Acute presentation of Chiari malformation type I in adulthood with arm swelling, a case report and literature review.

INTRODUCTION: Chiari malformation type I (CM-I) with cervicothoracic syringomyelia can progress slowly this condition which is very common in clinical practice, particularly in children. CASE PRESENTATION: Patients typically present with chronic complaints, including headache, dizziness, and numbness, although are few reports in the literature describing pediatric patients who developed acute neurological deficits caused by CM-I. Here, we report an unusual presentation of this condition; the patient presented with sudden onset arm swelling with no precipitating factors that could explain the diagnosis. DISCUSSION: This is an illustrated case report and literature review. The patient's condition improved post-operatively; in terms of arm and hand swelling which resolved, but he still complained of persistent numbness on a follow-up visit.

Unusual presentation of a giant thoracic spinal cord lipoma.

INTRODUCTION: Non-dysraphic intradural spinal cord lipomas are rare, and true intramedullary cervical-thoracic lipomas are extremely rare. Spinal lipomas usually present with chronic, progressive myelopathic features. Unlike dysraphic lipomas, which are usually located in the lumbo-sacral region, non-dysraphic lipomas are usually located in the cervical or thoracic spine. CASE PRESENTATION: We present an unusual case of a 21-year-old female who presented with four months of severe back pain, progressive spasticity, and weakness in the lower limbs. Magnetic resonance imaging (MRI) revealed a T1- and T2-hyperintense lesion between D4 and D6. DISCUSSION: This fatty intramedullary lesion had undergone evolution and a possible hemorrhagic infarct and cord compression. The patient underwent an urgent dorsal laminoplasty and total resection of this lesion, which histopathology indicated was a fibrous lipoma. Total resection is possible in such cases if a micro-surgical technique that includes neurophysiological monitoring is used.

Phenytoin Seizure Prophylaxis Therapy Resulting in Severe Thrombocytopenia After Brain Tumor Debulking Surgery.

BACKGROUND Phenytoin is an antiepileptic drug that is usually prescribed as a prevention treatment for tonic-clonic seizures or partial seizures, and as a prophylaxis for the neurosurgical related seizures. Phenytoin administration has several drawbacks; one drawback phenytoin-induced thrombocytopenia, which is a rare and significant adverse event. We report a rare adverse event after phenytoin prophylaxis therapy after a brain tumor debulking surgery, which resulted in severe unpredicted thrombocytopenia. CASE REPORT A 40-year-old male with no known health problems started to have an on/off headaches and loss of memory. Clinical investigations revealed a right frontal brain lesion. On the first day of admission, the patient was managed on neurosurgical seizure prophylaxis therapy of 100 mg intravenous phenytoin every 8 hours and 4 mg oral dexamethasone every 6 hours. On the fifth day of hospital admission, the patient underwent tumor debulking surgery. Twenty-four hours post-surgery, the patient's platelet level dropped to 26×109/L. Severe thrombocytopenia was managed first by transfusion of 17 units of platelets and by cessation of intravenous phenytoin plus the starting of 500 mg levetiracetam orally twice daily. Further management included infusion of 34 grams (0.4 g/kg) intravenous immunoglobulin (IVIG) over 5 days. Five days later, the patient gradually recovered with a platelet count of 239×109/L. CONCLUSIONS Phenytoin-induced thrombocytopenia is considered a rare event, but it has life-threatening consequences. The first and cornerstone management of this event is the cessation of phenytoin, followed by consideration of appropriate management based on the level of thrombocytopenia severity, and avoiding concomitant therapy of phenytoin and the use of dexamethasone as neurosurgical-related seizure prophylaxis.

Spinal arachnoid web-a review article.

The spinal arachnoid web is an abnormal formation of an arachnoid membrane in the subarachnoid space. It is a rare entity with some degree of uncertainty surrounding its etiology. It can result in a displacement of the spinal cord causing pain and neurological symptoms as well as blockage of cerebrospinal fluid (CSF) flow and subsequent syringomyelia. The syrinx resulting from the altered CSF flow dynamics has been described to assume variable positions relative to the web itself. The "scalpel sign" is regarded as a pathognomonic feature of a spinal arachnoid web. The arachnoid web, however, is relatively thin and may be elusive of routine radiological investigations. As such, a myriad of preoperative and intraoperative investigations have been postulated to improve the sensitivity of detecting this abnormality. Management of spinal arachnoid webs ranges from conservative management to surgical excision where in the latter, the extent of excision remains the subject of debate. The authors herein present a review of the available information on this rare topic.