Pub Date : 2016-02-01DOI: 10.1097/WNQ.0000000000000134
Xiaobin Li, Wei Wang, Yue Zhou
Both chronic subdural hematoma (CSDH) and arachnoid cyst (AC) are common diseases in neurosurgical department. However, the association of CSDH and AC is uncommon. AC is a predisposing cause in young patients with CSDH. Herein, we reported a 11-year-old young girl with CSDH associated with AC. The hematoma was evacuated through signal hole and the patient was discharged in well condition. We also review the literature on CSDH associated with AC in adolescent.
{"title":"Arachnoid Cyst Associated With Chronic Subdural Hematoma in Juvenile: A Case Report and Literature Review","authors":"Xiaobin Li, Wei Wang, Yue Zhou","doi":"10.1097/WNQ.0000000000000134","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000134","url":null,"abstract":"Both chronic subdural hematoma (CSDH) and arachnoid cyst (AC) are common diseases in neurosurgical department. However, the association of CSDH and AC is uncommon. AC is a predisposing cause in young patients with CSDH. Herein, we reported a 11-year-old young girl with CSDH associated with AC. The hematoma was evacuated through signal hole and the patient was discharged in well condition. We also review the literature on CSDH associated with AC in adolescent.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"58-60"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.1097/WNQ.0000000000000175
Elnaz Farajirad, M. Farajirad, M. Khajavi, S. Shojaie
Objectives:Hydatid diseases are both a medical and an economic problem in Iran, especially in the rural areas. The aim of this study was to analyze brain involvement in this disease, the related problems, the causes, and its diagnostic and therapeutic aspects. Materials and Methods:Medical records of 99 patients with cerebral hydatid disease treated between 1977 and 2013 in Qaem hospital were retrospectively reviewed. Clinical presentations, radiologic examinations, treatment modalities, and outcomes of the patients were analyzed. Results:Ninety-nine patients with hydatid disease of neuraxis underwent 149 operations. Of the 99 patients, 68 cases had primary cerebral hydatid cysts, 18 cases had unusual hydatid cysts of neuraxis (orbit: 3; spinal cord: 3; cerebellum: 3; cranial epidural: 1; bilateral hemispheric: 8), and 13 cases had >1 operations because of having multiple cysts. All patients were treated surgically. Complications related to surgery were observed in 4 patients. There were no recurrences or residual cysts among the patients. Conclusions:Hydatid disease should be considered in the differential diagnosis of intracranial space-occupying lesions in developing countries where there are still lots of rural areas and the quality of life is not good. Early diagnosis of cerebral hydatid cysts may prevent serious life-threatening complications of this disease. Outcome is favorable when the cyst is completely removed without rupture.
{"title":"Central Nervous System Hydatid Disease: Clinical Analysis of 99 Cases in Qaem Hospital of Mashad University of Medical Sciences, Iran","authors":"Elnaz Farajirad, M. Farajirad, M. Khajavi, S. Shojaie","doi":"10.1097/WNQ.0000000000000175","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000175","url":null,"abstract":"Objectives:Hydatid diseases are both a medical and an economic problem in Iran, especially in the rural areas. The aim of this study was to analyze brain involvement in this disease, the related problems, the causes, and its diagnostic and therapeutic aspects. Materials and Methods:Medical records of 99 patients with cerebral hydatid disease treated between 1977 and 2013 in Qaem hospital were retrospectively reviewed. Clinical presentations, radiologic examinations, treatment modalities, and outcomes of the patients were analyzed. Results:Ninety-nine patients with hydatid disease of neuraxis underwent 149 operations. Of the 99 patients, 68 cases had primary cerebral hydatid cysts, 18 cases had unusual hydatid cysts of neuraxis (orbit: 3; spinal cord: 3; cerebellum: 3; cranial epidural: 1; bilateral hemispheric: 8), and 13 cases had >1 operations because of having multiple cysts. All patients were treated surgically. Complications related to surgery were observed in 4 patients. There were no recurrences or residual cysts among the patients. Conclusions:Hydatid disease should be considered in the differential diagnosis of intracranial space-occupying lesions in developing countries where there are still lots of rural areas and the quality of life is not good. Early diagnosis of cerebral hydatid cysts may prevent serious life-threatening complications of this disease. Outcome is favorable when the cyst is completely removed without rupture.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"8 1","pages":"1–4"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61886258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.1097/WNQ.0000000000000123
Tingzhong Wang, Jian Yu, Xianlin Zhao
Trigonal cavernous malformations (CMs) are very rare. This paper presents a case of trigonal CM mimicking intraventricular tumor symptomatically and radiologically. A 55-year-old female patient presented with headache. Magnetic resonance imaging revealed a trigonal mass in the right lateral ventricle, which was isointense on T1-weighted and hyperintense on T2-weighted imaging and showed heterogenous enhancement on contrast image. The lesion was completely excised using microsurgery with a transinferior parietal lobule approach. Histopathologic analysis confirmed the diagnosis of CM. The patient had excellent outcome. The review of the pertinent literature has revealed that trigonal CMs with atypical magnetic resonance imaging incongruent with any Zabramski type could be misdiagnosed as intraventricular tumors. Radical excision through transcortical approaches provide good outcome for patients with trigonal CMs.
