A Unique Pediatric Case of Intratumoral Hemorrhage in a Sporadic Vestibular Schwannoma.

Vestibular schwannomas (VSs) are tumors that commonly occur in the eighth cranial nerve. They are usually associated with type 2 neurofibromatosis. They are uncommon in children, and sporadic cases of pediatric VS are even rarer. In general, VSs are benign lesions with less than 1% chance of intratumoral hemorrhage. Adult cases of hemorrhage in VS are well documented. We present the first pediatric case of intratumoral hemorrhage in VS in the absence of any features of NF in an 11-year-old child who complained of holocranial headache and sensorineural hearing loss in the left ear. We further discuss the pathogenesis and clinical features, and review the literature of intratumoral hemorrhage in patients of VS.

Concurrent Spinal Epidural Tubercular and Pyogenic Abscess of Cervical Spine without Bony Involvement.

Spinal epidural abscess (SEA) presents with vertebral body involvement. SEA is mostly pyogenic in developed countries, but in developing countries, tuberculosis is more common cause. Young female presented with fever, neck, and right upper limb pain for 1 month followed by acute onset weakness in the right upper limb. Magnetic resonance imaging study of cervical spine showed contrast-enhancing lesion in C2-C3 epidural region. Surgery-aided by initiation of antibacterial and antitubercular treatment based on culture and histopathological study of pus helped us to get good clinical outcome. One should always keep in mind possibility of tubercular abscess while treating cases of spinal epidural lesions, though it is rare in the absence of osseous involvement. Pyogenic and tubercular abscess can present concurrently and sending pus for culture and sensitivity is must as it plays important role in identifying dual organisms.

Ventral Craniovertebral Junction Arachnoid Cyst in an Elderly Patient-A Case Report of a Unique Occurrence at Extremes of Age.

BACKGROUND: Craniovertebral junction arachnoid cysts are uncommon. Among those reported, ventrally located arachnoid cysts at the extremes of age have been even rarer. We report a successfully managed case of a ventrally placed arachnoid cyst in an 88-year-old man using an unconventional surgical approach. CASE DESCRIPTION: An 88-year-old man presented to us with complaints of tingling and numbness in both upper and lower limbs. He had a weak handgrip on both sides. Spinal magnetic resonance imaging (MRI) showed a non-contrast-enhancing cystic lesion over the anterior lip of the foreman magnum that had displaced the cervicomedullary junction posteriorly. The lesion was homogenously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI. The lesion was excised using a posterior approach. The cyst contents were drained, followed by complete wall excision. Complete improvement in clinical symptoms and an absence of neurological deficits were noted in the patient. CONCLUSION: Arachnoid cysts are congenital lesions and can present at the extremes of age. Ventrally placed small symptomatic arachnoid cysts can be managed successfully through the posterior approach, especially in the elderly population.

Orbital Tuberculosis with Intracranial Extension.

We report a case of orbital tuberculosis (OTB) with intracranial extension without active tuberculosis in the rest of the body organs or a history of tuberculosis infection. A 29-year-male patient presented with left-sided painful periorbital swelling with pus discharging sinus and visual impairment. Orbital computed tomography revealed contrast enhancing cystic mass lesion in the left orbit with erosion of the lateral and superior orbital wall with intracranial extension. After the failure of 3 weeks' course of oral antibiotics, the patient underwent left lateral orbitotomy, pus was drained out, and granulation tissues were excised. Histopathological examination confirmed OTB. The patient had received antituberculous treatment. Periorbital swelling completely disappeared and vision improved over a period of 2 weeks. OTB should be considered in differential diagnosis of periorbital swelling especially when it does not respond to oral antibiotics.

Cervical Intramedullary Cystic Teratoma with Dermal Sinus Tract: A Case Report and Review of Literature.

Intramedullary spinal teratomas are rare. We report a case in a 40-year-male who presented with progressive weakness over the right side of the body and gait imbalance. He had dermal sinus with hair patch over nape of the neck. Magnetic resonance imaging revealed cervical (C4-C7) intramedullary tumor with dermal sinus tract. C3-C7 laminectomy was performed and tumor excised along with the sinus tract. Histopathological examination revealed mature cystic teratoma. Gait ataxia was improved immediately while near complete recovery in motor power was achieved over a period of 2-3 weeks.

Cerebral Arteriovenous Malformation Associated with a Cyst.

An 11-year-old child presented with chronic occipital headache and vomiting. Computed tomography (CT) scan revealed a cystic mass lesion in the right occipital region. Magnetic resonance imaging brain revealed a cystic mass lesion which was hypointense on T1-weighted images and hyperintense on T2-weighted images. A mural nodule was noted in the inferolateral wall of the lesion. CT angiography revealed small arteriovenous malformations (AVM) related to the lesion. The AVM associated with the cyst was excised. The patient recovered well. Cystic AVM is a rare vascular lesion, and only five such cases have been reported in the past. AVMs should be considered in the differential diagnosis of cystic lesions of the brain, especially when associated with a mural nodule.

Giant Craniospinal Intramedullary Neurenteric Cyst in Infant-Case Report and Review of Literature.

BACKGROUND: Neurenteric cysts are rare congenital lesions derived from an anomalous connection between the primitive ectoderm and endoderm. CASE DESCRIPTION: A 2-month-old infant presented with an insidious onset of upper limb weakness. Magnetic resonance imaging of the spine revealed a contrast-enhancing solid mass located anterior to the spinal cord at the level of the cervicothoracic junction, which was isointense on T1-weighted images and hyperintense on T2-weighted images. The lesion was associated with marked spinal cord compression and also with a giant intramedullary cyst that extended proximally into the cranium. Spinal dysraphism was noted. The patient underwent cervicothoracic laminotomy, drainage of the cyst contents, and a complete excision of the solid component. Neurologic function recovery was observed postoperatively. CONCLUSIONS: We report and discuss the clinical presentation, pathogenesis, and neuroradiologic findings in an infantile case of a giant craniospinal intramedullary neurenteric cyst. Early recognition is beneficial because of its benign nature and good clinical outcome following total surgical resection.

An Infected Dermoid Cyst Without a Sinus Tract: A Rarity Mimicking a Spinal Tumor.

Spinal dermoid cysts are rare and account for 0.8% to 1.1% of spinal intramedullary Tumors. Only a few cases of infected spinal dermoid cysts have been reported in the literature and most of them were associated with a dermal sinus as the source of infection. We report a case of an infected spinal dermoid cyst in the absence of a dermal sinus in a 3-year-old child who underwent excision of cyst. On a long-term follow-up of about 10 years, there was no evidence of any recurrence. However, bowel and bladder dysfunction persisted. In the light of the current literature, we discuss the clinical presentation, etiopathogenesis, radiological features, management, and long-term outcome of an infected conus dermoid cyst.