NMC case report journal最新文献

The clinical course of pyogenic spondylodiscitis varies based on its etiology. To the best of our knowledge, there have been only 7 cases of spondylodiscitis caused by Klebsiella oxytoca. This bacterium typically affects patients with underlying comorbidities or develops as a secondary infection. This case illustrates a rare instance of lumbar spondylodiscitis caused by Klebsiella oxytoca. A direct biopsy via endoscopic surgery may be beneficial when multiple bacterial culture investigations yielded negative results. It is important to recognize that identifying the causative pathogen is crucial when initiating antibiotic therapy for spondylodiscitis.

Introduction: Dural arteriovenous fistula is an abnormal shunt between arteries and veins located within or around the dural venous sinuses, comprising 10%-15% of cerebrovascular malformations. Falcotentorial dural arteriovenous fistula with hydrocephalus is extremely rare, with only a few cases reported. This paper presents the technical approach to managing such a condition.

Case description: A 56-year-old man presented with gait disturbance and cognitive decline for 3 months. Magnetic resonance angiography revealed hydrocephalus and a vascular malformation near the third ventricle. Digital subtraction angiography confirmed a falcotentorial dural arteriovenous fistula with multiple arterial feeders and deep venous drainage. Trans-arterial embolization was performed, achieving complete occlusion of the fistula while preserving the venous varices. The patient tolerated the procedure well, with both clinical and radiological improvement.

Discussion: Hydrocephalus in dural arteriovenous fistula is often caused by aqueductal compression from dilated venous structures. Treating hydrocephalus before addressing the fistula may risk hemorrhage due to fragile leptomeningeal vessels. In this case, embolization was performed with particular attention to preserving the venous varix located caudally at the fistula site. Embolizing this pouch could have led to acute thrombosis and worsening hydrocephalus. Following embolization, ventricular dilation regressed, and the patient's symptoms improved.

Conclusion: Falcotentorial dural arteriovenous fistula with hydrocephalus is exceptionally rare. During embolization, preserving the venous ectasia compressing the Sylvian aqueduct may help prevent the aggravation of hydrocephalus and support progressive ventricular size reduction.

An anti-neutrophil cytoplasmic antibody-associated vasculitis is a systemic autoimmune disease characterized by small-vessel inflammation, with rare central nervous system manifestations such as subarachnoid hemorrhage. Cerebral artery dissection, a rare but serious condition that can lead to ischemic stroke or subarachnoid hemorrhage, predominantly affects young to middle-aged adults and is less common in elderly patients. We report the case of an 86-year-old male with anti-neutrophil cytoplasmic antibody-associated vasculitis who developed subarachnoid hemorrhage due to a ruptured posterior inferior cerebellar artery aneurysm, suggestive of dissection. Despite diagnostic challenges related to the patient's advanced age, repeated vascular imaging indicated arterial dissection, and parent artery occlusion successfully prevented re-rupture. This case highlights the importance of considering cerebral artery dissection as a potential cause of subarachnoid hemorrhage in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis, even in octogenarians, and underscores the need for comprehensive vascular evaluation to ensure timely diagnosis and management.

Marginal zone B cell lymphoma, which can sometimes resemble a meningioma, originates in the dura mater. Reports of marginal zone B cell lymphoma complicated by intracranial hemorrhage are rare. There have been five reported cases of dural marginal zone B cell lymphoma complicated by acute subdural hematoma. To our knowledge, this is the first reported case of dural marginal zone B cell lymphoma diagnosed at the onset of a non-traumatic acute epidural hematoma. A 74-year-old man presented to our hospital with complaints of right hemiparesis without a history of head injury. He was diagnosed with left acute epidural hematoma based on the results of a computed tomography scan of the head; however, his serum soluble interleukin-2 receptor level was elevated (3,520 U/mL), and whole-body contrast-enhanced computed tomography revealed intra-abdominal and bilateral inguinal lymphadenopathy. Contrast-enhanced magnetic resonance imaging of the head revealed a well-enhanced, thickened dura mater with an acute epidural hematoma. The patient underwent a biopsy of the thickened dura mater and a hematoma removal, which on histopathology revealed dural marginal zone B cell lymphoma, as did a biopsy of an inguinal lymph node. After chemotherapy, the thickened dura mater shrank, and the marginal zone B cell lymphoma lesions showed remission. However, the mechanism underlying acute epidural hematoma in the dural marginal zone B cell lymphoma remains unclear. This case report provides new insights into dural marginal zone B cell lymphoma as a cause of non-traumatic acute epidural hematoma.

Spinal epidural lymphoma is a rare pathological entity that usually responds well to chemotherapy. However, it occasionally requires immediate surgical treatment for progressive neurological symptoms caused by a bulky epidural mass and bone destruction. In the management of spinal epidural lymphoma, the role of surgical interventions has not yet been fully defined, and few reports on long-term functional outcomes are available. We report 3 cases of thoracic spinal epidural lymphoma that required emergent surgical management for neural decompression and were followed postoperatively over 2 years or until death. Two patients (cases 1 and 2) underwent spinal instrumentation to prevent subsequent spinal deformity, whereas instrumentation was avoided in case 3 due to atopic dermatitis, which increases the risk of surgical site infection. During the 2-year postoperative period, 2 patients (cases 1 and 3) maintained disease-free survival and achieved sufficient neurological recovery to remain ambulant, while the other patient (case 2) died due to spinal epidural lymphoma relapse. Given the high treatment responsiveness and the potential for long-term disease-free survival in spinal epidural lymphoma, treatment should aim to maximize functional outcomes. Prompt surgical decompression is mandatory in patients with neurological deficits. Although spinal instrumentation is typically recommended to prevent spinal deformity, it should be withheld if it poses a risk of delaying chemotherapy, such as in cases with a high risk of surgical site infection. Therefore, spinal surgeons play several essential roles in managing spinal epidural lymphoma from the acute to the chronic phase, aiming to improve patients' prognosis and quality of life.

