Traumatic extradural haematoma in factor XI deficiency within pre-existing arachnoid cyst

Posterior fossa epidural haematoma [PFEH] is potentially a lethal complication of head injury. Factor XI [FXI] deficiency is a rare autosomal disorder that can manifest first as a bleeding or as an incidental laboratory abnormality. Reporting here a case of PFEH associated with arachnoid cyst and FXI deficiency. Twenty-year-old Moroccan man was admitted to our Neurosurgery Department due to occipital headache, vomiting, diplopia and decrease in consciousness. Seven days later the patient had a fall with occipital impact and he presented to emergency room. The neurological examination and the x-ray was normal. The patient returned to his home. Five days later the patient became symptomatic with occipital headache, vomiting, diplopia, deterioration of consciousness and nuchal stiffness. Cranial CT scan showed a huge unsuspected bilateral epidural haematoma with mass effect on the 4[th] ventricle and brainstem, with a hypodense area on left pontocerebellar angle suggestive to arachnoid cyst. Emergency preoperative blood crasis study showed prolonged activated partial thromboplastin time [aPTT] more than 120 milliseconds three times. A sub-occipital craniectomy on prone position was performed. An organized and collected "placenta like" epidural haematoma was evacuated. No source of bleeding was identified, only diffuse bleeding of dura was noted. The postoperative recovery unremarkable. The patient was alert with disappearance of symptoms and no neurological deficit was noted. The patient denied any recent self-medication. Lab study of blood erase showed prolonged aPTT. The level of FXI showed a severe deficiency of 3.1%. The level of factor XII, VIII and IX were normal. No other biologic abnormality was identified. This case confirms that FXI deficiency and arachnoid cyst are a risk factor of posterior fossa epidural haematoma

Neurinoma of cauda equina associated with normal pressure hydrocephalus

Neurinoma of cauda equina associated with normal pressure hydrocephalus is rare with only 13 cases reported in the literature. A 65-year-old man was operated for lumbar neurinoma, revealed by cauda equina syndrome. On the 15[th] postoperative day, the patient presented neurological stagnation, with mental deterioration. Cranial CT-scan showed tetraventricular hydrocephalus. Following insertion of ventriculoperitoneal shunt, we observed good amelioration of neurological deterioration. Twelve months postoperatively, the patient regained full neurological function. Many hypotheses were presented but alteration of craniospinal compliance distribution and the increase in CSF protein content are the most widely accepted theories explaining this association

Invasive skull base sphenoid mucocele

A mucocele is an epithelial lined mucus-containing sac completely filling a paranasal sinus and capable of expansion. Sphenoid mucoceles are unusual lesions, with about 130 cases reported until 2001. We present a case of a 56-year-old immunocompetent soldier with sphenoidal mucocele, documented by computed tomography and magnetic resonance imaging. The lesion was excised via translabial-transsphenoidal approach and the patient recovered completely. Early diagnosis followed by microsurgical drainage of sphenoidal mucocele and prolonged antibiotic treatment is recommended

Epidural extension of aggressive vertebral haemangioma in a child with congenital heart disease

Vertebral haemangioma is a common asymptomatic lesion in adults. Spinal cord compression is rare, especially in children. We report an unusual case of T9 vertebral haemangioma with extradural extension revealed by a thoracic spinal cord compression in a 10-year-old boy with congenital heart disease. The tumour was studied with plain radiography, computed tomography and magnetic resonance imaging. The occurrence of aggressive vertebral haemangiomas in paediatric age group is discussed

Intradural lumbar disc herniation

Intradural lumbar disc herniation is a very complication of spinal degenerative processes with about 100 cases reported up to 1998. The mechanism of intradural disc herniation is unclear. Diagnosis of intradural lumbar disc herniation is difficult and seldom preoperatively suspected. A case of intradural lumbar disc herniation is reported. Clinical, neuroradiological and surgical findings are briefly discussed

Brown-Sequard syndrome caused by cervical disc herniation

Cervical disc herniation can be a cause of neurological symptoms but rarely Brown-Sequard syndrome. This syndrome is most commonly observed in association with spinal cord injury, tumoural disease or herniation of the spinal cord. Cervical disc herniation manifesting as a hemicord syndrome is a rare clinical finding. We report two patients, aged 45 and 52 years old, presenting with a unilateral right-sided hemiparesis with associated controlateral sensory findings at the T2 dermatome level. Magnetic resonance imaging demonstrated an isolated cervical disc herniation with marked spinal cord compression at C4/C5 and C5/C6 level respectively. Surgical treatment was performed by an anterior cervical discectomy with intersomatic arthrodesis in both cases. After surgery, there was a rapid improvement in motor symptoms and signs, however sensory functions required more recovery time. The previous 19 published cases were analyzed

