scholarly journals Idiopathic Hypertrophic Pachymeningitis Manifesting with Frontal Brain Edema

2001 ◽  
Vol 19 (3) ◽  
pp. 491-495
Author(s):  
Mário Emílio Teixeira Dourado Júnior ◽  
Ricardo Humberto de Miranda Félix ◽  
Marcos Dias Leão

Introduction. Hypertrophic pachymeningitis (HP) is a rare inflammatory disease that results in thickening of the dura mater. Atypically, it can progress to include the involvement of the cerebral parenchyma. Method. In this paper, we report the rare case of a 31-year-old man with a three-week history of headaches, seizures, impairments of cognitive function, and changes in behavior and mood. Magnetic resonance imaging (MRI) of the brain showed a thickening and an abnormal enhancement of the dura mater over the falx cerebri with extensions into the adjacent cranial base and with brain edemas in the frontal lobes. Histopathological study of meningeal and brain biopsies showed an inflammatory process that was compatible with HP. The results of an extensive laboratory investigation were unremarkable and did not provide additional information on the cause of the meningeal disease. The patient exhibited relapses despite immunosuppressive therapy. Conclusion. This case shows the challenges associated with the management of the disease and the importance of early diagnosis to avoid worsening of the condition and cerebral damage.

2015 ◽  
Vol 6 (3) ◽  
pp. NP1-NP4 ◽  
Author(s):  
Nuri Jacoby ◽  
Ulrike Kaunzner ◽  
Marc Dinkin ◽  
Joseph Safdieh

This is a case of a 52-year-old man with a past medical history of 2 episodes of coital thunderclap headaches as well as recent cocaine, marijuana, and pseudoephedrine use, who presented with sudden, sharp, posterior headache associated with photophobia and phonophobia. His initial magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA) of the head, and magnetic resonance venography (MRV) of the head were all normal as well as a normal lumbar puncture. Given the multiple risk factors for reversible cerebral vasoconstriction syndrome (RCVS), the patient was treated for suspected RCVS, despite the normal imaging. Repeat MRI brain 3 days after hospital admission demonstrated confluent white matter T2 hyperintensities most prominent in the occipital lobes, typical of posterior reversible encephalopathy syndrome (PRES). Repeat MRA of the head 1 day after discharge and 4 days after the abnormal MRI brain showed multisegment narrowing of multiple arteries. This case demonstrates that RCVS may present with PRES on MRI brain and also exemplifies the need to treat suspected RCVS even if imaging is normal, as abnormalities in both the MRI and the MRA may be delayed.


2020 ◽  
Vol 11 (4) ◽  
pp. 5187-5191
Author(s):  
Sivapriya G Nair ◽  
Jina Raj ◽  
Sajesh K Menon ◽  
Suhas Udayakumaran ◽  
Roshni P R

Rosai Dorfman disease is a rare histiocytic disorder. It is also known as Sinus Histiocytosis. It is with massive lymphadenopathy involves an overproduction of a type of white blood cell. The disease is rarely associated with intracranial and intraorbital involvement. Intracranial Rosai-Dorfman can mimic meningioma. Other pathologies also underline its pathologies. Here, we report a nine-year-old boy with a history of proptosis of the right eye and presenting with multiple skull lesions. Histopathological study revealed Sphenopetroclival lesion, which features that of Rosai Dorfman Disease. His MRI scan of the brain was taken, which showed evidence of right optic nerve meningioma with sella and suprasellar extension, causing severe proptosis. The child underwent right frontotemporal craniotomy with petrosectomy and Transylvanian, subtemporal approach to multicompartmental Rosai-Dorfmans lesion. After four months, the patient had a recurrence of the disease on which chemotherapy and steroids were started, which also did not show much response while taking an MRI scan. A corticosteroid is a useful option in the Central Nervous System Rosai Dorfman disease treatment. But this patient showed a negative outcome to the treatment.


