Multiple Myeloma Involving Left Hemicranium

Multiple myeloma (MM) is a malignant neoplasm of bone marrow affecting plasma cells. It is commonly seen as multiple punched-out lesions in the skull bone as a characteristic feature. Its presentation as hemicranial involvement with intracranial extension is rare. A 46-year-old male presented with left side scalp swelling, prominent over parietal region. X-ray showed multiple punched out lesions involving left hemicranium. CT and MRI brain showed intracranial extension of lesion without brain parenchyma invasion. He was treated with biopsy of lesion followed by chemotherapy.

A rare case: Penetrating craneoencefalic trauma by knife

Background: Cranioencephalic penetrating trauma (CPT) is caused by a sharp or short- pointed object that passes through the bone, dura mater, brain and other structures. Its incidence is unknown and few cases are described; penetrating injuries represent 0.4%, therefore there is no protocolized management. Case report: A 24-year-old male patient suffered penetrating trauma at left parietal region with a "knife"; he was sutured and sent home with analgesics. Five days after the trauma, he was admitted for headache, disorientation and decreased visual acuity. X-ray (XR) of Cranium evidencing a foreign body, therefore it is sent to a reference hospital. Evolution: The diagnosis is confirmed by a computerized tomography (CT) scan of the skull with 3-dimensional reconstruction (3D) plus CT angiography (angio CT), which shows "knife" in the left parietal region without vascular compromise. Neurosurgeons perform removal of the foreign body plus a dura mater plasty. Patient stay 12 days hospitalized with a favorable evolution and improvement of neurological symptomatology. Conclusion: CPT due to a knife is an emergency and there is no protocolized management. The removal of the foreign body must be done in a hospital for the risk of lesions of large vessels.

Cerebriform congenital melanocytic nevus of scalp and its management using tissue expansion

Congenital melanocytic nevi are benign proliferations of cutaneous nevomelanocytes. Usually, they manifest at birth or become apparent within the first few years of life. The nevi show variable surface morphology (papular, rugose, verrucous, or cerebriform). Congenital melanocytic nevus showing cerebriform morphology is a rarity. Early diagnosis and surgical excision are usually recommended in congenital melanocytic nevus to prevent the future risk of malignant transformation which is higher in larger lesions, especially in giant forms (>20 cm in size). An excision of the lesion also helps to avoid the social and psychological consequences arising out of significant cosmetic deformity. We report a 21-year-old patient who presented with a cerebriform congenital melanocytic nevus measuring 10 cm × 7 cm × 2 cm in the right parietal region. Early-onset, pigmented lesion with a cerebriform surface, and the histopathology features of congenital melanocytic nevus were the points that favored the diagnosis of cerebriform congenital melanocytic nevus in our patient. He was treated with excision of the lesion and defect coverage with tissue expansion in two stages. Two rectangular tissue expanders were placed beneath the galea aponeurotica (one with a capacity of 300 cc in the left parietal region and another with 500 cc in the occipital region). Both the expanders were inflated twice to their capacity. Second stage surgery was performed after about 3 months in which the tissue expanders were removed and the pre-expanded scalp skin was used to drape the scalp defect that resulted from the excision of the lesion. An excision and a two staged reconstruction of the scalp using tissue expanders, may ensure a good aesthetic outcome in the management of intermediate to large sized congenital melanocytic nevus.

A new fMRI localizer for preoperative language mapping using a sentence completion task: Validity, choice of baseline condition, and test-retest reliability

To avoid post-neurosurgical language deficits, intraoperative mapping of the language function in the brain can be complemented with preoperative mapping with fMRI. The validity of an fMRI language localizer paradigm crucially depends on the choice of an optimal language task and baseline condition. This study presents a new fMRI language localizer in Russian using overt sentence completion, a task that comprehensively engages the language function by involving both production and comprehension at the word and sentence level. The paradigm was validated in 18 neurologically healthy volunteers who participated in two scanning sessions, for estimating test-retest reliability. For the first time, two baseline conditions for the sentence completion task were compared. At the group level, the paradigm significantly activated both anterior and posterior language-related regions. Individual-level analysis showed that activation was elicited most consistently in the inferior frontal regions, followed by posterior temporal regions and the angular gyrus. Test-retest reliability of activation location, as measured by Dice coefficients, was moderate and thus comparable to previous studies. Test-retest reliability was higher in the frontal than temporo-parietal region and with the most liberal statistical thresholding compared to two more conservative thresholding methods. Lateralization indices were expectedly left-hemispheric, with greater lateralization in the frontal than temporo-parietal region, and showed moderate test-retest reliability. Finally, the pseudoword baseline elicited more extensive and more reliable activation, although the syllable baseline appears more feasible for future clinical use. Overall, the study demonstrated the validity and reliability of the sentence completion task for mapping the language function in the brain. The paradigm needs further validation in a clinical sample of neurosurgical patients. Additionally, the study contributes to general evidence on test-retest reliability of fMRI.

