Giant chordoid meningioma symptomatic immediately after pregnancy: report of a rare case.

BACKGROUND: Chordoid meningioma is a very rare subtype of meningioma with less than 90 cases reported in the literature. Meningiomas related with a pregnancy are also very rare. Herein, we present a pregnancy-associated case of a chordoid meningioma and briefly discuss possible mechanisms. CASE HISTORY: Approximately 10 hours after a Caesarean section, a 37-year-old woman became stuporous with a Glasgow coma scale score of 9 - 10 and the right pupil became dilated without reaction to light. An emergency computed tomography scan showed a right frontotemporal lesion measuring 8 x 7 x 6 cm which enhanced moderately and homogenously after intravenous contrast injection. The patient's hemoglobin level was slightly lower than normal level but there was no dysgammaglobulinemia or lymphoid hyperplasia. The patient was immediately taken to the operating theater and the tumor was gross totally removed. The postoperative period was uneventful; and histopathological diagnosis was chordoid meningioma. CONCLUSION: The exact mechanism causing a pregnancy-associated increase in the size of meningiomas and the amount of peritumoral edema has not been clearly elucidated. As for this case of chordoid meningioma associated with pregnancy, we think mucin accumulation in tumor could be involved in an increase in the tumor size while delivery procedures with the common anaesthetic and sedative drugs may also have enhanced the peritumoral edema by causing a relative decrease in the cerebral blood flow.

An extreme lateral lumbar disc herniation mimicking L4 schwannoma.

OBJECTIVE: We herein describe a case with an extraspinal mass distorting the right L4 dorsal root ganglion. Initially presumed to be a nerve root schwannoma, the lesion turned out to be a free disc fragment. METHODS AND RESULTS: A 46-year-old woman presented with a history of mild low back and intense right leg pain. The leg pain was like electrical discharges. Right knee extension was weak together with hyperalgesia and loss of heat sensation in the right LA dermatome. The right patellar reflex was absent. Electromyography showed acute and chronic denervation of muscles innervated by the right L4 nerve root. MR scan showed a right L4-5 extraforaminal mass distorting the L4 dorsal root ganglion. The mass enhanced homogeneously after gadolinium injection and was thought to be a tumor. It was surgically removed using a midline incision and intraspinal, followed by extraspinal dissection. Under the operating microscope, the mass extended between an intact lateral longitudinal ligament and a swollen dorsal root ganglion. Histopathologic examination ruled out a tumor and showed that the mass consisted of degenerated disc material surrounded by a large peripheral zone of neovascularization. CONCLUSION: Extraforaminal periganglionic free, encapsulated disc fragments may mimic tumoral masses, from which they may not be distinguished on MRI.

Retro-tympanic pulsatile mass originating from dumb-bell jugular foramen schwannoma.

BACKGROUND: Jugular foramen (JF) tumours are uncommon with paraganglioma, schwannoma and meningioma occurring most commonly in this location. JF schwannoma with extension to the retro-tympanic area has been described only once. METHODS: 20-year-old man presented with headache, blurred vision, vomiting and diplopia. FINDINGS: A left pulsatile retro-tympanic mass was seen at otoscopy. A jugular foramen tumour was found on CT and MR images. The intracranial portion of the tumour later diagnosed as schwannoma was removed. Control ENT examination confirmed that the residual retro-tympanic mass was no-longer pulsatile. CONCLUSIONS: Jugular foramen schwannomas may also extend into the retro-tympanic area.

Spontaneous spinal cord herniation: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: Spontaneous herniation of the spinal cord substance through a previously uninjured and/or untouched dura is a very exceptional occurrence. Spontaneous spinal cord herniation, which was first reported 25 years ago, is a cause of myelopathy that is treatable but difficult to diagnose. CLINICAL PRESENTATION: A 49-year-old female patient who presented with a 3-year history of a burning sensation and hyperesthesia in her right leg and a 3-month history of left leg stiffness was diagnosed as exhibiting signs of Brown-Séquard syndrome. Magnetic resonance imaging of the thoracic spinal canal demonstrated S-shaped anterior kinking and transdural herniation of the spinal cord at the T3-T4 levels. INTERVENTION: The patient underwent surgery via a three-level laminectomy. The herniated part of the spinal cord was microsurgically reduced, and the dural defect was repaired with Gore-Tex membrane (WL Gore & Associates, Flagstaff, AZ). The outcome of surgery was excellent. CONCLUSION: Review of the world literature revealed 29 reported cases, with 27 of these cases being published since 1990. The clinical features, radiological diagnosis, and treatment options for this unique entity are summarized, with a synopsis of numerous misconceptions that appeared in the literature. With more familiarity with and increased awareness of this entity, more cases will be diagnosed.

