful catheter embolisation of a cerebral arteriovenous malformation (AVM). The patient presented to our unit after a fall. He had symptoms of confusion, change in mental status and expressive dysphasia. On initial inquiry, the patient had no past medical history of note. Plain brain CT showed a space-occupying lesion in the left frontal lobe with calcifications suggesting an oligodendroglioma. MRI of the brain revealed a heterogeneously enhancing lesion with cystic-solid areas. The patient underwent a craniotomy and excision of the tumour. A pathological examination of the specimen confirmed that it was a foreign body granuloma. Upon further probing into the patient's past medical history, his family recalled prior treatment many years ago at another institution. The old records revealed that the patient had undergone catheter embolisation of a frontal lobe AVM 10 years previously. A MEDLINE literature search (1980-2005) revealed a handful of case reports describing intracranial foreign body granulomas secondary to previous intracranial procedures. Although rare, foreign body granulomas should be included in the differential diagnosis of patients who have undergone prior neurosurgical procedures and then present with a space-occupying lesion on imaging.

Hypertension-induced reversible posterior leukoencephalopathy syndrome causing obstructive hydrocephalus.

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, altered mental status, abnormal visual perception and seizures. It is associated with neuroradiological findings characterized by reversible white matter abnormalities, predominantly in the parietal-occipital areas. Since the first description in 1996, it has been recognized in an increasing number of medical conditions, including hypertensive encephalopathy, eclampsia, and immunosuppressive treatment. The rapid resolution of clinical and neuroradiologic abnormalities suggests cerebral oedema, which is thought to result from impaired cerebrovascular autoregulation and endothelial injury. We report a patient presenting with acute onset progressively worsening headache and confusion associated with uncontrolled hypertension. CT and MRI revealed acute non-communicating hydrocephalus secondary to cerebellar and pontine oedema. The patient became drowsy, so an external ventricular drain was inserted for decompression of the acute hydrocephalus, and his blood pressure was aggressively managed. The patient recovered well with complete clinical and radiological resolution. This case illustrates the reversibility of RPLS if it is diagnosed early and appropriate treatment is instituted.

Decreased access to health care and social isolation among young adults with cerebral palsy after leaving school.

OBJECTIVE: To examine if leaving special schools has a negative impact on the health care and social isolation of young adults with cerebral palsy. METHODS: Young adults with cerebral palsy, aged between 15 and 22 years, were divided into 2 cohorts: current students, who were still receiving services from special schools, and school-leavers, who had since been discharged from care. A questionnaire and physical examination were administered to assess the extent of disability, health care received by, and social isolation of these young adults. RESULTS: School-leavers had a greater degree of dissability than did students, although the results were not statistically significant. Health care exposure to specialists, general practitioners, therapists physiotherapists, occupational therapists, and/or speech therapists), and medical social workers decreased after leaving school; with the exception of contact with general practitioners, these results were significant (p<0.05). The entire cohort was more socially isolated than a control cohort. School-leavers participated in fewer activities outside their homes, but showed less concern about their disability than did current students. CONCLUSIONS: Young adults with cerebral palsy continue to have health care and lifestyle needs after leaving school, which are currently not being adequately met.