Intracranial and subcutaneous lipoma associated with sagittal sinus fenestration and falcine sinus.

Intracranial lipomas are rare lesions. Intracranial lipoma associated with a subcutaneous lipoma is extremely rare. Various vascular abnormalities have been described in association with intracranial lipoma, including distension, kinking, or narrowing of arteries and veins; arteriovenous malformation; and aneurysm. To our knowledge, association of sagittal sinus fenestration, falcine sinus, and absent straight sinus with intraextracranial lipoma has not been reported before. We report the imaging findings of an infant with interhemispheric and subcutaneous lipoma associated with falcine sinus and sagittal sinus fenestration.

Active immunotherapy for cancer patients using tumor lysate pulsed dendritic cell vaccine: a safety study.

Cancer vaccine therapy represents a promising therapeutical option. Consistently, with these new treatment strategies, the use of dendritic cell vaccines is becoming increasingly widespread and currently in the forefront for cancer treatment. The purpose of this study was to evaluate the feasibility and safety of tumor lysate-pulsed dendritic cell (DC) vaccine in patients with advanced cancers. For this purpose, eighteen patients with relapsed or refractory cancer were vaccinated with peripheral monocyte-derived DCs generated with GM-CSF and IL-4, and pulsed consequently with 100 microg/ml of tumor lysate before maturation in culture in the presence of IL-1beta, PGE2 and TNF alpha for two days. The first two vaccinations were given intradermally every two weeks while further injections were given monthly. Tumor lysate-pulsed dendritic cell injections were well-tolerated in all patients with no more than grade 1 injection-related toxicity. Local inflammatory response was mainly erythematous which subsided in 48 hrs time. No end organ toxicity or autoimmune toxicity was identified. Clinical responses observed in our study were satisfactory for a phase I clinical study. We observed 4 (22%) objective clinical responses. These responses are significantly correlated with delayed type hypersensitivity testing (DTH) (p < 0.01). The results showed that this active immunotherapy is feasible, safe, and may be capable of eliciting immune responses against cancer.

Giant serpentine aneurysm with acute spontaneous complete thrombosis.

We report a case of a giant serpentine aneurysm (GSA) of the middle cerebral artery (MCA) that underwent complete spontaneous thrombosis after angiography. The patient was a 24-year-old man who had an acute headache. CT and MR examinations revealed a large partially thrombosed aneurysm of the MCA with residual flow in the artery. Angiography demonstrated a GSA arising from the left MCA. Thirteen days later, a second angiography showed complete thrombosis of the aneurysm.

Subacute spinal subdural hematoma associated with intracranial subdural hematoma.

We describe a subacute spinal subdural hematoma in a patient with psot-traumatic subacute intracranial subdural hematoma. CT and MRI demonstrated hematoma within the interhemispheric subdural space and at the lumbar posterior subdural space which extended from the L1 to the S2 level. The lesion showed high signal intensity on both T1 and T2 weighted images. Surgical decompression of the spinal subdural hematoma was performed. The symptoms completely resolved after surgery. Spinal subdural hematoma may be concomitant with or may occur after intracranial subdural hematoma. If a patient with intracranial subdural hematoma complains of low back pain and weakness in both legs; lumbosacral MR examination should be performed to exclude spinal subdural hematoma.

Cerebellar agenesis: a case report with clinical and MR imaging findings and a review of the literature.

We describe the clinical and MRI findings in a 22-year-old male patient with absence of the cerebellum, an extremely rare anomaly. Clinical features included ataxia of limbs, gait and stance, cerebellar oculomotor signs. MRI evaluation showed minute remnants of cerebellar tissue corresponding to the anterior quadrangular lobules. Nine previous cases of total or subtotal cerebellar agenesis have been reported, including Combettes's first report in 1831. We report an additional case and provide MRI of this unusual anomaly detected during life. Diagnosis in this case was made on the basis of MR findings. To our knowledge, this is the fifth report of this disorder being diagnosed in a living patient. Copyright 1998 Lippincott Williams & Wilkins

Intracerebral myiasis from Hypoderma bovis larva in a child. Case report.

Cerebral myiasis with a 10-day history of convulsions due to an intracerebral hematoma caused by a Hypoderma bovis larva is reported in an 8-year-old child. Computerized tomography (CT) showed the hematoma in a right parieto-occipital location. The H. bovis larva and the extensive intracerebral hematoma were discovered during surgery. Among human parasitoses, cerebral myiasis is rare: a review of the literature revealed only two reports, one published in 1969 and one in 1980. This is the first case that has been diagnosed as cerebral myiasis with exact identification of the Hypoderma bovis larva both from the CT scans and at surgery in a patient during life.

Diabetes insipidus secondary to penetrating spinal cord trauma: case report and literature review.