Pneumologia ◽  
2021 ◽  
Vol 69 (3) ◽  
pp. 182-185
Author(s):  
Mahmoud Sadeghi-Haddad-Zavareh ◽  
Mohammad Reza Hasanjani Roushan ◽  
Zeinab Mohseni Afshar ◽  
Masomeh Bayani ◽  
Soheil Ebrahimpour ◽  
...  

Abstract Miliary tuberculosis (TB) presents a major challenge following a renal transplant in humans. In the current report, we described a patient with disseminated TB following renal transplantation. The article presents the case of a 38-year-old man who presented an 8-month history of fever, chills, sweating, low-back pain and significant weight loss. Chest radiography and computed tomography (CT) scan showed miliary nodules distributed in the two lungs. The transbronchial lung biopsy revealed a granulomatous reaction with caseous necrosis. Magnetic resonance imaging (MRI) of the brain found multiple tuberculomas. Also, MRI of the lumbosacral was indicative of a psoas abscess. Therefore, miliary pulmonary, cerebral and spinal TB was confirmed. The patient was started on an anti-TB regimen and paravertebral aspiration was also done. The patient’s condition improved considerably. In conclusion, this case report can remind us of the importance of maintaining a high clinical suspicion and performing a thorough workup to establish a timely diagnosis and treatment of miliary TB.


2020 ◽  
Vol 18 ◽  
pp. 205873922092685
Author(s):  
Yunna Yang ◽  
Zheng Gu ◽  
Yinglun Song

Subdural osteomas are extremely rare benign neoplasms. Here, we report the case of a 35-year-old female patient with a right frontal and parietal subdural osteoma. The patient presented with a 2-year history of intermittent headache and fatigue. Computerized tomography (CT) scan showed a high-density lesion attached to the inner surface of the right frontal and parietal skull. Magnetic resonance imaging (MRI) demonstrated T1 hyperintensity and T2 hypointensity of the lesion. Intraoperatively, the hard mass was located in subdural space and attached to the dura mater. Histopathological examination revealed lamellated bony trabeculae lined by osteoblasts and the intertrabecular marrow spaces occupied by adipose tissue. The patient underwent neurosurgical resection and recovered without complication. Surgical excision is recommended to extract the symptomatic lesions with overlying dura mater.


Author(s):  
E Merz

ABSTRACT The corpus callosum is the main commissure of the fetal brain and can be displayed with two-dimensional (2D) and threedimensional (3D) ultrasound. However, only 3D ultrasound provides the operator with the possibility to adjust the three orthogonal planes of the brain in that way that the entire corpus callosum is shown precisely in the median plane. The aim of this article is to provide the most recent information on the assessment of the fetal corpus callosum by means of 3D ultrasound. Different topics are highlighted, such as advantage of 3D ultrasound over 2D ultrasound, indications for displaying the fetal corpus callosum, demonstration of the normal and abnormal corpus callosum and biometric measurements of the fetal corpus callosum by 3D ultrasound. Furthermore the question is raised whether fetal magnetic resonance imaging (MRI) can give additional information to the 3D ultrasound examination and whether the diagnosis resulting from 3D neurosonography gives us the chance for a better counseling of parents who are confronted with the diagnosis of a fetal corpus callosum pathology. How to cite this article Merz E, Pashaj S. What is Known about Corpus Callosum Prenatally? Donald School J Ultrasound Obstet Gynecol 2016;10(2):163-169.


2016 ◽  
Vol 38 (01) ◽  
pp. 064-067
Author(s):  
Tobias Ludwig ◽  
Luiz Rogerio ◽  
Marcelo Reis ◽  
Leandro de Almeida ◽  
Gabriel Frizzon ◽  
...  

