Primary Calvarial Lymphoma: A Case Report.

Calvarial lymphoma is radiologically similar in many respects to meningiomas, solid fibrous tumours, osteomyelitis, and metastatic carcinomas. Even though it is an extremely rare phenomenon, the initial suspicion and detection of calvarial lymphoma are paramount to establishing a correct diagnosis which helps to determine an appropriate management strategy. We present an illustrative rare case of primary calvarial lymphoma along with a literature review focusing on the best management strategy for this rare entity. A 45-year-old female presented to our center in March 2022. She had a history of forehead swelling, which was progressively increasing in size over time. The metastatic workup and bone marrow biopsy were negative. Initially, extensive surgery was planned to resect the lesion, but after a discussion with the multidisciplinary team, a biopsy of the lesion was taken, which revealed a large B-cell lymphoma. It is prudent to consider calvarial lymphoma in the differential diagnosis of a progressively growing skull lesion, which may obviate the need for large resective surgery. A biopsy plus chemoradiation may be all that is required.

Spinal adhesive arachnoiditis after spinal anesthesia complicated by communicating hydrocephalus - A case report.

Background: Adhesive arachnoiditis (AA) is a debilitating condition characterized by chronic inflammation of the arachnoid membrane, leading to the formation of intrathecal scars and dural adhesions. The etiology of AA is multifactorial, including factors such as infections, trauma, and iatrogenic damage. We present a case of a female patient who developed communicating hydrocephalus after spinal anesthesia complicated by severe AA. Case Description: A 33-year-old female underwent a cesarean section with epidural anesthesia. Five hours postoperatively, she experienced transient difficulty standing, which was resolved with assistance. Weeks later, she developed a severe holocephalic headache accompanied by nausea, vomiting, photophobia, and phonophobia. Imaging revealed hydrocephalus and pronounced AA. Lumbar puncture provided symptomatic improvement. The patient underwent ventriculoperitoneal shunt insertion, resulting in further symptom improvement and successful shunt function. Conclusion: AA is a challenging condition associated with inflammation and scarring of the arachnoid membrane. The development of hydrocephalus following epidural anesthesia, in this case, highlights a rare manifestation of arachnoiditis. Further research and documentation are needed to understand better the underlying mechanisms and risk factors contributing to hydrocephalus in the context of AA following epidural anesthesia.

A case report of an unusual cerebral hydatid cyst.

Background: Intracranial hydatid cyst is an exceedingly uncommon condition. Typically, it manifests as hydatid cysts in the liver, lungs, kidney, and spleen. In this report, we present a rare case of a hydatid cyst located in the brain, exhibiting atypical radiological characteristics, and successfully treated with complete microsurgical excision. Case Description: A 45-year-old male, a former smoker, presented with a new-onset seizure. Brain imaging revealed a solitary, intra-axial, and cystic lesion with wall enhancement in the right temporal region. The cyst extended into the temporal horn of the right lateral ventricle, surrounded by mild edema. Differential diagnoses included brain metastasis, abscess, and tuberculoma. However, following computed tomography (CT) scans of the chest, abdomen, and pelvis (CAP) and serological tests, the provisional diagnosis included a hydatid cyst. The CT CAP showed diffuse non-specific cystic lesions of variable sizes in the liver and spleen, along with numerous bilateral pulmonary cysts. A right temporal craniotomy was performed, and the cyst was microsurgically excised without rupture. Microscopic and histopathological examination confirmed the presence of a hydatid cyst. Conclusion: Intracranial hydatid cyst is an extremely rare condition and should always be considered a possible differential diagnosis in cases of cerebral cystic lesions. Hydrodissection is the preferred surgical method for resection; however, in atypical cases such as the one described here, meticulous dissection of the cyst capsule from the brain parenchyma may be successful with minimal risk of intraoperative rupture.

Posterior Reversible Encephalopathy Syndrome Following Intracranial Hypotension Due to Cerebrospinal Fluid (CSF) Leakage: A Report of Two Cases.

Posterior reversible encephalopathy syndrome (PRES) in cases of intracranial hypotension is a life-threatening condition. Early suspicion, appropriate treatment, and tight control of possible contributing factors that may facilitate PRES in cerebrospinal fluid (CSF) leak patients may bring a more favorable outcome, lowering the morbidity and mortality rate. Two cases of PRES with features of intracranial hypotension are presented. We also discussed the possible pathogenesis of PRES in patients with intracranial hypotension. We emphasize the importance of the early diagnosis and treatment of ICH by repairing the leakage and further prompt attention to tight blood pressure control in those patients to avoid PRES development.

