Cerebellar toxoplasmosis in HIV/AIDS infant: case report and review of the literature.

Cerebellar mass lesion is an uncommon presentation of toxoplasmosis. The authors report one rare case in an 11-month-old HIV/AIDS female infant who presented with deterioration in her developmental milestones. CT scan revealed a ring-enhancing mass lesion in the right cerebellar hemisphere with secondary obstructive hydrocephalus. A ventriculoperitoneal shunt was inserted prior to posterior fossa decompression and biopsy of the lesion. The specimens obtained were divided into two. One specimen was sent for histological diagnosis immediately after surgery while the second specimen was preserved until the release of the histology report. The initial histopathology report indicated a neoplastic process. Immunohistochemical stains were attempted but interpreted with difficulty due to severe tissue necrosis. After waiting for close to 6 weeks without a definite histological diagnosis, the preserved second specimen was sent for histological analysis as a fresh specimen, and reported a diagnosis of toxoplasmosis. This case presented diagnostic challenges to the authors whose radiological impressions of either a neoplastic lesion or a tuberculoma (based on our local neuroepidemiology) were reinforced by intraoperative findings highly suggestive of tuberculoma but which contrasted with the histological report, first as a neoplastic lesion and later toxoplasmosis. Although cerebellar toxoplasmosis is a rare complication of HIV/AIDS, this case report shows that toxoplasmosis should not be overlooked as a differential diagnosis of ring-enhancing cerebellar masses in HIV/AIDS patients irrespective of the patient's age and the absence of constitutional symptoms of toxoplasmosis.

Diagnostic challenges and surgical management of co-existent osteoblastoma and aneurysmal bone cyst of the lumbar spine in a child: case report.

BACKGROUND: Osteoblastomas (OTB) with co-existent aneurysmal bone cysts (ABC) of the spine are extremely rare and more so in the lumbar spine. To the authors' knowledge, only one case of lumbar spine involvement has been reported in a paediatric patient. OBJECTIVES: To highlight diagnostic challenges and surgical management of co-existent lumbar OTB-ACB in a child. METHODS: We present a 14-year old female with low back pain and progressive swelling of 2 months. She was evaluated by neuroimaging studies and histopathological assessment of resected tissue. RESULTS: X-ray showed a lytic lesion in L3 with loss of the left pedicle. Magnetic resonance imaging (MRI) revealed a fluid-filled, heterogeneously enhanced, lobulated lesion posterior to the vertebral bodies of L3, L4 and L5, which infiltrated the quadratus lumborum muscles bilaterally, and histologically diagnosed as ABC. The L3 pedicle also revealed an expanded, heterogeneously enhanced mass lesion which appeared to be different and showed no fluid-filled levels, histologically diagnosed as OTB. Surgical intervention involved tumour excision with partial spondylectomy of L3 vertebra, posterior instrumented stabilization and fusion. CONCLUSION: The case highlights the diagnostic challenges of co-existent OTB-ABC and the significant role of surgical management via spinal reconstruction, stabilization and fusion after gross total tumour excision.

Management challenges of traumatic spondylolisthesis of the Axis with an unusual C2-C3 posterior subluxation in a paediatric patient: case report and literature review.

INTRODUCTION: Paediatric cervical spine injuries are uncommon. Traumatic spondylolisthesis of the axis (TSA) is commonly encountered in the trauma setting. The management of TSA may be surgical or non-surgical. Decision making is quite challenging depending on patient presentation and nature of injury, and even more so in the paediatric age group. OBJECTIVES: To present a case report highlighting the challenges in the management of TSA. METHODS: We present an 8 year old male, who sustained a bilateral C2 pars fracture with associated unusual C2-C3 posterior subluxation. RESULTS: Neuroradiological studies identified the fracture/subluxation of C2-C3 and revealed an intact but posteriorly displaced C2-C3 disc causing cord compression. An Extension Halter traction was initially commenced. This seemed to have worsened the patient's neck pains, and caused motor weakness and autonomic dysfunction. An anterior cervical discectomy and fusion was finally decided on and performed after evaluation and brainstorming by our spinal Unit. Intra-operative findings revealed separation of the C2-C3 disc from the C3 superior end plate which probably explains the unusual nature of the subluxation. CONCLUSION: The case shows that surgical intervention as a primary management for TSA even in the paediatric age group is safe and also avoids risks inherent in conservative management.

Histo-pathological pattern of intracranial tumours in the National Hospital, Abuja.

BACKGROUND/AIMS: Intracranial tumours demonstrate characteristic diagnostic histopathological features. Our aims were to look at the histo-pathological pattern of intracranial tumours in our environment including their age and sex distribution. METHODS: The histology request forms and slides of all intracranial specimens submitted to the histo-pathology department of National Hospital, Abuja, over an 11 year period (2005 and 2015) were retrospectively reviewed. RESULTS: Intracranial specimens and intracranial tumours accounted for 0.6% and 0.5% respectively of all samples submitted. Meningiomas accounted for the most frequent diagnosis for all intracranial specimens and intracranial tumours at 35% and 41% respectively followed by pituitary adenoma at 19% and 22%, and astrocytoma at 13% and 20%. The male female ratio for all diagnoses was 1:1. The mean age at diagnosis was 35 ± 17.1 years. The frequency of intracranial tumours in children was 11.8% with a mean age of 8.3 ± 4.4 years and an equal sex distribution. In children, glioma and embryonal tumours were the most frequent diagnosis at 25%. CONCLUSION: The histo-pathological pattern of intracranial tumours in our environment showed that meningioma is the most common intracranial tumour in adults, while glioma and embryonal tumours are the most common intracranial tumours in children.

Demographic profile of patients diagnosed with intracranial meningiomas in two academic hospitals in Johannesburg, South Africa: a 12-month prospective study.

BACKGROUND: Meningiomas are common brain tumours and display gender, racial and ethnic differences in their demographic profile. The demographic profile of our patients diagnosed with intracranial meningiomas is presented and compared with the literature. OBJECTIVES: To determine the age, gender, racial and ethnic distribution of our patients diagnosed with intracranial meningiomas. METHODS: Consecutive patients (48 in number) seen at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, with histologically proven meningiomas over a 12 month period were recruited for the study. RESULTS: Meningiomas accounted for 33.8% of all primary brain tumours. The mean age of patients was 45.7 ± 10.5 years with a female-to-male ratio of 3.8:1. The mean age for male patients was 39.3 ± 13.5 years while that of female patients was 47.4 ± 9.0 years. The peak age range at presentation was in the fifth (41.7%) decade. The highest frequency was among Black Africans (75%) and Sotho ethnic nationality (27.1%). CONCLUSION: The study showed a female preponderance for intracranial meningiomas among our patients. Although intracranial meningiomas were more in frequency among Black Africans, the racial distribution mirrored our population distribution while the highest frequency was among Sotho ethnic nationality.