Chronic, otogenic, epidural pneumatocoele with delayed mass effect: case report

2009 ◽  
Vol 124 (5) ◽  
pp. 552-556 ◽  
Author(s):  
F Barbieri ◽  
F Fiorino
Keyword(s):  
Case Report ◽  
Mass Effect ◽  
Sudden Onset ◽  
Middle Ear Pressure ◽  
Bone Powder ◽  
Risk Of Rupture ◽  
Intracranial Complications ◽  
Traumatic Origin ◽  
Anterior Fossa ◽  
The Right

AbstractIntroduction: Mastoid hyperpneumatisation predisposes to intracranial pneumatocoele development, due to the risk of rupture of the thin, bony walls. Intracranial pneumatocoele may be precipitated by even minor head trauma or an abrupt change in middle-ear pressure, with the potential risk of infectious or compressive intracranial complications.Case report: A 19-year-old man with mastoid hyperpneumatisation developed a chronic intracranial–epidural pneumatocoele of traumatic origin in the right parieto-occipital area, in contiguity with the posterior mastoid cells. Eighteen months later, after a common cold, the patient developed signs of intracranial hypertension, due to the pneumatocoele spreading to the right epidural anterior fossa. A large right mastoidectomy extended to the retrosigmoid cells was performed, and a watertight seal applied over a large retrosigmoid cell using bovine pericardium and a mixture of bone powder and fibrin glue.Results: The patient was discharged on post-operative day three with no symptoms. Ten days after surgery, computed tomography monitoring showed complete reabsorption of the pneumatocoele.Conclusion: In cases of chronic, otogenic, epidural pneumatocoele, the possibility of the sudden onset of serious complications suggests the need for early repair of the communication between the temporal bone and the intracranial compartments. Closure of the fistula using autogenic and/or allogenic materials is usually adequate to resolve the pneumatocoele.

scholarly journals Flow diversion and microvascular plug occlusion for the treatment of a complex unruptured basilar/superior cerebellar artery aneurysm: case report

2019 ◽  
Vol 130 (6) ◽  
pp. 1978-1983 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Howard A. Riina ◽  
Omar Tanweer ◽  
Peyman Shirani ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Case Report ◽  
Treatment Options ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Endovascular Approach ◽  
Aneurysm Occlusion ◽  
The Right

The authors present the unusual case of a complex unruptured basilar artery terminus (BAT) aneurysm in a 42-year-old symptomatic female patient presenting with symptoms of mass effect. Due to the fusiform incorporation of both the BAT and left superior cerebellar artery (SCA) origin, simple surgical or endovascular treatment options were not feasible in this case. A 2-staged (combined deconstructive/reconstructive) procedure was successfully performed: first occluding the left SCA with a Pipeline embolization device (PED) coupled to a microvascular plug (MVP) in the absence of antiplatelet coverage, followed by reconstruction of the BAT by deploying a second PED from the right SCA into the basilar trunk. Six-month follow-up angiography confirmed uneventful aneurysm occlusion. The patient recovered well from her neurological symptoms. This case report illustrates the successful use of a combined staged deconstructive/reconstructive endovascular approach utilizing 2 endoluminal tools, PED and MVP, to reconstruct the BAT and occlude a complex aneurysm.

Risk of rupture from incidental cerebral aneurysms

2000 ◽  
Vol 93 (4) ◽  
pp. 550-553 ◽  
Author(s):  
Kazuo Tsutsumi ◽  
Keisuke Ueki ◽  
Akio Morita ◽  
Takaaki Kirino
Keyword(s):  
Risk Estimation ◽  
Cerebral Aneurysms ◽  
Ct Scanning ◽  
Mass Effect ◽  
Sudden Onset ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Risk Of Rupture ◽  
Fine Print ◽  
Saccular Aneurysms

