scholarly journals CT-guided drainage of a brainstem abscess in a cat as an emergency treatment procedure

2020 ◽  
Vol 6 (1) ◽  
pp. 205511691989611
Author(s):  
Erika Bersan ◽  
Thomas Maddox ◽  
Gemma Walmsley ◽  
Martina Piviani ◽  
Rachel Burrow
Keyword(s):  
Medical Treatment ◽  
Emergency Treatment ◽  
Mass Effect ◽  
Foramen Magnum ◽  
Ct Guided ◽  
Brainstem Lesion ◽  
Decerebrate Rigidity ◽  
Significant Clinical Improvement ◽  
Intracranial Lesions ◽  
The Brain

Case summary A 3-year-old male neutered domestic shorthair cat was presented with a 1-week progressive and rapidly deteriorating history of lethargy and abnormal behaviour. Neurolocalisation indicated multifocal intracranial lesions (right oculomotor nerve, brainstem [obtundation, non-ambulatory tetraparesis, vestibular dysfunction and intermittent decerebrate rigidity] and possibly the thalamus [left-sided pleurothotonus]), or more likely a single brainstem lesion with mass effect. MRI of the brain demonstrated a brainstem abscess causing severe dorsal displacement particularly affecting the pons and the medulla oblongata causing cerebellar vermis herniation through the foramen magnum. CT-guided free-hand technique drainage of the brain abscess was performed and broad spectrum antibiotics were started based on sensitivity results. The cat recovered uneventfully from anaesthesia displaying marked improvement immediately after the procedure. Antibiotics were continued for 8 months; repeat imaging prior to withdrawal found complete resolution of the brainstem abscess. Relevance and novel information Free-hand CT-guided drainage of a brainstem abscess is not without risk; however, in this case it led to significant clinical improvement and stabilisation likely owing to reduced intracranial pressure. It also provided a diagnostic sample that allowed successful medical treatment planning and outcome. To our knowledge, this is the first report describing the successful management of a brainstem abscess by CT-guided drainage in the veterinary literature. It suggests that stereotactic drainage followed by medical therapy can be considered a successful therapeutic alternative to brain surgery or medical treatment alone, providing an emergency treatment in cases of acute brainstem dysfunction.

Comparison of CT-guided and stereotaxic cranial diagnostic needle biopsies

1987 ◽  
Vol 67 (3) ◽  
pp. 341-348 ◽  
Author(s):  
Simon Goldstein ◽  
Mary Katherine Gumerlock ◽  
Edward A. Neuwelt
Keyword(s):  
Diagnostic Yield ◽  
Diagnostic Technique ◽  
Specific Procedure ◽  
Ct Guided ◽  
Content Type ◽  
Significant Difference ◽  
Intracranial Lesions ◽  
Scan Data ◽  
Time Required ◽  
The Brain

Needle biopsy of the brain utilizing computerized tomography (CT) scan data is an accepted diagnostic technique that has been performed both with and without the aid of stereotaxic frames. Experience with both techniques has resulted in a specific procedure for CT-guided free-hand biopsy which is performed in the CT suite under local anesthesia. Over the last 6 years the authors have performed 64 CT-guided free-hand biopsies and 13 stereotaxic biopsies with the Brown-Roberts-Wells system. Nonspecific gliosis, tumor, infection, radiation necrosis, or vascular malformation, were diagnosed in all but one biopsy, for a clinically accurate diagnostic yield of 92%. A comparison of diagnostic yield, morbidity, and mortality has shown no significant difference between the free-hand and the stereotaxic techniques. The time required for the procedures and their cost have been compared and have been found to be significantly less for the free-hand biopsy group. Thus, CT-guided free-hand biopsy may still represent the method of choice for histological diagnosis of many intracranial lesions.

scholarly journals Endoscopic Assistance in the Deep and Narrow Spaces of the Brain—Microscopic Tumor Surgery Supported by the New Micro-Inspection Tool QEVO® (Technical Note)

