Multiple Retrocerebellar Arachnoid Cysts Coexisted with Medulloblastoma: Case Report

Arachnoid cysts are usually classified as developmental anomaly, inflammatory and traumatic in origin. Arachnoid cyst in posterior fossa occur frequently in the midline posterior to the cerebellum. These cyst usually present symptoms and signs due to increased intracranial pressure and may be confused with cerebellar or fourth ventricular tumor. Recently we had experienced a case of multiple retrocerebellar arachnoid cysts coexisted with pathologically confirmed desmoplastic medulloblastoma in eight months lod infant and reviewed the literatures.

Intracerebral Metastatic Choriocarcinoma Simulating Cerebrovascular Accident

Choriocarcinoma a rare malignant neoplasm of trophoblastic tissue, is characterized by early blood borne metastasis to distant organs such as lung, liver and brain. Involvement of central nervous system by metastatic choriocinoma may be manifested as acute or subacute apoplexy due to vascular invasion with tumor emboli. Therefore the diagnosis of cerebral choriocarcinoma should be suspected in women of child bearing age presenting the signs of acute or subacute intracranial pathology. We present and discuss 2 cases of intracerebral metastatic choriocarcinoma simulating cerebrovascular accident. One case, a 35 years old Korean housewife, was admitted to the department of neurosurgery, Kyung Hee University Hospital, with the chief complaints of headache, vomiting, focal seizure and right sided hemiplegia for 2 weeks duration. She had a history of irregular vaginal bleeding from 3 months before admission. On admission, there were flaccid paralysis of the right extremities with right sided facial palsy, central type and neck stiffness in moderate degree. Gynecologically, round tumor mass about 1.5cm in size at vagina was palpable and urine HCG was positive. Chest X-ray film showed scattered multiple nodular densities at both lung fields. Carotid angiogram showed vascular tumor in the fronto-parietal region. Brain scan revealed increased uptake in the parietal area. She died suddenly 3 days later at home. Another case, 39 years old housewife, was admitted to the hospital with unconscious state. Although she had and operation of hysterectomy 5 months before admission due to massive vaginal bleeding, she was quite well till several hours prior to admission when she complained of headache and vomiting followed by sudden loss of consciousness. Neurologic examination revealed deep comatose state with full dilated and fixed pupil. Chest film showed several nodular densities at both lung fields. Carotid angiogram revealed avascular space occupying lesion at right posterior partietal region. On operation, Dura was tense and scanty subdural hematoma and massive brain swelling were identified and intracerebral hematoma estimated 80cc was evacuated. Atypical trophoblast was found microscopically from biopsy material. She died on the 2nd postoperative day.

A Clinical Observation on Posterior Fossa Injury

Posterior fossa injury is a relatively infrequent in all craniocerebral injuries, which may be a rapidly fatal disease unless the diagnosis and prompt treatment are made. Delay in operation or failure to make the diagnosis early may result in death from medullary decompensation. An injury to the occipital region, followed by signs and symptoms of cerebellar or medullary nerve dysfunction, should cause one to suspect the existence of this lesion. It is well to remember that neither the surgically demonstrated presence of a supratentorial clot nor the roentgenological failure to demonstrate an occipital fracure excludes the presence of a mass lesion in the posterior fossa. Authors studied 104 cases of posterior fossa injury admitted at Department of Neurosurgery, Kyung Hee Medical Center from October 5 th, 1971 to August 30 th, 1974. The results were as follows: 1) The incidence of posterior fossa injury was 5.7% of all craniocerebral injuries. 2) The age incidence was greatest in the age group between 10 and 20. 27.9% of all cases were belonged in this group. 3) Common causes were traffic accident(82 cases:78.8%), falls from(14 cases:13.5%) and direct blow(6 cases:5.8%). 4) Male outnumbered female by almost 2 to 1. 5) Common symptoms were disturbance of consciousness(67 cases:64.4%), headache(43 cases:41.3%) and vomiting(24 cases:21.3%). 6) Scalp injuries were demonstrated in 95 cases and occipital, bone fracture in 58 cases under gross and radiological examination of posterior fossa. 7) Time interval between injury and operation was greatest at 3 to 6 hours. 8) In 30 cases of operation, massive cerebellar contusion was 13 cases, extradural hematoma was 7 cases and subdural hematoma was 2 cases and negative exploration was 6 cases. 9) The overall mortality rate was 25%.