A Rare Extradural Spinal Meningioma with Nocturnal Chest Pain: A Case Report

OBJECTIVES@#To report a rare case of a spinal extradural meningioma in a patient with longstanding nonspecific thoracic nocturnal pain.SUMMARY OF LITERATURE REVIEW: Meningioma is a frequent intradural extramedullary tumor that is associated with pain, sensory/motor deficits, and sphincter weakness. Spinal meningiomas most commonly occur in the thoracic spine, although they can also be found at other locations.@*MATERIALS AND METHODS@#A 65-year-old woman first visited the cardiac and gastrointestinal departments of our institution due to chest pain 2 years previously. No explanation for the complaint could be found in the heart or other organs. On a computed tomography scan of the thorax, a spinal mass was found a few months before the diagnosis. On magnetic resonance imaging, an extramedullary and extradural mass was observed at T7/8.@*RESULTS@#We performed surgery and found an extradural spinal meningioma upon the histological diagnosis. Postoperatively, the patient could adequately move both legs and feet and the nocturnal chest pain disappeared after surgery without any complications.@*CONCLUSIONS@#Awareness of the rarity and nonspecific symptoms of extradural spinal meningiomas will be beneficial for their accurate diagnosis and proper treatment.

A Rare Extradural Spinal Meningioma with Nocturnal Chest Pain: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a rare case of a spinal extradural meningioma in a patient with longstanding nonspecific thoracic nocturnal pain. SUMMARY OF LITERATURE REVIEW: Meningioma is a frequent intradural extramedullary tumor that is associated with pain, sensory/motor deficits, and sphincter weakness. Spinal meningiomas most commonly occur in the thoracic spine, although they can also be found at other locations. MATERIALS AND METHODS: A 65-year-old woman first visited the cardiac and gastrointestinal departments of our institution due to chest pain 2 years previously. No explanation for the complaint could be found in the heart or other organs. On a computed tomography scan of the thorax, a spinal mass was found a few months before the diagnosis. On magnetic resonance imaging, an extramedullary and extradural mass was observed at T7/8. RESULTS: We performed surgery and found an extradural spinal meningioma upon the histological diagnosis. Postoperatively, the patient could adequately move both legs and feet and the nocturnal chest pain disappeared after surgery without any complications. CONCLUSIONS: Awareness of the rarity and nonspecific symptoms of extradural spinal meningiomas will be beneficial for their accurate diagnosis and proper treatment.

Differential Diagnosis of Lemierre's Syndrome in a Patient with Acute Paresis of the Abducens and Oculomotor Nerves

Lemierre's syndrome is characterized by anaerobic septicemia, internal jugular vein thrombosis, and septic emboli associated with infections of the head and neck. We describe an unusual and clinically confusing case of a young woman with an acute paresis of the abducens nerve and partial paresis of the right oculomotor nerve. After an extensive imaging diagnostic procedure, we also documented a peritonsillar abscess and various types of thromboses in intracranial and extracranial veins. Furthermore, we found brain and lung abscesses, which led us to establish the diagnosis of Lemierre's syndrome. Despite intensive anti-coagulation and antibiotic therapy, the patient developed a mycotic aneurysm in the right internal carotid artery directly adjacent to the previously thrombosed cavernous sinus. In summary, we were able to confirm that Lemierre's syndrome may occur in conjunction with uncharacteristic symptoms. Due to the sometimes confusing clinical symptoms as well as clinical and radiological specialties, we had to work on an interdisciplinary basis to minimize the delay prior to establishing the diagnosis and therapy.

Dual modality of 18F-Fluorodeoxyglucose-positron emission tomography / computed tomography in patients with cervical carcinoma of unknown primary

To evaluate an optimized F-18-flurodeoxyglucose-positron emission tomography/computed tomography [FDG-PET/CT] acquisition protocol for head and neck cancer and assess the usefulness of combined FDG-PET/CT in locating unknown primary tumors in patients with biopsy-proven cervical lymph node metastases. Subjects and Twenty-one patients with cervical lymph node metastases of unknown primary tumors underwent staging with FDG-PET/CT. The images of FDG-PET alone, CT alone, FDG-PET/CT read side by side and fused and FDG-PET/CT were evaluated separately by 2 physicians. Imaging results were correlated with either histology [n = 14] or clinical follow-up [n = 7]. On the fused FDG-PET/CT images, primary tumors were identified in 12 patients [57%]; with FDG-PET alone and FDG-PET and CT read side by side 11 [52%] primary tumors were found while CT alone identified 5 [23%] primary tumors. Our data indicate that fused FDG-PET and CT images increased the sensitivity of detecting carcinoma of unknown primary [CUP] tumors compared to CT alone, but not to FDG-PET alone or FDG-PET and CT read side by side. Hence accurate fusion of functional and morphologic data by FDG-PET/CT is a promising imaging modality in the clinical workup of patients with cervical CUP tumors