numbness. Clinical examination was revealed sensory deficit on the left side of face. Brain magnetic resonance imaging(s) revealed abnormal T2/fluid-attenuated inversion recovery hyperintense oval lesions causing diffuse enlargement of cisternal part of left trigeminal nerve [ Figure 1a and b, thick arrow] and both trigeminal ganglia in Meckel's cave [ Figure 1a and b, thin arrows]. Three dimensional-T2W-driven equilibrium radiofrequency reset pulse axial and sagittal oblique images excellently demonstrated the spread along trigeminal pathways [ Figure 1c-e]. These lesions appear heterogeneously hypointense on pre-contrast T1-weighted images [ Figure 2a]. Post-contrast scan shows homogenous enhancement of mass lesions as long cisternal part of left trigeminal nerve and both trigeminal ganglia [ Figure 2b-d]. Figure 2: Pre-contrast T1 axial (a) reveals hypointense mass lesions along cisternal part of left trigeminal nerve and both trigeminal ganglia with homogenous enhancement on post-contrast T1 axial (b), reformatted right (c) and left (d) sagittal oblique images d c b a Access this article online Quick Response Code: Website: www.neurologyindia.comFigure 1: Axial T2 (a) and fluid-attenuated inversion recovery (b) images reveal hyperintense mass lesions causing diffuse enlargement of cisternal part of left trigeminal nerve (thick arrow) and both trigeminal ganglia (thin arrows). Driven equilibrium radiofrequency reset pulse (three dimensional-T2W-driven equilibrium radiofrequency reset pulse) axial (c), reformatted right (d) and left (e) sagittal oblique images excellently demonstrates spread along trigeminal pathways d c b a e No extension was seen along the branches of trigeminal nerves. Brainstem revealed no focal lesion at the expected location of trigeminal nuclei. These findings are suggestive of bilateral trigeminal metastasis. This case illustrates the classic imaging findings in metastatic spread along central trigeminal pathways. Patient is being treated with palliative radiotherapy.Malignant trigeminal neuropathy is commonly due to perineural spread along the branches of trigeminal nerve secondary to squamous cell carcinomas and adenoid cystic carcinomas in head and neck region. Trigeminal nerve metastasis is uncommon reported manifestation in breast cancer, melanoma and colon cancer. [1,2] To the best of our knowledge; bilateral trigeminal metastasis with trigeminal ganglion involvement due to metastatic colon carcinoma is not reported. involvement of the Meckel's cave and trigeminal nerve. A case report. J Neurooncol 1997;32:87-90. 2. Hirota N, Fujimoto T, Takahashi M, Fukushima Y. Isolated trigeminal nerve metastases from breast cancer: An unusual cause of trigeminal mononeuropathy. Surg Neurol 1998;49:558-61.
Introduction: Nondysraphic intramedullary lipomas of the spinal cord are rare lesions. They are most commonly seen in the second or third decade of life. Their occurrence in the pediatric age group is even rarer. Case Report: The authors describe a 14-month-old child who presented with delayed motor milestones involving the bilateral lower limbs. The child was unable to sit or stand. MRI revealed a dorsally located intramedullary lipoma extending from C7 to D12. The child underwent C7–L1 laminotomy and gross total excision of the lipoma. Postoperatively, the child improved neurologically and attained normal power in the bilateral lower limbs. Discussion: Very few cases of extensive intramedullary lipomas involving the dorsal cord have previously been reported. Only two cases of pediatric extensive dorsal lipomas have been mentioned to date. The authors describe successful surgical excision of a holodorsal intramedullary lipoma in a 14-month-old child. To the best of the authors’ knowledge, this is the first case being reported of a holodorsal intramedullary lipoma in the youngest patient.
Thalamic injury is universal in the setting of severe TBI in patients who have decreased survival and may be a significant factor for the poor outcome in these patients.
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