1/14. Olfactory function in patients with olfactory groove meningioma.OBJECTIVES: Olfactory meningiomas are rare benign tumours and represent about 12% of all basal meningiomas. Anosmia is thought to be among the first symptoms, even though patients often present with headaches or visual problems. However, so far no detailed psychophysical tests of olfactory function have been performed in a large number of those patients. methods: Twelve patients (five men, seven women; mean age 52 years) with olfactory meningiomas were examined. In all patients extensive preoperative and postoperative lateralised olfactory testing was performed using the "Sniffin' Sticks" test battery, a psychometric testing tool. In eight cases the meningioma was lateralised (five left, three right), in four patients a bilateral meningioma was found. In addition to a detailed ear, nose, and throat examination MRI was performed in all patients. RESULTS: In preoperative testing six patients were found to be anosmic on the side of the tumour, two were hyposmic. Four patients were normosmic. Postoperative investigations showed lateralised anosmia in four patients on the operated side, three were normosmic on the contralateral side and one hyposmic. The remaining eight patients were completely anosmic postoperatively. CONCLUSIONS: (1) Contrary to expectations, olfactory testing seems to be of little help in detecting olfactory meningiomas. (2) The likelihood of normal postoperative olfactory function contralateral to the tumour was high when the tumour was less than 3 cm in diameter and preoperative normosmia had been established. (3) Preservation of olfactory function ipsilateral to the tumour seems to be extremely difficult, irrespective of tumour size or surgical approach.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/14. Primary C1-2, intradural, extramedullary meningeal sarcoma with glial fibrillary acidic protein-immunoreactive components: a spinal gliosarcoma? Case report and review of the literature.The authors report an exceedingly rare case of a patient harboring a primary, spinal, C1-2, intradural, extramedullary meningeal sarcoma in which there were glial fibrillary acidic protein-immunoreactive components, but, importantly, no physical connection with neural tissue. On initial diagnostic imaging, neuroradiological features suggestive of a spinal meningioma were demonstrated in this 73-year-old man. He underwent a C1-2 laminectomy and removal of the posterior ring of the foramen magnum, and the lesion was excised. Histological and immunohistochemical testing showed a gliosarcoma. The clinical, radiological, and operative data are reviewed, as are the histopathological findings. To the authors' knowledge, this is the first case of a primary spinal intradural extramedullary gliosarcoma reported in the literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/14. Castleman's disease in a child presenting with a partly mineralized solitary meningeal mass.We report a case of solitary intracranial childhood Castleman's disease (CD) presenting with a sudden onset of partial seizures due to a meningeal and cortical mass lesion. The patient was a previously healthy 8-year-old girl who developed a new onset of simple partial seizures with motor signs. On physical examination, she was neurologically intact. Other findings included low-grade fever, mild microcytic anemia and lymphopenia. magnetic resonance imaging (MRI) of the brain revealed a left posterior parietal, partly mineralized, contrast-enhancing meningeal mass with cortical invasion and adjacent white matter edema. A complete surgical resection of the dural-based component and a subtotal resection of the adherent, invasive cortical lesion were performed. Pathohistology and flow cytometry of the dural-based lesion disclosed a hyaline-vascular type of CD with striking proliferation of polyclonal B lymphocytes, scattered plasma cells and extensive multifocal cortical mineralization. At the 6-month follow-up, the patient was seizure free on antiepileptics and had returned to normal daily activities. MRI showed no residual lesion, and a workup for systemic disease was negative.- - - - - - - - - - ranking = 11.060656887393keywords = physical examination, physical (Clic here for more details about this article) |
4/14. Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. Report of three cases.The authors discuss the cases of three patients in whom thoracic paraplegia developed after lumbar spinal decompressive surgery for slight lumbar spinal canal stenosis. Careful computerized tomography myelography and magnetic resonance imaging examination of the thoracic spine revealed another compressive lesion (spinal cord tumor, disc herniation, osteophyte of vertebral body, and ossification of the ligamentum flavum). Additional thoracic decompressive surgery provided partial amelioration of each patient's neurological condition. The authors suggest that to avoid such a complication physical and radiographic examination of the thoracic spine should be performed preoperatively if the lumbar imaging is inconclusive.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/14. Headaches and brain tumors.A careful history and physical examination remain the most important aspects of headache assessment. enabling the neurologist to decide if any further studies are necessary. Only a minority of patients who have headaches have brain tumors; however, recognition of the headaches characteristically associated with tumors is most important. Some locations are more likely to produce headache (eg, a posterior fossa tumor causes headache more often than a supratentorial tumor). Rapidly growing tumors are more likely to be associated with headache. Uncommon headache presentations can occur with tumors, includin paroxysmal cough, cluster headache, and TACs. The classic brain tumor headache is not as common as a tension-type presentation or migraine. patients who have prior primary headaches may have more headache symptoms if they have a tumor and of course they still have their primary headache disorder. Mass lesions progress and inevitably develop other symptoms and signs besides headache, and these new symptoms and signs must be sought and found. Metastatic leptomeningeal involvement can present with headache and spinal pain in the neck and back. Imaging of headache patients for tumors, if they have primary headache disorders, such as migraine and typical cluster, generally is not cost effective but is necessary if there are any atypical features. Treatment of headache in patients who have metastatic brain tumors should be aggressive in terms of pain and symptoms control. Treatment of primary CNS tumors is dictated by the kind of neoplasm and site, but control of headache should not be ignored.- - - - - - - - - - ranking = 11.060656887393keywords = physical examination, physical (Clic here for more details about this article) |
