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Cureus Apr 2024Intracranial subdural empyema is a loculated collection of pus in the subdural space between the dura mater and the arachnoid that can be life-threatening. Here, we...
Intracranial subdural empyema is a loculated collection of pus in the subdural space between the dura mater and the arachnoid that can be life-threatening. Here, we present a case of a 22-year-old man hospitalized for management of sepsis due to right orbital cellulitis who experienced sudden-onset right-sided hemiplegia and was found to have a holohemispheric intracranial subdural empyema requiring emergent neurosurgical intervention. Subdural empyemas are commonly caused by maxillofacial infections, including orbital infections. We demonstrate that orbital cellulitis may cause an intracranial subdural empyema that can present with sudden-onset neurological deficits warranting prompt neurosurgical intervention.
PubMed: 38800139
DOI: 10.7759/cureus.59065 -
Scientific Reports May 2024Subarachnoid neurocysticercosis (SANCC) is caused by an abnormally transformed form of the metacestode or larval form of the tapeworm Taenia solium. In contrast to...
Subarachnoid neurocysticercosis (SANCC) is caused by an abnormally transformed form of the metacestode or larval form of the tapeworm Taenia solium. In contrast to vesicular parenchymal and ventricular located cysts that contain a viable scolex and are anlage of the adult tapeworm, the subarachnoid cyst proliferates to form aberrant membranous cystic masses within the subarachnoid spaces that cause mass effects and acute and chronic arachnoiditis. How subarachnoid cyst proliferates and interacts with the human host is poorly understood, but parasite stem cells (germinative cells) likely participate. RNA-seq analysis of the subarachnoid cyst bladder wall compared to the bladder wall and scolex of the vesicular cyst revealed that the subarachnoid form exhibits activation of signaling pathways that promote proliferation and increased lipid metabolism. These adaptions allow growth in a nutrient-limited cerebral spinal fluid. In addition, we identified therapeutic drug targets that would inhibit growth of the parasite, potentially increase effectiveness of treatment, and shorten its duration.
Topics: Animals; Taenia solium; Neurocysticercosis; Subarachnoid Space; Humans; Gene Expression Profiling; Transcriptome; Cell Proliferation; Cysts
PubMed: 38782926
DOI: 10.1038/s41598-024-61973-9 -
Indian Journal of Psychiatry Apr 2024Certain clinical features, like changes in presentation, the presence of neurological signs, and a poor response to treatment, mandate an organic evaluation of...
Certain clinical features, like changes in presentation, the presence of neurological signs, and a poor response to treatment, mandate an organic evaluation of psychiatric illnesses. In this case series, four cases with established mental illnesses who presented with psychiatric symptoms, on evaluation by neuroimaging, were found to have neurological disorders like neurocysticercosis, sub-arachnoid hemorrhage, sub-dural hemorrhage, and lacunar infarction. They were managed with a combination of medical and surgical treatment and psychotropics, and no relapse of symptoms was noted at follow-up. The formulation of clinical practice guidelines can be a way forward in holistic management for such patients.
PubMed: 38778857
DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_766_23 -
Acta Neurochirurgica May 2024In recent years there has been a re-evaluation regarding the clinical implications of temporal lobe arachnoid cysts (temporal arachnoid cysts) in children. These cysts...
BACKGROUND AND PURPOSE
In recent years there has been a re-evaluation regarding the clinical implications of temporal lobe arachnoid cysts (temporal arachnoid cysts) in children. These cysts have often been considered asymptomatic, or if symptomatic, only causing focal neurological symptoms or signs of increased intracranial pressure. However, several studies have more recently reported on cognitive symptoms improving after surgery. This study aimed to evaluate if reported cognitive improvement after surgery of temporal arachnoid cysts were stable after five years.
METHOD
Ten consecutive children (m = 14.65; range 12.1-19.415 were assessed cognitively five years after micro-neurosurgical fenestration of a temporal arachnoid cyst. Results were compared to results from their pre- and post-surgical evaluations. Evaluations included the Wechsler-scales, Boston Naming Test (BNT), Rey Auditory Verbal Learning Test (RAVLT), verbal fluency test (FAS) and Rey Complex Figure Test (RCFT).
RESULTS
The analysis revealed significant postsurgical improvement compared to baseline on the Wechsler-scales measures of general intelligence (FSIQ), verbal abilities (VCI) and processing speed (PSI). Mean differences after surgery were 8.3 for FSIQ, (p = 0.026), 8.5 for VI (p = < .01) and 9.9 for PSI (p = 0.03). There were no significant differences in mean test results when comparing postsurgical scores with scores five years after surgery, indicating long-term stability of improvements.
