Cheng-Ta Hsieh

Complete fracture-dislocation of the thoracolumbar spine without paraplegia.

Complete fracture-dislocation of thoracolumbar spine without significant neurologic deficits is a rare entity. The possible mechanism may result from the spontaneous decompressive fractures of the spinal elements with sparing of the spinal cord. Here, we report a case of a healthy 50-year-old man who presented with complete fracture-dislocation of T12 through L1 vertebrae without paraplegia. Early diagnosis and early surgery with decompression, reduction, and stabilization is the best policy in management of this unstable spine injury.

Transarterial embolization in the management of life-threatening hemorrhage after maxillofacial trauma: a case report and review of literature

There are many reasons for hypotension in trauma patients. Life-threatening hemorrhage associated with maxillofacial trauma is considered rare. Here, we present a 25-year-old patient with maxillofacial trauma complicated by life-threatening hemorrhage after a traffic accident. At the emergency department, massive epistaxis was noted. Nasal packing and blood transfusion were performed, but vital signs of the patient were still unstable. Cerebral angiography revealed contrast extravasation from the left superficial temporal and internal maxillary arteries of the left external carotid artery. After transarterial embolization was performed, the hemorrhage immediately stopped. When common treatment such as nasal packing, correction of coagulopathy, reduction of fractures, and arterial ligation fails to control the hemorrhage, transarterial embolization can offer a safe alterative to surgical exploration.

Hepatic cerebrospinal fluid pseudocyst: a case report and review of the literature.

An abdominal pseudocyst is a rare, but important complication in patients with a ventriculo-peritoneal (VP) shunt insertion. Several predisposing factors for this complication have been suggested, including infection, obstruction or dislodgement, but the pathophysiology is still unknown. However, the abdominal inflammatory process is accepted widely as a hypothesis for the formation of an abdominal pseudocyst. In this study, we report the case of a 21-year-old male that presented with a high-grade fever, poor appetite, shortness of breath and unconsciousness 1 week after receiving a VP shunt insertion for obstructive hydrocephalus. Ultrasonography and computed tomographic scans of the abdomen revealed a well-defined large hepatic cyst surrounding the peritoneal tube of the VP shunt. A hepatic cerebrospinal fluid (CSF) cyst was diagnosed and Staphylococcus epidermis was cultured via CSF. After externalization of the VP shunt and adequate antibiotic treatment, the hepatic cyst was resolved. There was no recurrence observed in the regular follow up.

Nocardia farcinica brain abscess in an immunocompetent patient treated with antibiotics and two surgical techniques

Nocardia farcinica brain abscesses rarely occur in immunocompetent hosts. We present a patient with an N. farcinica brain abscess. This was confirmed by 16S ribosomal RNA sequencing and was successfully treated using one medical and two different surgical techniques, highlighting the important role of surgical intervention if antibiotic treatment fails.

Paraganglioma of the cauda equina

A 48-year-old female presented with symptoms of low back pain and radiation down the posterior aspect of both the legs of six months duration. She was not a known case of diabetes and hypertension. On admission, physical examination was unremarkable. The neurological examination revealed sensory deficits in the distribution of L4 and L5 dermatomes on both the legs. The muscle power was normal and tendon reflexes were normal. The plain X-ray of lumbar spine was normal. Magnetic resonance imaging (MRI) showed an intrathecal extramedullary well-defined tumor measuring about 2.5 3 0.7 3 1.2 in size at the level of L4-5. The tumor appeared as isointensity with respect to the spinal cord on T1-weighted sequences and hyperintensity on T2-weighted image [Figure 1a and b]. Contrast MRI showed homogenous enhancement of the tumor and also a serpiginous enhancing vascular structure extending from conus medullaris to the tumor [Figure 1c]. She underwent L4 and L5 laminectomy to remove the tumor. At operation the tumor was soft and reddish and was attached to one of the nerve roots. A single vessel along the nerve root was found entrapped into the tumor [Figure 2]. Histopahtological examination shwed, nests of tumor cells separated by a fine vascular network, representing a ‘Zellballen’ pattern [Figure 3]. Immunohistochemical staining was negative for glial fibrilary acid protein and was positive for synaptophysin and chromogranin A. In

Primary Burkitt Lymphoma of the CNS in an Immunocompetent Elderly Woman

Primary central nervous system Burkitt lymphoma is rare and often occurs in patients in an immune deficient state, especially in acquired immunodeficiency syndrome. Herein, we present a report on an immunocompetent 77-year-old woman, who was healthy in the past but complained of general malaise and dizziness for three days before admission. A computed tomographic scan revealed a butterfly-shaped mass in the pericallosal white matter, extending to the left basal ganglion and peduncle. The mass was homogenously enhanced after contrast injection. Magnetic resonance images exhibited a huge, enhancing and infiltrative tumor involving the genu to splenium of the corpus callosum, bilateral radiata, bilateral corticospinal tract, hippocampi, posterior limb of the internal capsule and left cerebral peduncle and ventrolateral pons, causing prominent vasogenic edema of the bilateral parietal, left frontal and temporal lobes. She underwent stereotactic biopsy of the brain lesion, and the pathology confirmed the diagnosis of Burkitt lymphoma. Postoperative intrathecal chemotherapy and palliative radiotherapy were administered, and the patient died six months later because of systemic sepsis.

Choroid Plexus Papilloma in an Adult

Choroid plexus papillomas are rare intraventricular tumors and present infrequently in adults. Clinical presentation is typically associated with symptoms and signs of increased intracranial pressure secondary to hydrocephalus. Total tumor resection is reported to be curative for choroid plexus papillomas. Herein, we report a 39-year-old woman who complained of intermittent dizziness, nausea, and unsteadiness for nearly one month before admission. Magnetic resonance images revealed a mass about 3 cm in maximal diameter located in the left exit of the foramina of Luschka at the cerebellomedullary angle, with compression of the lower pons and medullary regions and obstructive hydrocephalus. The patient underwent a suboccipital craniotomy with total removal of the tumor with the assistance of a surgical navigator system. Pathology confirmed a diagnosis of choroid plexus papilloma. A ventriculo-peritoneal shunt was performed seven days later because of hydrocephalus. The patient was discharged on day 18 of hospitalization and no obvious neurological deficits were noted.

Appendectomy Induced Hepatic Cerebrospinal Fluid Pseudocyst in a Shunted Patient

Abdominal intraperitoneal cerebrospinal fluid pseudocyst is a rare complication in patients with ventriculoperitoneal shunt insertion. Various predisposing factors such as infection, obstruction, dislodgement, and iatrogenic causes have been discussed. However, the pathophysiology of the condition remains unknown. Case Report: The case of a shunted patient who complained of fever and low abdominal pain 1 week after appendectomy is presented. The distal tube of the ventriculoperitoneal shunt migrated to the right upper quadrant, and a hepatic cerebrospinal fluid cyst was discovered via CT scan. After liver drainage, adequate antibiotic treatment, and externalization of the ventriculoperitoneal shunt, the hepatic cyst was resolved. There was no recurrence observed upon follow-up. Conclusion: Although abdominal intraperitoneal cerebrospinal fluid pseudocyst seldom is encountered clinically, proper management of a diagnosed cyst can provide complete amelioration.