Naren Nayak

Surgical treatment and results in growing skull fracture.

Growing skull fracture is a rare complication of skull fracture and remains almost undetected in the first few years of life. Here, we report a series of 11 patients with growing skull fracture treated at our institute over a period of five years and discuss their clinical features, radiological findings, and principles of management. Of the 11 patients, six were females and five males, with the age ranging between 9 months and 12 years (mean, 3 years). Progressive scalp swelling was the most common presenting feature. Other clinical features included generalised tonic clonic seizures, eyelid swelling, and proptosis. Computed tomography scan of the head defined the growing skull fracture in all 11 patients and detected the underlying parenchymal injury. Postoperatively, all patients had a complete resolution of the scalp swelling. Two patients had postoperative seizures and one had cerebrospinal fluid leak. Early recognition and surgical repair is essential to prevent the development of neurological complications and cranial asymmetry.

Thoracic epidural angiolipoma with bilateral multilevel extraspinal extensions: A rare entity

134 Neurology India | Jan-Feb 2011 | Vol 59 | Issue 1 Surgical resection is the main treatment for spinal meningioma. The recurrence rate mainly depends on the degree of resection, but complete resection is more difficult to achieve in epidural en-plaque meningiomas because of the location and extent of the lesion, and the attachment to dura mater. Recurrence rates are high, and the prognosis of en-plaque spinal meningiomas remains poor.[2-4]

Spontaneous Resolution of Bilateral Chronic Subdural Hematoma.

A sixty five years old male had presented about two years back with progressive weakness of left upper and lower limb and altered mentation. On examination, as per the hospital records, he was in altered sensorium and had left hemiparesis grade 3/5. Computed tomography (CT) of the brain revealed a hypodense collection in the right frontotemporoparietal region with areas of hyperdensity posteriorly in the parietal region. This was suggestive of a predominant chronic subdural hematoma with an acute component in the parietal region (Figure 1). The hematoma was 1.5 cm in thickness and was causing significant mass effect resulting in compression of the ipsilateral ventricle. Midline shift of 8 mm was noted to the left side (Figure 1). Another hypodense collection was noted in left frontoparietal region with specks of hyperdensity in the left frontal region (Figure 1). Patient was advised surgical evacuation of bilateral subdural hematoma in order to reduce the mass effect and reverse the neurological deficit. However the patient’s relatives were not willing to undergo surgery and he was discharged on best possible medications. He was eventually lost to follow up. Two years later he presented to the emergency department with history of fall following an episode of giddiness. On examination he was conscious, oriented in time, place and person. His left hemiparesis had improved and he was ambulant without support. Brain CT revealed complete resolution of the left frontoparietal subdural hematoma (Figure 2). A thin rim of right subdural collection was noted with no evidence of midline shift or mass effect (Figure 2). He was symptomatically treated and discharged.

Concomitant occurrence of subfrontal extradural hematoma and orbital subperiosteal hematoma: A rare entity

Subfrontal extradural hematomas are uncommon, similar are orbital subperiosteal hematomas. Co-occurrence of both following head trauma is very rare. We describe co-occurrence of sub frontal extradural and orbital subperiosteal hematomas in four patients. The presenting symptoms were proptosis and visual complaints. Diagnosis was confirmed on computed tomography in three patients and magnetic resonance imaging in one patient. Frontal craniotomy and superior orbitotomy with evacuation of hematoma resulted in complete resolution of proptosis and visual symptoms. We emphasize on the early diagnosis of this rare condition and also emergency treatment to prevent permanent visual loss.

Frontal intraparenchymal "White epidermoid cyst": A rare occurrence.

Tubercular meningitis (TBM) is the commonest chronic meningitis in India. Syringomyelia can rarely develop as an acute or chronic complication of TBM. The incidence of CNS TB is related to the prevalence of TB in the community, and it is still the most common type of chronic CNS infection in developing countries, like India. The incidence of intracranial tuberculomas as a complication of TBM varies between 1% and 28%.[1,2] The most frequent outcome in tuberculoma patients is the resolution of tuberculomas and complete clinical recovery within 12 weeks to 1 year with antitubercular therapy.[3] Many cases have been reported of patients developing tuberculomas postTBM but the development of syringomyelia following TBM is very rare. TBM may rarely be followed by the development of a syrinx even aft er apparently successful chemotherapy. No medical treatment is known for patients with syringomyelia following TBM. However, a chronic, stable clinical course is common. Surgical treatment most likely will be necessary[4,5] though ideal treatment of syrinx following TBM is not known. However, our patient has been doing well on ATT without surgery. There has not been any progress of weakness and the condition of the patient remains stable. Thus, though rare acute or chronic syringomyelia can present as a complication of TBM or tuberculoma.

