1/57. Midline cerebellar cystic schwannoma : a case report.An extremely unusual case of a cystic schwannoma in the region of the inferior vermis and posterior to the fourth ventricle in a fifteen year old boy is reported. The cystic tumour caused partial obstruction to the outflow of cerebrospinal fluid from fourth ventricle and resulted in development of supratentorial hydrocephalus. On investigations, the schwannoma simulated a Dandy-Walker cyst. The boy presented with symptoms of increased intracranial pressure. On surgery, the lesion was not arising from any cranial nerve, nor was it attached to brain parenchyma, blood vessel or to the dura. The possible histogenesis of the cystic schwannoma in a rare location is discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/57. tinnitus as the presenting symptom in a case of Lhermitte-Duclos disease.Dysplastic gangliocytoma or Lhermitte-Duclos disease (LDD) is a hamartomatous malformation of the cerebellar hemisphere that usually presents with signs of increased intracranial pressure or symptoms of cerebellar dysfunction. In this paper, we report a case of LDD presenting with tinnitus, and postulate a probable mechanism for this unusual presentation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/57. ECT and intracranial vascular masses.In 1990, the APA Task Force on ECT cited no "absolute" contraindications to ECT but "Substantial risk" to be associated with ECT for patients with space occupying or other cerebral lesions with increased intracranial pressure and with bleeding or otherwise unstable vascular aneurysm or malformation. These findings indicate that patients with intracranial vascular masses are at increased risk for serious morbidity and mortality. Several authors have reported performing ECT in patients with intracranial vascular masses without adverse events by monitoring blood pressure both with and without pharmacologic intervention. Given the relatively recent change in practice of considering ECT for patients with intracranial vascular masses and the few number of cases thus far reported, we present a review of the existing literature and two additional cases of ECT performed with good result and no adverse events. With the cases we have presented, the literature now contains eight cases of ECT performed in patients with intracranial vascular masses, none of which had adverse outcomes. While such numbers do not establish unequivocal safety in this population, and the individual ECT practitioner must continue to make a risk/benefit analysis on a case-by-case basis, this report adds to the growing literature on the safety and efficacy of ECT for such patients.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/57. Spinal subdural haematoma mimicking tethered cord after posterior fossa open surgery.We report the MRI findings in a girl aged 3 years and 10 months who developed a spinal subdural haematoma after posterior fossa open surgery for cerebellar malignant rhabdoid tumour. Emergency surgery was performed immediately because of increased intracranial pressure. Control MRI 48 h after surgery showed a spinal subdural haematoma without clinical signs of paresis or bladder dysfunction. Spinal subdural haematoma is rare, and only few cases have been reported, especially in children. This report suggests that "silent" (without clinical symptoms) postoperative spinal acute subdural haemorrhage can occur after posterior fossa surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/57. Myelopathy and sciatica induced by an extradural S1 root haemangioblastoma.Haemangioblastomas are vascular tumours which mainly involve the central nervous system and retina, often in the setting of von hippel-lindau disease. Haemangioblastomas occurring outside the central nervous system are uncommon. Wherever it is, recognising this tumour prior to surgery is desirable, as preoperative embolisation may be considered. We report the clinical, imaging and pathological features of a sporadic sacral root haemangioblastoma in a 58-year-old man with chronic sciatica and myelopathy. The diagnosis was questioned preoperatively because an enlarged sacral foramen, seen to be filled by a highly vascular, enhancing mass and dilated vessels. Myelopathy was attributed to the presumed high venous pressure resulting from increased flow in veins draining the vascular tumour. Microneurosurgical excision was performed after endovascular embolisation and led to persistent clinical improvement.