1/293. Multiple skull base meningioma: case report.BACKGROUND: The incidence of multiple skull base meningiomas varies from 1 to 3% in different series. skull base meningiomas are rare. The pathogenetic role of low-dose radiation seems to be fairly well established in the oncogenesis of meningiomas. Calvarial location and multiplicity seem to be among the distinctive features of radiation-induced meningiomas. skull base location is a very rare occurrence, mainly because the path of irradiation does not significantly involve this region. CASE REPORT: We describe a rare case of simultaneous occurrence of two skull base meningiomas in a 66-year-old female. This patient underwent low-dose irradiation for tinea capitis when she was 8 years old. The patient complained of nuchal pain, paresthesias in both hands, and progressive weakness on her right side. She was admitted to the hospital in September 1994. An MRI showed two masses, one located at the level of the tuberculum sellae and the other at the foramen magnum. These seemed very likely to be multiple meningiomas. The latter lesion, which was more symptomatic and dangerous, was operated on first. Six months later, elective treatment of the suprasellar meningioma was performed with success. CONCLUSION: The actual role of previous head irradiation in the oncogenesis of the present meningiomas remains somewhat unclear. Proper management and judicious use of skull base surgery techniques were key factors in the successful treatment of the patient.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/293. Radicular pain can be a symptom of elevated intracranial pressure.We report two patients with leptomeningeal metastatic disease, one from breast cancer and the other from a spinal cord glioma, who developed episodic elevated intracranial pressure (ICP), each episode accompanied by the gradual onset of severe spine and radicular pain. Symptoms of pain promptly and completely resolved with opening of the on-off valve of each patient's ventriculoperitoneal shunt. It is theorized that the patients' radicular pain was caused by nerve root ischemia secondary to elevated ICP.- - - - - - - - - - ranking = 7keywords = pain (Clic here for more details about this article) |
3/293. lung carcinoma presenting as metastasis to intracranial meningioma: case report and review of the literature.Tumor-to-tumor metastasis is rare. The authors report a case of a 52-year-old man with a 1-year history of a right parasaggital meningioma, whose clinical signs were consistent with enlarging meningioma. In preparation for surgery, the routine preoperative chest radiograph revealed a lung mass. Fine-needle aspiration of the mass revealed adenocarcinoma. The patient underwent surgical excision of the intracranial mass, which was thought to be a meningioma. However, pathologic examination revealed a transitional meningioma extensively infiltrated with deposits of metastatic carcinoma from the patient's primary lung tumor. Metastasis to meningioma was therefore responsible for the rapid enlargement of the long-standing meningioma, and caused the first clinical manifestation of primary lung carcinoma. Recurrent metastasis developed at the surgical site 5 weeks later, requiring surgical excision and postoperative radiation to prevent further recurrence. This is a highly unusual presentation for lung carcinoma and, to the authors' best knowledge, is the first such case reported. A review of the published literature revealed 20 other cases of lung carcinoma metastatic to meningioma, which were incidentally discovered on surgery or autopsy.- - - - - - - - - - ranking = 0.026303401996436keywords = chest (Clic here for more details about this article) |
4/293. Foreign body granuloma mimicking intracranial meningioma: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Intracranial foreign body granulomas are rare. We describe a case of an intracranial foreign body granuloma found in a 17-year-old female patient 9 years after she underwent a craniotomy for a tumor of unknown type. Postoperative imaging of patients who have undergone neurosurgical procedures can often reveal enhancing masses, and foreign body granuloma should be included in the differential diagnosis. CLINICAL PRESENTATION: The patient presented with a history of developmental delay, panhypopituitarism, and chronic headache. Admission resulted from an acute increase in the severity of her headache. INTERVENTION: Imaging studies, including computed tomography and magnetic resonance imaging, demonstrated a 1.5 x 2 cm round, enhancing anterior interhemispheric mass, appearing to arise from the falx and causing mild mass effect. A nonenhancing cystic mass was also noted in the suprasellar region but was without mass effect. The patient underwent a craniotomy and removal of the anterior mass without complication, and her headache resolved. A pathological examination of the specimen confirmed the diagnosis of foreign body granuloma. CONCLUSION: Although rare, foreign body granuloma should be included in the differential diagnosis of previously operated intracranial masses. The importance of accurate historical information and guidelines that may assist in diagnosis are discussed.- - - - - - - - - - ranking = 113.08300172133keywords = headache (Clic here for more details about this article) |