POROCARCINOMA OVER SCALP: A RARE ENTITY

Porocarcinomas are aggressive adnexal tumors with a rare incidence. They are usually seen as a nodular or infiltrating growth over the lower extremities, infrequently over the scalp. They are thought to be arising from a pre-existing lesion and with a long clinical history. Treatment of choice is surgical resection with histopathologically confirmed negative margins. There are chances of local recurrence; hence a regular follow-up is must in these cases. Hereby we present a case of 42 year old male with 2 year history of growth over the right temporo-parietal region of the scalp. Histological confirmation of the diagnosis was done after wide local excision of the tumor. Porocarcinomas are mostly likely to be misdiagnosed clinically; therefore a histopathological correlation is necessary for the confirmation of diagnosis and further management of the patient.

Cytoarchitectonics of the Superior Parietal Cortex of an Outstanding Russian Scientist-Physiologist

The aim of the study is to identify possible cytoarchitectonic features of the structure of the cortex in the superior parietal region of an outstanding and talented scientist-physiologist.Material and methods. The cortex (area 7) of the superior parietal region of a scientist-physiologist and men of the senile age in the control group (8 hemispheres) was studied on the series of frontal brain slices, 20 μ thick, stained with cresyl purple according to Nissl method. The cortex area thickness, the thickness of the cytoarchitectonics layer III, the area of profile field of pyramidal neurons in layers III and V, the density of neurons surrounded by satellite glia and satellite glia density in layers III and V were measured in the cortex (area 7) of the superior parietal region in the left and right hemispheres of the brain.Results. We have identified several features of the cytoarchitectonics structure of the cortex (area 7) in the brain of the scientist-physiologist that may correlate with his outstanding scientific abilities. The cortex of a scientist-physiologist is characterized by a large thickness of the studied cortex and its cytoarchitectonic layers III and V, and a greater value of the area of the profile field of neurons if compared with the cortex in men of the senile age from the control group. A higher value of the neuron density and satellite glia in the cortex of the superior parietal region of the scientist-physiologist was revealed. There was also a lower severity of age-related changes in the cortex of the scientist-physiologist compared with the control group of men.Conclusion. The structure of the cortex (area 7) of the superior parietal region of the scientistphysiologist is characterized by a greater parameter of the cortical thickness and the thickness of the associative layer III, the size of neurons and the density of satellite glia if compared with those in men of the senile age of the control group. These features distinguish the structure of his cortex from the similar cortex of the control group of men and may be related to the features of the cognitive activity of the outstanding scientist-physiologist.

Relationship between the Types of Malocclusion and the Localization of Headaches in Adults

The aim of this study was to investigate the manifestations of headaches in adult patients with types of malocclusion and occlusion deformities. Methods and Results: The study was conducted in 171 adult patients (43 men and 128 women) with malocclusion and occlusion deformities at the age of 18 to 62 years old, who were examined in the orthopedic dentistry clinic. The nature of the dentition closing was studied directly in the patient's oral cavity, and with the help of the "Gnatomat" universal articulator on diagnostic plaster models of the jaws. The occlusal relationships of the teeth were analyzed in the position of the central, anterior, lateral and dynamic occlusions. The biomechanics of the lower jaw movements were studied in 3 mutually perpendicular directions. The detected anomalies and deformities of the occlusion were grouped as sagittal, transversal and vertical. Each group was diagnosed as independent forms of malocclusion, and combined with other anomalies and deformities of the dentoalveolar system. All the subjects were asked to answer the questions of a questionnaire specially developed for our study. The unified questionnaire was developed based on a modified rating questionnaire and the determination of the life disorders index in neck pain. The questionnaire includes blocks of questions aimed at identifying the localization of the headache in the temporal, parietal (in one or both) regions, occipital, frontal regions and in the longitudinal seam region. We identified complaints of patients with pain in adjacent regions of the head. Of the 171 examined adult patients with malocclusion and occlusion deformities, 99 (57.9%) complained of headaches. The presence of a headache in the parietal region of the head was associated most often with sagittal and transversal malocclusions. The presence of a headache in the temporal part of the head was associated often with vertical malocclusion The results of correlation analysis showed that pain in 2 regions of the head was associated with malocclusion: the temporal region (rb=0.9892, P=0.0013) and parietal region (rb=0.9712, P=0.0058). Other regions were not statistically significantly associated with malocclusion. Conclusion: There is a certain relationship between the types of malocclusion, occlusion deformities and localization of headaches in adults. Headaches in the parietal and temporal regions of the head are associated with malocclusion and occlusion deformities more often. The obtained data can serve as a basis for the development of recommendations for appropriate corrective measures in orthodontic practice.