CONCLUSION
The results indicate that affected cognitive functions in children with temporal arachnoid cysts improve after surgery and that the improvements remain stable five years later. The improvements and long term stability were also consistent with the experience of both parents and children. The findings provide a strong argument for neurosurgical fenestration of temporal arachnoid cysts in children.
Topics: Humans; Arachnoid Cysts; Male; Female; Child; Follow-Up Studies; Adolescent; Cognition; Young Adult; Neurosurgical Procedures; Microsurgery; Neuropsychological Tests; Treatment Outcome; Temporal Lobe
PubMed: 38777952
DOI: 10.1007/s00701-024-06120-z -
Journal of Neurosurgery. Case Lessons May 2024
PubMed: 38768517
DOI: 10.3171/CASE23701a -
Journal of Neurosciences in Rural... 2024
PubMed: 38746515
DOI: 10.25259/JNRP_554_2023 -
Surgical Neurology International 2024Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of benign intraspinal neoplasms. These are amenable to gross total excision but...
BACKGROUND
Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of benign intraspinal neoplasms. These are amenable to gross total excision but can have variable functional outcomes, which plays a key role in assessing their impact on a patient's quality of life. Understanding the functional outcomes associated with these tumors is crucial for healthcare professionals to devise appropriate treatment plans and provide comprehensive care.
METHODS
In this study, we retrospectively reviewed the outcomes of 130 patients with IDEM tumors who underwent surgery in the past six years between January 2017 and December 2022 at a single institution. Patient demographics, symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel grading. The back pain was assessed using the Denis pain scale (DPS).
RESULTS
The age range, gender distribution, presentation, histopathology, and tumor characteristics were analyzed. The histopathological outcomes of the study were as follows: 56 cases of schwannoma, 37 cases of meningiomas, 16 patients of neurofibroma, six cases of epidermoid cyst, five cases each of ependymoma and dermoid cyst, three cases of arachnoid cyst, two cases of metastasis, and one case of paraganglioma. Pain was the most common symptom (38.5%), followed by weakness in limbs (31.5%), paresthesia/numbness (22.3%), and sphincter disturbance (7.7%). Complete total resection was seen in 93% of cases, with 7% undergoing subtotal excision. The complications encountered were - four cases of surgical site infection and one case each of cerebrospinal fluid leak, pseudomeningocele, and epidural hematoma. In our series, 49.3% of patients had significantly good improvement in functional outcomes as per improvement in Frankel score, and 43% of patients had good functional improvement. Significant functional improvement was noted at immediate postoperative follow-up, 2-week follow-up, and six-month follow-up periods. Reoccurrence was seen in 7 cases (5.4%). The DPS score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significantly poor outcome was seen in IDEM tumours present anteriorly.
CONCLUSION
The IDEM tumors are usually benign and are readily detected by contrast-enhanced magnetic resonance imaging scans. These have variable functional outcomes in different centers. Assessing this functional outcome is an essential aspect of managing IDEM spinal tumors. It was observed through our study that the ventral location of the tumor, thoracic tumors, and poor preoperative neurological status of the patient correspond with poorer postoperative functional outcomes. Furthermore, a significant decrease in the pain symptoms with improvement of Frankel score was seen postoperatively, thus this being suggestive of a significant improvement of functional outcome after surgery. This study helps to conclude that the morbidity associated with the resection of IDEM tumors is not as significant as originally thought to be.
PubMed: 38742010
DOI: 10.25259/SNI_689_2023 -
Surgical Neurology International 2024Spinal extradural arachnoid cysts comprise <1% of all spinal lesions and are rare findings in pediatric patients. The pathogenesis of spinal extradural arachnoid cysts...
BACKGROUND
Spinal extradural arachnoid cysts comprise <1% of all spinal lesions and are rare findings in pediatric patients. The pathogenesis of spinal extradural arachnoid cysts is not well known but is thought to most commonly be due to congenital dural defects. Other origins include trauma, inflammation, or infection, such as arachnoiditis. Spinal magnetic resonance imaging is the gold standard for diagnosis, showing a fluid-filled space dorsal to the spinal cord with signal intensity akin to cerebrospinal fluid (CSF) and often the site of dural defect with CSF leak. While most spinal extradural arachnoid cysts are asymptomatic, large cysts can compress the spinal cord or nerve roots, leading to myelopathy, radiculopathy, or focal pain symptoms. In such cases, surgical management is indicated.
CASE DESCRIPTION
Here, we present a case of a 15-year-old female who presented with lower back pain radiating to her bilateral posterior thighs and knees, with imaging indicating a thoracolumbar spinal extradural arachnoid cyst. After failed conservative treatment, surgical intervention in the form of laminectomy, fenestration of the arachnoid cyst, and repair of the dural defect was required, resolving the patient's symptoms with no recurrence of the cyst.