5/293. Primary lymphoma of Meckel's cave mimicking trigeminal schwannoma: case report.OBJECTIVE AND IMPORTANCE: We report the first case of primary lymphoma of Meckel's cave. The ability of a lymphoma to mimic a trigeminal schwannoma, both clinically and radiographically, resulted in misdiagnosis and flawed surgical strategy. We discuss the characteristics of a Meckel's cave lymphoma on magnetic resonance images, the predisposing medical conditions that should cause the neurosurgeon to add lymphoma to the normal differential diagnosis, and appropriate management strategies. CLINICAL PRESENTATION: A 40-year-old African-American woman presented with a 5-month history of progressive facial numbness and pain in all three divisions of the left trigeminal nerve. magnetic resonance imaging revealed a mass in the left side of Meckel's cave, with extension into the lateral compartment of the cavernous sinus, without encasement of the internal carotid artery, through the foramen rotundum into the posterior aspect of the maxillary sinus, and through the foramen ovale into the pterygopalatine fossa. The diagnosis, based on clinical history and radiographic imaging, was schwannoma of Meckel's cave. The patient had a history of systemic lupus erythematosus that had been treated with intermittent steroid therapy. INTERVENTION: The surgical approach selected was a frontotemporal craniotomy with orbitozygomatic osteotomy and anterior petrosectomy. The lesion was totally excised, although the gross intraoperative appearance of the lesion was inconsistent with the preoperative diagnosis, and the pathological examination was unable to establish a histological diagnosis on the basis of frozen sections. Histological diagnosis was confirmed on permanent section after surgery as B-cell lymphoma. Evaluation for other primary sites produced negative results. The patient was then treated with cyclophosphamide (Cytotoxan; Bristol-Myers Oncology, Princeton, NJ), doxorubicin (Adriamycin; Pharmacia & Upjohn, Kalamazoo, MI), vincristine, and prednisone chemotherapy every 3 weeks for six cycles and then by radiation therapy to the affected area. CONCLUSION: The diagnosis of lymphoma should be considered for lesions affecting Meckel's cave in high-risk immunocompromised patients. The presence of an apparent dural tail in an otherwise typical schwannoma is the distinguishing characteristic of a lymphoma. The absence of hyperostosis helps differentiate it from a meningioma. At this point, the preferred surgical strategy is biopsy for diagnosis and then radiotherapy and chemotherapy rather than major cranial base surgery for total resection.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
6/293. Parasagittal solitary fibrous tumor of the meninges. Case report and review of the literature.The clinical, radiologic and pathologic features of a case of parasagittal solitary fibrous tumor of the meninges are reported. The patient was a 44 year-old male who presented with a complex partial seizure and a history of headaches and confusion. Radiological studies showed a large extra-axial dural-based mass in the right parietal region, predominantly isointense with gray matter and hypointense with respect to white matter on T1-weighted images, and hypointense with respect to gray matter on T2-weighted images. At surgery, the mass was very vascular, quite firm and very adherent to the convexity. Histologically the tumor was composed of spindle-shaped cells growing in fascicles within a collagenous matrix. Solitary fibrous tumor of the meninges is a newly described entity, which should be kept in mind in the clinical and radiological differential diagnosis of extra-axial brain tumors.- - - - - - - - - - ranking = 37.694333907109keywords = headache (Clic here for more details about this article) |