{"title":"Trigonal Cavernous Malformation Mimicking Intraventricular Tumor: A Case Report and Literature Review","authors":"Tingzhong Wang, Jian Yu, Xianlin Zhao","doi":"10.1097/WNQ.0000000000000123","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000123","url":null,"abstract":"Trigonal cavernous malformations (CMs) are very rare. This paper presents a case of trigonal CM mimicking intraventricular tumor symptomatically and radiologically. A 55-year-old female patient presented with headache. Magnetic resonance imaging revealed a trigonal mass in the right lateral ventricle, which was isointense on T1-weighted and hyperintense on T2-weighted imaging and showed heterogenous enhancement on contrast image. The lesion was completely excised using microsurgery with a transinferior parietal lobule approach. Histopathologic analysis confirmed the diagnosis of CM. The patient had excellent outcome. The review of the pertinent literature has revealed that trigonal CMs with atypical magnetic resonance imaging incongruent with any Zabramski type could be misdiagnosed as intraventricular tumors. Radical excision through transcortical approaches provide good outcome for patients with trigonal CMs.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"90–94"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61882293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.1097/WNQ.0000000000000125
P.M.M. Filho, R. Espanhol, N. Azambuja, Daniel L Varela, R. Rodriguez
Glioblastoma multiforme is the most common primary brain tumor; however, the occurrence of this tumor in >1 site without continuity is rare, especially in association with unusual histologic variants. These features might have prognostic implications, especially in terms of surgical and adjuvant therapy. We present a case of a patient with 2 lesions, without continuity, initially thought to be metastatic disease, but that revealed to be glioblastoma multiforme, in its giant cell variant, an extremely rare subtype. We discuss the pathogenesis, diagnostic challenges, and appropriate treatment available in the literature.
{"title":"Multicentric Giant Cell Glioblastoma: Case Report and Revision of the Literature","authors":"P.M.M. Filho, R. Espanhol, N. Azambuja, Daniel L Varela, R. Rodriguez","doi":"10.1097/WNQ.0000000000000125","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000125","url":null,"abstract":"Glioblastoma multiforme is the most common primary brain tumor; however, the occurrence of this tumor in >1 site without continuity is rare, especially in association with unusual histologic variants. These features might have prognostic implications, especially in terms of surgical and adjuvant therapy. We present a case of a patient with 2 lesions, without continuity, initially thought to be metastatic disease, but that revealed to be glioblastoma multiforme, in its giant cell variant, an extremely rare subtype. We discuss the pathogenesis, diagnostic challenges, and appropriate treatment available in the literature.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"64-68"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61882466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.1097/WNQ.0000000000000070
Ş. Yucetas, N. Huseyinoglu, H. Özlece, C. H. Yıldırım, Miktat Kaya, A. Akbaşak
Unilateral cerebellar agenesis/hypoplasia is defined as total or partial lack of one of the cerebellar hemispheres and it may occur due to etiopathogenetically different mechanisms. Patients usually show cerebellar symptoms, yet patients may occasionally be asymptomatic. This study provides a discussion of 5 cases of unilateral, congenital, rather rare cerebellar agenesis in light of the related literature. Five cases with unilateral cerebellar agenesis/hypoplasia who were seen in the neurosurgery and neurology clinics between April 2010 to September 2013 were evaluated. The youngest patient was a 2-year-old, whereas the oldest one aged 37 years. Three patients were younger than 16 years, whereas 2 patients were older than 16 years; 4 patients were female, whereas 1 patient was male. All patients underwent detailed physical and neurological examinations as well as magnetic resonance imaging. The cerebellar tests of 4 of the patients revealed positive results, whereas one patient was asymptomatic and was diagnosed with cerebellar hypoplasia during examinations performed to find the cause of headaches. Of the 4 patients who had positive cerebellar tests of ataxia, dysdiadochokinesia, and dysmetria, 3 were children and 1 was an adult. Wherever necessary, the patients were subjected to additional examinations of electroencephalography, electromyography, blood tests, abdominal ultrasonography, ophthalmological examination, and psychiatric evaluation. The aim of this study was to point out the fact that unilateral cerebellar agenesis/hypoplasia, which is a rare cerebellar anatomical disorder, may occasionally show minimal clinical cerebellar findings, or may be asymptomatic.
