Intracranial Tuberculoma Mimicking Neurosarcoidosis: A Clinical Challenge

Central nervous system (CNS) tuberculosis is a rare manifestation of all tuberculosis presentations. The incidence of brain tuberculoma is increasing in developed countries due to HIV infection and immigration from tuberculosis-endemic countries. Symptoms and radiologic findings of CNS tuberculosis can be non-specific and lead to misdiagnosis or mistreatment. Intracranial tuberculoma can present with a seizure, intracranial hypertension, or focal neurologic symptoms. In our case, the diagnosis was challenging between neurosarcoidosis and intracranial tuberculoma due to inconclusive results of stereotactic brain biopsy and clinical presentation. The pathology result of the open brain biopsy revealed non-caseating granuloma. Finally, we were able to diagnose intracranial tuberculoma following acid-fast bacilli culture results of open brain biopsy. This report highlights the importance of including intracranial tuberculoma in the differential diagnosis of cerebral space-occupying lesions, even in patients with negative laboratory findings of tuberculosis.

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Von-Willebrand-Syndrom Typ 1 und Schwangerschaft

Hämostaseologie ◽

10.1055/s-0037-1619742 ◽

2011 ◽

Vol 31 (S 01) ◽

pp. S11-S13 ◽

Cited By ~ 1

Author(s):

J. Oppermann ◽

A. Siegemund ◽

R. Schobess ◽

U. Scholz

Keyword(s):

Clinical Presentation ◽

Bleeding Disorder ◽

Bleeding Tendency ◽

Laboratory Findings ◽

Mucous Membranes ◽

Von Willebrand

SummaryThe von Willebrand-Jürgens syndrome (VWJS) type 1 is a common hereditary bleeding disorder with a bleeding tendency located especially in the mucous membranes. Women suffering from VWJS type 1 show menorrhagia and prolonged postoperative bleedings. During pregnancy the clinical presentation varies by the increase of the von Willebrand factors.In this article the laboratory findings and the clinical presentation of patients with VWJS during pregnancy was examined. The necessity of interventions during pregnancy and at the time of delivery was under consideration.

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Hepatic brucelloma: a rare complication of a common zoonotic disease

BMJ Case Reports ◽

10.1136/bcr-2020-237076 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237076

Author(s):

George Vatidis ◽

Eirini I Rigopoulou ◽

Konstantinos Tepetes ◽

George N Dalekos

Keyword(s):

Rare Complication ◽

Surgical Excision ◽

Coombs Test ◽

Inflammation Markers ◽

Laboratory Findings ◽

Ct Guided ◽

Rare Manifestation ◽

Bone Marrow Cultures ◽

History Of ◽

The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

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A Semi-Autonomous Stereotactic Brain Biopsy Robot With Enhanced Safety

IEEE Robotics and Automation Letters ◽

10.1109/lra.2020.2967732 ◽

2020 ◽

Vol 5 (2) ◽

pp. 1405-1412

Author(s):

Minxin Ye ◽

Weibing Li ◽

Danny Tat Ming Chan ◽

Philip Wai Yan Chiu ◽

Zheng Li

Keyword(s):

Brain Biopsy ◽

Stereotactic Brain Biopsy

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1H-MRS-Guided Stereotactic Brain Biopsy

Stereotactic and Functional Neurosurgery ◽

10.1159/000335168 ◽

2012 ◽

Vol 90 (1) ◽

pp. 63-65 ◽

Cited By ~ 1

Author(s):

Mikhail Chernov ◽

Yoshihiro Muragaki ◽

Takaomi Taira ◽

Hiroshi Iseki

Keyword(s):

Brain Biopsy ◽

Stereotactic Brain Biopsy

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Paraspinal gossybipoma: A case report and review of the literature

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.71725 ◽

2010 ◽

Vol 01 (02) ◽

pp. 102-104 ◽

Cited By ~ 11

Author(s):

Baris Kucukyuruk ◽

Huseyin Biceroglu ◽

Bashar Abuzayed ◽

Mustafa O Ulu ◽

Ali M Kafadar

Keyword(s):

