Classic central nervous system Hodgkin lymphoma masquerading as left sphenoid wing meningioma- A case report.

INTRODUCTION AND IMPORTANCE: Classic Hodgkin Lymphoma with an incidence of 2-3 cases per 100,000 population affects the Central Nervous System in 0.02 % of cases (Gerstner et al., 2008; Brice et al., 2021; Morawa et al., 2007). CNS lymphoma, contributing to 0.22 % of Central Nervous System tumors, is the uncommon extra-nodal manifestation of Hodgkin's Disease (Brice et al., 2021; Henkenberens et al., 2014). It affects the nervous system secondary to systemic lymphoma or the relapse of the disease (Gerstner et al., 2008). Only 17 cases of CNS lymphoma are reported which were limited to the CNS at the time of diagnosis (Paul et al., 2017). Only two cases of Dural-Based Hodgkin Lymphoma were reported in the literature (Paul et al., 2017). CASE PRESENTATION: We are reporting the third case of dural-attached extra-axial secondary CNS Hodgkin Lymphoma in a 33 years old female, which appeared and was operated as Left Sphenoid Wing Meningioma. CLINICAL DISCUSSION: Only 17 cases of CNS lymphoma are reported which were limited to the CNS at the time of diagnosis (Paul et al., 2017). Only two cases of Dural-Based Hodgkin Lymphoma were reported in the literature (Paul et al., 2017). Our case consists the third case of dural attached Classic CNS Hodgkin lymphoma and the first case of Classic CNS Hodgkin Lymphoma locating in the Sphenoid Wing. CONCLUSION: It is important to differentiate CNS Hodgkin Lymphoma from other types of brain tumors especially when it resides in an unusual location because the treatment of CNS Hodgkin Lymphoma is mainly combined chemo-radiotherapy than surgical intervention.

Upper Thoracic Spine (D2-D3) Fracture With Unilateral Lock Facets Without Associated Neurological Deficits: Case Report & Literature Review.

Introduction: Upper thoracic spine fractures are rare as compared to other spine segments due to anatomical landmarks. If they occur, they are usually associated with paraplegia or any other neurological dysfunction. We report upper thoracic fracture without neurological dysfunction which is a rare entity along with its radiological imaging, and management plan. Case Description: Forty-years old male presented after RTA. CT spine showed T2 vertebral body fracture with dislocation/locking of the right T2-T3 facet joint. The patient underwent surgical fixation and was neurologically intact. Conclusion: Upper thoracic spine fracture is a rare entity due to its anatomical location. And sometimes it is missed as well. Proper imaging should be considered if there is high suspicion and early surgery is warranted to prevent permanent damage.

Role of albumin-induced volume expansion therapy for cerebral vasospasm in aneurysmal subarachnoid hemorrhage: A systematic review.

Objectives: This study reviews the effect of albumin-induced volume expansion therapy on symptomatic vasospasm and clinical outcome in aneurysmal subarachnoid hemorrhage (aSAH). Materials and Methods: Computer searches carried out from the Scopus, Medline, Embase, Web of Science, the Cochrane Library, and Internet documents; hand searching of medical journals; and review of reference lists. Randomized controlled trials (RCT) and observational studies (OSs) comparing albumin therapy in combination or alone with crystalloid therapy for the treatment of cerebral vasospasm in aSAH were included in the study. Risk-of-bias assessment was conducted using ROB2.0 and ROBINS-I tools for RCTs and Oss, respectively. Results: Out of a total of 1078 searches, one RCT (published in two articles) and one observational (retrospective) study were included for final analysis. In RCT, albumin was used for volume expansion therapy with a baseline crystalloid regime and comparison made between hypervolemic and normovolemic groups and it showed no beneficial effects on symptomatic vasospasm and clinical outcomes based on the Glasgow outcome scale. Furthermore, the use of albumin showed a tendency for sodium retention with lowering of glomerular filtration rate, limiting the amount of total fluid required for targeted central venous pressure values, and thereby avoiding fluid overload manifestations. The retrospective study results between albumin versus non-albumin groups (crystalloids only) supported improved outcomes in the former group with lower in-hospital mortality. Cardiorespiratory complications were equivocal in RCT and increased in non-albumin group in the retrospective study. Risk-of-bias assessment analyses revealed "some concerns" in RCT and "serious" limitation in OS due to its retrospective design. Conclusion: Albumin-induced volume expansion therapy for cerebral vasospasm does not have substantiative evidence to improve cerebral vasospasm and clinical outcomes in aSAH. Studies with well-designed RCTs are required to compare the use of albumin for volume expansion therapy versus standard fluid management using crystalloids to mitigate the scarcity of published data.

