Jacob Braun

The incidence of multiple meningiomas—Do solitary meningiomas exist?

SummarySince the advent of computed tomography (CT) the recognition of the occurrence of multiple intracranial meningiomas (MIM) in the same individual has been on the increase. In our material the incidence of MIM at first assessment of CT films was 20%, with distant multiplicity prevailing over the regional one. This incidence will probably change in the course of time as MIM develop not only concurrently but also consecutively. On the other hand our surgical macroscopic incidence of regional multiplicity alone was 49%. The discrepancy between the CT and surgical findings prompted us to reevaluate the CT studies of 100 consecutive patients. This reevaluation demonstrated: 1. in two cases, small meningiomas were overlooked at first assessment; 2. nineteen cases of solitary globoid meningiomas seemed to be the consequence of the coalescence of adjacent smaller masses. Thus, the CT incidence of MIM increased to 40%, with regional multiplicity prevailing over the distant one.The authors think that the aforesaid findings question the very existence of solitary meningiomas as a pathological entity. They would be the end product of a coalescence of multiple adjacent smaller growths. Accordingly, a more aggressive surgical approach is suggested to include the resection of a generous fringe of dura mater around the main tumour. As this is not always possible, or too risky, a comprehensive complement to surgery like radiotherapy could be given a reasonable randomized trial.

Traumatic carotid aneurysm secondary to cavernous sinus penetration by wood: CT features.

Transorbital penetration of the cranial cavity by a small wooden object can pass unnoticed, while producing severe, life-threatening consequences. The occurrence of a traumatic intracranial aneurysm secondary to a wooden foreign body has not been reported previously in the English literature, to our knowledge. Familiarity with the CT features of this complication is crucial since the CT findings may be the first to suggest penetration of the cavernous sinus by wood, as well as the possibility of a traumatic carotid aneurysm. The CT features of this rare complication are discussed and the pertinent literature is reviewed.

Glutaric aciduria type I

SummarySerial CT findings in an infant with glutaric aciduria type I (GA-I) are reported. The major CT features were dilatation of the insular cisterns, regression of the temporal lobes, with “bat wings” dilatation of the Sylvian fissures and hypodensity of the lenticular nuclei. CT changes preceded the onset of symptoms by 3 months. An improvement in the temporal lobe atrophy was seen after a period of treatment, coinciding with marked clinical improvement. A peculiar feature was the presence of external hydrocephalus, which diverted the attention from manifestations of the primary disease and thus consitituted a diagnostic pitfall. The delineation and recognition of the characteristic radiologic manifestations of GA-I are essential for allowing an adequate radiologist/clinican interaction in diagnosing this inborn error of metabolism.

Occipital Aneurysmal Bone Cyst: CT Features

A case of aneurysmal bone cyst arising from the lower occipital squama with intracranial extension is presented. The case is unique in that the cyst showed fluid levels on CT. Another peculiarity of this case was postoperative recurrence.

Endovascular embolization of a hemorrhagic jugular bulb diverticulum

A jugular bulb diverticulum (JBD) is considered to be a rare venous anomaly. In exceptional cases it extends into the middle ear cavity with no bony covering, and slight oozing to massive bleeding might be encountered during routine middle ear surgical procedures. We report a case of massive bleeding from a dehiscent jugular bulb diverticulum that appeared during myringotomy and was successfully managed by endovascular embolization. This report emphasizes the value of interventional neuroradiology in otosurgical cases in which preoperative control of blood vessels or vascular malformations is crucial to avoid severe complications.

Non-Tropical Pyomyositis in Children–with Report of Severe Neurological Complications

ABSTRACT. Pyomyositis appears to occur rarely in temperate climate areas, compared with the incidence of the disease in the tropics. Three young adults with pyomyositis have previously been described in Israel, two of them were newly arrived Ethiopian immigrants. We report three Israeli children with pyomyositis, who presented initially with nonspecific abdominal pain; in one child the course was complicated by spinal cord compression due to extension of the infected mass into the spinal canal. All three patients attained full recovery after antibiotic therapy and surgical drainage. Computed tomography was most valuable in establishing the diagnosis and defining the extent of the process.

Unilateral Blindness following Septoplasty

Visual loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to orbital apex syndrome following septoplasty. We also review the literature and discuss probable causes. To the best of our knowledge, this is only the second published report of this complication.

Cochlear implantation in a patient with paget's disease

Hearing loss in Pagets disease, a metabolic bone disease, has been reported in as many as 60% of cases, and is presumably related to changes in mineral density of the otic capsule. We describe a 59‐year‐old man with Pagets disease who had severe to profound hearing loss and was referred to us for cochlear implantation. Preoperative evaluation revealed poor communication skills despite significant residual hearing, raising concerns about postimplantation outcome. Nevertheless, implantation was successful. As our literature search yielded only one report of cochlear implantation in Pagets disease, we record our clinical experience and discuss the hearing rehabilitation dilemmas in this case.

Brain mass as a manifestation of very late relapse in nonendemic Burkitt's lymphoma

A 4‐year‐old boy was diagnosed as suffering from Burkitts lymphoma with abdominal and maxillary involvement. The child was from a nonendemic area for Burkitts lymphoma, and no association with Epstein‐Barr virus was found. Two years after the completion of therapy, (3.25 years later) the child developed a solitary brain tumor, which was completely excised and was diagnosed as Burkitts lymphoma. No meningeal involvement was found. Very late relapse in nonendemic Burkitts lymphoma is very rare, and its presentation as a solid brain mass without meningeal involvement has not been reported before.

Severe complicated mastoiditis caused by nontypable Haemophilus influenzae

Non-typable Haemophilus influenzae (NTHi) is emerging as an important cause of invasive disease in immunized children. We describe a healthy, fully immunized 4-year old child who presented with bacteremia due to NTHi without overt acute otitis media (AOM), and subsequently developed severe mastoiditis complicated by sigmoid sinus thrombosis. Although, mastoiditis is typically regarded as a complication of AOM, those cases without antecedent AOM may represent an entirely different pathophysiological process with NTHi bacteremia seeding the mastoid. We present another example of the potential invasiveness of NTHi with a temporal sequence of events whereby NTHi bacteremia seeds the mastoid. This may represent novel sequelae of NTHi infection.