Clinical Presentation ◽

Review Of The Literature ◽

Disk Herniation ◽

Serous Fluid ◽

Lumbar Disk Herniation ◽

Radiologic Findings ◽

Initial Surgery ◽

History Of ◽

Retained Surgical Sponges ◽

Operation Wound

ABSTRACTSpinal or paraspinal retained surgical sponges (gossybipoma or textiloma) are rare incidents and mostly asymptomatic in chronic cases, but can be confused with other masses such as a hematoma, an abscess or a tumor. In chronic cases, the presentation can be as late as decades after the initial surgery; however, some gossybipomas cause infection or abscess formation in the early stages. The authors report a 40-year-old woman with a history of operation for lumbar disk herniation before 8 months, and got admitted with a complaint of serous fluid leakage from the operation wound. In this report, the authors discuss the clinical presentation, the radiologic findings and the differential diagnosis of gossybipoma.

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A second case of Marburg’s variant of multiple sclerosis with vasculitis and extensive demyelination

Multiple Sclerosis Journal ◽

10.1177/1352458511414042 ◽

2011 ◽

Vol 17 (12) ◽

pp. 1531-1538 ◽

Cited By ~ 18

Author(s):

Rania GA Elenein ◽

Leroy R Sharer ◽

Stuart D Cook ◽

Andrew R Pachner ◽

Jennifer Michaels ◽

...

Keyword(s):

Multiple Sclerosis ◽

Pathological Finding ◽

Brain Biopsy ◽

Original Description ◽

Clinical Findings ◽

Polymorphonuclear Neutrophils ◽

Inflammatory Cell Infiltrate ◽

Unexpected Finding ◽

Stereotactic Brain Biopsy ◽

True Variant

Marburg’s variant of multiple sclerosis is a rapidly progressive and malignant form of multiple sclerosis (MS) that usually leads to severe disability or death within weeks to months without remission. Few cases have been described in the literature since the original description by Marburg. The classic pathological findings usually include highly destructive zones of extensive demyelination, necrosis with dense cellular infiltrate, and giant reactive astrocytes. We report a case of a 31-year-old woman with Marburg’s variant of MS who, over a period of eight months, became totally disabled, blind, and quadriplegic, with vocal cord paralysis, requiring a tracheostomy. The patient underwent diagnostic stereotactic brain biopsy. Clinical findings, magnetic resonance imaging (MRI), serologic and cerebrospinal fluid (CSF) findings, and neuropathology are discussed. MRI showed extensive white matter involvement in the brain and spinal cord that continuously progressed over time. A diagnostic stereotactic brain biopsy revealed extensive active demyelination with unexpected finding of active vasculitis and fibrinoid necrosis with a vascular inflammatory cell infiltrate, including polymorphonuclear neutrophils and rare eosinophils. Serologic work-up for vasculitis and neuromyelitis optica was unremarkable and the CSF showed only one oligoclonal band (OCB) not present in serum. This is the second case of Marburg’s variant of MS that demonstrated both demyelination and vasculitis. In our case these features were demonstrated simultaneously, even though the demyelination was the predominant pathological finding. Since vasculitis is not a feature of classic MS, these findings pose the question as to whether Marburg’s variant of MS is a true variant or different entity altogether.

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Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique

Journal of Neurosurgery ◽

10.3171/jns.2006.104.2.233 ◽

2006 ◽

Vol 104 (2) ◽

pp. 233-237 ◽

Cited By ~ 132

Author(s):

Graeme F. Woodworth ◽

Matthew J. McGirt ◽

Amer Samdani ◽

Ira Garonzik ◽

Alessandro Olivi ◽

...

