Infected posterior fossa metastatic tumour

Encephalic abscess and brain metastases management are completely different but their clinical and radiological features can be so similar that differential diagnosis will be extremely difficult. To underline this difficulty, authors report a 50-year-old male patient with nicotine addiction who presented intracranial hypertensive signs and cerebellar syndrome, revealing a cerebellar process diagnosed as tuberculoma. He had antibacillary treatment and corticosteroids with temporarily good recovery and secondary neurological aggravation. He underwent suboccipital craniotomy. Peroperative findings were suggestive of abscess with strong yellow pus. Microbiologic exam did not show any bacterium and histopathological study concluded on a metastases of adenocarcinoma. He died two months later. Infected posterior fossa metastatic tumour can be defined as the presence in the same cerebellar lesion of infectious process and neoplasic metastatic cells. This situation is exceptional with a only a few cases reported in literature. Authors discuss this case along with the few cases reported in literature to approach the pathophysiological mechanisms and diagnostic difficulty of such lesion association, which is generally fatal. We must think to this association in patients with radiographic encephalic findings suggestive of "abscess" to ensure adequate treatment, which may improve prognosis

Neuromyelitis optica and tuberculosis

Neuromyelitis optica [NMO] or Devic's syndrome is defined by Gault and Devic as a retrobulbar neuritis or papillitis accompanied by acute myelitis and occasionally other neurological symptoms or sings not restricted to the spinal cord or optic nerves. Infectious aetiology was suggested but never recognised. We report a 36-year-old woman with NMO which revealed a multisystemic tuberculosis with fatal issue. We discuss this case with review of literature and try to demonstrate that tuberculosis can be considered as NMO's aetiology directly by Mycobacterium Tuberculosis [BK] infestation, or indirectly by immune mediated response to BK. We conclude to search tuberculosis in patients with NMO, especially in countries where tuberculosis is endemic and a great problem of public health, and not to consider it only as a variant of multiple sclerosis because of different therapeutical options

Von-Recklinghausen's disease and spine canal ectasis: An exceptional complication and a new therapeutic approach

Von-Recklinghausen's disease or neurofibromatosis type 1 [NF1] is a hereditary disorder in which the genetic transmission is autosomic dominant and supported by the chromosome 17. Scoliosis is a classical complication of this disease. Spinal canal ectasis, at the extremities of the arthrodesis, is a rare complication of scoliosis occurring in the context of NF1 and there is no clear treatment described in the literature. We report 3 observations of patients who were admitted for the complex association of NF1 and spinal canal ectasis occurring after the surgical treatment of scoliosis and discuss our concept of treating the spinal ectasis which weakened the fusion of arthrodesis. These 3 cases of NF1 in males whose mean age was 22-years-old [19, 23, 24 years-old] were operated at the age of 8, 9 and 14 years-old respectively for severe thoraco-lumbar scoliosis. At the initial surgical management, the spine canal diameter was within normal range. They underwent a two-stage surgery with anterior and posterior spinal arthrodesis. The abnormal spinal canal dilatation [spinal ectasis] appeared during the follow-up and was revealed by back pain of the lumbar and thoracic spine. Magnetic resonance imaging and computed tomography scan concluded a posterior body vertebral destruction with clear enlargement of the subdural space, mainly located at the extremity of the arthrodesis, which was directly at risk. It was hypothesized an abnormal hyperpression of the cerebrospinal fluid [CSF]. Magnetic resonance imaging of the whole spine and the brain did not show any spinal cord anomaly, Chiari's malformation or hydrocephalus. We decided to mearure the CSF pressure via lumbar puncture. It was abnormal in all 3 cases [18 - 21 mm Hg], as was the biochemical analysis of the CSF. All 3 patients underwent surgery with a lumbo-peritoneal programmeable shunt [Sophysa shunt]. The prostoperative follow-up [9months to 3 years] was good without recurrence of pain and no cerebral hypotension symptoms. Vertebral bone destruction was seen to be halted on control MRI or CT scan. The CFS hyperpression theory must be studied more carefully so as to understand the intrinsic mechanisms in this particular clinical context by a prospective larger series with monitoring of the CSF pressure before lumbo-periotoneal shunting and a longer postoperative course to confirm the validity of this therapeutic approach

Intramedullary spinal cord ganglioglioma

Gangliogliomas are mixed neoplasms composed of 2 types of cells: neuronal and glial cells. Spinal cord gangliogliomas are very rare and compromise 1.1% of all spinal neoplasms. About 70 cases of intramedullary spinal cord gangliogliomas have been reported in English literature. We report the case of a histologically confirmed intramedullary spinal cord cervical ganglioglioma removed with total resection without neurological deterioration. Ganglioglioma must be considered in the differential diagnosis of tumours affecting the spinal cord. As a rule, gangliogliomas are sharply delineated and well defined from surrounding tissues. Total removal or gross total resection can be done without any further neurological deterioration. In cases showing no sharp delineation from surrounding tissue, a subtotal tumour removal should be considered to prevent severe neurological deficits