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/57. Unusual presentation of carcinomatous meningitis: case report and review of typical CSF findings.This paper describes a previously unreported clinical onset of carcinomatous meningitis with bilateral deafness. Typical changes in the cerebrospinal fluid aside from positive cytology findings are reviewed. In cases of suspected carcinomatous meningitis the clustering of increased CSF protein, lactate, decreased glucose, and a high opening pressure is suggestive of the diagnosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/57. Cerebellar abscesses secondary to occipital dermoid cyst with dermal sinus: case report.BACKGROUND: hydrocephalus and cerebellar abscesses as the principal manifestations of posterior fossa dermoid cyst are rare. In addition, extradural dermoid cyst of the posterior fossa has been described in only 9 cases in the literature. We present an unusual case of obstructive hydrocephalus due to cerebellar abscesses induced by an adjacent extradural dermoid cyst with complete occipital dermal sinus. CASE DESCRIPTION: A 14-month-old child presented with acute raised intracranially pressure, seizures, and meningitis. Neuroradiological studies revealed cerebellar cysts with ring enhancement associated with a contiguous occipital cyst, with compression of the adjacent cisterns and the fourth ventricle causing hydrocephalus. The diagnosis of cerebellar abscesses with congenital occipital defect was briefly entertained. The patient was treated by radical excision of the occipital cyst with hair contents, the dermal sinus, and the abscesses through a suboccipital approach, followed by systemic antibiotic therapy with a good outcome. Pathologic examination revealed a dermoid cyst. CONCLUSION: Posterior fossa dermoid cyst should be considered in all children with occipital skin lesions, especially dermal sinus. CT scan and MRI are the methods of choice for further investigation of suspect congenital dermal lesions. Neurosurgical treatment of these malformations should be planned early to prevent the high incidence of infections such as bacterial meningitis and cerebellar abscess. Clinical presentation, diagnostic evaluation, and treatment of these rare lesions are reviewed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/57. Cerebellar liponeurocytoma (lipomatous medulloblastoma).Liponeurocytoma (lipomatous medulloblastoma) is an uncommon clinicopathologic entity. We report a case of cerebellar liponeurocytoma in an adult and attempt to better characterize this uncommon lesion. A 43-year-old woman presented with symptoms and signs of increased intracranial pressure and cerebellar dysfunction. CT and MRI showed a heterogeneous well-circumscribed mass in the left cerebellar hemisphere with hydrocephalus. Complete surgical excision of the tumor was accomplished through a suboccipital craniotomy. Pathological examination with immunohistochemical study revealed a medulloblastoma with neuronal, astrocytic and lipomatous differentiation. Postoperative radiation therapy was given. After surgery, the patient was followed up for a 16 month-period; symptoms improved dramatically and no evidence of tumor recurrence was found. Careful analysis of the histopathological and immunohistochemical studies correctly identifies liponeurocytoma (lipomatous medulloblastoma). To our knowledge, only 16 cases have been reported. Although this lesion appears to have a better prognosis than the conventional form of adult medulloblastoma, complete surgical removal with postoperative radiation therapy is recommended.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/57. Intracranial aneurysmal bone cyst manifesting as a cerebellar mass.A 17-year-old boy presented with symptoms of raised intracranial pressure for a month. Investigations revealed a large extra-cerebellar mass. The lesion was radically resected. It arose from the petrous bone. histology revealed that the lesion was an aneurysmal bone cyst [ABC].- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/57. Erroneous diagnosis within the cranial vault.The majority of pediatric neoplasias of the brain are midline growths in the posterior fossa. These mass lesions lead to obstruction of cerebrospinal fluid circulation and cause increased intracranial pressure. Affected children typically present with insidious complaints of headache and vomiting. ataxia, cranial nerve palsies, or pyramidal tract signs may be present at the time the diagnosis is entertained. In the reports describing pathognomonic clinical features of posterior fossa tumors, an accelerated presentation with minimal prodromal events has not been emphasized. This report details the case of a child with a cerebellar medulloblastoma who presented with abrupt onset of fever, nuchal rigidity, and altered mental status. Emergency department misdiagnosis occurred.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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