Paul Marks

Olfactory groove schwannoma revisited.

Schwannomas are benign, slowly growing nerve sheath tumours. They can arise from any peripheral nerve containing Schwann cells including distal portions of cranial nerves. The optic and olfactory nerves do not have a Schwann cell layer and therefore do not develop schwannomas. We report a very unusual case of a young woman who presented with partial seizures and had radiological and operative features of an olfactory groove meningioma. However, subsequent histological analysis revealed the tumour was in fact a schwannoma.

Ependymoma of the neurohypophysis

There are two reported cases of ependymomas arising in the pituitary fossa; one in a human, the other in a horse. Both died during their stay in hospital. The case presented here is the first published case of a patient who is well 3 months after surgery.

Ossified lipoma of the interpeduncular fossa: a case report and review of the literature.

The case of a 65-year-old woman with a calcified lipoma of the interpeduncular fossa presenting with a monoparesis is reported. This was excised, resulting in an improvement of her symptoms. The literature is reviewed.

Glioblastoma multiforme fades on CT imaging after dexamethasone therapy

We describe a patient in whom an enhancing lesion seen on CT scan faded following dexamethasone therapy. Subsequent biopsy revealed a glioblastoma multiforme. Various intrinsic cerebral lesions have been noted to disappear on CT imaging after the administration of corticosteroids, but it is less common for gliomas to exhibit this property.

Acute neurologic deterioration following lumbar puncture in an epidural abscess occurring 14 months after epidural catheter placement.

We report the case of a 19-year-old girl admitted to the hospital with a 2-month history of back pain and a 1-week history of severe weakness, who underwent a diagnostic lumbar puncture which was swiftly followed by acute neurologic deterioration requiring ventilation. She was subsequently shown to have an epidural abscess extending from the second cervical to the fifth lumbar vertebrae. She had received uneventful epidural analgesia for childbirth 14 months previously. The case is unusual in both the acute deterioration following lumbar puncture, and also in the length of time from epidural siting to abscess formation, if this were indeed the source of the infection.

Ruptured spinal arteriovenous malformation causing cauda equina syndrome: case report

We describe the case of an acute cauda equina syndrome secondary to a confined subarachnoid bleed from a spinal arteriovenous malformation. The patient was elderly and made a complete neurological recovery following surgery.

Acute head injury: assessment and practical management

Head injury has now become the commonest cause of death amonst young adults in developed countries. Each year in the UK, approximately one million persons will receive treatment in Accident and Emergency (A&E) departments for mild to severe head injuries. Of these, 100000 will be admitted for observation or specific treatment. In 5% of those admitted to hospital a neurosurgical opinion will be sought. Of those referrals 1500 individuals will have sustained permanent brain damage or remain in a persistent vegetative state.’ Head injury accounts for half of all deaths amongst adolescent males aged between 15-19 years. If death occurs after a road traffic accident (RTA) there is a 75% chance that it will be directly attributable to the head injury itself. Unfortunately, the assessment and management of head injury is perceived by many clinicians as an inpenetrable mystery when in fact, by the application of a few basic principles the treatment of such cases can be undertaken in a methodical and logical fashion.’ An accurate initial assessment of the patient is of paramount importance. Prompt action based on this assessment is essential. The forensic clinician is in a much more difficult position in many respects than hospital-based colleagues when assessing and treating a patient who may have a head injury. The nature of clinical forensic work may bring the forensic practitioner into contact with such patients frequently as a result of assaults or in association with road traffic accidents and offences. Recent studies have shown that the incidence ot assault is increasing, and a third or more of consultations undertaken by forensic clinicians may be assault or injury related3.’ and head injury may be involved in over 5O”L.‘~’ If the head-injured patient is also under the influence of alcohol or illicit drugs the assessment and management may be considerably more difficult.