Object. Controversy still exists about the risk estimation for rupture of untreated saccular aneurysms presenting for causes other than subarachnoid hemorrhage (SAH). The object of this study was to address this issue.Methods. Between January 1976 and December 1997 in the Aizu Chuou Hospital, 62 patients underwent observation for more than 6 months for saccular, nonthrombotic, noncalcified unruptured aneurysms at locations not related to the cavernous sinus, which were detected in cerebral angiography studies performed for causes other than SAH. Clinical follow-up data in those 62 patients were reviewed to identify the risk of SAH.All patients were followed until July 1998, with the observation period ranging from 6 months to 17 years (mean 4.3 years). Seven patients (11.3%) developed SAH confirmed on computerized tomography (CT) scanning at a mean interval of 4.8 years, six of whom died and one of whom recovered with a major deficit. In addition, one patient died of the mass effect of the aneurysm, and another after sudden onset of headache and vomiting. The 5- and 10-year cumulative risks of CT-confirmed SAH calculated by the Kaplan—Meier method were 7.5% and 22.1%, respectively, for total cases, 33.5% and 55.9%, respectively, for large (> 10 mm) aneurysms, and 4.5% and 13.9%, respectively, for small (< 10 mm) aneurysms.Conclusions. Although based on a relatively small, single-institution series, our data indicated that the risk of rupture from incidental, intradural, saccular aneurysms was higher than previously reported, and may support preventive surgical treatment of incidental aneurysms, considering the fatality rate of SAH.

scholarly journals Delayed heamatoma after melanoma metastasis resection upon restart of Immunotherapy: Case Report and Review of the Literature

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv19-iv19
Author(s):  
Ali Elhag ◽  
José Lavrador ◽  
Joseph Frantzias ◽  
Ahilan Kailaya-Vasan ◽  
Richard Gullan ◽  
...  
Keyword(s):  
Case Report ◽  
Brain Imaging ◽  
Mass Effect ◽  
Sudden Onset ◽  
Complete Resection ◽  
Melanoma Metastasis ◽  
Review Of The Literature ◽  
Midline Shift ◽  
Operative Complications ◽  
History Of

Abstract Background Supratentorial Metastatic Melanomas are common and increasingly treated with immunotherapy. While improving the outcome, the immunotherapy potentially increases the risks of the intracranial surgical procedures, particularly bleeding. However, scarce reports address this complications. Case Description A 52-year old male with a history of right upper limb excised skin lesion resected with wide local excision 6 months prior to admission, who presented with a three weeks history of progressive headaches, vomiting, odd behaviours, forgetfulness, and left lower sided weakness. Brain imaging showed a right frontal lesion with evidence of haemorrhage within it with midline shift and mass effect. He underwent craniotomy and resection of the lesion with no post-operative complication, resolution of left sided hemiparesis and post-operative imaging documenting complete resection and no post-operative complications. The histopathology confirmed metastatic melanoma and he received adjuvant immunotherapy (Nivolumab), however he represented 4 weeks post operatively with sudden onset headache with vomiting with no neurological deficit, brain imaging showed a delayed hematoma in the surgical site. Conclusions This case report highlights the risk of post-operative bleeding with the immunotherapy and paves the way for further studies with regards to the safety of immunotherapy after intracranial procedures

scholarly journals Spontaneous Epidural Hematoma of the Cervical Spine Mimicking a Cerebrovascular Accident: A Case Report

2018 ◽  
Vol 37 (03) ◽  
pp. 213-216
Author(s):  
Mohammad Jamali ◽  
Sepehr Entezam ◽  
Sulmaz Ghahramani
Keyword(s):  
Case Report ◽  
Cervical Spine ◽  
Cerebrovascular Accident ◽  
Epidural Hematoma ◽  
Lower Extremities ◽  
Sudden Onset ◽  
Spinal Epidural Hematoma ◽  
Upper And Lower Extremities ◽  
The Right ◽  
Spinal Epidural

Objective The present study is a case report of a 57-year-old female with controlled hypertension who presented with spontaneous spinal epidural hematoma (SSEH) mimicking a cerebrovascular accident (CVA) and was successfully treated by surgical decompression. Methods A 57-year-old woman with a medical history of hypertension presented with a sudden onset of weakness in the right upper and lower extremities. Weakness of grade 3/5 was noted in her right upper and lower extremities, but there was no motor weakness of the right facial muscles. A magnetic resonance imaging (MRI) exam of the cervical spine revealed an epidural hematoma extending from level C5 to level C7, causing spinal cord compression. Results During surgery, a cervical spinal epidural hematoma (SEH) was evacuated. Postoperatively, the power in both limbs improved to grade 5/5 just after surgery. Conclusions A high degree of suspicion, meticulous history taking, and physical examination have a great importance in these rare conditions because anticoagulant therapy as a routine treatment for ischemic CVA could be life-threatening.