Early postnatal irradiation‐induced age‐dependent changes in adult mouse brain: MRI based characterization

Background Brain radiation exposure, in particular, radiotherapy, can induce cognitive impairment in patients, with significant effects persisting for the rest of their life. However, the main mechanisms leading to this adverse event remain largely unknown. A study of radiation-induced injury to multiple brain regions, focused on the hippocampus, may shed light on neuroanatomic bases of neurocognitive impairments in patients. Hence, we irradiated BALB/c mice (male and female) at postnatal day 3 (P3), day 10 (P10), and day 21 (P21) and investigated the long-term radiation effect on brain MRI changes and hippocampal neurogenesis. Results We found characteristic brain volume reductions in the hippocampus, olfactory bulbs, the cerebellar hemisphere, cerebellar white matter (WM) and cerebellar vermis WM, cingulate, occipital and frontal cortices, cerebellar flocculonodular WM, parietal region, endopiriform claustrum, and entorhinal cortex after irradiation with 5 Gy at P3. Irradiation at P10 induced significant volume reduction in the cerebellum, parietal region, cingulate region, and olfactory bulbs, whereas the reduction of the volume in the entorhinal, parietal, insular, and frontal cortices was demonstrated after irradiation at P21. Immunohistochemical study with cell division marker Ki67 and immature marker doublecortin (DCX) indicated the reduced cell division and genesis of new neurons in the subgranular zone of the dentate gyrus in the hippocampus after irradiation at all three postnatal days, but the reduction of total granule cells in the stratum granulosun was found after irradiation at P3 and P10. Conclusions The early life radiation exposure during different developmental stages induces varied brain pathophysiological changes which may be related to the development of neurological and neuropsychological disorders later in life.

Primary essential cutis verticis gyrata – A case report

Cutis verticis gyrata (CVG) is a rare condition of the scalp characterized by convoluted folds and furrows produced by the excessive growth of the skin of the scalp and resembling the cerebral gyri. CVG can be identified as primary—essential or nonessential—or secondary. Herein, we report the case of a 20-year-old female with primary essential CVG, who presented herself with thickened and convoluted skin folds over the vertex and parietal region of the scalp persistent for one year prior without other symptoms. CVG is a rare congenital or acquired disease distinguished by redundancy of the scalp skin that resembles the cerebral gyri. The management of primary essential CVG can be symptomatic or surgical depending on the patient’s aesthetic expectations.

Combined dural inversion with multiple burr holes for refractory chronic subdural hematoma: A case report.

Background: Chronic subdural hematoma（CSDH） is a common disease in neurosurgery department. Burr-hole drainage is the main surgical treatment. And the recurrence rate is as high as 25%.Case presentation: In this case, a male patient with CSDH in the left frontotemporal parietal region underwent two drilling and drainage operations in the local hospital, but the hematoma recurred after operations. Being unable to bearing the repeated and progressive aggravation of headache, he came to our hospital for treatment. After considering the comprehensive situation, we use a new surgical method, removal of hematoma by drilling multiple holes in the lateral skull, to cure the patient.Conclusions: we get inspirations from the therapy for moyamoya disease, combining dura mater inversion and hole burr, the scalp forms many "meat column" like structures which have powerful capability in absorption through the bone holes, so the scalp could deep into the hematoma, then the CSDH could be cured. This case Provide a new surgical method for the treatment of refractory CSDH. Key words: CSDH R ecur Bone hole Scalp Dural mater inversion