Cases reported "Brain Neoplasms"

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1/34. Electroconvulsive treatment of a bipolar adolescent postcraniotomy for brain stem astrocytoma.

    This is the first reported use of electroconvulsive treatment (ECT) in an adolescent with bipolar mania who had been treated with craniectomy for an intracranial neoplasm. The reported case is of a 16-year-old girl with a history of brain stem glioma (pontomesencephalic astrocytoma) diagnosed at 13 years of age. She presented in a psychiatric emergency room with suicidal ideation, depressed mood, irritability, olfactory hallucinations, early insomnia, grandiosity, and guilt. Her symptoms failed to respond to a trial of an antidepressant, mood stabilizer alone, and mood stabilizer in conjunction with a neuroleptic. The decision to use ECT was based on suicidal ideation, extreme disinhibition, and danger to self and others. Significant improvement in mood and remission in psychosis were noted after the eighth treatment. Comparison of 2-week pre-ECT and 3-month post-ECT cognitive testing revealed no change in IQ. This report highlights rapid response and the ability to tolerate ECT in an adolescent diagnosed with bipolar disorder, who had also been treated with radiation and craniotomy.
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2/34. Metastatic adenocarcinoma to the brain mimicking hemorrhage: case report.

    BACKGROUND: Computerized tomography (CT) of metastatic adenocarcinoma to the brain usually shows low-to-moderate attenuation. However, mucinous adenomas may appear with high attenuation, mimicking hemorrhage. CASE DESCRIPTION: A 68-year-old man with a history of metastatic esophageal adenocarcinoma presented to the emergency room complaining of a chronic, progressive right occipital headache. A head CT demonstrated a moderate-to-high attenuation, homogenous mass in the right cerebellar hemisphere consistent with an intracerebral hemorrhage. There was no frank calcification in the mass by CT criteria. An emergent posterior fossa craniectomy revealed nonhemorrhagic metastatic mucinous adenocarcinoma. CONCLUSION: Moderate-to-high attenuation, noncalcified brain masses should raise the possibility of mucin-containing neoplasm.
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3/34. Surgical decompression and radiation therapy in epidural metastasis from cervical cancer.

    spinal cord compression by epidural metastasis is considered an exceptional complication in patients with cervical carcinoma. We report three patients treated for a cervical carcinoma who developed epidural metastasis with spinal cord compression at 9, 25 and 48 months after primary treatment of the uterine malignancy. All patients had poorly-differentiated adenocarcinomas with lymphovascular space invasion, and two had lymph node metastasis. All patients underwent emergency decompressive laminectomy followed by radiotherapy and a partial recovery of the neurological function was achieved. In two patients the spinal cord was the only site of recurrent disease, whereas the other had lung and brain metastasis at the time of epidural involvement diagnosis. All three patients, however, died of disseminated disease. Surgical decompression followed by radiation therapy may result in a complete preservation of the neurologic functions in patients with spinal cord compression secondary to metastatic carcinoma of the uterine cervix. Considering the propensity for disseminated disease, long term survival might be achieved only with the use of effective chemotherapy.
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ranking = 0.32374081496473
keywords = decompressive
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4/34. Toxoplasmic encephalitis in patients with acquired immunodeficiency syndrome--four case reports.

    Four patients, all males aged 40-64 years, presented with toxoplasmic encephalitis associated with human immunodeficiency virus (hiv) infection manifesting as nonspecific neurological deficits such as epilepsy or hemiparesis. magnetic resonance imaging showed single or multiple lesions with ring enhancement, mimicking metastatic brain tumor or brain abscess. Marked eosinophilia was noted in three patients. Two patients who received anti-toxoplasma chemotherapy in the early stage had a good outcome. However, the other two patients suffered rapid neurological deterioration and needed decompressive surgery, resulting in a poor outcome. toxoplasma diffusely infects the whole central nervous system from the early stage. The outcome for patients who needed emergency surgery was poor. Therefore, this rare but increasingly common infectious disease must be considered in the differential diagnosis of a patient with neuroimaging findings similar to those of metastatic tumor or brain abscess. Appropriate chemotherapy should be started immediately after hiv-positive reaction is identified in patients with single or multiple mass lesions with ring enhancement.
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ranking = 0.32374081496473
keywords = decompressive
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5/34. Fatal tumoural haemorrhage following decompressive craniectomy: a report of three cases.

    Three cases of large and deep seated anaplastic cerebral glioma were treated by bone and dural decompression. The patients worsened suddenly within 12 h of surgery and later died. Postmortem examination revealed a large intratumoural clot in each case. The effects of decompression and the probable causes of fatal bleeding are analysed in this report.
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ranking = 5.2949632598589
keywords = craniectomy, decompressive
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6/34. Acute isovolaemic haemodilution in two jehovah's witnesses presenting for major intracranial surgery.

