Case Report on: Dandy Walker Malformation Syndrome

Introduction: Dandy Walker Syndrome is a congenital brain malformation that affects the cerebellum and the fluid filled areas that accompany it. The cerebellum is a part of the brain that deals with movement coordination as well as cognition and behavior. Case Presentation: The male patient 8 year old who was apparently admitted in A.V.B.R.H on 18/8/2019 is diagnosed with a known case of dandy walker malformation and came with the complaints of headache since 4 days, fever since 3 days, vomiting since 5 days and 3 episodes of seizures. All the necessary blood investigations has been done. The CT scan as well as MRI reports has shown that large posterior fossa cyst with open communication with fourth ventricle with hypoplastic left cerebellar hemisphere and no visualized cerebellar vermis. Before taking this case, information was given to the patients and their relatives and Informed consent was obtained from patient as well as relatives. Therapeutic Intervention: The patient was treated with NSAIDS, antibiotics, anticonvulsant, antiemetic and antacid and physical therapy to help keep muscle strength and flexibility The patient underwent VP shunt head circumference assessed regularly, vital signs hourly, provided vitamins enriched diet as per dietician’s order assisted dressing for drainage and physical therapy. Conclusion: The patient was admitted in A.V.B.R.H in a critical condition with the diagnosis of dandy walker syndrome, after providing the required treatment by the health care team members of hospital the patient condition was improved and satisfactory.

Primary Intracranial Malignant Melanoma: A Case Report And Review Of Literature

Background Primary Intracranial Malignant Melanoma (PIMM) is a very rare neoplasm and account for 1% of all melanomas and 0.1% of all intracranial tumors. It carries a poor prognosis with overall poor survival. Case Presentation: We here present a case of PIMM in a 35-year-old male presenting with sign and symptoms of a left cerebellar hemisphere tumor with leptomeningeal spread. Conclusions Diagnosis on mere imaging findings of an intracranial melanoma is a daunting task. Multimodality treatment with surgery followed by chemotherapy and radiotherapy have proved to be effective in improving clinical outcome in these patients.

RARE PRESENTATION OF LHERMITTE-DUCLOS DISEASE

Lhermitte-Duclos disease (LDD) arises from an uncommon benign lesion which alters the normal cerebellar laminar pattern. This case report shows the imaging ndings of this condition in 39 year-old male, presented with history of headache and dizziness for duration of ten days. Intial assessment included a non-contrast CT which showed a mass in left cerebellar hemisphere with surrounding mass effect. MRI multiplanar sequences showed a well dened T2 hyperintense lesion with a tigroid appearance.The lesion showed a mild bright signal on diffusion-weighted images, whereas MR Spectroscopy shows reduced choline levels. Differential diagnosis in terms of imaging include subacute infarct, cerebellitis, glial tumor,encephalitis but these do not give the classical tigroid appearance on MRI. Lack of contrast enhancement , signicant diffusion and cellularity of the lesions can help in differentiating among them.

The Effect of Different tDCS Protocols on Drug Craving and Cognitive Functions in Methamphetamine Addicts

Background and objective: Drug craving is considered to be a major problem in addiction treatment. Neuroimaging research has revealed various areas for drug craving, among which two key areas are the dorsolateral prefrontal cortex (DLPFC) and the cerebellum. The DLPFC is involved in different cognitive tasks like the inhibitory control over seductive options harboring the promise of immediate reward. The cerebellum considered to be related to cognition and memory and gets activated by drug-related cues. Therefore based on the previous researches we decided to study the effects of applying tDCS on six different protocols in reducing Drug Craving and increasing Cognitive Functions in Methamphetamine Addicts. Methods: The present study is a semi-experimental, with pre/post-test, and a control group. Based on a simple sampling method, 15 male methamphetamine addicts in two rehabilitation centers in Tehran were recruited. The participants were 18-65 years old with a minimum 12-month history of methamphetamine dependence. Visual Analog Scale (VAS), The Go/No-Go Task and The N-Back Task was administered before and after single session of tDCS. tDCS applied on six protocols which were: 1. The right DLPFC anodal and the left DLPFC cathodal stimulation 2. The right DLPFC cathodal and the left DLPFC anodal stimulation 3. The right DLPFC anodal and the right arm cathodal stimulation 4. The left DLPFC anodal and the left arm cathodal stimulation 5. The right cerebellar hemisphere (O2) anodal and the left cerebellar hemisphere (O1) cathodal stimulation 6. The right cerebellar hemisphere (O2) cathodal and the left cerebellar hemisphere (O1) anodal stimulation. The data were analyzed by covariance method using SPSS-22 software Results: Study results indicated while single session tDCS effects on craving were not significant, it increased cognitive inhibition especially in protocol 2: The right DLPFC cathodal and the left DLPFC anodal stimulation Conclusion and discussion: Single session of tDCS has an insignificant effect on craving but it can increase cognitive inhibition significantly. These findings extend the results of previous studies on the effects of brain stimulation for drug craving reduction in other drug type settings.

