Objective: The authors report a rare case of giant thoracic meningocele causing acute respiratory compromise, treated with a ventriculoperitoneal shunt. Case Report: We report the case of a 36-year-old with severe sco...Objective: The authors report a rare case of giant thoracic meningocele causing acute respiratory compromise, treated with a ventriculoperitoneal shunt. Case Report: We report the case of a 36-year-old with severe scoliosis status post repair over a decade ago, neurofibromatosis type I, and a known large meningocele in the left thoracic cavity, presenting with new acute respiratory compromise. She was taken to the operating room for a lumboperitoneal shunt, but the operation was aborted due to her severe spinal deformity. Two days later, she successfully underwent a procedure for ventriculoperitoneal shunt placement. Upon discharge a week later, the patient was hemodynamically stable, able to move all extremities with good strength, and demonstrated improved oxygenation. In the following 7 months, the patient demonstrated continued minimal requirement on nasal cannula, and MRI showed a stable left thoracic giant meningocele. Conclusion: Ventriculoperitoneal shunting is a method of treating and stabilizing acutely symptomatic giant meningoceles.展开更多
Objective: The authors report a rare case of ossification of the anterior longitudinal ligament in the cervical spine underlying dysphagia. Case Report: We report the case of a 50-year-old male presenting with difficu...Objective: The authors report a rare case of ossification of the anterior longitudinal ligament in the cervical spine underlying dysphagia. Case Report: We report the case of a 50-year-old male presenting with difficulty swallowing and choking. CT of the cervical spine demonstrated anterior longitudinal ligament hypertrophy with osteophytes worst at C1-C2 and C6-C7, without spinal cord compression. A videofluoroscopic swallow study revealed reduced epiglottic inversion and hyolaryngeal elevation resulting in incomplete clearance from the pharynx, as well as compression of the esophagus. Subsequently, the patient underwent osteophytectomy. There were no intraoperative or postoperative complications. Two weeks after the surgery, videofluoroscopic swallow demonstrated improved function and reduced compression. Four weeks postoperatively, the patient completely regained swallowing function without pain.展开更多
Objective: The authors report an extremely rare case of stroke-mimicking, spontaneous cervical epidural hematoma treated with tissue plasminogen activator (TPA). Case Report: We report the case of a 69-year-old female...Objective: The authors report an extremely rare case of stroke-mimicking, spontaneous cervical epidural hematoma treated with tissue plasminogen activator (TPA). Case Report: We report the case of a 69-year-old female presenting with left-sided hemiparesis of the arm and leg. She was administered by TPA because she was thought to have an ischemic stroke and intracranial CT showed no hemorrhage. However, her neurological condition continued to decline, and MRI of her cervical spine revealed a large spontaneous epidural hematoma. Subsequently, the patient underwent emergency surgery. Conclusions: TPA administration to spinal epidural hematoma (SEH) patients is dangerous. Because cervical epidural hematomas can mimic stroke, the attending medical staff needs to exercise vigilance in diagnosis. In addition to the head, the spine should also be scanned prior to TPA administration.展开更多
Introduction: Langerhans cell histiocytosis (LCH) is a group of idiopathic disorders characterized by the proliferation of specialized bone marrow-derived Langerhans cells (LCs) and mature eosinophils, resulting in so...Introduction: Langerhans cell histiocytosis (LCH) is a group of idiopathic disorders characterized by the proliferation of specialized bone marrow-derived Langerhans cells (LCs) and mature eosinophils, resulting in solitary or few, indolent and chronic, lesions of bone or other organs called eosinophilic granulomas. Calvarial LCH is quite rare and an underappreciated differential etiology of skull lesions. We present a most unusual case of a young child with hyperacutely symptomatic langerhans histiocytosis of the skull. Method: A 7-year-old male presented with a history of increasing (progressive) frontal headaches of 8 days duration, unaccompanied by associated nausea, vomiting, or diplopia. His only additional complaint was a hard bump on his forehead. MRI and CT done in the ER identified a right fronto-parietal lesion with associated skull erosion. Nuclear medicine and SPECT studies confirmed an erosive skull lesion without significant metabolic activity. A right frontal craniectomy and excision was performed. Results: A soft, rubbery well-circumcised mass coming from the diploic layer of the skull with involvement of bone was identified. The mass had eroded both the outer and inner table of the skull, and the involved area of the right frontal bone was resected. Intra-operative histo-pathologic analysis of the lesion revealed Langerhans cell histiocytosis without involvement of the dura. The patient experienced no neurological worsening as a result of the resection. He was discharged home in stable condition. Conclusion: LCH lesions of the skull are common findings, however, this focal hyperacute symptomatic presentation is most rare and should not deter us from anticipating an erosive bony tumor and planning timely surgical management.展开更多