Pneumocephalus resulting from chest infection complicated by pleural-subarachnoid fistula.

Pleural-subarachnoid fistula is a rare type of Cerebrospinal fluid fistula with less than 60 cases reported in the literature. Here we present a case of 55-year-old female patient, known case of acute myeloid leukemia on chemotherapy, who developed pleural-subarachnoid fistula due to invasive atypical apical lung fungal infection. All of the reported cases in the literature were secondary to trauma or post-surgery. To our knowledge, this is the first reported case of pleural-subarachnoid fistula developed as sequela of fungal infection.

Intrasellar cavernous hemangiomas: A case report with a comprehensive review of the literature.

BACKGROUND: Extra-axial cerebral cavernous hemangiomas particularly those found in the sellar region, are extremely rare. Their clinical manifestations and imaging characteristics can mimic those of a pituitary adenoma thus making preoperative diagnosis difficult. Few cases are reported in the literature. We present a case, along with a comprehensive review of the literature regarding specific aspects of diagnosis and management of all similarly reported rare cases. CASE DESCRIPTION: We present the clinical, radiological, and operative data of a rare case of a large intrasellar cavernous hemangioma in a 49-year-old female patient presented with headache and diminution of vision, which was diagnosed intraoperatively during an endonasal endoscopic transsphenoidal approach. Subtotal debulking was performed with immediate postoperative clinical improvement. The patient was then referred for radiotherapy and maintained her clinical improvement since then. CONCLUSION: Neurosurgeons should consider this rare pathology in the preoperative differential diagnosis of sellar tumors. Bright hyperintense T2 signal with or without signal voids associated with centripetal delayed contrast enhancement in magnetic resonance imaging images might raise the suspicion which can be further confirmed intraoperatively with frozen sections. Due the reported high vascularity and intraoperative profuse bleeding leading to high operative morbidities, piecemeal subtotal resection followed by radiosurgery may be considered today as the safest and most effective strategy.

Atypical haemorrhagic colloid cyst: 2 case reports surgical management and review of literature.

INTRODUCTION: Colloid cysts are benign cystic lesions located at the anterior part of the third ventricle mostly at the foramen of Monro and contain colloid material. Hemorrhage in a colloid cyst is exceedingly rare. Only 15 clinically diagnosed cases of haemorrhagic cysts were reported in the literature and 5 more cases on autopsy. Here we report two rare cases of a haemorrhagic colloid cyst describing the atypical radiological findings, the undertaken surgical procedures and histopathological results. PRESENTATION OF CASES: We presented 2 cases of haemorrhagic third ventricle colloid cysts. First case is a 27-year-old male patient, presented with dizziness, nausea, vomiting and blurring of vision. He was operated by transcortical endoscopic transventricular excision of a third ventricular cyst and the insertion of external ventricular drain. The second patient is a 21-year-old male, presented with history of worsening headache for 1 month associated with blurring of vision. The patient had a transcortical microscopic, transventricular cyst excision. DISCUSSION: Many questions regarding the best way to diagnose and manage such lesions remain unanswered. Hence, we summarize the relevant diagnostic images and best surgical techniques. CONCLUSION: We concluded that, though exceedingly rare, colloid cyst can bleed and cause rapid deterioration in neurological status, thus, presence of atypical features should alert the physicians to consider atypical colloid cyst that would be valuable in surgical decision making whether endoscopic or microscopic.

A Saudi Patient with an Interstitial Deletion of Short Arm of Chromosome 3 (p13 to p21) and its Association with Joubert's Syndrome Features.

We report a case of 4 weeks old girl with a de novo interstitial deletion of the short arm of chromosome 3 (p13-p21) and clinical findings typical of proximal 3p deletion together with heart defects, choanal atresia, ear anomalies, central nervous system anomalies, renal anomalies and associated Joubert's syndrome (JS). Family history is unremarkable and parenteral chromosomes were normal. The clinical manifestations of the patient are compared with those of 11 patients previously described with a proximal 3p deletion. The additional JS features associated with this syndrome were described. This is the first case report in English literature describing 3p deletion associated with additional JS features.