Neurofibromatosis presenting with aqueductal stenosis due to a tumor of the aqueduct: case report

A 17-year-old boy with neurofibromatosis presented with delayed puberty and epileptic seizures of recent onset. A computed tomographic scan revealed aqueductal stenosis due to a tumor of the aqueduct. This tumor was found at autopsy to be a pilocytic astrocytoma. Aqueductal stenosis in neurofibromatosis is uncommon and has been considered to be a result of periaqueductal gliosis. This seems to be the first report of neurofibromatosis associated with a tumor of the aqueduct.     

Indications for neuroendoscopic aqueductoplasty without stenting for obstructive hydrocephalus due to aqueductal stenosis.

OBJECTIVE: Neuroendoscopic aqueductoplasty (EAP) is a curative and radical procedure for obstructive hydrocephalus due to aqueductal stenosis that re-establishes the physiological circulation of cerebrospinal fluid (CSF). We assessed the indications for safe neuroendoscopic aqueductoplasty without stenting to treat aqueductal stenosis. METHODS: In the past 5 years, 6 (5.5 %) of the 110 patients with obstructive hydrocephalus due to aqueductal stenosis were judged to be suitable for EAP on the basis of the MRI features of the aqueduct and intraoperative neuroendoscopic findings from the third ventricle for the aqueductal stenosis. The remaining 104 patients were treated by neuroendoscopic third ventriculostomy. Indications for safe EAP were determined retrospectively based on the clinical features, preoperative MRI, intraoperative neuroendoscopic findings and outcome of the 6 patients who underwent EAP. RESULTS: There were no deaths due to EAP. All of the patients showed improvement or resolution of their preoperative symptoms. In 5 patients, dilatation of the third ventricle and lateral ventricles diminished, and prestenotic dilatation of the aqueduct also disappeared. After an average follow-up period of 39.5 months, recurrence of aqueductal stenosis has not been observed. In one patient, there was a complication of oculomotor nerve paresis after EAP. CONCLUSIONS: EAP can be considered the best surgical procedure for restoring physiological circulation of CSF in patients with obstructive hydrocephalus caused by aqueductal stenosis. However, EAP candidates must be selected very carefully using the following indications: 1) obstructive triventricular hydrocephalus with increased intracranial pressure, 2) translucent membranous stenosis or aqueduct obstruction, and 3) prestenotic dilatation of the aqueduct.     

Transcutaneous therapeutic canalization of aqueductal stenosis in a hydrocephalic; Case report and technical note

Summary A technique of transcutaneous canalization of stenosed aqueduct in a hydrocephalic infant is described. Though not entirely successful, this technique is thought to be useful when certain modifications in catheter design are made. It is simple and, we feel, safe, and does not require an elaborate setup.     

Parkinsonism due to subdural hematoma. Case report

The authors describe the case of a 38-year-old woman who presented with parkinsonian syndrome associated with chronic subdural hematoma. Gradual disappearance of the symptomatology followed removal of the hematoma. Chronic subdural hematoma may in rare instances cause a parkinsonian syndrome, probably by a pressure effect on basal ganglia structures or by altering the function of neurotransmitters.     

Clinical manifestations of aqueductal stenosis in adults.

The authors review 17 cases of aqueductal stenosis in adults and describe five modes of clinical presentation. The average duration of symptoms was 6 years. Dementia was infrequent. Skull x-ray films frequently demonstrated some degree of cranial enlargement and signs of chronic increased intracranial pressure. Characteristic alterations of the sella included elongation of the anterior wall and flattening, erosion, and anterior displacement of the dorsum. Aqueductal configurations as defined by ventriculography and pneumoencephalography in all cases, and the angiographic findings in seven cases are described. Most of the patients improved substantially after shunt insertion. The clinical findings suggested that aqueductal narrowing and associated hydrocephalus had been present in most of these patients since early life.     

