‘Hand mechanogram’ in epilepsia partialis continua

Epilepsia partialis continua manifests as low-frequency, rhythmic involuntary movements of a focal body part. We report a young man, HIV-positive and with syphilis, who developed right-hand epilepsia partialis continua associated with a small left-sided cortico-subcortical frontal lesion. A pen and paper test provided ‘mechanographic’ data on frequency, amplitude and rhythmicity of the hand movements, helping distinguish it from other causes of low-frequency repetitive hand movements.

Calvarial tuberculosis in a paediatric patient: a diagnosis not to forget

We report the case of a 10-year-old boy that presented with a palpable, painless, frontal lesion. Laboratory assessments were unremarkable and the patient was asymptomatic. Initial investigation, with a skull radiograph and unenhanced CT scan, showed a lytic midline frontal lesion involving the inner and outer tables of the skull and a large subgaleal hypodense component. MRI further depicted communication with the epidural space and contact with the superior sagittal sinus (SSS). Subsequent evaluation by Doppler ultrasound and MR angiography excluded a sinus pericranii and showed normal patency of the SSS. Surgical biopsy revealed chronic granulomatous inflammation; PCR was positive for Mycobacterium sp. One year after surgical resection and antitubercular therapy, there are no signs of recurrence. Primary calvarial involvement by tuberculosis is rare, even in developing countries. Familiarity with the expected clinical and imaging features is required to avoid diagnostic delay.

Giant cavernoma mimicking a right frontal tumor

Cavernomas account for 9 to 16% of cerebrovascular malformations with a prevalence of 0.5% in the general population. We report a case of a large frontal cavernoma mimicking a frontal tumor and revealed by epileptic seizures. We report a 40-year-old man, without any particular history, received in consultation for tonic-clonic generalized convulsive seizures evolving for 5 years with a normal clinical examination on admission. Cerebral CT scan revealed a large right frontal lesion suggestive of a brain tumor, requiring surgical removal after persistent seizures despite dual antiepileptic therapy. The evolution was favorable at one year with the total cessation of the convulsive seizures without neurological after-effects. In conclusion, giant brain cavernomas are rare lesions and may be mistaken for a brain tumor.

Ayurvedic Management of Oligodendroglioma: A Case Report

Oligodendroglioma is a type of glioma arising out of oligodendrocytes of brain and spinal cord with a poor prognosis. The treatments include surgery, followed by radiation therapy and chemotherapy. Because of the long course of treatment including surgery followed by chemo and radiotherapy and the adverse effects of the same, many patients seek Ayurvedic management. A case of Oligodendroglioma in a 54-year-old female was managed as Vata kaphaja arbuda (~tumor) complicating to Asthi-majjagatavastha (~involvement of bone and marrow) with Shamana (~pacifying) procedures and medicines. 14 days of Shirolepa (~application of medicated paste over head) with Dhaturadikalka (~fruit paste of Datura metel linn) do at 4pm for a period of 45 minutes. This was followed by Shiropichu (~Application of oil-soaked wick on the vertex) with Rasathailam for 14 days in the evening 4pm-6pm. Guggulutiktaka kashaya 15 ml+ 60 ml hot water twice daily, Rasasinduram Capsule 125 mg twice daily with hot water, Nimbamrutadierandataila 10 ml with 50 ml warm milk for 1 week and Guggulutiktaka ghruta10 ml with luke warm water were given. Patient reported significant reduction of symptoms like headache, seizure, general weakness etc and improved Quality of life with a positive mind within two weeks. MRI change was remarkable after the treatment as the MRI taken on 29/1/20 has shown that Cortical based right frontal lesion measures 1.7*1.8cm, which was reduced in size compared to the previous MRI 2.3*2.3 cm taken after 22nd cycle of Inj. Avastin on 29/11/19. Rational application of Ayurvedic medicines can contribute much to the management of Oligodendroglioma.

A Rare Case of Metastatic Transformation to Pituitary Carcinoma

Background: Pituitary carcinomas are rare and comprise less than 0.5% of pituitary tumors and frequently arise from previously resected and/or radiated infiltrating adenomas.1 Radiation therapy is used to prevent regrowth but does not have significant data supporting improved prognosis.2 True pituitary carcinomas requires the presence of craniospinal and/or systemic metastases. Here, we present a case of benign pituitary adenoma that had progressed to a metastatic tumor and responded to radiation therapy. Clinical Case: Our patient was first diagnosed in 1982 with a pituitary mass after undergoing an MRI due to right eye blindness. He ultimately had a transcranial resection of the tumor and post-operative external radiation to residual tumor. Final pathology was consistent with a nonsecretory tumor. Additionally, he was diagnosed with panhypopituitarism and he was treated accordingly. Due to barriers of patient adherence, only one post-operative MRI was obtained, and he was lost to endocrine follow up. In 2007, he was again referred to endocrinology for new vision loss in the left eye. An MRI revealed a 3.0 x 3.8 x 4.4 cm tumor that compressed the optic chiasm. Additionally, multiple lesions were seen within the dural and leptomeningeal extra-axial areas including the largest left frontal lesion of 2.4 cm and a 1.7 cm lesion posterior to the cord within the foramen magnum. The patient underwent endonasal transsphenoidal resection of the sellar mass and biopsy of the frontal lesion in October 2007. Pathology showed pituitary adenocarcinoma in both the sellar and frontal lesions and immunoperoxidase staining was negative for all hormones. He completed salvage radiation to the sellar and craniospinal lesions in December 2007. MRI scans completed 7 months later showed stable residual pituitary and metastatic lesions. The patient received 6-month MRI screening exams for the first 2 years and then annually thereafter, as well as PET scanning, without significant progression or new metastatic lesions. Conclusion: We present a case of benign pituitary adenoma which transformed following resection to a malignant tumor with metastatic lesions in the brain and spinal cord that was treated with radiation with relative success. Despite the often-aggressive nature of these metastatic tumors, the patient has experienced a successful treatment course with minimal side effects and without progression 13 years after initial treatment of the metastatic pituitary carcinoma.

