A rare case of isolated cauda equina Nocardia farcinica infection.

Nocardia is a Gram-positive, partially acid-fast, catalase-positive, and urease-positive bacterium that grows aerobically. We present an extremely rare case of cauda equina syndrome due to isolated intramedullary Nocardia farcinica infection. A 44-year-old male presented with low backache and gradually progressive weakness in bilateral lower limbs followed by paraplegia. He was found to have a well-defined, sharply demarcated ring-enhancing lesion located from T11-T12 to L3 vertebral body. He underwent laminectomy and decompression. The histopathological examination revealed a Gram-positive filamentous organism that looks like Nocardia. The culture report was suggestive of Nocardia farcinica. He was then treated with antibiotics and had a remarkable clinical and radiological improvement.

Cervical Spinal Meningeal Melanocytoma Presenting as Intracranial Superficial Siderosis.

Meningeal melanocytoma is a rare pigmented tumor of the leptomeningeal melanocytes. This rare entity results in diagnostic difficulty in imaging unless clinical and histopathology correlation is performed. In this case report, we describe a case of meningeal melanocytoma of the cervical region presenting with superficial siderosis. Extensive neuroradiological examination is necessary to locate the source of the bleeding in such patients. Usually, the patient will be cured by the complete surgical excision of the lesion.

Computed tomography in spinal tuberculosis.

Exhaustive clinicoradiologic and computed tomographic (CT) analysis of 114 cases of spinal tuberculosis seen between January 1983 and January 1989 is presented. The mechanisms of the spinal involvement are reviewed. CT helped to diagnose cases of spinal tuberculosis in their initial stages. Inaccessible fixed areas of spine were seen with ease on axial sections of CT. The extent and anatomic depiction of soft-tissue involvement as depicted on CT helps surgeons choose the appropriate surgical approach, which may affect future spinal stability.

Lumbosacral plexopathy following regional paracervical block anaesthesia.

We report a 35 year old lady who developed lumbosacral plexopathy immediately following regional paracervical block anaesthesia for medical termination of pregnancy. There was only partial recovery at one year. The neurological deficit and its mechanisms are discussed.

PIP: A case of permanent injury to the nerves of the lumbosacral plexus as a result of regional paracervical block anesthesia before dilatation and curettage for abortion at 8 weeks' gestation is presented. The woman, aged 35, para 2, was given xylocaine. During injection she complained of pain in the gluteal muscle and left leg. The pain intensified and numbness, tingling and paraesthesia developed over 24 hours. The pain radiated to the L5-S1 distribution on the left when she raised her lower limb. She had difficulty moving her lower leg, and by 9 days later had hypotonia and foot drop, with absent ankle reflexes. While she gradually improved over 2 months, her condition stabilized with hypoesthesia of the left foot, foot drop and absent left ankle jerk reflex. The cause of this neuropathy is unknown, but thought to be either hematoma, direct trauma, infection. Thorough knowledge of nerve structure in the area is essential when giving paracervical block.

Choroid plexus papilloma of the fourth ventricle.

A 14 year old girl presented with a 6 months' history of headache with vomiting, ataxia and cerebellar signs. CT and MRI revealed obstructive hydrocephalus secondary to a large fourth ventricular mass which enhanced markedly on contrast administration. Histopathology of the resected mass revealed papillary structures lined by cuboidal cells confirming choroid plexus papilloma.

Extradural myxopapillary ependymoma with sacral osteolysis--a case report.

Extradural ependymomas arising from filum terminale externa in the sacrococcygeal region are very rare. Since 1937, out of 58 cases reported in English literature, only 13 cases of tumor located presacrally in the retrorectal space, have been reported. The authors report a 38 yrs old male with a primary ependymoma of the sacrococcygeal region causing extensive sacral destruction.

Syringomyelia--a complication of meningitis--case report.

Syringomyelia following meningitis is a rare condition. This report summarizes the history of a 43 year old Indian male who developed arachnoiditis as a sequalae of tubercular meningitis. This later progressed to syringomyelia. The patient was treated with a syringo-subarachnoid shunt.

Complete migration of ventriculoperitoneal shunt into the ventricle.

Proximal migration of ventriculoperitoneal (VP) shunt is extremely rare. A medium pressure VP shunt was inserted in a 10-month-old infant suffering from severe hydrocephalus. One month later, complete migration of the shunt into the lateral ventricle was encountered. Possible causative mechanisms and the literature on this subject are briefly discussed.

Appearing and disappearing CT scan abnormalities and seizures.

A group of patients presenting with seizures (focal or generalised) and abnormal CT scans who, on follow up, showed complete resolution of the CT scan changes, without any treatment other than anticonvulsants, are described.

Neurological complications following acute viral conjunctivitis: a new profile.

A study of eleven patients presenting with neurological complications following acute viral conjunctivitis, mostly haemorrhagic, is reported and the literature reviewed. A Guillain-Barre syndrome-like profile was seen in six patients while the remaining had features of radiculomyelitis. Besides asymmetrical neurological deficits, protein cell reaction and residual muscle wasting, the occurrence of dysautonomias was the striking feature noted in the patients with a Guillain-Barre syndrome-like profile. The dysautonomic features included fatal paroxysmal hypertensive and hypotensive crises in one patient and self limiting tachycardias, episodic profuse sweating, abnormal expiration-inspiration ratio and valsalva ratio in four patients. High antibody titers to EV-70 virus were seen in five patients. A follow up of one and a half year revealed poor neurologic recovery in patients with radiculomyelitis as compared to good functional recovery in others. The importance of early recognition and appropriate treatment of dysautonomias is emphasised. The probable aetiopathogenesis of the neurological complications including dysautonomias is discussed.

Cryptogenic osteomyelitis of the skull and intracerebral abscess.

The authors report a rare case of cryptogenic osteomyelitis of the skull with an intracerebral and a subgaleal abscess. Total excision of the abscess extending from the cortical surface to the lateral ventricle led to ventriculitis and subgaleal cerebrospinal fluid collection. These complications could have been avoided by aspirating the abscess after removing the infected portion of the skull and the epidural granulation tissue. Neurosurgeons preferring to excise such an abscess should leave a small area of capsule at the base in order to avoid having to open the ventricle.

The role of the perforated segment of the ventricular catheter in cerebrospinal fluid leakage into the brain.

Two cases of gross post-operative cerebrospinal fluid (CSF) leakage along an indwelling ventricular catheter are reported. The CSF appeared to leak through the perforations of the ventricular catheter, as well as at the site of penetration of the ventricular wall. A small or slit ventricle with high intraventricular pressure may thus be a predisposing factor for this localized CSF collection.

Medulloblastoma with extensive calcification.

Calcification in cases of medulloblastoma has been described with varying frequency (10%-15.4%) on computed tomographic (CT) scan. Usually these calcifications are small in size and speckled. The authors report a case of medulloblastoma with extensive calcification in the lateral hemisphere of the cerebellum in an 18-year-old boy.

Lymphocytic hypophysitis: can open exploration of the sella be avoided?

A case of lymphocytic hypophysitis (LYHY) in a menopausal woman is presented. A review of the literature suggests that conservative treatment may be tried in suspected cases of LYHY, if the vision of the patient is not threatened. A transphenoidal stereotactic biopsy of the mass may be performed if the patient fails to improve or deteriorates, thus avoiding open exploration of the sella in selected cases.