Hemimegalencephaly without epilepsy: case report.

Hemimegalencephaly is a rare sporadic brain malformation characterized by enlargement of one cerebral hemisphere. The classical clinical triad consists of intractable epilepsy, severe psychomotor delay and hemiparesis. In this report, we describe a case of a 3-year-old girl, with all the radiological features of severe hemimegalencephaly but with a comparatively benign clinical course. She had no hemiparesis, mild delay and no seizures. An extensive literature review reveals only one previously reported case of hemimegalencephaly with the absence of seizures, as part of case series. This is the first dedicated case report, with clinical description and radiological images, of this entity.

The use of Liposuction to treat significant contour abnormalities associated with Lipomyeloeningocoele.

INTRODUCTION: Since 1972 when first pioneered, liposuction has developed and is now one of the commonest aesthetic procedures performed worldwide. Evidence of its application in aesthetic lipomodelling is widely known, but there are scant reports in the literature on the use of liposuction in more unusual cases. We report its use as a safe and successful method of contour correction in two cases of lipomyelomeningocoele (LMMC), a form of spina bifida. To our knowledge, this has never been reported before. METHOD: A prospective review was performed and both cases were followed up during the treatment period. Both patients were treated at the Royal Belfast Hospital for Sick Children. Patient charts were reviewed and magnetic resonance imaging was used. RESULTS: Two patients, aged 11 and 17 years, had a large LMMC over the lumbosacral area. Preoperative imaging was obtained in each case to ensure the procedure could safely avoid the underlying spinal cord structures. The use of the Microaire© suction device allowed precise fat extraction. Postoperative images demonstrate reduction of lipomatous bulk and improved contour. CONCLUSION: We have shown that when used with caution liposuction is a safe and effective technique for volume reduction of a LMMC in carefully selected cases.

A traumatic pseudoaneurysm of the vertebral artery.

Although uncommon, vertebral artery pseudoaneurysms harbour significant risk of embolic stroke and their presence should be considered in cases of blunt cervical trauma. We illustrate a case of a traumatically ruptured vertebral artery pseudoaneurysm treated with coil embolisation.

Unlocking the 'locked-in syndrome'.

We present a case of a 48-year-old man who was initially thought to have had a brainstem stroke and was clinically 'locked-in'. Upon investigation, a petrous apex dural atriovenous fistula was identified causing profound brainstem venous hypertension. Surgical clipping lead to complete neurological recovery.

Air in the cavernous sinus may be due to venous cannulation.

The discovery of air in the cavernous sinus may cause some alarm. It may well, however, simply be a consequence of retrograde air embolism from venous cannulation. It rarely has any adverse effects and is self-limiting in nature. We provide an illustrative case report.

Rare case of basilar artery aneurysm in a young child.

A previously well, 14-month-old girl presented with acute decreased level of consciousness. There was no history of trauma, systemic upset or significant family history. Blood pressure was within normal range and no focal neurological deficit was elicited on examination. Neuroimaging revealed a subarachnoid haemorrhage secondary to a basilar tip aneurysm. Patient underwent endovascular embolisation with good clinical outcome. Follow-up MRI revealed anterior circulation vasospasm, and although clinically asymptomatic, she was treated with a calcium channel antagonist. She was later discharged home with no neurological deficit. Follow-up MRI 3 months following presentation suggested recurrent formation of the aneurysmal sac. The patient then underwent elective endovascular repair 2 months later and was discharged home on antiplatelet therapy with planned close outpatient clinical and radiological surveillance.

Prenatal surgery for spina bifida: a therapeutic dilemma. Proceedings of the SHINE conference, Belfast.

This is a transcript of a scientific conference on the subject of prenatal surgery for spina bifida. It represents the views of three patients, an obstetrician, a postnatal neurosurgeon, a neonatologist, a paediatric neurologist, two surgeons who practice open spina bifida foetal surgery, a fetoscopic surgeon and an obstetrician experienced in randomised trials and systematic reviews. Implications for current practice and recommendations for future research are also discussed in detail.

Spontaneous subdural haematoma in a healthy young male.

The authors present an unusual case of a healthy young male who developed a spontaneous subdural haematoma. Headache was followed by blurring of vision and left upper limb symptoms. The diagnosis was made from a CT scan. Symptoms resolved with surgical decompression. The authors explore the risk factors and pathophysiology implicated in this condition. The authors demonstrate that apparently 'healthy' pursuits can have significant consequences, but the physician must also exclude serious underlying risk factors for bleeding, which the authors discuss.