Intramedullary pyogenic abscess in the conus medullaris.

Primary pyogenic abscess in the conus medullaris in a healthy adult has never been reported. An urgent MRI scan with contrast and prompt surgical evacuation may lead to good neurological recovery.

Abdominal computed tomography in teratoma of the testis: its accuracy in stage I disease and an assessment of the distribution of retroperitoneal lymph-node metastases in other stages of the disease.

One hundred and one patients with Stage I teratoma of the testis have had an abdomino-pelvic computed tomography (CT) scan. These patients have been followed up for a minimum of 18 months and only eight patients have relapsed in the abdomen alone. The abdomino-pelvic CT scan has a negative predictive value of 92%. In those shown by CT to have retroperitoneal lymphadenopathy, the distribution of disease correlates closely with that reported in the literature following retroperitoneal lymphadenectomy. The CT scan provides information about the amount of tumour present and this influences treatment. Computed tomography is the imaging modality of choice for staging patients with teratoma of the testis and invasive techniques do not appear to be justified.

Spontaneous intracranial hypotension: clinical and magnetic resonance imaging characteristics.

The syndrome of spontaneous intracranial hypotension (SIH) is an uncommon cause of postural headache. We describe three patients with classical low pressure headache associated with low CSF pressure, one of whom presented with sudden deafness and another with a unilateral VIth nerve palsy. Initial magnetic resonance imaging (MRI) scans revealed bilateral diffuse subdural fluid collections in all three cases. Follow up MRI scans performed on two patients at 6 months demonstrated partial resolution of the subdural collections but persistent striking meningeal enhancement despite clinical recovery. These findings differ from previous reported cases wherein clinical resolution of postural symptoms was preceded or closely followed by resolution of the MRI changes.

Iatrogenic pulsatile tinnitus.

We present an unusual case of iatrogenic arteriovenous malformation following a myringoplasty and its treatment by embolization. Thorough examination and investigation of patients with pulsatile tinnitus is stressed. Angiography is essential to diagnose life-threatening and treatable lesions in the presence of normal otoscopy, audiologic assessment and enhanced computed tomography.

Intracranial metastasis masquerading as acute subdural haematoma.

We discuss a case of subdural metastasis in which the clinical features and associated images mimic acute subdural haematoma.

Hydrocephalus as presenting feature of spinal astrocytoma in a adolescent patient.

We report the case of an adolescent with a thoracic spine astrocytoma whose initial presentation was communicating hydrocephalus. We speculate that the mechanism may be reduced meningeal compliance due to meningeal spread of the tumour. Craniospinal MR imaging should be considered as part of the routine work up for patients presenting with unexplained hydrocephalus, elevated CSF protein and/or long tract symptoms/signs.

De novo meningioma arising at a previous burr hole site.

A case of meningioma that developed at a site of a previously performed burr hole is reported. To the best of our knowledge, this is the first reported case of a meningioma arising at a previous burr hole site. The possible reasons for its causation are discussed.

Cervical intra-/extramedullary solitary fibrous tumour.

A 53-year-old man presented with a 9-month history of symptoms of right-sided weakness, tingling and hypersentivity to clothes on both sides of the body. MRI revealed a large intraspinal intradural tumour at the level of C3-C4 in the cervical cord. The final histology was a solitary fibrous tumour (SFT) of the cervical spinal cord. The radiological diagnosis, surgical management and histology are reviewed.

Case report: bilateral lacrimal gland enlargement: an unusual manifestation of dacryops.

Dacryops is an uncommon condition and, because it is usually obvious clinically, patients rarely come to radiological investigation. However, it is important for the radiologist to consider this condition in the differential diagnosis of lacrimal gland swelling and therefore to look for a cystic component in the lesion. We present such a case and review the literature on this condition.

Cervical intramedullary schwannoma: complete excision using the KTP laser.

Intramedullary cervical spinal cord schwannomas are rare tumours and complete excision is often an elusive goal. The use of the KTP laser to accomplish complete excision has not been reported previously. Postoperatively, our patient had no additional deficit and after 1 year has made a good recovery. This case further highlights the difficulty in interpretation of intraoperative biopsy specimens.

Rosai-Dorfman disease presenting as a pituitary tumour.

A 45-year-old woman had pyrexia, headaches, collapse and hyponatraemia. Intracerebral abscess, bacterial meningitis and subarachnoid haemorrhage were excluded. She was given intravenous antibiotics and gradually recovered. One month later she was readmitted with diplopia, headache and vomiting. Serum sodium was low (107 mmol/l) and a diagnosis of inappropriate ADH secretion was made. MRI scan showed a suprasellar tumour arising from the posterior pituitary gland. A skin rash gradually faded. Serum cortisol, prolactin, gonadotrophins and thyroid hormone levels were low. A pituitary tumour was removed trans-sphenoidally, she had external pituitary radiotherapy, and replacement hydrocortisone and thyroxine. She was well for 12 months when she developed progressive weakness and numbness of both legs. Examination suggested spinal cord compression at the level of T2 where MRI scanning showed an intradural enhancing mass. This spinal tumour was removed and her neurological symptoms disappeared. Nine months after this she developed facial pain and nasal obstruction. CT scan showed tumour growth into the sphenoid sinus and nasal cavities. A right Cauldwell-Luc operation was done and residual tumour in the nasal passages was treated by fractionated external radiotherapy and Prednisolone. Histological examination of the specimens from pituitary, spinal mass, and nasal sinuses showed Rosai-Dorfman disease, a rare entity characterized by histiocytic proliferation, emperipolesis (lymphophagocytosis) and lymphadenopathy. Aged 48 she developed cranial diabetes insipidus. Although Rosai-Dorfman syndrome is rare, it is being reported with increasing frequency, and should be borne in mind as a possible cause of a pituitary tumour.

Syringomyelia in children: six case reports and review of the literature.

We present six cases of syringomyelia in children below the age of 16 years seen during the last 8 years at the neurosurgical departments in the west of Yorkshire. The clinical presentation of syringomyelia in children is different from that in adults and magnetic resonance imaging is the investigation of choice. Because of the natural history of syringomyelia, the long-term results of surgical treatment are very difficult to evaluate accurately. Although our series is small, it does highlight the presentations and the methods of investigation. The diversity of pathology is noted; in particular any associated hydrocephalus or intramedullary tumour.

Primary pituitary abscess: surgical management and endocrine assessment in three cases.

Three cases of pituitary abscess are described. All were women with varying degrees of anterior pituitary dysfunction, diabetes insipidus and headaches. None had visual disturbance. A history of prior head injury was obtained in both young women who developed secondary amenorrhoea and hyperprolactinaemia. All three had low density, thick rim intrasellar masses on computed tomography scanning. Certain aspects of the diagnosis and surgical management of this rare condition are discussed with particular emphasis on the importance of pre- and postoperative endocrine assessment and preoperative diagnosis and proper surgical management.