Cognitive disorders in a patient with an arachnoid cyst of the sylvian fissure and improvement after surgical treatment: Case description.

Arachnoid cysts cause a wide spectrum of clinical symptoms. Often it is difficult to clearly establish the relation between the presence of an arachnoid cyst and problems reported by the patient, which may, although not necessarily, be due to chronically elevated intracranial pressure. In recent years, increasing attention is paid to cognitive disorders accompanying arachnoid cysts, such as memory disorders, attention disorders, or language function disorders. This article presents a case of an 11-year-old patient, treated at the University Children's Hospital in Cracow for an arachnoid cyst, located in the left middle cranial fossa. This analysis is focused on the description of cognitive and intellectual deficits of the child, as well as the discussion on their connection with the arachnoid cyst. Prior to the neurosurgical procedure, the boy presented significant deficits in cognitive functions, especially mnestic and attention functions and, also, a quite low level of intellectual functioning. Neuropsychological examination performed after the procedure indicated a significant improvement of cognitive functioning for all the functions, as well as a higher level of intellectual functioning. This analysis attempts to answer whether and to what extent the child still suffers from cognitive deficits from the organic lesions.

Schizencephaly-diagnostics and clinical dilemmas.

BACKGROUND: Schizencephaly is an uncommon congenital disorder of cerebral cortical development. The defect is characterized by the presence of a cleft in the brain extending from the surface of the pia mater to the cerebral ventricles. The margins of the cleft are lined with heterotropic, dysplastic gray matter. The causes of schizencephaly are heterogeneous and can include teratogens, prenatal infection, maternal trauma, or EMX2 mutations. METHOD: In the present paper, the authors described difficulties in employing diagnostic imaging in differentiating between type II (open-lip) schizencephaly and much more common intracranial fluid spaces of a different origin (arachnoid cysts and hydrocephalus). RESULT: In all the three cases, the treatment consisted in implantation of a shunt system; nevertheless, it should be emphasized that a surgical intervention in the third presented case (type II schizencephaly) aimed at relieving the symptoms of intracranial hypertension-a directly life-threatening condition-since shunting is not a method of treating schizencephaly itself. CONCLUSIONS: Although proper interpretation of the character of intracranial fluid spaces is of significance for further therapeutic management, yet, the key decision as to the surgical intervention is made based on clinical presentation, predominantly on symptoms of intracranial hypertension.