Cases reported "Ependymoma"

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1/12. Spinal seeding of anaplastic ependymoma mimicking fungal meningitis. A case report and review of the literature.

    BACKGROUND: The spinal seeding from brain tumors sometimes mimicks fungal meningitis on examination of cerebrospinal fluid. methods AND RESULTS: A 19-year-old woman gradually developed increased intracranial hypertension. MRI identified a mass in the right parieto-occipital area. It was totally removed and histologically diagnosed as an anaplastic ependymoma. radiation- and chemotherapy were administered postoperatively. The patient reported low back pain 5 months after the surgical treatment. MRI disclosed neither spinal dissemination nor tumor recurrence at the primary site. Lumbar puncture was performed and the cerebrospinal fluid (CSF) was found to have an extremely low glucose level (5 mg/dl); no tumor cells were identified. blood samples were obtained and a relative increase of WBC and CRP was noted. A slight degree of inflammation and low-grade fever were recorded. A tentative diagnosis of fungal meningitis was made and anti-fungal therapy was administered transventricularly and transvenously. However, her neurological condition continued to deteriorate gradually. Sequential CSF studies showed that the glucose level remained extremely low, it even decreased to 0 mg/dl Eight months after the surgical treatment, MRI with Gd-DTPA revealed marked subarachnoid enhancement in both intracranial and spinal areas. An open biopsy was performed and a histological diagnosis of intracranial and spinal seeding of the anaplastic ependymoma was returned. CONCLUSIONS: We report a patient with intracranial and spinal seeding of an anaplastic ependymoma that mimicked fungal meningitis. We discuss the difficulty of obtaining a differential diagnosis in this case and describe the mechanism of the decreased CSF glucose level.
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2/12. Myelographic evaluation of nontraumatic spinal canal obstruction: a new approach.

    A new technique simplifies the evaluation of the spinal canal above obstructing lesions encountered during myelography via the lumbar route. After the demonstration of a block with 2--4 ml Pantopaque, a second injection of 2--4 ml Pantopaque is made through the lumbar needle with the patient in 45 degree Trendelenberg (or any degree necessary to keep the initial contast bolus against the inferior margin of the obstruction). In all 10 cases in this series, the second injection easily displaced contrast around and above obstructions that could not be overcome by gravity thereby obviating a lateral cervical or cisternal puncture. No technical failures of complications were encountered. The method is not recommended in cases of traumatic spinal canal obstruction.
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3/12. Percutaneous spinal cord puncture and myelocystography. Its role in the diagnosis and treatment of intramedullary neoplasms.

    Three patients with cystic tumors of the cervical spinal cord were evaluated with percutaneous cord puncture and myelocystography. This procedure gives relief of symptoms and permits delineation of the extent and character of the cystic mass.
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4/12. Superficial siderosis of the central nervous system: pathogenetic heterogeneity and therapeutic approaches.

    OBJECTIVE: Superficial siderosis of the central nervous system (CNS) is a rare chronic progressive disorder caused by chronic subarachnoid hemorrhage. We present four patients with superficial siderosis of the CNS to describe the characteristic symptoms, and to discuss the pathogenetic heterogeneity and possible new therapeutic approaches. RESULTS: The causes of chronic subarachnoid bleeding in superficial siderosis were different. In two patients surgical treatment of ependymoma or cerebral cavernomas were the underlying diseases. No cause was detected in one patient. For the first time, we present one patient with vasculitis of the central nervous system associated with systemic hemochromatosis in superficial siderosis. Therapeutic approaches included exstirpation of cavernomas as the source of chronic bleeding in one patient, immunosuppressive therapy and venupunctures in the patient with vasculitis and hemochromatosis, and symptomatic treatment with chelating agents and antioxidants. The patients remained clinically stable for the follow-up period of up to 2 years. CONCLUSIONS: Our cases underline the pathogenetic heterogeneity of superficial siderosis and favor the early diagnosis for prompt initiation of therapy. Besides treatment of the underlying condition, antioxidants and radical scavengers may be effective in halting the progression of the disease.
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5/12. Intratumoral methotrexate kinetics in a patient with intracranial anaplastic ependymoma.

    Little is known about intratumoral anticancer drug concentration in childhood brain tumors. We were able to measure methotrexate (MTX) tumor concentrations directly in a cystic anaplastic ependymoma. cyst fluid was obtained by puncture of a subgaleal Rickham reservoir connected to a catheter in the tumor cyst. MTX concentrations were determined by fluorescence polarization immunoassay and compared to serum concentrations. Maximum MTX concentrations in tumor and CSF were found at the end of MTX infusion. Twenty-four hour after MTX infusion the mean tumor concentration was significantly higher than in the serum indicating MTX retention and accumulation in the tumor cyst. An AUC(tumor)/AUC(serum) ratio of 1.95 was obtained. In response to the applied multiagent chemotherapy the clinical condition of our patient improved and the tumor showed partial response on MRI. Cystic ependymomas might benefit from high dose MTX especially because of drug retention in the tumor cyst.
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6/12. Filum ependymoma mimicking spontaneous intracranial hypotension.

    A 34-year-old man with a 2-week history of orthostatic headaches and a "dry tap" at lumbar puncture was found to have a lumbar intradural mass on magnetic resonance imaging (MRI) examination. A myxopapillary ependymoma was resected and the patient's headache completely resolved. The combination of spontaneous orthostatic headaches and a "dry tap" at the time of lumbar puncture does not always indicate the presence of a spontaneous cerebrospinal fluid (CSF) leak and intracranial hypotension.
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7/12. An unusual case of proctalgia.

    We report the case of a 21-year-old man with the sudden onset of severe proctalgia followed by headaches and fever. The patient had a lumbar puncture consistent with subarachnoid hemorrhage. After a normal four-vessel cerebral arteriogram, a myelogram and computed tomography scan of the spine were performed and revealed a mass lesion of the L1 level. Pathologic evaluation after resection of the mass resulted in a diagnosis of hemorrhage from a myxopapillary ependymoma. These relatively benign tumors of the cauda equina-filum terminale respond well to treatment. The differential diagnosis of proctalgia is reviewed, and the need for emergency physicians to consider spinal subarachnoid hemorrhage when a patient presents with the acute onset of rectal pain is emphasized.
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8/12. choroid plexus papilloma in a 4-month-old child: a case report.

    We report a case of choroid plexus papilloma arising from the right lateral ventricle in a 4-month-old infant. Because of intermittent vomiting, abdominal pain, and diarrhea, the child was initially treated with intravenous rehydration, which aggravated the symptoms, and a bulging fontanel developed. Before a planned lumbar puncture, cranial ultrasound was performed, which disclosed a choroid plexus papilloma. The tumor was removed surgically, and the child made an uneventful recovery. We discuss the diagnostic value of cranial ultrasound compared to computed tomographic (CT) scan and angiography.
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9/12. Hemorrhage into a spinal ependymoma after peridural anesthesia.

    The authors present a case of the accidental puncture of a spinal ependymoma causing bleeding and an increase in the preexisting neurological deficits.
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10/12. Percutaneous puncture of spinal cysts in the diagnosis and therapy of syringomyelia and cystic tumors.

    The experience with percutaneous puncture of intraspinal cystic lesions is reported in four cases: an extradural cyst demonstrated with air, a spinal cord tumor with lipiodol and two cases of syringomyelia with metrizamide. Percutaneous puncture of cystic lesions makes possible an accurate delineation of the lesion and a histological approach through biochemical and cytological analysis of the aspirated cystic fluid, while aspiration of the fluid of cystic tumors decompresses the spinal cord and thus plays a therapeutic role.
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