{"title":"Unilateral Cerebellar Agenesis With Minimal Clinical Symptoms","authors":"Ş. Yucetas, N. Huseyinoglu, H. Özlece, C. H. Yıldırım, Miktat Kaya, A. Akbaşak","doi":"10.1097/WNQ.0000000000000070","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000070","url":null,"abstract":"Unilateral cerebellar agenesis/hypoplasia is defined as total or partial lack of one of the cerebellar hemispheres and it may occur due to etiopathogenetically different mechanisms. Patients usually show cerebellar symptoms, yet patients may occasionally be asymptomatic. This study provides a discussion of 5 cases of unilateral, congenital, rather rare cerebellar agenesis in light of the related literature. Five cases with unilateral cerebellar agenesis/hypoplasia who were seen in the neurosurgery and neurology clinics between April 2010 to September 2013 were evaluated. The youngest patient was a 2-year-old, whereas the oldest one aged 37 years. Three patients were younger than 16 years, whereas 2 patients were older than 16 years; 4 patients were female, whereas 1 patient was male. All patients underwent detailed physical and neurological examinations as well as magnetic resonance imaging. The cerebellar tests of 4 of the patients revealed positive results, whereas one patient was asymptomatic and was diagnosed with cerebellar hypoplasia during examinations performed to find the cause of headaches. Of the 4 patients who had positive cerebellar tests of ataxia, dysdiadochokinesia, and dysmetria, 3 were children and 1 was an adult. Wherever necessary, the patients were subjected to additional examinations of electroencephalography, electromyography, blood tests, abdominal ultrasonography, ophthalmological examination, and psychiatric evaluation. The aim of this study was to point out the fact that unilateral cerebellar agenesis/hypoplasia, which is a rare cerebellar anatomical disorder, may occasionally show minimal clinical cerebellar findings, or may be asymptomatic.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"53–57"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61880506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.1097/WNQ.0000000000000117
F. Salehpoor, A. Meshkini, Azin Razmgiri, A. Mahdkhah
Objective:The aim of the study was to systematically review which factor of serum, assessed in traumatic brain injury (TBI), predicts patient’s outcome. Materials and Methods:Databases were searched for relevant publications between 2005 and January 2013, and those fulfilling the following selection criteria were included: (1) studies conducted from 2005 until February 2013; (2) studies in which factors affecting the outcome after TBI were evaluated; (3) studies that defined TBI as “acute changes in brain function resulting in a strong external force to the head”; (4) studies in which the result was measured by the Glasgow Outcome Score (GCS) or by means of a comparable measure describing the activity limitation and neurological state; (5) studies in which the correlation between the measured factors in the first month after injury and prognosis was addressed; and (6) studies involving patients with moderate and/or severe TBI (GCS<13). All of the papers shortlisted were checked and approved by a specialist and expert in that field. A systematic review and analysis was performed for the prognostic factors assessed in the studies. Results:A total of 71 studies were included, 58 of which were of high quality. Most studies used the GCS at 6 months after injury as the outcome measure, sometimes in combination with other outcome measures. Strong evidence for predicting outcome was found for serum concentration of S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, partial thromboplastin time, platelet count, D-dimer, HSP 70, serum levels of IL-8, number of circulating endothelial progenitor cells (EPCs), and DNA levels in serum.Moderate evidence for predicting outcome was found for high serum MMP9. Strong evidence of no association was found for WBC count and serum cortisol levels, and moderate evidence of no association was found for serum total cholesterol. For other determinants, inconclusive or no evidence or limited evidence was found. Conclusions:S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, partial thromboplastin time, platelet count, D-dimer, HSP 70, serum levels of IL-8, number of circulating EPCs, and DNA levels in serum predicted outcome after TBI. WBC count, serum cortisol levels, total cholesterol, and MMP9 did not have predictive values.
