Tuberculoma of the Conus Medullaris: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 651-653 ◽  
Author(s):  
Kudret Türeyen
Keyword(s):  
Histopathological Examination ◽  
Inflammatory Cells ◽  
Mass Effect ◽  
Giant Cells ◽  
Conus Medullaris ◽  
Antituberculosis Therapy ◽  
Patient Reported ◽  
History Of ◽  
Leg Weakness ◽  
Muscle Groups

Abstract OBJECTIVE AND IMPORTANCE: Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. This article describes an affected patient who presented with left leg paresis. CLINICAL PRESENTATION: A 46-year-old man presented with a 7-day history of left leg weakness. The patient's medical history included infection with pulmonary tuberculosis 15 years previously, at which time he had been treated with antituberculosis therapy. The neurological examination performed at admission revealed left leg paresis with Grade 2/5 power in all muscle groups. The patient reported no urinary or bowel problems. INTERVENTION: Surgery was performed with the patient in the prone position. The procedure involved laminectomies at T11, T12, and L1, followed by a midline myelotomy. The mass was excised completely. Histopathological examination revealed a granulomatous lesion that contained Langhans' giant cells, inflammatory cells, and evidence of caseating necrosis. The patient was prescribed a 6-month course of antituberculosis therapy with pyrazinamide, isoniazid, and rifampin. CONCLUSION: The outcome was favorable. Recently, a number of authors have reported success with medical management of intraspinal tuberculoma. Intraspinal tuberculoma produces a mass effect that can jeopardize spinal cord function. The optimal treatment is a combination of microsurgical resection and antituberculosis chemotherapy.

Multiple hemangiomas (hemangiomatosis) of the cauda equina and spinal cord

2000 ◽  
Vol 92 (2) ◽  
pp. 229-232 ◽  
Author(s):  
Federico Roncaroli ◽  
Bernd W. Scheithauer ◽  
H. Gordon Deen
Keyword(s):  
Spinal Cord ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Unique Case ◽  
Nerve Roots ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal ◽  
History Of ◽  
Leg Weakness

✓ A case of multiple hemangiomas of the cauda equina nerve roots, conus medullaris, and lower spinal cord is described. The 74-year-old male patient presented with a 9-month history of progressive bilateral leg weakness. He had a history of lymphoma at the age of 39 years and renal cell carcinoma in his early 40s. Neither disease was evident at the time of this presentation. A magnetic resonance image revealed multiple enhancing nodules in the cauda equina region as well as on the pial surface of the lower thoracic spinal cord and conus medullaris. The patient underwent an L2–3 laminectomy. Cauda equina nerve roots were found to be studded with numerous purple nodules, the largest measuring 6 to 8 mm. The nodules were adherent to nerve roots from which they could not be resected. Two lesions were histologically examined and found to be capillary hemangiomas. Twelve months into an uneventful postoperative course, the patient is neurologically unchanged. This unique case might represent a distinct form of hemangiomatosis confined to the cauda equina nerve roots and spinal cord.

scholarly journals Painless Multidermatomal Herpes Zoster in an Immunocompetent Elderly Male: a Case Report

2015 ◽  
Vol 7 (4) ◽  
pp. 172-180 ◽  
Author(s):  
Shikhar Ganjoo ◽  
Mohinder Pal Singh Sawhney ◽  
Dikshak Chawla
Keyword(s):  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Ganglion Cells ◽  
Giant Cells ◽  
Elderly Male ◽  
Left Groin ◽  
Varicella Zoster ◽  
Patient Reported ◽  
History Of ◽  
Serology Test

