Arun Kumar Srivastav

Bilateral thalamic glioma in a 6-year-old child

Bithalamic gliomas are extremely rare tumors of central nervous system. Although they are usually benign in nature, their outcome is poor because of the involvement of thalamic nuclei and inadequate surgical excision. Surgery is usually done to get tissue for diagnosis. Role of radiotherapy and chemotherapy is questionable. They are unique in their metabolic and neuroradiological properties. We report herein a 6-year-old male of bithalamic astrocytoma (WHO grade 2) who presented with raised intracranial pressure and tremors in right upper limb. The child had a very huge bithalamic mass which was debulked through the interhemispheric transcallosal approach in order to reduce the mass effect. He had a stormy post-operative course to recover gradually.

Calvarial tuberculosis of the parietal bone: A rare complication after dental extraction

Tuberculosis (TB) is a well-known endemic in developing countries. However calvarial TB is quiet rare even in such endemic areas. The most common sites affected are the frontal and parietal bones with destruction of both the inner and outer table. We hereby report a young male presenting to us with scalp swelling in the right temporal region with pus discharging sinus after an episode of tooth extraction for dental infection. Radiology revealed a loculated swelling within the right temporalis muscle and an associated bony defect in the right parietal bone. The patient was operated upon and the biopsy was suggestive of tubercular pathology. The patient improved on antitubercular therapy. The rare presentation of calvarial TB occurring secondary to dental infection along with relevant literature is discussed here.

Intracranial dural metastasis presenting as chronic subdural hematoma: a case report and review of literature.

Intracranial dural metastasis presenting as chronic subdural hematoma is a relatively rare clinical scenario. There are different theories explaining the formation of subdural hematoma in such cases. In this report we present a case of chronic subdural hematoma in a 44-year old lady who did not have any clinical evidence of primary tumour anywhere in the body. This lady died in spite of two emergency surgeries. During second surgery, the subdural membrane was sent for histopathological examination which revealed presence of metastatic tumour. We discuss the case along with a review of literature and recommend subdural membrane biopsy in all cases of chronic subdural hematoma.

An unusual case of post-traumatic intradiploic leptomeningeal cyst and review of the literature.

1. Matsumoto K, Akagi K, Abekura M, Maeda Y, Kitagawa M, Ryujin H, et al. Hypothalamic pilocytic astrocytoma presenting with intratumoral and subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 1997; 37:849-51. 2. Broniscer A, Laningham FH, Kocak M, Krasin MJ, Fouladi M, Merchant TE, et al. Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma. Cancer 2006;106:1364-71. 3. Can SM, Aydin Y, Turkmenoglu O, Aydin F, Ziyal I. Giant cell glioblastoma manifesting as traumatic intracerebral hemorrhage–case report. Neurol Med Chir (Tokyo) 2002;42:568-71. 4. Russel DS, Rubenstein LJ. Pathology of Tumours. 3rd ed. Philadelphia: Williams and Wilkins; 1979. p. 147-54. 5. Liwnicz BH, Wu SZ, Tew JM Jr. The relationship between the capillary structure and hemorrhage in gliomas. J Neurosurg 1987 66:536-41.

Intraparenchymal schwannoma of brainstem in a pediatric patient

A 13-year-old boy was admitted with complaints of progressive left hemiparesis, ataxia and slurring of speech of 4 months duration and mild to moderate holocranial headache of 3 months duration. Family history revealed presence of multiple neurofibromas in his father, and detailed family screening could not be done. Neurological examination revealed slurred speech, left fifth, sixth, seventh and lower cranial nerve paresis, spastic left hemiparesis (grade 4/5) and bilateral cerebellar signs. His general physical examination was unremarkable. Cranial computed tomography (CT) showed a well-defined non-enhancing intra-axial cystic lesion in midbrain and pons with obstructive hydrocephalus [Figure 1]. Magnetic resonant imaging (MRI) revealed a lesion, hypointense on T1-weighted images and homogenously hyperintense on T2-weighted images. On gadolinium-DTPA administration, there was intense enhancement of the rim of the tumor with some solid part anterior and superior to the predominantly cystic part [Figure 2]. The patient underwent midline suboccipital craniectomy and, through a transvermian approach, partial excision of the lesion was performed. The lesion was subpial and the cyst wall was pinkishwhite, vascular and firm having xanthochromic fluid inside. Part of the cyst wall was left behind as it was adherent to the normal brain stem, and there was no plane of cleavage. Partial resection of the solid part was done, as attempt to further dissection resulted in hemodynamic instability. Post-operatively, the patient had improvement in hemiparesis and ataxia and was discharged on day 7 of surgery. Post-operative MRI revealed residual enhancing cyst wall in midbrain with resolution of hydrocephalous [Figure 3]. Histopathology of the tumor tissue revealed spindle cells, with nuclear palisading and formation of Verocay bodies. Immunohistochemistry revealed positivity for S-100, vimentin and ki-67 [Figure 4a and b]. At 3-month follow-up, his hemiparesis and ataxia have improved as compared with the pre-operative status, and he is able to perform routine activities with minimal support. The patient was not offered radiation therapy and was advised to follow-up every 6 months.

