Awdhesh Kumar Yadav

Larsen syndrome with C3-C4 spondyloptosis and atlantoaxial dislocation in an adult.

Study Design. This is a clinical case report with a review of relevant literature. Objective. To describe a case of Larsen syndrome with C3–C4 spondyloptosis and atlantoaxial dislocation in a middle-aged female patient and to discuss management strategies. Summary of Background Data. Spondyloptosis of the cervical spine is relatively rare and is caused by trauma, destruction of the vertebral bodies by tumors, or tuberculosis. Such gross vertebral displacement is usually associated with significant neurological deficits. Larsen syndrome is characterized by multiple joint displacements and can, very rarely, be associated with nontraumatic spondyloptosis of the cervical vertebra. A single case report of C1–C2 joint laxity causing atlantoaxial dislocation in a patient with Larsen syndrome is available in literature. No reports of any patient (with Larsen syndrome or nonsyndromic) who had both cervical spondyloptosis and atlantoaxial dislocation are available in literature. Methods. A 36-year-old female presented with chronic neck pain, bilateral hand deformity, and mild spasticity involving all 4 limbs. Cervical radiograph, computed tomographic scan, and magnetic resonance image revealed C3–C4 spondyloptosis and atlantoaxial dislocation. Results. A combined ventral decompression of subaxial spine and instrumentation from C2 to C5, followed by posterior C1–C2 distraction arthroplasty and lateral mass stabilization of the subaxial spine up to C6, was done. The cervical deformity was corrected, and the patient remains symptom free. Conclusion. Patients with spondyloptosis of the cervical spine can rarely present with chronic neck pain and minimal neurological deficits. An additional pathology, such as atlantoaxial dislocation, can add to the complexity. Circumferential stabilization and fusion would be required in such cases to achieve a good outcome. Larsen syndrome is a rare cause of nontraumatic cervical displacements.

Idiopathic Intraventricular Aneurysm Presenting with Intraventricular Hemorrhage: Case Report and Review of the Literature

Intraventricular hemorrhage (IVH) is a relatively commonly encountered problem in neurosurgical practice. The underlying causes could include hypertension, arteriovenous malformations (AVM), angiomas, trauma, tumors, aneurysms and moyamoya disease. Truly idiopathic intraventricular aneurysms (IVA) are rare. A high index of suspicion needs to be maintained since, with the appropriate treatment, the outcome is generally good. We report the case of a 14-year-old boy who presented with sudden onset headache and vomiting. CT angiogram pointed to the possibility of an IVA. This was confirmed by MRI with three-dimensional constructive interference in steady state (CISS-3D) sequences and digital subtraction angiography. The patient underwent microsurgical excision of the aneurysm and is doing well on follow-up. Idiopathic IVA can present with IVH at any age. MRI with CISS-3D and MR angiography would be the imaging modality of choice since it can also rule out other causes of intraventricular bleeding such as tumors and AVM. These lesions could be managed effectively by microsurgical excision/clipping. The necessity of investigating every patient who presents with IVH is debatable.

Tuberculoma of the Cavernous Sinus and Meckel's Cave in a Child.

Tuberculous infection of the cavernous sinus and Meckels cave is extremely rare. In this report, we describe a patient with tuberculoma of the cavernous sinus and Meckels cave, extending to the petrous apex. The patient underwent microsurgical excision of the lesion and antitubercular chemotherapy resulting in a good outcome. We describe the diagnostic difficulties and review the relevant literature.

Totally thrombosed giant anterior communicating artery aneurysm.

Giant anterior communicating artery aneurysms are rare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass. At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery. The difficulty in preoperative diagnosis and relevant literature are reviewed.

Opportunistic Fonsecaea pedrosoi brain abscess in a patient with non-cirrhotic portal fibrosis-induced hypersplenism- a novel association

Abstract Non-cirrhotic portal fibrosis, a common cause of splenomegaly in tropical countries, can lead to hypersplenism and pancytopenia. Hypersplenism in this setting has not been associated with opportunistic infections. We describe a patient with hypersplenism secondary to non-cirrhotic portal fibrosis who developed a Fonsecaea pedrosoi brain abscess and succumbed to the illness despite aggressive management.

Intradural thoracic disc presenting with radiculopathy.

257 Neurology India | Mar-Apr 2012 | Vol 60 | Issue 2 Review of previous reports seems to indicate that herniation and incarceration of spinal cord through the dural defect presents in a delayed fashion (6 months to 15 years),[1,2,4-7] whereas direct compression by an enlarging pseudomeningocele presents earlier, as in the present case. The likely explanation for delayed deterioration following spinal cord herniation and incarceration is gradual and prolonged ischemia of the cord. MRI scan is the diagnostic modality of choice.[7] Diagnosis prior to MRI typically involved a conventional myelogram. This is the fi rst patient with post-cervical laminectomy neurological decline secondary to pseudomeningocele where the MRI has clearly demonstrated the pseudomeningocele compressing the cord. In the case reported by Hosono et al.,[7] MRI demonstrated a pseudomeningocele, but no cord compression. Cord herniation into the pseudomeningocele was the cause of deterioration in that case.