Abstract The varicella-zoster virus is the cause of both varicella and herpes zoster. The primary infection of varicella includes viremia and a widespread eruption, after which the virus persists in nerve ganglion cells, usually sensory. Herpes zoster is the result of reactivation of this residual latent virus. The first manifestation of zoster is usually pain, which may be severe and accompanied by fever, headache, malaise and tenderness localized to one or more nerve roots. The lymph nodes draining the affected area are enlarged and tender. Occasionally, the pain is not followed by eruption (zoster sine herpete). We hereby report an 85-year-old otherwise healthy male patient with a 3-day history of a non-painful rash on the left side of abdomen, pubic and penile regions, left groin and the left leg. He denied any pain and/or abnormal sensations before the rash onset. On examination, there were closely grouped multiple vesicles over the anterior left abdominal wall, left groin, thigh, knee and left upper quarter of penis, involving the left T12, L1-L4 and S2 dermatomes. The patient reported no pain, fever, rigor or any other symptoms; he had no associated cervical, axillary or inguinal lymphadenopathy. He denied any abdominal pain, nausea, vomiting, any weakness or sensory changes in the limbs. There was no history of penile numbness, urinary retention, and increased frequency of micturition or constipation. The varicella-zoster virus serology test performed by Calbiotech VZV IgG ELISA Kit (Calbiotech, Spring Valley, Canada) was strongly positive. The human immunodeficiency virus serology test, as well as herpes simplex virus type 1 and type 2 serology tests performed by ELISA were all negative. The Tzanck smear, stained with Giemsa, demonstrated multinucleated giant cells. The patient responded well to valacyclovir with complete clearance of lesions within one week. An extensive PubMed search revealed only few reports of painless herpes zoster. We present a rather peculiar case of painless herpes zoster in an elderly patient with no apparent systemic immunosuppression, with severe involvement affecting multiple adjacent and one remote dermatome. We hereby propose the term ”herpes zoster sine algesia” in cases where eruption is not followed by pain.

Thoracolumbar spine subdural hematoma as a result of nonaccidental trauma in a 4-month-old infant

2008 ◽  
Vol 2 (2) ◽  
pp. 139-142 ◽  
Author(s):  
Thomas J. Gruber ◽  
Curtis J. Rozzelle
Keyword(s):  
Subdural Hematoma ◽  
Emergency Services ◽  
Pediatric Trauma ◽  
Thoracolumbar Spine ◽  
Male Infant ◽  
Mass Effect ◽  
Respiratory Arrest ◽  
Conus Medullaris ◽  
Nonaccidental Trauma ◽  
History Of

The authors describe the previously unreported occurrence of thoracolumbar subdural hematoma (SDH) resulting from nonaccidental trauma and emphasize the need for a complete and thorough neurological, physical, and radiological examination in all cases of suspected nonaccidental trauma. A 4-month-old male infant presented to the authors' Level 1 pediatric trauma center in respiratory arrest. According to the family, he had been previously healthy with a 1-day history of fussiness and irritability. While with one of the parents, the patient was noted to be apneic and had been shaken in 2 separate episodes in an attempt to stimulate respiration. Emergency services personnel intubated the child's trachea and transported him to the hospital. On arrival in the emergency department, the child was unresponsive and exhibited signs of myelopathy. A CT scan of his head demonstrated SDH and subarachnoid hemorrhage. Magnetic resonance imaging of the spine demonstrated an SDH dorsal to the spinal cord with some mass effect on the conus medullaris and descending nerve roots. The patient underwent emergency T-12 to L-3 laminotomies, evacuation of the hematoma, and laminoplasty. The rigid nature of the rib cage provides a point of fixation around which the thoracolumbar spine can hyperflex and hyperextend when shaken, resulting in severe injury to the bony, vascular, and neural elements of the spine.

scholarly journals Extra-synovial Pigmented Villonodular Synovitis of the knee joint, Case Repor

2021 ◽  
pp. 192
Author(s):  
Keyword(s):  
Histopathological Examination ◽  
Giant Cells ◽  
Pigmented Villonodular Synovitis ◽  
Villonodular Synovitis ◽  
Biopsy Result ◽  
Posterior Aspect ◽  
Case Presentation ◽  
History Of ◽  
Full Flexion ◽  
Pigmented Villonodular

