Primary cranial vault lymphoma presenting as a traumatic subdural hematoma.

OBJECTIVE AND IMPORTANCE: The authors present a rare case of a primary cranial vault lymphoma, mimicking a subacute subdural hematoma after head trauma. CLINICAL PRESENTATION: A 78-year-old woman was admitted to the hospital with progressive left hemiparesis, headache and a gradually increasing soft lump over the right parietal region 1 week after head trauma due to falling from a high place. A computed tomography (CT) scan demonstrated a hyperdense parieto-occipital subdural and subgaleal lesion together with marked midline shift and white matter edema. INTERVENTION: Considering her trauma story and clinical progression, the patient underwent an emergency operation with the diagnosis of subdural hematoma. However, the lesion was found to be of a tumors nature and the histopathological diagnosis was high-grade malignant non-Hodgkin's lymphoma. CONCLUSION: The authors emphasize the rarity of primary cranial vault lymphoma and its importance in the differential diagnosis of cranial vault mass lesions extending either intra- or extracranially. This case may be considered as another example where magnetic resonance imaging (MRI) is the ultimate definitive test in the emergency ward whenever CT demonstrates any findings which are unclear.

Meningioma presenting with only urinary symptoms which is diagnosed by magnetic resonance imaging followed by urodynamic study.

Neurological tumour processes when involving bladder organs or innervations may give rise to urological symptoms. Depending on the organ or nerve tract affected, and emptying capacity of the bladder, the clinical signs manifested may be extremely varied, simulating different pathological entities that may lead to unnecessary treatment.

Abnormal bony protuberance of anterior atlas causing dysphagia. A rare congenital anomaly.

STUDY DESIGN: A Case report. OBJECTIVE: To report an exceedingly rare case of dysphagia caused by abnormal bony protuberance of anterior atlas. SETTING: Kocaeli University Faculty of Medicine, Departments of Neurosurgery and Otorhinolaryngology. METHOD: Radiological examinations revealed a large anterior abnormal bony tuberance of atlas in an 11-year-old boy who complained of dysphagia of 5 years donation. RESULT: The anterior bony tuberance of the atlas was resected by a transoral approach. Histopathological examination of the surgical specimens showed normal bone tissue. Resection resulted in complete resolution of the dysphagia. CONCLUSIONS: Dysphagia can be caused by disorders of the cervical spine. These disorders are usually seen in elderly adults. In the pediatric population, spinal abnormality is an exceedingly rare cause of dysphagia. Abnormal inductive signals from the adjacent notocord and ventral neural tube may play role in the pathogenesis of this abnormal bony protuberance.

Multiple sclerosis and coexisting intradural extramedullary spinal cord tumour: a case report.

We report the coexistence of multiple sclerosis (MS) and an intradural extramedullary spinal cord tumour in a 46-year-old woman with a 2-year history of MS. The patient presented with right hemitrunk and lower extremity paraesthesias, urinary incontinence, and intermittent lower right back and abdominal pain, which did not respond to pulse steroid therapy. A spinal magnetic resonance imaging (MRI) study revealed an intradural extramedullary spinal cord tumour in the lower thoracic spine, later diagnosed as schwannoma. We call attention to this rare association of MS and a spinal cord tumour, and emphasize the need for scrutiny of new and uncommon symptoms during the follow-up of MS patients.

Reconstruction of the middle cerebral artery after excision of a giant fusiform aneurysm.

A patients with a giant fusiform aneurysm of the left inferior trunkus of the middle cerebral artery (MCA) is presented. The size of the aneurysm was 5 cm at its largest diameter. Retrograde flow was well developed. After the application of temporary clips the aneurysm was excised and microsurgical reconstructions were undertaken. Adequate flow in the reconstructed MCA trunkus was maintained. This rare case is discussed in the light of the literature.

Non operative management of acute extradural hematomas in children.

The Authors have reported a series of 15 patients with acute epidural hematomas (EDHs) that were not evacuated surgically. These EDHs were diagnosed 6 hours after injury and were followed by serial CT scanning. All patients showed resolution of the hematoma on CT scanning over a period of 2 to 5 weeks. Factors that influence outcome of medical treatment have been discussed.

Treatment of acute spinal cord injuries: comparison of thyrotropin-releasing hormone and nimodipine.

The effects of nimodipine and thyrotropin-releasing hormone (TRH) were compared in a clip-compression model of experimental spinal cord injuries (SCI) in rats. Thirty rats received a 50-g clip-compression injury on the cord at T9. Ten rats were given 0.02 mg/kg nimodipine and dextran 40 (3 ml) i.v. 1 h after injury. Ten rats were given 2 mg/kg TRH and dextran 40 (3 ml) i.v. 1 h after injury followed by 1 mg/kg per hour for 4 h. The remaining ten rats were given only saline. TRH treatment significantly improved somatosensory-evoked potentials (SEPs) and mean arterial blood pressures (MABPs), whereas nimodipine treatment had no effect on these variables (Fisher's exact test (P less than 0.01).

Intraventricular meningioma of the fourth ventricle.

A rare case of meningioma of the fourth ventricle is reported. A review of the literature revealed only 24 reported cases of this type of tumor.