Onyx Embolization of Distal Middle Cerebral Artery Aneurysm in a Patient with Nontraumatic Subdural Hematoma.

Distal cortical middle cerebral artery (MCA) aneurysm is a rare entity. Despite the challenging procedure, the role of endovascular treatment is emerging due to its safety and efficacy in obliterating the microaneurysm. We report a 25-year-old male, who presented with a history of dizziness and headache for almost 2 weeks. Computed tomography scan showed a right front parietal subdural hematoma (SDH). We could not identify any underlying defining etiology of SDH neither head injury nor coagulopathy disorder. Therefore, diagnostic cerebral angiogram was performed, which showed a microaneurysm in the distal right MCA cortical branch. Hence, complete obliteration of this microaneurysm was performed using Onyx for endovascular embolization. Therefore, this case report demonstrates the efficacy of this modality in the treatment of microaneurysms with SDH.

Obstructive hydrocephalus and facial nerve palsy secondary to vertebrobasilar dolichoectasia: Case Report.

BACKGROUND: Symptomatic hydrocephalus due to vertebrobasilar dolichoectasia is a rare occurrence. CASE DESCRIPTION: We report a patient who presented with acute confusion and vomiting. Neuroimaging revealed elongated and tortuous basilar artery indenting and elevating the floor of third ventricle causing obstructive hydrocephalus. Initially, the patient was treated with external ventricular drain and then with ventriculo-peritoneal shunt. CONCLUSION: We suggest prompt surgical intervention upon diagnosis as a first choice of treatment in order to avoid further complications.

Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management.

BACKGROUND: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. MATERIALS AND METHODS: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. RESULTS: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. CONCLUSION: Prolonged bradycardia was associated with significantly higher incidence of asystole. Endotracheal suctioning and positioning of HSCI patients were significant provocative factors for prolonged bradycardia; hypotension on admission, pneumonia and tracheostomy were the risk factors for the development of prolonged bradycardia in these patients.

Pilomyxoid astrocytoma of the cerebellum.

Pilomyxoid astrocytomas (PMAs) are low-grade (WHO Grade II) tumors for which the imaging features are similar to pilocytic astrocytomas (PAs), but for which histological features and the clinical course differ. They are classified as a variant of PA. They have only been recently recognized, and they behave more aggressively than PAs. Most cases occur in the hypothalamic-chiasmatic area, although they may be located in any part of the neuraxis. Posterior fossa PMAs are very rare. The authors report a case of a 2-year-old girl with cerebellar PMA.

Neuroleptic malignant syndrome and closed head injury: A case report and review.

Neuroleptic malignant syndrome (NMS) is a rare, but potentially lethal neurological emergency. Fifty percent of traumatic brain injury (TBI) patients will have emotional disorders and post-traumatic agitations. Haloperidol is a neuroleptic antipsychotic medication commonly used in the traumatic brain injury patients due to its advantage of no effect on respiration and conscious level. But it is one of the common medications causing NMS. A 19-year-old male driver involved in the road traffic accident had an acute subdural hematoma, which was immediately evacuated. Postoperatively, he was awake. He was weaned from ventilator and extubated. He received 20 mg of intravenous haloperidol in divided doses with in 24 hours to control his agitation. Next day, he became drowsy, spastic, febrile, and tachycardic with labile blood pressure. He was diagnosed to have NMS, needed intubation, aggressive hydration and pharmacological treatment with dentrolene sodium and bromocriptin. He was weaned from ventilator and extubated on day 17. He was transferred to the ward and then discharged to be followed in out-patient clinic. NMS in head injury patient is rare and difficult to diagnose. Diagnosis of NMS should be suspected if two of the four cardinal signs and symptoms are developed following the use of neuroleptic or dopamine agonist medication withdrawal.