1/14. Intracranial meningiomas revealed by non-traumatic subdural haematomas: a series of four cases.OBJECTIVE: A review of the literature shows 33 cases of ipsilateral subdural haematomas (SDH) associated with meningiomas. We suggest that physiopathological mechanisms could be primary haemorrhages from abnormal vessels in the tumours and the opening of the intratumoral haematomas into the subdural space. Our working hypothesis relies on a series of 300 meningiomas operated upon in our department since 1990; of these, 4 were revealed by SDH. CLINICAL PRESENTATION: The four patients surgically treated in our department had developed a progressive impairment of consciousness. There was no history of trauma, blood dyscrasia or anticoagulant therapy. After diagnosis, the SDH was drained, and the meningeal tumour was totally resected once it had been discovered. In one case, the presence of a tumour was demonstrated by magnetic resonance imaging (MRI) performed only after the evacuation of a recurrent SDH. INTERVENTION: In each case, an acute SDH showing signs of recent bleeding was evacuated. The meningeal tumour discovered proved to be the source of the haemorrhage because of the numerous fresh blood clots both around and inside it. histology: In the four cases histology showed fresh intratumoral haemorrhages (ITH), large blood vessels with thin endothelial linings and haemosiderin deposits. In this review, SDH is associated with other haemorrhage sites in 24 of 37 cases (33 our 4 cases). ITH was present in 14 cases (40%). CONCLUSION: The treatment should consist of the extirpation of the meningioma at the same time as the evacuation of the haematoma. If primary ITH from abnormal vessels is the source of SDH, complete meningioma resection should prevent the recurrence of SDH. Subdural membranes and haematomas should therefore be inspected for their intrinsic pathology, especially when there is no history of trauma.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
2/14. Falcotentorial meningioma accompanied by temporal lobe hematoma.We report a case of a falcotentorial meningioma accompanied by hematoma in the temporal lobe. A healthy 51 year-old-female with no history of hypertension presented with sudden onset of consciousness disturbance and right hemiparesis. Computed tomography revealed a hematoma 5.5 cm in diameter surrounded by thick edematous brain in the left temporal lobe and a tumor 3.5 cm in diameter in the pineal region. Bilateral carotid angiography detected occlusion of the Galenic vein and straight sinus. No causative abnormality of hemorrhage was apparent. However, the left basal vein of Rosenthal had disappeared, and anastomotic venous channels could be observed in the medial left temporal lobe, contiguous to the hematoma. Emergency craniotomy failed to detect any abnormality which could cause hemorrhage in the brain parenchyma surrounding the hematoma. Subtotal removal of the tumor, histologically diagnosed as fibrous meningioma, was achieved three months later employing an occipital transtentorial approach. Venous congestion caused by compression due to the tumor was considered to be one of possible causes of the hemorrhage.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
3/14. The Charles Bonnet syndrome: a case report.The Charles Bonnet syndrome is a condition in which individuals experience complex visual hallucinations without evident psychopathology or disturbance of normal consciousness. Although it can affect people of any age, it is more frequent among the elderly. It occurs mostly in people with damaged sight, as a result of peripheral eye pathology or pathology within the brain. A common definition of the syndrome is, however, not yet available nor has its pathophysiology been elucidated. This report concerns a 72-year-old widow who was practically blind after a cataract operation on both eyes ten years ago. Visual hallucinations appeared in the absence of other psychopathological symptoms. During hospitalization of the patient, an extensive meningeoma sellae turcicae was discovered, which destroyed both nervi optici. This case shows that multiple causes of the Charles Bonnet syndrome should be taken into consideration and that an exact diagnostic evaluation is essential.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
4/14. Tentorial schwannoma: a case report and review of the literature.INTRODUCTION: Schwannomas are most often found in association with the eighth cranial nerve, but may also arise from any other cranial nerve. They are rarely found in an intra-parenchymal location. Unusual locations for intracranial schwannomas have also been reported in association with neurofibromatosis. CLINICAL PRESENTATION: A 23-year-old male without von Recklinghausen's disease presented with intermittent dizziness and difficulty swallowing. Past medical history was significant for a motor vehicle accident (MVA) without loss of consciousness 6 months prior. magnetic resonance imaging revealed a large tentorial-based tumor. At surgery the origin of the tumor was clearly the tentorium, and while the trigeminal nerve was displaced, it easily separated from the mass. There was no attachment to any other cranial nerve in the immediate vicinity and postoperative cranial nerve examination was unremarkable. Pathological review was consistent with schwannoma. CONCLUSION: While there are few reported cases of tentorial-based schwannoma, these tumors have been noted in unusual locations within the intracranial vault, and clinicians should be aware of this diversity of origin.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
