1/33. Frontal intraosseous cryptic hemangioma presenting with supraorbital neuralgia.Primary intraosseous cranial hemangiomas are rare benign tumors comprising 0.2% of all osseous neoplasms. Symptomatic cranial cryptic hemangiomas are extremely rare. We report the case of a 43-year-old man with a cryptic hemangioma of the superior orbital rim. Radiological investigations revealed it to be an intraosseous cryptic mass which was totally excised and the supraorbital nerve was decompressed, relieving the patient of his symptoms. Histopathology showed features of an intraosseous hemangioma.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
2/33. Possible role of an endovascular provocative test in the diagnosis of glossopharyngeal neuralgia as a vascular compression syndrome.We utilized endovascular provocative techniques to identify the indications for microvascular decompression surgery in a serious case of glossopharyngeal neuralgia. This is the first reported case in which an endovascular provocative test was applied for diagnosis of glossopharyngeal neuralgia as a vascular compression syndrome. A 68-year-old woman presented with severe paroxysmal facial pain which could not be controlled by medical therapy. Partial effectiveness to carbamazepine led us to wonder whether or not the selection of microvascular decompression surgery would be appropriate. Pre-operative angiography was performed. During the examination a microcatheter was inserted into the right posterior inferior cerebellar artery (pica), and an attack of typical glossopharyngeal neuralgia occurred. The patient thus underwent microvascular decompression surgery. The pica was verified to compress the glossopharyngeal nerve and therefore was moved to induce decompression. The patient has since experienced no further pain for one year postoperatively. The diagnosis of glossopharyngeal neuralgia is sometimes complex and it is difficult to select the most appropriate surgical modality. In such cases this endovascular provocative technique may thus be useful for making a definitive decision or microvascular decompression surgery.- - - - - - - - - - ranking = 1.0911598847823keywords = complex (Clic here for more details about this article) |
3/33. Visual field deficit caused by vascular compression from a suprasellar meningioma: case report.OBJECTIVE AND IMPORTANCE: Suprasellar meningiomas typically cause bitemporal hemianopsia by direct compression of the chiasm, its blood supply, or both. We report another mechanism for visual loss in suprasellar meningiomas, whereby compression by the suprajacent vascular complex is the offending agent. CLINICAL PRESENTATION: A 78-year-old woman with a suprasellar meningioma was diagnosed incidentally. During the follow-up period, she developed an inferior homonymous wedge defect consistent with superior compression, without any detectable radiological progression. It was decided to resect her tumor. INTERVENTION: The patient underwent a fronto-orbital approach for tumoral excision. Intraoperatively, a groove by the anterior cerebral artery complex was found along the superior surface of the chiasm. Postoperatively, the patient's visual deficit resolved. CONCLUSION: This case illustrates an unusual visual field deficit associated with a suprasellar meningioma. It also emphasizes the importance of frequent and careful visual field monitoring, which can precede radiological and symptomatic progression.- - - - - - - - - - ranking = 2.1823197695647keywords = complex (Clic here for more details about this article) |
4/33. Management of traumatic optic neuropathy.Visual loss caused by trauma to the optic nerve is a well-recognized sequela to cranio-maxillofacial trauma. The authors reviewed their experience with 90 patients with pure traumatic optic neuropathy and optic nerve trauma with concomitant maxillofacial injuries. All patients were treated with intravenous steroids. Those not improving underwent extracranial optic canal decompression. patients with initial visual acuity of 20/100 or better all responded favorably with improvement in visual acuity or visual field to a course of intravenous megadose corticosteroids. patients with initial vision of 20/200 or worse who failed to respond to corticosteroids may have improved visual function after undergoing extracranial optic canal decompression. Preoperative and postoperative computed tomography scans on 6 patients enhanced with intrathecal iopamidol indicate the site of optic nerve compression to be at the optic canal. This article discusses the diagnosis and the medical and surgical treatment of pure and complex optic nerve injuries.- - - - - - - - - - ranking = 1.0911598847823keywords = complex (Clic here for more details about this article) |
