Supratentorial and infratentorial haemangioblastomas: literature review with lllustrative cases

The central nervous system haemangioblastomas are a unique group of life threatening, histologically benign tumours occurring solely within the neuroaxis. They are characterised by a familial incidence, a striking diversity of associated lesions in the organs and a gratifying response to microsurgical treatment. They are uncommon intracranial neoplasms constituting approximately 1 - 2% of intracranial masses and 7% of all infratentorial tumours. They may be associated with Von Hippel Lindau Complex [VHLC]. Among central nervous system haemangioblastomas, solitary or multiple, supratentorial haemangioblastomas are rare. They account for 2 - 8% of all haemangioblastomas. They are commonly intraparenchymatous, infrequently intraventricular and rarely in meningeal location. Interesting clinical, neuroradiological [computed tomography [CT] and magnetic resonance imaging [MRI]] findings are described in this review of literature with illustrative cases

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

Chronic subdural haematoma and bilharziasis

Chronic subdural haematoma[CSH] in elderly or late middle age is a common problem in neurological practice. History of trauma, although frequently present in many, may be trivial in some and absent in a fair number of cases. A report on a patient with visceral bilharziasia who developed CSH is presented. He is surgically treated with good outcome

Minimally invasive neurosurgery using CRW-3 sterotaxy

The Cosman-Roberts-Wells [CRW-3] scanner independent stereotactic system is a recent arc-radius design developed from the Brown-Roberts-Wells system. The results of 74 supratentorial non-basal tumor suspect cases treated with this second generation computed tomography [CT] guided stereotactic apparatus are presented. Using a simple stereotactic target classification coupled with biopsy, trephine or mini-craniotomy, it has been possible to biopsy, excise and develop new strategies using microneurosurgical techniques with extremely low morbidity

Fatal intracranial hemorrhage and subacute bacterial endocarditis in pregnancy: case report and literature review

Fatal intracranial haemorrhage due to mycotic aneurysm of the middle cerebral artery during the eighth month of pregnancy is an uncommon complication of subacute bacterial endocarditis. Early neurological symptoms and signs are often overlooked or if present are considered as "expected to occur" in pregnancy. The subtle clinical features do not get the kind of attention they deserve until maternal catastrophy follows. Delay in the obstetric management in such situations may lead to foetal death as well. One such case is presented to generate greater awareness in the management of pregnancy complicated by an acute neurological emergency such as bleeding mycotic aneurysm

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

Fluorosis induced hypertrophic ossification of posterior longitudinal ligament resulting in spinal stenosis and progressive myelopathy

Hypertrophic ossification of the posterior longitudinal ligament causes an acquired spinal stenosis with attendant neurological manifestations in patients with skeletal fluorosis. Such cases are uncommon. In Asian and African countries where fluorosis is endemic it should definitely be considered while working up progressive myelopathy and or radiculopathy to effect an early diagnosis and surgical intervention. Severely affected individuals are crippled with kyphotic rigid spine, quadriplegia and deformed limbs with spastic contractures and have poor long-term prognosis. Two cases of severe fluorosis induced hypertrophic ossification of the posterior longitudinal ligament resulting in spinal stenosis are described