Spinal Epidural Inflammatory Pseudotumor: A Case Report and Review of Literature.

BACKGROUND: Inflammatory pseudotumor is a histologically proven benign tumor-like lesion of unknown etiopathogenesis. It is less commonly found in central nervous system, and least commonly in the spinal canal. Spinal epidural inflammatory pseudotumor is a rarely reported entity. CASE DESCRIPTION: We report a patient who presented with paraplegia, in whom a spinal epidural mass was diagnosed as an inflammatory pseudotumor after surgical excision followed by histopathology. CONCLUSIONS: It was a radiologic dilemma; thus, complete excision was required for diagnosis and a better outcome.

Contrecoup Extradural Hematoma with Coronal Suture Diastasis.

Extradural hematoma (EDH) generally occurs in the site of impact, that is, coup injury site. EDH is associated with fracture of skull in many a times due to direct impact. However, EDH in counter coup site is a rare occurrence. Hardly, yet, 12 cases have been reported including this case. Here, we reported a case of a 22-year-old male of contrecoup acute EDH who had sustained head injury due to fall from bike. Physical examination revealed direct impact at the left occipito-parietal region with laceration of scalp and bruise with transient loss of consciousness at the time of injury. There was no evidence of impact on the right side of his head. Computed tomography scan revealed an EDH in the right fronto-temporal region without any bone fracture on bone windows. On intraoperative exploration, it is found that there was coronal suture diastasis with small subgaleal hematoma and right fronto-temporal extradural hematoma. The evacuation of EDH was done. The patient discharged on 3rd postoperative day. It can be concluded that direct impact on head causes exactly opposite hit of brain, and compensatory rebound causes a negative pressure in between the layers causing disruption of vessels and potential accumulation of blood. This mechanism mostly favors for acute subdural hematoma due to compact attachment of dura with cranium. However, in this case, diastasis of coronal suture due to transmitted force is the cause of accumulation of blood extradurally in relatively loosely adhered dura in fronto-temporal region where a potential negative pressure space is created by contrecoup injury.

Masson Hemangioma-An Unusual Cause of Thoracic Compressive Myelopathy.

BACKGROUND: Masson hemangioma is a rare pathologic entity characterized by intravascular papillary endothelial hyperplasia. Although benign, this hemangioma grows to form an expansile compressing mass. This lesion is mostly seen in skin and subcutaneous tissue. Occurrence in the central nervous system is rare. Still rarer is a spinal location with only 5 case reports published to date in the literature. CASE DESCRIPTION: A 32-year-old man presented with paraplegia secondary to extradural compression at the T4-5 level. Histopathologic features were consistent with intravascular papillary endothelial hyperplasia, also known as Masson hemangioma. Differential diagnosis, management, and review of literature are discussed in this report. CONCLUSIONS: This rare pathology should be in the differential diagnosis when spinal cord compressive myelopathy is encountered.

Intracerebellar haemorrage in a haemophilia child.

Hemophilia A is an inherited, X-linked, recessive disorder caused by deficiency of clotting factor VIII. Intracranial hemorrhage is the leading cause of morbidity and mortality in these patients. Use of factor replacement products and medications had improved outcome in these patients. But in developing countries many such patients are not able to afford factor replacement products. We report a case of traumatic intracerebellar hemorrage in a hemophilia child. This child presented to us as a case of sub-acute intracerebellar hemorrage, he was managed conservatively with six units of fresh frozen plasma transfusion. He improved clinically and on follow-up investigation hematoma was found to have dissolved spontaneously. Through this report we want to emphasize that those cases of hemophilia presenting with acute or sub-acute intracranial bleed, conservative approach through procoagulant transfusion and intravenous fibrinolysis inhibitors should be tried as first line of management. Before daring for surgery sufficient amount of factor replacement should be kept available.

Cerebellar giant cell glioblastoma multiforme in an adult.

Cerebellar glioblastoma multiforme (GBM) is a rare tumor that accounts for only 1% of all cases of GBM and its giant cell variant is even much rarely encountered in adults. A case of cerebellar giant cell GBM managed at our institution reporting its clinical presentation, radiological and histological findings, and treatment instituted is described. In conjunction, a literature review, including particular issues, clinical data, advances in imaging studies, pathological characteristics, treatment options, and the behavior of such malignant tumor is presented. It is very important for the neurosurgeon to make the differential diagnosis between the cerebellar GBM, and other diseases such as metastasis, anaplastic astrocytomas, and cerebellar infarct because their treatment modalities, prognosis, and outcome are different.

Intrinsic brainstem white epidermoid cyst: An unusual case report.

Epidermoid cysts involving the brainstem are extremely rare, with only 18 reported cases in the literature and only five purely intrinsic epidermoid cysts within this group. "White epidermoids", a rare entity, have high protein content and show reversed signal intensity on magnetic resonance images. In contrast to the classical variety, these cysts show high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Here, we report an interesting case of intrinsic brainstem "white epidermoid cyst" in a 15-year-old girl and discuss its clinical characteristics, radiological features, and surgical treatment. The girl presented with a one-year history of progressive quadriparesis, and features of multiple cranial nerve involvement. Because the cyst was purely intrinsic and had altered signal intensity, the diagnosis was initially unclear until definitive neuroimaging was performed using diffusion-weighted magnetic resonance imaging (DW-MRI) sequences.

A case of multiple myeloma presenting as scalp swelling with intracranial extension.

Multiple myeloma is a malignant neoplasm of bone marrow affecting plasma cells. It is usually detected in skull bone with characteristic features of multiple punched-out lesions. Its presentation as a solitary scalp swelling with underlying skull bone erosion and intracranial extension is very rare. A 35-year-old female presented to us with complains of rapidly growing left-side scalp swelling with right-side paresis and simple partial seizure of right upper limb. Local examination, X-ray skull, CT scan, and MRI of brain were suggestive of a malignant lesion. Near total excision of lesion was done. Histopathological study was suggestive of plasmacytoma of skull. Bone marrow study further confirmed it as a case of multiple myeloma. Cases presenting with solitary osteolytic skull lesions, possibility of plasmacytoma, or multiple myeloma should be kept in mind.

Primary malignant peripheral nerve sheath tumor at unusual location.

Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma. Most arise in association with major nerve trunks. Their most common anatomical sites are the proximal portions of the upper and lower extremities and the trunk. MPNSTs have rarely been reported in literature to occur in other unusual body parts. We review all such cases reported till now in terms of site of origin, surgical treatment, adjuvant therapy and outcome and shortly describe our experience with two of these cases. Both of our case presented with lump at unusual sites resembling neurofibroma, one at orbitotemporal area and other in the paraspinal region with characteristic feature of neurofibroma with the exception that both had very short history of progression. They underwent gross total removal of the tumor with adjuvant radiotherapy postoperatively. At 6-month follow-up both are doing well with no evidence of recurrence.

Tethered cord syndrome in adolescents: Report of two cases and review of literature.

The symptoms of tethered cord syndrome (TCS) cases mostly appear during infancy and childhood. Though the adolescent presentation of TCS is well-recognized, it continues to pose significant diagnostic and management controversies. In this report, we describe two cases of adolescent onset TCS associated with two different etiologies. Our first case, an 18-year-old girl who presented due to overflow incontinence in association with TCS was diagnosed to have lumbar meningocele. The second case, a 19-year-girl presenting with perianal anesthesia and bowel and bladder incontinence had lipomyelomeningocele as the cause of TCS. Both of them underwent untethering surgery. The clinical charts and follow-up data were studied in respect to the clinical manifestation, surgical intervention and outcome with a brief review of pertinent literature.