Superior Hypophyseal Artery Ruptured Aneurysm in a 5-Month-Old Child Presenting as an Acute Subdural Hematoma: A Case Report

2020 ◽  
pp. 1-6
Author(s):  
Piotr Komuński ◽  
Emilia Nowosławska ◽  
Krzysztof Zakrzewski ◽  
Bartosz Polis ◽  
Wojciech Świątnicki
Keyword(s):  
Case Report ◽  
Subdural Hematoma ◽  
Mass Effect ◽  
Ruptured Aneurysm ◽  
Treatment Modalities ◽  
Acute Subdural Hematoma ◽  
Clot Removal ◽  
Right Cerebral Hemisphere ◽  
The Right ◽  
Significant Mass Effect

<b><i>Introduction:</i></b> We present a very rare case of ruptured superior hypophyseal artery (SHA) aneurysm that presented as an acute subdural hematoma (SDH) discussing its initial presentation, diagnosis, and treatment modalities. To our knowledge it is one of very few if any cases of a ruptured aneurysm in infants regarding that specific vascular location. <b><i>Case Report:</i></b> A 5-month-old boy was referred to our department due to acute SDH over the right cerebral hemisphere without significant mass effect nor hydrocephalus. Further evaluation revealed a right internal carotid artery (ICA) aneurysm arising from the SHA segment. Microsurgical clip ligation using a fenestrated, angled clip was performed with simultaneous subdural clot removal and proximal control of the ICA dissected in the neck. Our patient made an excellent recovery without any complicating features. <b><i>Conclusion:</i></b> Surgical management seems to be a better option in this subgroup of patients given the long life expectancy and durability of microsurgical clip ligation. We believe that our brief case report would add some insight into the management of this rare subgroup of patients, leading to better decision-making and outcome.

scholarly journals Surgical resection of a giant cardiac hemangioma encroached upon the right coronary artery: A case report

2020 ◽  
Author(s):  
guangpu fan ◽  
Yu Chen
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Surgical Resection ◽  
Surgical Removal ◽  
Cardiac Tumors ◽  
Cardiac Hemangioma ◽  
Risk Of Rupture ◽  
The Right ◽  
Primary Cardiac Tumors

Cardiac hemangioma is relatively rare for primary cardiac tumors. The diagnose is mainly based on surgical resection and biopsy, imaging examinations only provide limited diagnostic clues. For those giant cardiac hemangiomas, which may raise a risk of rupture, need thoroughly surgical removal. However, meticulous follow-up is required due to its possibility of recurrence.

scholarly journals Mastoiditis and Citelli’s abscess: a case report

2021 ◽  
Vol 7 (12) ◽  
pp. 1919
Author(s):  
Amin M. A. Siddig
Keyword(s):  
Case Report ◽  
Ct Scan ◽  
Otitis Media ◽  
Surgical Intervention ◽  
Learning Difficulties ◽  
Neck Abscess ◽  
Cortical Mastoidectomy ◽  
Intracranial Complications ◽  
The Right

<p>Citelli’s abscess is a rare often undocumented complication of otitis media. This is a case of a 52-year-old lady with learning difficulties, who presented with right sided mastoid swelling. On initial consultation the patient denied any otological symptoms but after being discharged and returning with her mother it was revealed she suffered with otalgia the previous month. On her return, the mastoid swelling had increased in size and there was also a large swelling across the right side of the neck. CT scan showed mastoiditis with Citelli’s abscess. The patient underwent a cortical mastoidectomy and myringotomy as well as drainage of the neck abscess. The report emphasises the importance of a clear, concise history and urgent surgical intervention to prevent further spread of the infection and potential intracranial complications.</p>

scholarly journals Dysembryoplastic Neuroepithelial Tumor: A Rare Brain Tumor with Excellent Seizure Control after Surgical Resection

