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Surgical Neurology International 2023Infratentorial chronic subdural hematoma (cSDH) is still a rather elusive neurosurgical entity, which, due to its proximity and likely compression of the cerebellum and...
BACKGROUND
Infratentorial chronic subdural hematoma (cSDH) is still a rather elusive neurosurgical entity, which, due to its proximity and likely compression of the cerebellum and brainstem, can lead to devastating consequences. To establish standardized treatment, more studies and reports regarding its therapy are needed. We report a case of a simultaneous unilateral supratentorial and bilateral infratentorial cSDH, with the latter causing hydrocephalus and successfully treated with a bilateral burr-hole trepanation of occipital bone and placement of subdural drains.
CASE DESCRIPTION
A 71-year-old man with gait disturbance, Glasgow Coma Scale 12, and a radiologically verified unilateral supratentorial and bilateral cSDH of the posterior fossa causing cerebellum, brainstem, and fourth ventricle compression with obstructive hydrocephalus, underwent surgical evacuation of infratentorial hematoma with a bilateral burr-hole trepanation. The postoperative course was uneventful, with a control head computed tomography scan showing the resolution of the hematoma and hydrocephalus. The patient was discharged with no newly acquired neurological deficits.
CONCLUSION
Due to a limited number of reports and studies involving infratentorial cSDHs causing hydrocephalus, decision-making and optimal surgical treatment remain unclear. We recommend a timely surgical evacuation of the hematoma if the patient is symptomatic while avoiding placement of external ventricular drainage.
PubMed: 38213427
DOI: 10.25259/SNI_178_2023 -
Journal of Spine Surgery (Hong Kong) Dec 2023Traumatic atlanto-occipital dislocation (AOD) is most commonly treated with cranio-cervical fusion. We present a unique case in which a partial neurological recovery was...
BACKGROUND
Traumatic atlanto-occipital dislocation (AOD) is most commonly treated with cranio-cervical fusion. We present a unique case in which a partial neurological recovery was made after non-operative treatment was done for AOD. Reports of non-operative treatment of this condition are rare in the literature.
CASE DESCRIPTION
An 18-year-old male sustained a traumatic AOD and atlanto-axial dislocation. His injury was characterized by bony avulsion fractures of the occipital condyles bilaterally as well as atlanto-axial dissociation. Non-operative treatment was done because of his comorbidities, primarily his morbid obesity. He was treated in a hard cervical collar for 6 months. He showed radiographic evidence of healing after being treated non-operatively in a rigid cervical collar for 6 months. Follow up at 17 months showed a partial neurological recovery with ability to ambulate assisted with a walker.
CONCLUSIONS
Successful outcomes are possible with non-operative treatment of AOD. A predominant factor contributing to this patient's successful outcome with non-operative management was likely related to the bony avulsion fractures he had which allowed bone to bone healing and settling of the fracture with gravity assisted reduction in a collar. Non-operative treatment may be considered in patients who are too unhealthy or unstable to undergo surgical intervention, although the standard of care remains surgical cranio-cervical fusion.
PubMed: 38196734
DOI: 10.21037/jss-23-60 -
Legal Medicine (Tokyo, Japan) Feb 2024We present the case of a 69 years old man who was hit by a car while crossing the road. A CT scan of the skull and brain showed fracture of the left occipital bone,...
We present the case of a 69 years old man who was hit by a car while crossing the road. A CT scan of the skull and brain showed fracture of the left occipital bone, bilateral hemispheric subarachnoid hemorrhage, right frontal-temporal-parietal subdural hematoma with a shift of midline structures of 18 mm and complete obliteration of the third ventricle. He showed signs of anisocoria, absence of mobility of all 4 limbs and was immediately intubated and admitted to intensive care. The neurosurgeon was immediately consulted. He underwent drainage of subdural hematoma and two decompressive craniotomies, but died 15 days after the initial trauma. At autopsy, the stomach was full of a greenish poltaceous material. This gave us vital information in reconducting the actual brain death of the man to the immediacy of the investment, helping in the process of ruling out any possible profiles of professional liability.
