Skull base osteomyelitis mimicking skull base tumor in immunocompetent pediatric patient: case report.

Central skull base osteomyelitis (CSBO) is a rare complication of infection in pediatric patients, especially when there are no comorbidities like immunosuppression or metabolic illness. The diagnosis of CSBO is a challenge in children, and imaging findings can mimic skull base tumor. We describe the clinical history and image diagnosis of a case in a 6-year-old girl with no relevant history who presented an extensive skull base lesion. She underwent tumor resection surgery. The intraoperative finding confirmed clivus osteomyelitis, and the histopathological studies discarded malignancy. After diagnosis, the patient completed 6-week antibiotic treatment with adequate evolution. In conclusion, CSBO should be considered within the differential diagnoses due to the fact that it can mimic skull base lesions and it may present without relevant history.

Psychiatric alterations after previous temporal lobectomy: Report of cases and review.

INTRODUCTION: Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS: A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS: The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS: Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.

Psychiatric Alterations after Previous Temporal Lobectomy: Report of Cases and Review. / Alteraciones psiquiátricas tras lobectomía temporal anterior: reporte de casos.

INTRODUCTION: Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS: A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS: The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS: Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.

Alteraciones psiquiátricas tras lobectomía temporal anterior: reporte de casos / Psychiatric alterations after previous temporal lobectomy: Report of cases and review

RESUMEN Introducción: La lobectomía temporal anterior (LTA) es un procedimiento quirúrgico comúnmente utilizado para el tratamiento de la epilepsia del lóbulo temporal refractario al tratamiento médico, con altas tasas de éxito en el control de las crisis. Sin embargo, se ha descrito una asociación importante con enfermedades psiquiátricas que puede afectar al resultado posquirúrgico en estos pacientes. Métodos: Se exponen 2 casos representativos de pacientes que sufrieron complicaciones psiquiátricas en el posoperatorio de lobectomía temporal anterior, a pesar del control exitoso de las crisis. Resultados: Un varón sin antecedentes de enfermedad mental que sufre un episodio depresivo mayor en el periodo posoperatorio mediato, y una mujer con psicosis previa que evidencia exacerbación de su afección como complicación quirúrgica. Conclusiones: La enfermedad psiquiátrica se puede presentar en pacientes posoperatorios de epilepsia de lóbulo temporal tanto con antecedentes de enfermedad mental como sin ellos. Las alteraciones más frecuentes reportadas son depresión, ansiedad, psicosis y trastornos de la personalidad. La inclusión de evaluaciones psiquiátricas en los protocolos prequirúrgicos y posquirúrgicos pueden llevar a una mejora en el pronóstico de los resultados neurológicos y mentales de los pacientes sometidos a la intervención.

ABSTRACT Introduction: Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. Methods: A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. Results: The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. Conclusions: Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.

Síndrome de Millard-Gubler secundario a angioma cavernoso: reporte de un caso / Millard-Gubler syndrome secondary to cavernous angioma: report of a case

RESUMEN El síndrome de Millard-Gubler es considerado un síndrome protuberancial debido a una lesión pontina inferior y caracterizado, desde el punto de vista clínico, por parálisis facial y del VI par, ipsilateral a la lesión y parálisis braquiocrural contralateral; frecuentemente es de causa vascular, menos frecuente de causa traumática o por efecto de masa secundario a un tumor. Se realiza reporte de un caso de un paciente de 45 años de edad que acude al servicio hospitalario de la Fundación Centro Colombiano y Enfermedades Neurológicas FIRE con cuadro clínico caracterizado en pérdida de la fuerza muscular en hemicuerpo izquierdo, y déficit motor de la hemicara derecha, disartria y deterioro del estado de consciencia. La TAC de cráneo simple al ingreso evidenció sangrado extenso del tallo cerebral. De acuerdo con los hallazgos clínicos se concluye que el paciente presentó un síndrome de Millard-Gubler.

SUMMARY The Millard Gubler syndrome is considered a protuberant syndrome due to a lower pontine lesion and characterized, from the clinical point of view, by facial paralysis and VI pares, ipsilateral to the lesion and contralateral brachiocrural palsy; frequently it is of vascular cause, less frequent of traumatic cause or by effect of mass secondary to a tumor. A case report is presented of a 45-year-old patient who attends the hospital service of the Fundación Centro Colombiano y Neurológicas FIRE with a clinical picture characterized by loss of muscle strength in the left side of the body, and motor deficit of the right side of the face, dysarthria and deterioration of the state of consciousness. The simple skull CT on admission showed extensive brainstem bleeding. According to the clinical findings, it is concluded that the patient presented a Millard Gubler syndrome.