隐源性脑脓肿1例报道及文献回顾

目的:了解隐源性脑脓肿的临床特点,总结诊疗经验,提高临床诊断的准确性,降低早期误诊率。方法:回顾分析1例经成功诊断和治疗的隐源性脑脓肿患者的临床表现、影像学特点,并结合文献对诊疗经验进行总结。结果:隐源性脑脓肿临床表现不典型,无明确感染途径,予经验性抗感染治疗,颅内病灶完全吸收,据此该病例临床诊断成立。结论:隐源性脑脓肿因感染源不明,起病隐匿,症状不典型易误诊,链球菌、葡萄球菌和厌氧菌是常见病原体。需与颅内结核瘤、脑寄生虫、脑胶质瘤、脑转移瘤等相鉴别。     

原发性颅内滑膜肉瘤1例报道及文献复习

目的研究原发性颅内滑膜肉瘤的临床表现、病理、治疗与预后的特点。方法回顾性分析1例原发性颅内滑膜肉瘤11岁患儿的临床资料、影像学表现、病理、治疗和预后。结果 CT检查示右颞枕大片混杂密度影,肿瘤大小为3.5 cm×3.0 cm×2.0 cm。接受右颞枕叶肿瘤根治性切除术,术后病理示镜下小圆核瘤细胞呈片巢状或围绕血管密集排列,细胞异型,可见核分裂相,部分区域见胶原纤维增生,部分区域黏液变性;免疫组化染色示CK(部分+)、Vim(部分+)、Syn(+)、EMA(-/+)、CK7(-)、CK19(+)、INI-1(+)、AFP(-)、Oct-4(-)、Des(-),GFAP(-),CD99(-),CgA(-),PLAP(-),NF(-)、CD117(-/+),MIB-1 10%,诊断为(右颞枕叶)间叶组织来源的恶性肿瘤——滑膜肉瘤。术后在当地医院行放射治疗,总剂量为50 Gy,共25次。术后11个月复查头颅MRI见肿瘤复发累及右侧小脑半球。结论原发性颅内滑膜肉瘤是一种非常罕见的恶性肿瘤,目前采用手术切除肿瘤结合术后放、化疗的方案,但预后不良。     

Recurrent Cerebral Arteriovenous Malformation in a Child : Case Report and Review of the Literature

Arteriovenous malformations (AVM) are generally considered to be cured following angiographically proven complete resection. However, rare instances of AVM recurrence have been reported in both children and adults with negative findings on postoperative angiography. The authors present the case of a 12-year-old boy with recurrent AVM. The AVM was originally fed by the pericallosal arteries on both sides, and it showed changing patterns of supply at recurrence. The authors concluded that a negative postoperative angiogram is not necessarily indicative of a cure. Repeat angiography and regular follow-up examinations should be performed to exclude the possibility of recurrence, especially in children.     

Concurrent Nocardia Related Brain Abscess and Semi-Invasive Pulmonary Aspergillosis in an Immunocompetent Patient

We describe here the first case of a concurrent brain abscess caused by Norcardia spp. and semi-invasive pulmonary aspergillosis in an immunocompetent patient. After one year of appropriate antimicrobial therapy and surgical drainage of the brain abscess, the nocardia brain abscess and pulmonary aspergillosis have resolved.     

1例血管性帕金森综合征报道及文献学习

1 病例介绍 患者女性,73岁,因"走路缓慢4年,加重伴反应迟钝1年"于2021年11月9日入院.患者于4年前出现走路缓慢,启动困难,行动迟缓,偶有跌倒,偶有饮水呛咳;近1年行动迟缓加重,伴有反应迟钝.发病以来无肢体震颤,无睡眠中多梦及肢体活动,无肢体感觉异常,无视幻觉,无嗅觉障碍,无二便异常.     

Topiramate Overdose: A Case Report and Literature Review

Topiramate is a medication introduced in the United States in 1997 for the treatment of epilepsy. Studies are currently underway to determine its effectiveness in the treatment of multiple conditions including bipolar disorder. It is generally well tolerated at doses commonly used in the clinical setting, however, there is little information regarding its safety in overdose. We report the case of a 24-year-old woman who ingested 4000 mg of topiramate in a suicide attempt. She was asymptomatic following the overdose and did not develop any adverse sequelae. In this article we will discuss the commonly seen side effects of topiramate use and examine the available data concerning topiramate overdose. We will review recommendations for the management of such an overdose.     

Pleomorphic Xanthoastrocytoma with an Intracystic Hemorrhage : A Case Report and Literature Review

Pleomorphic xanthoastrocytoma (PXA) has been considered as a low grade tumor of adolescents and young adults. Although this tumor often shows cystic component, the hemorrhage within the cyst is extremely rare. The authors report a rare case of cystic PXA with a hemorrhage within the cyst and the mural nodule in the left frontal lobe. A 64-year-old male presented with a week history of the right side hemiparesis. After gross total resection of the tumor, the patient was fully recovered from neurological deficit. It is suggested that this typically benign tumor could be presented with hemorrhage, causing a rapid neurological deterioration. Prompt surgical intervention, especially total removal of the tumor can provide an excellent functional recovery.     