2020 ◽  
Author(s):  
Rajnish Kumar Arora ◽  
Pranshu Bhargava ◽  
Poonam Arora ◽  
Prashant Joshi ◽  
Garga Basu ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Medial Temporal Lobe ◽  
Seizure Control ◽  
Intractable Epilepsy ◽  
Mass Effect ◽  
Sudden Onset ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Focal Neurological Deficit ◽  
Fluid Attenuated Inversion Recovery ◽  
The Right

Abstract Introduction Dysembryoplastic neuroepithelial tumor (DNET) is a rare cause of intractable epilepsy, which has excellent results in terms of seizure control after surgical resection. We present one such case, because of its rarity, to highlight the effect of tumor removal on seizure control, particularly DNET. Materials and Methods/Case Summary A 9-year-old male patient presented with sudden onset of partial seizures for the past 6 months. There were five episodes. In each episode, the patient engaged in irrelevant talk, followed by deviation of mouth to left and twitching movements. The episode lasted 5 minutes and there was no loss of consciousness. There was no aura or tongue bite, and in one of the episodes, the patient lost consciousness. There was no other significant positive history. On examination, the child was consciously alert, without focal neurological deficit or features of meningitis. There was no papilledema. The patient was on phenytoin sodium, phenobarbitone and clobazam. Magnetic resonance imaging (MRI) of brain was done with and without contrast. MRI revealed a lesion approximately 4.1 × 3.6 × 3.2 cm in the right medial temporal lobe. It was hypointense to brain on T1 and fluid-attenuated inversion recovery (FLAIR), and hyperintense on T2-weighted images. Diffusion restriction was present and there was minimal contrast uptake. There was no evidence of mass effect or midline shift After discussing the risks and benefits with parents, the patient underwent preanesthetic checkup, and was taken up for craniotomy and excision of tumor. Gross total excision was done. The child was started orally on day 1 postoperatively and ambulated. There were no further seizure episodes. The patient was continued on phenytoin and clobazam, and phenobarbitone was tapered gradually. At 6 months, the child was seizure-free. Conclusions DNET are rare tumors occurring early in life and presenting with intractable seizures. Surgical resection offers a good and safe chance for long-term seizure control.

scholarly journals CD8 encephalitis in an HIVinfected patient undergoing regular antiretroviral therapy: a case report

2021 ◽  
Author(s):  
Saul Didmar Alquez Montano ◽  
José Marcos Vieira de Albuquerque Filho
Keyword(s):  
Case Report ◽  
Antiretroviral Therapy ◽  
Oral Prednisone ◽  
Undetectable Viral Load ◽  
Mass Effect ◽  
Pulse Therapy ◽  
Clonic Seizure ◽  
Mononuclear Phagocytes ◽  
Large Area ◽  
The Right

CD8 + encephalitis, and a destructive complication of HIV, that produces severe brain damage, described in patients regularly using antiretroviral therapy. It arises by viral propagation in mononuclear phagocytes leads to persistent activation of CD8 + lymphocytes. It produces demyelinating lesions, brain infiltration by CD8 + lymphocytes, and vessel hyalinization. Magnetic resonance imaging is characterized by a large area of demyelination with a mass effect and enhancement of the ring in the image. In spite of being a potentially fatal picture, it has treatment. Case report: female patient, 43 years old, with decreased strength in MSD. HIV + for 14 years on regular use of ART (Atazanavir, Tenofovir + Lamivudine and Ritonavir), CD4 +> 400 and undetectable viral load for 3 years, Alcoholist (1-2 cans beer / day). It evolved rapidly with weakness of the right hemibody, tonic-clonic seizure, inattention, and decreased level of consciousness. Liquor- cells 21 (lymphomonocyte), analysis for viruses, bacteria, mycobacteria, and negative fungus. SARS-CoV-2 detection, Blood cultures: HTLV-I and II Antibodies screening, Serology for B and C viruses - negative. WBC: 11,600 lymphocytes 27.9%. Treated with pulse therapy with 1g for 5 days. He evolved with an improvement in the level of attention, managing to walk again without help, and remission of seizures. Discharged from hospital with oral prednisone Conclusions: CD8 + encephalitis is associated with HIV despite satisfactory control rates. With an exacerbated brain immune response, there is bilateral hypersignal in the FLAIR, punctiform or linear foci of perivascular enhancements are very suggestive. At the beginning it can manifest itself as acute or subacute neurological decline, the response to corticosteroids is dramatic.

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