RESUMO
Chronic inflammatory lesions (CIL) in the body are rare and inflammatory pseudotumor (IPT) is a subtype of CIL. Spine is an uncommon location of CIL, with most cases reported in the thoracic spine. Our objective was to review the current literature on IPT. To the best of our knowledge only about 13 cases are reported till date. A retrospective review of 13 existing cases was done. The etiopathogenesis of CIL is uncertain and total surgical excision remains the mainstay. It's a diagnosis of exclusion after ruling out commonly found lesions, both clinically and radiologically. Only histopathology can confirm the diagnosis. Total surgical resection remains the mainstay of treatment with adjuvant treatment only if there is a residue or a recurrence. CILs are rare lesions in the body with IPT being the commonest. Surgical excision remains the mainstay of treatment and a long-term follow up is warranted.
Assuntos
Vértebras Torácicas , Humanos , Vértebras Torácicas/patologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/cirurgia , Granuloma de Células Plasmáticas/patologia , Granuloma de Células Plasmáticas/diagnóstico por imagem , Feminino , Masculino , Espaço Epidural/patologia , Espaço Epidural/diagnóstico por imagem , Adulto , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
Cerebral phaeohyphomycosis (CP) is a rare but a highly morbid fungal infection of the central nervous system caused by the fungi belonging to the order Chaetothyriales, which includes Cladophialophora bantiana, Exophiala dermatitidis, Rhinocladiella mackenziei (RM) etc. This disease is associated with poor clinical outcomes, with reported mortality of over 80%. We present the case of a 65-year gentleman who developed CP secondary to RM infection following COVID-19 and the associated challenges in his medical and surgical management.
Assuntos
COVID-19 , Infecções Fúngicas do Sistema Nervoso Central , Feoifomicose Cerebral , Micoses , Humanos , Feoifomicose Cerebral/diagnóstico , Feoifomicose Cerebral/tratamento farmacológico , Feoifomicose Cerebral/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Micoses/tratamento farmacológico , Antifúngicos/uso terapêuticoRESUMO
BACKGROUND: Giant intracranial aneurysms (GIAs) are treacherous lesions and in spite of the many advances, endovascular therapy (EVT) of GIAs is challenging. OBJECTIVE: A retrospective analysis of our results with microsurgery of GIAs is presented to examine the role of microsurgery in the current trend of EVT. MATERIALS AND METHODS: Between 1996 and 2019, 134 patients with 147 GIAs had microsurgery by the senior author in a single institute. The medical and imaging records for all the patients were reviewed. The patient outcome was determined by modified Rankin scale (mRS); ≤3 was considered as a good outcome. Statistical analysis was done using the SPSS program and odds ratios and their 95% confidence intervals were computed; a probability value of < 0.05 was considered significant. RESULTS: There were 123 aneurysms (83.7%) in the anterior circulation and 24 aneurysms (16.3%) in the posterior circulation. Overall 103 out of 134 (76.8%) patients had a good outcome postoperatively. Good preoperative mRS score (≤3) had an overall good prognosis in the postoperative period and was statistically significant (P = 0.000, odds ratio: 0.036, 95% CI: 0.008-0.171). Presence of subarachnoid hemorrhage (SAH) was also statistically significant for good outcome (P = 0.04, odds ratio: 2.898, 95% CI: 1.051-7.991), but age was not a significant prognostic factor. Mortality within 30 days of treatment was 4.47%. CONCLUSION: GIAs need treatment because of their dismal natural history. Results of microsurgical treatment by a single surgeon of the large current series compare well with the results of EVT and justifies pursuing microsurgery for GIAs.
Assuntos
Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Aneurisma Intracraniano/cirurgia , Microcirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Contralateral ear hearing loss (CHL) is an extremely rare but a potentially devastating complication in a patient with already compromised hearing due to a Vestibular schwannoma (VS). Our patient had CHL accompanied by contralateral facial palsy. Our case is only the second case reported in literature to the best of our knowledge. PRESENTATION OF CASE: A 55-year elderly male presented with right sided sensorineural hearing loss, cerebellar signs and Grade II House & Brackmann (H&B) facial nerve weakness for last1-year. Magnetic resonance imaging (MRI) scan revealed a large right sided vestibular schwannoma (VS) with severe compression of the ipsilateral pons. The pre-operative pure tone audiometry (PTA) documented severe sensory neural hearing loss (SNHL) on the right side along with mild SNHL on the left side. A right retromastoid suboccipital craniotomy was performed and VS was completely excised. The ipsilateral facial nerve was preserved anatomically. On the 4th post-operative day he developed severe pain and tinnitus in left ear. In the next 24-h there were hearing loss and grade II facial nerve paresis. The PTA done on the 5th post-operative day revealed severe SNHL on both sides. He was managed conservatively with steroids and vasodilators. At 6-months of follow-up the left side hearing loss and facial weakness had significantly recovered. The PTA showed significant improvement in the left side SNHL DISCUSSION: Contralateral hearing disturbance with contralateral facial palsy after acoustic neuroma surgery is extremely rare. The exact etiopathogenesis of this unusual phenomenon is not clear and various theories have been proposed. There is no standard recommendation for treatment of these rare complications and the etiology remains obscure. CONCLUSION: Hearing loss and facial palsy on the contralateral side after VS surgery is extremely rare. It is imperative that this rare complication should be considered following VS surgery.
RESUMO
Petrous apex cephalocele (PAC) is a rare condition with very few case reports in the literature. We report a 26-year-old man with cerebrospinal fluid rhinorrhea that was misdiagnosed elsewhere and operated unsuccessfully via the endonasal route. CT cisternography revealed a 3mm right PAC for which he underwent a right subtemporal extradural approach and successful repair. We present what is to our knowledge the first case report in the literature of an adult presenting with cerebrospinal fluid leak and discuss the diagnostic dilemmas in the diagnosis of PAC, difficulties in management and review the available literature.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/etiologia , Encefalocele/complicações , Encefalocele/diagnóstico , Adulto , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Erros de Diagnóstico , Encefalocele/cirurgia , Humanos , Masculino , Osso PetrosoRESUMO
Spinal glioblastoma multiforme is a rare entity comprising 1.5% of all spinal cord tumors. We report a 57-year-old man presenting with a 1.5 month history of left sided radiculopathy, lower cranial nerve weakness and difficulty in walking. MRI of the brain and spine showed an exophytic intramedullary lesion extending from the cervicomedullary junction to the lower margin of C4. To our knowledge, we report the first patient with dorsally exophytic cervicomedullary and cervical intramedullary glioblastoma multiforme.
Assuntos
Neoplasias Encefálicas/patologia , Glioblastoma/patologia , Neoplasias da Medula Espinal/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Diagnóstico Diferencial , Evolução Fatal , Glioblastoma/diagnóstico , Glioblastoma/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Bulbo/patologia , Pessoa de Meia-Idade , Medula Espinal/patologia , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/terapiaRESUMO
Cervical intradural disc herniation (IDH) is a rare condition with very few case reports in the literature. We report a 64-year-old man who presented with sudden onset neck pain and rapidly progressing weakness in the left upper and lower limb. There was no history of trauma. MRI of the cervical spine showed a C6-C7 disc prolapse, for which he underwent a C6-C7 discectomy and fusion with bone graft through an anterior cervical approach. To our knowledge, all patients with a cervical IDH reported in the literature have a traumatic etiology. To the best of our knowledge, we report the first patient with a spontaneous cervical IDH.