Kleine-Levin Syndrome: A Case Report and Review of Literature

BackgroundKleine-Levin syndrome presents with recurrent hypersomnia along with a number of other neuropsychiatric features, of which hyperorality has not been described frequently.MethodWe report a male adolescent who presented with recurrent hypersomnia, hypersexuality, and hyperorality. Magnetic resonance imaging of the brain and overnight polysomnography followed by a multiple sleep latency tests were ordered. Excessive daytime sleepiness was assessed with the Epworth Sleepiness Scale.ResultsMagnetic resonance imaging of the brain did not reveal any abnormality. Overnight video-synchronized polysomnography and multiple sleep latency tests ruled out narcolepsy. Epworth Sleepiness Scale score at baseline was 22. He was prescribed lithium carbonate 300 mg twice a day. The symptoms improved within a week after starting lithium carbonate therapy.ConclusionKleine-Levin syndrome may present with hyperorality, and our patient responded well to lithium carbonate therapy.     

Spontaneous Spinal Epidural Hematoma in an Infant : A Case Report and Review of the Literature

Spontaneous spinal epidural hematoma (SSEH) is rare in children, especially in infants, in whom only 12 cases have been reported. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed. We report herein a case of SSEH in a 20-month-old girl who initially presented with neck pain, and developed lower extremity motor weakness and symptoms of neurogenic bladder 2 weeks prior to admission. The magnetic resonance imaging showed an epidural mass lesion extending from C7 to T4, and the spinal cord was severely compressed by the mass. After emergency decompressive surgery the neurologic function was improved immediately. Two months after surgery, the neurological status was normal with achievement of spontaneous voiding. We suggest that surgical intervention can provide excellent prognosis in case of SSEH in infants, even if surgery delayed.     

Fatal Case of Cerebral Aspergillosis : A Case Report and Literature Review

Cerebral aspergillosis is rare and usually misdiagnosed because its presentation is similar to that of a tumor. The correct diagnosis is usually made intra-operatively. Cerebral abscess with fungal infection is extremely rare and few cases have been reported, but it carries a poor prognosis.A 73 year-old man presented with decreased visual acuity and paresis of the right cranial nerve III. Magnetic resonance imaging (MRI) revealed a mass in the right cavernous sinus, extened to the anterior crainial fossa and the superior orbital fissure. During surgery, a well encapsulated pus pocket was found, and histopathological examination of the mass resulted in the diagnosis of aspergillosis. Despite appropriate anti-fungal treatment, the patient eventually died from fatal cerebral ischemic change and severe brain swelling.The correct diagnosis of cerebral aspergillosis can only be achieved by histopathological examination because clinical and radiological findings including MRI are not specific. Surgical intervention and antifungal therapy should be considered the optimal treatment. Early diagnosis and aggressive antifungal treatment provide good results.     

肢带综合征1例及文献复习

目的:探讨淋巴瘤肌肉侵犯的临床特点。方法:报道1例肌肉病理确诊为淋巴瘤合并肌肉侵犯患者,对其临床、肌肉MRI表现和肌肉活检病理结果结合复习文献予以分析,总结淋巴瘤肌肉侵犯的临床特点。结果:淋巴瘤肌肉侵犯发生率较低,主要表现为受累肌肉肿块、疼痛和无力。MRI中可表现为局部肿块或弥漫性肿大及异常信号。肌肉活检及免疫组化有助于与肌炎鉴别和淋巴瘤的分型。以肌肉侵犯为主要表现的淋巴瘤化疗以CHOP方案为主,预后较好。结论:淋巴瘤肌肉侵犯可引起包括肢带综合征在内的肌病表现,有肌肉肿块或无力症状以及相应MRI表现的病例应考虑淋巴瘤肌肉侵犯可能。     

Giant Cavernous Malformation : A Case Report and Review of the Literature

Giant cavernous malformations (GCMs) occur very rarely and little has been reported about their clinical characteristics. The authors present a case of a 20-year-old woman with a GCM. She was referred due to two episodes of generalized seizure. Computed tomography and magnetic resonance image demonstrated a heterogeneous multi-cystic lesion of 7 × 5 × 5 cm size in the left frontal lobe and basal ganglia, and enhancing vascular structure abutting medial portion of the mass. These fingings suggested a diagnosis of GCM accompanying venous angioma. After left frontal craniotomy, transcortical approach was done. Total removal was accomplished and the postoperative course was uneventful. GCMs do not seem differ clinically, surgically or histopathologically from small cavernous angiomas, but imaging appearance of GCMs may be variable. The clinical, radiological feature and management of GCMs are described based on pertinent literature review.     

Group C Streptococcal Leptomeningitis and Brain Abscess Secondary to Frontal Sinusitis: A Case Report

Group C streptococcus has emerged as a potentially lethal pathogen causing serious intracranial infections. The pediatric population in particular has been susceptible to this pathogen; its virulence has increased due to antibiotic resistance. This organism has rarely been reported in the literature as a cause of brain abscess [1-5]. Herein is a report of pansinusitis secondary to group C streptococcus, complicated by an extensive intracranial infection in an adolescent.     

