Primary CNS vasculitis masquerading as glioblastoma: A case report and review.

Isolated angitis of the central nervous system (IACNS)/primary angitis of central nervous system vasculitis (PACNS) is an uncommon vascular disease, sparingly presenting as an isolated inflammatory lesion on magnetic resonance imaging (MRI). The disease usually manifests as a long-drawn and progressive ischemic event. Delay in diagnosis due to focal nature of the lesion also contributes to the poor prognosis as the dismal natural history and immunosuppressive therapy. To date, only a few cases with tumor-like isolated angitis of CNS have been reported with clear and definitive diagnostic workup.

A rare case of congenital glioblastoma with atypical presentation in an eleven month-old infant: Case report with review of literature.

Glioblastoma multiforme (GBM) is the most common and malignant primary brain tumor in adults. The occurrence of this entity in infants is a rarity and portends a uniform dismal prognosis and survival in spite of all the latest available management options. The authors herein report a case of a GBM in an 11 month-old infant with tumor involving predominantly the left temporal and frontal regions who expired 10 weeks after tumor decompression. Literature and available management options have been reviewed in the context of the presented case.

Pre-operative and post-operative psychiatric manifestations in patients with supratentorial meningiomas.

OBJECTIVES: In the present study, we have tried to delineate the nature of psychiatric abnormalities caused by supratentorial meningiomas and the effect of surgery on them. We have tried to find the patient and tumor characters influencing the psychiatric abnormalities and their post-operative outcome. MATERIALS AND METHODS: This is a prospective study conducted on patients with supratentorial meningiomas, admitted and operated in neurosurgery department, Nizam's Institute of Medical Sciences, India, from July 2006 to July 2009. We have included fifty-seven patients aged between 15 and 65 years with a clinico-radiological diagnosis of supratentorial meningioma in our study. We later confirmed the diagnosis by histopathological examination of the tumor. We have evaluated the patients for psychiatric manifestations before and after surgery and also analyzed the various clinical and radiological factors influencing the psychiatric status. RESULTS: We have enrolled 57 patients into the study. Frontal group had 22 patients (38.6%), parietal group had 10 patients (17.5%), temporal group had 10 patients (17.5%), occipital group had 6 patients (10.5%), and suprasellar group had 9 patients (15.8%). Twenty patients (35.1%) presented with psychiatric symptoms. The frequency of psychiatric symptoms was highest in the temporal group (60%) followed by the frontal group (45.5%). Frontal convexity meningiomas presented predominantly with depression, basifrontal and sphenoid wing meningiomas presented with mania or depressive symptoms, Suprasellar lesions and temporal convexity lesions presented with organic delusional disorder. Basifrontal meningiomas also caused organic personality disorders. The frequency of psychiatric symptoms was much higher in meningiomas with volume greater than 35cc compared to the smaller ones, in the frontal group. None of the patients developed new psychiatric symptoms after surgery. Among the twenty patients with psychiatric symptoms, 3 (15%) didnot improve, 8 (40%) improved partly and 9 (45%) improved completely. CONCLUSIONS: Meningiomas, although extra-axial, cause significant psychiatric symptoms up to 35.1%. Frontal and temporal group of meningiomas have the highest frequency of psychiatric symptoms. The frequency of psychiatric symptoms was significantly higher in meningiomas with volume greater than 35cc compared to the smaller ones, in the frontal group. Surgical excision of meningiomas ameliorates the psychiatric symptoms, either completely or partly, in the majority of the patients.

Pre-operative and post-operative cognitive deficits in patients with supratentorial meningiomas.

OBJECTIVES: Cognitive deficits caused by extra-axial benign brain tumors like meningiomas and the course of these deficits after surgery is not well known. The aim of the study is to assess the pre-operative and post-operative cognitive functions in patients with meningiomas in the supratentorial compartment. MATERIALS AND METHODS: In this prospective study, patients with clinico-radiological diagnosis of supratentorial meningioma, operated upon and later confirmed by histopathological examination, were included. The patients were evaluated for cognitive deficits before and after surgery. The various clinical and radiological factors influencing the cognitive status were evaluated. RESULTS: A total of 57 patients were enrolled into the study. Out of 57, 22 were males and 35 were females. The frontal group had 22 patients, the parietal group had 10 patients, the temporal group had 10 patients, the occipital group had 6 patients, and the suprasellar group had 9 patients. Meningiomas, although extra-axial, caused significant cognitive deficits in 42 patients (73.7%). The highest frequency of cognitive deficits is seen in the frontal and temporal group of meningiomas (90% each). Frontal meningiomas with volume greater than 35 cc and peritumoral edema greater than 40 cc caused a higher frequency of cognitive deficits. Also, patients with raised ICP had significant cognitive deficits. Postoperatively there was a significant improvement in the cognitive functions in the frontal and temporal groups. CONCLUSION: Meningiomas cause cognitive deficits in 73.7% of patients. Anatomical location of meningioma, elevated ICP, the volume of meningioma and extent of peritumoral edema significantly influence the incidence of cognitive deficits. Post-operatively, the cognitive deficits improve significantly in the frontal and temporal group.

