Yam B Roka

Cerebellopontine epidermoid presenting with trigeminal neuralgia for 10 years: a case report

Trigeminal neuralgia, also called tic douloureux, is a common and potentially disabling pain syndrome, which affects the trigeminal or fifth cranial nerve. The precise pathophysiology of Trigeminal neuralgia remains obscure. The disorder causes extreme, sporadic, sudden burning or shock-like face pain that lasts from few seconds to minutes and can be physically and mentally incapacitating. More than one nerve branch can be affected by the disorder. A 55-year-old female presented with pain over the left side of face for 10 years uncontrolled with carbamazepine. On examination the positive findings were reduced sensation by 25% over the left side of face with House and Brackman grade II facial nerve palsy. The corneal reflex was absent on left side. Magnetic resonance imaging showed left cerebellopontine angle (CPA) mass suggestive of an epidermoid involving the Vth nerve and Gasserian ganglion and extending into the middle cranial fossa. She underwent left suboccipital craniectomy and near total excision of the tumor with decompression of the Vth nerve which was fully engulfed by the tumor. Postoperative the VII nerve palsy increased to grade III and she had 50% loss of sensation over left side. She had no further attacks of pain and hence tapered off the carbamazepine. TN caused by cerebellopontine angle epidermoids is uncommon and should be kept in view in all cases presenting with TN. The aim of surgery for epidermoids is to decompress the cranial nerves and brain stem and not total removal with its attendant morbidity and mortality.

Unusual cause for ventriculoperitoneal shunt failure: carcinoma breast compressing distal catheter.

Insertion of a ventriculoperitoneal (VP) shunt is one of the most common surgical procedures in any neurosurgery unit worldwide. Distal catheter obstruction outside the peritoneum is a rare cause of shunt failure. We report the first case of distal obstruction in a 70-year old female by carcinoma breast engulfing the catheter and causing kinking. Intraoperatively, the catheter was intratumoral with no flow of cerebrospinal fluid distally. She underwent relocation of a new catheter to the opposite side of the abdomen and modified mastectomy with resolution of the hydrocephalus. The postoperative course has been uneventful.

High cervical nondysraphic intradural extramedullary lipoma

350 Neurology India | May-Jun 2012 | Vol 60 | Issue 3 5. Mie le WR, Pfannl R, Kryzanski JT. Primary holocord ganglioneuroblastoma: Case report. J Neurosurg Spine 2011;15:457-63. 6. Sibilla L, Martelli A, Farina L, Uggetti C, Zappoli F, Sessa F, et al. Ganglioneuroblastoma of the spinal cord. AJNR Am J Neuroradiol 1995;16:875-7. 7. Singh SK, Srivastava C, Ojha BK, Chandra A, Husain N. Ganglioneuroblastoma of the conus: A rare and aggressive tumor. Neurol India 2010;58:966-8. 8. Amato VG, Assietti R, Morosi M, Arienta C. Acute brainstem dissection of syringomyelia associated with cervical intramedullary neurinoma. Neurosurg Rev 2005;28:163-7.

Giant sacrococcygeal teratoma in an adult: case report.

Congenital sacrococcygeal teratoma (SCT) is the most common germ cell tumour of infancy and childhood. Authors report a case of 18-year -ld female with progressively enlarging sacral mass since birth. MRI showed a solid-cystic mass with no involvement of surrounding structures and it was excised completely by the post-anal route.

Isolated cervical anterior spinal artery aneurysm: case report

Abstract Isolated cervical anterior spinal artery (CASA) aneurysms are extremely rare with most of them mostly associated with arteriovenous malformation. The underlying pathology is not known but some factors leading to the aneurysm are inflammatory, infection and connective tissue disorders. Trauma with formation of pseudoaneurysm has also been reported. We report a case which presented with fourth ventricle bleed and was managed successfully with conservative treatment.

Penetrating head injury with bilateral eye avulsion due to Himalayan bear bite

The Himalayan black bear (Ursus thibetanus or Selenarctos thibetanus), although an omnivore, is more carnivorous than its American counterpart. It is also more aggressive towards humans and is a threatened species because of the deforestation in the Himalayas. Furthermore, poverty, encroachment of the forest, extensive deforestation, lack of education and living near the forest are factors that increase the probability of such animal injuries. We report the case of a 35‐year‐old woman who suffered a severe penetrating head injury with scalp and bilateral eye avulsion, which was managed successfully.

Clinical, radiological and endocrinological findings in a case of McCune-Albright syndrome.

The McCune-Albright syndrome was described as a syndrome of polyostotic fibrous dysplasia, café au lait skin pigmentation, and autonomous endocrine hyperfunction in 1937. We report a 17-year girl with early menarche and accelerated growth for the past three years. The endocrinological examination showed slight rise of growth hormone with other hormones in normal range. The CT showed an expansive bony lesion over the left parietal area. The bone mass was excised with bone cement cranioplasty performed for the defect. Histology confirmed it was fibrous dysplasia. Although uncommon, this syndrome must be kept in mind in cases with bony abnormalities and extensive endocrinological workup done and treatment given for best results.