Spontaneous extradural and subgaleal hematoma: A rare neurosurgical crisis of sickle cell disease.

Extradural hematoma (EDH) in absence of trauma is a rare entity with only few cases reported in literature. The various causes reported include: Vascular malformation of dura, coagulopathies, sinus infection, middle ear or orbital infection, and tumor. Occurrence of spontaneous EDH as a complication of sickle cell disease is even much rarer. We report a case with sickle cell disease who presented with spontaneous extradural and subgaleal hematomas following an episode of vaso-oclusive crisis. He was managed successfully with surgery. The association of epidural hematomas in sickling hemoglobinopathies is reviewed. In all cases, we noticed one episode of sickle cell crisis just before the occurrence of spontaneous EDH. Perhaps this crisis puts an extra demand over the hematopoietic skull tissue disrupting inner and outer skull margins leading to spontaneous EDH and subgaleal hematoma.

Intraventricular glioblastoma multiforme mimicking meningioma and review of the literature.

Glioblastoma multiforme (GBM) is the most common primary brain tumor and is usually found in aged persons in the cerebral hemispheres particularly the frontotemporal region. But intraventricular GBM is rare and only few cases have been reported in the literature. We report a case of a 27-year-old man who presented with headache, vision loss in both eyes, and other signs and symptoms of increased intracranial pressure. Computed tomography and magnetic resonance imaging showed an intraventricular, well-circumscribed lesion with homogeneous enhancement of contrast, suggestive of meningioma that is more common than GBM in this location. The patient underwent surgical removal through transcortical route. The final pathologic diagnosis was GBM. We present the clinical features, radiological findings, and surgical management of this case and discuss the pathogenesis and review of the literature of intraventricular GBM.

Recurrence of spinal schwannoma: Is it preventable?

Spinal schwannomas account for about 25% of primary intradural spinal cord tumors in adult. The prognosis for spinal schwannomas is excellent in most cases. Complete resection is curative. However following subtotal removal, recurrence develops after several years. We describe a case of recurrent spinal schwannoma who had been operated twice before for same disease. The possible cause of recurrence and difficulties in reoperation are discussed.

Pineal epidermoid.

BACKGROUND: Tumors of pineal region are uncommon, accounting for ≤1% of intracranial tumors in adults and 3-8% of pediatric brain tumors. Epidermoid cysts account for 0.2-1% of all intracranial tumors. The majority occur in and around the cerebellopontine angle and suprasellar area. Getting an epidermoid in pineal region is very rare. CASE DESCRIPTION: We report a case of pineal epidermoid, which was diagnosed correctly as epidermoid depending on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Knowing its benign nature, we accordingly planned for its near-total removal. CONCLUSION: Most cases of pineal tumors present as obstructive hydrocephalus. They either require pre- or postoperative ventriculoperitoneal (VP) shunt. If properly planned, many benign pineal tumors may be successfully excised and, most importantly, postoperative VP shunt could be avoided.

A rare case of primary extranodal, extradural histiocytic sarcoma of the thoracic spine and review of literature.

BACKGROUND: Histiocytic sarcoma (HS) is a rare aggressive malignant neoplasm of hematopoietic cell origin showing features of fever, weight loss, adenopathy, hepatosplenomegaly, and pancytopenia. Primary histiocytic sarcoma of spine without involvement of lymph nodes, bone marrow or systemic features is very rare. Due to highly malignant, aggressive behavior and frequent local and distant metastases, prognosis of histocytic sarcoma is poor. CASE DESCRIPTION: We report a case of primary extranodal variety of histiocytic sarcoma without involvement of bone marrow at extradural location of thoracic spine. Immunohistochemistry panel ruled out other more common lesions in this location. We could not find such presentation of extradural histiocytic sarcoma at the thoracic region in the literature. CONCLUSION: Primary involvement of extradural space by histiocytic sarcoma could arise from the proliferation of multipotent hematopoietic stem cells which are left in this space embroyologically.

Management of chronic subdural haematoma in a case of idiopathic thrombocytopenic purpura.

Intracranial hemorrhage is a rare devastating complication of idiopathic thrombocytopenic purpura (ITP), mostly presenting as intraparenchymal or subarachnoid haemorrhage. Isolated chronic subdural haematoma (SDH) is still very rare and the optimal management is unsettled. Spontaneous resolution of chronic SDH in patients with idiopathic thrombocytopenic purpura is possible. We report a case of spontaneous chronic SDH in a patient with ITP with hemiparesis where the haematoma significantly decreased in size with complete resolution of hemiparesis as a result of platelet transfusions and continuing therapy with steroids. Surgical treatment of subdural haematoma with consequent bleeding complications can be avoided in this scenario.