Giant Intracranial Aneurysmal bone cyst: Case Report and literature Review

We present the case of a 13-year-old male patient with a two-month clinical picture of global headache and progressive decrease in visual acuity. Neuroimaging showed a well-defined giant left frontal lesion, hypointense in T1, with heterogenous signal in T2 and intense enhancement after gadolinium. The patient was treated with surgical resection and the lesion confirmed pathologically as Cavernous Hemangioma with focal component of aneurysmal bone cyst. The aneurysmal bone cyst is a benign lesion of rapid growth and very destructive, which commonly occurs in metaphysics of long bones or axial skeleton, requiring radical treatment. It was first described in 1942, as an injury that occurred mostly in people under 20 years of age with a peak between 12 and 13 years, but very rarely occurs in the head and neck, mostly involving the occipital bone. The case is presented below together with a review on the subject of Aneurysmal Bone Cyst, through databases such as EMBASE, PubMed and COCHRANE, selecting 70 articles that covered relevant aspects of its physiopathology, clinical and radiological manifestations and surgical approach.

Giant Cell Glioblastoma Associated with Intrinsic Arteriovenous Malformation

Background: Primary brain tumors associated with cerebral arteriovenous malformations (AVM) although known is a rarely reported finding. There have been approximately 50 cases reported. Only two cases of a single lesion with coexistence of AVM and glioblastoma were described. Case Report. We report a case of a 46-year-old woman with headache and seizures for 2 months who performed a MR which displayed a large right frontal lesion suggesting a glioblastoma. Results. During surgical resection, two large veins could be seen draining tumoral vascularization in the surrounding cortex. After reaching the deepest portion of tumor, veins were coagulated and cut to allow tumor removal. However, unexpected bleeding started to occur with associated lesion growth and edema, resembling an AVM. Material sent to pathology revealed giant glioblastoma in association to an AVM with some thrombosed vessels and ischemic necrosis. Two previous studies discussed similar cases. Conclusion. The need of magnetic resonance in all AVM cases is highlighted in order to analyze brain parenchyma within AVM. We also remark the need of pathological analysis of whole surgical material, in order to characterize whole piece and to avoid not diagnosingan associated lesion.

Risk Factors for Nonconvulsive Status Epilepticus after Stroke

Background: Status epilepticus (SE) sometimes occurs after stroke. SE is classified as convulsive SE (CSE) and nonconvulsive SE (NCSE). Clinical characteristics, outcomes, mortality, and recurrences of post-stroke NCSE are yet to be clarified. Methods: We retrospectively identified post-stroke SE patients between April 2010 and September 2015, with follow-ups continued until March 2016. We compared baseline clinical characteristics (age, sex, past history of epilepsy, early seizure, stroke type, and localization) between the CSE and NCSE groups. We determined the Glasgow Outcome Scale (GOS) at discharge, along with the mortality and seizure recurrence rates for the two groups. Results: We identified 300 consecutive post-stroke seizure patients admitted to our department. A total of 50 post-stroke SE patients (33 men; mean age, 71.6 ± 14.2 years; 38 CSE; 12 NCSE; 20 ischemic strokes; 23 intracerebral hemorrhages; 7 subarachnoid hemorrhages) were included. Multivariable analysis showed that cardioembolic stroke and frontal lesion were significant risk factors of NCSE after stroke. GOS (Scale 1/2/3/4/5) results at patient discharge showed there was no significant difference between the groups (CSE; 8/26.3/18.4/26.3/21%, NCSE; 0/25/33/25/17%). Follow-up in 31 patients (21 CSE, 10 NCSE, median 815 days, interquartile range 538–1,327 days), revealed that seizure recurred in 15 CSE patients (71%) and in 4 NCSE patients (40%). During the follow-up, 3 CSE patients (14%) and 2 NCSE patients (20%) died. Seizure recurrence and mortality were not significantly different between the 2 groups. Conclusion: Cardioembolic stroke and frontal lesion were significant risk factors of NCSE after stroke.