Syringostomy using myringostomy tube: technical note.

OBJECTIVE: We describe the concept of a new syringostomy technique. METHODS: The technique includes the insertion of a myringostomy tube through a small myelotomy at the level of maximum enlargement of the syrinx. The inner diameter of the myringostomy tube is 1.14 mm. RESULTS: This technique reduces the potential risks that are associated with other techniques that use bulky silastic catheters that are left inside the spinal cord. CONCLUSION: We think that this technique is the least invasive of all similar techniques and that, in terms of drainage, the myringostomy tube is as efficient as commonly used silastic catheters.

Primary spinal extradural hydatid disease: report of a case with magnetic resonance characteristics and pathological correlation.

A rare case of hydatid disease of the lumbar extradural area and of the paravertebral muscles is reported. The patient underwent surgery, resulting in complete recovery. The limitations of computed tomography and the benefits of magnetic resonance imaging in forming a diagnosis are discussed. Magnetic resonance has been found to be an invaluable tool, not only in detecting the soft tissue extent of the disease but also in delineating the viability of hydatid cysts.

Intramedullary epidermoid cyst of the cervical spinal cord associated with an extraspinal neuroenteric cyst: case report.

A 4-year-old girl presented with an intramedullary epidermoid cyst of the cervical spinal cord. The clinical, radiological, and surgical features and a brief critical review of the literature are included in this report. The cyst contents were removed totally in two operations. The child had a coexisting neuroenteric cyst in the posterior mediastinum. To our knowledge, this coexistence has not been previously reported. Contemporary imaging modes and prospects of the surgical treatment are discussed.

Congenital external carotid-jugular fistula: report of two cases and a review of the literature.

Congenital arteriovenous communications involving the external carotid artery and the jugular vein(s) are exceptionally rare. We report two cases of congenital external carotid-jugular fistulae with clinical, radiological, and surgical features and a review of the literature. The prospects of endovascular treatment and the limits of surgery are discussed.

Posttraumatic gas-containing brain abscess caused by Clostridium perfringens with unique simultaneous fungal suppuration by Myceliophthora thermophila: case report.

OBJECTIVE AND IMPORTANCE: Gas-containing brain abscesses are rare, and the vast majority are caused by Clostridium perfringens. Significant simultaneous fungal infection in a bacterial abscess is even rarer. We present such a case and review the literature. CLINICAL PRESENTATION: A 21-month-old male patient sustained a penetrating head injury in a barnyard, developed a gas-containing left parietal brain abscess, and presented with high fever, galeal swelling, and seizure. INTERVENTION: The patient initially underwent debridement of his wound and then repeated aspirations. The initial cultures revealed pure growth of Clostridium perfringens. Despite appropriate antibiotic therapy, serial neuroimaging did not demonstrate a decrease in the size of the cavity. An excision had to be undertaken 6 weeks after the injury. The culture from the excised specimen revealed an unexpected growth of a saprophytic and opportunistic fungus, Myceliophthora thermophila. Antifungal treatment consisting of the administration of liposomal amphotericin B and itraconazole was then performed. The child was well and neurologically intact 6 months after the excision. CONCLUSION: Our review revealed 38 cases of clostridial brain abscess in the literature. Despite the reputation of the organism, the outcome with clostridial brain abscesses was relatively benign. The main characteristics of clostridial brain abscesses are highlighted, with reference to their optimal treatment. Our review also revealed that fungal infection after a penetrating head injury is extremely rare and often fatal. Our case seems to be the first in the medical literature with growth of M. thermophila as a causative agent for intracranial suppuration.

Vertebral hemangioma symptomatic during pregnancy--report of a case and review of the literature.

A spinal tumor complicating pregnancy is a rare condition. A 25-year-old woman who became paraplegic during the 35th week of her second pregnancy presented during the postpartum period. She underwent two surgical interventions, and the cord compression caused by a T5 vertebral body hemangioma with laminar involvement and extradural extension was relieved. The occurrence of vertebral hemangiomas during pregnancy is discussed; the radiological features with special reference to magnetic resonance imaging are outlined; and cases from the literature are reviewed.

Brucellosis of the spine.