Vertebral osteomyelitis (VOM) and spinal epidural abscesses (SEA) are rare infections on the spinal column, more prominently seen in intravenous drug users, diabetics and the immunosuppressed. We report an extremely r...Vertebral osteomyelitis (VOM) and spinal epidural abscesses (SEA) are rare infections on the spinal column, more prominently seen in intravenous drug users, diabetics and the immunosuppressed. We report an extremely rare case of a patient with a chronic history of lumbar post-surgical cutaneo-spinal fistulous infection that was unresponsive to conventional antibiotic therapy and ultimately required surgical debridement and spinal re-instrumentation. The novelty of this case was the chronic nature of the patient’s condition that was made possible only by a fortunate post-surgical cutaneo-spinal fistula that withdrew infected particles away from the neurological structures and thus prevented imminent compressive and neurological deficits, and possible eventual death. This rare case highlights the need for prompt surgical evaluation and intervention in patients with progressive VOM or SEA with associated cutaneo-spinal fistulas, especially in cases where conventional antibiotic treatments have failed. We highly recommend a low threshold for surgical debridement and hardware removal with re-instrumentation as appropriate before a spinal compressive emergency arises and/or sepsis develops.展开更多
Objective and Importance: The authors report a case of a symptomatic giant serpentine MCA aneurysm treated with double STA-MCA bypass with thrombectomy and excision of aneurysm. This is the first reported case of a do...Objective and Importance: The authors report a case of a symptomatic giant serpentine MCA aneurysm treated with double STA-MCA bypass with thrombectomy and excision of aneurysm. This is the first reported case of a double bypass with concomitant thrombectomy and excision of aneurysmal segment. Clinical Presentation/Methods: We report the case of a 27-year-old Hispanic male with severe acute decline in mental status with a giant serpentine MCA aneurysm with significant mass effect and midline shift trapping the lateral ventricular system. Intervention/Results: Patient presented initially to an outside hospital for altered mental status and confusion. Patient was diagnosed with a giant serpiginous aneurysm and hydrocephalus. A left ventriculoperitoneal shunt was placed at the outside hospital and patient was transferred to University of New Mexico. At this time, his mental status declined rather abruptly. He was treated with a double STA-MCA bypass procedure with aneurysm resection.展开更多
Objective: The authors report a rare case of uterine adenocarcinoma metastasis to both the skull base and cervical spine presenting with pathological fracture and myelopathy. Methods: We report the case of a 43-year-o...Objective: The authors report a rare case of uterine adenocarcinoma metastasis to both the skull base and cervical spine presenting with pathological fracture and myelopathy. Methods: We report the case of a 43-year-old Asian female with widely metastatic uterine adenocarcinoma who over the course of 3 years was diagnosed with a large clival mass and more recently a cervical spine pathological fracture presenting with myelopathy. Results: This patient underwent multiple procedures over a three-year period, including total hysterectomy with tumor debulking, endonasal biopsy of clival mass and most recently cervical corpectomy and fusion. She has received chemotherapy and radiation therapy for treatment of the unresectable clival mass and has done quite well despite having this pathology. Conclusion: This is the first documented case of clival involvement of endometrial adenocarcinoma. Additionally, this is a unique case of spinal metastatic endometrial adenocarcinoma presenting with pathological fracture and myelopathy.展开更多
The authors report the first case of a giant supratentorial enterogenous cyst presenting with acute symptomatic hemorrhage within the cyst. We report the case of a 78-year-old Philipino female who was found to have a ...The authors report the first case of a giant supratentorial enterogenous cyst presenting with acute symptomatic hemorrhage within the cyst. We report the case of a 78-year-old Philipino female who was found to have a large right fronto-parietal mass after a minor fall. She had a small amount of hemorrhage within the cyst but was stable for discharge the following day. She was readmitted 5 days later with acute onset severe headache and leftside weakness. On repeat imaging, her cyst had grown in size and had large acute hemorrhage within it. She was taken to the operating room for craniotomy and cyst resection. She recovered well post-operatively. This is the first known case of a giant supratentorial enterogenous cyst presenting with symptomatic enlargement due to large hemorrhage within the cyst. Enterogenous cysts should be considered on the differential diagnosis of hemorrhagic supratentorial giant cysts.展开更多