Background: PVNS is a rare, benign & aggressive disorder arising from either synovial joints or tendon sheaths; it may erode articular structures and bones. We present a case with unique features of PVNS being extra-synovial and by this report we open a gate for more researches in this field. Case Presentation: This case report concerns a 35-year-old female with a history of right knee pain for 6-month duration proceeded by gradual swelling over posterior aspect of the knee, she denies any history of trauma, clinical examination was unremarkable but apart from tenderness over the infrapatellar region with full flexion. MRI shows a heterogenous signal extra-articular and extra-synovial lesion in posterior aspect of the knee suggesting Pigmented Villonodular Synovitis, FNA revealed a hemosiderin-laden macrophages and multinucleated giant cells, Tru-cut biopsy result was suggesting PVNS as synovial cells were seen admixed with hemosiderin-laden macrophages with fibroblastic elements. Through posterior approach; the lesion was surgically excised and histopathological examination confirmed the diagnosis, the lesion was recurrent after 1-year and MRI revealed the same features, the lesion was excised by arthroscopic intervention. Conclusion: We concluded that PVNS cannot be excluded when extra-synovial lesion is assessed, and further researches on this topic will expand our understanding of the etiological and pathological aspects of this tumor.

scholarly journals Ameloblastic Transformation of a Primarily Diagnosed Dentigerous Cyst of Jaw- A Rare Case Report

2021 ◽  
pp. 90-94
Author(s):  
Bose Surajit ◽  
Bhakta Ipsita ◽  
Karar Chandan Kumar ◽  
Singh Dharvind Kumar ◽  
Banerjee Abhishek
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Histopathological Examination ◽  
Dentigerous Cyst ◽  
Facial Asymmetry ◽  
Biological Behavior ◽  
Unerupted Tooth ◽  
Patient Reported ◽  
Rare Case Report ◽  
History Of

The separation of the follicle from around the crown of an unerupted tooth causes formation of dentigerous cyst. It may undergo metaplasia in several cases. In this case a 30 year old female patient reported with a history of dentigerous cyst with respect to impacted 48. The swelling started growing gradually causing facial asymmetry. On intraoral examination the swelling seem to extend from 48 to 46 region and cortical plates were expanded. The histopathological examination revealed the sample to be cystic ameloblastoma (mural variety). This paper sends a message that the potential of a cyst should never be understated, instead it must be kept in an observation or understanding the biological behavior over a course of time.

scholarly journals A Rare Case of Lateral Canthal Gouty Tophus Presenting as an Eyelid Mass

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Austin S. Nakatsuka ◽  
Timothy F. McDevitt ◽  
Pamela S. Tauchi-Nishi
Keyword(s):  
Clinical Examination ◽  
Rare Case ◽  
Histopathological Examination ◽  
Giant Cells ◽  
Crystalline Material ◽  
Multinucleated Giant Cells ◽  
Lateral Canthus ◽  
History Of ◽  
Gouty Tophus

A 41-year-old man with a history of gout presented with an enlarging eyelid growth. Clinical examination revealed a mildly indurated nodule at the lateral canthus. Following resection, histopathological examination revealed needle-shaped, crystalline material surrounded by multinucleated giant cells, findings consistent with gouty tophus. This represents just the sixth case of gouty tophus of the eyelid reported in the literature.

scholarly journals Sudden Infant Death Due to Postvaccinal Myocarditis: A Case Report

2021 ◽  
Vol 11 (3) ◽  
pp. 32227-32227
Author(s):  
Babak Salahshour ◽  
◽  
Sajjad Sadeghi ◽  
Ahmad Sajadianfar ◽  
Kambiz Soltaninejad ◽  
...  
Keyword(s):  
Infant Death ◽  
Causality Assessment ◽  
Histopathological Examination ◽  
Cardiopulmonary Arrest ◽  
Inflammatory Cells ◽  
Sudden Infant Death ◽  
Cardiac Monitoring ◽  
Sudden Infant ◽  
Case Presentation ◽  
History Of

