Neurocysticercosis in a Japanese woman with lung cancer who repeatedly visited endemic countries

Background Taenia solium, present in most developing countries, infects many individuals and may result in their death. Neurocysticercosis (NCC) develops after invasion of the brain by parasitic larvae. It is the most common parasitic disease of the human central nervous system. On imaging scans it can be similar to brain tumors. We report a patient with a metastatic brain tumor and NCC. The co-presence of NCC was diagnosed based on specific neuroimaging- and epidemiologic findings. Case presentation A 36-year-old non-smoking Japanese woman with a history of non-small-cell lung cancer had undergone resection of the lower lobe followed by cytotoxic chemotherapy 2 years before apparently suffering recurrence. A positron emission computed tomography (PET) scan incidentally revealed multiple intracranial cold spots exhibiting differences in their shape and size. On brain magnetic resonance imaging (MRI) scans we observed many different patterns of peripheral edema and gadolinium-enhancing effects. As she had often visited Latin America and Southeast Asia and had eaten raw pork and Kimchi, we suspected that the brain lesions were due to NCC rather than metastatic brain tumors. However, serum immunoblotting assay and DNA analysis were negative for T. solium. Rather than performing resection, we administered albendazole (ABZ) and dexamethasone because her earlier cytotoxic chemotherapy had elicited severe pancytopenia. Except for a single large lesion in the left frontal lobe, this treatment resulted in a significant reduction in the size of these lesions and a decrease in perilesional edema. She underwent resection of the residual lesion 10 months later. Histology revealed it to be a metastatic tumor. Polymerase chain reaction (PCR) assay for NCC was negative. In the course of 11-months follow-up there has been no recurrence. Conclusion This is the first presentation of NCC in a Japanese woman with a metastatic brain tumor. NCC was incidentally discovered on PET scans and, based on her travel history and epidemiological findings; it was diagnosed and successfully treated with ABZ. NCC is endemic in most developing countries and as visits to such countries have increased, NCC must be ruled out in patients with multiple cystic nodular brain lesions.

Ring enhanced aneurysm due to vasa vasorum of aneurysm wall mimicking a metastatic brain tumor

Background: A spherical intracranial mass can be occasionally misdiagnosed due to the lack of typical radiographic features. Completely thrombosed intracranial aneurysms (CTIA) are uncommon, but a possible differential diagnosis must be considered to guarantee the best surgical approach for these lesions. Case Description: Here, we report an extremely rare case of a right frontal mass mimicking a brain tumor, in which the surgery unveiled a CTIA of the right middle cerebral artery (MCA). A 56-year-old woman presented with right hemiparesis and mild headache. Magnetic resonance imaging (MRI) revealed a right frontal mass with peripheral edema. The lesion enhanced on initial and follow-up MRI of the brain. Subsequent vascular studies and metastatic workup were negative. A temporal craniotomy with neuronavigation (Brain Lab AG, Germany) was performed and an intraoperative diagnosis of a thrombosed aneurysm along the branch of the MCA was established. The aneurysm was successfully trapped and resected. The patient did not exhibit any postoperative neurological deficits. Conclusion: This is the rare report of a ring enhanced completely thrombosed aneurysm due to vasa vasorum which is misdiagnosed as metastatic brain tumor. In case of an intracranial ring enhanced mass with signs of intralesional hemorrhage and peripheral edema, CTIA should be considered as a possible differential diagnosis.

Anesthesia for Awake Craniotomy in Patients with Metastatic Brain Tumor in Ibadan, Nigeria

Introduction: Craniotomies can be performed under general anaesthesia or with the patients awake known as awake craniotomy. Awake craniotomy requires that the patients be conscious and cooperative during intraoperative neurological testing. Methods: This was a retrospective study of the anaesthetic protocol and the complications encountered during the perioperative management of patients who had awake craniotomy for metastatic brain resection in a developing country over a 3- year period. The information retrieved were demographic data, tumor location, anaesthetic technique and perioperative complications. Results: There were ten patients comprising of 9 (90%) females and 1 (10%) male. The age ranged from 33 to 66 years with a mean age of 44.00 ± 12.02 years. Eight patients had metastatic brain tumor from the breast carcinoma, one from the lung and the last patient had metastasis from the colon. Four patients had tumor excision from the frontal lobe while 6 patients had excision from the parietal lobe. They all had solitary brain tumor. The anaesthetic technique used was conscious sedation and scalp block. Propofol and fentanyl were used for the conscious sedation while 0.25% Plain Bupivacaine and 1% Lidocaine with adrenaline (1: 200,00) were used for the scalp block. Patients were allowed to breathe spontaneously 100% oxygen. Two patients had respiratory depression with oxygen saturation less than 95% and laryngeal mask airway was inserted. Hypertension and tachycardia were seen in 4 patients, focal seizure in 2 patients and aphasia in 1 patient. Intensive care unit admission was for 24 hours and the today length of hospital stay was 2-7 days. No mortality in this series. Conclusion: Conscious sedation with scalp block is a safe and a tolerable technique for awake craniotomy. The complications observed were minimal and can be treated to obtain a good outcome.

MET-04 A case of Brain Metastases with repeated bleeding from Esophageal carcinoma

Brain metastases from esophageal cancer is rare and the incidence has been reported at approximately 5%. We report a case of brain metastases with repeated bleeding from Esophageal carcinoma. The case is a 76-year-old man. Three years ago he was diagnosed with small cell carcinoma of the esophagus by endoscopic biopsy. Metastasis was found only in the cervical lymph node, but the condition was stable by chemoradiotherapy and no metastases were found throughout the body before 1 month. He was admitted to the hospital because of a sudden convulsion, and CT scan revealed cerebral hemorrhage in the right frontal lobe. We performed conservative treatment, but rebleeding was observed from the same site repeatedly after 1 month and 2 months. Due to the influence of bleeding, it was difficult to distinguish cerebral hemorrhage from brain tumor by contrast MRI. After surgery, the cause of bleeding was diagnosed as metastatic brain tumor of esophageal small cell carcinoma. Postoperative radiation therapy was performed in another hospital, but rebleeding was observed 3 months after the operation. A reoperation was performed at another hospital, and a recurrence of metastatic brain tumor was diagnosed. In the case of highly malignant metastatic brain tumors, it was considered necessary to frequently follow the images.