Objective and Importance: The authors report the first known case of a giant multiloculated grape-like enterogenous cyst extending from the upper cervical canal to the ambient cistern. Clinical Presentation/Methods: W...Objective and Importance: The authors report the first known case of a giant multiloculated grape-like enterogenous cyst extending from the upper cervical canal to the ambient cistern. Clinical Presentation/Methods: We report the case of a 40-year-old male who had a prior transmastoid craniotomy at an outside facility 14 months prior with an indeterminate diagnosis, who presented to the University of New Mexico with recurrent headaches and nausea. Scans demonstrated a giant multiloculated cystic lesion in the right cerebellopontine angle that extended superiorly and inferiorly with brainstem compression and hydrocephalus. Intervention/Results: We took the patient to the operating room for a retrosigmoid suboccipital craniectomy for tumor resection. Post-operatively, the patient improved but required ventriculoperitoneal shunting for continued communicating hydrocephalus. Conclusion: This is the first known case of a giant multiloculated grape-like enterogenous cyst extending simultaneously from the upper cervical canal to the ambient cistern. Enterogenous cysts should be considered on the differential diagnosis of giant grape-like lesions extending from the cervical canal to the prepontine cistern.展开更多
文摘Objective: The authors report a rare case of giant thoracic meningocele causing acute respiratory compromise, treated with a ventriculoperitoneal shunt. Case Report: We report the case of a 36-year-old with severe scoliosis status post repair over a decade ago, neurofibromatosis type I, and a known large meningocele in the left thoracic cavity, presenting with new acute respiratory compromise. She was taken to the operating room for a lumboperitoneal shunt, but the operation was aborted due to her severe spinal deformity. Two days later, she successfully underwent a procedure for ventriculoperitoneal shunt placement. Upon discharge a week later, the patient was hemodynamically stable, able to move all extremities with good strength, and demonstrated improved oxygenation. In the following 7 months, the patient demonstrated continued minimal requirement on nasal cannula, and MRI showed a stable left thoracic giant meningocele. Conclusion: Ventriculoperitoneal shunting is a method of treating and stabilizing acutely symptomatic giant meningoceles.
文摘Objective: The authors report a rare case of ossification of the anterior longitudinal ligament in the cervical spine underlying dysphagia. Case Report: We report the case of a 50-year-old male presenting with difficulty swallowing and choking. CT of the cervical spine demonstrated anterior longitudinal ligament hypertrophy with osteophytes worst at C1-C2 and C6-C7, without spinal cord compression. A videofluoroscopic swallow study revealed reduced epiglottic inversion and hyolaryngeal elevation resulting in incomplete clearance from the pharynx, as well as compression of the esophagus. Subsequently, the patient underwent osteophytectomy. There were no intraoperative or postoperative complications. Two weeks after the surgery, videofluoroscopic swallow demonstrated improved function and reduced compression. Four weeks postoperatively, the patient completely regained swallowing function without pain.
文摘Objective: The authors report an extremely rare case of stroke-mimicking, spontaneous cervical epidural hematoma treated with tissue plasminogen activator (TPA). Case Report: We report the case of a 69-year-old female presenting with left-sided hemiparesis of the arm and leg. She was administered by TPA because she was thought to have an ischemic stroke and intracranial CT showed no hemorrhage. However, her neurological condition continued to decline, and MRI of her cervical spine revealed a large spontaneous epidural hematoma. Subsequently, the patient underwent emergency surgery. Conclusions: TPA administration to spinal epidural hematoma (SEH) patients is dangerous. Because cervical epidural hematomas can mimic stroke, the attending medical staff needs to exercise vigilance in diagnosis. In addition to the head, the spine should also be scanned prior to TPA administration.
文摘Introduction: Langerhans cell histiocytosis (LCH) is a group of idiopathic disorders characterized by the proliferation of specialized bone marrow-derived Langerhans cells (LCs) and mature eosinophils, resulting in solitary or few, indolent and chronic, lesions of bone or other organs called eosinophilic granulomas. Calvarial LCH is quite rare and an underappreciated differential etiology of skull lesions. We present a most unusual case of a young child with hyperacutely symptomatic langerhans histiocytosis of the skull. Method: A 7-year-old male presented with a history of increasing (progressive) frontal headaches of 8 days duration, unaccompanied by associated nausea, vomiting, or diplopia. His only additional complaint was a hard bump on his forehead. MRI and CT done in the ER identified a right fronto-parietal lesion with associated skull erosion. Nuclear medicine and SPECT studies confirmed an erosive skull lesion without significant metabolic activity. A right frontal craniectomy and excision was performed. Results: A soft, rubbery well-circumcised mass coming from the diploic layer of the skull with involvement of bone was identified. The mass had eroded both the outer and inner table of the skull, and the involved area of the right frontal bone was resected. Intra-operative histo-pathologic analysis of the lesion revealed Langerhans cell histiocytosis without involvement of the dura. The patient experienced no neurological worsening as a result of the resection. He was discharged home in stable condition. Conclusion: LCH lesions of the skull are common findings, however, this focal hyperacute symptomatic presentation is most rare and should not deter us from anticipating an erosive bony tumor and planning timely surgical management.
