Acute paraplegia due to thoracolumbar schwannoma following trauma: A case report and literature review.

Spinal schwannomas account for one third of primary spinal neoplasms. Clinical presentation is related to the tumor location. An atypical case of acute paraplegia following a fall, on the ground of a thoracolumbar schwannoma, without intratumoral hemorrhage, in a previously asymptomatic patient is reported. A 58-year-old male patient presented with acute paraplegia, and urinary and bowel incontinence, following a fall. The patient had no previous history of back and/or leg pain or neurological symptoms. Magnetic resonance imaging revealed a subdural mass, as well as a fracture of the right T12-L1 facet joint and the right transverse process. The patient underwent emergency T11-L1 wide laminectomy, exploration of the subdural space and T10-L2 posterolateral transpedicular stabilization and fusion. An intradural, extramedullary mass, causing severe cord compression, was found and excised. Pathology revealed schwannoma, without intratumoral hemorrhage. The patient recovered completely 6 months postoperatively. To the best of our knowledge, this is the first report of spinal intradural schwannoma causing sudden paraplegia in a previously asymptomatic patient in the setting of trauma, without intratumoral hemorrhage. Emergency canal decompression and complete excision of the tumor represent the optimal management of such cases.

Clinical characteristics, microbiology and outcomes of external ventricular drainage-associated infections: The importance of active treatment.

Data concerning clinical characteristics, microbiology, treatment and outcomes of external ventricular drainage-associated infections (EVDAI) are limited. All hospitalized patients with EVDAI in a University Hospital between January 2009 and December 2015 were retrospective recorded. Only the first episode per patient was included. An antibiotic was considered "active" when its pharmacokinetic properties were appropriate for EVDAI and the implicated microorganism was in vitro susceptible. During the 7-year study period, 36 EVDAI were identified. Median patient age was 53years and 23 (63.9%) were male. Catheter types were intraventricular (70.6%) and lumbar (29.4%). Median catheterization duration before infection was 14days. Gram-negative bacteria (GNB) predominated (57.9%), followed by gram-positives (36.8%) and fungi (5.3%). Administered antibiotics were considered "active" in 69.4% of empirical and in 86.1% of definitive treatment regimens. In 10 infections, intraventricular/intrathecal (IVT) antibiotics were administered. Eleven patients died (30.6%) during hospitalization. Patients who died had higher rates of EVDAI by GNB (p=0.011) and higher rates of treatment with intravenous colistin (p=0.019 for empirical and p=0.006 for definitive colistin). Compared to EVDAI by other pathogens, patients with EVDAI by GNB had longer catheter-days before infection (p<0.001) and higher mortality (p=0.011). In our study, GNB were a frequent cause of EVDAI, and were related with high rates of inactive treatment and mortality. Intravenous colistin alone is not effective and treatment should include IVT antibiotics and intravenous antibiotics that achieve adequate CSF levels.

Infections in patients with traumatic brain injury who undergo neurosurgery.

OBJECTIVE: Several factors place victims with traumatic brain injury (TBI) at increased risk for infection. The purpose of this study was to delineate the frequency, types and risk factors for infection in patients with TBI who undergo neurosurgery. MATERIALS AND METHODS: Retrospective surveillance of infections in patients with TBI, aged  ≥18 years who underwent neurosurgery in University of Crete between 1999 and 2005. RESULTS: Two hundred fifty-eight patients (76.7% men) who underwent 342 procedures were included. One hundred forty-two infections occurred, mainly lower respiratory tract infections (44.4% of the number of infections) and surgical site infections (SSIs) (25.4%). In multivariate analysis, SSIs were independently associated with the length of stay (p < 0.001), history of malignancy (p = 0.008), CSF leak (p = 0.012), any concomitant infection (p = 0.010), particularly urinary tract infections (p = 0.001) and the use of lumbar and/or ventricular drains (p = 0.005). Meningitis was independently associated with the total length of stay (p < 0.001), the need for intubation and mechanical ventilation beyond surgery (p = 0.028) and the presence of a lumbar and/or ventricular drain (p < 0.001). CONCLUSIONS: Respiratory tract infections were common in patients with TBI who underwent surgery with Acinetobacter spp. being the emerging offending pathogens. Device-related postoperative communication of the CSF and the environment was a significant risk factor for SSI development and meningitis in particular. Malignancy was an independent risk factor for SSIs. The prevalence of the offending pathogens must be determined institution by institution for the establishment of proper antibiotic treatment on suspicion.

YY1 Over-expression in human brain gliomas and meningiomas correlates with TGF-beta1, IGF-1 and FGF-2 mRNA levels.

In this study we examined by QRT-PCR the mRNA expression of TGF-beta 1, IGF-1, EGF, FGF-2 and YY1 in human brain tumors. Our findings introduce YY1, for the first time, as a novel gene implicated in brain gliomatogenesis and meningioma establishment. We present a positive correlation between the autocrine expression of YY1 and TGF-beta 1, IGF-1 and FGF-2, known to be involved in the progression of gliomas and meningiomas. We suggest that mRNA profiling of the above genes in the early stages of disease development could be useful for prognostic purposes, and these genes can be considered as potential targets for therapeutic approaches against brain tumors.

Transient acute obstructive hydrocephalus of unknown origin in a 13-month-old infant.

We report on a case of a 13-month-old female infant who was admitted to our department with the chief complaints of drowsiness and vomiting. A history of an unspecified viral infection was reported. Clinical examination was negative for focal neurological signs or signs of central nervous system infection. Initial CT scan revealed obstructive hydrocephalus, and shunting was scheduled. Dexamethasone treatment was started. Eight hours after admission the child almost restored his baseline mental status and the operation was postponed. The dexamethasone treatment was discontinued 3 days later. Follow up CT and MRI scans were normal. We discuss the case and the possible causes of transient hydrocephalus in children.

Psychosis-like syndrome associated with intermittent intracranial hypertension caused by a large arachnoid cyst of the left temporal lobe.

Lesions on certain brain areas can cause psychiatric signs. Symptomatic arachnoid cysts can produce a variety of symptoms like headache, seizures, increased ICP, and rarely psychiatric disorders. We report a case of a young woman with a left temporal lobe arachnoid cyst, presented with headache and an atypical psychosis. A 72-h epidural ICP recording revealed incidental elevation of ICP. After a permanent shunt was placed, patient's symptoms improved substantially, and antipsychotic medication was significantly reduced.