Topics: Male; Humans; Aged; Hematoma, Subdural; Brain; Subarachnoid Hemorrhage; Fractures, Bone; Tomography, X-Ray Computed
PubMed: 38154350
DOI: 10.1016/j.legalmed.2023.102377 -
Annals of Medicine and Surgery (2012) Dec 2023Epidermal cysts are the most common subcutaneous tumor typically observed on the scalp, face, neck, back, or trunk. Epidermal cysts conventionally range in size from 1...
INTRODUCTION AND IMPORTANCE
Epidermal cysts are the most common subcutaneous tumor typically observed on the scalp, face, neck, back, or trunk. Epidermal cysts conventionally range in size from 1 to 5 cm, with sizes greater than 5 cm rarely reported.
CASE PRESENTATION
Here, we present a case of a 58-year-old female housewife who presented to our surgery outpatient department (OPD) with a history of a mass in the left occipital region. The mass was first noticed 3 years back and was small and associated with mild itching. The mass progressively increased in size over the course of 3 years. Her present complaint was a painful mass associated with itching, headache, and pus discharge when compressed. The pain was relieved by taking medication.
CLINICAL DISCUSSION
The epidermal cyst was confirmed on biopsy, and subsequent excision of the cyst was done under general anesthesia; the occipital bone was eroded by the inferior part of the cyst - reconstruction of scalp defect done by rotational scalp flap.
CONCLUSION
Epidermal cysts, being a slow-growing benign tumor, can pose diagnostic difficulties, especially when located in the scalp area. In addition to that, when cranial bones and intracranial structures are affected by the cyst, they can even lead to complications and interventional difficulties.
PubMed: 38098565
DOI: 10.1097/MS9.0000000000001406 -
ENeurologicalSci Dec 2023Dandy-Walker malformation or syndrome is the most common posterior fossa malformation. It is commonly associated with other congenital anomalies such as cardiac defects;...
BACKGROUND
Dandy-Walker malformation or syndrome is the most common posterior fossa malformation. It is commonly associated with other congenital anomalies such as cardiac defects; however, association with a giant occipital meningocele is extremely rare, as only around 34 cases have been described.
CASE DESCRIPTION
We report a case of a 2-month-old female infant who presented with a midline, gigantic mass in the back of the head. It was first discovered on a prenatal ultrasound. The mass measured about 15 × 5 cm, extending to the midback, not changing in size with crying, not attached to the back, and with a positive transillumination test. The diagnosis was confirmed after doing a brain computed tomography, which revealed hypoplasia of the vermis with an enlarged posterior fossa as well as cystic dilation of both ventricles with herniation through a bone defect.
CONCLUSION
Our case highlights a rare association between giant occipital meningocele and Dandy-Walker syndrome that is rarely discussed or reported in the medical literature. By reporting this extremely rare case of Dandy-Walker syndrome associated with a giant occipital meningocele, we hope to contribute to the creation of a database for future research so that a management protocol can be established for use by clinicians and neurosurgeons for better management of the condition.
PubMed: 38053652
DOI: 10.1016/j.ensci.2023.100486 -
Journal of Neurosurgery. Case Lessons Dec 2023Dermoid cysts located laterally in the posterior fossa are rare. The authors report the case of a dermoid cyst in the cerebellar hemisphere presenting with hemifacial...
BACKGROUND
Dermoid cysts located laterally in the posterior fossa are rare. The authors report the case of a dermoid cyst in the cerebellar hemisphere presenting with hemifacial spasm (HFS) caused by multiple vascular attachments due to remote compression effects.
