Clinical presentation of neuroendocrine cancer metastasis to an anterior clinoid process meningioma invading superior orbital fissure. A case report.

Metastasis to a meningioma is an uncommon phenomenon however reported in the literature. Meningiomas are common primary intracranial tumours which most frequently occur to be a recepient of metastases. A 66-year-old female presented with rapid development of visual acuity and visual field loss in the right eye with ipsilateral oculomotor nerve palsy. Magnetic resonance imaging (MRI) showed well-defined tumour intensely enhanced with contrast like a typical skull base meningioma. The neuropathological examination revealed two different morphological fragments of the tumour. In the cell-rich part of the tumour, immunopositivity for CK, chromogranin, and SY were detected. The less cellular portion of the tumour, immunopositivity to epithelial membrane antigen (EMA) and vimentin were detected. To our knowledge, we present the first rare metastasis of neuroendocrine carcinoma to the medial sphenoid meningioma that preceded the clinical symptoms of systemic neuroendocrine carcinoma.

Battery for deep brain stimulation depletion in Parkinson's Disease and dystonia patients - a systematic review.

INTRODUCTION: Deep brain stimulation (DBS) therapy for Parkinson's Disease (PD) and dystonia is associated with the possibility of both minor and major complications. One possible side effect is the depletion of implantable pulse generator (IPG) battery and the associated sudden recurrence of PD or dystonia symptoms, which can be potentially life-threatening. Delayed or postponed outpatient visits due to COVID -19 may be a risk factor of battery end-of-life consequences. OBJECTIVE: To analyse the clinical outcomes in reported PD and dystonia patients treated with DBS, who, as a result of the sudden depletion of the neurostimulator battery, developed life-threatening symptoms. MATERIALS AND METHODS: The databases of PubMed, Scopus, EMBASE and Google Scholar were searched using pre-established criteria. RESULTS: A total of 244 articles was found, of which 12 met the adopted criteria. Selected papers presented a total of 17 case reports of DBS-treated patients - 11 with PD, and six with dystonia - who had depleted IPG batteries and due to rapid worsening of PD/dystonia symptoms required urgent hospital admission. IPG battery replacement was the only effective treatment in the majority of cases. CONCLUSIONS: IPG battery depletion can result in fatal outcomes. Sudden recurrence of PD or dystonia symptoms in patients treated by DBS can be potentially life-threatening, so scheduling the replacement of a discharged IPG battery should not be postponed. The COVID-19 pandemic should alert staff at emergency, neurology and movement disorders wards not to postpone the visits of patients with an implanted DBS system.