AbstractMeningitis or meningoencephalitis are the most common presentations of Koch bacilli infection on the central nervous system (CNS), especially in immunosuppressed patients, in whom the bacilli normally reaches the meninges and the cerebral parenchyma.. A least common pathological presentation is the tumoral growth pattern disease known as tuberculoma. This pathological entity is more common in the cerebral hemispheres and is rarely located in the brainstem. The present case report describes a case of a 55-year-old patient under regular antiretroviral therapy who was hospitalized with signs of brainstem and cerebellar disturbances. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain showed an exophytic lesion in the dorsal region of the pons. The patient underwent total resection of the lesion and the histopathologic analysis was consistent with a tuberculoma.


1913 ◽  
Vol 48 (4) ◽  
pp. 827-847 ◽  
Author(s):  
David Hepburn

The material placed at my disposal for the purposes of this paper comprised the brains of four adult specimens of the Weddell seal, in addition to the brain of the young animal which has formed the subject of my former contributions. The four adult brains having been removed at the time the animals were killed, and preserved in a solution composed of spirit (90 per cent.) 6 pints and formal (2 per cent.) 4 pints, were, with one exception, in a firm and satisfactory condition for detailed anatomical examination. The body of the young seal had been preserved with a view to ordinary dissection, and therefore its brain was not in the firm state of the adult specimens; but as I had the opportunity of removing this brain from the skull, I was able to observe the disposition of the dura mater to the hemispheres of the cerebrum and cerebellum. While the dura mater presented, as a whole, its usual arrangements, it was noteworthy that the falx cerebri did not act as a septum between the two hemispheres of the cerebrum except to a very slight extent, and certainly for not more than one-third of the distance between the vertex of the cerebrum and the dorsal surface of the corpus callosum. As a result, in the region referred to the opposing mesial surfaces of the two hemispheres lay not only in close apposition with each other, but their convolutions were intimately adapted to each other. Similarly, the tentorium cerebelli only extended a short distance between the cerebrum and the cerebellum, and, as the occipital ends of the cerebral hemispheres fell considerably apart from each other, there was space for the accommodation of the well-developed vermis of the cerebellum as well as for the bulbous pineal body, which occupied a position upon its dorsal aspect. As I removed the brain from the skull the stalk of the pineal body gave way, and probably the same thing had occurred during the removal of the adult brains, for, while different lengths of the stalks had been preserved, there was only one complete specimen of its bulbous extremity. Looked at from the vertex, the general outline of the whole brain was that of a four-sided figure with rounded angles, and the cerebral hemispheres concealed the cerebellum except where the vermis was exposed between them at their occipital ends. The frontal ends of the hemispheres were not rounded into frontal poles; but, on the contrary, they almost formed flat frontal surfaces. Similarly, the occipital ends were rounded and not pointed to form occipital poles. There was a small amount of difference in the absolute size of the adult brains, and the largest specimen measured 120 mm. in its fronto-occipital diameter ; 115 mm. in its greatest transverse diameter at a point well forward on the temporo-sphenoidal lobes; and 71 mm. in vertical height, measured from the pons varolii to the vertex of the cerebrum. Thus, apart from the peculiarity of its general outline in total size, it was only slightly less than an average human brain. Throughout the anterior two-thirds of their extent the cerebral hemispheres were, as already indicated, in very close apposition, and the falx cerebri only dipped into the pallial or superior longitudinal fissure to a slight extent; but in its posterior third this cleft opened to form a wide interval, measuring 65 mm. in the transverse direction at its hinder end and narrowing as it ran forwards towards the posterior end of the corpus callosum. In the deep level of this interval the pineal body and the upper surface of the vermis were visible, as well as part of the upper surface of the cerebellar hemispheres. It should be stated that the backward extension of the occipital lobes of the cerebrum carried them 2 mm. beyond the cerebellar hemispheres.In its essential features the basal aspect of the brain conformed to current descriptions of the mammalian brain ; but it presented many special points of interest, to which reference will be made in the course of my survey.


