Acute purulent meningitis associated with chronic subdural hematoma and subdural hygroma.
(25/57)
A male infant aged nine months with meningeal irritation and +3.5SD expansion of the circumference of the head was admitted. Brain computed tomography (CT) detected right chronic subdural hematoma and contralateral subdural hygroma. Since the cell count was increased on a cerebrospinal fluid test, acute purulent meningitis was diagnosed. A rapid latex test and culture of cerebrospinal fluid identified Streptococcus pneumoniae (PSSP) as the pathogen. Panipenem/betamiprom (PAPM/BP) was administered at 100 mg/kg/3 times for 14 days and dexamethasone was administered at 0.6 mg/kg/4 times for 4 days, and the patient recovered without sequelae. Acute purulent meningitis complicated by chronic subdural hematoma and subdural hygroma is rare. In this case, acute subdural hygroma may have concomitantly developed with acute purulent meningitis in the presence of the chronic subdural hematoma, and rapid disequilibrium of intracranial pressure may have been the developmental mechanism. (+info)
Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension.
(26/57)
Diffuse pachymeningeal hyperintensity and subdural effusion/hematoma detected by fluid-attenuated inversion recovery MR imaging in patients with spontaneous intracranial hypotension.
(28/57)
We report a 29-year-old man with a unique presentation of vasculitis as acute unilateral subdural effusion and meningoencephalitis. Magnetic resonance imaging showed a brainstem lesion that spread to the thalamus over time. There were no systemic features of vasculitis other than a positive pathergy test. Histopathological examination from the pathergy site showed neutrophilic infiltrate and leucocytoclastic vasculitis. The condition was steroid responsive and he remained in remission at two years' follow-up. The anatomy of the brainstem lesion, absence of other inflammatory and infective conditions on evaluation suggests a vasculitic pathology either as primary central nervous system angiitis or as neurological presentation of systemic vasculitis like Behetaet's disease although the international diagnostic criteria for Behetaet's were not fulfilled. (+info)
Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome.
(31/57)
Endoscopic endonasal transsphenoidal approach through the bilateral nostrils for pituitary adenomas.
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The endoscopic endonasal transsphenoidal approach through the bilateral nostrils was evaluated for the treatment of pituitary adenoma. The surgical approach is through the bilateral nostrils via minimal or wide dissection of the septal mucosa, depending on the degree of tumor extension. After anterior sphenoidotomy, the endoscope is fixed in one nostril and required instrumentation is inserted in either nostril. In addition, neuronavigation and real-time hormone monitoring are used. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 194 patients with pituitary adenomas who underwent 213 procedures between December 2001 and March 2008. Greater than 95% resection was achieved in 74 of 131 nonfunctioning adenomas, and the removal rate was significantly higher during 2005-2008 compared to 2002-2004 (p < 0.05). Endocrinological remission was achieved in 20 of 26 growth hormone-secreting tumors of Knosp grades 0-2, 16 of 17 microprolactinomas, and 6 of 9 cases of pure Cushing's disease. Postoperative complications were cerebrospinal fluid leakage in 9 cases, visual worsening in 5, anterior pituitary insufficiency in 5, and permanent diabetes insipidus in 2. The bilateral endonasal approach provides a wide working area without the need for special instrumentation. By modifying mucosal dissection, the endoscopic approach provides flexibility and less invasiveness. The use of neuronavigation or intraoperative hormone monitoring leads to improved surgical results. The present study confirms that this approach is suitable for more extensive sellar tumors. (+info)