Giant cerebral hydatid cyst manifesting as seizures in a child: A case report and literature review
Maher khashea Mustafa, Wamedh E. Matti, Hussain Kadhum, Zahraa M. Kareem, Zahraa A. Alsubaihawi, Zahraa F. Al-Sharshahi, Samer S. Hoz
Introduction: Cerebral hydatid disease, accounts for 1 – 25 of all hydatid cases. In this paper, we report a rare case of a giant primary cerebral hydatid cyst presenting solely as a seizure in a two-year-old child. This case is unique both in the size of the cyst and clinical presentation. We additionally review the literature on giant cerebral hydatid cysts.
Methods: A PubMed database search was conducted using the following combination of medical subject headings terms: “giant cerebral hydatid cyst” OR “giant intracranial hydatid cyst”. The focus of the review was to identify cases of giant intracranial hydatid cyst in the pediatric age group and whether it was associated with seizures. The following set of data was collected from each study: age, gender, presence of seizure, other presentations, site of intracranial hydatid cyst, and other organ involvement.
Results: A total of 23 studies (26 cases) were included in the review of those, nine studies (10 cases) including ours described the presence of seizures. The most common presentations were headache (17 cases), papilledema (15 cases), hemiparesis, seizure, and vomiting (10 cases). The most common location for intracranial cysts was intraventricular at 19.2% (five cases). The next common locations were the parietal and frontoparietal, accounting for 30.6% (eight cases) of all cases. Other reported sites were temporoparietal (11.5%, three cases), frontotemproparietal (3.8%, one case), and cerebellar (3.8%, one case).
Conclusion: Giant cerebral hydatid cysts should be in the differential of children presenting with seizures and cystic brain masses, especially in endemic regions. Meticulous surgical technique is paramount to maximize patient outcomes.
Complete isolated third nerve palsy of tuberculous meningitis: A case report
Mardjono Tjahjadi, Yulianti Pranoto, Krisandi Susanto, Christian Permana, Muhammad Sinatrya Caropeboka
Background: Tuberculous meningitis (TBM) is one of the most severe presentations of central nervous system tuberculosis. The disease has an insidious onset with subacute to chronic progression at which point may deteriorate rapidly. The inflammatory reaction in the basal cistern causes the development of thick gelatinous exudate, which eventually encases the surrounding cranial nerves. Amongst the cranial nerve “injured” by this exudate, complete and isolated third nerve palsy is rarely reported.
Case presentation: This present study reported a case of TBM presenting with isolated left-sided third nerve palsy. A 27-year-old woman came to our hospital with the chief complaint of a decrease in consciousness and left-sided ptosis. Neurological examination revealed complete and isolated left third nerve palsy. Brain magnetic resonance imaging with contrast and cerebrospinal fluid studies indicated TBM.
Conclusion: The patient was successfully treated with an anti-tuberculosis drug regimen and showed an outstanding clinical outcome.
Keywords: case report; tuberculous meningitis; third nerve palsy
Intraventricular trigone meningioma associated with visual disturbance: A case report
Roland Sidabutar, Agung Budi Sutiono, Guata Naibaho
Background: Surgical approaches to the trigone of the lateral ventricle are challenging because of the eloquent nature of the surrounding anatomy. In this article, we described trigone intraventricular meningioma on the right side and its management in the developing country of Bandung Indonesia.
Case presentation: A 43 years old male came to our hospital with a chief complaint of headache and homonymous hemianopia on the left eye for the past two months before surgery. He had severe vomiting seven days prior to admission. Magnetic resonance imaging with contrast revealed an enhanced tumor in the right intraventricular trigone. Preoperatively he underwent a tractography to see the optic radiation. We performed craniotomy tumor removal by using a trans-sulcal approach on the parietooccipital sulcus to avoid damaging fibers of the internal capsule and optic radiation. The safe entry zone was confirmed with neuronavigation during surgery. The pathology showed a fibroblastic meningioma.
Conclusion: We have successfully performed a total craniotomy tumor removal on the right trigone intraventricular meningioma. For the best outcome, it was mandatory to use multimodal tools during surgery, such as preoperative tractography, high magnification microscope, neuronavigation, and intraoperative monitoring as well as surgical strategy to avoid the evidence of new neurological deficits.
Keywords: case report; developing country; intraventricular; meningioma
Introduction: Basal ganglia are the commonest predicted site for hypertensive spontaneous intracerebral hemorrhage. However, simultaneously bilateral basal ganglia hemorrhage is not common and is even rarer in young adults.
Case presentation: We reported a case of a 25-year-old male with underlying poorly controlled hypertension and chronic kidney disease who presented with sudden onset of bilateral upper motor quadriparesis. Non-contrast head computed tomography (CT) scan showed bilateral basal ganglia hemorrhage with a dominant left-sided hematoma in size than the other side and slight variation in the Hounsfield unit. The coronavirus screening was negative. As he was declining, the further family was counseled for life-saving surgery. However, they were not keen. He was pronounced dead on the seventh day of admission.
Conclusion: It was theorized, symmetrically vulnerable vessels might be reasons for simultaneous bilateral basal ganglia hemorrhage with the interval of ruptures varying. Although timely surgical intervention is recommended, but most often not feasible with prognostic factors like admission Glasgow Coma Scale score, hematoma distribution, and total hematoma volume. Prevention measures like controlled hypertension and tobacco/alcohol cessation are recommended.