6/14. Clinicopathological and radiological features of two cases of intraventricular meningioma in childhood.The clinical, radiological and pathological features of two cases of intraventricular meningioma in a 9-year-old boy and a 9-year-old girl are reported. Presenting features included headache, vomiting and somnolence with no localizing neurological signs on physical examination. Neither patient showed evidence of neurofibromatosis. CT scans were helpful in establishing the preoperative diagnoses with uniformly hyperdense, well-circumscribed lesions showing bright enhancement after contrast within the lateral and third ventricles respectively. Histological examination revealed mixed fibroblastic/angioblastic and fibroblastic patterns, with typical electron-microscopic and immunohistochemical features of meningioma. Successful surgical removal was achieved in both cases.- - - - - - - - - - ranking = 11.060656887393keywords = physical examination, physical (Clic here for more details about this article) |
7/14. Meningiomas and hemorrhagic diathesis.The physical act of operating on 13 patients with meningiomas was studied for its effect on the fibrinolytic system. Fibrinolytic abnormalities, mainly due to an increase of plasma fibrinolytic activity, appeared in three patients prior to, during, or after surgery. These patients demonstrated hemorrhagic diathesis in the operative wounds which was associated with a consumptive coagulopathy, namely, an increase of fibrin/fibrinogen degradation product concentration and a decrease of fibrinogen concentration in plasma. Antiplasmin agents (gabexate and tranexamic acid) were effective in minimizing loss of blood during and after the operation. Abnormal hyperfibrinolysis seems to play a role in hemostatic difficulties in patients undergoing surgery for meningioma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/14. An unusual posterior cranial fossa tumour causing hearing loss.Clivus meningioma is an uncommon tumour arising from the region of the synchrondrosis between the basal portions of the sphenoid and occipital bones. We report a case of a patient with a large meningioma of the clivus whose presenting symptom was auditory change. Alteration of hearing is a rare mode of presentation for such a tumour although it may present at a later stage in about 50 per cent of cases. The discrepancy between the size of the tumour and the paucity of physical findings, the value of a multiple test auditory screening strategy, and the surgical approach in this case are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/14. Warning symptoms of sinister headache.Headache is a common complaint. In most patients, it is usually a problem of migrainous or tension-type headache. It is crucial that a physician is able to differentiate sinister causes of headache from the more benign ones. Six cases are presented to illustrate the fact that there are clues in the history to suggest a sinister cause of headache even though there are minimal or no neurological deficits on physical examination. At some point of time, these cases were examined by a senior physician but they were diagnosed as migrainous or tension-type headaches. The first case is a 41-year-old labourer with cryptococcal meningitis. He presented with severe headaches at a relatively late age. A 20-year-old female complained of the worst headache she ever had and this was due to a subarachnoid haemorrhage. The third case was a young woman with a large parietal meningioma. Her headaches had recently assumed a different character. The fourth case involved an investment manager who developed headaches with transient diplopia and projectile vomiting and investigations revealed an ependymoma. A shipyard worker complained of a constant headache which disturbed his sleep. Two weeks after medical consultation, the character of his headache changed and he developed diplopia in all directions of gaze. He succumbed to pituitary apoplexy. The final case is a 28-year-old woman who had a complicated migraine. CT scan of the brain showed a large arterio-venous malformation.- - - - - - - - - - ranking = 11.060656887393keywords = physical examination, physical (Clic here for more details about this article) |
10/14. dermatomyositis, carcinoma of colon and meningioma in the same patient.dermatomyositis and carcinoma of colon were diagnosed in a 66-year-old woman. Meticulous physical examination excluded further systemic or cutaneous involvement. The musculocutaneous disorders responded well to daily oral corticosteroid, and the malignant tumor was totally removed surgically. After a seven-year follow-up of actual dermatomyositis controlled by maintenance doses of prednisone ranging from 5 to 15 mg daily, the patient developed a meningioma. Current concepts and data regarding various aspects of the combination between dermatomyositis and tumors are discussed. To our knowledge, this is the first reported case of meningioma associated with dermatomyositis.- - - - - - - - - - ranking = 11.060656887393keywords = physical examination, physical (Clic here for more details about this article) |
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