Anterior sacral meningocele mimicking ovarian cyst: a case report.
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Anterior sacral meningocele (ASM) is a rare congenital anomaly, characterized by herniation through a defect in the anterior aspect of the sacrum. We reported a case of ASM associated with neurofibromatosis, which was mimicking a complex ovarian cyst in ultrasonography. ASM can easily be misdiagnosed as an ovarian cyst and needle aspiration can cause intracranial hypotension syndrome or even death. (+info)
Emergent intrathecal baclofen withdrawal after pseudomeningocele aspiration.
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Intrathecal baclofen (ITB) infusion has become a common treatment for severe spasticity. Many complications of these drug delivery systems have been reported such as those related to improper dosing, mechanical failure of the implanted pump or catheter, or post-operative wound issues. We report a case of ITB withdrawal after pseudomeningocele aspiration. A 21 year-old male with spastic quadriparesis due to traumatic brian injury (TBI) presented with a pseudomeningocele surrounding an ITB pump (215 mcg/day, continuous) implanted in the abdomen. The pseudomeningocele was percutaneously aspirated and approximately 15 hours later the patient developed signs and symptoms of acute baclofen withdrawal. As a result, the patient underwent an exploration of the ITB infusion system with an intraoperative epidural blood patch. The symptoms of ITB withdrawal improved over the next 18 hours. The subcutaneous cerebrospinal fluid (CSF) collection partially recurred 48 hours later, but this resolved after a second epidural blood patch. The case illustrates a unique presentation of a serious complication of ITB infusion. This underscores that timely diagnosis and treatment of acute baclofen withdrawal is key to optimal outcomes. (+info)
Transmastoid approach to repair meningoencephalic herniation in the middle ear.
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Meningoencephalic herniation (MEH) in the middle ear and mastoid is a rare pathological entity with possible life-threatening complications. We treated 24 patients with a trans-mastoid approach, and the bony defect was closed by heterologous materials positioned in a multilayer fashion. The cause of the bony defect were chronic otitis media with cholesteatoma, iatrogenic, spontaneous and post-traumatic. The major presenting symptoms were meningitis, headache, conductive hearing loss, cerebrospinal fluid (CSF leak), neurologic deficit and pneumoencephalus, and stenosis of a canal wall down cavity. During follow-up, no patient developed complications due to surgery or related to the pathology, and imaging showed a stable occlusion of the bony defect. Different surgical treatments have been proposed to repair MEH, and the choice is based on the localization and size of the bony defect, preoperative auditory function and the presence of a coexisting pathology. We propose the use of collagenous membranes and bone substitutes for reconstruction of the floor of the middle fossa. (+info)
Large encephalocele at the anterior fontanel--case report.
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The authors report a newborn girl with a large meningoencephalocele, 18.5 cm in diameter, at the anterior fontanel. She had several accompanying anomalies, including microcephalus, cleft palate, and a uvula bifida. A plain skull x-ray revealed craniolacunia and a computed tomography (CT) scan showed maldevelopment of the cerebrum. The mass was resected, after which the fontanel was noted to bulge. CT demonstrated dilated lateral ventricles. A successful shunting procedure permitted the infant to leave the hospital in good general condition. (+info)
Central nervous system malformations in Mohr's syndrome.
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A boy with severe developmental delay, bilateral, symmetrical hallucal duplication, and accessory alveolar frenula was found to have radiological evidence of a large arachnoid cyst compressing the cerebellum and brain stem. We review neurological abnormalities in Mohr's syndrome. (+info)
Aqueduct stenosis. Case review and discussion.
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Twenty-seven cases of hydrocephalus associated with aqueduct stenosis are reviewed, and a further nine cases discussed in which hydrocephalus was present and the aqueduct was stenosed but some additional feature was present. This was either a meningocoele or an encephalocoele, or else the aqueduct was not completely obstructed radiologically at the initial examination. The ratio of the peripheral measurement from the inion to the nasion to the distance between the inion and the posterior lip of the foramen magnum is presented for each case with an outline of the ventricles. The cases behave as would be expected if the aqueduct was being blocked by the lateral compression of the mid-brain between the enlarged lateral ventricles. On reviewing these cases and other evidence it is suggested that non-tumourous aqueduct stenosis is more likely to be the result of hydrocephalus than the initial cause. The response to treatment is reviewed and a high relapse rate noted. It is suggested that assessment of the extracerebral pathways may be advisable before undertaking third ventriculostomy or ventriculo-cisternostomy. (+info)