Atypical Bourneville sclerosis without epilepsy and mental retardation: case report and literature review.

Twenty-four-year-old woman without familiar detected signs of Bourneville's disease or tuberous sclerosis complex (TSC) was diagnosed with this disease by casual discovery on cerebral magnetic resonance imaging (MRI) of an intraventricular tumor, after symptoms consist in headache, equilibrium disturbances, and progressive loss of vision. MRI shows an intracranial mass, 33÷24÷30 mm in size, localized at the level of third ventricle and lateral ventricles, with irregular shape, interesting the foramen of Monroe. There are also nodular areas of calcification and a supratentorial hydrocephalus involving the lateral ventricles and the posterior part of the third ventricle. The patients present facial angiofibromas, but from the classical triad of the disease, the epilepsy and mental retardation were absent, the patient never presented seizures. The total removal of the tumor (peace to peace) was performed surgically, the macroscopic features of resected tumor (20/10/10 mm) was of white-gray color, elastic consistency, localized in the both lateral ventricles (left>right) and into the third ventricle, traversing the foramen Monroe. The histopatological examination associated with specific localization of tumor and the facial angiofibromas are very suggestive for subependimar giant cell astrocytoma (SEGA). We have a rare case of atypical or incomplete TSC in which the epileptic seizures and the mental retardation are absent, the intelligence is normal, but occur some psychical symptoms: anxiety, sleeplessness, and autism or behavior disturbances. The evolution of this case was marked by complications because of postoperative hydrocephalus and multiple shunt insertions and revisions were performed after the tumor resection.

Giant wing sphenoid meningioma with principal manifestation depression.

UNLABELLED: A 68-year-old woman with no previous mental illness presented with a three-month history of decreased energy, fatigue, feelings of hopelessness, pessimism, difficulty concentrating, and persistent feelings of "emptiness", worthlessness, insomnia, appetite loss, diminished functionality. The patient's neurological examination was normal. She was diagnosis with major depressive disorder (MDD) by Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria and received psychiatric treatment. Resistance at therapy leaded at cerebral axial computed tomography (CT) indication. Cerebral CT-scan revealed an intracranial expansive mass (EPIC) located in frontal-temporal (F-T) right lobe, size 42/45/66 mm, hyperdense lesion, without peri-lesional edema, inserted on the great sphenoid wing, image suggestive for meningioma. MRI confirmed the presence of tumor and angiography showed the arterial source of the meningioma. The neurosurgical intervention removed successfully the tumor. Grossly examination revealed a giant tumor with a maximal diameter of 7 cm. The histological aspect of the tumor was highly representative for the diagnosis of meningioma. Patient mental status was evaluated at baseline, in preoperative period and postoperative period and had been using Hamilton Depression Rating Scale (HDRS) - 17 items version, Clinical Global Impression Scale (CGI), and Global Assessment of Functioning (GAF). After neurosurgical intervention, functioning was improving with completed remission of depression symptoms at six-month postoperative evaluation. CONCLUSION: Most meningiomas are slow growing and many are found incidentally. The decision to perform a cerebral CT-scan depends on the clinician's degree of suspicion that a tumor is present. A first depressive episode is a clinical condition with principal indication for cerebral CT-scan.

Orbital hydatid cyst in childhood: a report of two cases.

Intraorbital hydatid disease (IHD) is quite rare and represents < 1% of the Echinococcus cases. In our current communication, we report two children with solitary, primary intraorbital hydatid cysts. Both children presented with nontender, nonpulsatile proptosis. Imaging workup, including CT and MRI scans of the head and the orbits, revealed a retro-bulbar cyst in both patients. Surgical resection was performed by employing a fronto-temporo-orbito-zygomatic (FTOZ) approach. Accidental intraoperative rupture occurred in one case with no further consequences. Albendazole was postoperatively employed for 12 weeks. Outcome was excellent in both cases with complete resolution of their symptoms and complete visual recovery. Pertinent literature was reviewed with this opportunity.

Intradural dermoid tumor of the posterior fossa in a child with diastematobulbia.

Dermoid tumors (DTs) are rare lesions and represent 0.3% of all intracranial tumors. More than 50% of these tumors are diagnosed in childhood or early adolescence. Authors report an intradural DT of the posterior fossa in a child aged 4 years, possibly originating in the brainstem in which the diastematobulbia was detected postoperatively. Magnetic resonance imaging investigations are mandatory to diagnose these cases. The only curative treatment in DT is the total removal of the lesion. The reported case presents good recovery in the follow-up period of 3 years. The surgical intervention is particularly related to the DT type. Diastematobulbia associated with DT and the origin of the DT in the brainstem is discussed based on the literature.

[Predictive value of diagnostic tests in polytrauma patients with abdominal and craniocerebral injuries]. / Valoarea predictiva a testelor de diagnostic la politraumatizatii cu leziuni abdominale si cranio-cerebrale.

In a study on 1024 polytrauma patients with craniocerebral injury, abdominal injury was present in 206 (20.11%) of them. In order to identify the intraabdominal organs injury, physical examination and specific diagnostic tests will be used. Their value was calculated by means of informational indices. The main indices, sensitivity, positive predictive value and accuracy were: for physical examination = 81.06%, 90.3%, 94.72%; for peritoneal lavage = 94.17%, 95.12%, 97.94%; for abdominal computed tomography = 98.44%, 97.65% and 99.25%. As one might expect the abdominal computed tomography is the most accurate method for the diagnosis of intraabdominal organs injuries.

Posterolateral approach in the treatment of unstable vertebral body fractures of the thoracic-lumbar junction with incomplete spinal cord injury in the paediatric age group.

OBJECTS: Our retrospective study was carried out to demonstrate the value of, indications for, and results of use of the posterolateral approach (PLA) with decompression and instrumental stabilisation in paediatric patients with unstable vertebral body fractures at the thoracic-lumbar junction. METHODS: Fourteen patients aged 7-14 years were operated on from 1990 to 2000. All these patients were admitted with unstable vertebral body fractures at the thoracic-lumbar junction with incomplete spinal injuries and were operated on within 24 h after sustaining the trauma: a PLA was used to achieve unilateral or bilateral spinal canal decompression and instrumental stabilisation with the Cotrel-Dubousset instrumentation. RESULTS: A good neurological recovery was noted in 13 patients (4/13 Frankel D and 9/13 Frankel E) during 1 year of follow-up. The postoperative anterior-posterior diameter of the spinal canal was evaluated by percentile referred to an average value between the measurements at the superior and inferior levels. The radiographic control estimated the vertebral alignment. An important tendency to hyperkyphosis in 1 patient necessitated surgical correction after 1 month in the interests of a good vertebral alignment. CONCLUSIONS: The PLA makes if possible to define a proper surgical corridor to accomplish all surgical goals in the treatment of spinal fractures in children: decompression, spinal alignment and stabilisation minimising the surgical stress, that are essential in paediatric surgery. It allows early mobilisation and an early start on the rehabilitative treatment, which is very important in children and is difficult to reconcile with bracing and a long period of bed rest as recommended for conservative treatment.