Intracranial Tumor

2018 ◽  
Author(s):  
Rebecca S. Isserman ◽  
Justin L. Lockman
Keyword(s):  
Postoperative Complications ◽  
Intracranial Hypertension ◽  
Posterior Fossa ◽  
Hemodynamic Instability ◽  
Cerebrospinal Fluid Flow ◽  
Solid Malignancy ◽  
Presenting Symptoms ◽  
Cranial Nerve Palsies ◽  
Complications Of Surgery ◽  
Symptoms And Signs

Intracranial tumors are the most common solid malignancy in pediatrics, with the majority found in the posterior fossa. In these patients, presenting symptoms and signs are frequently related to intracranial hypertension due to obstruction of cerebrospinal fluid flow. Specific cranial nerve palsies and ataxia may also be presenting signs, with or without intracranial hypertension. The anesthesia for surgical resection is nuanced by management of intracranial hypertension, the potential for hemodynamic instability, and postoperative complications resulting from damage to critical brainstem structures. This chapter discusses signs, symptoms, and differential diagnosis; tumor classification; anesthetic induction; and intraoperative and postoperative complications of surgery for a posterior fossa tumor.

Syringobulbia in a Pediatric Population

Neurosurgery ◽  
2005 ◽  
Vol 57 (6) ◽  
pp. 1147-1153 ◽  
Author(s):  
Jeremy D.W. Greenlee ◽  
Arnold H. Menezes ◽  
Bryan A. Bertoglio ◽  
Kathleen A. Donovan
Keyword(s):  
Posterior Fossa ◽  
Cranial Nerve ◽  
Fourth Ventricle ◽  
Pediatric Population ◽  
Demographic Data ◽  
Posterior Fossa Decompression ◽  
Radiographic Findings ◽  
Presenting Symptoms ◽  
Cranial Nerve Dysfunction ◽  
Cranial Nerve Palsies

Abstract OBJECTIVE: To better understand the presentation, management, and outcome of syringobulbia in the pediatric age group. METHODS: The University of Iowa pediatric neurosurgery database was searched for patients under the age of 18 with a diagnosis of syringobulbia. The patients' records were retrospectively reviewed for demographic data, chief complaint and presenting symptoms, neurological and radiographic findings, treatment, outcome, and complications. Children with open neural tube defects and Chiari II malformations were excluded. RESULTS: Six pediatric patients were identified as meeting inclusion criteria. The average age at time of surgery was 14.8 years. The chief complaints were vision impairment in three children and numbness, gait instability, and headache worsened with Valsalva in one patient each. Other prominent symptoms included sleep apnea and weakness. All patients showed at least one cranial nerve dysfunction. Radiographs revealed hindbrain herniation and associated syringomyelia in all cases. Two patients had scoliosis. Treatment was posterior fossa decompression with cerebellar tonsillar shrinkage, opening of foramen of Magendie, and duraplasty. Two patients also required concomitant ventral decompression. The cavity of syringobulbia communicated with syringomyelia and the fourth ventricle in most children but was distinct from the fourth ventricle. Two patients received fourth ventricle to subarachnoid shunts. Follow-up averaged 3.2 years, and all patients clinically improved after surgery. Magnetic resonance imaging documented resolution of syringobulbia in all cases, with syringomyelia improving in all cases. There was no permanent morbidity or mortality in the series. CONCLUSION: Syringobulbia is strongly associated with Chiari malformation and syringomyelia, and patients often present because of cranial nerve palsies. Posterior fossa decompression is a safe and effective treatment.

scholarly journals Idiopathic intracranial hypertension with multiple cranial nerve palsies in 10 years old thin Sudanese boy: case report

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Mumen Abdalazim Dafallah ◽  
Elsanosi Habour ◽  
Esraa Ahmed Ragab ◽  
Zahraa Mamoun Shouk ◽  
Mohammed Izzadden
Keyword(s):  
Intracranial Hypertension ◽  
Cranial Nerve ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Unknown Etiology ◽  
Normal Brain ◽  
Case Presentation ◽  
Cranial Nerve Palsies ◽  
Symptoms And Signs ◽  
Ct And Mri

