Medulloblastoma is the most common central nervous system tumor in children. Extra-axial medulloblastomas, especially tumors with no connection to the brain stem or cerebellum are extremely rare. We report a case of a 3-year-old patient, who presented with a history of subacute headache and vomiting. After performing a head computed tomography scan, a mass was detected in the left cerebello-pontine angle, along with concomitant hydrocephalus. The treatment was total resection of the tumor. Despite the fact that extra-axial medulloblastomas are extremely rare, this differential diagnosis should be included in the management of pediatric patients who present with posterior fossa tumors.
Background Temporal lobe epilepsy (TLE) is a high prevalence neurological disorder. Surgery has emerged as a promising treatment. Objective The objective of this work is to compare the surgical results of anterior temporal lobectomy (ATL) versus selective amygdalohippocampectomy (SAH) in a cohort of 132 patients. Methods We performed a retrospective study of 146 patients operated for TLE from 2008 to 2019. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. One patient was excluded from the analysis of the results due to death in the first postoperative week. We used the ILAE scale to classify seizure control after surgery. In patients with left hippocampal sclerosis, SAH was performed and in right temporal lobe epilepsy, ATL was the approach of choice. Results The mean follow-up time after surgery was 57.2 months (12–137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57.1% versus 31%) and a higher rate of satisfactory seizure control (88.6% versus 69.3%) p = 0,006, when compared with patients undergoing SAH. Conclusion The literature is still controversial about seizure control concerning the technique used due to the lack of a robust methodology. Our data analysis identified the superiority of ATL over SAH in seizure outcomes. ATL may be the best option for adequately controlling seizures with minimal additional morbidity in countries with a cost limitation for extended propaedeutics.
IntroductionTemporal Lobe Epilepsy (TLE) is a high prevalence neurological disorder and tends to drug refractoriness. Surgery has emerged as a promising treatment for managing crises and a better quality of life for these patients. The objective of this work is to compare the surgical results in terms of seizures control concerning the surgical technique performed (Anterior temporal lobectomy (ATL) vs. Selective amygdalohippocampectomy (SAH)) in a cohort of 132 patients operated in an epilepsy reference center.Materials and methodsWe performed a retrospective study based on the review of medical records of 146 patients operated for TLE from 2008 to 2019 at the Santa Casa de Misericordia in Belo Horizonte, Brazil. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. We used the ILAE (International League Against Epilepsy) scale to classify seizure control after surgery. We compared the surgical groups using the survival and Kaplan-Maier curves.ResultsA total of 132 patients were evaluated in this study, with a mean follow-up time after surgery of 57.2 months (12-137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57,1% vs. 31%) and a higher rate of satisfactory seizure control (88,6% vs. 69,3%) p =0.006.ConclusionThe literature is still controversial about seizure control results concerning the surgical technique used due to the lack of studies with a robust methodology for an adequate comparison. In our data analysis, we identified the superiority of ATL over SAH in seizure outcomes.
INTRODUCTION Temporal Lobe Epilepsy (TLE) is a high prevalence neurological disorder and tends to drug refractoriness. Surgery has emerged as a promising treatment for managing crises and a better quality of life for these patients. The objective of this work is to compare the surgical results in terms of seizure control concerning the surgical technique performed (Anterior temporal lobectomy (ATL) vs. Selective amygdalohippocampectomy (SAH)) in a cohort of 132 patients operated in an epilepsy reference center. MATERIALS AND METHODS We performed a retrospective study based on the review of medical records of 146 patients operated for TLE from 2008 to 2019 at the Santa Casa de Misericordia in Belo Horizonte, Brazil. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. One patient was excluded from the analysis of the results due to death in the first postoperative week. We used the ILAE scale to classify seizure control after surgery. In patients with left hippocampal sclerosis, the most selective approach was performed (SAH), and in right temporal lobe epilepsy, ATL was the approach of choice. We compared the surgical groups using the survival and Kaplan-Maier curves. RESULTS A total of 132 patients were evaluated in this study, with a mean follow-up time after surgery of 57.2 months (12-137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57.1% vs. 31%) and a higher rate of satisfactory seizure control (88.6% vs. 69.3%) p =0,006, when compared to patients undergoing SAH. CONCLUSION The literature is still controversial about seizure control results concerning the surgical technique used due to the lack of studies with a robust methodology for an adequate comparison. In our data analysis, we identified the superiority of ATL over SAH in seizure outcomes. In countries with a cost limitation for extended propaedeutics, ATL may be the best option for the proper control of seizures with minimal additional morbidity.
Context: Spondylodiscitis is a term that includes vertebral osteomyelitis, spondylitis and discitis. Among the vertebrae, the most affected are the lumbar (45%), followed by the thoracic (35%). Adults present themselves progressively, with a predominant complaint of low back pain and pain on palpation of the affected site, with significant limitation of movement due to muscle spasms. Report a clinical case with an emphasis on the possibility of early diagnosis and correct treatment aimed at the recovery of patients with neurological sequelae. Analysis of medical records in a patient admitted to the neurology ward of Santa Casa de Belo Horizonte. Clinical Case report: A.I.S. patient, 45 years old, with chronic low back pain due to asymmetry of the left lower limb. History of wear of the femoral head diagnosed in adolescence. Evolving for 2 months with progressive weakness in the lower limbs, associated with paresis and paresis in the left lower limb. He performed abdominal USG which showed hepatosplenomegaly with collateral circulation, increased caliber of the portal, splenic and superior mesenteric veins. Tomography of the lumbosacral spine with osteolytic lesions in the joints of L2-L3, L3-L4 and L4-L5., With almost total osteolysis of the L4 vertebral body, retropulsion of much later at this level, suggesting spondylodiscitis. The resonance of the lumbar spine performed with acute spondylodiscitis L2-L3 and L3-L4, compressing the roots of the equine tail with a comprehensive potential, remains as the emerging emerging roots. Liquid filling of the L3- L4 intervebral disc compatible with acute spondylodiscitis. Staphylococcus aureus and enterobacteria are responsible for more than half of the cases of non-tuberculosis. Conclusion: The diagnosis of discitis can be quite difficult, due to the rarity of the disease, the insidious symptoms and the high prevalence of low back pain in the general population. It is considered an important morbidity factor, as it causes an important neurological sequel. In addition, it points to the importance of differential diagnosis of low back pain in the population.
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