Synchronous Presentation of Rare Brain Tumors in Von Hippel–Lindau Syndrome

Von Hippel–Lindau (VHL) disease is a heritable cancer syndrome in which benign and malignant tumors and/or cysts develop throughout the central nervous system (CNS) and visceral organs. The disease results from mutations in the VHL tumor suppressor gene located on chromosome 3 (3p25-26). A majority of individuals (60–80%) with VHL disease will develop CNS hemangioblastomas (HMG). Endolymphatic sac tumor (ELST) is an uncommon, locally aggressive tumor located in the medial and posterior petrosal bone region. Its diagnosis is based on clinical, radiological, and pathological correlation, and it can occur in the setting of VHL in up to 10–15% of individuals. We describe a 17-year-old male who presented with a chief complaint of hearing loss. Brain and spine Magnetic Resonance Imaging documented the presence of an expansive lesion in the left cerebellar hemisphere, compatible with HMG in association with a second cerebellopontine lesion compatible with ELST. The peculiarity of the reported case is due to the simultaneous presence of two typical characteristics of VHL, which led to performing comprehensive genetic testing, thus allowing for the diagnosis of VHL. Furthermore, ELST is rare before the fourth decade of life. Early detection of these tumors plays a key role in the optimal management of this condition.

Case of penetrating brain injury caused by a ventriculoperitoneal shunting procedure

Brain injury with ventricle puncture is a well-known complication of ventriculoperitoneal (VP) shunting. However, parenchymal injuries caused by a shunt tunneller are rare. Herein, we present a case of penetrating brain injury caused by a shunt tunneller during VP shunting. An 83-year-old woman with brainstem glioma underwent VP shunting to control hydrocephalus due to tumour growth. She underwent brainstem tumour biopsy with a lateral suboccipital approach. After the shunting, CT showed a linear haematoma in the left occipital lobe far from the site of the ventricular puncture. MRI revealed a small contusion in the left cerebellar hemisphere, disconnection of the left tentorial membrane and linear haematoma on a straight line. These facts suggested that the shunt tunneller had penetrated the skull through the craniotomy of the posterior fossa. This is a rare complication of VP shunting, with limited cases reported in the literature.

Utility of indocyanine green in the detection of radiologically silent hemangioblastomas: case report

Hemangioblastomas (HBs) are rare, benign, hypervascularized tumors. Fluorescent imaging with indocyanine green (ICG) can visualize tumor angioarchitecture. The authors report a case of multiple HBs involving two radiologically silent lesions only detected intraoperatively by ICG fluorescence. A 26-year-old woman presented with a cystic cerebellar mass on the tentorial surface of the left cerebellar hemisphere on MRI. A left paramedian suboccipital approach was performed to remove the mural nodule with the aid of ICG injection. The first injection, applied just prior to removing the nodule, highlighted the tumor and vessels. After resection, two new lesions, invisible on the preoperative MRI, surprisingly enhanced on fluorescent imaging 35 minutes after the ICG bolus. Both silent lesions were removed. Histological analysis of all three lesions revealed they were positive for HB. The main goal of this report is to hypothesize possible explanations about the mechanism that led to the behavior of the two silent lesions. Intraoperative ICG videoangiography was useful to understand the 3D angioarchitecture and HB flow patterns to perform a safe and complete resection in this case. Understanding the HB ultrastructure and pathophysiological mechanisms, in conjunction with the properties of ICG, may expand potential applications for their diagnosis and future treatments.

Transient total locked-in syndrome due to vertebral and basilar artery dissection

A 52-year-old woman suddenly presented with right conjugate eye deviation, anarthria and quadriplegia, and appeared to be in a deep coma. MRI revealed a new infarct in the left cerebellar hemisphere and stenosis in the distal portion of the basilar artery caused by arterial dissection. Her deficits improved within 6 hours of onset. Moreover, on day 1, she described that she had been alert and her vision, hearing and somatic sensation had been preserved during the illness. Total locked-in syndrome should be considered while assessing patients with total immobility who are unable to communicate.

OTHR-12. ANEURYSMAL BONE CYST RESEMBLING A POSTERIOR FOSSA TUMOR

We presented the case of a 6-year-old boy who was seen in the emergency room because of signs of intracranial hypertension and left cerebellar syndrome. The CT scan revealed a heterogeneous lesion within the left hemisphere displacing the fourth ventricle and eroding the occipital bone. The MRI showed the same heterogeneous lesion majorly cystic, involving the bone and displacing the left cerebellar hemisphere. A minor hydrocephalus was evident in both studies. A suboccipital craniectomy was done and a cystic epidural tumor remodeling and eroding the bone was noted. The histopathological diagnosis corresponded to an aneurysmal bone cyst. Aneurysmal bone cyst is a rare benign tumor accounting for 3–6 % of tumors of the cranial base. We discuss the unusual location of the lesion.

Rare Abnormality of the Posterior Fossa: Unilateral İsolated Cerebellar Hypoplasia

The cerebellum abnormalities may be hypoplastic, dysplastic, or hypoplastic. It is very rare that the cerebellar hemisphere is affected unilaterally in the posterior fossa abnormalities. The reason for this effect is mostly sequela. This pathology presents with neuromotor developmental abnormalities. In this presentation, isolated left cerebellar hypoplasia is described radiologically in a 21-month-old male patient with neuromotor development defects. Dysplastic appearance was noticeable in the observable part of the left cerebellar hemisphere and folia. The cerebellar vermis could not be shaped. The right cerebellar hemisphere, other posterior fossa formations, and supratentorial area were natural. In patients with neuromuscular abnormalities, the posterior fossa is applied with care. It should be remembered that cerebellar hypoplasia and dysplasia can be unilateral.