Spinal extradural arachnoid cyst: an uncommon cause of thoracic spine compression

Spinal extradural arachnoid cysts are unusual causes of symptomatic spinal cord compression. They represent expanding diverticula of the subarachnoid space herniating through a dural defect into the extradural space. The pathogenesis of this entity is still unclear. We describe the clinical, neuroradiological and surgical aspects of two young patients in whom symptoms attributable to thoracic spine compression were caused by spinal extradural arachnoid cysts. The first child presented with progressive spastic paraparesis accompanied by urinary incontinence, superficial and deep sensory disturbance below the umbilical level. The second patient presented with unstable gait as a result of weakness and diminished sensation in the lower extremities. Magnetic resonance imaging showed a thoracic posterior extradural arachnoid cyst in both patients. The cyst was completely removed by posterior approach. Histological examination confirmed the diagnosis of arachnoid cyst. Neurological symptoms progressively resolved after surgical decompression. Although quite rare, the diagnosis of arachnoid cyst should be included in the differential diagnosis of intraspinal extradural cystic lesions, causing spinal cord compression. Surgery is the treatment of choice, providing good clinical outcome

Traumatic extradural haematoma in factor XI deficiency within pre-existing arachnoid cyst

Posterior fossa epidural haematoma [PFEH] is potentially a lethal complication of head injury. Factor XI [FXI] deficiency is a rare autosomal disorder that can manifest first as a bleeding or as an incidental laboratory abnormality. Reporting here a case of PFEH associated with arachnoid cyst and FXI deficiency. Twenty-year-old Moroccan man was admitted to our Neurosurgery Department due to occipital headache, vomiting, diplopia and decrease in consciousness. Seven days later the patient had a fall with occipital impact and he presented to emergency room. The neurological examination and the x-ray was normal. The patient returned to his home. Five days later the patient became symptomatic with occipital headache, vomiting, diplopia, deterioration of consciousness and nuchal stiffness. Cranial CT scan showed a huge unsuspected bilateral epidural haematoma with mass effect on the 4[th] ventricle and brainstem, with a hypodense area on left pontocerebellar angle suggestive to arachnoid cyst. Emergency preoperative blood crasis study showed prolonged activated partial thromboplastin time [aPTT] more than 120 milliseconds three times. A sub-occipital craniectomy on prone position was performed. An organized and collected "placenta like" epidural haematoma was evacuated. No source of bleeding was identified, only diffuse bleeding of dura was noted. The postoperative recovery unremarkable. The patient was alert with disappearance of symptoms and no neurological deficit was noted. The patient denied any recent self-medication. Lab study of blood erase showed prolonged aPTT. The level of FXI showed a severe deficiency of 3.1%. The level of factor XII, VIII and IX were normal. No other biologic abnormality was identified. This case confirms that FXI deficiency and arachnoid cyst are a risk factor of posterior fossa epidural haematoma

Spheno-orbital mesenchymal chondrosarcoma: a rare cause of exophthalmia

Intracranial primitive mesenchymal chondrosarcoma is a highly malignant and extremely rare tumour. Orbital chondrosarcomas was reported in only 18 cases until 2004. A 36-year-old woman presented with left painless exophthalmia with temporozygomatic tumefaction. This exophthalmia was progressive during 4 months, with decrease in visual acuity in left eye. Oculomotricity examination showed near ophtalmoplegia. Palpebral occlusion was impossible. Visual acuity was 10/10 on right eye and 6/10 in left eye. A temporal tumefaction was noted. This swelling was firm, non mobilisable and adhered to deep zygomatic area. Cranial and skull base CT scan showed a process occupying space lesion in the orbit and sphenotemporal area with extension in intracranial temporal fossa. Cranial and orbital MRI showed a hypo intense signal on T1- and hyper signal on T2- images. Cerebral angiography showed intense tumoural blush fed by external carotid and internal maxillary artery. Twenty-four hours before the surgery the internal maxillary artery was embolised. Surgery was performed using a left fronto temporal approach with lateral orbitotomy to access intraorbital tumoural extension and complete removal was performed. Histopathological specimens showed a mesenchymal chondrosarcoma with immunoreactivity to antivimentine body and no reactivity to leucocyte commun antigen, epithelial membrane antigen, cytokeratine, protein S 100 ordesmine. Postoperative period was unremarkable with regression of exophthalmia. The patient received chemotherapy and radiotherapy. After 12 months follow-up the patient is asymptomatic. Spheno-orbital chondrosarcoma is a rare cause of tumoural exophthalmia

Neurinoma of cauda equina associated with normal pressure hydrocephalus

Neurinoma of cauda equina associated with normal pressure hydrocephalus is rare with only 13 cases reported in the literature. A 65-year-old man was operated for lumbar neurinoma, revealed by cauda equina syndrome. On the 15[th] postoperative day, the patient presented neurological stagnation, with mental deterioration. Cranial CT-scan showed tetraventricular hydrocephalus. Following insertion of ventriculoperitoneal shunt, we observed good amelioration of neurological deterioration. Twelve months postoperatively, the patient regained full neurological function. Many hypotheses were presented but alteration of craniospinal compliance distribution and the increase in CSF protein content are the most widely accepted theories explaining this association