Abstract Background Idiopathic intracranial hypertension is a rare neurological disorder of unknown etiology. It is characterized by symptoms and signs of raise intra cranial pressure, normal brain neuroimaging, and high opening pressure ≥ 280 cm H2O in the presence of normal cerebro spinal fluid constituents. Case presentation Ten years old thin boy presented with severe throbbing headache, vomiting, and visual obscurations for a duration of 10 days. Physical examination revealed body mass index of 14.8, VI and VII cranial nerve palsies. Fudoscopy showed grade 4 papilledema; brain CT and MRI were normal. Lumbar puncture revealed pressure of 300 cm H2O with normal CSF constituents. He was treated with acetazolamide, methylprednisolone, and paracetamol. Conclusion Pediatricians need to be more aware of idiopathic intracranial hypertension as it can lead to permanent vision loss.

scholarly journals Syringobulbia in pediatric patients with Chiari malformation type I

2018 ◽  
Vol 22 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Arnold H. Menezes ◽  
Jeremy D. W. Greenlee ◽  
Brian J. Dlouhy
Keyword(s):  
Posterior Fossa ◽  
Cranial Nerve ◽  
Chiari Malformation ◽  
Fourth Ventricle ◽  
Pediatric Patients ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Presenting Symptoms ◽  
Cranial Nerve Palsies

OBJECTIVESyringobulbia (SB) is a rare entity, with few cases associated with Chiari malformation type I (CM-I) in the pediatric population. The authors reviewed all pediatric cases of CM-I–associated SB managed at their institution in order to better understand the presentation, treatment, and surgical outcomes of this condition.METHODSA prospectively maintained institutional database of craniovertebral junction abnormalities was analyzed to identify all cases of CM-I and SB from the MRI era (i.e., after 1984). The authors recorded presenting symptoms, physical examination findings, radiological findings, surgical treatment strategy, intraoperative findings, and outcomes. SB cases associated with tumors, infections, or type II Chiari malformations were excluded.RESULTSThe authors identified 326 pediatric patients with CM-I who were surgically treated. SB was identified in 13 (4%) of these 326 patients. Headache and neck pain were noted in all 13 cases. Cranial nerve abnormalities were common: vagus and glossopharyngeal nerve dysfunction was the most frequent observation. Other cranial nerves affected included the trigeminal, abducens, and hypoglossal nerves. Several patients exhibited multiple cranial nerve palsies at presentation. Central sleep apnea was present in 6 patients.Syringomyelia (SM) was present in all 13 patients. SB involved the medulla in all cases, and extended rostrally into the pons and midbrain in 2 patients; in 1 of these 2 cases the cavity extended further rostrally to the cerebrum (syringocephaly). SB communicated with the fourth ventricle in 7 of the 13 cases.All 13 patients were treated with posterior fossa decompression with intradural exploration to ensure CSF egress out of the fourth ventricle and through the foramen magnum. The foramen of Magendie was found to be occluded by an arachnoid veil in 9 cases. Follow-up evaluation revealed that SB improved before SM. Cranial nerve palsies regressed in 11 of the 13 patients, and SB improved in all 13.CONCLUSIONSThe incidence of SB in our surgical series of pediatric patients with CM-I was 4%, and all of these patients had accompanying SM. The SB cavity involved the medulla in all cases and was found to communicate with the fourth ventricle in 54% of cases. Posterior fossa decompression with intradural exploration and duraplasty is an effective treatment for these patients.

scholarly journals Surgical treatment of Chiari I malformation: indications and approaches

2001 ◽  
Vol 11 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Tord D. Alden ◽  
Jeffrey G. Ojemann ◽  
T. S. Park
Keyword(s):  
Posterior Fossa ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Cerebrospinal Fluid Flow ◽  
Hindbrain Herniation ◽  
Chiari I ◽  
Symptoms And Signs ◽  
Exact Origin

Chiari I malformation is a well-described entity characterized by hindbrain herniation through the foramen magnum. Although the exact origin of congenital Chiari I malformation is unknown, it appears to be caused by a mismatch between the volume of the posterior fossa neural elements and the posterior fossa cranial content. Several theories have been proposed to describe the resultant pathophysiology of this mismatch. It is clear, however, that abnormal cerebrospinal fluid flow and velocity play a role in the symptoms and signs associated with this disorder. The authors will review the pathophysiology, clinical presentation, and treatment options for patients with Chiari I malformation.

scholarly journals Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (3) ◽  
pp. 382
Author(s):  
Dinesh Ramanathan ◽  
Zachary D. Travis ◽  
Emmanuel Omosor ◽  
Taylor Wilson ◽  
Nikhil Sahasrabudhe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Subdural Hygroma ◽  
Presenting Symptoms ◽  
Minimal Improvement ◽  
Sinus Stenosis ◽  
Work Up

