Dimitrios Giakoumettis

Pediatric infratentorial subdural empyema: A case report

Background: Infratentorial subdural empyemas in children are extremely rare and potentially lethal intracranial infections. Delay in diagnosis and therapy is associated with increased morbidity and mortality. Case Description: A 4-year-old boy presented with cerebellar signs following a failed treatment of otitis media. Imaging studies revealed a subdural empyema and left transverse and sigmoid sinus thrombosis. The empyema was evacuated operatively and antibiotic treatment was initiated and administered for 6 weeks. The patient recovered fully and was discharged 4 weeks following the evacuation of the empyema. Conclusion: While prompt identification and treatment of subdural infratentorial empyemas are crucial for favorable outcomes, their diagnosis in children might be initially missed. This is, in part because they are so rare and in part, because imaging artifacts arising from the complex posterior fossa anatomy may obscure their presence in the computer tomography (CT) scan. Therefore, high level of suspicion is necessary, given the appropriate history and clinical presentation. In children, this is a recent history of protracted otitis media and central nervous system symptomatology—cerebellar or other.

Antithrombotic Treatment Management in Patients with Intracerebral Hemorrhage: Reversal and Restart

BACKGROUND Intracerebral hemorrhage is the pathological accumulation of blood within the brain. It is a type of stroke more likely to be lethal or to severely disable the patient and results from a wide variety of causes. On the other hand antithrombotic therapy is used for the prevention or/and the therapy of thromboembolic episodes. Antithrombotic drugs are very effective in reducing risk or mortality rate after a thromboembolic event, yet they are associated with significant hemorrhages. OBJECTIVE The aim of this article is to review current literature for intracerebral hemorrhage and antithrombotic therapy and offer recommendations on the reversal, the discontinuation and the resumption of antithrombotic therapy. METHODS AND MATERIALS Current literature has been reviewed for intracerebral hemorrhage associated with three major categories of patients, those with atrial fibrillation, those with prosthetic mechanical valves and those with venous thromboembolism. Antithrombotic therapy is categorized in antiplatelet agents and anticoagulants. The risk of intracerebral hemorrhage, of a thromboembolic event and of a rebleeding with or without antithrombotic therapy was also reported. CONCLUSION Although no one can deny the usefulness of antithrombotic therapy a therapeutic strategy should be developed in order to optimize the clinical decision of stopping, reversing and restarting antithrombotic treatment. This review concludes in strong recommendations, yet a multidisciplinary panel by a stroke physician or neurologist, a cardiologist, a neuroradiologist and a neurosurgeon should evaluate the benefits and the risks for each patient and decide the best therapeutic strategy.

Post-traumatic tremor in child after mild head trauma

Despite the fact that movement disorders can be noted after severe traumatic brain injury (TBI), there are very few cases in the literature regarding children with a mild head injury. In addition, their pathophysiological mechanism, radiological features, and treatment options have not been well described yet. Hereby, we report a case of a 3-year-old girl who suffered a head injury after a two-meter fall, resulting in generalized body tremor and dystonia.

Primary Ewing sarcoma of the axis-C2: A case report and the review of the literature

INTRODUCTION Neck pain and torticollis are common symptoms in the pediatric population that rarely requires further investigation. However, in case symptoms persist, then a more meticulously approach should be considered. Underlying conditions such as infections, neck injury, autoimmune disorders or even cervical spine cancer should be excluded from diagnosis. Cervical spine cancer is a rare neurosurgical entity in the pediatric population and even rarer is atlantoaxial Ewings sarcoma. In this report, we present a rare case of primary Ewings sarcoma of the axis. CASE REPORT A 3.5-year-old female with progressive neck pain and intermittent episodes of torticollis was referred to our outpatient clinic. Imaging studies revealed a malignant tumor located on C2 vertebra. Diagnosis of Ewings Sarcoma was confirmed via open biopsy and the patient was treated with Euro-EWING 99 chemotherapy. CONCLUSION Pediatric neck pain and/or torticollis should raise high suspicion for malignancy of cervical spine. Modern diagnostic means and techniques can assist in the screening and diagnosis of these tumors.

Primitive synovial sarcoma of suboccipital region in child

Abstract Synovial sarcoma (SS) most commonly affects the lower limbs of males in the third to fifth decades of life, with masses of the head and neck accounting for 3–10% of all cases, mainly as a metastatic lesion. The lack of specific symptoms and radiological features in addition to the diversity of their microscopic aspects may cause confusion in the diagnosis; hence, knowledge of the unusual locations of SSs is very important. The immunohistochemistry, and more recently the cytogenetic studies, contribute to the differential diagnosis. We report the case of a 12-year-old girl with a rare primary SS in the suboccipital region, which underwent complete surgical resection.