2021 ◽  
Vol 8 ◽  
Author(s):  
Karl-Michael Schebesch ◽  
Christian Doenitz ◽  
Julius Höhne ◽  
Amer Haj ◽  
Nils Ole Schmidt
Keyword(s):  
Time Frame ◽  
Foramen Magnum ◽  
Technical Note ◽  
Intracranial Lesions ◽  
Endoscopic Assistance ◽  
Surgical Field ◽  
Rhomboid Fossa ◽  
The Brain ◽  
Anatomical Area ◽  
Endoscopic Device

Introduction: To evaluate the feasibility and efficacy of the innovative micro-inspection tool QEVO® (Carl Zeiss Meditec, Oberkochen, Germany) as an endoscopic adjunct to microscopes for better visualization of the surgical field in complex deep-seated intracranial tumors in infants and adults.Materials and Methods: We retrospectively assessed the surgical videos of 25 consecutive patients with 26 complex intracranial lesions (time frame 2018–2020). Lesions were classified according to their anatomical area: 1 = sellar region (n = 6), 2 = intra-ventricular (except IV.ventricle, n = 9), 3 = IV.ventricle and rhomboid fossa (n = 4), and 4 = cerebellopontine angle (CPA) and foramen magnum (n = 7). Indications to use the QEVO® tool were divided into five “QEVO® categories”: A = target localization, B = tailoring of the approach, C = looking beyond the lesion, D = resection control, and E = inspection of remote areas.Results: Overall, the most frequent indications for using the QEVO® tool were categories D (n = 19), C (n = 17), and E (n = 16). QEVO® categories B (n = 8) and A (n = 5) were mainly applied to intra-ventricular procedures (anatomical area 2).Discussion: The new micro-inspection tool QEVO® is a powerful endoscopic device to support the comprehensive visualization of complex intracranial lesions and thus instantly increases intraoperative morphological understanding. However, its use is restricted to the specific properties of the respective anatomical area.

scholarly journals Hemispheric strokes: clinical or surgical management? Intracranial pressure monitoring of a case and review of the literature

1995 ◽  
Vol 53 (4) ◽  
pp. 821-824
Author(s):  
Gustavo Adolpho Carvalho ◽  
Adolpho Carvalho Filho
Keyword(s):  
Intracranial Pressure ◽  
Medical Treatment ◽  
Intracranial Hypertension ◽  
Surgical Management ◽  
Mass Effect ◽  
Review Of The Literature ◽  
Pressure Monitoring ◽  
Pressure Monitor ◽  
Ischemic Infarction ◽  
The Brain

The authors report a case of a right hemispheric ischemic infarction on a 77-year-old patient that was monitored with an extradural intracranial pressure monitor (Ladd device).We show the huge intracranial hypertension that the brain was submitted despite of the medical treatment. The treatment of hemispheric strokes can be very challenging. The usual antiedema drugs very often prove to be of no help against the mass effect and the high intracranial pressure that some patients present. More recently reports on the literature are showing good results following a decompressive surgery on such ischemic infarcts.

Influence of Foramen Magnum Boundary Condition on Intracranial Dynamic Response Under Forehead Impact Using Human Body Finite Element Model

2019 ◽  
Vol 17 (07) ◽  
pp. 1950029 ◽  
Author(s):  
Lihai Ren ◽  
Dangdang Wang ◽  
Chengyue Jiang ◽  
Yuanzhi Hu
Keyword(s):  
Boundary Condition ◽  
Finite Element ◽  
Brain Stem ◽  
Axonal Injury ◽  
Human Head ◽  
Foramen Magnum ◽  
Dynamic Responses ◽  
Human Model ◽  
Modeling Methods ◽  
The Brain