Keywords: basal ganglia; bilateral; case report; intracerebral hematoma; stroke
Management and prevention of surgical site infections in spine surgery in a resource-poor setting: The Irrua protocol
Morgan E, Onuminya JE, Usifoh I, EdwardPoluyi EO, Poluyi AO
Background: Surgical site infections (SSIs) in spine surgeries represent one of the commonest hospital-acquired infections.
Literature review: SSI (refers to infection of the surgical wound within 30 days of surgery or one year of implant usage) portends a huge disease burden with devastating consequences to the patient and the hospital facility with attendant physical and psychological trauma to the patient and it is associated increase rate of morbidity and mortality. Despite, the improved surgical protocol for asepsis and the role of prophylactic antibiotics in clean spine surgeries. There is still a substantial increase in the rate of SSIs.
Conclusion: Reviewing and identifying factors that predispose a spine patient to SSIs is essential and this is aimed at formulating a local protocol that will help to curtail SSIs and could be reproducible in any setting in the world putting into perspective the limitations encountered in our settings.
Keywords: challenges, local protocol, predisposing factors, prevention, surgical site infection
Adult primary frontal ganglioneuroma: A case report
Zahraa F. Al-Sharshahi, Zahraa A. Alsubaihawi, Zahraa M. Kareem, Narges Ali, Saja A. Albanaa, Aktham O. Al-Khafaji, Ali M. Neamah, Samer S. Hoz
Introduction: Ganglioneuromas (GNs) are rare lesions of the peripheral autonomic ganglia. The occurrence in the central nervous system (CNS) is even rarer. The authors report the first case of a frontal lobe GN.
Case presentation: A twenty-one-year-old female had a two-year history of progressively severe headaches and a two-month history of focal seizures. A computed tomography and magnetic resonance imaging scan showed a well-circumscribed left frontal lesion with surrounding edema. The lesion was surgically excised and confirmed to be a GN. The patient recovered well and had no residual lesions on follow-up.
Conclusion: Ganglioneuromas are mostly peripheral lesions. Rarely, GNs may affect the CNS, but frontal lesions have not been documented. Here, we report the first case of a frontal GN. Hence, GNs should be included in the differential diagnosis of enhancing frontal lobe masses.
Keywords: central nervous system; frontal lobe; ganglioneuroma; tumor
Surgical intervention results in traumatic central cord syndrome: A case series
Almira Dyah Puspitarini, Wisnu Baskoro
Background: Traumatic spinal cord injury (SCI) is a trauma that affects the spinal cord. The most commonly encountered form of SCI is acute traumatic central cord syndrome (ATCCS). Currently, there are a few debates on the management of ATCCS. In this case series, we aimed to explain the results of surgical intervention and also the prognosis following the surgical treatment
Case presentation: We presented two cases of SCI. Both patients have a history of trauma and a chief complaint of pain in the neck. Weaknesses in the upper and lower extremity were presented in both patients. Through the magnetic resonance imaging examination, we found a canal impingement with spinal cord stenosis at the level of C3 – C4 on the first patient, and a compression on C4, C5, and C6 with vertebral body protrusion to the spinal canal on the second patient. Both patients went through surgery; decompressive laminectomy on the first patient and cervical corpectomy on the second patient. Both patients showed improvement post-surgery.
Conclusion: Surgical intervention, in the appropriate patient, is associated with an earlier improvement in neurologic status, shorter hospital stay, and shorter intensive care unit stay. However, in patients with mechanical instability, the role of surgery is critical to both address the ATCCS as well as the instability
Keywords: case series; traumatic central cord syndrome; traumatic spinal cord injury
Post-traumatic intracranial parenchymal epidermoid cyst: A rare entity with a unique presentation
Vishwanath Sahukar Eshwarappa, M. Balamurugan, K. Chandrasekar, Shankar Ganesh CV, Sachin Chemate, Mayank Nakipuria, Sudhakshina Nathan, Chetana G
Background: Supratentorial intraparenchymal accounts for 2% of all intracranial epidermoid cysts. The most common site is the cerebellopontine angle. Intraparenchymal epidermoid cysts are rare, most of them occurring in the brainstem, followed by the temporal lobe. Here we present a rare case of a post-traumatic intraparenchymal epidermoid cyst.
Case presentation: A 58 years old male, had a history of head injury, compound comminuted depressed fracture, for which he underwent left frontoparietal craniotomy. The patient started having giddiness, progressive speech difficulty, and right-sided weakness 25 years later. A brain computed tomography scan showed a hypodense lesion in the left frontoparietal region. Brain magnetic resonance imaging showed T1 mixed intensity with predominantly hypointense, T2 hyperintense, non-contrast enhancing, and diffusion-restricted lesion in the left frontoparietal cortex extending from the motor cortex, deep until the left trigonal region. The tumor was completely excised except for a small bit, at the trigonal region where it was firmly adherent to the deep vein. Sections showed abundant laminated keratinous material and a few strips of stratified squamous epithelium suggestive of an epidermoid cyst.
Conclusion: This rare case to our knowledge is the first case of a post-traumatic intraparenchymal epidermoid cyst. Complete microsurgical excision of the tumor is the standard of care. However, if the tumor capsule is firmly attached to the eloquent areas of the brain or to vessels it is better to leave a small component behind to prevent morbidity.
Keywords: case report; epidermoid cyst; intraparenchymal; post-traumatic; supratentorial