Benjamin B. Kuzma

The natural history of untreated skull base meningiomas

BACKGROUND This study was undertaken to determine the natural history of untreated skull base meningiomas. Although there are reports on the natural history of meningiomas, most series contain only a few cases of meningiomas involving the skull base. Natural history information is important when recommending treatment and evaluating results. METHODS The case records and imaging studies of 40 patients with skull base meningiomas from a single practice were reviewed. These patients either did not receive treatment or there was a long delay from the onset of symptoms to the initiation of treatment. RESULTS Skull base meningiomas may be very indolent tumors. Patients with these tumors have lived long, comfortable, and relatively productive lives without treatment or with delayed treatment. Impairment may be much less than imaging studies would suggest. CONCLUSION The authors are not advocating that skull base meningiomas not receive treatment. However, their unique experience with this group of patients provides convincing evidence that the indolent behavior of some skull base meningiomas must be considered when recommending various surgical and radiation procedures and interpreting their results in relationship to the functional outcome of the patient.

Second impact syndrome in football: new imaging and insights into a rare and devastating condition

Premature return to play for the concussed pediatric athlete may result in devastating neurological injury. Identification of at-risk patients and ideal management of the concussed athlete remain challenging for the pediatrician. The authors review a case of second impact syndrome in which neuroimaging was obtained between the first and second impacts, a circumstance which to their knowledge has not been previously reported. This case offers new insights into the underlying pathophysiology of this disease process and potential risk factors for its development.

Paradoxic appearance of calcification on MRI.

This 37-year-old male with a l-year history of partial complex seizures presented with a major motor seizure. Emergency magnetic resonance imaging (MRl) scan revealed a large right medial temporal lobe mass with bright areas of T, signal suggestive of hemorrhage (Figure 1). The patient had no focal neurologic signs and clinically did not appear to have had a hemorrhage. Subsequent computed tomography (CT) scan showed close correspondence of calcium to the areas of bright T, signal (Figure 2).