{"title":"Prognostic Serum Factors in Patients With Traumatic Brain Injury: A Systematic Review","authors":"F. Salehpoor, A. Meshkini, Azin Razmgiri, A. Mahdkhah","doi":"10.1097/WNQ.0000000000000117","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000117","url":null,"abstract":"Objective:The aim of the study was to systematically review which factor of serum, assessed in traumatic brain injury (TBI), predicts patient’s outcome. Materials and Methods:Databases were searched for relevant publications between 2005 and January 2013, and those fulfilling the following selection criteria were included: (1) studies conducted from 2005 until February 2013; (2) studies in which factors affecting the outcome after TBI were evaluated; (3) studies that defined TBI as “acute changes in brain function resulting in a strong external force to the head”; (4) studies in which the result was measured by the Glasgow Outcome Score (GCS) or by means of a comparable measure describing the activity limitation and neurological state; (5) studies in which the correlation between the measured factors in the first month after injury and prognosis was addressed; and (6) studies involving patients with moderate and/or severe TBI (GCS<13). All of the papers shortlisted were checked and approved by a specialist and expert in that field. A systematic review and analysis was performed for the prognostic factors assessed in the studies. Results:A total of 71 studies were included, 58 of which were of high quality. Most studies used the GCS at 6 months after injury as the outcome measure, sometimes in combination with other outcome measures. Strong evidence for predicting outcome was found for serum concentration of S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, partial thromboplastin time, platelet count, D-dimer, HSP 70, serum levels of IL-8, number of circulating endothelial progenitor cells (EPCs), and DNA levels in serum.Moderate evidence for predicting outcome was found for high serum MMP9. Strong evidence of no association was found for WBC count and serum cortisol levels, and moderate evidence of no association was found for serum total cholesterol. For other determinants, inconclusive or no evidence or limited evidence was found. Conclusions:S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, partial thromboplastin time, platelet count, D-dimer, HSP 70, serum levels of IL-8, number of circulating EPCs, and DNA levels in serum predicted outcome after TBI. WBC count, serum cortisol levels, total cholesterol, and MMP9 did not have predictive values.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"19–36"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61882676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.1097/WNQ.0000000000000120
Sameh A. Sakr, Alaa Azzazi, Ahmed M. Elsayed, H. Fathalla
Objectives:This study aimed to determine the outcome after gunshot wounds (GSWs) to the head and to evaluate the impact of prognostic factors mentioned in the literature on the outcome. Methods:This prospective study included 30 patients; 24 males and 6 females with a mean age of 31 years. All with penetrating GSWs to the head admitted to the emergency department of Cairo University Hospitals from January 2008 till June 2011. Shotgun was the most common injury in this study, whereas bullet injury was in only 3 patients (10%). Preoperatively, patients were categorized according to their Glasgow Coma Scale (GCS) into mild, moderate, and severe penetrating head injury. Upon admission, all patients underwent a complete physical and neurological examination together with a computed tomography of the brain without contrast. Initial management included a variety of the following according to indications; resuscitation, prophylactic antiepileptics, antibiotics, control active bleeding from wounds, and measures to decrease intracranial pressure. Surgical intervention ranged from simple debridement to hematoma evacuation and/or bullet extraction. Outcome was assessed after surgical interference using GCS and Glasgow Outcome Scale. Results:Fifteen (50%) patients had mild penetrating head injury (GCS 13 to 15), 12 patients (40%) were severely injured (GCS 3 to 8), and only 3 patients (10%) were moderately injured (GCS 9 to 12). Eighteen patients (60%) were found to have isolated intracranial injury, whereas 40% had other associated injuries. Twelve patients (40%) had an associated intracranial hematoma on their initial computed tomography scan. The average follow-up period was 16 months. The most common systemic complications were urinary tract infection (12 patients) and chest infection (12 patients), whereas the most common local complications were wound infection (10 patients), cerebrospinal fluid fistula (8 patients), and hydrocephalus (5 patients). At the follow up, The GCS of 10 patients (33.3%) was (13 to 15), 6 patients (20%) were (9 to 12), 5 patients (16.7%) showed persistent vegetative state (<3), and 9 patients (30%) died. Postoperative outcome was significantly correlated with the preoperative one (P<0.001). According to Glasgow Outcome Scale, 33.3% of patients had good recovery and 30% of the patients died. The others suffered from various degrees of disability. Conclusions:The prevalence of GSWs to the head is increasing dramatically as private ownership of weapons and gang-related urban violence increases. Most of the irreversible brain damage from a GSW is sustained at impact and can be understood in terms of a missile’s trajectory and the pattern of energy transfer to brain tissue. Treatment is aimed at preventing subsequent brain injury that might further limit recovery. One third of patients obtain a good recovery.
