Solitary tuberculoma of the cerebellopontine angle: a rare presentation.

Central nervous system tuberculoma presenting as a solitary mass in an extrinsic location is rare. Due to the increase in incidence of tuberculosis in the western world, there is a corresponding increase in CNS tuberculosis. Cerebellopontine angle tumours are most commonly acoustic schwannomas or meningiomas. Radiosurgery as a primary modality of treatment for many CNS masses without prior pathological diagnosis is increasing in popularity. This report shows that a mass in the CP angle can closely mimic a tumour radiologically and inappropriate radiation treatment was avoided after surgery. Histopathological examination proved it to be a tuberculoma. Awareness of this rare presentation of a solitary tuberculoma in the CP angle is emphasised.     

Brain-stem tuberculoma: An unusual presentation

Summary A brain-stem tuberculoma is described in a 30-year-old woman who had recurrent episodes of neurological deficit with partial recovery. There was good clinical improvement and complete radiological resolution with antituberculous treatment alone.

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Zusammenfassung Verursacht durch ein Tuberkulom des Hirnstammes wies eine 30jährige Patientin rezidivierende Episoden mit neurologischen Ausfällen und teilweiser Erholung auf. Durch eine tuberkulostatische Behandlung kam es zu einer guten klinischen Besserung und einer vollständigen Rückbildung der neuroradiologischen Befunde.

     

Unilateral hydrocephalus: atypical presentation of intracranial tuberculoma

A 43-year-old male presented with 3-month history of low-grade fever and headache. Radiological investigations revealed unilateral hydrocephalus. Unilateral obstruction of the foramen of Monro due to chronic tubercular ependymal inflammation was suspected and endoscopic septostomy was planned. Though ventriculo-peritoneal shunt is a simple method to treat hydrocephalus, complications related to this procedure are numerous. Neuroendoscopy is a safe method to treat hydrocephalus in selected cases, and also provides access to biopsy the lesion in question. An isolated tuberculoma obstructing the foramen of Monro was seen during endoscopy. Presentation and management of this unusual tuberculoma is reported along with a review of the pertinent literature.     

Cerebellar tuberculoma: a rare disease in an industrialized country

A nine-year-old Somalian boy was treated in Denmark for a posterior fossa tumor, which proved to be a tuberculoma. This disease is virtually unknown in our highly industrialized country, which emphasizes the fact that due to increased international traveling, knowledge of endemic diseases in other parts of the world is necessary. The treatment of tuberculoma and their diagnostic features are reviewed.     

Spinal intramedullary tuberculoma and abscess: a rare cause of paraparesis

Five cases of spinal intramedullary tuberculomas (IMT) and one case of spinal intramedullary tuberculous abscess (ITA) are presented. Gd enhanced MRI revealed ring enhancing lesion with central hypodensity, suggesting granulomatous pathology. Surgical excision of the intramedullary lesions was carried out in four cases, while two patients received presumptive anti-tuberculous chemotherapy only. Repeat MRI after completion of anti-tuberculous therapy showed total resolution of the lesion. In other cases following surgical excision, the patients improved significantly. The management of these rare lesions is discussed and the literature reviewed.     

Stroke: a rare presentation of cardiac hydatidosis

A 13-year-old boy presented with acute stroke leading to right-sided hemiparesis. A contrast CT scan of the brain showed a hemorrhagic infarct in the left basal ganglia region with surrounding edema. Echocardiography showed a hydatid cyst in the right atrial chamber extending into the left atrium. A single hepatic hydatid was also seen.     

Pyridoxine-dependency seizure: Report of a rare presentation

A child developed minor motor seizures at the age of 14 months accompanied by an abnormal electroencephalogram showing single spikes and polyspikes over the vertex and frontocentral regions. Seizures continued until the age of 22 months despite administration of several standard anticonvulsants. At age 22 months, pyridoxine, 75 mg daily, was initiated and anticonvulsants were discontinued. Both the seizures and the electroencephalographic abnormality have disappeared over the ensuing 20 months with pyridoxine therapy.     

Neoplastic meningitis: a rare presentation of bronchial adenocarcinoma

Following chronic daily headache, neoplastic meningitis was diagnosed in a non-smoking 44-year-old man. A bronchial adenocarcinoma was found to be the primary tumor. He was treated with erlotinib. Meningitis as the first manifestation of a malignancy is very rare.     

Reversible coma: a rare presentation of spontaneous intracranial hypotension

BACKGROUND: Spontaneous intracranial hypotension (SIH) is a well-recognized neurologic disorder that typically presents with orthostatic headaches, low cerebral spinal fluid pressures and distinct abnormalities on magnetic resonance imaging. METHODS: We present a case of a rare presentation of SIH. RESULTS: A 49-year-old man presented with a two week history of orthostatic headaches that rapidly progressed to encephalopathy and coma, requiring intubation. Neuroimaging revealed abnormalities typical of SIH; diffusely enhancing pachymeninges, subdural fluid collections, and descent of the brain. Treatment with an epidural blood patch reversed his coma within minutes. Following a second blood patch, the patient became asymptomatic. No cerebral spinal leak could be identified on magnetic resonance imaging or on a nuclear medicine technetium cerebral spinal fluid flow study. At six month follow-up, he remained symptom free. CONCLUSION: The mechanism of coma in SIH is presumed to be compression of the diencephalon from downward displacement of the brain. Although it is very unusual for patients with SIH to present with coma, it is important to recognize since the coma may be reversible with epidural blood patches.     

Midbrain infarction: a rare presentation of cryptococcal meningitis.

A 20-year-old farmer who had headache and fever for 1 month, suddenly developed left hemiplegia, tremor in left arm and titubation followed by deep coma. Cranial CT scan revealed an infarction in right crus of midbrain. His CSF revealed 66 mg/dl protein, 10 lymphocytes/mm3, and 70 mg/dl glucose. CSF was positive for cryptococcal antigen. He improved following i.v. amphotericin 0.5 mg/kg and fluconazole 200 mg daily, continued for 6 and 12 weeks respectively. Infarctions though rare in cryptococcal meningitis should be considered in patients with chronic meningitis with vasculitis.     

Hydrophobia as a rare presentation of Cotard's syndrome: a case report

OBJECTIVE: To discuss a case of Cotard's syndrome in a 65-year-old male patient who refused to eat and drink. METHOD: A single case is presented. RESULTS: The patient was especially sensitive to water and showed panic reactions when he was offered a glass of water. These symptoms began when he deluded himself to believe that his stomach shrunk. Diagnosis was major depressive disorder with psychotic feature based on DSM-IV. CONCLUSION: Hydrophobia as a symptom of Cotard's syndrome was not reported before. This symptom is often known as evidence of rabies but may be seen in Cotard's syndrome.