scholarly journals Large left posterior fossa meningioma presenting with quadriplegia in a woman with history of carbidopa-levodopa resistant parkinsonism

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Antonio Jose Reyes ◽  
Kanterpersad Ramcharan ◽  
Maria Alvarez ◽  
Wesley Greaves ◽  
Fidel Rampersad
Keyword(s):  
Posterior Fossa ◽  
Mass Effect ◽  
Foramen Magnum ◽  
Acute Onset ◽  
Surgical Removal ◽  
Left Posterior ◽  
Spastic Quadriplegia ◽  
History Of ◽  
Posterior Fossa Meningioma ◽  
Correlation Consistent

A 56–year-old Afro-Trinidadian woman with a history of a carbidopa-levodopa resistance Parkinsonian-like syndrome for 2 years, presented with acute onset spastic quadriplegia and decreased responsiveness. Diagnosis involved clinical and MR-imaging correlation consistent with a large left posterior fossa meningioma. Surgical removal of the tumor led to complete reversibility of the neurological manifestations associated with cerebellar tonsillar herniation beyond the foramen magnum and mass effect on the brainstem, cerebellum and midbrain regions. Pathological findings were typical of a meningioma. This case demonstrates the association of a large left posterior fossa meningioma and carbidopalevodopa resistant parkinsonism in an Afro-Trinidadian woman who presented with acute onset acute quadriplegia and decreased responsiveness. This case reminds clinicians that patients with dopa unresponsiveness and/or acute neurological deficit or deterioration should be worked up for other possible causes and adds to the literature on the association of parkinsonism and intracranial space occupying lesions.

scholarly journals Genomic Analysis of Posterior Fossa Meningioma Demonstrates Frequent AKT1 E17K Mutations in Foramen Magnum Meningiomas

2019 ◽  
Vol 80 (06) ◽  
pp. 562-567 ◽  
Author(s):  
Sally R. Williams ◽  
Tareq A. Juratli ◽  
Brandyn A. Castro ◽  
Tyler T. Lazaro ◽  
Corey M. Gill ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Genomic Analysis ◽  
Treatment Decision ◽  
Foramen Magnum ◽  
High Morbidity ◽  
Anatomical Distribution ◽  
Pik3ca Mutations ◽  
Posterior Fossa Meningioma ◽  
Therapeutic Alternatives ◽  
Treatment Decision Process

Objective Posterior fossa meningiomas are surgically challenging tumors that are associated with high morbidity and mortality. We sought to investigate the anatomical distribution of clinically actionable mutations in posterior fossa meningioma to facilitate identifying patients amenable for systemic targeted therapy trials. Methods Targeted sequencing of clinically targetable AKT1, SMO, and PIK3CA mutations was performed in 61 posterior fossa meningioma using Illumina NextSeq 500 to a target depth of >500 × . Samples were further interrogated for 53 cancer-relevant RNA fusions by the Archer FusionPlex panel to detect gene rearrangements. Results AKT1 (E17K) mutations were detected in five cases (8.2%), four in the foramen magnum and one in the cerebellopontine angle. In contrast, none of the posterior fossa tumors harbored an SMO (L412F) or a PIK3CA (E545K) mutation. Notably, the majority of foramen magnum meningiomas (4/7, 57%) harbored an AKT1 mutation. In addition, common clinically targetable gene fusions were not detected in any of the cases. Conclusion A large subset of foramen magnum meningiomas harbor AKT1 E17K mutations and are therefore potentially amenable to targeted medical therapy. Genotyping of foramen magnum meningiomas may enable more therapeutic alternatives and guide their treatment decision process.

scholarly journals Carotid Space Mass Proximal to Vagus Nerve Causing Asystole and Syncope

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Julie Leviter ◽  
Daniel H. Wiznia
Keyword(s):  
Case Reports ◽  
Mass Effect ◽  
Bundle Branch Block ◽  
St Depression ◽  
Left Posterior ◽  
Pacemaker Placement ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
High Degree ◽  
Carotid Space