5/33. Unusual presentation of multiple myeloma with unilateral visual loss and numb chin syndrome in a young adult.A 39-year-old man presented with unilateral visual loss as the first sign of multiple myeloma (MM). His visual loss was due to a plasmacytoma in the sphenoid sinus compressing the optic nerve with resultant optic nerve atrophy. Shortly after this presentation he developed numb chin syndrome due to a mandibular plasmocytoma compressing the mental nerve. His MM progressed rapidly despite treatment with high-dose steroids and alkylating agents and he required allogeneic bone marrow transplantation in order to achieve a remission. We reviewed the published medical literature on the presentation of MM with visual impairment and present a summary in tabular form in this paper. This is the first reported case of MM presenting with isolated complete visual loss due to intracranial extrinsic compression of the optic nerve since the advent of modern cross-sectional imaging. multiple myeloma needs to be included in the differential diagnosis of cranial neuropathies and skull base neoplasms even in adults under 40 years of age.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
6/33. Vision recovery following nasopharyngeal angiofibroma excision.'Juvenile' nasopharyngeal angiofibroma is a locally aggressive, yet histologically benign, vascular neoplasm. This neoplasm accounts for less than 0.5% of head and neck neoplasms. We report an unique case of a 14-year-old male with a nasopharyngeal angiofibroma compressing the optic nerve and causing great visual impairment. The tumor was a red lobulated mass in left nostril, invading maxillary sinus, anterior and posterior ethmoid sinus, sphenoid sinus, and cavum area. Midfacial degloving approach and total excision of the tumor resulted in almost completely visual recovery. Optic nerve decompression was not performed. We consider that an early diagnosis, an adequate approach, total tumor excision, and efforts by a team of sub-specialists are most likely to yield optimal results.- - - - - - - - - - ranking = 3keywords = neoplasm (Clic here for more details about this article) |
7/33. Acute cauda equina compression revealing Hodgkin's disease: a case report.STUDY DESIGN: This is a case report of a young patient who experienced an acute epidural compression of cauda equina revealing Stage IV Hodgkin's disease. OBJECTIVES: To draw attention to this rare presentation of Hodgkin's disease, and to assess the role of surgery in acute cauda equina compression in a context of a chemosensitive disease. SUMMARY OF BACKGROUND DATA: Lymphomatous tissue in Hodgkin's disease may involve the spine usually in the setting of advanced disease. Initial manifestation of Hodgkin's disease in the spine is rare. The management of this rare presentation may be conservative, but surgery provides the most rapid way of neurologic tissue decompression. methods: The case of a 14-year-old patient who experienced an acute epidural compression of cauda equina revealing Stage IV Hodgkin's disease is presented. RESULTS: The patient complained of an increased lower back pain of 1-month duration before he developed lower limbs numbness, loss of perineal sensation, and urinary retention. Sagittal and axial T2-weighted magnetic resonance images of the lumbar spine revealed tumoral invasion of the epidural space compressing the cauda equina. Emergency surgical decompression was performed. In fine, Stage IV Hodgkin's disease revealed by acute epidural cauda equina compression was diagnosed. The patient recovered normal neurologic functions in a few days and then underwent chemotherapy and radiotherapy. CONCLUSION: Although a rare situation, Hodgkin's disease may involve the spinal epidural space at presentation. The management is complex, but surgery provides the most rapid means of diagnosis and neurologic tissue decompression in severely affected patients.- - - - - - - - - - ranking = 1.0911598847823keywords = complex (Clic here for more details about this article) |