The spinal form of brucellosis is still a disabling disease in many countries outside North America and northern and central Europe. Fifteen consecutive cases of spinal brucellosis diagnosed and treated over a 20-year period were reviewed retrospectively. Six patients were farmers, while 10 patients had a history of ingestion of unpasteurized milk or other dairy products. A high index of suspicion is necessary for the diagnosis, since there are no pathognomonic signs or symptoms. Radiological assessment of the disease was reviewed and highlights in the differential diagnoses were stressed. The diagnosis was based on actual culture of Brucella bacilli in seven patients. The principal treatment of brucellosis of the spine is conservative, namely, immobilization and antimicrobial therapy. We have found both a combination of ofloxacin and rifampin and ofloxacin monotherapy efficient as the early regimens used in this series. Three patients had to undergo surgery, since a diagnosis could not be made in any other way.

Distal end revision of ventriculoperitoneal shunts sparing minilaparotomy. Technical note.

Distal end malfunction of a ventriculoperitoneal shunt occurs secondary to outgrown, disconnected, fractured, or occluded peritoneal catheters. Replacement of such catheters normally requires a minilaparotomy. The authors describe a simple technique for peritoneal catheter replacement without minilaparotomy.

Intracranial plasma cell granuloma.

Plasma cell granulomas (PCGs) are benign, inflammatory masses of unknown etiology composed of polyclonal mature plasma and lymphoid cells. The lung is their most common location, and occurrence within the cranial cavity is extremely rare. We report the case of an 11-year-old girl who presented with seizures and was diagnosed as having a dural-based right frontal tumor that extended toward the sagittal sinus and the falx. The lesion was totally excised, together with the abnormal dura. A limited cortical excision was also performed using electrocorticographic guidance. Histopathologic diagnosis of intracranial plasma cell granuloma was reached after extensive immunohistochemical tests and electron microscopy. This is the third case of PCG with description of changes in the neighboring cerebral tissue. Although PCGs are well-circumscribed lesions, lymphoplasmocytic inflammation, neuronal loss, and reactive gliosis occur within the adjacent cortex. Disturbed cortical lamination, as we have observed, appears to be a histological finding that has not been described previously.

Primary choroid plexus carcinoma in an infant. Report of a case evaluated by MRI.

Primary carcinoma of the choroid plexus is a very rare neoplasm. We report a 17-month old female patient who was evaluated by MRI. The tumor was gross totally removed and radiotherapy was given subsequently. CT and MR correlation and histopathological differential diagnosis criteria of such tumors are discussed with an emphasis on total tumor removal. New chemotherapy regimens are needed for better survival especially in cases of recurrences.

Optic nerve glioma presenting as a huge intrasellar mass. Case report.

We report the case of a twelve-year-old boy who presented with visual impairment and headache and was found to harbour a purely intrasellar cystic pilocytic astrocytoma originating from proximal left optic nerve. The mass was explored transcranially and decompression of the optic apparatus and subtotal resection of the cyst wall was accomplished. The patient received post-operative radiotherapy and stays symptom-free after two years. A review of the literature revealed six cases of optic pathway astrocytomas associated with cyst formation. Our case appears as the first case of an optic glioma to present as an intrasellar mass.

Jugular foramen meningioma. Report of a case and review of the literature.

The occurrence of a meningioma within the jugular foramen is very rare. We present the case of a 33-year-old man who presented with five-year history of hoarseness and was found to have paralysis of lower four cranial nerves on the left. High resolution computed tomography showed a dumbbell shaped tumor of the left jugular foramen extending intracranially over the jugular tubercle and extracranially into the parapharyngeal space. The patient underwent staged neuro-otological surgery and the mass was removed subtotally with no recurrence in six years. Histopathologic diagnosis was transitional meningioma. Our review of the literature revealed 33 previously reported cases. Four of these cases had neurofibromatosis. All but one underwent some form of otolaryngologic surgery. Although twenty had an intracranial component to their tumor, only 11 had a craniotomy. The majority of the tumors were meningothelial meningiomas (60%). Only two cases were malignant meningiomas. We reviewed the clinical and radiological characteristics and summarized the benefits and pitfalls of existing surgical options.

Fibromuscular dysplasia of the basilar artery: a case with brain stem stroke.

Fibromuscular dysplasia of the basilar artery is a rare and usually asymptomatic vascular disease with only 5 cases reported in the literature. A thirty-eight-year-old man who developed ischemic neurologic symptoms of the brain stem due to dysplasia of the basilar artery is presented, and the clinical features, radiology, treatment, and prognosis of this disease are discussed in correlation with the current data.