Usefulness of synaptophysin immunohistochemistry in an adult case of choroid plexus carcinoma

Abstract

Choroid plexus carcinoma in an adult case is a very rare tumor and difficult to differentiate from metastatic tumors. The authors report a case of a 49-year-old female with choroid plexus carcinoma who previously had multiple carcinomas. In this case, synaptophysin immunohistochemistry proved to be extremely helpful for the histological diagnosis. [Neurol Res 2000; 22: 478-480]     

Stent-supported angioplasty for acute stroke caused by carotid dissection

Introduction  Carotid dissection is a less common but important cause of acute ischemic stroke, which has specific treatment implications. Case record  We describe the case of a patient with acute, fluctuating neurological symptoms found to be caused by carotid dissection who underwent endovascular stent-supported angioplasty of this lesion with good outcome. Discussion  Pros and cons of the various treatment options encountered in this case including intravenous thrombolysis, angioplasty and stenting, and antithrombotic therapy are discussed. Conclusion  Endovascular treatment of carotid dissection in acute stroke can be performed safely. Treatment must ultimately be individualized to each specific case.     

Neurologic paraneoplastic syndrome with anti-CV2/CRMP5 antibodies revealing a small cell lung cancer. Effectiveness of the lung cancer treatment

IntroductionParaneoplastic neurological syndrome associated with anti-CV2/CRMP5 antibodies are rare. Various clinical manifestations can occur, cerebellar ataxia, polyneuropathy, optic neuritis with NORB or uveitis. Small cell lung carcinoma is generally responsible.Case reportWe report the case of a 64-year-old man who developed visual symptoms with papilledema, cerebellar signs, polyneuropathy confirmed with a neurophysiological studies. Anti-CV2/CRMP5 antibodies were present. A small cell lung carcinoma was responsible for this paraneoplastic syndrome revealing the cancer. The paraneoplastic syndrome improved with radio chemotherapy of the cancer alone.ConclusionA paraneoplastic neurological syndrome must be evoked in case of an atypic neurological syndrome. This diagnostic can be confirmed by the presence of anti-neuronal antibodies. In this case, a small cells cancer of the lung must be research.     

Risperidone,a risk factor for valproate-induced encephalopathy?

Valproate-induced encephalopathy (ViE) has been increasingly reported and several risk factors have been proposed. We report a case whereby a patient became encephalopathic while treated with valproate and upon initiation of risperidone. The underlying mechanism could be risperidone's interference with valproate's binding to albumin, raising free valproate levels, which would impair the urea cycle and reduce ammonia conversion, leading to a hyperammonemic encephalopathy. The present case suggests a causal link, although further studies will be necessary to establish this. Nevertheless, clinicians should be aware of this possible interaction and consider carefully before concomitant administration of valproate and risperidone, mainly in patients with other risk factors for ViE, so this complication can be avoid or promptly diagnosed and treated.     

Trouble alimentaire précoce avec une cause organique associée : complémentarité des approches

Objective

First, this article aims at demonstrating the value of a multifocal approach, i.e. combining paediatric, psychological and speech therapy, in the treatment of infants with a disorder of restrictive eating behaviour of somatic origin. Second, this article seeks to emphasize the importance of the therapists’ sequence in the care's efficiency.

Method

A case study based on a joint psychologist–paediatrician hospital consultation meets these two objectives. The case study is presented in four parts: a case history, the diagnostic criteria as presented on the basis of the classification of Irene Chatoor from the University of Washington, the watching of a videotaped meal and the psychodynamic interpretation of the material.

Results

Two major therapeutic axes have to be discussed with parents. The first axis is devoted to the infant's anxieties linked to the food and its absorption conditions (meal's climate, atmosphere) as well as to the parents’/infant's interactions during feeding time. The second axis, known as functional, corresponds to the stressful experiences of the infant faced with the functional experiments of absorption and swallowing.

Discussion

These two therapeutic axes are complementary areas. However, they should not be handled concomitantly. Indeed, it is necessary, to enhance their articulation, that one step follows the other in a specific order. The psychotherapeutic care has to come first, followed by the speech therapy. Still, each situation must be dealt with on a case by case basis.

Conclusions

In the case of a functional swallowing disorder due to a somatic pathology, the corporo-psychic imprints left by traumatic experiences related to food, as well as by the interactive awkwardness arising therefrom, should be treated through positive in vivo experiences involving the parents, and through a harmonious reappropriation of the damaged function. For this, the first psychotherapeutic axis must be completed by a rehabilitative axis, centred on the feeding functions of absorption and swallowing.     

Myelomnachweis mittels Liquorcytologie

Summary Myeloma cells in CSF have been described by Spaar and Argyrakis in a case of an unusual type of plasocytoma which involved the cerebrospinal leptomeninges and subarachnoid spaces mainly.In addition to this paper a case of myeloma is reported, in which the diagnosis of this disease could only be verified by specific cytologic evaluation of the CSF too.

