Low- and Negative-Pressure Hydrocephalus: New Report of Six Cases and Literature Review.

Low- or very-low-pressure hydrocephalus is a serious and rare phenomenon, which is becoming better known since it was first described in 1994 by Pang and Altschuler. Forced drainage at negative pressures can, in most cases, restore the ventricles to their original size, thus achieving neurological recovery. We present six new cases that suffered this syndrome from 2015 to 2020: two of them after medulloblastoma surgery; a third one as a consequence of a severe head trauma that required bifrontal craniectomy; another one after craniopharyngioma surgery; a fifth one with leptomeningeal glioneuronal tumor; and, finally, a patient with a shunt for normotensive hydrocephalus. Before the development of this condition, four of them had mid-low-pressure cerebrospinal fluid (CSF) shunts. Four patients required cerebrospinal fluid (CSF) drainage at negative pressures oscillating from zero to -15 mmHg by external ventricular drainage until ventricular size normalized, followed by the placement of a new definitive low-pressure shunt, one of them to the right atrium. The duration of drainage in negative pressures through external ventricular drainage (EVD) ranged from 10 to 40 days with concomitant intracranial pressure monitoring at the neurointensive care unit. Approximately 200 cases of this syndrome have been described in the literature. The causes are varied and superimposable to those of high-pressure hydrocephalus. Neurological impairment is due to ventricular size and not to pressure values. Subzero drainage is still the most commonly used method, but other treatments have been described, such as neck wrapping, ventriculostomy of the third ventricle, and lumbar blood patches when associated with lumbar puncture. Its pathophysiology is not clear, although it seems to involve changes in the permeability and viscoelasticity of the brain parenchyma together with an imbalance in CSF circulation in the craniospinal subarachnoid space.

Tumor glioneuronal leptomeníngeo difuso: diagnóstico y tratamiento con un caso ilustrativo / Diffuse leptomeningeal glioneuronal tumor: A review of diagnosis and management with an illustrative case

El tumor glioneuronal leptomeníngeo difuso es una entidad infrecuente, con un curso indolente; fue descrito en la clasificación de los tumores del sistema del sistema nervioso central de la OMS 2016. Presentamos el caso de un varón de 11 años que comienza con un cuadro clínico inespecífico de cefalea, dolor lumbosacro e hidrocefalia comunicante. En el curso clínico aparecen crisis epilépticas con lesiones nodulares en RM craneal; fue diagnosticado de meningitis tuberculosa y tratado con tuberclostáticos. Ante un deterioro clínico progresivo, a pesar del tratamiento, y empeoramiento de los hallazgos en RM craneoespinal, se le realiza biopsia cerebral y de leptomeninges que confirma el diagnóstico de tumor glioneuronal leptomeníngeo difuso. El tumor glioneuronal leptomeníngeo difuso debe incluirse en el diagnóstico diferencial de los cuadros que se presentan con hidrocefalia comunicante y lesiones leptomeníngeas. Se precisa un diagnóstico histológico precoz mediante biopsia para establecer un tratamiento adecuado (AU)

Diffuse leptomeningeal glioneuronal tumors (DLGNTs) are a rare indolent neoplasm described in the 2016 WHO classification of tumors of the central nervous system (CNS). We describe a case of an 11 year old boy who initially presented intermittent headache, low back pain and communicating hydrocephalus, misdiagnosed as having tuberculous meningitis. Further clinical deterioration with seizures was observed and follow-up MRI showed further aggravation of leptomeningeal enhancement in the basal cisterns. Biopsy of the brain and leptomeninges revealed a diffuse leptomeningeal glioneuronal tumor. DLGNT should be considered in the differential diagnosis of conditions presenting as communicating hydrocephalus with nodular lesions and leptomeningeal enhancement. A timely histologic diagnosis through a biopsy of the brain is necessary to confirm the diagnosis (AU)

Diffuse leptomeningeal glioneuronal tumor: A review of diagnosis and management with an illustrative case.

Diffuse leptomeningeal glioneuronal tumors (DLGNTs) are a rare indolent neoplasm described in the 2016 WHO classification of tumors of the central nervous system (CNS). We describe a case of an 11 year old boy who initially presented intermittent headache, low back pain and communicating hydrocephalus, misdiagnosed as having tuberculous meningitis. Further clinical deterioration with seizures was observed and follow-up MRI showed further aggravation of leptomeningeal enhancement in the basal cisterns. Biopsy of the brain and leptomeninges revealed a diffuse leptomeningeal glioneuronal tumor. DLGNT should be considered in the differential diagnosis of conditions presenting as communicating hydrocephalus with nodular lesions and leptomeningeal enhancement. A timely histologic diagnosis through a biopsy of the brain is necessary to confirm the diagnosis.

