Post-traumatic chronic-encapsulated and calcified intracerebral hematoma mimicking a supratentorial hemangioblastoma: a case report and literature review.

Chronic-encapsulated intracerebral hematomas are a rare type of hematoma. They tend to be mistaken for abscesses or tumors. The etiology of these hematomas is not yet clear, although they have mainly been linked to arteriovenous malformations, cavernomas, and head trauma. Surgical evacuation is effective in improving neurological symptoms with a good prognosis. However, the lesion may be difficult to diagnose. Case presentation: Here, the authors report a case of a chronic-encapsulated and calcified intracerebral hematoma following recurrent mild head injuries mimicking a supratentorial hemangioblastoma in a healthy 26-year-old female patient presented with progressive raised intracranial pressure and left body heaviness with good outcomes after en bloc surgical resection. Clinical discussion: The chronic-encapsulated intracerebral hematoma was first described by Hirsh et al. in 1981. Their etiology is not yet clear, although they have mainly been linked to arteriovenous malformations, cavernomas, and head trauma. Pathologically, they are characterized by the presence of a fibrous capsule composed of an outer collagen layer and an inner granulated layer. Radiologically, they appear as cystic lesions with a homogeneous high signal on T1-weighted and T2-weighted images associated with a lower signal ring sign and ring enhancement after gadolinium administration that may suggest hemangioblastoma. Conclusion: Although chronic parenchymal hematomas remain a rare phenomenon, it has become increasingly logical to consider this entity in differential diagnoses with other lesions. In cases with recurrent head trauma, a detailed investigation will aid in making the diagnosis of such a rare pathology.

Ruptured Central Nervous System Dermoid Cyst of Suprasellar Region Manifesting as Unusual Epileptic Seizure.

BACKGROUND: Central nervous system dermoid cysts are rare lesions derived from ectopic epithelial cells. They are slow-growing benign tumors but may cause significant morbidity through compression of neurologic and vascular structures and, rarely, rupture into the subarachnoid space. CASE DESCRIPTION: We present a rare case of a spontaneously ruptured intracranial dermoid cyst in a 32-year-old man presenting as new-onset epileptic seizures due to chemical meningitis caused by dissemination of fat or lipid droplets. CONCLUSIONS: The dermoid cyst is a rare entity, the rupture of which is exceptional and often spontaneous. It is manifested by a polymorphic and nonspecific clinical picture requiring the use of imaging. This is based on CT and especially MRI, which make it possible to positively diagnose the nature of the cyst and the rupture, specify the extent of the dissemination of the lipid content in the subarachnoid spaces, and detect possible complications such as hydrocephalus. It also makes it possible to carry out a precise topographic assessment to plan the therapeutic conduct and guide a possible surgical intervention.

Applicability, Safety, and Cost-Effectiveness of Improvised External Ventricular Drainage: An Observational Study of Tunisian Neurosurgery Inpatients.

OBJECTIVE: External ventricular drainage (EVD) is an emergent neurosurgical procedure. Many commercial sets are available for EVD that are not always obtainable in all hospitals. The aim of our study was to describe new techniques to perform EVD using simple improvised materials to check the real-world applicability of the same device in the management of acute hydrocephalus and its effectiveness and safety. METHODS: We illustrated 2 techniques for a "do it yourself" improvised EVD device using materials available even in non-neurosurgery-dedicated operating rooms. We performed an observational study in our institution (April 2015 to December 2016). We included all patients presenting with acute hydrocephalus and requiring EVD. RESULTS: During a 20-month period, the new EVD device was used as a lifesaving solution for 33 patients. Good outcomes were noted in 11 of the 33 patients (33%). The EVD was complicated by fatal meningitis in 4 of the patients (12%). Malfunction occurred in 6 patients. The new EVD device costs less than US$20 for the first technique and less than US$10 for the second technique. In contrast, the cost of a standard EVD set ranges from US$170 to US$380 in Tunisia. CONCLUSIONS: The new EVD device has the potential to improve the quality of efficiency of care in difficult economic times that have changed the medical landscape, because it is both easy to make and cost-effective. Because it is an inexpensive technique, it could also be suitable for low-income countries, where neurosurgery is not yet the first and foremost health priority.