Is management of spontaneous intracranial extradural hematoma in chronic renal failure is different with traumatic extradural hematoma — Case report and review of literature

Abstract Intracranial extradural hematoma is commonly associated with head trauma. Spontaneous EDH is a rare entity and associated with various co morbid conditions. Chronic renal failure (CRF) is one of them. In case of CRF, spontaneous EDH has been reported in those patients who were either on hemodialysis or had long history of CRF. We report a case of concurrently asymptomatic chronic renal failure that developed spontaneous EDH with neurological deficits and during investigation, diagnosed to have acute on chronic renal failure. Investigation and management is discussed in the report.

Multiple neural tube defects in the same patient with no neurological deficit

Congenital deformities involving the coverings of the nervous system are called neural tube defects (NTDs). NTD can be classified as neurulation defects, which occur by stage 12, and postneurulation defects. Cervical meningocele and myelomeningocele are rare spinal dysraphic lesions. Unlike lumbosacral dysraphic lesions, there is often no neurologic deficits and thus the subtle features of cervical cord tethering may be overlooked on imaging. The presence of meningomyelocele and/or encephaloceles at multiple (two or more) sites along the vertebral axis is a very rare event occurring in <1% of cases. Less than 10 cases have been described in the published literature. We are reporting a case of multiple NTD in same patient with no neurological deficit.

Intraparenchymal hemorrhage: As an unusual manifestation of glioblastoma in a young patient

Glioblastoma in young patient presenting as recurrent intracerebral hemorrhage is rare event, only few cases have been reported in world literature. Intratumoral bleeding c an be the sole and first manifestation of glioblastoma in chil dren. It is difficult to say that the events like dehydration and infecti on can precipitate such bleeding in tumor. It should be emphasized that possibility of tumoral bleeding should be kept in mind while evaluating young patient with spontaneous supratentorial intracranial hemorrhage with negative angiogram and should be treated on an emergency basis. We are reporting a case of glioblastoma in a patient aged 17 years with clinical and radiological featur es suggestive of cortical venous thrombosis.

Outcome of dorsolumbar vertebral hemangiomas presenting with neuraxial compression

Background: Hemangiomas are benign vascular tumors associated with proliferation of blood vessels in bone or soft tissue and they are usually incidental findings in vertebrae. When symptomatic, they present with features of radiculopathy, myelopathy, or vertebral fractures. Treatment options are varied, include sole embolization, embolization combined with surgical excision, surgical excision alone, percutaneous ablation, and radiotherapy. We hereby describe a series of seven cases of symptomatic vertebral hemangiomas operated from 2006 to 2009. Materials and Methods: Their clinical and radiological profile and outcome have been described. All patients were subjected to surgical excision followed by instrumentation. Outcome was assessed at a followup of 2 years following surgery with Frankel grading system. Results: Seven patients (five females and two males) were included in the study. The mean age was 33.85 years with the mean duration of symptoms of 12 months. All seven cases were symptomatic vertebral hemangiomas with cord compression and underwent surgical excision. Preoperatively, patients with poor Frankel grade such as A and B improved postoperatively to C, D, or E. Conclusion: Surgical excision of these lesions is difficult due to the tremendous amount of intraoperative bleeding. During surgery, brisk bleeding is usually encountered, but can be brought under control with adequate preoperative preparation and expertize. Preoperative embolization may help to reduce the bleeding, but at times it may be difficult to do if vertebrae are replaced by a solid hard mass. In spite of the risks associated with surgery, it still is the treatment of choice as a single intervention, especially in aggressive vertebral hemangiomas.

Intramedullary abscess extending to the cauda equina with paraplegia in a 6-month-old infant

Intramedullary spinal cord abscesses are uncommon lesions. Forty percent of all such abscesses occur before 20 yr of age. Patients with acute onset of symptoms and signs have a graver prognosis. This generally occurs in the setting of systemic bacteremia. A case of large intramedullary spinal cord abscess extending up to the terminal spinal canal in a 6-month-old male baby who developed flaccid paraplegia without an evidence of systemic infection or septicemia or anatomical defect is reported. The possibility of infection of an epidermoid in such cases cannot ruled out.