Prithvi Narayan

Treatment of degenerative cervical disc disease

The different clinical presentations and treatment options available to treat neck pain from degenerative disc disease have been discussed. With proper patient selection, good correlation between clinical and radiographic findings, and selecting the correct procedure for each patient, surgical treatment of cervical radiculopathy and myelopathy can be one of the most gratifying operations performed in neurosurgery.

Stroke and pediatric human immunodeficiency virus infection. Case report and review of the literature.

Stroke is an uncommon complication in pediatric patients with acquired immunodeficiency syndrome (AIDS). However, with the increasing life span of this patient population, more cases of stroke are being reported. We report the case of a 13-year-old girl with a known history of AIDS who presented with new-onset seizures and right hemiparesis. Serial imaging studies revealed progressive occlusion of the left middle cerebral artery and both anterior cerebral arteries with development of collateral circulation. The workup for other etiologies of stroke was negative. This nonatherosclerotic occlusive disease is most likely secondary to vasculopathy caused by the human immunodeficiency virus (HIV). HIV infection should be included in the differential diagnosis of children who present with seizures, mental status change or focal neurological deficits. Treatment options are limited. The different prognoses associated with the etiologies of stroke in this patient population mandate a careful and thorough evaluation.

Clinical significance of cervicomedullary deformity in Chiari II malformation.

Objective: The purpose of this study was to determine if there is a difference in the caudal extent of brain stem herniation and the degree of cervicomedullary deformity between symptomatic and asymptomatic Chiari II patients. Methods: Magnetic resonance imaging and the clinical presentation of 14 symptomatic and 59 asymptomatic patients were analyzed. The level of the cervicomedullary deformity below the foramen magnum was measured in both groups. The level of the deformity was identified by the cervical vertebral body or disc space level. Results and Conclusion: Review of our results shows no obvious relationship between the level of cervicomedullary deformity and the presenting symptoms or the outcome after surgical decompression. We conclude that the level of herniation and the cervicomedullary deformity is not a reliable marker to determine which patients may become symptomatic and require decompression or to determine prognosis.

Synchronous Primary Central Nervous System and Pulmonary Lymphoma in a 7-Year-Old Female with Unspecified T-Cell Immunodeficiency

Primary central nervous system lymphoma (PCNSL) is rare in children with immunocompromise as an important risk factor. A 7-year-old girl with unspecified T-cell immunodeficiency presented with left-sided weakness and was found to have a right-sided frontal lobe mass on imaging. The mass was resected; histopathology and molecular studies evidenced diffuse large B-cell lymphoma. Prior chest imaging had revealed left upper lobe mass, and repeat chest imaging revealed multiple pulmonary nodules, initially concerning for metastasis. Video-assisted thoracoscopic surgical wedge resection of the lung mass was performed; the molecular profile was distinct from the PCNSL, suggesting synchronous de novo lymphomagenesis of brain and pulmonary primaries.

Supratentorial Anaplastic Ependymoma with Bilateral Papilledema

Ependymomas constitute the third most common histological type of CNS tumor in children. Compared to classic cellular ependymoma (WHO grade II), anaplastic ependymoma is a more aggressive and less common subtype of ependymal neoplasm. We report a case of a supratentorial anaplastic ependymoma in a child presenting with a right sixth nerve palsy with bilateral papilledema. To our knowledge, the ophthalmic findings presented herein have not been previously reported in the context of this tumor type.

management of Anaplastic Astrocytoma

Learning Objectives: After reading this article, the participant should be able to:1. Provide an update on the incidence and clinical presentation and diagnosis of anaplastic astrocytoma.2. Recall the genetics of anaplastic astrocytoma.3. Describe the current treatment of newly diagnosed and recurrent anaplastic astrocytoma.4. Describe the new approaches and future trends in the treatment of anaplastic astrocytoma.