Pathophysiology of intracranial epidural haematoma following birth.

Epidural haematoma in newborn infants is rare, and few specific obstetrical data related to its formation are available in the literature. The aim of this study is to discuss the pathophysiology of this condition. EDH is always a post traumatic lesion and it is only possible if the insult has produced a cleavage of the dura mater from bone. Therefore, EDH results from the mechanical forces exerted on the foetal head during birth, with or with no instrumental interference. Although it is still unclear whether the injury (and dura mater cleavage) was directly caused by the forceps or had already been inflicted by natural forces, or a combination of both however, in some patients (with neither dystocia nor skull fracture), there is no basis for explaining EDH formation, apart from propulsion of the fore coming head through the birth canal. Excessive moulding, whether or not associated with iatrogenic trauma, has been incriminated in most cases of EDH. As dystocia cannot always be anticipated, EDH will remain an ever-present cause of morbidity in the neonatal population, albeit a rare occurrence.

Intracranial epidural hematoma in newborn infants: clinical study of 15 cases.

OBJECTIVE: Epidural hematoma (EDH) in newborn infants is rare. We have described the history of 15 newborns with EDH to provide a better understanding of this pathology. METHODS: This is a descriptive case series study using a retrospective review of the medical records of newborns who were admitted to the Pediatric Intensive Care Unit and Neurosurgery Department with the diagnosis of birth EDH over a 24-year period (1979-2002). RESULTS: There was no sex predominance, and most of the mothers were young, nulliparous women. The time latency from birth to the first signs varied from 0 to 24 hours. Clinical presentation was nonspecific: seizures and hypotonia were the main symptoms. The parietal area was the most frequent location. Surgical drainage was required in nine patients, and no deaths were reported. CONCLUSION: This report highlights the clinicoradiological characteristics of newborn EDH, which occurs more frequently in newborns that experienced difficult delivery from a nulliparous mother. Surgery is not a rule; some patients can be managed with conservative treatment. The outcome is generally good.

Multicentric pleomorphic xanthoastrocytoma in a patient with neurofibromatosis type 1. Case report and review of the literature.

The authors report an unusual case of multicentric pleomorphic xanthoastrocytoma (PXA) in a 36-year-old woman with neurofibromatosis Type 1 (NF1). Both lesions were diagnosed as PXA but demonstrated different neuroimaging features and very different outcomes. Although the occipital lesion was cured surgically, the cerebellar tumor recurred three times and underwent malignant transformation into an anaplastic oligodendroglioma. The authors discuss the causes of PXA and suggest that it could originate from common bipotential precursor cells with two phenotypes.

Capillary haemangioma arising from the anterior choroidal artery.

BACKGROUND: Capillary haemangioma of the central nervous system is extremely rare. Histologically proven cases developed in the dura mater and choroid plexus, or were typically intracranial extensions of an extra-cranial lesion. FEATURES: This report details a case that developed in the anterior choroidal artery of a newborn infant and manifested as a lethal intra-cerebral haemorrhage. Pathological criteria for the diagnosis of vascular malformations should be carefully investigated and the differential diagnoses of the present case are discussed. PROGNOSIS: Intracranial haemangioma presents a diagnostic challenge and the treatment of deep lesions remains problematic.

Diagnosis-related pitfall of a lateral sacral cyst. Case report.

Because physical examination typically demonstrates normal findings in cases of low-back pain, diaglosis of the cause can be challenging. Frequent magnetic resonance imaging studies of the lumbosacral spine can typically lead to discovery of benign diseases and thus misinterpretation of these images. The authors report an unusual case in which a functional ovarian cyst was incidentally associated with a perineural cyst and mimicked a lateral sacral meningocele. In light of this, the authors recommend repeated examinations to avoid mistakes.

Epidural hematoma as a complication of endoscopic biopsy and shunt placement in a patient harboring a third ventricle tumor.

Although some complications have been reported when using endoscopic techniques, epidural hematoma (EDH) has rarely been caused. The authors report a case of EDH complicating a concomitant endoscopic biopsy procedure with ventricular shunt placement in a young, 14-year-old boy harboring a third ventricle tumor with a hydrocephalus. Few cases have been reported; however, the authors warn that there is a risk that EDH may develop following an endoscopic procedure and shunt placement.