    The jehovah's witnesses (JWS) is a religious sect with strong convictions against acceptance of blood and its products for medical care, including surgery. We present two cases of JWS, aged 24 and 19 years old, who had craniectomy for trauma and craniotomy for tumour excision, respectively. A team approach was employed in the care of both patients. During exhaustive preoperative discussions they re-affirmed their religious convictions but agreed to some modifications. Both patients accepted Acute Isovolaemic Haemodilution (AIH). However one of them insisted on non-discontinuation of the line used in collecting the blood from the vein, as that would constitute blood storage. The preoperative Packed Cell Volume (PCV) was 45% and 41% for the trauma and the tumour patients respectively. Two units of blood (1000 ml) were collected from each patient resulting in post donation PCV of 40% and 33%. The intraoperative blood loss was 300 ml and 2000 ml, respectively, and the units and crystalloid fluids were transfused for replacement. Postoperative PCV were 42% and 25%. The latter improved to 30% over the following two weeks with oral haematinics. The two cases are discussed in the light of the experience gained.
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7/34. Malignant fibrous histiocytoma of scalp with intracranial invasion 20 years after postoperative irradiation.

    We report a case of malignant fibrous histiocytoma with intracranial invasion occurring 20 years after radiation therapy for astrocytoma. magnetic resonance imaging suggested that a dumbbell-shaped tumor arising from soft tissue was pressing the brain. Histopathological findings revealed a storiform pattern with spindle cells such as fibroblasts, histiocytes, epithelioid cells with irregularly shaped nuclei, and bizarre giant cells. Three operations involving craniectomy were necessary because of recurrence.
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keywords = craniectomy
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8/34. Surgical management of a meningioma in the retrosellar region.

    Lesions ventral to the brainstem in the retrosellar and interpeduncular region are major challenges to the surgeon because of their location at great depth in the centre of the cranial base. We report the operative management of a patient with a meningioma in an unusual location, extending from the upper clivus, retrosellar and interpeduncular region into the suprasellar area up to the level of the foramen of Monro. A 41-year-old man presented with a 3-month history of progressive visual disturbance, episodic headache and signs and symptoms of endocrinological disturbance. magnetic resonance imaging (MRI) studies showed a homogeneously enhancing tumour ventral to the brainstem with large cranio-caudal extension from the upper clivus to the suprasellar area. Operative removal was planned in two stages. First, through a right lateral suboccipital retrosigmoid craniectomy the caudal portion of the tumour at the upper clivus and prepontine region was removed. Second, the residual suprasellar part of the tumour was removed totally through a fronto-lateral craniotomy on the right side one week later.When a tumour is very large or involves different areas of the skull base, it is necessary to decide between removal in one stage, which requires a complex and time consuming skull base approach, or in multiple stages. Our case demonstrates how a retrosellar meningioma extending to the suprasellar region can be totally removed using two simple skull base approaches without the risk of compromise to venous drainage and without the need for extensive bone removal as described in other skull base approaches.
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keywords = craniectomy
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9/34. Intraparenchymal schwannoma of the medulla oblongata. Case report.

    A 48-year-old man presented with a rare intraparenchymal schwannoma of the medulla oblongata. After he underwent gamma knife surgery, the patient's condition deteriorated and the mass, which at the time was thought to be a glioma, became larger on magnetic resonance images. The mass was resected through a suboccipital craniectomy via the transcerebellomedullary fissure approach. The tumor, which was moderately firm but distinct from the surrounding parenchyma, was removed totally. Postoperative histological and immunohistochemical examinations confirmed the diagnosis of a benign schwannoma. Brainstem schwannomas can be cured by microneurosurgery. It is important to distinguish these tumors from glioma. The main theories on the cause(s) of this lesion are briefly reviewed.
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10/34. Controversies in the management of brainstem cavernous angioma: report of two cases.

    Two cases of cavernous angioma involving the medulla oblongata are presented. Both cases underwent surgical excision with excellent outcome. The use of surgery via craniectomy is contrasted with stereotactic radiosurgery in light of the known natural history of the lesions. As a result, it is suggested that surgical excision provides immediate protection from the risks of recurrent haemorrhage, establishes a tissue diagnosis, allows complete removal at the primary intervention, avoids complications of radiation-induced damage and is performed more easily in these vascular anomalies due to the presence of a capsule with surrounding gliotic tissue. Additionally, it is implied that the natural history of lesions in this region is still unclear. For these reasons, it is suggested that surgical excision should be the primary therapeutic intervention for cavernous angiomata that involve the brainstem.
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