Contralateral Superior Cerebellar Artery Syndrome: A Consequence of Brain Herniation

Vascular compromise is a well-known consequence of brain herniation syndromes. Transtentorial brain herniation most often involves posterior cerebral arteries. However, isolated involvement of contralateral superior cerebellar artery (SCA) during unilateral impending brain herniation is reported only once and we present another case of this exceedingly rare entity. A 24-year-old man was referred to us with impending herniation due to a multiloculated hydrocephalus, and during the course of illness, he developed an isolated SCA ischemia in the opposite side of the most dilated entrapped horn. In the current article we discuss the probable pathophysiologic mechanisms of this phenomenon, as well as recommending more inclusive brain studies in cases suspected of Kernohan-Woltman notch phenomenon in unilateral brain herniation. The rationale for this commentary is that contralateral SCA transient ischemia or infarct might be the underdiagnosed underlying pathomechanism of ipsilateral hemiparesis occurring in many cases of this somehow vague phenomenon.

Cerebellar staphylococcal abscess accompanied with high alfa-fetoprotein in a young infant

Brain abscess in young infants is extremely rare and usually associated with a previous history of bacterial meningitis or septicemia. Here we report a cerebellar abscess mimicking brain tumor with atypical clinical and paraclinical presentations. A two-month old previously well-baby boy was referred to us with persistent vomiting, strabismus and developmental regression. The brain imaging showed a right cerebellar mass with multiple small cysts inside the lesion. Elevated serum alfa-fetoprotein associated with cystic and solid posterior fossa mass proposed the preoperative diagnosis of teratoma but tumor cells were not found inside the pathology specimen. The culture of the sample was positive for staphylococcus aureus. The interest of this case lies in the atypical features of clinical and radiological evaluations in a young infant associated with an abnormal alfa-fetoprotein level of serum

Lumbar vertebral hemangioma with extradural extension, causing neurogenic claudication: a case report

The authors present a rare case of lumbar vertebral hemangioma extending to the epidural space with a bisected appearance and impinging on thecal sac. This 52-year-old lady presented with one year history of low back pain and bilateral leg radiation. Plain radiography showed vertical linear streaks at L2 vertebral body and axial computed tomography [CT] scan revealed small "polka dot" appearance within the vertebral body. Magnetic resonance imaging [MRI] showed low signal intensity on T1-weighted images in L2 vertebral body which was not characteristic for hemangioma. The patient underwent an L2 laminectomy, spinal canal decompression and posterior spinal instrumentation. This study indicates that lumbar vertebral hemangioma can extend to the epidural space and cause neurologic symptoms. Magnetic resonance imaging may not show diagnostic features, especially in active lesions and plain radiography and CT scan may be helpful

Comparison of sacral ratio in normal children and children with urinary and/or faecal complaints

Sacral ratio [SR] measurements in children with urinary and faecal complaints is less than that in normal children. We performed the current study on 401 normal and 193 children with urinary and/or faecal complaints from April 2002 to April 2003. None of the children in either group had a history of a known neurologic disease, myelodysplasia, cloacal exstrophy, Hirschprung's disease, ureteropelvic junction obstruction, ureterovesical junction obstruction or anorectal malformation. Due to ethical and health aspects, we couldn't request radiography in completely normal children to determine SR. The normal value for SR in antero-posterior view [APSR] ranged from 0.36-1.33 with an average of 0.71. The mean APSR in patients with urinary and/or faecal signs and symptoms [case group] was 0.554. The differences of SR values between the two groups were statistically significant [P<0.05]. The curve of mean APSR and age in normal group shows no obvious steepness but the curve in case group has an obvious slope with increasing age to adolescence. The SR is considered as a reliable tool to evaluate sacral development in patients with urinary and/or faecal complaints. It has a wide range of values and should be noted abnormal when it is less than 0.4. Age has a significant influence on SR values in children with urinary and/or faecal complaints

Primary cerebral hydatid cyst: two cases report

Cerebral hydatid disease [CHD] is a rare manifestation of echinococcosis but it constitutes a significant fraction of all intracranial mass lesions. In this paper we have reported two children with primary CHD without associated extracranial lesions. Two cases of isolated cerebral hydatid disease are described. They were 7- and 10-year old children referred with focal neurological deficits and intracranial hypertension. Extensive extracranial investigations were negative. The literature concerning isolated cerebral hydatid disease is reviewed, and possible mechanisms by which the disease can be limited to brain, are discussed. Isolated CHD can occur with different mechanisms. Lack of effective immune system in the brain, the special architecture of brain tissue permitting rapid growth of cyst, patent ductus arteriosus, and patent foramen ovale, have been the proposed factors, but none of them has been proved yet

Congenital brain tumors, a series of seven patients

Congenital brain tumors are very rare. We review these tumors in patients younger than 2 months diagnosed in our Department. Seven congenital brain tumors were diagnosed during five years. Clinical and radiological findings and prognosis are analyzed. The study included 5 female and two male infants. Two cases were diagnosed antenatally by means of ultrasonography. All patients presented with intracranial hypertension. The tumor was non-homogenous with cystic and solid components in all neuroimaging, except for the case with choroid plexus papilloma. Hydrocephalus was evident in all of them. Most findings were infra-tentorial lesions. There were three teratomas, one primitive neuro-ectodermal tumor, one ependymoblastoma and one choroid plexus papilloma. Six patients were operated on, with one intra-operative death. Two passed away postoperatively with aspiration pneumonia. One patient died due to complications of chemotherapy and another one due to tumor recurrence one year after surgery. Only the patient with choroid plexus papilloma is alive after 2 years. Today, the availability of noninvasive imaging procedures such as computerized tomography scan and magnetic resonance imaging has improved the diagnosis of congenital brain tumors. Inspite of development in prenatal diagnosis, appropriate pre and post operative management, the mortality associated with these tumors still remains high. The final prognosis in these patients is still discouraging despite early surgery and operative and anesthetic improvements. Choroid plexus papilloma accompanies the best prognosis, whereas teratoma and primitive neuroectodermal tumors have the worst prognosis

Intramedullary spinal cord abscess: report of two cases

Intramedullary spinal cord abscess is a treatable cause of paraparesis. It can rapidly lead to complete paralysis below the lesion. In this article two cases of spinal intramedullary abscess in pediatric age [3 and 4-year-old males] are presented. Incidence, clinical presentation, neurologic investigation and treatment are discussed. Although intramedullary spinal cord abscess is a rare disease, we should have knowledge of its existence because misjudgment and deferring adequate treatment may lead to an unfavorable outcome