Suprasellar Arachnoid Cyst with Spontaneous Intracystic Hemorrhage: A Rare Complication - Role of MR and Illustration of a Case.

BACKGROUND: Arachnoid cysts are congenital or developmental intra-arachnoidal CSF-filled lesions, which develop probably as a result of splitting or duplication of the arachnoid membrane. Most of them are asymptomatic and are detected as incidental findings on Computed Tomography or Magnetic Resonance Imaging of the head carried out for other reasons. Although complications such as intracystic, subdural, and extradural hematomas are well known after a trauma, spontaneous hemorrhage in an arachnoid cyst is a rare and serious complication with atypical imaging features on cross-sectional imaging and only less than ten cases are documented in the literature till date, with none of them in the suprasellar location. CASE REPORT: A 40-year-old female patient presented with history of headache since two months, which was sudden in onset, holocranial. CONCLUSIONS: Spontaneous intracystic hemorrhage is an uncommon and serious complication of arachnoid cysts, which can give rise to atypical features on imaging. Therefore familiarity with this rare complication is indeed essential.

Outcome of supratentorial intraaxial extra ventricular primary pediatric brain tumors: A prospective study.

INTRODUCTION: Tumors of the central nervous system (CNS) are the second most frequent malignancy of childhood and the most common solid tumor in this age group. CNS tumors represent approximately 17% of all malignancies in the pediatric age range, including adolescents. Glial neoplasms in children account for up to 60% of supratentorial intraaxial tumors. Their histological distribution and prognostic features differ from that of adults. AIMS AND OBJECTIVES: To study clinical and pathological characteristics, and to analyze the outcome using the Engel's classification for seizures, Karnofsky's score during the available follow-up period of minimum 1 year following the surgical and adjuvant therapy of supratentorial intraaxial extraventricular primary pediatric (SIEPP) brain tumors in children equal or less than 18 years. MATERIALS AND METHODS: The study design is a prospective study done in NIMS from October 2008 to January 2012. All the patients less than 18 years of age operated for SIEPP brain tumors proven histopathologically were included in the study. All the patients with recurrent or residual primary tumors or secondaries were excluded from the study. Post operative CT or magnetic resonance imaging (MRI) is done following surgery. RESULTS AND ANALYSIS: There were 2, 8 and 20 patients in the age range of 0-2 years, >2-10 years and 10-18 years, respectively. There were 21 male patients and 9 female patients. Out of 30 patients, 16 had lesion in the temporal lobe, 6 in frontal lobe, 4 in thalamus, 3 in parietal lobe and 1 in occipital lobe. Out of 30 patients, 11 patients had malignant lesions and nineteen patients had benign lesions. Gross total excision could be achieved in 19 patients and subtotal in 11 patients. Seven patients had mortality and four of the remaining 23 patients had increased deficits postoperatively. Remaining 19 patients either improved or remained same. CONCLUSIONS: SIEPP brain tumors have male preponderance, occur in 95% of patients in the age range of 7-18 years and have temporal lobe as the most common site of origin. The seizure presentation has good outcome compared to raised intracranial pressure features. The seizure control is quite good irrespective of subtotal or gross total excision in temporal lobe low grade tumors. All PNETs have survival of less than 1 year even with adjuvant chemo and radiotherapy.

Neglected primary Ewing's sarcoma of ethmoid presenting as surgical emergency.

We present a male child with primary Ewing's sarcoma arising from ethmoid sinuses with intradural and extracranial extension (bilateral nasal cavities, orbits, and maxillary sinuses). This is a rare condition. He presented with recurrent episodes of epistaxis for 2 years, sudden onset rapidly progressive bilateral proptosis, with painful restriction of extraocular movements, and decreased visual acuity for 4 days. Sudden complete loss of vision following admission demanded emergency tumor decompression.