CSF orbitorrhoea with tension pneumocephalus.

A seventy eight year old man sustained penetrating injury to right orbit about 15 years ago. Later he developed right orbital infection leading to phthisis bulbi. Two months before admission he developed CSF leak from the right orbit, tension pneumocephalous and meningitis. A rare case of CSF orbitorrhoea is reported here along with the discussion on mechanisms and management.

Transient cerebellar mutism after evacuation of a spontaneous vermian haematoma.

Cerebellar mutism after surgery for posterior fossa tumours in children is a well-described, though rare, entity. Most of these tumours are located in the region of the cerebellar vermis extending to the hemispheres. The authors report a case of cerebellar mutism in an 8-year-old boy who underwent surgical evacuation of a spontaneous vermian haematoma. We feel that his mutism was an extreme form of cerebellar dysarthria.

Encysted haematoma in a cerebello-pontine angle.

A young primi-gravida with pre-eclamptic toxaemia underwent an elective caesarean at 38 weeks. On 10th day of delivery, she suddenly developed symptoms and signs of right cerebello-pontine angle lesion. On investigation a haematoma with a fluid level could be identified. Coagulation parameters were deranged and blood culture grew coagulase negative staphylococcus aureus. Possible causes of intracranial haematoma at such an unusual location are discussed.

Sclerosing aspergilloma mimiking sphenoid ridge meningioma in an immunologically competent patient.

A 30 year old man presented with history suggestive of a parasellar tumour. Computerised tomography of brain revealed a hyperdense lesion on either side of sphenoid ridge having extension to floor of middle cranial fossa on the left side, enhancing homogenously with contrast and suggestive of a meningioma. Paranasal sinuses and orbit were free of tumour. He did not have any predisposing factor to harbour oppurtunistic infection. Craniotomy and total excision of the lesion was done. Histopathology was reported as aspergilloma.

Trigeminal neurinoma with an apoplectic onset.

Intratumoural bleeding into a trigeminal neurinoma is rare. The authors describe a case which had an apoplectic presentation with subsequent persistent unilateral ptosis, hemifacial pain and sensory loss. This proved to be due to a haemorrhage into a large trigeminal neurinoma.

Intraparenchymal cerebellar schwannoma.

A case of left cerebellar intraparenchymal schwannoma in an adult is being presented along with ten available reports in the literature, differential diagnosis and management of the condition.

Claudicatory penile erection in lumbar canal stenosis with prolapsed disc : a case report of 2 cases.

Two adult male patients having lumbar canal stenosis with prolapsed disc, developed claudicatory priapism along with classical symptoms of claudication, are reported in this article. The first patient complained of severe claudicatory pain in anal canal along with other symptoms. The second patient had a protruded bony rim at the lower margin of L4 vertebra in addition to the prolapsed disc. All the symptoms totally subsided after relieving the compression.

Synchronous multi-focal central nervous system gliomas.

Multifocal synchronous gliomas are uncommon in the absence of phakomatosis. Two cases are reported and their possible mode of spread is discussed. A guideline is proposed in the management of such lesions.

Diagnostic dilemma of an intramedullary vascular malformation. A case report.

A young man was seen at a neurologic center for a slowly progressive myelopathy involving the lower limbs in 1983. After examination and investigations, a diagnosis of chronic tuberculous spinal arachnoiditis was made and the patient was administered antituberculous treatment. However, his condition continued to deteriorate. He was reviewed at another center in 1985, where a diagnosis of demyelinating disorder was made, for which he was treated. However, this also did not help, and he was diagnosed as having a nonspecific spinal arachnoiditis at yet another center in 1988. His condition continued to worsen, and after ten years of symptoms, when magnetic resonance imaging (MRI) was done, an intramedullary cystic lesion opposite D-12 vertebrae was seen, which on histopathology was proved to be a vascular malformation. After excision of the lesion his neurologic status has been slowly improving. The conditions that a malformation could mimic, misleading a clinician, and the role of MRI in clinching the diagnosis are highlighted.

Hemangioblastoma of the IV ventricle.

A case of solid hemangioblastoma in the IV ventricle in a 16-year-old boy is reported because of the rarity of this type of lesion. Microsurgical removal of the lesion was accomplished without any side effects in this highly vascular tumor in a strategic location.

Early surgery for thoracolumbar spinal cord injury: initial experience from a developing spinal cord injury centre in India.

The spinal cord injury centre of Nizam's Institute of Medical Sciences, Andhra Pradesh, India has been functioning now for 8 months and offers its services to the population of 80 million in the state. To date, 92 patients with a spinal cord injury have been treated; 51 had a thoracolumbar spinal injury. This report presents the results of the management of these 51 patients. Preoperatively both CT and MRI were performed and the radiological findings were correlated with outcome. Twenty five had a thoracic and 26 a lumber location. Twenty nine patients underwent surgical treatment (15 thoracic and 14 lumbar) and the others were treated conservatively (10 thoracic and 12 lumbar). All these operations were carried out within 2 weeks following trauma, and methylprednisolone therapy was instituted in those who reached the hospital early. Contraindications for surgery included a delay in admission of more than 3 weeks following trauma, a focus of sepsis, bedsores, a generalised bone disorder such as osteopenia, and medical illnesses. Transpedicular screw-plate fixation was performed in 27 patients, and two patients underwent decompressive laminectomy and interlaminar bone and wire fixation. Delayed spinal decompression was offered to one patient to relieve radiculopathy. Fracture-dislocation spinal injury and those with transection of the spinal cord had the worst outcome, whilst patients with a wedge compression fracture and cord oedema fared better. Operated cases had a shorter hospital stay, and complications of immobilisation were limited. Positive psychological influence of mobilisation and early acclimatisation to the altered style of living with their disability were the most significant outcomes following surgery.

Diabetes insipidus in cervico-dorsal spinal cord injury.

Three cases of acute spinal cord trauma developing transient diabetes insipidus are described. The level of spinal injury was cervical in one, cervicodorsal in second, and upper dorsal in the third. Two patients sustained transaction at cervical and dorsal spinal cord while the third had diffuse cordedema and partial neurological injury. In all the cases the onset of diabetes insidious was noted after 3-6 weeks following trauma and it subsided requiring no active treatment. No relevant craniocerebral injury was noted clinically or radiologically. A central medullary descending vasopressin mediated pathway, demonstrated only in experimental animals, may be involved in the spinal cord injury producing diabetes insipidus.

Extrinsic infratentorial lesion causing ataxic hemiparesis--a new localization.

The case of an 18-year-old woman is reported who had developed progressive inability to use her left limbs since the age of 13 years. Ataxic hemiparesis was noted on the left side. A CT scan of the brain revealed a non-enhancing hypodense lesion in the cerebellopontine angle with a supratentorial extension consistent with an epidermoid. Ataxic hemiparesis has previously been reported only with intrinsic lesions of the brain, except for one case. An unusual clinical localization of this entity is reported.