Ventriculostomía y biopsia endoscópica de una masa pineal con hidrocefalia y diagnóstico final inesperado / Ventriculostomy and endoscopic biopsy of pineal mass with hydrocephalus and unexpected definitive diagnosis

Presentamos el caso de una paciente de 72 años de edad sin antecedentes de interés que consultó en urgencias por un cuadro de 2 semanas de evolución de alteración de la marcha, cefalea y vómitos. El TAC craneal reveló la presencia de hidrocefalia obstructiva secundaria a una lesión pineal con impronta en el tercer ventrículo. La resonancia magnética mostró, además de la lesión ya referida, otra más pequeña situada en el foramen de Lushcka derecho. Se llevó a cabo una ventriculostomía endoscópica del suelo del tercer ventrículo y la biopsia endoscópica de la lesión, cuyo resultado fue de metástasis compatible con carcinoma de pulmón. Se realizó un TAC toracoabdominopélvico que mostró una masa pulmonar compatible con el carcinoma primario. Se decidió tratamiento sistémico de la enfermedad. La paciente falleció 2 meses tras el diagnóstico

A 72-year-old female with no relevant medical history consulted in the emergency room for a two-week history of headache, vomiting and gait disturbance. Head CT scan revealed obstructive hydrocephalus secondary to a pineal mass with compression of the third ventricle. Magnetic Resonance showed another mass located in the right Lushcka foramen. Endoscopic third-ventriculostomy and biopsy of pineal mass were performed. Pathological analysis was consistent with metastasis of carcinoma. Full-body CT scan showed a lung mass related to primary carcinoma. The patient received systemic treatment for metastatic lung cancer. She died two months after diagnosis

Absceso en la fosa posterior por Streptococcus intermedius tras una limpieza dental en una paciente inmunocompetente / Streptococcus intermedius posterior fossa abscess after a minor dental procedure in an immunocompetent woman

Presentamos el caso de una mujer de 52 años, sin antecedentes de interés, que fue derivada a nuestro centro tras ser diagnosticada de una lesión ocupante de espacio en el hemisferio cerebeloso derecho. La sospecha inicial era de metástasis. En la RMN cerebral, sin embargo, se apreciaba una marcada restricción en la secuencia de difusión concordante con un absceso cerebeloso. La paciente se había sometido a una limpieza dental tres semanas antes. El análisis microbiológico tras la evacuación quirúrgica de la lesión mostró la presencia de Streptococcus intermedius

A 52-year-old woman with no relevant previous medical history was diagnosticated of an infratentorial bulky cerebellar mass. The mass showed restricted diffusion on MR images, which was consistent with cerebellar abscess. The patient had undergone a minor dental procedure three weeks before. Microbiological analysis after surgical evacuation of the mass confirmed the presence of Streptococcus intermedius

Streptococcus intermedius posterior fossa abscess after a minor dental procedure in an immunocompetent woman. / Absceso en la fosa posterior por Streptococcus intermedius tras una limpieza dental en una paciente inmunocompetente.

A 52-year-old woman with no relevant previous medical history was diagnosticated of an infratentorial bulky cerebellar mass. The mass showed restricted diffusion on MR images, which was consistent with cerebellar abscess. The patient had undergone a minor dental procedure three weeks before. Microbiological analysis after surgical evacuation of the mass confirmed the presence of Streptococcus intermedius.

Ventriculostomy and endoscopic biopsy of pineal mass with hydrocephalus and unexpected definitive diagnosis. / Ventriculostomía y biopsia endoscópica de una masa pineal con hidrocefalia y diagnóstico final inesperado.

A 72-year-old female with no relevant medical history consulted in the emergency room for a two-week history of headache, vomiting and gait disturbance. Head CT scan revealed obstructive hydrocephalus secondary to a pineal mass with compression of the third ventricle. Magnetic Resonance showed another mass located in the right Lushcka foramen. Endoscopic third-ventriculostomy and biopsy of pineal mass were performed. Pathological analysis was consistent with metastasis of carcinoma. Full-body CT scan showed a lung mass related to primary carcinoma. The patient received systemic treatment for metastatic lung cancer. She died two months after diagnosis.

