Neurosurgical cases
New case: ? IV lesion ? Corpus callosum lesion
27/5/99
This 29 ys Somalian lady is a known case of repeated
generalized convulsion since 6 years.
Last attack was one months ago and she is on and off
antiepileptic. Patient is conscious, oriented but has
slow cerebration. No other neurological deficit can be detected. CT scan was done
and showed curvilinear
calcification ! in the region of the rt. thalanus (not available).
MRI -axial
with with and without contrast
MRI sagittal
MRI coronal
6- Multiple brain lesions 16/3/99
This 63 year gentleman is a known case of hypertension on medication.
He was brought to our hospital A/E room in acute onset confusion state and incont. of
urine.
He was in good general health till 10 days back when he started to have repeated attacks
of
vertigo associated with vomiting.
Neurological exam revealed confused patient, disoriented with tendency to sleep &
horizontal
nystagmus. There was no neck rigidity nor limb weakness. Other cerebellar
signs can not be test because of patient confusion state. No manifestations
of cranial nerves involvement.
CSF : WBCs <5 prot.: 48 Glu.: 80
AFB -ve
alpha-protein : not detectable
CR protein 53 (high)
5- Angiofibroma of nasal sinuses ... 10/3/99
This 43 gentleman referred to our
hospital with history few weeks of nasal block.
seen by ENT specialist and diagnosed as nasal polyp.
acute symptoms started Three days prior to admission with watery nasal discharge,
dysphagia,
change of speech and breathing difficulty. No attacks of epistaxis.
Neurological exam revealed that patient is conscious, oriented, walking balanced and
talking
but has nasal tone. His nose is abnormally big, has mild proptosis of rt. eye,CSF
Rhinorrhea,
rt. LMNL 7th nerve and rt. partial 3rd nerve palsy. He has also bilateral anosmia.
No pyramidal manifestations.
a- CT scan-axial
b- CT -coronal
c- MRI -axial
d- MRI-coronal
e- MRI-sagittal
f- Biopsy-nasal .... Angiofibroma
4- Cervical anterior Intraspinal mass:
Simple Benign cyst 3/3/99
This is 42 year old gentleman complains of neck pain since one month. This pain radiates
to both shoulders and
usually associated with parathesia in both arms. Patient has no sphincteric troubles and
has no significant trauma to
head or neck. His gait is normal and no recent change was noticed.
Neurological exam showed moderate degree of pyramidal signs (exg. deep tendon reflexes and left extensor plantar response) but no spasticity of the limbs and no abnormal gait and patient is walking nicely. There is moderate limitation of neck movement in all directions due to pain. Motor power is 5/5 and has no sensory loss. Deep sensation was intact.
MRI
cervical region
What we did in Rashid Hosp. Dubai:
The running diagnosis was either meningioma or neurofibroma. I myself was in
favor of meningioma. The debate was to approach
anteriorly through
corpectomy (2 levels) or posterior approach
with risk of cord retraction and
uncontrolled bleeding. Finally we choose post.
approach .. after opening the
dura and cutting the dentate ligaments on both
sides we got some range to
mobilize the cord .. the tumor edge appear but
the surprise was that the
wall is transparent and the lesion is a cyst .
with fine needle the contents
was aspirated and lesion collapsed as a
balloon.. Fluid was clear watery.
fluid and cytology did not reveal any abnormal
cells it was CSF. The
collapsed wall was excised and Pathology came
as simple benign cyst !!!
Operative
pictures
Biopsy Result : Simple
benign cyst.
3- Posterior fossa Ependymoma
This patient is a female baby 2 years old. She was in healthy normal condition
till one week prior to admission when She hit the door at home and it seems she is
not seeing it.
Father noticed change of her gait. She became slow in walking and unbalanced and She
started to vomit frequently.
Examination showed that the baby is fully conscious, alert and in good general condition.
She has truncal ataxia and her gait is unbalanced. She has no papilledema. Cranial nerves
are intact and there is no other neurological deficit including other cerebellar signs.
a- MRI
b- more MRI
c- MRI post-op.
d- MRI post-chemo
The child was operated in June 1997. The mass was found originating from fourth ventricle
and as much as possible was removed leaving the deep part which was attached to brain
stem.
Pathology: Ependymoma
There is a lack of clear cut criteria for grading but the presence of some mitotic figures
and focal raise in Ki-67 labeling index may indicate a more aggressive biological behavior
Chemotherapy course
She received chemotherapy according to Baby brain
protocol-UKCCSG CNS 9204
Vincristine- Carboplatin - Methotrexate- Cyclophosphamide - Cisplatinum
7 courses over one year.
2- Vein of Galen malformation:
Five month old boy infant presented with
progressive enlargement of the head,
sunset appearance and frequent crying attacks. Neurological exam revealed only big head
with
head circum= 49 cm , tense bulging ant. fontanel with healthy scalp full of prominent
tortuous veins.
Codman medium pressure shunt was inserted on emergency basis.
a- CT brain plain and enhanced
b- MRI, T1 and T2
c- MRA
d- Comments
e- Subject details
1- Cerebral cysticercosis
This is 28 year
old Muslim lady. She is a known epileptic since 1994.
She was on anticonvulasant since then. But she is off treatment in the last year. She
presented with frequent attacks of tonic clonic seizures. Past history is irrelevant apart
from intestinal ameobiasis.
Neurological exam was unremarkable apart from that the patient is
euphoric and talkative. All routine lab investigations are within normal.
CT and MRI showed multiple small enhanced ring and solid lesions in
Rt. frontal, mid brain and occipita lobe.
a- CT brain plain and enhanced
b- MRI, T1 and T2
c- Comments