CONCLUSION
Complete resolution of pain in our patient following surgical management of spinal arachnoid cyst suggests that treatment of the arachnoid cyst can be achieved through minimal exposure to the site of the CSF leak to fenestrate the cyst and repair the leak.
PubMed: 38741998
DOI: 10.25259/SNI_27_2024 -
Primary extradural meningioma with a history of traumatic head injury during infancy: A case report.International Journal of Surgery Case... May 2024Meningiomas are an extra-axial tumour arising from arachnoid cells and are typically benign and slow growing. Primary extradural meningiomas refer to meningiomas that...
INTRODUCTION AND IMPORTANCE
Meningiomas are an extra-axial tumour arising from arachnoid cells and are typically benign and slow growing. Primary extradural meningiomas refer to meningiomas that arise outside the subdural compartment and are extremely rare (0.3 % of meningiomas).
CASE PRESENTATION
A 42-year-old female presented to her primary health care provider with a 2-year history of a painful mass on her left forehead with a past medical history of a traumatic brain injury and intracranial hematoma from a motor vehicle accident when she was 11 months old. An ultrasound reported as likely sebaceous cyst. The lesion was resected and sent for pathological examination. The diagnostic summary reported an ectopic subgaleal left frontal meningioma WHO Grade 1.
CLINICAL DISCUSSION
Extracranial meningiomas have been divided into two classifications; primary extracranial meningiomas and secondary extracranial meningiomas. In the female population group 88 % of extracranial meningiomas found on the scalp/skin are grade 1 meningiomas. Most extracranial meningiomas are diagnosed after histology examination, due to the rarity. They can arise via entrapment of arachnoid cells during embryologic development and from traumatic events displacing arachnoid cells.
CONCLUSION
The authors suggest that the patient's aetiology of her PEM is from the entrapment of arachnoid islet cells secondary to her traumatic brain injury during infancy. Interestingly, the patients' symptoms began 40 years post trauma. Other case studies of this rare tumour have correlated a shorter time period between the trauma and the diagnosis. We suggest that all patients should have radiographic and histologic investigations of scalp masses.
PubMed: 38728970
DOI: 10.1016/j.ijscr.2024.109743 -
Acta Neurochirurgica May 2024While hearing loss is a well-known condition following microvascular decompression (MVD) for hemifacial spasm (HFS), tinnitus is an underreported one. This study aims to...
PURPOSE
While hearing loss is a well-known condition following microvascular decompression (MVD) for hemifacial spasm (HFS), tinnitus is an underreported one. This study aims to identify prevalence, characteristics, severity, and predictors of tinnitus following MVD for HFS.
METHODS
A single-center cohort of 55 HFS patients completed a questionnaire approximately 5 years following MVD. Data encompassed tinnitus presence, side, type, onset, and severity measured by a 10-point Visual Analogue Scale (VAS). Descriptive, correlation, and logistic regression analyses were conducted. RESULTS : At surgery, participants' median age was 58 years (IQR 52-65). The median duration of HFS symptoms before surgery was 5 years (IQR 3-8), slightly predominant on the left (60%). Postoperative tinnitus was reported by 20 patients (36%), versus nine (16%) that reported preoperative tinnitus. Postoperative tinnitus was ipsilateral on the surgical side in 13 patients (65%), bilateral in six (30%), and contralateral in one (5%). Among patients with bilateral postoperative tinnitus, 33% did not have this preoperatively. Tinnitus was continuous in 70% of cases and pulsatile in 30%. Onset of new tinnitus was in 58% immediately or within days, in 25% within three months, and in 17% between three months and one year after surgery. The mean severity of postoperative tinnitus was 5.1 points on the VAS. Preoperative tinnitus and presence of arachnoid adhesions had suggestive associations with postoperative tinnitus in initial analyses (p = 0.005 and p = 0.065). However, preoperative tinnitus was the only significant predictor of postoperative tinnitus (p = 0.011).
CONCLUSION
Tinnitus is a common condition following MVD for HFS, with a moderate overall severity. Causes behind postoperative tinnitus remain obscure but could be related to those of postoperative hearing loss in this patient population. Clinicians should be aware of tinnitus following MVD and vigilantly monitor its occurrence, to facilitate prevention efforts and optimize outcome for HFS patients undergoing MVD.
Topics: Humans; Tinnitus; Hemifacial Spasm; Middle Aged; Microvascular Decompression Surgery; Female; Male; Aged; Postoperative Complications; Cohort Studies
PubMed: 38719997
DOI: 10.1007/s00701-024-06103-0