Hadi Sasani

Idiopathic spinal cord herniation at two separate zones of the thoracic spine: the first reported case and literature review

BACKGROUND CONTEXT Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy. Preoperative diagnosis can be made with magnetic resonance imaging (MRI). Many surgical techniques have been applied by various authors, and ISCH is usually reversible by surgical treatment. PURPOSE To present a case of ISCH in two separate zones at two thoracic levels. To our knowledge, this is the first such case to be published in English literature. We also discuss the clinical findings, surgical procedures, and surgical outcomes for other previously reported cases of ISCH in the literature. STUDY DESIGN Case report. METHODS A 52-year-old woman with bilateral lower extremity weakness underwent thoracic MRI, which revealed transdural spinal cord herniation at two separate zones, namely, the T4-T5 and T5-T6 intervertebral disc levels. RESULTS During surgery, the spinal cord was reduced, the two separate dural defects were connected, and the new single defect was restored then reinforced with a thin layer of fascial graft. The posterior dural defect was then closed with interrupted stitches. The patients neurologic status was characterized by no changing of the preoperative motor status. Follow-up MRI scans showed that the cord was replaced in the dural sac and showed cord hyperintensity in the herniation levels. The patient could move with a cane at the sixth month postoperatively. CONCLUSIONS Idiopathic spinal cord herniation is a rare clinical condition that should be considered in the differential diagnosis of paraplegia. Although progression of neurologic deficits can be very slow, reduction of the spinal cord and repair of the defect are crucial to stop or reverse the deterioration. The outcome for patients who initially have Brown-Séquard syndrome is significantly better than for patients who presented with spastic paralysis. To our knowledge, this case study represents the first reported instance in which two separate anterior dural defects caused two levels of anterior spinal cord herniation.

Bilateral late remote cerebellar hemorrhage as a complication of a lumbo-peritoneal shunt applied after spinal arteriovenous malformation surgery.

Abstract Background/Objective: Cerebellar hemorrhage is a very infrequent and unpredictable complication of spinal surgery. To the best of our knowledge, cerebellar hemorrhage resulting from the insertion of a lumbo-peritoneal shunt through which cerebrospinal fluid (CSF) is slowly drained has not been documented to date. Methods: Case report. Results: A 47-year-old woman presented with lower extremity weakness. Spinal arteriovenous malformation was diagnosed, and she underwent surgery. Her neurologic status improved; however, CSF collected subcutaneously as a cyst and leaked 21 days after surgery. The patient underwent urgent surgery during which the durai defect was repaired and a lumbo-peritoneal catheter was put in place to treat the CSF leakage. The lumbo-peritoneal drainage system was removed when bilateral cerebellar hemorrhage was seen 12 days later. Physical therapy was stopped, and conservative treatment was initiated consisting of bed rest, analgesics, sedatives, and careful monitoring of blood pressure. The patients headache gradually resolved; physical therapy was restarted to rehabilitate this patient with paraparesis. Conclusions: Remote cerebellar hemorrhage seems to be life threatening and entails significant morbidity. Cerebellar symptoms, and even a late sudden headache after spinal surgery, may be signs of remote cerebellar hemorrhage, which is a rare complication. J Spinal Cord Med. February 2010; 33(1): 77–79

Remote cerebellar hemorrhage following resection of a supratentorial tumor: a case report

Remote cerebellar hemorrhage after supratentorial surgery is rare, ranging between 0.08% and 0.29% in adults and children. However, it is extremely rare in children. This phenomenon underlying mechanisms remain obscure. A 14-year-old male child patient had a history of right focal seizures and underwent craniotomy for a left frontal mass (Dysembryoplastic Neuroepithelial Tumor). First hours post recovery period, the patient was somnolent and had right hemiparesis. Postoperative Computer Tomography and magnetic resonance imaging findings revealed that the patient had developed remote cerebellar hemorrhage. He was treated conservatively, and was free of neurological deficits.Although dehydration and the displacement of the cerebellum are associated with this phenomenon after supratentorial surgery, the identification of the exact etiological factors remains elusive. It is advisable for case givers to be aware of the high potential risk of morbidity and mortality of this entity. Preoperative attention to prevent cerebrospinal fluid overflow leakage and exaggerated dehydration of the patient may prevent remote cerebellar hemorrhages.

Primary central nervous system lymphoma presenting as a pure third ventricular lesion: a case report

IntroductionPrimary central nervous system lymphomas are infrequently occurring lymphomas that account for only 0.3-1.5% of all intra-cranial neoplasms in patients without acquired immune deficiency syndrome. However, a pure third ventricle lymphoma is extremely rare. Here, we discuss the similar radiological appearances of lesions localized in the third ventricle and the importance of accurately diagnosing primary central nervous system lymphomas for favorable treatment outcomes.Case presentationA 38-year-old Caucasian man from Turkey presented with a severe headache lasting for three months that failed to respond to any medication. Both severity and duration of the symptoms increased gradually, resulting in vomiting, nausea and gait disturbance that accompanied the headache for three weeks. Neuro-imaging studies showed a lesion located solely in the third ventricle, resulting in partial obstruction of the foramen of Monro. The pre-operative diagnosis was a colloid cyst. Following the surgical procedure, the results of pathological and immunochemical assays revealed that the pre-operative diagnosis was incorrect and that the lesion was a primary central system lymphoma.ConclusionPure third ventricle lymphomas are extremely rare and are exceptionally localized. It is important to be aware of, and to differentiate between, other possible third ventricular lesions that may mimic the same radiological appearance. Accurate diagnosis is necessary for selecting appropriate treatment modalities.