     

The CARE-AAT Guideline: Development and testing of a consensus-based guideline for case reports in anthroposophic art therapy

ABSTRACT

Anthroposophic art therapists (AATs) report individual cases in narratives of poor scientific quality. Good quality case reports are an important factor in the development of evidence-based practice. A guideline for scientific case reports could contribute to this. However, the recently published guideline for medical case reports (the CARE Guidelines, covering diagnosis, treatment and outcomes) is not completely suitable for AAT. This study aimed at the development of a guideline for AAT case reports. The CARE Guidelines were adjusted following the recommended steps for health reporting guidelines. The proposed adjustments are based on AAT literature and expert opinions. The face validity of the new CARE-AAT Guideline was judged by an international group of 35 AATs and 3 experts on case study methodology. Seven items of the CARE Guidelines needed specification or addition. One item (Treatment Objectives and Plan) had to be added and six items could be used without change. The face validity of the new guideline is good. The CARE-AAT Guideline is suitable for scientific case reporting of AAT practice. It is assumed to be suitable for art therapy case reporting as well. Future use of the guideline will show whether further optimisation of the guideline is needed.     

Bipolar disorder,testosterone administration,and homicide: A case report

Objective. Homicide is a major public health and social concern in the United States. Studies have found higher rates of psychiatric disorders in homicide offenders than in the general population. The aim of this article is to report and to discuss a case of a patient with bipolar disorder and hypogonadism who murdered his wife shortly after a testosterone injection. Methods. A case study and a review of the relevant literature. Results. Our case study as well as several case reports in the literature suggests that testosterone administration or high testosterone levels may be associated with homicidal behavior. Conclusion. Further studies of the role of testosterone in the neurobiology of violent and homicidal behavior may lead to improvements in the prevention of homicides.     

Fulminant blastomycosis with blastomycotic infection of a cerebral glioma

Summary Except for isolated case reports, blastomycosis has not been identified as a significant problem in immunosuppressed patients. We describe an unusual case with blastomycotic infection of a cerebral glioma in a 56-year-old man who underwent radiotherapy for his tumor and died of fulminant blastomycotic pneumonia. This is believed to be the first reported case of Blastomyces dermatitidis infection of a cerebral glioma. The light microscopic and ultrastructural features of B. dermatitidis, the giant forms of which were encountered in our patient, are described, and the role of immuno-suppression due to steroid therapy in the pathogenesis of this fulminant infection are reviewed.     

Metastatic gastric adenocarcinoma to the pineal body a case report

Summary The case of metastatic gastric adenocarcinoma to the pineal body reported herein is believed to be the first case of this kind reported in the literature. It appears also to be the first unequivocal case in which a metastatic pineal tumor gave rise to clinical signs of a primary pineal tumor.

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Zusammenfassung Es wird ein Fall von Magencarcinommetastase in der Zirbeldrüse beschrieben; es ist anzunehmen, daß dies der erste bisher bekannt gewordene Fall dieser Art ist. Von besonderem Interesse erscheint die Tatsache, daß die Metastase die klinischen Symptome eines Pinealoms hervorgerufen hatte, was bisher ebenfalls noch nicht mit Sicherheit beobachtet wurde.

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With 2 Figures in the Text     

An intracerebral intraparenchymatous triton tumor in a man with neurofibromatosis

Abstract We report the second case of a cerebral intraparenchymatous malignant nerve sheath tumor, triton tumor variant. It is the first case associated with neurofibromatosis reported in literature thus far. The therapy of these aggressive tumors is rather disappointing as recurrence of the tumor despite complete surgical resection and even adjuvant radiotherapy and/or chemotherapy is seen in most patients. It is still unknown if survival is influenced by tumor localization, size or malignancy grade. In this case therapy also proved to be unsuccessful.     

A gase of trichotillomania in a child treated in a home token program

A case of trichotillomania (chronic hair-pulling) in an 8$\text{1}\text{2}$-yr-old non-retarded, non-psychotic girl was successfully treated at home by means of a token program. The child was able to earn “stars” which could be exchanged for cents for periods without any hair-pulling. In addition, time-out was used as a consequence of hair-pulling. One of the interesting aspects of the case is the apparent origin of this behavior, which first occurred when this child underwent orthopaedic surgery at the age of 10 months.     

Extreme correction of hyponatremia in a patient treated with intravenous conivaptan

Intravenous administration of conivaptan, an arginine vasopressin (AVP) receptor antagonist, has been demonstrated to be a safe and effective therapy for euvolemic and hypervolemic hyponatremia. In this case report, we report an extremely rapid correction of serum sodium with a typical dosing regimen of conivaptan. The patient was a 24 year woman who presented with nausea and vomiting, and was found on imaging to have two intracranial tumors, one of which was a large pituitary macroadenoma. Her serum sodium declined to 121 mmol/L and intravenous conivaptan therapy was started. After approximately 25 mg of conivaptan, her sodium increased 16 mmol/L over 8.5 hours. Fortunately, in this case, this correction was well tolerated, and the patient experienced no adverse effects of such a dramatic correction of serum sodium. Despite the good clinical result in this case, it should serve as a warning regarding the use of conivaptan, that although a gradual steady improvement in serum sodium can be expected in the majority of patients, more extreme corrections can be inadvertently achieved with even moderate doses. Thus, the exact clinical situation should be taken into consideration, especially in cases of subacute to chronic hyponatremia, where such an extreme correction could lead to neurologic devastation.     