Tumor de las células envolventes del olfatorio: caso clínico y revisión de la literatura / Olfactory ensheathing cell tumour: Case report and literature review

Las células envolventes olfatorias son células gliales que se encuentran en el bulbo y el nervio olfatorios. Las células de Schwann y las células envolventes del olfatorio presentan características morfológicas e inmunohistoquímicas similares. Sin embargo, las células de Schwann son positivas en la tinción con Leu-7(CD-57) mientras que las células envolventes lo son negativas. Presentamos el caso de un varón de 49 años con pérdida de agudeza visual e hiposmia. Los estudios de TC y RM craneal muestran una lesión extraaxial subfrontal quística, que erosiona la lámina cribosa derecha y capta contraste heterogéneamente. Con resección completa mediante craneotomía bifrontal, el estudio histológico inicial sugería schwannoma, con inmunorreactividad positiva para S100 y negativa para EMA. Sin embargo, la tinción con Leu-7 negativa y el diagnóstico definitivo fue de tumor de las células envolventes del olfatorio. Describimos el sexto caso de tumor de las células envolventes del olfatorio intracraneal subrayando la importancia de las técnicas inmunohistoquímicas en su diagnóstico (AU)

Olfactory ensheathing cells are glial cells located in the olfactory bulb and nerve. Microscopically, both olfactory ensheathing cells and Schwann cells have similar morphological and immunohistochemical features. However, olfactory ensheathing cells are negative for Leu-7(CD-57), whereas Schwann cells are positive. We present the case of a 49 year-old male with a history of visual impairment and hyposmia. Radiological CT and MRI studies showed a subfrontal cystic extra-axial mass, which eroded the right cribriform plate, with heterogeneous contrast enhancement. Total excision of the tumour was performed by bifrontal craniotomy. Histological examination initially suggested a schwannoma, with immunohistochemical staining being positive for S-100 protein and negative for epithelial membrane antigen (EMA). However, the tumour was negative for Leu-7. Accordingly, the final diagnosis was olfactory ensheathing cell tumour. Herein, we describe the sixth case of intracranial olfactory ensheathing cell tumour and stress the important role of immunohistochemical techniques in obtaining a definitive diagnosis

[Olfactory ensheathing cell tumour: case report and literature review]. / Tumor de las células envolventes del olfatorio: caso clínico y revisión de la literatura.

Olfactory ensheathing cells are glial cells located in the olfactory bulb and nerve. Microscopically, both olfactory ensheathing cells and Schwann cells have similar morphological and immunohistochemical features. However, olfactory ensheathing cells are negative for Leu-7(CD-57), whereas Schwann cells are positive. We present the case of a 49 year-old male with a history of visual impairment and hyposmia. Radiological CT and MRI studies showed a subfrontal cystic extra-axial mass, which eroded the right cribriform plate, with heterogeneous contrast enhancement. Total excision of the tumour was performed by bifrontal craniotomy. Histological examination initially suggested a schwannoma, with immunohistochemical staining being positive for S-100 protein and negative for epithelial membrane antigen (EMA). However, the tumour was negative for Leu-7. Accordingly, the final diagnosis was olfactory ensheathing cell tumour. Herein, we describe the sixth case of intracranial olfactory ensheathing cell tumour and stress the important role of immunohistochemical techniques in obtaining a definitive diagnosis.

Absceso epidural y de psoas bilateral tras anestesia epidural obstétrica: una complicación poco frecuente / Epidural and bilateral psoas abscess after obstetric epidural anaesthesia: a rare complication

El absceso epidural espinal tras anestesia epidural es una complicación rara. Se describe un caso de absceso epidural y de psoas tras anestesia epidural para un parto sin complicaciones. Su diagnóstico requiere un alto índice de sospecha clínica y un estudio de resonancia magnética. La descompresión quirúrgica precoz y antibioterapia prolongada son los elementos clave en el tratamiento del absceso epidural, mientras el absceso de psoas precisa drenaje percutáneo con control radiológico y cobertura antibiótica. El absceso epidural tras anestesia epidural puede suponer una complicación catastrófica. Un diagnóstico precoz es esencial para prevenir daños neurológicos permanentes (AU)

Epidural abscess is a rare but serious complication of epidural anesthesia. We present the case of a healthy parturient who developed spinal epidural and psoas muscle abscesses following spinal analgesia for uneventful labor and delivery. Diagnosis requires a high index of suspicion and magnetic resonance imaging. Early surgical decompression and prolonged antibiotic therapy are the mainstays of epidural abscess treatment, while percutaneous drainage under imaging guidance with antibiotic coverage is an effective front-line treatment of psoas muscle abscess. Epidural abscess can be a catastrophic consequence of epidural anesthesia. Early diagnosis is essential to prevent permanent neurological damage (AU)