Keyword(s):

Stereotactic Biopsy ◽

Diagnostic Yield ◽

Brain Biopsy ◽

Morbidity Rate ◽

Frameless Stereotaxy ◽

Cortical Lesions ◽

Stereotactic Brain Biopsy ◽

Biopsy Procedure ◽

Image Guided ◽

Permanent Morbidity

Object The gold standard for stereotactic brain biopsy target localization has been frame-based stereotaxy. Recently, frameless stereotactic techniques have become increasingly utilized. Few authors have evaluated this procedure, analyzed preoperative predictors of diagnostic yield, or explored the differences in diagnostic yield and morbidity rate between the frameless and frame-based techniques. Methods A consecutive series of 110 frameless and 160 frame-based image-guided stereotactic biopsy procedures was reviewed. Associated variables for both techniques were reviewed and compared. All stereotactic biopsy procedures were included in a risk factor analysis of nondiagnostic biopsy sampling. Frameless stereotaxy led to a diagnostic yield of 89%, with a total permanent morbidity rate of 6% and a mortality rate of 1%. Larger lesions were fivefold more likely to yield diagnostic tissues. Deep-seated lesions were 2.7-fold less likely to yield diagnostic tissues compared with cortical lesions. Frameless compared with frame-based stereotactic biopsy procedures showed no significant differences in diagnostic yield or transient or permanent morbidity. For cortical lesions, more than one needle trajectory was required more frequently to obtain diagnostic tissues with frame-based as opposed to frameless stereotaxy, although this factor was not associated with morbidity. Conclusions With regard to diagnostic yield and complication rate, the frameless stereotactic biopsy procedure was found to be comparable to or better than the frame-based method. Smaller and deep-seated lesions together were risk factors for a nondiagnostic tissue yield. Frameless stereotaxy may represent a more efficient means of obtaining biopsy specimens of cortical lesions but is otherwise similar to the frame-based technique.

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Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

Journal of Neurosurgery ◽

10.3171/jns.1998.89.1.0031 ◽

1998 ◽

Vol 89 (1) ◽

pp. 31-35 ◽

Cited By ~ 83

Author(s):

Abhaya V. Kulkarni ◽

Abhijit Guha ◽

Andres Lozano ◽

Mark Bernstein

Keyword(s):

Ct Scan ◽

Neurological Deficit ◽

Stereotactic Biopsy ◽

Brain Biopsy ◽

Ct Scanning ◽

Ct Scans ◽

Stereotactic Brain Biopsy ◽

Content Type ◽

Fine Print

Object. Many neurosurgeons routinely obtain computerized tomography (CT) scans to rule out hemorrhage in patients after stereotactic procedures. In the present prospective study, the authors investigated the rate of silent hemorrhage and delayed deterioration after stereotactic biopsy sampling and the role of postbiopsy CT scanning. Methods. A subset of patients (the last 102 of approximately 800 patients) who underwent stereotactic brain biopsies at the Toronto Hospital prospectively underwent routine postoperative CT scanning within hours of the biopsy procedure. Their medical charts and CT scans were then reviewed. A postoperative CT scan was obtained in 102 patients (aged 17–87 years) who underwent stereotactic biopsy between June 1994 and September 1996. Sixty-one patients (59.8%) exhibited hemorrhages, mostly intracerebral (54.9%), on the immediate postoperative scan. Only six of these patients were clinically suspected to have suffered a hemorrhage based on immediate postoperative neurological deficit; in the remaining 55 (53.9%) of 102 patients, the hemorrhage was clinically silent and unsuspected. Among the clinically silent intracerebral hemorrhages, 22 measured less than 5 mm, 20 between 5 and 10 mm, five between 10 and 30 mm, and four between 30 and 40 mm. Of the 55 patients with clinically silent hemorrhages, only three demonstrated a delayed neurological deficit (one case of seizure and two cases of progressive loss of consciousness) and these all occurred within the first 2 postoperative days. Of the neurologically well patients in whom no hemorrhage was demonstrated on initial postoperative CT scan, none experienced delayed deterioration. Conclusions. Clinically silent hemorrhage after stereotactic biopsy is very common. However, the authors did not find that knowledge of its existence ultimately affected individual patient management or outcome. The authors, therefore, suggest that the most important role of postoperative CT scanning is to screen for those neurologically well patients with no hemorrhage. These patients could safely be discharged on the same day they underwent biopsy.

