Schwannoma quístico incidental del seno esfenoidal y cavernoso izquierdo en una mujer asintomática / Incidental cystic schwannoma of the left sphenoid and cavernous sinuses in an asymptomatic woman

CASO CLÍNICO: Mujer de 63 años, con antecedentes personales de hipertensión y sinusitis reciente, quien se presentó en el centro por un episodio de síncope. No describió presión o dolor de los senos paranasales o frontales, cambios en la visión, cefalea o pérdida de peso. La exploración física y la neurológica fueron normales, sin déficit evidente de los pares craneales. La tomografía computarizada de cráneo (Figura, a y b) descubrió incidentalmente un defecto óseo de dimensiones 3,8 × 3,6 × 2,4 cm causado por una masa expansiva con epicentro aparente en el hueso esfenoidal izquierdo, con remodelación adyacente del seno esfenoidal, el clivus, el ala mayor del hueso esfenoidal y la punta del hueso petroso izquierdo. No hubo evidencia obvia de extensión hacia el cerebro. La resonancia magnética de cabeza con y sin contraste (Figura c-f) demostró una masa parcialmente quística, expansiva, compleja, de dimensiones 4,8 × 3,4 × 2,1 cm, que surgía del seno esfenoidal/cavernoso lateral con extensión al aspecto medial de la fosa craneal izquierda medial, el espacio masticador y el seno cavernoso. La masa mostraba un realce heterogéneo en las imágenes con contraste. No se apreció un componente hemorrágico en la secuencia eco de gradiente. Se realizó una biopsia con la aparente impresión macroscópica de un gran mucocele, con resultados patológicos que demostraron atipia nuclear. La inmunohistoquímica reveló células fusiformes positivas para S-100 y vimentina. El informe final de patología concluyó que la ma­sa esfenoidal izquierda era un schwannoma. La paciente se sometió a cirugía sinusal endoscópica guiada por imagen para la reducción de la masa. Se concluyó que el episodio de síncope inicial era secundario a un reflejo vasovagal no relacionado con la masa en cuestión

CASE REPORT: A 63-year-old woman with a past medical history of hypertension and recent sinus infection presented to our institution due to an episode of syncope. She reported no sinus pressure or pain, changes in vision, headache, or weight loss. Physical and neurological examinations were both normal, including no cranial nerve deficits. As part of her workup she underwent a computed tomography scan of the head (Figure, a, b), which incidentally discovered a large 3.8 × 3.6 × 2.4 cm bone defect by an expansile mass with apparent epicenter in the left sphenoid sinus with adjacent remodeling of the sphenoid sinus, clivus, greater wing of the sphenoid bone, and tip of the left petrous bone. There was no obvious evidence of brain extension. Brain magnetic resonance imaging with and without contrast (Figure, c-f) demonstrated a 4.8 × 3.4 × 2.1 cm expansile, complex, partially cystic mass apparently arising from the lateral sphenoid/cavernous sinus with extension to the medial aspect of the left middle cranial fossa, masticator space, and cavernous sinus. The mass demonstrated hetero­genous enhancement on contrast images. No hemorrhagic component was seen on gradient-recalled echo. A biopsy was performed with the impression of a large mucocele, with frozen pathology showing nuclear atypia. Immunohistochemistry showed spindle cells that were positive for S-100 and vimentin. Final pathology report stated the left sphenoid mass was a schwannoma. Our patient underwent endoscopic sinus surgery with image guidance for debulking of her mass. Her original syncope was ultimately deemed to be of vasovagal etiology

Neglected and (re-)emergent infections of the CNS i n low-/middle-income countries.

Low- and middle-income countries (LMIC) have suffered from long-term health system deficiencies, worsened by poor living conditions, lack of sanitation, a restricted access to health facilities and running water, overcrowding, and overpopulation. These factors favor human displacement and deepen marginalization; consequently, their population endures a high burden of infectious diseases. In this context, the current epidemiological landscape and its impact on health and economic development are not promissory, despite the commitment by the international community to eradicate neglected tropical infections - especially tuberculosis and malaria, by 2030. Neglected and (re)-emerging infectious diseases affecting the central nervous system (CNS) are a major public health concern in these countries, as they cause a great morbidity and mortality; furthermore, survivors often suffer from severe neurological disabilities. Herein, we present a retrospective review focused on some neglected and (re)-emerging infectious diseases, including neurocysticercosis, malaria, rabies, West Nile virus encephalitis, tuberculosis, neuroborreliosis, and SARS-CoV-2 in LMIC. A retrospective review of studies on selected neglected and (re)-emerging infectious diseases in LMIC was performed, including reports by the World Health Organization (WHO) published within the last five years. Data on infection by SARS-CoV-2 were provided by the John Hopkins University Coronavirus Resource Center. CNS neglected and (re)-emerging infectious diseases remain as important causes of disease in LMIC. An alarming increase in the prevalence of malaria, tuberculosis, and cysticercosis is observed in the region, compounded by the recent COVID-19 pandemic. The WHO is currently supporting programs/efforts to cope with these diseases. Herein, we highlight the epidemiological burden of some CNS infections in LMIC, and their clinical and neuroimaging features, to facilitate an accurate diagnosis, considering that most of these diseases will not be eradicated in the short term; instead, their incidence will likely increase along with poverty, inequality, and related socioeconomic problems.

