BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the...BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the age,peaking around 65 years.The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location,as with the majority of brain tumors.Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.CASE SUMMARY We present a case describing a 78-year-old female who came in following a ground level fall.The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss.Further neurological examination was otherwise largely unremarkable.A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx.Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm×4.2 cm×5.5 cm.A partial surgical resection of the right-sided portion of the lesion was performed.Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region.Further histopathological analysis confirmed a fibrous meningioma with focal necrosis,consistent with World Health Organization Grade 2 classification.She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.展开更多
BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spin...BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spine.It’s usually caused by a bacterial infection,most commonly Staphylococcus aureus.The infection can spread to this area from other parts of the body,through the bloodstream,or it may be intro-duced directly during spinal procedures like epidural injections or surgery.Symptoms often include severe back pain,fever,and neurological deficits like weakness or numbness,which can progress quickly if untreated.It's considered a medical emergency because if the abscess compresses the spinal cord,it can lead to permanent paralysis or even death.Treatment usually involves antibiotics and,in many cases,surgical drainage.CASE SUMMARY Spinal epidural abscess(SEA)represents a rare yet potentially severe infection affecting the epidural space.We present the following case of a 54-year-old Hispanic white male who initially presented to the emergency department with acute deteriorating symptoms of bilateral lower extremity weakness,which subsequently progressed to involve the upper extremities.However,further evaluation uncovered additional notable symptoms,including urinary inconti-nence and decreased appetite.Further investigation broadened the differential diagnosis,including meningitis,spinal cord compression,acute pyelonephritis,osteomyelitis,bacteremia,torticollis,and acutely progressive ascending bilateral lower extremity weakness,raising the concern for possible Guillain-Barre syndrome.Diagnostic imaging,including magnetic resonance imaging of the spine,confirmed the presence of C5-C6 osteomyelitis and a C6-C7 spinal epidural abscess with severe canal narrowing.The patient underwent an emergency evacuation of epidural abscess with a C6 corpectomy and C5-C7 cervical fusion,followed by an 8-week course of intravenous antibiotics.Cultures from the abscess and bone revealed Staphylococcal aureus.The patient was discharged after 54 days with significant improvement in power and function.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for SEA in patients presenting with atypical symptoms,even in the setting of seemingly unrelated conditions.Early recognition and prompt intervention are crucial to prevent permanent neurological deficits and improve outcomes in patients with SEA.展开更多
文摘BACKGROUND Meningiomas represent the most common primary intracranial tumor in adults.The majority of meningiomas are indolent,benign,and sporadic in nature.The incidence of meningiomas is directly proportional to the age,peaking around 65 years.The presenting symptomatology of intracranial meningiomas is mainly dependent on their anatomical location,as with the majority of brain tumors.Surgical resection and radiation therapy remain the treatment modality for meningiomas of all grades.CASE SUMMARY We present a case describing a 78-year-old female who came in following a ground level fall.The primary assessment was notable for a history of similar recurrent falls and subtle left-sided peripheral visual field loss.Further neurological examination was otherwise largely unremarkable.A computed tomography scan of the head revealed a large extra-axial mass located along the posterior aspect of the falx.Follow-up magnetic resonance imaging confirmed a lesion measuring around 6.6 cm×4.2 cm×5.5 cm.A partial surgical resection of the right-sided portion of the lesion was performed.Complete resection was limited by insufficient visualization and challenges with hemostatic control of the left parafalcine region.Further histopathological analysis confirmed a fibrous meningioma with focal necrosis,consistent with World Health Organization Grade 2 classification.She was subsequently scheduled for outpatient follow-up to assess the residual tumor management.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for intracranial pathology in elderly patients with nonspecific presentation.
文摘BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spine.It’s usually caused by a bacterial infection,most commonly Staphylococcus aureus.The infection can spread to this area from other parts of the body,through the bloodstream,or it may be intro-duced directly during spinal procedures like epidural injections or surgery.Symptoms often include severe back pain,fever,and neurological deficits like weakness or numbness,which can progress quickly if untreated.It's considered a medical emergency because if the abscess compresses the spinal cord,it can lead to permanent paralysis or even death.Treatment usually involves antibiotics and,in many cases,surgical drainage.CASE SUMMARY Spinal epidural abscess(SEA)represents a rare yet potentially severe infection affecting the epidural space.We present the following case of a 54-year-old Hispanic white male who initially presented to the emergency department with acute deteriorating symptoms of bilateral lower extremity weakness,which subsequently progressed to involve the upper extremities.However,further evaluation uncovered additional notable symptoms,including urinary inconti-nence and decreased appetite.Further investigation broadened the differential diagnosis,including meningitis,spinal cord compression,acute pyelonephritis,osteomyelitis,bacteremia,torticollis,and acutely progressive ascending bilateral lower extremity weakness,raising the concern for possible Guillain-Barre syndrome.Diagnostic imaging,including magnetic resonance imaging of the spine,confirmed the presence of C5-C6 osteomyelitis and a C6-C7 spinal epidural abscess with severe canal narrowing.The patient underwent an emergency evacuation of epidural abscess with a C6 corpectomy and C5-C7 cervical fusion,followed by an 8-week course of intravenous antibiotics.Cultures from the abscess and bone revealed Staphylococcal aureus.The patient was discharged after 54 days with significant improvement in power and function.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for SEA in patients presenting with atypical symptoms,even in the setting of seemingly unrelated conditions.Early recognition and prompt intervention are crucial to prevent permanent neurological deficits and improve outcomes in patients with SEA.