The biofidelity is an essential requirement of the application of human head finite element (FE) models to investigate head injuries under mechanical loadings. However, the influence of the foramen magnum boundary condition (FMBC) on intracranial dynamic responses under head impacts has yet to be fully identified until now. This study aimed to investigate the effect of different modeling methods of the FMBC on intracranial dynamic responses induced by forehead impact, especially the axonal injury associated dynamic responses. The total human model for safety (THUMS) was applied in this study. Two FE models with different FMBC modeling methods were developed from the THUMS model. Then, three forehead impact FE models were established respectively, including the original THUMS model. Further FE simulations were conducted to investigate the influence of FMBC modeling methods on intracranial dynamic responses. Though, difference between the intracranial dynamic responses (relative skull-brain motion and strain responses) at areas far from the foramen magnum were slightly, the corresponding difference at the brain stem area were distinctly. Meanwhile, the predicted axonal injury risk of the brain stem white matter was varying among each other. Different modeling methods of FMBC could result in different intracranial dynamic responses of the brain stem, and affect the axonal injury prediction. Therefore, the modeling of the FMBC should be further evaluated for the study of brain stem injury using human head FE models.

Occlusive arteriopathy and brain tumor

1978 ◽  
Vol 49 (1) ◽  
pp. 22-35 ◽  
Author(s):  
Koreaki Mori ◽  
Fuji Takeuchi ◽  
Masatsune Ishikawa ◽  
Hajime Handa ◽  
Mitsuo Toyama ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Cerebral Angiography ◽  
Mass Effect ◽  
Clinical Analysis ◽  
Sudden Onset ◽  
Circle Of Willis ◽  
Ischemic Lesion ◽  
Neurocutaneous Syndrome ◽  
The Brain ◽  
Occlusive Arteriopathy

✓ Four cases with the association of occlusive arteriopathy and brain tumor are presented. A clinical analysis of these cases and cases reported in the literature revealed that occlusive arteriopathy at the base of the brain was often associated with a slowly growing basal tumor in children. Possible causes of occlusive arteriopathy in these cases were compression of the circle of Willis by a slowly growing basal tumor, secondary arterial occlusive changes by radiation therapy for a basal tumor, or vasculopathy associated with neurocutaneous syndrome. Symptoms of sudden onset or episodic nature suggest the presence of occlusive arteriopathy rather than the mass effect of a tumor. Cerebral angiography is mandatory whenever computerized tomography (CT), performed to rule out recurrence of a basal tumor, shows an ischemic lesion with low-density areas without any evidence of mass effect of the tumor. Cerebral angiography is also necessary when a basal tumor is suspected in children, particularly in cases associated with neurocutaneous syndrome and a basal tumor. Care should be taken not to scarify the abnormal vascular network at the base of the brain at the time of operation, because it is considered to be functioning as collateral circulation. The potential hazards of radiotherapy to radiation-induced occlusive changes of the circle of Willis must be considered in treating a benign basal brain tumor in children. Even in adults, repeated large doses of irradiation could cause occlusive arteriopathy.

scholarly journals VARIANTS OF MASTOID AND OCCIPITAL EMISSARY FORAMENS AND THEIR CLINICAL CORRELATION

2021 ◽  
Vol 27 (4) ◽  
pp. 4004-4009
Author(s):  
Ivan Maslarski ◽  
◽  
Lyudmila Belenska-Todorova ◽  
Keyword(s):  
Varicose Veins ◽  
Foramen Magnum ◽  
Clinical Correlation ◽  
Tissue Separation ◽  
Emissary Veins ◽  
Important Study ◽  
Long Time ◽  
The Brain ◽  
Standard Techniques ◽  
Dural Venous Sinuses