OBSERVATIONS
A 48-year-old man presented with left HFS. Computed tomography showed a mass lesion in the left cerebellar hemisphere with calcification and erosion of skull bone. Magnetic resonance imaging showed no contrast enhancement of the lesion and a dural defect. The lesion compressed the brainstem and cerebellopontine cistern, but no vascular attachments to the facial nerve were seen. Tumor removal and microvascular decompression were performed. The lesion was composed of soft tissue containing oil-like liquid and hairs, and the border of the cerebellar arachnoid was clear. There were multiple vascular attachments to the root exit zone, facial nerve, and brainstem. After displacing these arteries, the intraoperative abnormal muscle response disappeared. Histopathological findings showed stratified squamous epithelium, keratin flakes, calcifications, and hairs. The HFS disappeared completely and has remained absent for 27 months.
LESSONS
The dermoid cyst originating from occipital bone compressed the cerebellar hemisphere, displacing multiple vessels and leading to HFS. Tumor removal and the removal of all vascular factors can completely resolve HFS.
PubMed: 38048565
DOI: 10.3171/CASE23592 -
Cureus Nov 2023Tapia syndrome is characterized by unilateral tongue paralysis, hoarseness, and dysphagia. It is often associated with issues in the lower cranial nerves and is rarely...
Tapia syndrome is characterized by unilateral tongue paralysis, hoarseness, and dysphagia. It is often associated with issues in the lower cranial nerves and is rarely caused by malignant tumors. A 71-year-old Japanese male with prostate cancer and bone metastases experienced severe headaches, oral discomfort, dysphagia, and hoarseness for a month. Neurological examination revealed left-sided tongue atrophy and left vocal cord paralysis, suggesting problems with cranial nerves IX and XII. CT scans showed bone metastasis in the left occipital bone. Brain MRI showed no brain or meningeal metastasis, but neck MRI revealed a mass near the left hypoglossal canal. His prostate-specific antigen (PSA) level was 53.2 ng/mL. Based on these findings, we diagnosed him with occipital bone metastasis of prostate cancer with Tapia syndrome. We treated him with palliative radiation therapy (RT), delivering 30 Gy in 10 fractions over two weeks. We did not use drug treatment or chemotherapy due to side effects and the patient's preferences. After just one day of RT, his severe headache and oral discomfort significantly improved. By the end of the two-week treatment, his hoarseness had also improved, and he was able to eat. However, tongue atrophy had not improved three months after RT. We presented a unique case of palliative RT for occipital bone metastasis of prostate cancer with Tapia syndrome. Within two weeks, the patient's headache and dysphagia had greatly improved, although tongue atrophy remained partially unresolved after palliative RT.
PubMed: 38024075
DOI: 10.7759/cureus.49327 -
American Journal of Nuclear Medicine... 2023Children and young adults have a vast array of electronics at their fingertips. While it can provide endless hours of entertainment and education, we are also seeing a...
BACKGROUND
Children and young adults have a vast array of electronics at their fingertips. While it can provide endless hours of entertainment and education, we are also seeing a structural consequence. Children are using these devices with their head tilted down with poor posture resulting in increased stress on the skull from attached structures which can lead to a bone spur (exostosis) at the external occipital protuberance (EOP). While typically painless, it can progress to necessitate surgical intervention.
OBJECTIVES
The purpose of this study is to understand the prevalence of exostosis at the EOP and how the finding can affect the nuclear medicine bone scan.
MATERIALS AND METHODS
43 pediatric patients who underwent a whole-body bone scan over a period of 1 year were included in the study (10-19 years old). Images were reviewed by 2 board-certified Nuclear Medicine physicians to assess for uptake midline in the occipital skull. Suspected cases were followed up with all available clinical and radiographic reports and images.
RESULTS
Bone scan demonstrated an occipital focus of uptake in 7 (16%) of the 43 patients (5 males and 2 females with a mean age of 15 years; range 10-19). Of these, 5/7 (71%) were confirmed by additional imaging.