文摘Vertebral osteomyelitis (VOM) and spinal epidural abscesses (SEA) are rare infections on the spinal column, more prominently seen in intravenous drug users, diabetics and the immunosuppressed. We report an extremely rare case of a patient with a chronic history of lumbar post-surgical cutaneo-spinal fistulous infection that was unresponsive to conventional antibiotic therapy and ultimately required surgical debridement and spinal re-instrumentation. The novelty of this case was the chronic nature of the patient’s condition that was made possible only by a fortunate post-surgical cutaneo-spinal fistula that withdrew infected particles away from the neurological structures and thus prevented imminent compressive and neurological deficits, and possible eventual death. This rare case highlights the need for prompt surgical evaluation and intervention in patients with progressive VOM or SEA with associated cutaneo-spinal fistulas, especially in cases where conventional antibiotic treatments have failed. We highly recommend a low threshold for surgical debridement and hardware removal with re-instrumentation as appropriate before a spinal compressive emergency arises and/or sepsis develops.
文摘Objective and Importance: The authors report a case of a symptomatic giant serpentine MCA aneurysm treated with double STA-MCA bypass with thrombectomy and excision of aneurysm. This is the first reported case of a double bypass with concomitant thrombectomy and excision of aneurysmal segment. Clinical Presentation/Methods: We report the case of a 27-year-old Hispanic male with severe acute decline in mental status with a giant serpentine MCA aneurysm with significant mass effect and midline shift trapping the lateral ventricular system. Intervention/Results: Patient presented initially to an outside hospital for altered mental status and confusion. Patient was diagnosed with a giant serpiginous aneurysm and hydrocephalus. A left ventriculoperitoneal shunt was placed at the outside hospital and patient was transferred to University of New Mexico. At this time, his mental status declined rather abruptly. He was treated with a double STA-MCA bypass procedure with aneurysm resection.
文摘Objective: The authors report a rare case of uterine adenocarcinoma metastasis to both the skull base and cervical spine presenting with pathological fracture and myelopathy. Methods: We report the case of a 43-year-old Asian female with widely metastatic uterine adenocarcinoma who over the course of 3 years was diagnosed with a large clival mass and more recently a cervical spine pathological fracture presenting with myelopathy. Results: This patient underwent multiple procedures over a three-year period, including total hysterectomy with tumor debulking, endonasal biopsy of clival mass and most recently cervical corpectomy and fusion. She has received chemotherapy and radiation therapy for treatment of the unresectable clival mass and has done quite well despite having this pathology. Conclusion: This is the first documented case of clival involvement of endometrial adenocarcinoma. Additionally, this is a unique case of spinal metastatic endometrial adenocarcinoma presenting with pathological fracture and myelopathy.
文摘The authors report the first case of a giant supratentorial enterogenous cyst presenting with acute symptomatic hemorrhage within the cyst. We report the case of a 78-year-old Philipino female who was found to have a large right fronto-parietal mass after a minor fall. She had a small amount of hemorrhage within the cyst but was stable for discharge the following day. She was readmitted 5 days later with acute onset severe headache and leftside weakness. On repeat imaging, her cyst had grown in size and had large acute hemorrhage within it. She was taken to the operating room for craniotomy and cyst resection. She recovered well post-operatively. This is the first known case of a giant supratentorial enterogenous cyst presenting with symptomatic enlargement due to large hemorrhage within the cyst. Enterogenous cysts should be considered on the differential diagnosis of hemorrhagic supratentorial giant cysts.
文摘Objective and Importance: The authors report the first known case of a giant multiloculated grape-like enterogenous cyst extending from the upper cervical canal to the ambient cistern. Clinical Presentation/Methods: We report the case of a 40-year-old male who had a prior transmastoid craniotomy at an outside facility 14 months prior with an indeterminate diagnosis, who presented to the University of New Mexico with recurrent headaches and nausea. Scans demonstrated a giant multiloculated cystic lesion in the right cerebellopontine angle that extended superiorly and inferiorly with brainstem compression and hydrocephalus. Intervention/Results: We took the patient to the operating room for a retrosigmoid suboccipital craniectomy for tumor resection. Post-operatively, the patient improved but required ventriculoperitoneal shunting for continued communicating hydrocephalus. Conclusion: This is the first known case of a giant multiloculated grape-like enterogenous cyst extending simultaneously from the upper cervical canal to the ambient cistern. Enterogenous cysts should be considered on the differential diagnosis of giant grape-like lesions extending from the cervical canal to the prepontine cistern.
