Rima Kumari

MRI findings in Hirayama disease

The objective of the study was to study the magnetic resonance imaging (MRI) features of Hirayama disease on a 3 Tesla MRI scanner. Nine patients with clinically suspected Hirayama disease were evaluated with neutral position, flexion, contrast-enhanced MRI and fast imaging employing steady-state acquisition (FIESTA) sequences. The spectrum of MRI features was evaluated and correlated with the clinical and electromyography findings. MRI findings of localized lower cervical cord atrophy (C5-C7), abnormal curvature, asymmetric cord flattening, loss of attachment of the dorsal dural sac and subjacent laminae in the neutral position, anterior displacement of the dorsal dura on flexion and a prominent epidural space were revealed in all patients on conventional MRI as well as with the dynamic 3D-FIESTA sequence. Intramedullary hyperintensity was seen in four patients on conventional MRI and on the 3D-FIESTA sequence. Flow voids were seen in four patients on conventional MRI sequences and in all patients with the 3D-FIESTA sequence. Contrast enhancement of the epidural component was noted in all the five patients with thoracic extensions. The time taken for conventional and contrast-enhanced MRI was about 30–40 min, while that for the 3D-FIESTA sequence was 6 min. Neutral and flexion position MRI and the 3D-FIESTA sequence compliment each other in displaying the spectrum of findings in Hirayama disease. A flexion study should form an essential part of the screening protocol in patients with suspected Hirayama disease. Newer sequences such as the 3D-FIESTA may help in reducing imaging time and obviating the need for contrast.

Intracranial epidermoid cyst: Magnetic resonance imaging features

Neurology India | May-Jun 2009 | Vol 57 | Issue 3 A 27-year-old young male presented with a fiveyear history of headache and seizures with recent onset tingling and numbness in the right upper limb. Magnetic resonance imaging (MRI) revealed a large nonenhancing well-marginated extra-axial mass in the left frontotemporal region. On T1-weighted image the lesion showed mixed intensity reticulated appearance with interspersed hyperintense areas and it was hyperintense on T2-weighted (T2W) and diffusionweighted images (DWI) [Figure 1]. At surgery, a cyst with viscous, pearly white contents was removed. Microscopic examination of the cyst revealed keratinizing squamous epithelium with keratinous debris arranged in laminated layers with many anucleate squames [Figure 2].

Extra-axial medulloblastoma in the cerebellopontine angle: Report of a rare entity with review of literature

With only 33 cases reported so far, a purely extra-axial position of medulloblastoma at cerebellopontine (CP) angle is quite exceptional. We report a case of extra-axial medulloblastoma in a 15-year-old male child located in the CP angle that was surgically treated with a provisional diagnosis of schwannoma. Histopathological diagnosis of medulloblastoma was made with the routine hematoxylin and eosin stain and immunohistochemical markers. This case report highlights the fact that although extremely rare, the possibility of an extra-axial mass being a medulloblastoma does exist.

Central nervous system tumors: Radiologic pathologic correlation and diagnostic approach.

Objective: This study was conducted to formulate location-wise radiologic diagnostic algorithms and assess their concordance with the final histopathological diagnosis so as to evaluate their utility in a rural setting where only basic facilities are available. Materials and Methods: A retrospective analysis to assess the concordance of radiology (primarily MRI) with final histopathology report was done. Based on the most common incidence of tumor location and basic radiology findings, diagnostic algorithms were prepared. Results: For supratentorial intraaxial parenchymal location concordance was seen in all high-grade astrocytomas, low- and high-grade oligodendrogliomas, metastatic tumors, primitive neuroectodermal tumors, high-grade ependymomas, neuronal and mixed neuro-glial tumors and tumors of hematopoietic system. Lowest concordance was seen in low-grade astrocytomas. In the supratentorial intraaxial ventricular location, agreement was observed in choroid plexus tumors, ependymomas, low-grade astrocytomas and meningiomas; in the supratentorial extraaxial location, except for the lack of concordance in the only case of metastatic tumor, concordance was observed in meningeal tumors, tumors of the sellar region, tumors of cranial and paraspinal nerves; the infratentorial intraaxial parenchymal location showed agreement in low- as well as high-grade astrocytomas, metastatic tumors, high-grade ependymoma, embryonal tumors and hematopoietic tumors; in the infratentorial intraaxial ventricular location, except for the lack of concordance in one case of low-grade astrocytoma and two cases of medulloblastomas, agreement was observed in low- and high-grade ependymoma; infratentorial extraaxial tumors showed complete agreement in all tumors of cranial and paraspinal nerves, meningiomas, and hematopoietic tumors. Conclusion: A location-based approach to central nervous system (CNS) tumors is helpful in establishing an appropriate differential diagnosis.