Spinal hydatid disease: diagnosis and management challenge of 20 cases

the aim of this study is to highlight the benefit of medical treatment in spinal hydatid disease. between 1984 and 1998, 20 cases of spinal hydatid disease were treated in our department. Plain x-ray was performed in all cases, computed tomography scan and myelography in 16 cases and 5 cases were explored by resonance imaging. Nineteen patients were surgically treated. Anthelmintic drugs [albendazole] were used parentally alone in 1 case and associated with surgery in 5 cases. We divided our patients into two groups: the first called "surgical group", has only surgical treatment without albendazole [14 patients] and the second, called "medicosurgical group" received albendazole alone or associated with surgical treatment [6 patients]. out of 20 cases, 11 were male and 9 were female. Patients' age ranged from 9 to 70 years, with an average of 32 years. The mean duration of symptoms before admission was six months. The most common sign was weakness in 18 cases; pain was present in 12 cases. The thoracic spine was involved in 9 cases, lumbar in 5 cases, thoraco-lumber in 2 cases, cervical, cervicothoracic and craniovertebral junction, in 1 case each. One vertebra was affected in 2 cases and more than one vertebra in 14 cases. The cyst was intradural but extra-medullary in 3 cases, epidural without vertebral involvement in one case. Evolution was characterised by total recovery in 4 cases without bone involvement. Among the 10 patients with vertebro epidural location, treated only surgically, 6 presented multiple recurrences and repeat surgery was often needed, 4 were totally or partially improved; 5 among the 6 patients who received anthelmintic drugs are living without evidence of recurrence during a period ranging from 1 to 6 years. we conclude that spinal hydatid is chracterised by a high rate of recurrence. Albebdazole used in our department since 1993, seems to change the course of the disease

Spinal arachnoid cysts - 10 cases

The authors report their experience of 10 patients with spinal arachnoid cyst at the Hopital des specialties in Rabat. There were 5 females and 5males. The mean age was 27 years [range 6 to 70 years]. Eight patients had sings of spinal cord compression and the other two were admitted with severe sciatica. All patients had computed tomography-myelography or magnetic resonance imaging. The lesion involved the thoracic spine in 7, lumbar in 2 and cervical in 1 patient. The cysts were intradural in 6 an extradural in 4 patients. Treatment consisted of complete removal in 5 patients, marsupalisation in 3 and perforation aspiration in 2 patients. Follow-up ranging between 2-7 years, showed total improvement in 6 patients, partial recovery in 3 patients and 1 patient remained unchanged. Recurrence of the cyst was seen in 2 patients. The authors discuss the aetiology, pathogenesis, clinical, radiological and therapeutic aspects of this benign condition

Parinaud syndrome from tuberculoma of pineal area

Computerised tomography and magnetic resonance imaging [MRI] revealed obstructive hydrocephalus and a pineal mass in a 44-year-old woman who presented with headaches and Parinaud's syndrome. Although there was no major evidence of extracranial tuberculosis, and cerebrospinal fluid obtained during third ventriculostomy contained no leukocytes, stereotactic biopsy of the lesion revealed it to be a tuberculoma. MRI showed resolution of the lesion following antituberculous therapy. The implications of this case with regard to difficulties in the diagnosis of cerebral tuberculoma and the management of pineal region tumours are discussed

Cavernous haemangioma of the frontal bone

A 28-year-old female presented with a progressive right frontal mass. CT scan and plain films showed an osteolytic lesion in the right frontal bone. Surgery consisted of total resection of the lesion and cranioplasty. The postoperative source was uneventful. Histological examination revealed a cavernous haemangioma of the diploe. In view of this observation and the literature review, aetiology, clinical, radiological and therapeutic aspect of this rare entity are discussed

Cerebral infection by candida albicans

We present a case of cerebral infection by candida albicans in a previously healthy 64-year-old man who had symptoms indicative of raised intracranial pressure without fever. Computed tomography scan and magnetic resonance imaging revealed multiple cerebral granulomas. Diagnosis was made after stereotactic biopsy. The patient's symptoms improved progressively with decrease in the size of lesions after antifungal therapy. No lesions were detected outside the central nervous system. However, he died 3 weeks later from pulmonary embolism. Candida albicans of the central nervous system is uncommon and occurs rarely in immunocompetent patients. As the neurologic sings and symptoms are vague, most cases of cerebral candidiasis are diagnosed just before death or during postmortem study. We have reviewed the main clinico-pathologic features of neurocandidiasis

Transient mutism following removal of cerebellar tumor in a child

to report a case of cerebellar mutism after surgery for posterior fossa tumour n a child. Mutism after posterior fossa surgery is a well described, although rare entity. Most of these tumours are located in the cerebellar vermis and/or extending to the hemispheres. The authors report a case of cerebellar mutism in a 9-year-old Moroccan boy who underwent surgical removal of a vermian medulloblastoma. The child became mute 24 hours postoperatively. He was fully alert without pyramidal signs and without lower cranial nerve palsies. His psychiatric examination was normal. The postoperative computed tomography images revealed nothing remarkable. He was mute for three weeks. Cerebellar mutism should be recognized as an important side effect of surgery