Glomus tumor closely related to a branch of the left sural nerve: a case of a rare lesion occurring at unusual location.

Glomus tumors are rare benign neoplasms arising from the glomus bodies of the skin; they account for 1.6 % of all soft tissue tumors. Since the great majority of these lesions are found on fingers and toes (especially under the nail, on the fingertip, or in the foot), a correct clinical diagnosis may prove difficult if one or more glomus tumors occur on an extra digital location. We report a case of a glomus tumor with prominent vascular component found in the left leg closely related to a branch of the sural nerve and originally believed to be a schwannoma.

Cytotoxic Lesion in the Splenium of Corpus Callosum Associated with Intracranial Infection After Deep Brain Stimulation.

Cytotoxic lesions of the corpus callosum will be present in a wide range of clinical conditions. The term "cytotoxic lesions of the corpus callosum" reflects our current understanding of the underlying pathophysiology of these lesions and does not necessarily imply confinement to the splenium. Because the symptoms vary and are not specific, the clinical diagnosis can be difficult. Brain magnetic resonance imaging will be of pivotal value in the investigation. We report the case of a patient with obsessive-compulsive disorder who underwent bilateral deep brain stimulation of the nucleus accumbens and developed infection along the surgical path of both electrodes associated with a cytotoxic lesion in the splenium of corpus callosum.

Deep Brain Stimulation of the Caudal Zona Incerta and Motor Thalamus for Postischemic Dystonic Tremor of the Left Upper Limb: Case Report and Review of the Literature.

BACKGROUND: Dystonic tremor is defined as a tremor occurring in a body region affected by dystonia. The pathophysiologic mechanisms behind dystonic tremor supposedly involve anomalies affecting the pallidothalamic-receiving area (for the dystonic component) and the ventralis intermedius-cortical loop (for the tremor component). Interest in posterior subthalamic area stimulation for various types of involuntary abnormal movements has arisen owing to positive results in patients affected by tremor refractory to ventralis intermedius deep brain stimulation. CASE DESCRIPTION: A 23-year-old man, with a 15-year history of left upper limb dystonic tremor due to a stroke in the right thalamus, underwent deep brain stimulation with a single electrode passing through the right ventralis oralis anterior/ventralis oralis posterior nuclei and caudal zona incerta. Objective movement outcomes were assessed through the Unified Dystonia Rating Scale and Fahn-Tolosa-Marin Clinical Rating Scale for Tremor. The impact of tremor on activities of daily living was assessed with the ADL-T24 questionnaire, and quality of life was assessed with the Quality of Life Scale. All questionnaires were administered before deep brain stimulation and at 5-year follow-up. Unified Dystonia Rating Scale and Fahn-Tolosa-Marin Clinical Rating Scale for Tremor scores decreased from 14.5 to 4.5 and from 46 to 7, respectively. ADL-T24 score decreased from 19 to 3, whereas Quality of Life Scale score increased from 49 to 82. CONCLUSIONS: Stimulation of motor thalamus and caudal zona incerta could be a viable treatment for patients affected by tremor of various origins, including dystonic tremor, refractory to medical therapy.

Music and Medicine: The Tragic Case of Gershwin's Brain Tumor and the Challenges of Neurosurgery in the First Half of the 20th Century.

OBJECTIVE: Although neurosurgery has gone through moments of great renewal in recent decades, at the beginning of the 20th century it was still dealing with the unfathomable mysteries of the nervous system and its disorders. Historical insight improves understanding of the great personalities of the past and allows us to look at the efforts of pioneering surgeons with greater awareness. METHODS: The literature was reviewed using online databases, textbooks, and retrieved articles. RESULTS: An overview of the case of Gershwin's brain tumor and its surgical resection is presented. CONCLUSIONS: This article presents the tragic case of Gershwin's brain tumor. Through his story, it is possible to get an idea of the difficulties with which the great neuroscientists and surgeons of the past approached the human nervous system and its pathologic manifestations. The first part of this article deals with the evolution of Gershwin's disease over the years and the subsequent brain surgery. In the second part, general considerations on the most striking symptoms experienced by the composer are reported, as well as a description of the different hypotheses on the nature of Gershwin's tumor.

A Singular Case of Neurosyphilis Manifesting Through a Meningovascular Chronic Inflammatory Process in Association with the Occurrence of Two Aneurysms Involving the Distal A2 Segment of Both Anterior Cerebral Arteries: A Case Report and Review of the Literature.

BACKGROUND: Although syphilis has become a rare disease in the Western world since the Second World War, it is believed to have infected 12 million people in 1999, with greater than 90% of cases occurring in the developing world. Moreover, since the year 2000, the rates of syphilis have been increasing in the United States, the United Kingdom, Australia, and Europe. Because of the mimic nature of the disease and the overall low rate of occurrence of its manifestations in advanced stages, a proper diagnosis may prove difficult. CASE REPORT: We report the case of a 41-year-old African man affected by neurosyphilis that manifested itself through a meningovascular chronic inflammatory process, with the peculiar feature of a bilateral aneurysm of probable mycotic origin involving the distal tract of A2 segment of both anterior cerebral arteries. CONCLUSIONS: Because of the mostly nonspecific nature of clinical manifestations of syphilis (particularly advanced syphilis) and its consequent tendency to masquerade as many other diseases, even a skilled physician may find its diagnosis quite challenging; thus, thorough clinical and radiologic investigations should be supported by serologic testing for syphilis in all cases of cognitive impairment. Mycotic intracranial aneurysms in association with neurosyphilis rarely are reported; however, they require early diagnosis and meticulous, individualized treatment. Because syphilis appears to be on the raise, further studies on the topic are warranted.