Background: Vaccination is a fundamental strategy in public health for controlling and eradicating infectious diseases. However, the undesirable Adverse Events Following Immunization (AEFI) should be effectively monitored, prevented, and managed in societies. Previously, Sudden Infant Death (SID) has been reported as a serious AEFI. We present a rare case of SID in an 18-month-old girl due to severe myocarditis following vaccination. Case Presentation: An 18-month-old girl presented to the Emergency Department (ED) with a history of the injection of Diphtheria-Tetanus-Whole Cell Pertussis (DTwP); Measles, Mumps, and Rubella (MMR), and oral poliovirus vaccines. She expired one-hour post ED admission after the episodes of vomiting and cardiopulmonary arrest. Postmortem histopathological examination signified marked congestion and the destruction of muscle fibers in the myocardium with inflammatory cells infiltration predominantly eosinophils. Given the postmortem histopathological findings, the cause of death was concluded as severe myocarditis following vaccination. Finally, the causality assessment was performed according to the Naranjo scale; the relevant data revealed a probable association in this regard (Naranjo score 6). Conclusion: Myocarditis is a rare and probable AEFI; thus, cardiac monitoring should be recommended as a diagnostic measure in managing postvaccinal adverse effects.

scholarly journals MON-LB49 Atypical Presentation for a 5.5-cm Macroprolactinoma: Unilateral Visual Loss and Only Partial Hypopituitarism; Asymptomatic Hypogonadism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
panadeekarn panjawatanan ◽  
Vijaykumar Sekar ◽  
Joseph Hughes
Keyword(s):  
Family History ◽  
Optic Nerve ◽  
Visual Field ◽  
Prolactin Level ◽  
Mass Effect ◽  
Optic Nerve Atrophy ◽  
Suprasellar Region ◽  
Patient Reported ◽  
History Of ◽  
Bitemporal Hemianopia

Abstract Background: Macroprolactinoma is an uncommon pituitary tumor which presents mainly in males. The usual presentation is headache, bitemporal hemianopia, and signs/symptoms of hypogonadism. Ours is a case report of 5.5 –cm macroprolactinoma presented with unilateral optic nerve atrophy and asymptomatic hypogonadism. Clinical case: A 50-year-old male with past medical history of type 2 diabetes mellitus and essential hypertension presented with progressive blurred vision of the left eye for 6 months. He was able to perceive color but had difficulty reading. There was occasional headache with left periorbital pain. He was seen by an optometrist and was found to have left optic disc atrophy with suspicion of glaucoma. Subsequent visual field test showed entire left and right superior temporal loss. MRI of the pituitary showed 5.5 x 5.6 x 5.3 cm enhancing mass centered in the sellar/suprasellar region. There was significant mass effect with compression of the optic chiasm, temporal lobe and brainstem. The patient reported mood changes, normal libido, but loss of morning erection. He has family history of pituitary macroadenoma with left optic nerve compression. On physical examination, there were left visual field defect and decreased visual acuity. There were no signs of Cushing’s syndrome, hypothyroidism, acromegaly, or hypogonadism. Laboratory tests showed prolactin of >200 ng/ml and 16,610 ng/ml after dilution (male <13), total testosterone 92 ng/dl (240-950) and free testosterone 1.20 mg/dl (4.26-16.40). Surprisingly, other pituitary hormones were normal: AM cortisol 20.3 µg/dl (6-27), GH 0.24 ng/ml (0.01-0.97), IGF-1 58 ng/ml (40-259), FSH 4 IU/l (1-18), LH 3 IU/l (1.3-9.6), TSH 1.38 µIU/ml (0.34-3), and free T4 0.8 ng/dl (0.6-1.6). The patient underwent surgery with partial resection. Pathology revealed lactotroph adenoma. Postoperative prolactin level was 11,900 ng/ml. Medical treatment with cabergoline 0.25 mg twice weekly has been started. Conclusion: Even though profoundly hypogonadal by labs, the presentation for this 5.5-cm prolactinoma was acute vision loss. The highly elevated prolactin level correlates with the size of macroadenoma. The typical presentation of local mass effect is bitemporal hemianopia, but in our case the patient presented with unilateral optic nerve atrophy. Despite a 5.5-cm lesion, there is partial hypopituitarism; hypogonadism. Based on the size, one would have expected panhypopituitarism. Given a family history of macroadenoma, there might be genetic predisposition. Molecular testing is planned.