Intramedullary meningioma of spinal cord: Case report of a rare tumor highlighting the differential diagnosis of spinal intramedullary neoplasms

A 15-year-old male presented with progressive weakness of both lower limbs with urinary incontinence. Magnetic resonance imaging revealed a spinal intramedullary mass at D7-D8 level. The child was operated with a preliminary diagnosis of an intramedullary tumor. Atypical ependymoma and astrocytoma were considered in the differential diagnosis. Per- and post-operative histopathological examination reported the case as transitional meningioma (WHO Grade I). Spinal intramedullary meningiomas being a rare entity may be confused with other common intramedullary tumors. Though, rare still the possibility of an intramedullary spinal mass of being a meningioma does exist and therefore should be considered in the differential diagnosis of intramedullary tumors.

Spinal cysticercosis: A report of two cases with review of literature

Neurocysticercosis is the most common parasitic infection of the central nervous system worldwide. However, Cysticercosis affecting the spine is considered extremely rare. We report two cases of spinal cysticercosis with review of literature.

Spinal tumour: primary cervical extradural meningioma at an unusual location

Extradural spinal meningiomas are extremely rare, more so in the cervical region. A purely extradural location as reported in this paper is quite exceptional. The authors report a case of extradural meningioma in a 50-year-old male located in the cervical spine that was surgically treated with the provisional diagnosis of a neurofibroma. Histopathological diagnosis of meningothelial meningioma was made with the routine hematoxylin and eosin (HE) stain. The origin, clinical course, radiological features, pathological findings with the differential diagnosis and surgical treatment are discussed based on a review of the literature. An extradural spinal meningioma, an extremely rare entity, is still a diagnostic dilemma on radiology as the radiologic findings overlap with many other common extradural spinal masses.

Upper Airway Dimensions in North Indian Population: A Possible Guide to Appropriate Length of Laryngoscope Blade

Background  The use of adequate size of blade may help minimize failures of endotracheal intubation (ETI) in non–operating room (OR) settings which are usually done by non–anesthesia health care professionals (NAHP). Prospective study was done to assess the appropriate length of the laryngoscope blade for North Indian population. Materials and Methods  Upper incisor-to-vallecula (UI-V), lower incisor-to-vallecula (LI-V), and lower end of mandible to hyoid (M-H) distances were measured on routine computed tomography (CT) images of head and neck, done in the neuroradiology department in successive patients older than 11 years of age with normal airway structures. Results  A total of 126 patients, which included 53 females and 73 males with an average age of 34.5 years (range 14–67 years), formed the study group. UI-V of males and females were 7.35 ± 0.54 and 6.99 ± 0.51 cm, respectively, and the difference was significant. LI-V of males and females were 7.05 ± 0.51 and 6.66 ± 0.50 cm, respectively, and the difference was significant. M-H in males and females were 3.42 ± 0.63 and 3.59 ± 0.52 cm, respectively, and the difference was not significant. Open mouth CT in 11 patients revealed an average increase of 1.66 and 0.45 cm in UI-V and LI-V ( n  = 11), respectively, and 0.59 cm decrease in M-H ( n  = 9) which were significant. Conclusion  Upper airway dimensions of the population may be the used for selecting appropriate size of blade of laryngoscope for ETI in non-OR settings especially by NAHP.

Transpedicular Surgical Decompression ofDorsal Spinal Tuberculosis (Pottâs Disease)with Vertebral Collapse without Fixation

Introduction: Spinal tuberculosis is prevalent in developing countries. Advancements in technique and technology has improved the outcome, but cost of the newer prosthetic implants and insufficient public healthcare infrastructure in third world countries pose difficulty in surgical treatment of many of these patients. Methods: Twenty two patients of dorsal Pott’s disease having anterior or anterolateral compressionswith significantneurologicaldeficitswereprospectively studied in five years period (2010 to 2015) and were subjected to unilateral transpedicular decompression of the dorsal cord with maximal preservation of bony elements including ribs without fixation by prosthetic implants. Patients were advised absolute bed rest for 3 months after surgery. Results: Study group included 12 males and 10 females of with average age 37.5 years (range 14 to 68 years). Clinical improvement was observed in all but one patient, who showed recovery in the follow up. Three patients had recurrence with neurological deterioration due to discontinued antitubercular chemotherapy and required second surgery leading to clinical recovery. There was no increase in kyphosis in follow up in any patient. Conclusion: Unilateral transpedicular decompression with bed rest for three months appear an option in selected patients of dorsal Pott’s disease with anterior/ anterio-lateral compression with significant neurological deficit.

Primary leiomyosarcoma of frontoethmoidal sinus

Leiomyosarcoma is rarely encountered in the sinus and skull base. The common location of this tumor is the female genital tract and the limbs because of the preponderance of smooth muscle at these sites. Clinically, these tumors are very aggressive, and the prognosis is poor. Here, a report of a bilateral frontoethmoidal leiomyosarcoma with review of literature is presented. A 28 year-old male presented with a gradually progressive painful frontal swelling with episodes of headache. The patient underwent a frontal craniotomy and the tissue was sent for histopathological examination. Histopathological diagnosis of leiomyosarcoma was made with the routine hematoxylin and eosin stain and immunohistochemical markers. Although there have been case reports in the literature describing the primary intracranial leiomyosarcoma involving the frontal and ethmoidal sinuses, this lesion continues to cause difficulty in preoperative diagnosis. The case is reported for the rarity of its location and the diagnostic challenge it poses.