Hemorrhagic colloid cyst: Case report and review of the literature

Colloid cysts are cystic lesions located at the anterior part of third ventricle, close to foramen of Monro and contain colloid material. Hemorrhage in a colloid cyst is very rare. On literature review, we found only six cases of hemorrgic colloid cyst; among them, four were diagnosed at postmortem examination. We report a rare case of a hemorrhagic colloid cyst in a young lady who presented with sudden onset severe headache and vomiting. Computed tomography (CT) scan showed isodense lesion located at foramen of Monro with hyperdense areas suggestive of hemorrhage with foraminal obstruction. The lesion was not enhancing on contrast. Magnetic resonance imaging (MRI) brain revealed a well-defined cystic mass lesion located at the foramen of Monro which was hyperintense on T1 and hypointense on T2-weighted images. Excision of the colloid cyst was performed which revealed hemorrhagic clot instead of colloid material. Histopathological examination revealed a colloid cyst with hemorrhage. We believe that this is the first such reported case of successful clinical outcome following early diagnosis and excision of a hemorrhagic colloid cyst in an adult.

Primary multiple calvarial hydatid cysts—a rare occurrence

Central nervous system hydatidosis comprises about 1–3% of cases of hydatid disease.1–4 Primary hydatid cyst of the brain is uncommon and usually seen as a single cyst. Multiple hydatid cysts of the brain are rare. We present a rare case of calvarial hydatid cyst in a 20-year-old man who presented with scalp swelling for 14 years (figure 1). Figure 1 Clinical picture showing a lobulated midline scalp swelling over the vertex with prominent scalp veins. CT scan showed multiple contrast non-enhancing cysts in both parietal regions, with evidence of calcification (figure 2). MRI showed a 11.5×8 cm sized lesion involving both …

Cerebral Myiasis Associated with Artificial Cranioplasty Flap: A Case Report

BACKGROUND Cranioplasty is a commonly performed procedure for the repair of cranial defects. Various materials have been used for this procedure and have a good safety profile. Human cerebral myiasis is an exceedingly rare condition. It involves the invasion of live or dead human tissues by larvae of the insect species dipterous. CASE DESCRIPTION We describe the first case of cerebral myiasis associated with an artificial cranioplasty bone flap. There was delayed cerebral cortex infestation of the species dipterous after cranioplasty with polymethyl methacrylate bone flap. The patient initially presented with an acute subdural hematoma and contaminated, comminuted frontal bone fracture that required craniectomy with interval cranioplasty at 3 months. Two years after the index procedure, the patient presented for neurosurgical follow-up because of 2 months of nonhealing ulcers and a foul smell emanating from the cranioplasty site, as well as acute onset of unilateral arm and leg weakness. Surgical exploration found live larvae invading the dura and cerebral cortex, an area that was thoroughly debrided with good outcomes for the patient. CONCLUSIONS Cerebral myiasis can be managed via surgical and antibiotic therapy to obtain a good clinical outcome.

Transorbital craniocerebral penetrating injury with iron cutting metal blade

Abstract A 36-year-male presented with foreign body in the right orbital region. He had sustained a transorbital craniocerebral penetrating injury by a broken piece of rotating iron cutting metal blade while working in an industrial unit. CT scan brain revealed a metallic foreign body entering through the right orbit traversing through the anterior skull base and reaching up to the frontal horn of the lateral ventricles. Emergency surgical exploration was performed and foreign body was removed along with the intraparenchymal hematoma.

Hemorrhage in acoustic neurinoma

Sir, Hemorrhage in acoustic neurinoma is very rare and only few cases are reported in world literature.[1] Large size, mixed Antoni type and secondary vascular changes are thought to be risk factors. Gradual onset of unilateral hearing loss and tinnitus are the usual initial symptoms. Unusually, presentation can be of catastrophic onset resulting from sudden, massive intratumoral hemorrhage or subarachnoid hemorrhage.