Manipulation of vagal nerve rootlets, whether surgical or through mass effect of a neoplasm, can result in asystole and hypotension, accompanied by ST depression and right bundle branch block. There are few case reports of a neoplasm causing these effects, and this case describes a patient with such a mass presenting with syncopal episodes. A 43-year-old man with a past medical history of HIV, bipolar disorder, and epilepsy was admitted to the neurology service for a video electroencephalogram (vEEG) to characterize syncopal episodes that were felt to be epileptic in origin. During the study, he experienced symptoms of his typical aura, which correlated with a transient symptomatic high degree AV block on telemetry, and an absence of epileptic findings on vEEG. Magnetic Resonance Imaging (MRI) of the brain showed a mass in the left posterior carotid space at the skull base. The patient underwent permanent dual chamber MRI-compatible pacemaker placement for his heart block. His syncopal episodes resolved, but presyncopal symptoms persisted. We discuss the presentation and treatment of vagal neoplasms.

Calcifying Pseudoneoplasm of the Cerebellopontine Angle: Case Report

2011 ◽  
Vol 69 (suppl_1) ◽  
pp. ons117-ons120 ◽  
Author(s):  
Tiffany R. Hodges ◽  
Isaac O. Karikari ◽  
Shahid M. Nimjee ◽  
June Tibaleka ◽  
Allan H. Friedman ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Cerebellopontine Angle ◽  
Histopathological Examination ◽  
Ct Scanning ◽  
Foramen Magnum ◽  
Occipital Condyle ◽  
History Of ◽  
Blurry Vision ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND AND IMPORTANCE: Calcifying pseudoneoplasms are rare tumors of the neuraxis. To our knowledge, this is only the second reported case in the literature of calcifying pseudoneoplasm of the cerebellopontine angle. The etiology and natural history of these neoplasms are not well understood. This case report provides a thorough review of the histology and potential origins of calcifying pseudoneoplasm. CLINICAL PRESENTATION: A 34-year-old previously healthy man presented with a 6-month history of progressive worsening headaches, fatigue, tinnitus, dizziness, and blurry vision. Neurological examination was notable for tongue deviation, tongue atrophy, and left uvula deviation. Computed tomography (CT) scanning showed a 3.3 × 3.5 cm densely calcified posterior fossa mass appearing to arise from the occipital bone. Magnetic resonance imaging (MRI) revealed a 4.3 × 2.9 × 2.9 cm left posterior fossa enhancing mass with the margin tip from the left occipital condyle. A transcondylar approach was used to resect the lesion. The mass was found to have eroded through the bone into the foramen magnum. Histopathological examination confirmed the diagnosis of calcifying pseudoneoplasm of the cerebellopontine angle. CONCLUSION: Calcifying pseudoneoplasms should be considered in the differential diagnosis of calcified cerebellopontine angle tumors. Histopathologic diagnosis is extremely important in the characterization of these lesions in order to direct the course of appropriate management. An inaccurate diagnosis of a malignant tumor can result in potentially harmful and unnecessary therapies, as prognosis for these lesions is generally favorable.

Surgical removal of a microchip from a puppy’s spinal canal

2009 ◽  
Vol 22 (01) ◽  
pp. 63-65 ◽  
Author(s):  
T. J. Smith ◽  
N. Fitzpatrick
Keyword(s):  
Spinal Cord ◽  
Telephone Interview ◽  
Cervical Vertebra ◽  
Acute Onset ◽  
Cervical Region ◽  
Radiographic Examination ◽  
Surgical Removal ◽  
Good Recovery ◽  
History Of

SummaryA 1.6 kg, six-week-old Tibetan Terrier was admitted with a 12-hours history of acute onset of progressive tetraparesis following insertion of a microchip to the dorsal cervical region. Neurological examination indicated a lesion to the Ce1 to Ce5 spinal cord segments. Radiographic examination confirmed the intra-spinal location of a microchip foreign body at the level of the second cervical vertebra. Microchip removal was achieved following dorsal hemi-laminectomy; significant intra-operative haemorrhage was encountered. The puppy was ambulatory at day seven. Follow-up telephone interview 18 months postoperatively confirmed that the patient had made a good recovery although it had a mild residual right- sided torticollis.

