Cerebrospinal fluid (CSF) within the cerebral ventricular system is secreted by a neuroepithelial tissue which is called as the choroid plexus. Tumors arising from these tissues are rare. Choroid plexus papillomas (CPPs) have been denoted as WHO grade I of the choroid plexus tumors. Among the intracranial tumors, neoplasms of the choroid plexus constitute around 0.36-0.6%. CPPs are mostly slow growing and cause symptoms due to mass effect and obstructive hydrocephalus, resulting in increased intracranial pressure. We report a case of CPP arising from the temporal horn in a 7-year-old girl presenting with progressive head enlargement since birth due to bilateral massive hydrocephalus without any obstruction, making it purely a hypersecretory hydrocephalus. A drainage procedure followed by complete tumor resection was carried out in our case and the patient showed marked relief from her symptoms.
Schwannoma with acute hemorrhage is rarely seen. A 44-years-old male patient presented with complaint of neck pain and acute onset of quadriparesis. Magnetic resonance imaging (MRI) of his cervical spine revealed evidence of an intradural extramedullary tumor with intratumoral acute hemorrhage. He was operated in emergency and the mass was found to be schwannoma with acute hemorrhage. Post operatively the patient improved significantly. Though schwannomas show microscopic intratumoral hemorrhage and necrosis at times, schwannoma with acute hemorrhage resulting acute onset of neurological deficit is very uncommon.
Aim
Delayed intracerebral tension pneumatocele is an uncommon cause of raised intracranial pressure (ICP) following trauma. However it can cause herniation syndrome due to sudden increase in ICP which requires emergent intervention. The present case reports a late onset intracerebral tension pneumatocele in an adult male.
Subject
A 35-year-old man was admitted to our emergency unit with alleged h/o head injury following a road traffic accident. The computerised tomographic (CT) scan of head showed left frontal sinus fracture, basi frontal contusion and minimal pneumocephalus. Conservative treatment was given and patient discharged on 10th day in normal neurological state. After almost a month he was re-admitted with h/o of repeated vomiting and altered sensorium. A repeat CT head at this time revealed a large left frontal intracerebral tension pneumatocele with mass effect. The patient was operated on urgently and the tense air was evacuated. Dural graft covered over the tear behind the left frontal sinus. During the postoperative period the patient's neurological status improved.
Result
Although traumatic pneumatocele generally develops during the early post-traumatic period, it can also develop to a tension pneumatocele resulting in mass effect in the late period leading to increased ICP and deterioration of conscious level.
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