{"title":"Surgical Management of Penetrating Intracranial Bullet Injuries","authors":"Sameh A. Sakr, Alaa Azzazi, Ahmed M. Elsayed, H. Fathalla","doi":"10.1097/WNQ.0000000000000120","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000120","url":null,"abstract":"Objectives:This study aimed to determine the outcome after gunshot wounds (GSWs) to the head and to evaluate the impact of prognostic factors mentioned in the literature on the outcome. Methods:This prospective study included 30 patients; 24 males and 6 females with a mean age of 31 years. All with penetrating GSWs to the head admitted to the emergency department of Cairo University Hospitals from January 2008 till June 2011. Shotgun was the most common injury in this study, whereas bullet injury was in only 3 patients (10%). Preoperatively, patients were categorized according to their Glasgow Coma Scale (GCS) into mild, moderate, and severe penetrating head injury. Upon admission, all patients underwent a complete physical and neurological examination together with a computed tomography of the brain without contrast. Initial management included a variety of the following according to indications; resuscitation, prophylactic antiepileptics, antibiotics, control active bleeding from wounds, and measures to decrease intracranial pressure. Surgical intervention ranged from simple debridement to hematoma evacuation and/or bullet extraction. Outcome was assessed after surgical interference using GCS and Glasgow Outcome Scale. Results:Fifteen (50%) patients had mild penetrating head injury (GCS 13 to 15), 12 patients (40%) were severely injured (GCS 3 to 8), and only 3 patients (10%) were moderately injured (GCS 9 to 12). Eighteen patients (60%) were found to have isolated intracranial injury, whereas 40% had other associated injuries. Twelve patients (40%) had an associated intracranial hematoma on their initial computed tomography scan. The average follow-up period was 16 months. The most common systemic complications were urinary tract infection (12 patients) and chest infection (12 patients), whereas the most common local complications were wound infection (10 patients), cerebrospinal fluid fistula (8 patients), and hydrocephalus (5 patients). At the follow up, The GCS of 10 patients (33.3%) was (13 to 15), 6 patients (20%) were (9 to 12), 5 patients (16.7%) showed persistent vegetative state (<3), and 9 patients (30%) died. Postoperative outcome was significantly correlated with the preoperative one (P<0.001). According to Glasgow Outcome Scale, 33.3% of patients had good recovery and 30% of the patients died. The others suffered from various degrees of disability. Conclusions:The prevalence of GSWs to the head is increasing dramatically as private ownership of weapons and gang-related urban violence increases. Most of the irreversible brain damage from a GSW is sustained at impact and can be understood in terms of a missile’s trajectory and the pattern of energy transfer to brain tissue. Treatment is aimed at preventing subsequent brain injury that might further limit recovery. One third of patients obtain a good recovery.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"22 1","pages":"37–41"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61882692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 25-year-old young man presented to our emergency room with a 3-month history of progressive headache and being easily tired. The familial and personal history of the patient was not significant. On examination, he appeared generally weak. The neurological examination revealed no visual defects, decreased muscle power, or other neurological deficits. Laboratory studies showed normocytic anemia with serum hemoglobin 12.7 g/dL. Magnetic resonance imaging (MRI) of brain was performed, which disclosed a 1.9 cm sellar mass that caused compression and mild elevation of the optic chiasm. The diagnosis of pituitary macroadenoma was established. Therefore, navigator-assisted endoscopic transnasal transsphenoidal approach to remove the tumor was performed and postoperative recovery was uneventful. A definitive diagnosis of a gonadotroph adenoma is made by pathologic evaluation of the tumor. We emphasize that pituitary adenoma should be a tentative diagnosis in a male patient with normocytic and normochromic anemia with hypogonadism. The anemia is associated with hypogonadism and tumor size, and improves following treatment that increases testosterone level. Headache may be the only neurological sign.