We describe a case of severe headaches, double vision, and progressive vision loss secondary to a ruptured intracranial cyst (IAC) in a 31-year-old woman with no relevant past medical history. The case is peculiar because drainage of the subdural hygroma led to a minimal improvement in vision with persistent elevated intracranial pressure (ICP). Further exploration revealed transverse sinus stenosis necessitating stenting. Evaluation post-stenting showed marked reduction of ICP and improvement in symptoms. This report underscores the importance of comprehensive work-up and suspicion of multiple underlying etiologies that may be crucial to complete resolution of presenting symptoms in some cases. We provide an overview of the clinical indications and evidence for venous sinus stenting in treating idiopathic intracranial hypertension (IIH).

scholarly journals Posterior Fossa Arachnoid Cyst Masking a Delayed Diagnosis of Hyperparathyroidism in a Child

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
B. Dhamija ◽  
D. Kombogiorgas ◽  
I. Hussain ◽  
G. A. Solanki
Keyword(s):  
Differential Diagnosis ◽  
Primary Hyperparathyroidism ◽  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Hospital Admissions ◽  
Delayed Diagnosis ◽  
Visual Disturbance ◽  
Organ Damage ◽  
Presenting Symptoms ◽  
History Of

Background. Primary hyperparathyroidism in childhood is a very rare entity, often being diagnosed late after the onset of its presenting symptoms. It most commonly affects patients in their fourth decade of life and beyond. The inclusion of primary hyperparathyroidism in the differential diagnosis is necessary when evaluating patients presenting with nonspecific symptoms such as polyuria, fatigue, weight loss, abdominal pain, nausea, and vomiting.Methods. We report the case of an eleven-year-old girl presenting with three years history of headaches, visual disturbance, along with episodes of emotional lability. Neuroimaging confirmed a large posterior fossa arachnoid cyst. It was decided to manage this lesion conservatively with surveillance. Only after further hospital admissions with recurrent loss of consciousness, dizziness, and nausea to add to her already existing symptoms, a full biochemical and endocrine assessment was performed to look for more specific causes for her presentation. These pointed to a diagnosis of primary hyperparathyroidism.Conclusions. The inclusion of primary hyperparathyroidism in the differential diagnosis should be considered when evaluating paediatric patients presenting with nonspecific (neurological, gastrointestinal, and renal) symptoms in order to establish a prompt diagnosis of the disorder and to avoid severe complications of prolonged hypercalcaemia and end-organ damage.

scholarly journals Evaluation of transvaginal ultrasound role in the prediction of adenomyosis: correlation with histopathology

2021 ◽  
Vol 10 (8) ◽  
pp. 2987
Author(s):  
Naglaa Ali M. Hussein ◽  
Mohammed H. El Rafaey
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
True Positive ◽  
Women Of Reproductive Age ◽  
Presenting Symptoms ◽  
Us Findings ◽  
Histopathological Results ◽  
Symptoms And Signs

Background: Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.Methods: All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients.Results: Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity.Conclusions: Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus.

Clinical features of osteoarthritis

2013 ◽  
pp. 1174-1186 ◽  
Author(s):  
Abhishek Abhishek ◽  
Michael Doherty
Keyword(s):  
Poor Correlation ◽  
Range Of Movement ◽  
Crystal Deposition ◽  
Knee Oa ◽  
Presenting Symptoms ◽  
Carpometacarpal Joints ◽  
The Common ◽  
Joint Line Tenderness ◽  
Radiographic Changes ◽  
Symptoms And Signs

Osteoarthritis (OA), the commonest arthropathy, targets specific joints e.g. the knees, hips, interphalangeal joints, and first carpometacarpal joints. Most patients develop symptoms in their middle or older age. Usage-related (’mechanical’) joint pain, short-lived morning stiffness, and locomotor restriction are the common presenting symptoms. Pain at extremes of movement and joint line tenderness may be present in early disease. Crepitus, bony enlargement, and reduced range of movement suggest more severe OA. Advanced OA is characterized by rest pain, night pain, muscle wasting, and deformity. Notably, symptoms and signs of inflammation are absent or only modest, although mild-moderate effusions are not uncommon at the knee. OA may be diagnosed on clinical grounds alone in the at-risk age group, in the presence of typical symptoms and signs. Radiographic changes of OA are commonly asymptomatic. In general there is poor correlation between symptoms, signs, radiographic changes, and disability in OA, and due care should be used to differentiate the ’disease OA’ from the ’illness OA’. More inflammatory symptoms and signs suggest coexistence of calcium crystal deposition. Evaluation of people with OA should include targeted assessment for treatable comorbidities such as depression and obesity that compound disability from OA.

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