Cervical epidural hematoma with Brown-Sequard syndrome caused by an epidural injection: a case report

Epidural hematoma with Brown-Sequard syndrome caused by an epidural injection is a rarely found condition in the emergency department (ED). We report an unusual case of Brown-Sequard syndrome in a 55-year-old man who presented at the ED with right-sided weakness and contralateral loss of pain and temperature sensation after a cervical epidural injection for shoulder pain. Cervicla spine magnetic resonance imaging showed an epidural hematoma from C4 to C6. After admission, his right hemiparesis and contralateral sensory loss improved within eight days, and surgical decompression was not required. Diagnosing spinal lesions in the ED is challenging, especially in patients with acute neurological signs requiring immediate evaluation for stroke. In this case, definite hemiparesis and some contralateral sensory loss were noted. Therefore, a potential spinal lesion was suspected rather than a stroke. This case emphasized the importance of conducting a focused neurological examination after history taking.

Indolent Enhancing Spinal Lesions Mimicking Spinal Metastasis in Pediatric Patients With Malignant Primary Brain Tumors

BackgroundSpinal metastasis from malignant primary brain tumor (MPBT) in pediatric is rare, often appearing as enhancing lesions on MRI. However, some indolent enhancing spinal lesions (IESL) resulting from previous treatment mimic metastasis on MRI, leading to unnecessary investigation and treatment. MethodsIn 2005-2020, we retrospectively enrolled 12 pediatric/young patients with clinical impression of spinal metastasis, and pathological diagnosis of their spinal lesions. Three patients had MPBT with IESL, and 9 patients had malignant tumors with metastases. The histopathologic diagnosis of IESL was unremarkable marrow change. We evaluated their MRI, CT, and bone scan findings.Results Image findings of IESL vs spinal metastasis were 1) shape: round/ovoid (3/3, 100%) vs irregular (9/9, 100%) (P= .005); 2) target-shaped enhancement: (3/3, 100%) vs (0/9, 0%) (P= .005); 3) pathologic fracture of vertebral body: (1/3, 33.3%) vs (9/9, 100%) (P= .045); 4) expansile vertebral shape (0/3, 0%) vs (9/9, 100%) (P= .005); 5) obliteration of basivertebral vein: (0/3, 0%) vs (9/9, 100%) (P= .005); 6) osteoblastic change on CT: (3/3, 100%) vs (2/9, 22.2%) (P= .034).ConclusionsIESL in pediatrics with MPBT can be differentiated from metastasis by their image characteristics. We suggest close follow-up rather than aggressive investigation and treatment for IESL.

Expending the Phenotypic Spectrum of Encephalocraniocutaneous Lipomatosis: About a Prenatal Case With Complete Autopsy

Encephalocraniocutaneous lipomatosis (ECCL) or Haberland syndrome (MIM #613001) is a rare congenital neurocutaneous disorder. It is characterized by unilateral ocular, cutaneous and central nervous system anomalies. Key clinical features include hairless fatty tissue nevus of the scalp, choristoma of the eye and intraspinal and intracerebral lipomas. We report one of the first cases diagnosed after termination of pregnancy at 35 WG, including antenatal and post-mortem imaging, complete autopsy and genetic analysis. Prenatal ultrasound and MRI of the third trimester showed multifocal spinal lesions and left lateral cerebral ventriculomegaly with cerebral atrophy. Diagnosis of ECCL was suggested at complete autopsy which revealed nevus psiloliparus of the scalp, facial hamartomas and intracranial and spinal lipomas. In addition, our case also exhibited a cardiac rhabdomyoma and a multicystic dysplastic kidney, both never reported to date in this syndrome. ECCL was confirmed by the identification of a postzygotic FGFR1 mutation. We reviewed the literature and discuss the pathogenesis of this syndrome.

Hypofractionated stereotactic body radiation therapy (SBRT) in pediatric patients: preliminary toxicity results of a national prospective multicenter study

Objectives: While hypofractionated stereotactic body radiotherapy (SBRT) has been largely adopted in the adult setting, its use remains limited in pediatric patients. This is due, among other factors, to fear of potential toxicities of hypofractionated regimens at a young age. In this context, we report the preliminary acute (<3 months from SBRT) and middle-term (3–24 months) toxicity results of a national prospective study investigating SBRT in pediatric patients. Methods: Between 2013 and 2019, 61 patients were included. The first 40 patients (median age: 12 y, range: 3–20) who completed a 2-year-follow-up were included in the present analysis. SBRT was used for treating lung, brain or (para)spinal lesions, either as first irradiation (35%) or in the reirradiation setting (65%). Results: Acute and middle-term grade ≥2 toxicities occurred in 12.5 and 7.5% of the patients, respectively. No grade ≥4 toxicities occurred. Almost all toxicities occurred in the reirradiation setting. Conclusion: SBRT showed a favorable safety profile in young patients treated for lung, brain, and (para)spinal lesions. Advances in knowledge: SBRT appeared to be safe in pediatric patients treated for multiple oncology indications. These results support further evaluation of SBRT, which may have a role to play in this patient population in the future.

Exacerbating of chronic disease as risk factor for surgical delay in patients with spinal metastases

Object. Determining the degree of influence of exacerbation of somatic pathology on the shift of the terms of surgical treatment in patients with spinal metastases. Methods. A retrospective analysis of the data of 210 patients with spinal neoplasms undergoing treatment in the period from 2013 to 2017 was performed. In this cohort, the average terms from the moment of determining the indications for surgical treatment to surgery, as well as the frequency of somatic pathology, which was a contraindication to surgical treatment, were analyzed Results. The average time from the moment of determining the indications for surgical treatment to surgery in the main cohort of patients was 46.4 days (12 - 86). An aggravation of the gastrointestinal tract pathology with the formation of ulcers or erosion of the stomach and duodenum was the most common cause of delayed surgical treatment (41%). At the same time, 86% of cases of this complication led to a shift in the timing of surgery to 1 month. The presence of foci of chronic infection statistically significantly determined the greatest duration of the preoperative period (> 1 month) in 52.6% of cases. Conclusion. An aggravation of the gastrointestinal tract pathology and the presence of foci of chronic infection in patients with metastatic spinal lesions are the most frequent contraindications to surgical treatment and the reasons for the increase in the duration of the preoperative period.