Dysembryoplastic neuroepithelial tumor presenting as a hypothalamic hamartoma in a child with gelastic seizures: case report

Dysembryoplastic neuroepithelial tumors (DNETs) are benign intracranial tumors of neuroglial origin, mostly located in the supratentorial regions and particularly in the temporal lobe. Few cases of DNETs in the hypothalamus have been described. The authors present the case of a DNET in the hypothalamus. The 5-year-old girl with complaints of limb and gelastic seizures was admitted to the neurosurgical department of Xiangya Hospital. Neurological examination findings were unremarkable. MRI showed isointensity without significant enhancement on T1- and T2-weighted images. The lesion exhibited clearly defined borders on the sagittal, coronal, and axial images. The preliminary diagnosis was hypothalamic hamartoma (HH); however, the lesion was surgically removed, and histopathological examination confirmed the diagnosis of a DNET. Hypothalamic DNETs are extremely rare. Based on their clinical manifestation and imaging, DNETs are easily misdiagnosed as HHs. Diagnoses apart from HHs must be entertained when a hypothalamic lesion is being investigated.

Clinical and Experimental Study on Thermoregulatory System and its Relation with Vasomotor Rhinitis

Introduction Much of the perennial cold are of vasomotor origin still a less appreciated phenomenon even among the medical personnel, much of which is dubbed in a cursorily in the clinical analogue of a west paper wrap as ‘allergic rhinitis’. This study was attempted to find out the role of thermoregulatory system with causation of vasomotor rhinitis and assessing role of hypothalamus in causation of vasomotor rhinitis. Materials and Methods In this study conducted during the period of July 1987 to August 1988, 20 normal adult individuals were taken as control and thermoregulatory study was done on them. The results were compared with cases of vasomotor rhinitis/non-allergic rhinopathy cases. In experimental study thermoregulatory study was done on albino rats before and after stereotaxis of anterior and posterior hypothalamic nuclei and the result were compared before stereotaxis and post stereotaxis. Results Among human study in clinical subjects, patient suffering from vasomotor rhinitis showed a definite shift towards thermoregulatory imbalance both for generalized body caloric fluctuation and particularly on the nasal mucosa. Post-vidian neurectomy results for thermoregulation test was highly significant. In animal study post-hypothalamic stereotaxis temperature measurement showed minimal depression. Dorsal anterior hypothalamic lesion ablation showed significant derangement in the thermoregulatory tolerance profile of the rats’ belly temperature. Posterior hypothalamic lesion showed that there may be some amount of derangements in the thermoregulatory tolerance, which however is not statistically conclusive. Thermoregulatory control is done at hypothalamus, particularly at anterior hypothalamic nuclei level and posterior hypothalamic nuclei in the brain. Thermoregulatory study proves a close correlation between non allergic rhinitis with imbalance in central thermal regulation by hypothalamus. Conclusion Thermoregulatory study in control and clinical subjects proves a close correlation between vasomotor rhinitis and sympathetic, parasympathetic system.

A rare case of hyponatremia from a hypothalamic lesion in a patient with multiple sclerosis

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur from a variety of neurologic and systemic processes; however, it has rarely been seen in multiple sclerosis (MS). We report a case of SIADH in a patient with MS and compare it with previously reported English-only cases. A 32-year-old woman experienced generalized fatigue followed by confusion and was found to have profound hyponatremia. Her work-up demonstrated SIADH secondary to a discrete enhancing hypothalamic lesion. Despite the seldom occurrence of SIADH in MS, hypothalamic lesions are more common than appreciated and should be considered in patients presenting with hyponatremia or endocrinopathy symptoms.

Cluster-like headache and a cystic hypothalamic tumour as first presentation of sarcoidosis

Introduction Sarcoidosis is a granulomatous, multisystem inflammatory disease of unknown cause, which presents with a wide variety of symptoms. We describe a rare case of a newly diagnosed sarcoidosis, with cluster-like headache as a presenting symptom. Case A 31-year-old man presented with cluster headache with a cystic lesion in the hypothalamus. A non-caseating granuloma consistent with the diagnosis sarcoidosis was found at biopsy. Pulmonary involvement was confirmed on positron electron tomography-computed tomography (PET-CT). Treatment with prednisone led to regression of the hypothalamic lesion. Headache attacks did not recur. Discussion Cluster-like headache with a cystic hypothalamic lesion as first presentation of sarcoidosis has never been reported. Their possible relationship seems to underline the role of the hypothalamus in the central pain-regulatory areas in the brain, but is not undisputed. This case clearly demonstrates once again the relevance of neuroimaging in new-onset cluster-like headache.