Calcified lumbar disc herniation is a challenging subtype of lumbar disc herniation to treat owing to high associated risks of nerve root injury and dural tears. Traditional treatments favor open surgery, but recent advances have increased the use of full-endoscopic discectomy. The patient was a 72-year-old woman with a 4-year history of severe right lower extremity pain. Computed tomography indicated right foraminal stenosis at L2/3 caused by extraforaminal calcified lumbar disc herniation. Full-endoscopic discectomy was performed under local anesthesia through a transforaminal approach. Drilling was conducted within the herniated disc; next, the calcification was broken and removed piece by piece. Symptoms improved after the surgery, and the calcified lumbar disc herniation disappeared. In conclusion, transforaminal full-endoscopic discectomy under local anesthesia is a safe and effective approach for calcified lumbar disc herniation, especially in cases with extraforaminal involvement. The technique described in this study, "intradiscal drilling," avoids the need to detach adhesions, minimizing the risk of nerve injury.

Cerebral venous sinus thrombosis (CVST) is rare but serious adverse complication of coronavirus disease 2019 (COVID-19) vaccination. CVST can sometimes lead to development of dural arteriovenous fistula (DAVF), but DAVF secondary to CVST following COVID-19 vaccination is rarely reported. Here, we present a case of CVST occurring after COVID-19 vaccination, followed by subsequent development of DAVF, which was successfully treated. A 45-year-old male presented with headache and progressive visual impairment beginning 4 days after COVID-19 vaccination. Papilledema was noted. Cerebrospinal fluid pressure was elevated at 300 mmH₂O, and magnetic resonance imaging (MRI) revealed right transverse sinus thrombosis, prompting initiation of anticoagulant therapy. Four months later, MRI suggested DAVF in right transverse sinus, and he was referred to our department. Digital subtraction angiography confirmed DAVF in right transverse sinus, as well as concurrent convexity DAVF and pial arteriovenous fistula over right vein of Labbé, all draining solely into right vein of Labbé. Anticoagulation therapy was discontinued due to aggressive nature of this DAVF. Transarterial embolization (TAE) with Onyx was performed in 2 sessions, achieving complete occlusion of shunt. Postoperatively, anticoagulation therapy was not resumed. Ten months later, the patient again experienced visual deterioration. Recurrence of convexity DAVF over right vein of Labbé was identified, and TAE with Onyx was performed again, resulting in successful shunt occlusion. Postoperatively, anticoagulant therapy was resumed. The patient's visual acuity gradually improved, and at 18 months post-treatment, no recurrence was observed. CVST following COVID-19 vaccination can progress to DAVF; therefore, careful follow-up is recommended.

Myxoid glioneuronal tumour (MGNT) is a new WHO classification of brain tumours and is defined as tumours with PDGFRA p.K385 mutations. MGNT has a predilection for the septum pellucidum, their clinical features have not yet been clarified because only a few reports exist. In this report, we present the case of a patient with an MGNT that was suitable for endoscopic resection. We discuss the clinical characteristics of MGNTs discovered during a literature review. A 19-year-old female presented with a worsening headache and a disturbance of consciousness. Head MRI revealed a mass lesion in the septum pellucidum and severe obstructive hydrocephalus. She underwent neuroendscopic surgery under general anaesthesia, and near total resection was achieved. Her symptoms improved immediately after surgery, and she was discharged without any morbidities. Pathological examination and genetic testing confirmed the diagnosis of an MGNT. A literature review revealed that 7 of 18 MGNTs developed in the septum pellucidum. Three patients had disseminated lesions at initial diagnosis, and one showed dissemination during the follow-up period. Among the 14 patients who underwent tumour resection surgery, 3 experienced recurrence or regrowth and required additional treatments. All 18 patients were alive at the last follow-up. An MGNT is a tumour that predominantly affects young people and is currently considered to have a good prognosis. However, close postoperative observation is needed because an MGNT often disseminates intracranially and/or into the spinal cord. In addition, we believe that MGNTs located in the septum pellucidum are good candidates for endoscopic resection.

The incidence of syphilis is increasing rapidly worldwide and has become a public health threat. Although osseous lesions are commonly observed in congenital or tertiary syphilis, some cases of skull involvement have been reported in earlier stages of the disease. A 22-year-old woman with a history of tension headaches presented with a severe, new-onset headache localized to the forehead. Imaging studies revealed multiple osteolytic lesions confined to the skull, and serological tests confirmed cranial syphilitic osteomyelitis in the early stage of syphilis. The patient's condition improved with antibiotic therapy. This case highlights the importance of considering syphilitic osteomyelitis in young adults with unexplained headaches and emphasizes the importance of early recognition and treatment.

A 5-year-old boy presented to our hospital with ptosis and an abnormal ocular position. Magnetic resonance imaging showed a well-defined mass measuring 20 mm in diameter in the medial sphenoid bone extending to the orbit and compressing the external ocular muscle. The patient underwent total surgical excision and was subsequently diagnosed with a solid variant of aneurysmal bone cyst via molecular integrated diagnosis. Solid variant of aneurysmal bone cyst is an extremely rare subtype of aneurysmal bone cyst, accounting for 0.2% of all primary bone tumors. It is characterized by the absence of a solid cystic component, which is difficult to diagnose via conventional hematoxylin and eosin staining. Molecular analyses revealed that this subtype is also characterized by the rearrangement of USP6 and the absence of the H3F3A mutation. This report discusses the clinical features of this extremely rare neoplastic lesion, the importance of an integrated diagnosis, and treatment options.