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Persistence of Fetal Cardiopulmonary Circulation: One Manifestation of Transient Tachypnea of the Newborn

PEDIATRICS ◽

10.1542/peds.58.2.192 ◽

1976 ◽

Vol 58 (2) ◽

pp. 192-197

Author(s):

Richard L. Bucciarelli ◽

Edmund A. Egan ◽

Ira H. Gessner ◽

Donald V. Eitzman

Keyword(s):

Clinical Presentation ◽

Ductus Arteriosus ◽

Newborn Infants ◽

Transpulmonary Pressure ◽

Pressure Gradients ◽

Respiratory Condition ◽

Course Of Illness ◽

Rare Manifestation ◽

Tentative Diagnosis ◽

Pathophysiologic Mechanisms

Five cyanotic newborn infants underwent cardiac catheterization between 8 and 36 hours of age with a tentative diagnosis of cyanotic congenital heart disease. All had normal cardiovascular anatomy. Cyanosis was the result of persistence of fetal cardiopulmonary circulation with right-to-left shunting across the ductus arteriosus. In all infants, cyanosis resolved spontaneously and the infants survived without sequelae. Admission chest roentgenograms of all infants showed marked hyperinflation of the lungs. Except for severe hypoxemia, the clinical presentation, chest films, and course of illness of these infants were consistent with transient tachypnea of the newborn. It is proposed that an increase in pulmonary vascular resistance, due to hyperinflation of the lungs, was the mechanism which reopened the fetal cardiopulmonary circulatory channels and produced hypoxemia, and that these infants suffered from a rare manifestation of a usually benign newborn respiratory condition. Further, given these pathophysiologic mechanisms, the use of continuous transpulmonary pressure gradients in the management of such infants would be contraindicated.

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Stereotactic Brain Biopsy in Eloquent Areas Assisted by Navigated Transcranial Magnetic Stimulation: a Technical Case Report

Operative Neurosurgery ◽

10.1093/ons/opy321 ◽

2018 ◽

Vol 17 (3) ◽

pp. E124-E129 ◽

Cited By ~ 2

Author(s):

Jiri Bartek ◽

Gerald Cooray ◽

Mominul Islam ◽

Margret Jensdottir

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Stereotactic Biopsy ◽

Brain Biopsy ◽

Awake Surgery ◽

Histopathological Diagnosis ◽

Navigated Transcranial Magnetic Stimulation ◽

Stereotactic Brain Biopsy ◽

Eloquent Areas ◽

The Brain

Abstract BACKGROUND AND IMPORTANCE Stereotactic brain biopsy (SB) is an important part of the neurosurgical armamentarium, with the possibility of achieving histopathological diagnosis in otherwise inaccessible lesions of the brain. Nevertheless, the procedure is not without the risk of morbidity, which is especially true for lesions in eloquent parts of the brain, where even a minor adverse event can result in significant deficits. Navigated transcranial magnetic stimulation (nTMS) is widely used to chart lesions in eloquent areas, successfully guiding maximal safe resection, while its potential role in aiding with the planning of a stereotactic biopsy is so far unexplored. CLINICAL PRESENTATION Magnetic resonance imaging of a 67-yr-old woman presenting with dysphasia revealed a noncontrast enhancing left-sided lesion in the frontal and parietal pars opercularis. Due to the location of the lesion, nTMS was used to chart both primary motor and language cortex, utilizing this information to plan a safe SB trajectory and sampling area according to the initial work-up recommendations from the multidisciplinary neuro-oncology board. The SB was uneventful, with histology revealing a ganglioglioma, WHO I. The patient was discharged the following day, having declined to proceed with tumor resection (awake surgery) due to the non-negligible risk of morbidity. Upon 1- and 3-mo follow-up, she showed no signs of any procedure-related deficits. CONCLUSION nTMS can be implemented to aid with the planning of a stereotactic biopsy procedure in eloquent areas of the brain, and should be considered part of the neurosurgical armamentarium.

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