Pineal and Suprasellar Germinoma Cooccurence with Vertebra Plana: A Case Report

Germinoma is the most common type of intracranial germ cell tumors (GCTs). Pineal gland and suprasellar region are the most frequent sites of central nervous system (CNS) involvement. Intracranial masses caused by Langerhans cell histiocytosis (LCH) mimics features of CNS GCTs. LCH frequently involve spine and is the most common cause of vertebra plana in children. A 15-year-old boy presented with progressing symptoms of polydipsia, polyuria, general headache, nausea and severe back pain. Brain MRI showed brain tumor with simultaneous involvement of suprasellar region and pineal gland. An excisional biopsy of suprasellar mass was done. The pathologic assessment confirmed the diagnosis of germinoma. Patient's treatment continued accordingly. A spine MRI, done due to persistent backache, showed a vertebra plana. We reevaluated the primary diagnosis suspecting LCH. Germinoma of CNS was confirmed and a biopsy of vertebral lesion resulted in hemangioma. Thus we report a case of CNS germinoma with co-occurrence of vertebra plana. We emphasized the importance of histopathologic diagnosis of pineal/suprasellar masses and primary investigation of other CNS regions including spine for possible metastasis or comorbidities.

Acoustic neurinomas

Acoustic neuromas [AN] are schwann cell-derived tumors that commonly arise from the vestibular portion of the eighth cranial nerve also known as vestibular schwannoma[VS] causes unilateral hearing loss, tinnitus, vertigo and unsteadiness. In many cases, the tumor size may remain unchanged for many years following diagnosis, which is typically made by MRI. In the majority of cases the tumor is small, leaving the clinician and patient with the options of either serial scanning or active treatment by gamma knife radiosurgery [GKR] or microneurosurgery. Despite the vast number of published treatment reports, comparative studies are few. The predominant clinical endpoints of AN treatment include tumor control, facial nerve function and hearing preservation. Less focus has been put on symptom relief and health-related quality of life [QOL]. It is uncertain if treating a small tumor leaves the patient with a better chance of obtaining relief from future hearing loss, vertigo or tinnitus than by observing it without treatment. In this paper we review the literature for the natural course, the treatment alternatives and the results of AN. Finally, we present our experience with a management strategy applied for more than 30 years

Hypoglossal schowannoma: a case report and review of literature

Schawannomas [neuromas, neurilemmomas] are benign tumors originating from showann cells or nerve fiber sheet cells. They are solitary, encapsulated tumors usually attached to, or surrounded by a nerve. We present a case of left hypoglossal nerve schwannoma in a 19 year old man who was admitted with progressive left tongue atrophy. Schwannoma of the hypoglossal nerve usually develops in the intracranial and extracranial portion or both in the intracranial and extracranial components forming a dumbbell shape tumor .The peripheral hypoglossal schwannomas are extremely rare

Dysphagia due to anterior cervical spine osteophyte: a case report

Degenerative changes of the cervical spine are more common in elderly, but anterior cervical osteophytes that cause problems in swallowing is rare. The most common cause of this problem is DISH disease [diffuse idiopathic skeletal hyperostosis]. Trauma is also suggested as a potential cause in osteophyte formation. We report a rare case of anterior cervical osteophyte with problems in swallowing that was caused by cervical spine trauma in during a car accident 4 years ago, treated with a cervical collar. Dysphagia was the initial symptom of the disease. Barium swallowing showed a large cervical osteophyte at the C3-C4 level with compression effect on the esophagus. X-ray, CT scan and MRI of the cervical spine confirmed the osteophyte and its correlation with the esophagus. Endoscopic study of esophagus and stomach also ruled out other disorders. Surgical osteophytectomy was performed. Up to now, only two cases of post-traumatic anterior cervical osteophyte have been cited in the literature. In this report, we introduce an unusual case of dysphagia caused by cervical spine trauma

study on the risk factors for obstetrical brachial plexus palsy

Considerable medical and legal debates have surrounded the prognosis and outcome of obstertrical brachial plexus injuries and obstetricians are often considered responsible for the injury. In this study, we assessed the factors related to the outcome of brachial plexus palsy. During 24 months, 21 neonates with obstetrical brachial plexus injuries were enrolled. Electrophysiology studies were done at the age of three weeks. They received physiotherapy and occupational therapy. They were examined ever 3 months for one year and limbs function was assessed according to Mallet scores; also, maternal and neonatal factors were collected by a questionnaire. There were 10 boys and 11 girls. Of all, 76.2% had Erb's palsy, 19% had total brachial palsy and 4.8% had klumpke paralysis. Risk factors including primiparity, high birth weight, shoulder dystocia, and prolonged second stage of labor were assessed. Electrophysiology studies showed neuropraxia in 52.4% and axonal injuries in 42.9% of the patients. At the end of the first year, 81% of the patients had functioned recovery around grade III or IV of Mallet scores. There were only significant relationships between functional improvement and neurophysiologic findings. Outcome of obstetrical brachial injuries has a close relationship to neurophysiologic study results than other risk factors