7/293. A leptomeningeal metastasis revealed by sciatica.Meningeal metastatic disease usually occurs as a complication of a brain tumor and is exceptionally isolated in patients with solid tumors. We report the case of a 74-year-old woman admitted for mechanical S1 sciatica refractory to drug therapy. She had been treated for breast cancer three years earlier. Physical findings were pain upon hyperextension of the lumbar spine and absence of the ankle jerks. Analysis of cerebrospinal fluid sampled during an intrathecal glucocorticoid injection showed 1 g/L of protein and 11 normal cells per mm3. Grade 3 L5-S1 spondylolisthesis was seen on plain radiographs, computed tomography scans, and magnetic resonance imaging scans. At that point, the patient developed sphincter dysfunction and motor loss in the left lower limb in the distribution of several nerve roots. Findings were normal from a myelogram and a magnetic resonance imaging study of the brain. A repeat cerebrospinal fluid analysis showed 1.1 g/L of protein and 5 cells/mm3. Because of the discrepancy between the clinical and imaging study findings, the patient was transferred to a neurology department. A third cerebrospinal fluid study showed numerous adenocarcinoma cells, and a repeat magnetic resonance imaging demonstrated a mass in the dural sac opposite L2. A program of monthly intrathecal methotrexate injections was started. A fatal meningeal relapse occurred eight months later. CONCLUSION: This case shows that a leptomeningeal metastasis can cause isolated nerve root pain, and demonstrates the diagnostic value of magnetic resonance imaging and cerebrospinal fluid cytology in patients with atypical symptoms, particularly when there is a history of malignant disease.- - - - - - - - - - ranking = 2keywords = pain (Clic here for more details about this article) |
8/293. Primary brain myxoma, an unusual tumor of meningeal origin: case report.OBJECTIVE AND IMPORTANCE: Primary myxoma of the central nervous system is an extremely rare tumor arising from cells of primitive mesenchymal origin. Only two cases of primary intracranial myxoma have been described previously. We report a patient with a primary myxoma originating from the right frontoparietal convexity dura, which we studied in detail with diagnostic imaging and pathological analysis. CLINICAL PRESENTATION: A female adolescent presented to the emergency department with a 3-day history of mild headache, abdominal pain, and intermittent left-sided focal motor seizures. Neurological examination was remarkable for left leg hyperreflexia and difficulty with tandem gait. Cranial computed tomography and magnetic resonance imaging demonstrated an inhomogeneously enhancing mass in the right frontoparietal region. INTERVENTION: A right frontoparietal craniotomy was performed. During surgery, a tumor appearing similar to a typical convexity meningioma was completely removed along with the dural attachment. CONCLUSION: The patient had an uneventful recovery and returned to normal activity. Primary intracranial myxoma should be distinguished from other meningeal tumors and metastatic cardiac myxoma by appropriate pathological analysis and cardiac evaluation. A circumscribed myxoma completely excised with adequate dural margin carries a good prognosis for surgical cure.- - - - - - - - - - ranking = 38.694333907109keywords = headache, pain (Clic here for more details about this article) |
9/293. Case of the month: March 1999--A 26 year old hiv positive male with dura based masses.A 26-year-old male with AIDS presented with a chief complaint of headaches and neck pain. An MRI revealed two enhancing extra-axial dura based masses, one in the area of the left sphenoid wing and one at the level of C2-3. In both cases, microscopic sections showed actin positive spindle cell neoplasms with long slender nuclei, consistent with leiomyomas. Both tumors were positive for Epstein Barr virus by in situ hybridization. This case report serves to emphasize the importance of considering soft tissue tumors such as leiomyoma in the differential diagnosis of mass lesions that occur in the central nervous system in AIDS and discusses the role of EBV in tumorigenesis.- - - - - - - - - - ranking = 38.694333907109keywords = headache, pain (Clic here for more details about this article) |
10/293. Rosai-Dorfman disease presenting multiple intracranial lesions with unique findings on magnetic resonance imaging. Case report.Rosai-Dorfman disease (RDD) is a rare idiopathic histoproliferative disease affecting the systemic lymph nodes. Although an extranodal lesion has also been recognized, central nervous system involvement is extremely rare. To the authors' knowledge, only 20 cases of intracranial lesions have been reported previously. Intracranial RDD is clinically and radiologically difficult to distinguish from meningioma, and histological examination is essential for a definitive diagnosis. The authors treated a large frontal lobe tumor associated with multiple meningeal nodules in a 67-year-old patient presenting with diplopia and headache. Radiological examination indicated that the mass was an inflammatory lesion rather than a meningioma. Microscopically the lesion consisted of mixed inflammatory infiltrate with marked emperipolesis, which is characteristic of RDD. A review of the literature and a discussion of the differential diagnosis of this rare lesion are also presented.- - - - - - - - - - ranking = 37.694333907109keywords = headache (Clic here for more details about this article) |
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