Foot drop after percutaneous treatment with radiopaque gelified ethanol (Discogel®)

Sciatica due to a lumbar disc herniation is a frequent symptom, between 13% and 40% of the general population will experience an episode of sciatica during their lives. Different techniques exist to treat this condition. Among them the percutaneous intradiscal Discogel®. In all the series of patients reviewed treated with Discogel®, so far, there is not any case reported with disc extrusion and significant neurological damage. We present a case of a foot drop, caused by a disc herniation after percutaneous treatment with Discogel®. We hypothesize that the pathogenic mechanism would be the increased intradiscal volume and pressure post-puncture and annulus fibrosus damage, which could produce the disc extrusion.The extrusion of Discogel® material is possible. To the best of our knowledge, this is the first reported case of this complication with this product.     

Un cas « mixte » de meurtre sexuel sadique avec incendie criminel nocturne : psychopathie ou psychose ?

Bénézech organised sexual homicide into two distinct categories — psychopathic and psychotic — but warned that this taxonomy has only an indicative value, since certain sexual homicides fall in-between these categories. Therefore forensic experts must determine which of the two components (psychopathic or psychotic) dominate as the risk of recidivism as well as the measures that should be taken are determined by the subjective structure of the perpetrator. Given this need, criminal analysis could benefit greatly from a thorough clinical analysis. The author presents a mixed case of sexual psychotic homicide with criminal nocturnal arson. The difficulties in diagnosing of such a case are discussed.     

Hyperactivité de l'enfant : une approche psychopathologique

Hyperactivity is nowadays a very fashionable syndrome and a source of conflicts that are harmful for patients and their families. Indeed, two approaches seem to be opposed: 1) A purely psychoanalytical approach taking into account only the interpretation of the “symptome”; 2) A biological or cognitive approach, which postulates a cerebral organic origin and recommends behavioural therapy or stimulants only. In fact, the solution should be between these two positions. Anyway, hyperactivity disorder comprises very different clinical situations. The biological approach alone is not sufficient to explain this disorder, in no case, should treatment be exclusive (stimulants, psychoanalytical therapy…). The interest of different approaches is discussed in three contrasted case reports.     

Spasmodic dystonic laterocollis in familial cerebellar ataxia

The case of a woman affected by familial ataxia who developed marked spasmodic laterocollis is described. As this appears to be an uncommon association, it is worth reporting one more case.

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Sommario Viene descritto il caso di una donna affetta da una sindrome atassica famigliare nella quale si osservò anche la comparsa di un marcato laterocollo con caratteristiche distoniche. Questa associazione è infrequente ed appare utile segnalarne un altro caso.

     

Un croisement institutionnel entre la neuropsychologie et la psychopathologie dans l’évaluation cognitivoclinique d’un homme âgé

This article is about an 88 years old man's case, hospitalized because of a worrying somatic symptomatology: deterioration of a cardiac deficiency, oedema of bottom legs and anorexia. Actually the patient shows cognitive troubles, but one year ago he has been hospitalized, for a confusional state, associated with comportmental troubles and light temporospacial disorientation. At this time, the cerebral imaging showed a diffuse atrophy, prevalent in frontal level. In front of this case, the diagnostical question proves to be delicate because of the complicated interactions between depression, dementia and normal ageing in the very old age. The main object of this work tries to situate this patient's case in its structural and historical subjective globality, with the help of a clinical thought. The clinical thought of the authors includes an interface with neuropsychological and psychopathological approaches and tries to overtake the only quantitative point of view of a technical evaluation.     

Paradoxical brain embolism caused by an arterial−venous fistula: a diagnostic pitfall

The transesophageal echocardiography (TEE) and contrast-enhanced transcranial Doppler/Duplex ultrasonography (ceTCD) are complementary methods for diagnosing a right to left shunt across a patent foramen ovale. We report on a case of paradoxical embolism across a subclavian arterial–venous fistula. This case underlines the necessity of performing the ceTCD, as in this condition the right to left shunt could be detected by means of ceTCD, whereas the TEE reveals regular findings.     

Callosotomy for generalized seizures associated with hypothalamic hamartoma

Abstract

A case is reported of intractable epilepsy associated with a hypothalamic hamartoma in an 18 year old man. The patient underwent a two-third anterior callsotomy and, subsequently, removal of the hamartoma. CaUosotomy did not affect the generalized seizure pattern. The authors believe this to be the first documented case of hypothalamic hamartoma in which callosotomy for seizure control was attempted. The poor response to callosotomy suggests the extracallosal diffusion of the generalized seizures from hypothalamic hamartomas. [Neurol Res 1993; 15: 139-141]