Medha Tatke

Hypophyseal tuberculoma: direct radiosurgery is contraindicated for a lesion with a thickened pituitary stalk: case report.

OBJECTIVE AND IMPORTANCE Hypophyseal tuberculomas are extremely rare lesions. The recognition of hypophyseal tuberculomas in the differential diagnosis of pituitary tumors is important, even with no evidence of systemic tuberculosis. CLINICAL PRESENTATION A 27-year-old female patient presented with continuous, dull, generalized headaches and amenorrhea, with no history of visual diminution, galactorrhea, or endocrinological abnormalities and no evidence of systemic tuberculosis. The patient exhibited a normal water balance, without polyuria or polydipsia. A gynecological examination, including an endometrial biopsy for amenorrhea, did not reveal any abnormalities. Perimetric and endocrinological examination results were normal. Contrast magnetic resonance imaging revealed a dense enhancing intrasellar mass, with thickening of the pituitary stalk. INTERVENTION Sublabial rhinoseptal transsphenoidal decompression of the lesion was performed. The histopathological features were consistent with a diagnosis of tuberculoma, and acid-fast bacilli were demonstrated in the surgically removed tissue with Ziehl-Neelsen staining. As soon as the histopathological features were known, the patient underwent a lumbar puncture for cerebrospinal fluid analysis, which indicated normal findings. An intradermal tuberculin test yielded negative results. The patient was treated with medical therapy for 18 months, and complete resolution of the lesion was observed in follow-up examinations. CONCLUSION Hypophyseal tuberculomas are often mistaken for pituitary adenomas. The finding of a thickened pituitary stalk in contrast magnetic resonance imaging scans may be useful for the differentiation of these lesions from pituitary adenomas. Direct radiosurgery is not an appropriate primary treatment method for pituitary adenomas and is principally restricted to elderly, medically unfit patients with microadenomas and patients with residual or recurrent tumors after microsurgery. It is contraindicated for patients who exhibit a thickened pituitary stalk in contrast magnetic resonance imaging scans.

Isolated vitamin E deficiency with demyelinating neuropathy

A 22‐year‐old man, with a past history of generalized tonic‐clonic seizures treated with phenobarbital, presented with spinocerebellar ataxia. The electrophysiological studies revealed a demyelinating motor‐sensory neuropathy. The serum vitamin E level was low. Sural nerve biopsy revealed loss of large myelinated fibers with evidence of remyelination. Vitamin E supplementation led to clinical and electrophysiological recovery of sensory conduction and evoked potentials. Motor nerve conduction, however, showed only partial recovery. Vitamin E deficiency leading to a demyelinating neuropathy, as in the present case, suggests that the full spectrum of the disease entity is not fully defined. Muscle Nerve, 2005

Progressive multifocal leukoencephalopathy in a patient with idiopathic CD4+T lymphocytopenia.

Progressive multifocal leukoencephalopathy (PML) is demyelinating of central nervous system caused by JC virus infection and often occurs in immunodeficient individuals. We report progressive PML in a 30-year-old male with idiopathic severely depressed CD4+T lymphocyte count. He was sero-negative for human immunodeficiency virus (HIV) infection.

Spectrum of pediatric brain tumors in India: a Multi-Institutional study

BACKGROUND Till date there is no published multi-institutional data regarding the epidemiological profile of pediatric brain tumors in India. AIM The present retrospective study analyses the histological spectrum of pediatric age group brain tumors in seven tertiary care hospitals in India. MATERIAL AND METHODS Data regarding frequencies of various primary brain tumors (diagnosed according to the World Health Organization (WHO) classification), in 3936 pediatric patients (<18 yrs of age), was collected from seven tertiary care hospitals in India. RESULTS The most common primary pediatric brain tumors were astrocytic tumors (34.7%), followed by medulloblastoma and supratentorial primitive neuro-ectodermal tumors (22.4%), craniopharyngiomas (10.2%) and ependymal tumors (9.8%). The most common astrocytic tumor was pilocytic astrocytoma. In comparison to adults, oligodendrogliomas and lymphomas were rare in children. CONCLUSIONS Our study is the first such report on the histological spectrum of brain tumors in children in India. Except for a slightly higher frequency of craniopharyngiomas, the histological profile of pediatric brain tumors in India is similar to that reported in the Western literature.

Recurrent tumefactive demyelination in a child

A 13-year-old female presented with two episodes of hemiplegia and hemianopia involving opposite sides, each time associated with seizures. On both occasions, the magnetic resonance (MR) scan showed a giant demyelinating, peripherally enhancing lesion with mass effect. MR spectroscopy (MRS) was indistinguishable from a tumor. At the first episode, she had undergone tumor decompression but the histopathology revealed an acute demyelinating lesion with no evidence of tumor. Each time there was partial clinical recovery and resolution of the radiological lesion, the patient having received corticosteroids during both of the episodes. She also developed hemiballismus postoperatively which resolved on withdrawing phenytoin. It is suggested that a trial of corticosteroids be given in suspected tumefactive demyelinating lesions, although they may be indistinguishable from a tumor.

Lumbar spinal meningeal melanocytoma of the l3 nerve root with paraspinal extension: a case report.

Study Design. A case report of spinal meningeal melanocytoma with a dumbbell-shaped extension and its magnetic resonance imaging features is presented. Objective. To present a rare spinal tumor with pathologic and radiologic features. Summary of Background Data. Meningeal melanocytomas are rare lesions usually found in the posterior fossa and upper cervical spine. The review of literature shows the variation in different studies. The characteristic magnetic resonance imaging features of meningeal melanocytoma have not yet been defined. Methods. A 33-year-old woman presented with a 3-year history of backache and weakness of her left lower limb. Magnetic resonance imaging showed a large dumbbell tumor at L3–L4 with extension in the paraspinal region. Schwannoma was the first possibility suggested by the MRI features. Histopathology of the lesion showed a meningeal melanocytoma. Results. The patient showed a significant recovery after surgery and a full course of radiotherapy. Conclusions. Radiologic presentation could be confusing in cases of spinal dumbbell-shaped tumors. Awareness of the lesion characteristics will facilitate diagnosis and treatment of this condition.

Squash Smear Technique in Rapid Intraoperative Diagnosis of Brain Tumors

The role of rapid intraoperative diagnosis is crucial to neurosurgeons to not only define surgical approach, but also to ensure that minimum injury is caused to normal structures surrounding the lesion. Intraoperative cytology has been shown to be an important diagnostic modality. Squash smears are gaining popularity with increasing use of stereotactic biopsies which give limited tissue yield. The study was designed to assess the accuracy of intraoperative squash smear in the rapid intraoperative diagnosis of brain tumors. 100 consecutive cases of CNS tumors in which the tissue was removed at craniotomy or burr-hole biopsy were studied. The age range of the cases varied from 1 to 80 years. The diagnostic accuracy of squash smears was found to be 91%. In all the cases, clinicoradiological correlation was done with smear diagnosis. Smears were stained with 1% toluidine blue/H&E. In all the cases, results were compared with the paraffin section prepared from tissue remaining after the squash smears were made. Immunohistochemistry/Immunocytochemistry was done as needed.