2019 ◽  
Vol 50 (06) ◽  
pp. 395-399
Author(s):  
Sangeetha Yoganathan ◽  
Ramamani Mariappan ◽  
Sniya Valsa Sudhakar ◽  
Sunithi Elizabeth Mani ◽  
Vivek Mathew ◽  
...  

AbstractSpontaneous intracranial hypotension (SIH) is an under-diagnosed cause of headache in children and adolescents. SIH results from cerebrospinal fluid (CSF) leak due to breach in the dura mater and the etiology for dural breach is often diverse. We report an adolescent boy who presented with chronic episodic headache that later progressed to daily headache. There was a typical history of worsening of headache on upright position and relief of headache on lying down. He was treated with migraine prophylaxis in another hospital but there was no response. Marfanoid features and brisk deep tendon reflexes were observed on clinical examination. Brain magnetic resonance imaging (MRI) revealed sagging of the brain stem, pachymeningeal enhancement, and tonsillar herniation. MRI of spine myelogram confirmed multiple levels of CSF leak. He was initially managed with supportive measures and fluoroscopic-guided fibrin glue injection. Although child remained symptom-free for the next 6 months, he again developed headache. MRI and computed tomography spine myelogram revealed a meningeal diverticulum in the lumbar spine. He was managed with an autologous epidural blood patch and he has been well since then. In this report, we highlight the clinical and radiological pointers to the presence of SIH in children with recurrent headache.


Neurosurgery ◽  
1984 ◽  
Vol 14 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Michael McDermott ◽  
Ross J. F. Fleming ◽  
Graham R. Vanderlinden ◽  
William S. Tucker

Abstract The occurrence of spontaneous arterial subdural hematomas is very rare. We report five patients who presented with sudden severe headache and who developed progressive neurological deficits, two becoming comatose. None had a history of trauma. A diagnosis of subarachnoid hemorrhage was suspected in all patients, but all proved to have subdural hematomas caused by “spontaneous” rupture of a cortical artery. Nineteen similar cases have been reported in the English literature. The source of bleeding was identified as a cortical artery located near the sylvian region in four of our five patients and in most of the reported cases. There are several possible anatomical situations that may predispose a cortical artery to “spontaneous” rupture: (a) spontaneous rupture of a cortical artery at the point of origin of a fragile arterial twig, especially a right-angled branch, a point of potential weakness; (b) rupture of a small artery traversing the subdural space and connecting a cortical artery to the dura mater (a “bridging” artery); (c) adhesions between a cortical artery and arachnoid or dura mater; (d) a knuckle of cortical artery protruding through the arachnoid and adherent to the dura mater. In each situation, the artery is probably torn by a sudden movement of the brain during a vigorous head movement, not severe enough to be considered trauma.


2008 ◽  
Vol 193 (3) ◽  
pp. 192-196 ◽  
Author(s):  
Peter Mason ◽  
Michael Rimmer ◽  
Anna Richman ◽  
Gagan Garg ◽  
Joe Johnson ◽  
...  

BackgroundOne hundred years ago psychiatrists thought that ear disease could cause insanity by irritation of the brain. Current understanding of the role of the temporal lobes in schizophrenia and their proximity to the middle ear supports this hypothesis.AimsTo establish the rate of middle-ear disease pre-dating the onset of schizophrenia.MethodEighty-four patients with schizophrenia were each matched to four non-psychiatric controls by age, gender and season of birth. History of ear disease was obtained from general practice records. Additional information on symptoms was collected for participants in the case group, who also had audiometry.ResultsThe odds ratio of recorded middle-ear disease pre-dating schizophrenia was 3.68 (95% CI 1.86–7.28). This excess was particularly marked on the left (OR=4.15, 95% CI 2.08–8.29). Auditory hallucinations were associated with middle-ear disease but not with hearing loss.ConclusionsThere is an association between middle-ear disease and schizophrenia which may have aetiological significance.


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