Tubular intranuclear inclusions in a patient with methotrexate-associated pulmonary fibrosis

1983 ◽  
Vol 41 ◽  
pp. 796-797
Author(s):  
W.T. Gunning ◽  
P.J. Goldblatt
Keyword(s):  
Interstitial Fibrosis ◽  
Inflammatory Cells ◽  
Giant Cells ◽  
Skin Condition ◽  
Intermittent Fever ◽  
Electron Microscopic ◽  
Type Ii Pneumocytes ◽  
Microscopic Evaluation ◽  
Microscopic Studies ◽  
History Of

A forty-six year old male, who had received methotrexate therapy for the past year for psoriasis of twenty years' duration, presented with a cough which had persisted for two to three months. There was a two year history of dyspnea upon exertion as well as intermittent fever, chills and sweats. The methotrexate treatment did not improve the skin condition and, because there was evidence of hepatic toxicity, the drug was discontinued. Radiological examination of the chest revealed diffuse bilateral interstitial fibrosis with extensive changes; a subseguent lung biopsy was obtained. Light microscopic evaluation demonstrated marked interstitial fibrosis, chronic inflammation, thickening of the alveolar septa, proliferation of alveolar macrophages, occasional fibrin deposits and multinucleated giant cells.Electron microscopic studies revealed massive fibrosis with a mixed population of infiltrating inflammatory cells. Some alveolar spaces were lined by metaplastic cuboidal epithelial cells, and in numerous residual type II pneumocytes, aggregates of branching tubules lined by trilaminar membranes were identified within the nucleus.

scholarly journals Spinal lipomas

2001 ◽  
Vol 10 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Jeffrey P. Blount ◽  
Scott Elton
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Mass Effect ◽  
Conus Medullaris ◽  
Neurological Deterioration ◽  
Bladder Control ◽  
History Of ◽  
Compressive Myelopathy

Lipomas of the spinal cord are among the most fascinating lesions encountered by the pediatric neurosurgeon. An understanding of spinal lipomas may, however, be difficult because the terminology used to describe the accumulations of spinal fat is confusing, inconsistently applied, and at times contradictory. An anatomical characterization of lipomas may assist in understanding these lesions. Lipomas of the spinal cord are very rare and cause symptoms related to mass effect and secondary compressive myelopathy. Lipomas of the conus medullaris (or lipomyelomeningocele) are the most common form of fatty masses in the spine and can be divided into dorsal, caudal, and transitional forms. These lesions are a manifestation of occult spinal dysraphism and a common cause of the tethered cord syndrome (TCS). The natural history of untreated lipomyelomeningocele, although incompletely understood, appears to be progressive neurological deterioration with loss of bladder control. Timely, careful surgical intervention may prevent significant neurological deterioration and progressive disability in the majority of children harboring these lesions. In surgical intervention the surgeon seeks to disrupt the connection between the fibrofatty mass and underlying cord as well as to reestablish normal anatomical planes. Several intraoperative video segments illustrating lipomyelome-ningocele resection are included in this paper. Lipomas of the terminal filum (fatty filum) are truly occult and are also associated with TCS. Surgical treatment of filum lipomas carries significantly lower risk than that for lipomas of the conus medullaris. Again, the goal of surgery is to disrupt the connection between the abnormal fibrofatty tissue and the underlying spinal cord.

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