A large choroid plexus cyst diagnosed with magnetic resonance imaging in utero: a case report

The incidence of choroid plexus cysts represents approximately 1% of fetal anomalies. We describe a case in which fetal ultrasonography and fetal magnetic resonance scans were used to identify a large choroid cyst in a fetus without the use of a diagnostic amniocentesis to detect aneuploidy. After birth, the child underwent surgery. In conclusion, the nature of prenatal intracranial cysts should be fully evaluated and differentiated between choroid plexus cysts and other types of cysts. We believe that a detailed evaluation of detected cysts and other structural brain abnormalities are essential. Prenatal magnetic resonance scans clearly can decrease the need for risky procedures, such as an amniocentesis, in the evaluation of antenatal choroid plexus cysts.

Leptin as an important link between obesity and cardiovascular risk factors in men with acute myocardial infarction

OBJECTIVE The levels of leptin, a major regulator of lipid metabolism, may increase in obesity, and contribute to the development of metabolic syndrome. Leptin is produced by adipose tissue and is a peptide hormone, which has strong association with obesity, elevated cardiovascular risk, and morbidity. The present study was designed to evaluate the relationships between leptin levels, obesity, and cardiovascular risk factors in men with acute myocardial infarction. METHODS AND RESULTS Twenty-four obese and twenty-three nonobese male patients, who had experienced their first myocardial infarction, were included in the study. Their leptin levels, biochemical parameters, and anthropometric measures were obtained. Mean leptin levels were significantly higher in the obese group compared to the nonobese group (2.53ng/mL versus 1.23ng/mL; p<0.01). Leptin levels correlated positively with anthropometric measurements, triglyceride, fasting glucose, C-reactive protein, and uric acid levels, and negatively with high-density lipoprotein cholesterol levels. CONCLUSION Findings indicate high leptin levels to be positively correlated with obesity and diastolic blood pressure in male patients with myocardial infarction.

A case of combined congenital anterior and posterior arch anomaly of C1 vertebra

A very rare case of the craniovertebral junction (CVJ) anomaly is reported owing to its rarity and clinical significance. Computed tomography (CT) and magnetic resonance imaging (MRI) studies of the cervical spine of a 56 -year-old female patient presented with head trauma, revealed an anterior midline arch cleft of atlas with totally aplastic posterior neural arch, as well as anteriorly subluxed right atlantoaxial joint. The coexistence of a total aplasia of the posterior neural arch and anterior arch cleft of atlas is very rare. Congenital anomalies affecting the craniovertebral junction (CVJ) may mimic traumatic injury in the setting of a previous trauma. In this presented case, the absence of an associated bone and soft-tissue edema on the MR imagings helped us to make a differention between the acute traumatic injury and congenital anomaly

Primary Splenic Hemangioendothelioma: A Case Report and Literature Review

Splenic tumors are rarely seen tumors. Primary non-lymphoid vascular tumors of spleen are hemangioma, lymphangioma, hamartoma, littoral cell angioma, hemangioendothelioma, myoid angioendothelioma and angiosarcoma. Primary splenic epithelioid hemangioendothelioma is very rare tumor among this group. Hemangioendothelioma is generally considered to have a potentially intermediate-borderline malignancy. In the literature review, among splenic hemangioendothelioma cases, rarely of them were reported as primary splenic epithelioid hemangioendothelioma. Its frequency among splenic tumors is 0.3-14%. These tumors do not become in large sizes and have better prognosis. If they become large, they may cause symptoms such as pancytopenia and hemolytic anemia due to splenomegaly and hypersplenism. Early diagnosis and treatment may prevent conditions such as widespread metastasis, splenic rupture and operative complications. In this article, we present clinical and imaging findings of epitheloid splenic hemangioendothelioma with review of other reported cases in the light of literature.

Malignant Pleural Mesothelioma and Gastric Metastasis: A Very Rare Case Report and Literature Review

Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm. It has closed association with occupational asbestos exposure. Symptoms are commonly due to local invasion of pleura and mediastinal structures. MPM may have local or rarely distant organ metastasis by haematogenous spread in different organs such as liver, adrenal gland, kidney and contralateral lung. However, gastrointestinal involvement is very rare. Case Report: We report herein a 58-year-old female patient who was presented with back painand finally was diagnosed as MPM with distant metastasis to the stomach. Conclusion: Clinical, imaging and histopathologic findings play an important role in influencing the prognosis as well as treatment.