8/33. Some forms of tinnitus may involve the extralemniscal auditory pathway.It has previously been shown that the click-evoked responses recorded from the intracranial portion of the eighth nerve in patients with incapacitating tinnitus are not abnormal, nor is the latency of peak III of the click-evoked brainstem auditory-evoked potentials significantly altered; however, the latency of peak V is slightly (but significantly) shortened in comparison to that of patients with the same degree of hearing loss but no tinnitus. In this study the hypothesis that the extralemniscal auditory system is involved in the generation of tinnitus is tested. We made use of the fact that neurons of the extralemniscal auditory system also receive input from the somatosensory system, and that stimulation of the somatosensory system can influence the processing of auditory information in the extralemniscal system. In 4 of 26 patients with mild-to-severe tinnitus whose median nerve was stimulated electrically, the tinnitus increased noticeably during stimulation, in 6 the intensity of the tinnitus decreased noticeably, and in the remaining 16 there was no noticeable change in the tinnitus. In some of the patients the character of the tinnitus changed in a complex way. There were no significant differences in hearing thresholds in these three groups of patients. Electrical stimulation of the median nerve in 12 individuals with normal hearing who did not have tinnitus either had no effect on the loudness of sounds or it caused a slight increase in the loudness.- - - - - - - - - - ranking = 1.0911598847823keywords = complex (Clic here for more details about this article) |
9/33. Intrapelvic intrusion of the lumbosacral spine.A 34-year-old female fell 7 meters onto her lower back and side, and sustained a nondislocated fracture of the 7th thoracic vertebra, a complex pelvic fracture with symphysiolysis and a left acetabular fracture in combination with a bilateral comminuted sacral fracture and downward intrusion of the lumbosacral spine. There was also a cauda equina-syndrome. laparotomy with exploration of the lumbosacral area was terminated early because of hemorrhage. Later internal fixation of the fractures was performed by an anterior approach with complete reduction of the bilateral sacral fracture and the lumbosacral spine intrusion. We conclude that an anterior approach to this area gives good visualization, but is hazardous owing to the close proximity of the fractures to the central vessels and retroperitoneal muscles. A posterior approach gives less good visualization but may cause less hemorrhage.- - - - - - - - - - ranking = 1.0911598847823keywords = complex (Clic here for more details about this article) |
10/33. Transcranial motor evoked potential recording in a case of Kernohan's notch syndrome: case report.OBJECTIVE AND IMPORTANCE: Compression of the cerebral peduncle against the tentorial incisura contralateral to a supratentorial mass lesion, the so-called Kernohan-Woltman notch phenomenon, can be an important cause of false localizing motor signs. Here, we demonstrate a case in which clinical, radiological, and electrophysiological findings were used together to define this syndrome. CLINICAL PRESENTATION: A 21-year-old man sustained a left temporal depressed cranial fracture from a motor vehicle accident. Serial computed tomographic examinations demonstrated no evolution of hematomas or contusions, and he was managed nonsurgically with ventriculostomy for intracranial pressure control. Throughout his course in the neurosurgical intensive care unit, he displayed persistent left hemiparesis. INTERVENTION: Further radiological and electrophysiological studies were undertaken in an attempt to explain his left hemiparesis. brain magnetic resonance imaging demonstrated T2 prolongation in the central portion of the right cerebral peduncle extending to the right internal capsule. Electrophysiological studies using transcranial electrical motor evoked potentials revealed both a marked increase in voltage threshold, as well as a reduction in the complexity of the motor evoked potential waveform on the hemiparetic left side. This contrasted to significantly lower voltage threshold as well as a highly complex motor evoked potential waveform recorded on the relatively intact contralateral side. CONCLUSION: This is the first time that clinical, radiological, and electrophysiological findings have been correlated in a case of Kernohan's notch syndrome. Compression of the contralateral cerebral peduncle against the tentorial incisura can lead to damage and ipsilateral hemiparesis. The anatomic extent of the lesion can be defined by magnetic resonance imaging and the physiological extent by electrophysiological techniques.- - - - - - - - - - ranking = 2.1823197695647keywords = complex (Clic here for more details about this article) |
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