Metronidazole-induced Encephalopathy: Case Report and Review Literature

Purpose: Neurotoxicities resulting from various medications are under diagnosed; Metronidazole-induced encephalopathy is one of them. Here we present two patients with a history of metronidazole use and discuss neuroimaging findings. Case Report: We report two patients suffering from acute neurological symptoms associated with metronidazole use. A 70-year-old female who received a cumulative dose of 41.25g of metronidazole within one month, developed seizure. Brain magnetic resonance imaging (MRI) showed T2 hyperintensity over bilateral dentate nuclei and dorsal midbrain. A 56-year-old female suffering from acute onset of central vertigo with metronidazole use, took a total dose of 24g. The brain MRI showed T2 hyperintensity over dorsal midbrain and dorsal medulla, which disappeared in the following neuroimaging 50 days later. Metronidazole-induced encephalopathy (MIE) was suspected in both patients. Conclusion: Metronidazole-induced encephalopathy is an uncommon but potentially reversible disease in patients with acute neurological deficits from the use of metronidazole. Nonalcoholic Wernicke's encephalopathy may share a similar metabolic pathway with MIE, resulting in difficulties in diagnosis.     

Isaacs综合征1例报道和文献复习

目的：探讨Isaacs综合征的发病机制、临床特征、诊断和治疗。方法：回顾性分析中国医科大学附属第一医院神经内科收治的1例Isaacs综合征患者的临床表现、辅助检查、治疗和预后,结合文献进行分析。结果：患者男性,71岁。主要表现为自发性肌肉颤搐,睡眠时症状不消失。肌电图可见颤搐电位和轻度运动神经传导速度减慢。卡马西平治疗后症状控制良好。结论：Isaacs综合征是一种自身免疫性疾病,病因尚不明确,肌肉颤搐及典型肌电图表现是诊断关键,卡马西平和苯妥英钠为首选治疗药物。     

Altered Taste and Stroke: A Case Report and Literature Review

Abstract

Patients with altered taste perception following stroke are at risk for malnutrition and associated complications that may impede recovery and adversely affect quality of life. Such deficits often induce and exacerbate depressive symptomatology, which can further hamper recovery. It is important for clinicians and rehabilitation specialists to monitor stroke patients for altered taste perception so that this issue can be addressed. The authors present the case of a patient who experienced an isolated ischemic infarct affecting a primary cortical taste area. This case is unusual in that the isolated injury allowed the patient to remain relatively intact cognitively and functionally, and thus able to accurately describe her taste-related deficits. The case is further used to describe the relevant neurological taste pathways and review potential taste-related therapies.     

Pseudotumor Cerebri in Lyme Disease: A Case Report and Literature Review

Pseudotumor cerebri is an unusual presentation of Lyme disease. The case of an 8-year-old girl with pseudotumor cerebri secondary to acute neuroborreliosis is reported. She presented with acute onset of headache, papilledema, sixth nerve palsy, increased intracranial pressure, and cerebrospinal fluid pleocytosis. Serum and cerebrospinal fluid Lyme antibodies were positive. Twelve reported cases that mostly presented with systemic findings and signs of Lyme disease before development of pseudotumor cerebri were reviewed. We conclude that acute neuroborreliosis can present with pseudotumor cerebri as an initial manifestation. It is important to include Lyme disease in the differential diagnosis of pseudotumor cerebri in an area endemic for Lyme disease.     

原发性视交叉恶性胶质瘤1例并文献回顾

目的:了解原发性视交叉恶性胶质瘤的疾病特点。方法:对收治的1例以无诱因出现视力下降为首发症状,并经手术病理确诊的原发性视交叉恶性胶质瘤患者予以回顾性分析,并结合文献复习分析该病特点。结果:患者影像学检查CT平扫示鞍上视交叉区有一等密度、形状不规则的2.5cm×1.2cm×2cm病灶。MRI平扫见视交叉明显增大,形态可辨,双侧视神经不对称增粗,T1相呈等或低信号,T2相呈稍高信号;增强后见视交叉内有一体积约1.1cm×1cm×1.2cm强化灶,伴有多处囊变坏死,增粗的双侧视神经内亦有异常强化灶,无明显边界。手术治疗经右侧改良翼点入路,术中见肿瘤主体位于视交叉,色灰红,间有黄色组织,血供丰富。肿瘤尽量切除,大脑前动脉、垂体柄保护完好。术后患者双眼视力无改善。1个月后复查增强MRI,见残余肿瘤进一步生长。于术后3个月后病死于当地医院。结论:结合文献复习表明,原发性视交叉恶性胶质瘤十分罕见,主要见于成人,目前仅4例见于文献,恶性程度很高,预后极差。手术切除是首选治疗方法,但不易全切,术后后续放疗和化疗可延长患者生存期。