1/63. 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.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/63. Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature.Acute subdural spinal hematoma occurs rarely; however, when it does occur, it may have disastrous consequences. The authors assessed the outcome of surgery for this lesion in relation to causative factors and diagnostic imaging (computerized tomography [CT], CT myelography), as well as eventual preservation of the subarachnoid space. The authors reviewed 106 cases of nontraumatic acute subdural spinal hematoma (101 published cases and five of their own) in terms of cause, diagnosis, treatment, and long-term outcome. Fifty-one patients (49%) were men and 55 (51%) were women. In 70% of patients the spinal segment involved was in the lumbar or thoracolumbar spine. In 57 cases (54%) there was a defect in the hemostatic mechanism. spinal puncture was performed in 50 patients (47%). Late surgical treatment was performed in 59 cases (56%): outcome was good in 25 cases (42%) (in 20 of these patients preoperative neurological evaluation had shown mild deficits or paraparesis, and three patients had presented with subarachnoid hemorrhage [SAH]). The outcome was poor in 34 cases (58%; 23 patients with paraplegia and 11 with SAH). The formation of nontraumatic acute spinal subdural hematomas may result from coagulation abnormalities and iatrogenic causes such as spinal puncture. Their effect on the spinal cord and/or nerve roots may be limited to a mere compressive mechanism when the subarachnoid space is preserved and the hematoma is confined between the dura and the arachnoid. It seems likely that the theory regarding the opening of the dural compartment, verified at the cerebral level, is applicable to the spinal level too. Early surgical treatment is always indicated when the patient's neurological status progressively deteriorates. The best results can be obtained in patients who do not experience SAH. In a few selected patients in whom neurological impairment is minimal, conservative treatment is possible.- - - - - - - - - - ranking = 646.21282816644keywords = subdural (Clic here for more details about this article) |
3/63. Revisited: spinal angiolipoma--three additional cases.Angiolipomas are benign tumours which usually arise from subcutaneous tissue, particularly in the forearm, but they do occur rarely in the spinal canal. To the best of our knowledge 60 cases of histologically confirmed spinal angiolipoma have been reported in the medical literature. They show a female predominance (1.6:1), and the mean age at presentation is 43 years. They usually arise in the thoracic spine, most cases presenting with slowly progressive signs and symptoms of cord compression. Rarely, massive acute haemorrhage into the tumour may herald its presence. Surgical resection or decompression are the most satisfactory methods of treatment in most patients. We describe three further cases of spinal angiolipoma, and discuss their aetiology, pathogenesis, clinico-pathological features and surgical management.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
4/63. Non-traumatic spinal extradural haematoma: magnetic resonance findings.Non-traumatic extradural spinal haematoma is an uncommon condition that is usually associated with a poor outcome. It may present acutely with signs and symptoms of major neurological dysfunction secondary to cord compression, or subacutely over a number of days or weeks with fluctuating symptoms. The exact aetiology of this condition is incompletely understood, but it is believed that the blood is venous in origin, as distinct from the arterial origin of intracranial extradural haematomas. Causes of non-traumatic extradural spinal haematoma include anticoagulation, vasculitis such as systemic lupus erythematosus (SLE), and spinal arteriovenous malformations. Conditions that may mimic an acute spinal haematoma include extradural abscess and extradural metastatic infiltration. It is important to make a diagnosis of extradural compression because surgery may offer the best hope in restoring neurological function in these patients. Imaging modalities used for the investigation of extradural haematomas include myelography, CT myelography (CTM) and MRI with or without gadolinium enhancement. The MR appearances of acute extradural abscess and extradural tumour can mimic an extradural haematoma. In subacute haematoma, owing to the magnetic properties of blood degradation products, MR is more specific in diagnosing and ageing of the haematoma.- - - - - - - - - - ranking = 2420.5209438807keywords = haematoma (Clic here for more details about this article) |
5/63. Complete paraplegia as a result of regional anesthesia.Complications after spinal or epidural anesthesia are rare. We report 2 cases of postoperative, complete paraplegia after regional anesthesia in orthopaedic patients not on anticoagulants. The paralysis was likely the result of spinal cord compression secondary to an epidural hematoma in 1 case and subdural hematoma in 1 case. A review of the literature regarding complications of regional anesthesia is presented. Regional anesthesia should be administered with caution and in selected patients.- - - - - - - - - - ranking = 92.316118309491keywords = subdural (Clic here for more details about this article) |
6/63. Acute spontaneous spinal epidural haematoma in a child.Spontaneous spinal epidural haematomas rarely occur. patients tend to be in their sixties or seventies. Acute spontaneous spinal epidural haematomas in children without a predisposition for bleeding disorders, trauma, vascular malformations or anticoagulant therapy have seldom been described. We present a case of a 4-year-old girl with a spontaneous cervical epidural haematoma diagnosed with MR.- - - - - - - - - - ranking = 1411.9705505971keywords = haematoma (Clic here for more details about this article) |
7/63. Haemorrhage in upper cervical cord: an unusual manifestation in moderate haemophilia patients who ride motorbikes.A young asymptomatic patient, with moderate haemophilia due to factor ix deficiency, developed symptoms of upper cord compression caused by a haemorrhage 12 hours after riding a motorcycle on a poorly maintained road. This led to quadriparesis with respiratory paralysis. In spite of neurosurgical intervention and intensive management with respirator therapy, the patient died 13 days after the incident from pneumonia and multi-organ failure. This is a very rare presentation of moderate haemophilia with serious consequences and has not to our knowledge, previously been reported in the English literature.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
8/63. Intraspinal oxidised cellulose (Surgicel) causing delayed paraplegia after thoracotomy--a report of three cases.Oxidised regenerated cellulose (Surgicel) is a commonly used haemostatic agent in neurosurgery, thoracic surgery, and orthopaedics. We present three cases of paraplegia after thoracic surgery during which oxidised cellulose had been used during thoracotomy for haemorrhage control, and was later found to have passed through the intervertebral foramen causing spinal cord compression. In all intraspinal and perispinal procedures, the over-liberal use of Surgicel should be avoided, and attempts made to remove all excess Surgicel once adequate haemostasis is obtained.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
9/63. Arachnoid calcification producing spinal cord compression.A case of spinal cord compression, presumed to be due to a calcification in the arachnoid, is presented. Its relationship to a previous spinal subarachnoid haemorrhage is mentioned. The literature is reviewed and the relationship of this condition to spinal subarachnoid haemorrhage, previous myelogram, and spinal anaesthetic is stressed.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
10/63. Spinal dural involvement in erdheim-chester disease: MRI findings.There are very few reported cases of erdheim-chester disease that document involvement of dura at the level of the spinal cord. Among these reports, we know of no publication that includes detailed MRI findings. To the best of our knowledge, the case presented here is the first published report of this specific manifestation of erdheim-chester disease that includes detailed MRI findings in addition to the related history. Spinal manifestations of erdheim-chester disease in our patient were at the dorsal and lumbar levels (T1-T6 and T12-T11 respectively). Both epidural and subdural linear large masses were present, causing spinal cord compression at the dorsal level and epidural thickening at the lumbar level.- - - - - - - - - - ranking = 92.316118309491keywords = subdural (Clic here for more details about this article) |
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