Maxillary Giant Cell Granuloma: A Long-Term Follow-Up.

A case of a 32-year-old female with a known diagnosis of Turner syndrome who presented with complaints of chronic progressive right-sided facial pain and sinus pressure and who was afebrile. On physical examination, there was eye proptosis on the right and significant increased fullness in the right infraorbital and maxillary regions. Computed tomography and magnetic resonance imaging demonstrated a large expansile space-occupying lesion in the right maxillary area that histologically turned out to be a giant cell reparative granuloma. The lesion was completely removed, and of interest, the patient was followed up both clinically and on imaging for 10 years with no signs of recurrence. A discussion on this entity, as well the clinical and imaging differential diagnoses, is discussed.

Maxillary Giant Cell Granuloma: A Long-Term Follow-Up.

This is a case of a 32-year-old female with a known diagnosis of Turner syndrome who presented with complaints of chronic progressive right-sided facial pain and sinus pressure, and who was afebrile. On physical examination, there was eye proptosis on the right and significant increased fullness in the right infraorbital and maxillary regions. Computed tomography and magnetic resonance imaging demonstrated a large expansile space-occupying lesion in the right maxillary area, that histologically turned out to be a giant cell reparative granuloma. The lesion was completely removed and of interest, the patient was followed up both clinically and on imaging for 10 years with no signs of recurrence. A discussion on this entity, as well the clinical and imaging differential diagnoses, is carried out.

Osmotic Demyelination Syndrome Revisited: Review With Neuroimaging.

Osmotic demyelination syndrome (ODS) is a general term that has become commonplace in the practice of medicine, encompassing both central pontine myelinolysis and extrapontine myelinolysis. Historically ODS arises as a serious complication of rapid correction of hyponatremia, yet its manifestations seem to be influenced by a multifactorial process. Further understanding of this rare demyelinating disease has elucidated the significant role of other electrolyte disturbances and the presence of chronic comorbidities as disease risk factors. This review discusses the current research regarding the pathophysiology, clinical manifestations, neuroimaging features, patient management, and prognosis of osmotic demyelination syndrome. We hope that this review will further endorse and aid in the proper diagnosis of ODS and its suitable management through the understanding of clinical and imaging correlations and outcomes, and the comorbid factors that may predispose the development of ODS in certain patient populations.

Radiology Case of the Month: Idiopathic CD4 Lymphocytopenia.

A 39 year-old male with a history of diabetes, retinitis pigmentosa, and genital warts presented with intractable occipital headaches accompanied with nausea and vomiting. The patient had markedly depressed CD4 counts. Furthermore the patient tested negative for HIV and HTLV 1/2 and had normal immunoglobulin levels. During hospital course the patient underwent a lumbar puncture and multiple imaging exams, including both CT and MR. Except for occasional nausea and vomiting controlled by therapeutic lumbar punctures, phenergan, and dilaudid the patient's hospital course was uncomplicated.

Radiology Case Of The Month: Mental Disturbance for 4 days.

A 56 year old African-American man presented to the emergency department with dyspnea and dysphagia with drooling. On his initial evaluation, disproportionate obesity of the face, neck and shoulders were noted. The patient's history was significant for obstructive sleep apnea, end-stage renal disease, alcoholic liver disease, pulmonary hypertension and alcoholic cardiomyopathy. He had multi-decade history of heavy alcohol abuse, but quit drinking two years previously.

Rare primary mucosal melanoma of the larynx.

Few cases of primary mucosal melanoma of the larynx have been documented in the literature, so only a limited amount of data exists regarding its diagnosis and treatment. The prognosis is poor, as patients often present at a late stage with regional or distant metastases. We describe the case of a 66-year-old man who presented with hoarseness and dysphagia. Laryngoscopy identified a dark discoloration of the supraglottic larynx and incomplete mobility of the right vocal fold; an excisional biopsy confirmed the diagnosis. We discuss the epidemiology, clinical features, diagnosis, interpretation of imaging findings, and management of this rare malignant melanoma.

Radiology Case of the Month: Gliomatosis Cerebri.

A 71 year-old female with a past medical history significant for hypertension, hyperlipidemia, diabetes, and strokes, presented initially to the stroke service with a sudden onset of right facial droop, right-sided weakness, dysarthria, and seizures that had gotten progressively worse for six weeks.

Fungal Infections of the Central Nervous System: A Pictorial Review.

Fungal infections of the central nervous system (CNS) pose a threat to especially immunocompromised patients and their development is primarily determined by the immune status of the host. With an increasing number of organ transplants, chemotherapy, and human immunodeficiency virus infections, the number of immunocompromised patients as susceptible hosts is growing and fungal infections of the CNS are more frequently encountered. They may result in meningitis, cerebritis, abscess formation, cryptococcoma, and meningeal vasculitis with rapid disease progression and often overlapping symptoms. Although radiological characteristics are often nonspecific, unique imaging patterns can be identified through computer tomography as a first imaging modality and further refined by magnetic resonance imaging. A rapid diagnosis and the institution of the appropriate therapy are crucial in helping prevent an often fatal outcome.

Radiology Case Of The Month: Brain Magnetic Resonance Imaging with Bilateral Hyperintensities in the Globus Pallidi.

An MRI of the brain and spine of an 11-year-old male revealed the following abnormality which is consistent with his chronic condition.