Roukoz B. Chamoun

Spontaneous subdural haematoma in anabolic steroids dependent weight lifters: reports of two cases and review of literature

SummarySpontaneous subdural haematoma is very rare in young patients. The complications of anabolic steroid intake in weight lifters are numerous, yet subdural haematomas have not been reported. We report on two cases of spontaneous subdural haematomas in young weight lifters. Both patients underwent surgical evacuation and made a full recovery. A review of the literature on the complications associated with valsalva manoeuvres is also presented including hemodynamic and intracranial changes. We propose that patients on chronic anabolic steroids may have vascular changes that predispose them to bleeding during a Valsalva manoeuvre (VM).

Role of temozolomide in spinal cord low grade astrocytomas: results in two paediatric patients

SummaryBackground. The optimal treatment of low grade intramedullary spinal cord tumours remains controversial. In many cases the tumours continue to progress even after surgery and radiation. Effective chemotherapy may be an important therapeutic adjunct in this setting. Temozolomide is widely used for brain gliomas, yet its role in the management of spinal cord tumours has not been reported. Procedure. Two paediatric patients with low grade spinal cord astrocytomas were diagnosed to have progression of the tumour in spite of surgery and radiotherapy. They received temozolomide, 200 mg/m2 daily for five days every four weeks for 10 cycles, and were followed serially. Results. Stabilization of the spinal tumour in both patients was observed at 18 months of follow-up. One of the patients developed haematological toxicity requiring platelet transfusion and dose reduction. Conclusion. Based on our findings in two paediatric patients, temozolomide may be a useful agent in the management of progressive recurrent low grade spinal cord astrocytomas.

Baclofen pump pocket infection: a case report of successful salvage with muscle flap

Programmable pump for continuous infusion of intrathecal baclofen, an agonist of the inhibitory neurotransmitter gamma‐aminobutyric acid, is nowadays being widely used to control spasticity. The most common complications leading to explantation of the pumps are skin breakdown and infection at the pump implantation site which cannot be effectively treated without pump removal. We report a 37‐year‐old man who developed a baclofen pump pocket infection that did not respond to antibiotic therapy. Because the continuation of intrathecal baclofen administration was critical to the patient, and because the high cost of the pump precluded its prompt replacement, the pump was salvaged using the ipsilateral rectus abdominis muscle that was elevated on its inferior vascular pedicle and wrapped around the pump. Abdominal skin was then approximated, leaving a small portion of exposed muscle overlying the refill site that was covered by a split‐thickness skin graft. Continuous intrathecal baclofen administration was never discontinued. Three months later, the pumps refill site could be easily identified manually for pump refill. There were no signs of recurrent infection during the 2‐year follow‐up period.

PERIOSTEAL OSTEOBLASTOMA OF THE CALVARIA MIMICKING A MENINGIOMA

While osteoblastoma of the cranial vault is rare, the periosteal form of the tumor is highly unusual, with only one case reported in the English literature. We report on a 24-year-old woman presenting with headache and tinnitus. Magnetic resonance imaging of the brain showed an extra-axial temporal mass with findings that were suggestive of a meningioma. The mass was excised completely, and histological examination revealed a periosteal osteoblastoma arising from the inner surface of the temporal bone and adhering to the dura. The tumor was strongly positive for epithelial membrane antigen, a feature not previously described in osteoblastoma, and one that could lead to a mistaken diagnosis of metaplastic meningioma in a limited sample. A detailed literature review of 40 other reported cases of calvarial osteoblastoma is presented. Apart from being slightly more common in females, calvarial osteoblastoma is similar in all other respects to that arising at conventional skeletal sites. Accurate histological diagnosis of a calvarial osteoblastoma requires adequate sampling of the tumor, including its interface with adjacent structures. Correlation with the radiological findings is crucial for the diagnosis in most cases; however, it is not helpful in differentiating the rare intracranial periosteal variant from a meningioma.

Functional recovery following resection of an epileptogenic focus in the motor hand area.

Despite recent technical advances, the surgical management of epileptic foci in the primary motor area, especially the motor hand area, continues to represent a significant challenge because of the risk of permanent neurological deficit. We describe the case of a 19-year-old woman with intractable epilepsy secondary to cortical dysplasia of the motor hand area who was treated with surgical resection. The patient showed immediate complete motor deficit, started improving at around 1 month of follow-up, and had a substantial recovery at 6 months, with only mild limitations of fine hand movements. At the latest follow-up (3 years), she remained seizure-free. This case demonstrates that, in selected cases, resections in the primary motor cortex can be performed and that the immediately observed motor deficit is transient. We discuss the proposed mechanisms for recovery based on available data from experimental animal and clinical human studies.