Purpose: Emissary foramens in the skull and emissary veins (EV), respectively, have been known for a long time, but their importance is often disregarded. In the present study, we introduce variants of occipital emissary foramens (OEF) unilaterally located on the left, close to оccipital condylе in a formation of three apertures that open together in a sinus near clivus. Material/Methods: Corpses of 30 dеad people were dissected in the Department of Anatomy, and standard techniques for soft tissue separation or maceration of the skull were used. After the removal of the calvaria, fixed bones of the skull were disarticulated. Foramens were cleaned using a double-ended probe, and depth and diameter measurements were performed using an atomical caliper. Results: We found variants of mastoid emissary foramens (MEF) situated into two groups, each of a couple of foramens. Their clinical significance is discussed, compared with existing experience and analysis of their phylogeny and embryogenesis. Conclusion: We introduce OEF and MEF to be important markers for detection of dural venous sinuses (DVS). The latter, together with EV, provide an important mechanism for decreasing intracranial pressure. This happens due to the absence of a valve apparatus in the veins of the brain, and the lack, or small amount, of muscle tissue. There is a possibility of existing varicose veins, such as those caused by arterio-venous fistulas and the pathology associated with it. We suggest the application of EV in imaging as an important study before surgery by lateral and transcondylar approach to the anterior foramen magnum.

Spontaneous resolution of invasive cerebral aspergillosis following partial resection in a medically untreated infant

2012 ◽  
Vol 10 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Sumit Thakar ◽  
Yasha T. Chickabasaviah ◽  
Alangar S. Hegde
Keyword(s):  
Emergency Services ◽  
Mass Effect ◽  
Cerebral Hemiatrophy ◽  
Right Cerebral Hemisphere ◽  
History Of ◽  
Subcortical Regions ◽  
The Right ◽  
Mri Study ◽  
The Brain

Invasive craniocerebral aspergillosis, often encountered in an immunocompromised setting, is almost uniformly fatal despite radical surgical and medical management, and is frequently a necropsy finding. The authors report a unique, self-resolving clinical course of this aggressive infection in a 10-month-old infant. The infant was brought to the emergency services in altered sensorium with a 1-week history of left-sided hemiparesis, excessive irritability, and vomiting. An MRI study of the brain revealed multiple, heterogeneously enhancing lesions in the right cerebral hemisphere with mass effect. The largest lesion in the frontotemporal cortical and subcortical regions was decompressed on an emergent basis. Histopathological findings were suggestive of invasive aspergillosis, although there was no evidence of the infection in the lungs or paranasal sinuses. Computed tomography–guided aspiration of the remaining lesions and follow-up antifungal therapy were recommended. The parents, however, requested discharge without further treatment. The child was seen at a follow-up visit 3 years later without having received any antifungal treatment. Imaging showed resolution of the infection and features of Dyke-Davidoff-Masson syndrome (cerebral hemiatrophy). This report of invasive cerebral aspergillosis resolving without medical therapy is the first of its kind. Its clinicoradiological aspects are discussed in light of previously reported cases.

scholarly journals A retrospective study of the neuropathology and diagnosis of naturally occurring feline infectious peritonitis

2018 ◽  
Vol 30 (3) ◽  
pp. 392-399 ◽  
Author(s):  
Daniel R. Rissi
Keyword(s):  
Fluorescent Antibody ◽  
Foramen Magnum ◽  
Antibody Testing ◽  
Diagnostic Features ◽  
Fresh Tissue ◽  
Tissue Samples ◽  
Feline Infectious Peritonitis ◽  
Multiple Organs ◽  
The Brain ◽  
Feline Coronavirus

Feline infectious peritonitis (FIP) is one of the most important viral diseases of cats worldwide. Our study describes the neuropathology and the diagnostic features of 26 cases of FIP in domestic cats. The average age of affected individuals was 11.8 mo, and there was no sex or breed predisposition. Clinical neurologic signs were noted in 22 cases, and rabies was clinically suspected in 11 cases. Twenty cats had lesions in multiple organs, and 6 cats had lesions only in the brain. Gross neuropathologic changes occurred in 15 cases and consisted of hydrocephalus (10 cases), cerebellar herniation through the foramen magnum (6 cases), cerebral swelling with flattening of gyri (2 cases), and accumulation of fibrin within ventricles (2 cases) or leptomeninges (1 case). Histologically, 3 main distinct distributions of neuropathologic changes were observed, namely periventricular encephalitis (12 cases), rhombencephalitis (8 cases), and diffuse leptomeningitis with superficial encephalitis (6 cases). Fresh tissue samples were submitted for fluorescent antibody testing (FAT) after autopsy in 17 cases, and positive results were found in only 7 cases. Immunohistochemistry (IHC) for feline coronavirus confirmed the diagnosis in all 26 cases. IHC appears to be a more sensitive and reliable test for confirmation of FIP than is FAT.