Spinal synovial cysts. A case series and current treatment options

Synovial cysts constitute an uncommon degenerative lesion of the spine. They are usually asymptomatic but they may also cause symptoms of variable severity. The authors present three cases of such cysts, two in the lumbar region of a 55-year-old female and a 66 year old female and one in the cervical region of a 56-year-old male patient. All patients presented with radiculopathy. Magnetic Resonance Images revealed a cystic lesion at the L4/5 level in the first case, at L5/S1 level in the second case and at the C7/T1 junction level in the third case. Treatment has been microsurgical resection of all cysts with no post-operative complications and an excellent outcome. A discussion of current management options for this unusual disease is presented and a decision making flow chart is proposed.

Antiepileptic Treatment Strategy in Vascular Malformations

BACKGROUND Antiepileptic treatment strategy plays an important role in the management of intracranial vascular malformations. The intracranial vascular malformations can be divided into cavernous hemangiomas, arteriovenous malformations, developmental venous anomalies and capillary telangiectasias. Seizures and hemorrhage are among their most common clinical manifestations. OBJECTIVE The aim of this article is to review the current literature on the antiepileptic treatment in the setting of intracranial vascular malformations and offer an updated view on when antiepileptic drug treatment should be employed for each type of vascular malformation. METHODS AND MATERIALS Current literature has been reviewed on cavernous malformations, arteriovenous malformations, developmental venous anomalies and capillary telangiectasias. Epidemiological features, epileptogenesis, clinical presentation and antiepileptic treatment have been analyzed. RESULTS A variety of treatment modalities exist for the management of intracranial vascular malformations, including antiepileptic treatment, microsurgery, radiosurgery and embolization. The decision-making process is different for each type of intracranial vascular malformation. Moreover, a plethora of other clinical factors needs to be taken into consideration during the decision-making process, such as the patients age and comorbidities, the risk of hemorrhage the need for definitive treatment of the malformation, the seizure rates after the definitive treatment, the efficacy and side effects profile of antiepileptic drugs. CONCLUSION Antiepileptic treatment strategy is a multifactorial decision that should be individualized and ideally be made by multidisciplinary teams.

Brainstem dermoid cyst rupture with hydrocephalus in a child

Abstract Intracranial dermoid cysts are ectodermal lesions of embryological origin. They are of slow progression and symptoms associated with unruptured cysts are most commonly due to mass effect. However, a potential rupture in the ventricular system is rare and can cause meningitis, seizures and hydrocephalus. Hereby, we report a case of a 12-year-old boy presenting with obstructive hydrocephalus due to brainstem dermoid cyst rupture.

Herpes simplex virus Type 1 encephalitis in an adolescent presenting with acute hydrocephalus

Abstract Herpes simplex virus Type 1 (HSV-1) is a human neurotropic virus causing encephalitis, corneal blindness or several peripheral nervous system disorders. Herpes Simplex encephalitis (HSE) is the most devastating clinical syndrome with severe morbidity and mortality. Hydrocephalus associated with viral meningoencephalitis is an extremely rare entity with only few documented cases, predominantly due to HSV-2 infection. HSV-1 infection of central nervous system present in the majority of the cases as encephalitis. We report a rare case of an 11-year-old child suffering from HSV-1 infection of central nervous system causing hydrocephalus without evidence of encephalitis.

The use of antiepileptic drugs in paediatric neurosurgical conditions

BACKGROUND Epileptic seizures are a relatively common problem in pediatric neurosurgery that can have physical, mental and/or behavioral implications. Pediatric neurosurgery is involved in the treatment of secondary epilepsy, which is mainly associated with brain tumors, traumatic brain injury and intracranial vascular malformations. OBJECTIVE The aim of this article is to review the current literature for commonly used antiepileptic drugs in pediatric neurosurgery and offer an updated view on epilepsy treatment with antiepileptic drugs in the most commonly encountered neurosurgical entities in the pediatric population. METHODS AND MATERIALS Current literature has been reviewed for epilepsy, antiepileptic drugs and common neurosurgical conditions in children that cause seizures and/or epilepsy. Epidemiological features, epileptogenesis and treatment have been thoroughly examined. CONCLUSION The most common neurosurgical conditions that cause seizures and/or epilepsy in the pediatric population are brain tumors and traumatic brain injury. Newer antiepileptic drugs are powerful instruments in the management of epilepsy and they improve the quality of life of patients as well as decrease the epilepsy associated morbidity.