Nocardia cyriacigeorgica brain abscess with Pemphigus vulgaris: first report.

Nocardia brain abscess is an uncommon but potentially life threatening opportunistic infection that generally occurs in immunocompromised patients. Nocardia cyriacigeorgica is a recently described species rarely reported as a cause of human disease. Pemphigus vulgaris is managed with immunosuppression. There have been four prior reports of brain abscess caused by Nocardia cyriacigeorgica.

Efficiency of Distraction and Ligamentotaxis in Posterior Spinal Instrumentation of Thoracolumbar Retropulsed Fractures.

AIM: To compare the efficiency of distraction and ligamentotaxis in posterior spinal instrumentation of thoracolumbar retropulsed fractures according to the grade of spinal canal compression and fracture levels. MATERIAL AND METHODS: This study retrospectively reviewed 56 patients diagnosed with thoracolumbar fractures and significant fracture fragments retropulsed into the spinal canal who only underwent posterior instrumentation with distraction and ligamentotaxis, and compared groups according to the grade of spinal canal compression and fracture levels. The pre-and postoperative clinical outcomes were evaluated using Oswestry Disability Index and visual analog scale scores, and neuroimaging studies showed percentage of the spinal canal compression and fractured vertebral unit height. RESULTS: A total of 34 male (60.7%), and 22 female (39.3%) patients with a mean age of 46.25 years was enrolled in study. The percentage of spinal cord compression reduced significantly from 40.2% preoperatively to 26.8% postoperatively (+13.4%). The vertebral unit height increased significantly from 25.20 ± 3.2 mm to 31.85 ± 2.6 mm (+6.65 ± 2.7). The absolute spinal canal compression reduction was higher for grade II fractures (1/3 to 2/3 compression) (+13.3%) than for grade I fractures (up to 1/3) (+7.9%). Greater widening was observed at L1?L2 level (+16.2%) than at T11?T12 level (+10.2%). Statistically significant differences were found between the two groups according to the grade of canal compression and fracture levels in the mean preand postoperative spinal canal compression reduction. CONCLUSION: Indirect decompression techniques reduce retropulsed fragments, effectively improve the degree of spinal canal compression, and ensure safe laminectomy. The efficiency of distraction and ligamentotaxis after posterior spinal instrumentation correlated with the preoperative percentage of spinal canal compression and higher spinal canal area for fractures with a high preoperative stenosis.

Medulloblastoma in Adults: Surgical Outcomes and Survival - A Single Center Analysis of 16 Patients.

AIM: To look into the clinicopathological characteristics, surgical outcomes, and survival rates of adult patients with medulloblastoma. MATERIAL AND METHODS: Adult patients (age > 17 years) who had surgery in our clinic with the diagnosis of cerebellar mass between 2009 and 2015 and whose pathological diagnosis was medulloblastoma were examined. The study was carried out retrospectively by analyzing the clinicopathological data, surgical outcomes, and complications of the patients. In the postoperative and follow-up periods, contrast-enhanced cranial magnetic resonance imaging (MRI) was used to assess the presence of recurrence or residual disease. Moreover, the overall 5-year survival rates of the patients were evaluated. RESULTS: A total of 16 patients were diagnosed with medulloblastoma, with a mean age of 32.25 years old (age range 18?57 years). The tumor was found in the vermis in eight (50%) patients and the cerebellar hemispheres in the rest (50%) of them. Total excision was performed on 14 (87.5%) patients, near-total excision on 1 (6.25%) patient, and subtotal excision on 1 (6.25%) patient. The histopathological results were consistent with desmoplastic type medulloblastoma in nine (56.25%) patients, classical type in six (37.5%) patients, and anaplastic medulloblastoma in one (6.25%) patient. All patients received posterior fossa boost dose + craniospinal radiotherapy after the surgery. Recurrent lesions were found in six (40%) of the patients. A total of ten (62.5%) patients were still alive, and mortality rate was found to be 25% (4 patients) at 5 years. CONCLUSION: After 5 years, 10 of the 16 patients in our study were still alive. Lateral localization of the tumor, desmoplastic histologic variant, and total excision were all good prognostic indicators. Total excision is difficult in patients with brainstem invasion, and even if total excision is performed, the prognosis is poor.

Concomitant chronic subdural hematomas and arachnoid cysts in young adults.

Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment  methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5-60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.

Guillain-Barre Syndrome After Craniocerebral Gunshot Injury: First Report.

BACKGROUND: Guillain-Barre syndrome (GBS) is a rare but serious disorder involving peripheral nerve inflammatory demyelination characterized by acute onset tetraparesis and areflexia. Generally, GBS is preceded by a bacterial or viral infection, and post-traumatic or postsurgical GBS is rarely seen. CASE DESCRIPTION: A 41-year-old man with severe craniocerebral gunshot injury and open depressed occipital bone fracture was operated urgently. Two weeks postoperatively, he suffered from sudden quadriparesis. He had flaccid paralysis of his bilateral muscle lower extremities (0/5), along with bilateral upper extremity weakness (2/5). CONCLUSIONS: We report the first case, to our knowledge, with post-traumatic GBS after craniocerebral gunshot injury. We want to indicate the possibility of post-traumatic GBS in cases of unexplained quadriparesis or quadriplegia after trauma or surgery.