CONCLUSION
The rapidly advancing technology is leading to increased screen time in children and young adults. Our study shows that 16% of the pediatric population imaged at our facility between the ages of 10-19 years have signs of exostosis at the EOP. It is particularly important for clinicians to be aware of this entity when reading bone scans to avoid false positive interpretations.
PubMed: 38023820
DOI: No ID Found -
Journal of Osteopathic Medicine Apr 2024Deformational plagiocephaly (DP) is on the rise in pediatric patients. The current standard of care recommended for management is repositioning with possible addition of...
CONTEXT
Deformational plagiocephaly (DP) is on the rise in pediatric patients. The current standard of care recommended for management is repositioning with possible addition of cranial orthoses. However, strong data are lacking to support these recommendations. Osteopathic manipulative treatment (OMT) is another treatment option for DP that is also lacking evidential support.
OBJECTIVES
This retrospective chart review study investigated the effects of OMT at restoring a more symmetrical cranial bone configuration in children with DP.
METHODS
A retrospective chart review was performed on medical records of patients with a diagnosis of DP from three private practices over a 4-year period from September 2017 to December 2021. Inclusion criteria were diagnoses of DP by a referring physician and aged 10 months or less at the time of initial evaluation and treatment. Patients were excluded if they had confounding diagnoses such as genetic syndromes or severe torticollis. A total of 26 patients met these criteria, and their records were reviewed. The main outcome reviewed was anthropometric assessment of the cranium, mainly the cranial vault asymmetry index (CVAI).
RESULTS
Participants demonstrated a mean CVAI - a measure that determines the severity of DP - of 6.809 (±3.335) (Grade 3 severity) at baseline, in contrast to 3.834 (±2.842) (Grade 2 severity) after a series of OMT treatments. CVAI assessment after OMT reveals statistically significant (p≤0.001) decreases in measurements of skull asymmetry and occipital flattening. No adverse events were reported throughout the study period.
CONCLUSIONS
The application of OMT has shown potential benefit for reducing cranial deformity in patients with DP.
Topics: Child; Humans; Manipulation, Osteopathic; Retrospective Studies; Plagiocephaly
PubMed: 37999741
DOI: 10.1515/jom-2023-0168 -
Audiology Research Nov 2023Low-frequency air-bone gap (ABG) associated with pulsatile tinnitus (PT) and normal impedance audiometry represents a common finding in patients with third window...
Low-frequency air-bone gap (ABG) associated with pulsatile tinnitus (PT) and normal impedance audiometry represents a common finding in patients with third window syndromes. Other inner disorders, including Meniere's disease (MD), perilymphatic fistula and intralabyrinthine schwannoma, might sometimes result in a similar scenario. On the other hand, PT is frequently associated with dural arteriovenous fistula (DAVF), while conductive hearing loss (CHL) is extremely rare in this clinical setting. A 47-year-old patient was referred to our center with progressive left-sided PT alongside ipsilateral fullness and hearing loss. She also experienced headache and dizziness. Otoscopy and video-oculographic examination were unremarkable. Conversely, a detailed instrumental audio-vestibular assessment revealed low-frequency CHL with normal impedance audiometry, slight left-sided caloric weakness, slightly impaired vestibular-evoked myogenic potentials on the left and normal results on the video-head impulse test, consistent with an MD-like instrumental profile. Gadolinium-enhanced brain MRI revealed an early enhancement of the left transverse sinus, consistent with a left DAVF between the left occipital artery and the transverse sinus, which was then confirmed by angiography. A trans-arterial embolization with Onyx glue was performed, resulting in a complete recession of the symptoms. Post-operatively, the low-frequency ABG disappeared, supporting the possible role of venous intracranial hypertension and abnormal pressure of inner ear fluids in the onset of symptoms and offering new insights into the pathomechanism of inner ear CHL.
PubMed: 37987331
DOI: 10.3390/audiolres13060073