Follow-up MR of Intracranial Cavernomas the Relationship between Haemorrhagic Events and Morphology

1996 ◽  
Vol 2 (2) ◽  
pp. 127-135 ◽  
Author(s):  
R. Willinsky ◽  
W. Harper ◽  
M.C. Wallace ◽  
W. Kucharczyk ◽  
W. Montanera ◽  
...  
Keyword(s):  
Natural History ◽  
Posterior Fossa ◽  
Classification System ◽  
Classification Scheme ◽  
Mass Effect ◽  
Blood Products ◽  
History Of ◽  
The Relationship ◽  
Regressive Changes

The purpose of this review was to determine whether a classification scheme for cavernomas based on the MR appearance is predictive of the natural history of the lesions with particular reference to the risk of haemorrhage. We reviewed the clinical and MR findings in 156 patients with intracranial cavernomas. The dominant or symptomatic cavernoma was graded into three groups according to the appearance of the blood products. The presence of haemorrhage, mass effect and oedema was evaluated. Sixty patients had serial MRs with a mean follow-up of 1.9 years. Subacute haemorrhage with mass effect and oedema was evident on the initial MR in 30 patients (19%). In seven patients follow-up MR showed haemorrhage with mass effect and oedema. Six of these bleeds were in the posterior fossa. The haemorrhages seen on follow-up MR occurred in all three morphological types. Regression was found on follow-up MR in five of the seven patients who initially showed a bleed. In 35% of patients, the dominant or symptomatic cavernoma changed on serial MR. Intracranial cavernomas are dynamic lesions with both active and regressive changes seen on follow-up MR. A classification system based on morphology was not found to be useful in predicting future bleeds. Bleeding rates, based on MR follow-up, were 10.9% in the posterior fossa and 1.7% in the supratentorial compartment.

Omental Infarction: A Case Treated with Laparoscopic Surgery

2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Acute Onset ◽  
Laparoscopy Surgery ◽  
History Of ◽  
Background History ◽  
The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

Young Male with Bilateral ICA Dissection: Beyond CADISS Trial

2021 ◽  
pp. 251660852098428
Author(s):  
Vikas Bhatia ◽  
Chirag Jain ◽  
Sucharita Ray ◽  
jay Kumar
Keyword(s):  
Management Strategies ◽  
Young Male ◽  
Acute Onset ◽  
The Body ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke Study ◽  
History Of

Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.

scholarly journals A Rare Case of Spontaneous Arachnoid Cyst Rupture Presenting as Right Hemiplegia and Expressive Aphasia in a Pediatric Patient

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 78
Author(s):  
Anne Bryden ◽  
Natalie Majors ◽  
Vinay Puri ◽  
Thomas Moriarty
Keyword(s):  
Cognitive Processing ◽  
Arachnoid Cyst ◽  
Memory Loss ◽  
Acute Onset ◽  
Word Finding ◽  
Outpatient Visits ◽  
The Family ◽  
History Of ◽  
Cyst Rupture ◽  
The Brain

This study examines an 11-year-old boy with a known history of a large previously asymptomatic arachnoid cyst (AC) presenting with acute onset of right facial droop, hemiplegia, and expressive aphasia. Shortly after arrival to the emergency department, the patient exhibited complete resolution of right-sided hemiplegia but developed headache and had persistent word-finding difficulties. Prior to symptom onset while in class at school, there was an absence of reported jerking movements, headache, photophobia, fever, or trauma. At the time of neurology consultation, the physical exam showed mildly delayed cognitive processing but was otherwise unremarkable. The patient underwent MRI scanning of the brain, which revealed left convexity subdural hematohygroma and perirolandic cortex edema resulting from ruptured left frontoparietal AC. He was evaluated by neurosurgery and managed expectantly. He recovered uneventfully and was discharged two days after presentation remaining asymptomatic on subsequent outpatient visits. The family express concerns regarding increased anxiety and mild memory loss since hospitalization.

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