Intracranial tuberculomas are one of the most serious formsof tuberculosis disease after meningitis tuberculosis. It incidence varies around 0.15% -0.18% in the development world to 5% -30% of intracranial masses in some under developments areas. These tuberculomas, of course ubiquitous, are mostly diagnosed in the adulthood and usually located in the cerebellum and the cerebral hemispheres. Intra ventricular involving is uncommon and just 10 cases had been described in the literature. We report a case of an intraventricular tuberculoma in a 26-year-old man and we discuss the pathogenesis and the radiological findings according this location.
Bedside percutaneous twist drill aspiration (TDA) is described as a surgical method of management of Chronic subdural hematoma (CSDH) and appear to be a reasonable approach in low medical resources environment. We report the results of TDA of CSDH in a single tertiary centre in Conakry Republic of Guinea in West Africa, for the period March 2015 to October 2017. The charts and medical record of 38 cases of CSDH treated with TDA were collected retrospectively, with a mean follow-up of 84.2 days. The outcome data assessed were neurologic status evaluated by the follow-up Markwalder grading scale (MGS: 0=normal to 4=coma), recurrence, infection and mortality. The Male-Female ratio was 1.3:1. Mean age at diagnosis was 78.2+/-12 years. Traumatic brain injury (TBI) was identified as causal in 28.2% of cases studied. All patients were operated on under local anesthesia and had a postoperative drain left in place for 3 days. The mean postoperative MGS was 1.06, up from a mean preoperative MGS of 3.7. Two cases of recurrence occurred subsequent to TDA causing death and three other patients died from unknown causes during the follow-up period. No cases of post-operative infection were diagnosed during the follow-up. Our study shows that Bedside TDA appears to be a suitable alternative to burr hole craniotomies in urgent cases of CSDH in the low socio-economic setting, where a surgical theatre is not always available.
Lipomatous medulloblastoma is not a separate entity but apparently distinct variant of medulloblastoma. Since the first case report in 1978 by Bechtel et al. [1], few cases have been published. We report an additional case of a 52-year-old right-handed man presented to the emergency department with evaluation of progressive severe intracranial hypertension and ataxia. His past medical history was unremarkable. His physical examination showed cerebellar syndromes. He underwent magnetic resonance imaging (MRI) which revealed a unique mass in the posterior fossa, lying within a cerebellar hemisphere. The patient underwent a suboccipital craniotomy for with a complete resection and samples were sent for histologic examination, showing closely packed, and round to oval cells. The nuclei had an irregular shape with clumps of heterochromatin. Lipid accumulation was a prominent feature of neoplastic cells. Postoperatively the patient did not receive fractionated radiotherapy. He is alive without deficit and with no evidence of recurrence on neuroimaging.
Pachymeningeal en plaque tuberculoma is a rare manifestation of tuberculosis and has a poor prognosis if not diagnosed early and treated adequately. The aim of the present paper is to collect the reported clinical and radiological signs in the literature and compare it with a personal observation to evaluate the possibility of a presumptive diagnosis. A 4-year-old boy presented at the pediatric emergency department with 7 days history of severe headache, vomiting blurred vision and had one partial seizure. His neurologic examination was notable for decreased visual acuity with bilateral papilledema and intact extra-ocular muscles. His neck was rigid. Neuroimaging revealed a multifocal dural-based mass on the fronto-parietal convexity with dense heterogeneous contrast enhancement and hydrocephalus. He has undergone a Ventriculoperitoneal shunt and surgical excision of the mass the next day. Outcome was favorable with antituberculosis therapy and corticosteroids. The clinical presentation and outcome were similar to the reported cases in the literature.
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