{"title":"Pituitary Macroadenoma May be a Tentative Diagnosis in a Young Patient With Anemia","authors":"Wen-Yi Chiu, En-Li Shiau, Yi-Hao Lo, Chien-Chou Chen","doi":"10.1097/WNQ.0000000000000121","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000121","url":null,"abstract":"A 25-year-old young man presented to our emergency room with a 3-month history of progressive headache and being easily tired. The familial and personal history of the patient was not significant. On examination, he appeared generally weak. The neurological examination revealed no visual defects, decreased muscle power, or other neurological deficits. Laboratory studies showed normocytic anemia with serum hemoglobin 12.7 g/dL. Magnetic resonance imaging (MRI) of brain was performed, which disclosed a 1.9 cm sellar mass that caused compression and mild elevation of the optic chiasm. The diagnosis of pituitary macroadenoma was established. Therefore, navigator-assisted endoscopic transnasal transsphenoidal approach to remove the tumor was performed and postoperative recovery was uneventful. A definitive diagnosis of a gonadotroph adenoma is made by pathologic evaluation of the tumor. We emphasize that pituitary adenoma should be a tentative diagnosis in a male patient with normocytic and normochromic anemia with hypogonadism. The anemia is associated with hypogonadism and tumor size, and improves following treatment that increases testosterone level. Headache may be the only neurological sign.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"80-81"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61882734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.1097/WNQ.0000000000000129
Tingzhong Wang, Liming Zhang, Xianlin Zhao
A case of suspected glioblastoma accompanied by systemic syphilis was referred to our institute for surgery. She was a 47-year-old woman presenting with headache and vomiting. A frontal mass with ring enhancement and surrounding edema was revealed by MRI. Although neurosyphilis was considered a differential diagnosis, surgery was performed and cerebral syphilitic gumma was confirmed by histology. To reduce misdiagnosis, we reviewed the related literature and summarized pathogenesis, radiologic features, and treatment strategy of cerebral syphilitic gumma.
{"title":"Cerebral Syphilitic Gumma Mimicking Glioblastoma: A Case Report","authors":"Tingzhong Wang, Liming Zhang, Xianlin Zhao","doi":"10.1097/WNQ.0000000000000129","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000129","url":null,"abstract":"A case of suspected glioblastoma accompanied by systemic syphilis was referred to our institute for surgery. She was a 47-year-old woman presenting with headache and vomiting. A frontal mass with ring enhancement and surrounding edema was revealed by MRI. Although neurosyphilis was considered a differential diagnosis, surgery was performed and cerebral syphilitic gumma was confirmed by histology. To reduce misdiagnosis, we reviewed the related literature and summarized pathogenesis, radiologic features, and treatment strategy of cerebral syphilitic gumma.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"82–86"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-01DOI: 10.1097/WNQ.0000000000000094
Bon-Jour Lin, Hsin-I. Ma
Chronic encapsulated intracerebral hematoma is a rare disease characterized by progressive neurological deficit accompanied with ring-enhancing intracranial mass lesion. A 43-year-old woman presented with weakness over bilateral lower limbs over days. Computed tomography of the brain showed a hypodense parenchymal lesion over the left frontal lobe with mass effect. Magnetic resonance imaging revealed the presence of a peripheral hyperdense with central isointense parenchymal lesion on T1-weighted and T2-weighed images, with surrounding brain edema. The patient underwent craniotomy for excision of lesion under the preoperative impression of brain tumor. The pathologic report was hemorrhagic infarction with marked gliosis. This report highlights that chronic encapsulated intracerebral hematoma is similar to brain tumor in clinical expression and neuroimaging appearance.
{"title":"Chronic Encapsulated Intracerebral Hematoma Mimicking Malignancy","authors":"Bon-Jour Lin, Hsin-I. Ma","doi":"10.1097/WNQ.0000000000000094","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000094","url":null,"abstract":"Chronic encapsulated intracerebral hematoma is a rare disease characterized by progressive neurological deficit accompanied with ring-enhancing intracranial mass lesion. A 43-year-old woman presented with weakness over bilateral lower limbs over days. Computed tomography of the brain showed a hypodense parenchymal lesion over the left frontal lobe with mass effect. Magnetic resonance imaging revealed the presence of a peripheral hyperdense with central isointense parenchymal lesion on T1-weighted and T2-weighed images, with surrounding brain edema. The patient underwent craniotomy for excision of lesion under the preoperative impression of brain tumor. The pathologic report was hemorrhagic infarction with marked gliosis. This report highlights that chronic encapsulated intracerebral hematoma is similar to brain tumor in clinical expression and neuroimaging appearance.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"25 1","pages":"502-504"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61881732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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