Intracranial hypertension and empty Sella from adrenal adenoma and excessive and prolonged steroid usage: a case report

Background There is only one documented case of intracranial hypertension (IH) and empty sella from cortisol-producing adrenal adenoma so far. And IH and empty sella caused by long-term exogenous hypercortisolism has never been reported before. The purpose of this case report is to alert clinicians to glucocorticoid-induced IH. Case presentation We present retrospectively a 50-year-old woman with cortisol-secreting adrenal adenoma, who progressed to intractable intracranial hypertension and a markedly expanded empty sella due to improper treatment. In 2011, the patient presented with hypertension, lack of cortisol circadian rhythm, low ACTH, a left adrenal adenoma and a partial empty sella, but did not receive low-dose dexamethasone suppression test (LDDST) and 24-h urinary cortisol. In 2014, she exhibited truncal obesity, raised cortisol, LDDST non-suppression, high urinary free cortisol and low ACTH, proving her cortisol-producing adrenal adenoma. She was simultaneously diagnosed with unexplained IH because of papilledema and elevated intracranial pressure, and her partial empty sella changed to a complete empty sella. In 2015, she underwent adrenal adenoma resection. From 2015 to 2018, she kept taking dexamethasone at least 2 mg daily without her doctors’ consent. During this period, she developed transient cerebrospinal fluid rhinorrhea, and her empty sella further worsened. After switching to low dose hydrocortisone, her papilledema disappeared completely, but optic atrophy has become irreversible. Conclusions The patient seems to be just an extreme case, but it may reveal and illustrate a general phenomenon: Both cortisol-producing adrenal adenoma and long-term exogenous hypercortisolism could cause varying degrees of elevated intracranial pressure and empty sella. Clinicians should remain vigilant for this phenomenon in patients with cortisol-producing adrenal adenoma or excessive and prolonged steroid usage and give them corresponding examinations to identify this complication.

A Case of Rhino-Orbital Cerebral Mucormycosis presenting with spontaneous Cerebrospinal fluid Rhinorrhoea

Rhino-orbital cerebral mucormycosis has increased in the recent second wave of post-Covid-19 illness, mainly in tropical countries like India. The burden of diabetes mellitus and rampant use of corticosteroid, environmental factors, post-covid-19 immunological derangement might be contributory factors to the development of extensive outbreak of ROCM. Cerebrospinal fluid rhinorrhea is rarely documented with such fungal infection in literature. This case report described a 45-year diabetic woman in the post-Covid-19 phase,who developed rhino-orbital cerebral mucormycosis, presenting with spontaneous cerebrospinal fluid rhinorrhea.

Case Report: A Case of Sarocladium strictum Meningoencephalitis in an Immunocompetent Patient After Invasive Operation

As an opportunistic phytopathogen, Sarocladium strictum has only been shown to cause neurological disease in immunocompromised patients, where antifungal therapy was not effective. We report a case of Sarocladium strictum meningoencephalitis in an apparently immunocompetent young woman who presented with severe headache and slight fever after undergoing transnasal endoscopic repair of cerebrospinal fluid rhinorrhea. Chronic sinusitis and suspicious intracranial fungal lesions were observed on enhanced magnetic resonance imaging (MRI). Both culture and metagenomic next-generation sequencing of her cerebrospinal fluid were positive for Sarocladium strictum. After local debridement, treatment with amphotericin B plus voriconazole and Ommaya reservoir implantation, the patient improved significantly. Unfortunately, her symptoms worsened again despite plenty of antifungal therapy for a month.

Simultaneous repair of the skull base and the frontal lobe defect using CAD-CAM technology

Many patients with traumatic brain injury develop complications in the postoperative period. The article describes a case of revision surgery in a female patient with cerebrospinal fluid rhinorrhea following a severe car accident. During one surgery, the skull base and the frontal bone defect were repaired and a lumboperitoneal shunt was placed. The skull base was repaired using an autologous musculoaponeurotic graft. For a better cosmetic effect, the implant was designed using CADCAM technologies. The patient had a relapse of the leak in the postoperative period, which required revision surgery (multilayer reconstruction using a fibrin-thrombin sponge). The patient was followed up for 2 years, with no relapse. The desired clinical and cosmetic effects were successfully achieved.