Atypical location, younger age and histopathological features are some of the interesting findings in this case, which need to be documented. To the best of our knowledge, this is the youngest patient of spinal cord neurocytoma.

Hydatid disease or hydatidosis caused by Echinococcus granulosus is the most widespread, serious human cestode infection in the world. Bone involvement is reported in 0.5-4% with spinal involvement reported in 50% of these cases. We report a case of this rare entity of an isolated primary hydatid cyst of the spine in a 15-year-old boy, who presented with progressive back pain for 8 months, lower extremity weakness and urinary incontinence for 3 months. Neurological examination was suggestive of upper motor neuron type of paraperesis grade 1/5 with complete sensory loss below T4 level. MRI of the spine showed multiple cystic extradural lesions at the T4-5 level with involvement of the paraspinal muscles. The patient underwent a T4-5 laminectomy, and a total excision of the multiple epidural and paraspinal cysts. The diagnosis of hydatid disease was confirmed on histopathology. Albendazole was started postoperatively. At 6 months follow-up the boy had no neurological deficit, was playful, active and walking. Postoperative MRI at 6 months showed no recurrence of the lesion. Analysis of the other reported cases is discussed with relevance to our case.

BackgroundPapillary meningiomas are rare meningeal tumors and are associated with aggressive clinical behavior as compared with other meningiomas. Because of their rare occurrence, they may pose a diagnostic dilemma to the unwary pathologist. We report a case of papillary meningioma in a 16-year-old boy.Case PresentationA 16-year-old boy presented with complaints of headache, progressively diminishing vision and more recently generalized seizures. MRI revealed a large bifrontal meningioma which showed presence of a predominantly papillary pattern with areas of focal necrosis, frequent mitoses and bone invasion. He underwent radical excision of the tumor and is free from recurrence or metastasis at 15 months follow-up.ConclusionPapillary meningiomas are rare but well recognized variants of meningioma. They need to be differentiated from other intracranial tumors with a papillary pattern. They are malignant, frequently show bone and parenchymatous invasion and have the potential for extracranial metastasis. Their timely recognition could prevent local and distant metastasis and the mortality or morbidity associated with it.

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Head injury is a major cause of disability and death in adults. The commonest pathological substrate in patients dying with blunt head injury is ischemic brain damage. Evaluation of cerebral perfusion is currently not a standard practice. We reviewed the medical records of 40 patients with Mild & Moderate Head Injury (GCS 9?14) who had 43 SPECT brain perfusion studies (Tc99m-ECD). They were evaluated in relation to GCS, NCCT (TCDB) grading, timing of scan and other factors. It was found that some degree of hypoperfusion in SPECT was noted in most, with moderate head injury patients having more severe hypoperfusion than those with mild head injury. Also, hypoperfusion was more marked during the first 24 hours of injury. In univariate analysis of various factors on the outcome, severe hypoperfusion and moderate/severe hypoperfusion emerged as significant predictors of unfavourable outcome (P values 0.05 and < 0.001 respectively). With respect to the area of hypoperfusion, parietal involvement had more impact on neurological outcome than other areas (P = 0.07). Bilateral involvement and other factors had no significant relationship with outcome. In multivariate analysis using binary logistic regression, severe hypoperfusion was found to have significant effect on outcome independent of GCS, CT category and timing of SPECT (P=0.02).