Non-communicating hydrocephalus due to congenital aqueductal stenosis in an infant presenting as an irritable baby syndrome

A case is reported of an infant with a definitive diagnosis of hydrocephalus secondary to congenital stenosis of the Sylvan Aqueduct who presented to a chiropractor with colicky, irritable type symptoms. These symptoms ultimately proved to be unrelated to the raised intracranial pressure and were ameliorated by the application of one chiropractic adjustment. The literature is reviewed and a discussion of the usual clinical presentation, natural history and pathogenesis of hydrocephalus in infancy is given. The inferential value of this case is to highlight the need for all clinicians engaged in the clinical care of children to perform serial measurements of the head circumference, height, weight and anterior fontanelle as a matter of routine. This case also highlights the fact that alterations of the symptomatic state by a trial of therapy is an unreliable indicator of positive clinical progress.     

Splenic abscess due to Streptococcus anginosus. Case report

Splenic abscess is a rare condition. Haematogenous seeding to the spleen from an infection at a distant site, most often endocarditis, is been the most common predisposing condition but an increase has been observed in immuno-compromised patients too. Fever, leukocytosis and left upper quadrant pain are suggestive, but the signs and symptoms of splenic abscesses are often non-specific. Rare is the onset with diarrhoea as in our case. Ultrasound and computed tomography are reliable diagnostic tools. Splenectomy and antibiotics are the treatments of choice. We describe a case of splenic abscess with gas level and peritonitis from dissemination of Streptococcus anginosus (of Streptococcus millerii group) from duodenal ulcer contaminated. It was diagnosed with CT, ultrasound, and abdomen X-ray with contrast then treated with splenectomy and peritoneal lavage.     

Dysphagia due to anterior cervical osteophyte. Case report.

A case of 61-year-old man with a 2-year history of progressive difficulty in swallowing solid foods is presented. CT-scan and barium swallow test demonstrated an anterior osteophyte at C6. Resection of the osteophyte resolved the dysphagia. The rarity in the neurosurgical literature, the pathogenesis and the management of this condition are discussed.     

Fatal meningitis due to Staphylococcus Cohnii. Case report

We report a case of fatal meningitis due to Staphylococcus (S.) Cohnii in a 63-year-old male. S. Cohnii is often isolated from farm animals and known to be less pathogenic in humans. To our knowledge, S. Cohnii has not yet been reported to cause infection of the central nervous system in humans.     

Abdominal wall infection due to Mucormycosis. Case report

Zygomycosis are infections due to fungus from the Zygomycetes family, and one of them is Mucor. They are a rare opportunist species that may cause severe invasive and often fatal infections. This infection has a special predilection for diabetic patients, transplant patients and those undergoing intensive cancer therapies, as well as other patients with an immunocompromised condition. Rapid diagnosis and opportune and current treatment is the key for patient surveillance. The most frequent site of this infection is the upper respiratory tract due to spore transport by air, although there are other sites in which these organisms can produce infection such as soft tissue of the abdominal wall. In this study, we present an abdominal wall infection by Mucor and describe its medical and surgical treatment.     

Communicating hydrocephalus as a cause of aqueductal stenosis.

Eleven cases of presumed aqueductal stenosis with onset of symptoms after the first decade were reviewed. Ten patients had complete occlusion and one a high-grade stenosis. In 10, the dilated lateral ventricles caused a marked inferior displacement of the third ventricle. Postshunting diagnostic studies on six of these patients revealed ascent of the third ventricle, and in three of these the aqueduct was shown to be patent. It appears that in some cases of advanced communicating hydrocephalus the descending third ventricle kinks or pinches shut the aqueduct, adding an obstructive component which accelerates the clinical picture. The mechanism and clinical features of this process are discussed.     

Intrasellar mass with hypopituitarism as a manifestation of sarcoidosis. Case report

A 45-year-old woman was admitted suffering from headache, weight loss, asthenia, pedal edema, and amenorrhea. Morphological and functional studies revealed an intrasellar mass causing hypopituitarism without diabetes insipidus. Histological examination of the tissue obtained at transsphenoidal surgery was compatible with a diagnosis of sarcoidosis. The clinical and histological features, together with the presence of cutaneous anergy and ocular lesions, led to the diagnosis of sarcoidosis. The presentation of sarcoidosis in this patient was very unusual because it was not accompanied by characteristic intrathoracic findings or by diabetes insipidus.