Delayed traumatic interacranial haematoma in postoperative patients: a case for serial computerised tomography

Delayed traumatic intracranial haematoma [DTIH] is an uncommon entity and an epiphenomenon of head injury. Its time of evolution and location is unpredictable. We report two cases of DTIH. First patient was a road traffic accident victim who had left fronto-temporal acute subdural haemoatoma [SDH] with brainstem haemorrhage. Following evacuation of acute SDH, his intracranial pressure [ICP] remained high and repeat computerised tomography [CT] scan of the head done 36 hours later, revealed a large right parieto-temporal acute extradural haematoma [EDH]. The second patient had a minor head injury, 2 weeks prior to admission and CT scan of the head revealed an isodense right fronto-parietal chronic SDH. Eleven days following evacuation of chronic SDH, he developed headache and altered sensorium and repeat CT scan of the head showed right medial temporal intracerebral haematoma [ICH]. Evolution of second intracranial haematoma changes the total clinical scenario. Their clinical manifestation, especially in a postoperative patient is delayed and the prognosis adversely affected by the delay in treatment. Early detection of such haematoma is crucial. Combination of close clinical surveillance, ICP monitoring and radiological evaluation is suggested, however there are limitations and inherent fallacies. Mechanism of evolution and strategies for early detection of DTIH in a postoperative situation is discussed

Unusual case of cystic cerebellar metastasis from breast cancer

Cerebellar metastasis in a 70-year-old female is reported. She was admitted with a 1-month history of vertigo and unsteadiness of gait. There was no history suggestive of raised intracranial pressure. Except for cerebellar signs on right side, she had no other neurological deficit. Systemic examination revealed no abnormality except for a 3cm mobile lump under the nipple that was present for last 10 years without increasing in size. Computed tomography and magnetic resonance imaging of the head revealed a cystic tumour 3 x 3 cm diameter in right cerebellar hemisphere with a possible diagnosis of haemangioblastoma. The lesion was excised and she had an uneventful recovery. Histopathology revealed a metastatic carcinoma of the breast. After two months she underwent modified radical mastectomy. She received deep x-ray therapy for the brain and the breast. Follow-up 6 months later showed no neurological deficits or local recurrence

Multiple central nervous system tumors and combined treatment modalities - an illustrative case

Multiple space occupying lesions in the craniospinal axis pose special type of challenges in their management. Surgeries for decompression or total excision of the symptomatic tumors at various sites and at different times are needed. Radiosurgery and administration of chemotherapeutic agents are other modalities for the treatment of such lesions caused by benign or malignant conditions and acute or chronic infections. We report a case of a young woman with central neurofibromatosis harbouring bilateral acoustic neurinomas multiple meningiomas and other cranial and spinal neurofibromas. she underwent radiosurgery for the right vestibular schwannoma [VS] and surgery for the left sphenoidal wing meningioma and a large right C5 nerve root neurofibroma. There was no evidence of tumor necrosis or shrinkage 4 years after the radiosurgery. Brain stem compression increased over 4 years period. she is likely to need futher intervention for symptomatic lesions

Spontaneous appearing and disappearing acute traumatic intracranial haematomas - an interesting clinical entity case reports and review of literature

Two cases of appearing and disappearing traumatic intracranial haematomas have been described. In the first case, with an initiol normal CT brain scan, a delayed intracerebral haematomas appeared ten hours after injury, while in the second case, an acute subdural haematoma, seen immediately after traumatic brain injury [TBI], disappeared ten hours later. The importance of a delayed CT brain scan in cases of TBIs has been emphasised

Ossification of posterior longitudinal ligament in ankylosing hyperostosis as a cause of myelo-radiculopathy

Development of hypertrophic ossification in the region of posterior longitudinal ligament [OPLL] in patients with ankylosing hyperostosis [AH] may result in significant spinal stenosis and progressive myelopathy and/or radiculopathy. Severe neurological manifestations in such cases are indicators of long term poor prognosis.Therefore it is important to recognise these cases early enough to offer effective therapy when working up myeloradiculopathy. A clinico-radiological analysis of seven patients of OPLL in AH with myelopathy and radiculopathy is presented. Surgically treated patients [4 cases]had remarkably good outcome on long term basis

Post-traumatic occlusion in vertebro-basilar system: report of two cases

OccIusions of the vertebral and basilar arteries following trauma are uncommon occurrences. Most patients present with brain stem or cerebellar dysfunction and although four vessel angiography is essential for localising the anatomic diagnosis, computed tomography of the head [CT head] is helpful in showing associated changes such as infarction, haemorrhage or hydrocephalus. Two cases form the basis of the present report. One patient developed occlusion of the cervical vertebral artery following a gun shot injury and presented with Brown Sequard syndrome and the other patient, who was treated initially for a left frontal extradural haematoma, later developed acute coma eight weeks following the injury. Angiography showed vertebro-basilar dissection, occlusion and posterior inferior cerebellar artery [PICA] pseudo-aneurysm, and computer tomography showed subarachnoid and intraventricular haemorrhage and left cerebellar infarction