Invasive skull base sphenoid mucocele

A mucocele is an epithelial lined mucus-containing sac completely filling a paranasal sinus and capable of expansion. Sphenoid mucoceles are unusual lesions, with about 130 cases reported until 2001. We present a case of a 56-year-old immunocompetent soldier with sphenoidal mucocele, documented by computed tomography and magnetic resonance imaging. The lesion was excised via translabial-transsphenoidal approach and the patient recovered completely. Early diagnosis followed by microsurgical drainage of sphenoidal mucocele and prolonged antibiotic treatment is recommended

Epidural extension of aggressive vertebral haemangioma in a child with congenital heart disease

Vertebral haemangioma is a common asymptomatic lesion in adults. Spinal cord compression is rare, especially in children. We report an unusual case of T9 vertebral haemangioma with extradural extension revealed by a thoracic spinal cord compression in a 10-year-old boy with congenital heart disease. The tumour was studied with plain radiography, computed tomography and magnetic resonance imaging. The occurrence of aggressive vertebral haemangiomas in paediatric age group is discussed

Intramedullary spinal cord ganglioglioma

Gangliogliomas are mixed neoplasms composed of 2 types of cells: neuronal and glial cells. Spinal cord gangliogliomas are very rare and compromise 1.1% of all spinal neoplasms. About 70 cases of intramedullary spinal cord gangliogliomas have been reported in English literature. We report the case of a histologically confirmed intramedullary spinal cord cervical ganglioglioma removed with total resection without neurological deterioration. Ganglioglioma must be considered in the differential diagnosis of tumours affecting the spinal cord. As a rule, gangliogliomas are sharply delineated and well defined from surrounding tissues. Total removal or gross total resection can be done without any further neurological deterioration. In cases showing no sharp delineation from surrounding tissue, a subtotal tumour removal should be considered to prevent severe neurological deficits

Intradural lumbar disc herniation

Intradural lumbar disc herniation is a very complication of spinal degenerative processes with about 100 cases reported up to 1998. The mechanism of intradural disc herniation is unclear. Diagnosis of intradural lumbar disc herniation is difficult and seldom preoperatively suspected. A case of intradural lumbar disc herniation is reported. Clinical, neuroradiological and surgical findings are briefly discussed

Brown-Sequard syndrome caused by cervical disc herniation

Cervical disc herniation can be a cause of neurological symptoms but rarely Brown-Sequard syndrome. This syndrome is most commonly observed in association with spinal cord injury, tumoural disease or herniation of the spinal cord. Cervical disc herniation manifesting as a hemicord syndrome is a rare clinical finding. We report two patients, aged 45 and 52 years old, presenting with a unilateral right-sided hemiparesis with associated controlateral sensory findings at the T2 dermatome level. Magnetic resonance imaging demonstrated an isolated cervical disc herniation with marked spinal cord compression at C4/C5 and C5/C6 level respectively. Surgical treatment was performed by an anterior cervical discectomy with intersomatic arthrodesis in both cases. After surgery, there was a rapid improvement in motor symptoms and signs, however sensory functions required more recovery time. The previous 19 published cases were analyzed

Cavernous haemangioma of the frontal bone

A 28-year-old female presented with a progressive right frontal mass. CT scan and plain films showed an osteolytic lesion in the right frontal bone. Surgery consisted of total resection of the lesion and cranioplasty. The postoperative source was uneventful. Histological examination revealed a cavernous haemangioma of the diploe. In view of this observation and the literature review, aetiology, clinical, radiological and therapeutic aspect of this rare entity are discussed

Cerebral infection by candida albicans

We present a case of cerebral infection by candida albicans in a previously healthy 64-year-old man who had symptoms indicative of raised intracranial pressure without fever. Computed tomography scan and magnetic resonance imaging revealed multiple cerebral granulomas. Diagnosis was made after stereotactic biopsy. The patient's symptoms improved progressively with decrease in the size of lesions after antifungal therapy. No lesions were detected outside the central nervous system. However, he died 3 weeks later from pulmonary embolism. Candida albicans of the central nervous system is uncommon and occurs rarely in immunocompetent patients. As the neurologic sings and symptoms are vague, most cases of cerebral candidiasis are diagnosed just before death or during postmortem study. We have reviewed the main clinico-pathologic features of neurocandidiasis

Transient mutism following removal of cerebellar tumor in a child

to report a case of cerebellar mutism after surgery for posterior fossa tumour n a child. Mutism after posterior fossa surgery is a well described, although rare entity. Most of these tumours are located in the cerebellar vermis and/or extending to the hemispheres. The authors report a case of cerebellar mutism in a 9-year-old Moroccan boy who underwent surgical removal of a vermian medulloblastoma. The child became mute 24 hours postoperatively. He was fully alert without pyramidal signs and without lower cranial nerve palsies. His psychiatric examination was normal. The postoperative computed tomography images revealed nothing remarkable. He was mute for three weeks. Cerebellar mutism should be recognized as an important side effect of surgery