Godtfredsen syndrome - recurrent clival chondrosarcoma with 6 years follow up: a case report and literature review.

BACKGROUND: We report a rare case of Godtfredsen syndrome caused by clival chondrosarcoma and perform a review of literatures. This article also explains the clinico-anatomical correlation of this rare neurological syndrome. CASE PRESENTATION: A 22-year-old gentleman presented with binocular diplopia. Clinical examination revealed an isolated right abducent nerve and right hypoglossal nerve palsy, with other cranial nerves intact. Neuroimaging revealed a right clival mass. Supraorbital craniotomy and tumour debulking were done in the same year. Histopathological examination showed low-grade chondrosarcoma. After 5-years of default, he came back with the tumour enlarged. He underwent a right orbitozygomatic craniotomy and tumour excision with 33 cycles of radiotherapy. Despite two surgeries and radiotherapy, the abducent nerve and hypoglossal nerve did not improve throughout 6 years of follow-up. Cranial nerve VI palsy is not always a false localizing sign, in Godtfredsen syndrome it serves as a localizing sign. CONCLUSION: To the best of our knowledge, this is the first case report of Godtfredsen Syndrome secondary to clival chondrosarcoma. Cranial nerve VI and XII palsy with no involvement of other cranial nerves, most likely the pathology is located at the clivus.

Fatal Orbital Cellulitis With Intracranial Abscess: A Case Report.

Orbital cellulitis is a sight- and life-threatening condition. Prompt diagnosis and immediate intervention are required. We report a case of fatal odontogenic orbital cellulitis complicated with intracranial abscesses in a 55-year-old gentleman. The patient presented with painful swelling of the left eye associated with reduced eye movement, blurry vision, and a headache. There was generalized periodontitis. Initial imaging was suggestive of left eye orbital cellulitis with intracranial abscess, and intensive systemic antibiotic therapy was initiated. After six weeks of antibiotic therapy, there was an improvement in ocular signs and symptoms. However, the patient developed signs of meningism with a persistent fever. Serial brain imaging demonstrated worsening intracranial abscesses. The patient died eight weeks after the initial onset of presentation. This case emphasized that brain abscesses could be a fatal complication of odontogenic orbital cellulitis. A high index of suspicion is important in diagnosing orbital cellulitis and its complications. Early consideration of surgical intervention is necessary in cases not responding to antibiotic therapy.

Primary Basal Cell Carcinoma of the Conjunctiva.

Epithelial conjunctival malignancies are one of the most prevalent ocular surface tumors. Primary basal cell carcinoma (BCC) of the conjunctiva is extremely rare. We report the case of a 67-year-old Indian gentleman who presented with a fleshy conjunctival lesion for one year on his right eye. Examination revealed a lightly pigmented conjunctival mass adjacent to the limbus. The surface was irregular and non-ulcerated with few feeder vessels. The working diagnosis was ocular surface squamous neoplasia (OSSN). A wide excisional biopsy using the no-touch technique and double-freeze-thaw cryotherapy to the conjunctival margins was performed. The bare scleral area was covered with an amniotic membrane. Histopathological examination revealed a basaloid cell neoplasm favoring BCC, and a tumor-free margin was achieved. Three cycles of topical mitomycin-C 0.02% were prescribed as adjunct chemotherapy postoperatively. There was no evidence of recurrence three months after treatment. The primary BCC of the conjunctiva is unusual and can resemble OSSN. Therefore, it should be considered in the differential diagnosis of patients presenting with atypical features of OSSN.