STUDY DESIGN: Case report. OBJECTIVE: To present a case of central diabetes insipidus (CDI) that developed after a gunshot injury to the thorax and thoracic spinal cord and to discuss the disease process in light of the relevant literature. SUMMARY OF BACKGROUND DATA: Antidiuretic hormone (ADH) abnormalities may develop after spinal trauma and/or surgery. Although there are published reports of inappropriate ADH syndrome arising in this clinical picture, CDI is rare. METHODS: A 33-year-old woman with hemopneumothorax and a gunshot wound to her thoracic spine was treated with chest tube drainage. No surgery was performed for the spinal injury. The patient was paraplegic on admission and rapidly developed excessive urine output. Testing revealed that her serum ADH level was low, consistent with CDI. Desmopressin acetate nasal spray was the prescribed treatment. RESULTS: The patient responded well to the desmopressin acetate spray. CONCLUSIONS: CDI is a complicated hormonal disorder characterized by excessive urine output. It is typically linked to an abnormality in the hypothalamohypophyseal axis that markedly reduces ADH production. The most common inciting causes are craniocerebral trauma, brain tumor and/or surgery, and central nervous system infection. Although uncommon, CDI should be considered when a spinal trauma patient develops excessive urine output.

Non operative management of acute extradural hematomas in children.

The Authors have reported a series of 15 patients with acute epidural hematomas (EDHs) that were not evacuated surgically. These EDHs were diagnosed 6 hours after injury and were followed by serial CT scanning. All patients showed resolution of the hematoma on CT scanning over a period of 2 to 5 weeks. Factors that influence outcome of medical treatment have been discussed.

A case of acute encephalopathy after iohexol lumbar myelography.

A case of acute encephalopathy after lumbar myelography is reported in a female aged 26 years. Fourteen hours after the procedure, the patient developed coma (GCS 6) and had generalized slowing of EEG activity. This state lasted about 12 h, followed by gradual and full recovery.

Ogilvie's syndrome after cervical discectomy.

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by abdominal distention and massive colonic dilatation without any mechanical cause of obstruction. Lumbar spine operations can be an etiologic factor. We had a case with Ogilvie's syndrome after cervical discectomy. We also treated successfully this case by parasympathetic agent, neostigmine.

Intraventricular meningioma of the fourth ventricle.

A rare case of meningioma of the fourth ventricle is reported. A review of the literature revealed only 24 reported cases of this type of tumor.

Bilateral posterior fossa epidural hematoma--report of two cases.

Two cases of posttraumatic bilateral posterior fossa epidural hematoma are presented. Such hematomas are extremely rare, but can be surgically cured. Computed tomography helps to establish the diagnosis and determine the neurosurgical treatment.

The anesthetic management of a patient with pemphigus vulgaris--a case report.

The anesthetic management of a patient with pemphigus vulgaris who required general anesthesia and endotracheal intubation for craniotomy operation is described. The anesthesia was assured with Diprivan. Vecuronium bromide/isoflurane/nitrous oxide in oxygen and fentanyl when necessary. No anesthetic and surgical complication occurred.

Two unusual complications of ventriculo-peritoneal shunts. Report of two cases.

Two cases in which thoracal extrusion and cervical disconnection complicated ventriculo-peritoneal shunts are reported. Other complications of distal shunts are also reviewed.

Solitary plasmacytoma of the skull. A case report.

A case of solitary plasmacytoma of the skull is presented. The tumor was radically removed. There was no systemic involvement and the patient was not submitted to radiotherapy. Lytic lesions of the skull are discussed.

Hirsutism as a first manifestation of a giant arachnoid cyst of the sylvian fissure.

In this report, we present a case presenting with hirsutism. In this case, there was a large sylvian fissure arachnoid cyst demonstrated by radiology. This case is discussed in view of clinical findings and a literature review is presented.

Choroid plexus arteriovenous malformation (AVM) in a newborn. Case report.

We report here on an unusual case of AVM with intraventricular hemorrhage in a full-term newborn infant. Clinical and radiological findings are discussed in the light of the recent literature.

Giant cell tumor of the fronto-parietal bone. A case report.

Giant cell tumor of the skull is very rare clinical entity. This paper presents a case of giant cell tumor of the fronto-parietal bone and a brief review of the literature.

Epidermoid cyst of the brain stem. Case report.

Brain stem epidermoid cysts are extremely rare lesions. Only nine cases have been reported. Management of the epidermoid cyst is decompression of cyst contents and removal of cyst capsule. But in some cases resection of the cyst may result in a poor outcome because of cyst wall adhesion into the brain stem.

Primary intraosseous meningioma of the temporal bone in an infant. A case report.

Primary intraosseous meningioma of the skull bone is a very rare entity. Although it can occur at any age, it is very rare in children. We present a case and review the literature.