Weiying Zhong

Spontaneous spinal epidural hematoma

Spontaneous spinal epidural hematoma (SSEH) is a rare emergent condition. It may result in paraplegia, quadriplegia and even death. Prompt diagnosis and emergent decompressive surgical management have been recommended to prevent mortality and morbidity. Although several factors have been associated with prognosis, controversy remains, partly due to its rarity. Thus, the history, clinical presentation, physical examination findings, radiological images, and surgical and pathological records of 30 patients with SSEH (21 male, nine female [sex ratio of 2.3:1], average age of 35 years) treated between January 2002 and September 2010 have been reviewed. The association of age, sex, hypertension, vascular malformation, vertebral level, position and extension of the hematoma, progression interval, operative interval, spinal cord edema, and preoperative neurological condition with the prognosis is discussed. The outcome was better for patients with incomplete neurological deficit (p = 0.001), lesions extending <4 vertebral segments (p = 0.026), and lesions in the thoracolumbar and lumbar region. A shorter progression interval often led to a less favorable prognosis (p = 0.017). Patients with spinal cord edema experienced a worse preoperative neurological deficit (p = 0.005) and a worse outcome (p = 0.000). Patients with a progression interval ≤12hours presented with a worse preoperative neurological deficit (p = 0.026). Early surgical intervention to evacuate the hematoma remains the main treatment for most symptomatic patients. Conservative treatment may be used only for those in a good preoperative neurological condition. Prognosis is associated with the preoperative neurological condition, progression internal, spinal cord edema, and extension and vertebral level of the SSEH. Patients with SSEH in the cervical or cervicothoracic region with a complete preoperative motor deficit have a higher mortality rate.

Symptomatic Rathke cleft cyst

Rathke cleft cysts (RCC) are uncommon intrasellar lesions. Although their clinical manifestations, radiological features and treatment are frequently reported, controversy remains as a result of their rarity. We reviewed the preoperative clinical manifestations, neurological examination findings, visual acuity and fields, endocrinological function, radiographic study findings, surgical and pathological records, and prognosis of 45 patients with RCC (21 males, 24 females, average age: 47 years) admitted to our department between January 2002 and January 2011. The most common clinical manifestations included headaches, and visual and hormonal disturbances. Most RCC were intrasellar with a suprasellar extension. The most common MRI patterns were hypointense on T1-weighted and hyperintense on T2-weighted images, isointense on T1-weighted and hyperintense on T2-weighted images, and hyperintense on T1-weighted and hyperintense on T2-weighted images. Aspiration and biopsy of the cyst wall were performed in most patients. Most patients experienced improved headaches and visual disturbance, but the hormonal disturbance rarely returned to normal, especially in those patients with a serious preoperative hormonal disturbance. The recurrence rate was 14%, which was associated with the extent of cyst removal, inflammation and rim enhancement, as well as the surgical approach. Aspiration and biopsy of the cyst wall still seems to be an effective treatment for most RCC for its low morbidity and good prognosis. Conservative treatment and close follow-up may be suitable for small cysts with subtle clinical manifestations.

Expression of β‑amyloid precursor protein in refractory epilepsy

β-amyloid precursor protein (β-APP), also known as Aβ peptide, has a key role in the pathogenesis of Alzheimers disease, and is also likely to be involved in the development of refractory epilepsy. The mechanism behind the association between β-APP and refractory epilepsy remains to be elucidated. The aim of the present study was to examine the levels of APP mRNA and β-APP protein in patients with refractory epilepsy. Tissue samples were obtained from patients with chronic pharmacoresistant epilepsy who underwent surgery. Levels of APP mRNA and β-APP protein in epileptic temporal lobe and hippocampal tissue were assessed using quantitative polymerase chain reaction, immunohistochemistry and immunofluorescence. The expression levels of protein significantly increased in the temporal cortex and the hippocampus of the patients with epilepsy. β-APP may thus contribute to the pathogenesis of refractory epilepsy.

Intradiploic hemangioma with repeated hemorrhage in a child with hemophilia

Intraosseous hemangioma is an uncommon benign vascular tumor, which is most frequently found in middle-aged female patients. The clinical course is usually insidious and the outcome excellent after total resection. The authors report a case of a calvarial hemangioma in a child with hemophilia who experienced a catastrophic postoperative hematoma and discuss the mechanism, clinical features, and treatment of this condition.

Lack of association between GSTM1 and GSTT1 polymorphisms and brain tumour risk.

OBJECTIVE Glutathione S-transferases (GSTs) are important enzymes that are involved in detoxification of environmental carcinogens. Molecular epidemiological studies have been conducted to investigate the association between GSTM1 and GSTT1 homozygous deletion polymorphisms and brain tumours but results have been conflicting. The aim of this study was to clarify this problem using a meta-analysis. METHODS A total of 9 records were identified by searching the PubMed and Embase databases. Fixed- and random-effects models were performed to estimate the pooled odds ratios. RESULTS No significant association was found between the GSTM1 and GSTT1 homozygous deletion polymorphisms and risk of brain tumours, including glioma and meningioma. Similar negative results were also observed in both population-based and hospital-based studies. CONCLUSION These findings indicate that the GSTM1 and GSTT1 polymorphisms may not be related to the development of brain tumours.

A spinal epidural dumbbell cellular schwannoma in an infant

Intraspinal schwannoma is a rare neoplasm in pediatric patients; cellular schwannoma is an unusual histological subtype of schwannoma. A six-month-old infant with an epidural dumbbell cellular schwannoma presented with progressive weakness of his arms and legs. A spinal MRI revealed an epidural mass from C5 to T4, and a complete surgical resection was achieved after laminotomy and facetectomy. The patient experienced a gradual neurological improvement and was still healthy without recurrence at the latest follow-up. The diagnosis of cellular schwannoma was confirmed on immunohistological examination.

Free fat droplets from ruptured spinal tumors

450 Neurology India | Jul-Aug 2012 | Vol 60 | Issue 4 clopidogrel 150 mg and aspirin 150 mg four hours prior to the procedure. The procedure was conducted under general anesthesia. Y stenting with two enterprise stents (Cordis Neurovascular, Miami, Florida, USA) was done for aneurysm neck remodeling, which was then densely packed with multiple detachable coils. The post-procedure angiogram [Figure 1d] showed complete exclusion of the aneurysm from the circulation, with good pial collaterals to the anterior circulation. There were no untoward effects during or after the procedure. At the clinical follow-up at one month, the neurological examination was normal. He was kept on clopidogrel 75 mg per day and ecospirin 150 mg per day for a period of one year and was advised to continue ecospirin 150 mg per day life-long. A control angiogram done after one year showed stable occlusion of the aneurysm with good collaterals [Figure 1e and f].