scholarly journals Mesenchymal Chondrosarcoma of the Brain with Metastasis: A Case Report with Literature Review

2020 ◽  
Vol 11 (02) ◽  
pp. 344-348
Author(s):  
Sandeep Bhardwaj ◽  
Ashish Sharma ◽  
Akangsha Sharma
Keyword(s):  
Left Lung ◽  
Lumbar Vertebrae ◽  
Lateral Wall ◽  
Mesenchymal Chondrosarcoma ◽  
Radical Excision ◽  
Temporal Region ◽  
Ct Guided ◽  
Dismal Prognosis ◽  
Extraskeletal Mesenchymal Chondrosarcoma ◽  
The Brain

AbstractMesenchymal chondrosarcoma of the brain is one of the rarest tumors with dismal prognosis. A 26-year-old man presented with headache, vomiting, and diplopia. On evaluation, a moderately enhancing extra-axial lesion was seen in right temporal region involving right greater wing of sphenoid, adjacent right maxillary sinus, and lateral wall of right orbit. Patient underwent magnetic resonance imaging of the spine and computed tomography (CT) of the chest for possible metastasis which showed lesion in lumbar vertebrae and left lung. Patient was planned for CT-guided lung biopsy which proved inconclusive. The patient was further planned for craniotomy and underwent craniotomy with microscopic excision of the mass. Histoimmunochemistry was suggestive of extraskeletal mesenchymal chondrosarcoma. Mesenchymal chondrosarcoma of the brain is highly aggressive tumors which are difficult to differentiate radiologically. Radical excision followed by chemoradiotherapy is optimal treatment of choice.

scholarly journals Cerebral aspergillosis due to Aspergillus fumigatus in AIDS patient: first culture - proven case reported in Brazil

2005 ◽  
Vol 47 (3) ◽  
pp. 161-165 ◽  
Author(s):  
José E. Vidal ◽  
Rafi F. Dauar ◽  
Marcia S.C. Melhem ◽  
Walderez Szeszs ◽  
Sandra R.B.S. Pukinskas ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Brain Abscess ◽  
Brain Biopsy ◽  
Mass Effect ◽  
Aids Patients ◽  
History Of ◽  
Proven Case ◽  
Mycological Examination ◽  
The Brain

Cerebral aspergillosis is a rare cause of brain expansive lesion in AIDS patients. We report the first culture-proven case of brain abscess due to Aspergillus fumigatus in a Brazilian AIDS patient. The patient, a 26 year-old male with human immunodeficiency virus (HIV) infection and history of pulmonary tuberculosis and cerebral toxoplasmosis, had fever, cough, dyspnea, and two episodes of seizures. The brain computerized tomography (CT) showed a bi-parietal and parasagittal hypodense lesion with peripheral enhancement, and significant mass effect. There was started anti-Toxoplasma treatment. Three weeks later, the patient presented mental confusion, and a new brain CT evidenced increase in the lesion. He underwent brain biopsy, draining 10 mL of purulent material. The direct mycological examination revealed septated and hyaline hyphae. There was started amphotericin B deoxycholate. The culture of the material demonstrated presence of the Aspergillus fumigatus. The following two months, the patient was submitted to three surgeries, with insertion of drainage catheter and administration of amphotericin B intralesional. Three months after hospital admission, his neurological condition suffered discrete changes. However, he died due to intrahospital pneumonia. Brain abscess caused by Aspergillus fumigatus must be considered in the differential diagnosis of the brain expansive lesions in AIDS patients in Brazil.

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