5/14. Spontaneous intracranial meningioma bleeding: clinicopathological features and outcome.OBJECT: The aim of this study was to determine the clinicopathological features of patients with intracranial bleeding from unsuspected meningioma and to relate these data to surgery-related outcome. methods: The authors report on two cases in which hemorrhage of an unsuspected meningioma occurred in the tentorial ridge and in the falx, and they discuss the details of 143 cases described in the literature. A bleeding propensity index of the meningioma, related to the patient's age, sex, and the lesion's intracranial location and histological type was computed as a ratio between the frequencies of bleeding meningioma and all meningiomas. This was tested by independent samples t-test for proportions. A chi-square test was used to determine the correlations between several variables: location and type of bleeding; survival and type of bleeding; and consciousness and survival. Increased bleeding tendency was found to be associated with two age groups (< 30 years and > 70 years), convexity and intraventricular locations, and fibrous meningiomas. The overall mortality rate documented in cases of bleeding meningiomas was 21.1% (13.9% in the computerized tomography [CT] scanning era), and that in surgically treated cases was 9.5% (7.5% in the CT scanning era). The overall major morbidity rate was 36% (33.8% in the CT scanning era). overall 96.2% of conscious patients survived after their meningiomas spontaneously hemorrhaged. In patients who were unconscious before surgery, overall mortality rate was 74.1%, and that in surgically treated cases was 46.2%. CONCLUSIONS: The mortality rate in preoperatively conscious patients (those in whom acute deterioration and irreversible brain damage were prevented by early diagnosis and definitive surgery) was similar (< 3% in the CT scanning era) to that documented in cases in which meningiomas did not bleed. In contrast, the associated morbidity rates were much higher. One-stage total removal of the hemorrhagic meningioma and hematoma is the treatment of choice in such patients.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
6/14. Atypical meningioma with large cyst. Case report.A 29-year-old male presented with loss of consciousness and generalized seizure, followed by right hemiparesis and speech disturbance. Computed tomography and magnetic resonance imaging showed a solid, enhanced tumor with a cyst in the left frontal area with surrounding edema and mild mass effect. The cyst wall was also enhanced. The preoperative diagnosis was cystic falx meningioma. The tumor was totally resected, but most of the cyst wall adhered tightly to the surrounding brain and could not be removed. Histological examination revealed atypical meningioma and tumor cells in the cyst wall. The patient received local radiotherapy to the residual cyst wall with a total dose of 50 Gy.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
7/14. Clinical experience of intraorbital optic nerve sheath meningioma--report of eight cases.Eight cases of primary optic nerve sheath meningioma were treated between 1980 and 1988. Five were females aged 37-61 years. The other three were two boys, one with neurofibromatosis, and an old male aged 71 years. They were first seen by the ophthalmologist with complaints of unilateral progressive visual loss or proptosis. Although blindness of the affected eye mainly occurred between 1 month and 3 years after the initial symptoms, the diagnosis tended to be made late in the adult cases. Intracranial extension was demonstrated in four of the six adult cases when contralateral visual loss or disturbance of consciousness presented. Larger intraorbital meningiomas were easily diagnosed by a combination of computed tomographic (CT) scanning, magnetic resonance (MR) imaging, and carotid angiography. MR imaging provided clear delineation of the optic nerve and its course through the tumor, and perioptic meningioma could be diagnosed. However, it was difficult to make a diagnosis without biopsy at the early stage, for example, when just the enlargement of the optic nerve was demonstrated by CT or MR imaging. Tumor removal was performed when blindness developed after definitive diagnosis by biopsy, intracranial extension was demonstrated, and advanced proptosis presented. The transcranial supraorbital approach or transcranial transorbital approach with resection of the supraorbital rim was used for these large intraorbital meningiomas. From our clinical experience, early diagnosis and early treatment should be emphasized.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
8/14. Clinical evaluation of the action of dexamethasone.The antioedematous action of dexamethasone was assessed in 28 patients with supratentorial and infratentorial intracranial tumours and craniocerebral trauma. The criteria of evaluation included the state of consciousness, signs of focal cerebral injury, autonomic disturbances and signs of raised intracranial pressure. The greatest improvement was obtained in patients having intracranial tumours with herniation of the brain stem. In cases of extensive craniocerebral trauma no evident improvement was achieved.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
9/14. Schwannoma of the sellar region.A 25-year-old woman who had experienced brief periods of loss of consciousness and grand mal seizures was found to have a midline mass in the sellar region as evidenced by computer tomography and angiography. Preoperatively, it was thought to be a meningioma but histologically and ultrastructurally it turned out to be a Schwannoma. Since cranial nerves were not involved, clinically or morphologically, this nerve sheath tumour could have originated from schwann cells of sensory, possibly trigeminal, nerves, vasomotor nerves, or ectopic schwann cells.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
10/14. Lipomatous meningioma associated with cerebral vascular malformation.A unique epileptic patient with intracranial neoplasm is reported in which a meningioma with lipomatous and osseous components was found associated with cerebral arteriovenous malformation at the same location in the right frontal lobe. The development of the leptomeningeal neoplasm may have been influenced by the underlying vascular anomaly. The cerebral arteriovenous malformation and altered hemodynamics also could have induced the sudden onset of clinical seizures, hemiparesis, and unconsciousness.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
| | Next -> |