ABSTRACT
OBJECTIVE: We herein describe a case with an extraspinal mass distorting the right L4 dorsal root ganglion. Initially presumed to be a nerve root schwannoma, the lesion turned out to be a free disc fragment. METHODS AND RESULTS: A 46-year-old woman presented with a history of mild low back and intense right leg pain. The leg pain was like electrical discharges. Right knee extension was weak together with hyperalgesia and loss of heat sensation in the right LA dermatome. The right patellar reflex was absent. Electromyography showed acute and chronic denervation of muscles innervated by the right L4 nerve root. MR scan showed a right L4-5 extraforaminal mass distorting the L4 dorsal root ganglion. The mass enhanced homogeneously after gadolinium injection and was thought to be a tumor. It was surgically removed using a midline incision and intraspinal, followed by extraspinal dissection. Under the operating microscope, the mass extended between an intact lateral longitudinal ligament and a swollen dorsal root ganglion. Histopathologic examination ruled out a tumor and showed that the mass consisted of degenerated disc material surrounded by a large peripheral zone of neovascularization. CONCLUSION: Extraforaminal periganglionic free, encapsulated disc fragments may mimic tumoral masses, from which they may not be distinguished on MRI.
Subject(s)
Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/pathology , Intervertebral Disc/pathology , Lumbar Vertebrae/pathology , Neurilemmoma/physiopathology , Female , Gadolinium , Humans , Intervertebral Disc Displacement/surgery , Magnetic Resonance Imaging , Middle Aged , Pentetic AcidABSTRACT
Aggressive behaviour is rarely observed as an ictal semiology. Ictal aggression can occur in lesions of frontal and limbic structures. In limbic structure lesions, the main mechanism of aggressive behaviour is hyperactivity; whereas frontal lesions may cause aggressive behaviour with an indirect mechanism in which the suppression on limbic system is lost. Here we present a patient with ictal aggression. In this case a right frontoparietal epileptiform focus was detected during the postictal period. Magnetic resonance imaging showed cortical dysplasia on the right inferior frontal gyrus. The seizures disappeared completely after pharmacological treatment.
Subject(s)
Aggression/physiology , Epilepsy, Frontal Lobe/physiopathology , Adolescent , Aggression/psychology , Electroencephalography/methods , Epilepsy, Frontal Lobe/pathology , Female , Humans , Magnetic Resonance Imaging/methodsABSTRACT
STUDY DESIGN: A case report with review of literature since 1961. SETTING: Departments of Neurology and Radiology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey. METHOD: A 22-year-old male patient diagnosed and treated as mumps encephalomyelitis is described. The clinical findings of the patient and the difficulties in differential diagnosis are discussed with the help of previously reported eight adult cases. RESULTS: Increased T2 signals in the spinal cord from C4 to C6 and T5 to T10 were seen by magnetic resonance imaging. This was the largest spinal involvement in the reported mumps cases. He was treated with supportive therapy oral steroids and early rehabilitation. On the sixth month, his neurological examination revealed bilateral 2/5 paresis in lower extremities. CONCLUSION: Encephalomyelitis following mumps is an uncommon but serious event in adults.
Subject(s)
Encephalitis, Viral/diagnosis , Encephalitis, Viral/etiology , Mumps/complications , Mumps/diagnosis , Adult , Humans , MaleABSTRACT
Post-traumatic epilepsy is more frequent after severe head injuries, however the severity of the trauma is not always correlated with the injured brain tissue. We report a patient whose seizures developed 4 years after a face trauma. Upward displacement of the sphenoid wing caused a contusion at the orbital surface of the frontal lobe. Computed tomography, magnetic resonance imaging and electroencephalographic findings are presented. The patient responded well to commonly used antiepileptic drugs.
Subject(s)
Epilepsy, Post-Traumatic/etiology , Head Injuries, Closed/complications , Sphenoid Bone/injuries , Adult , Anticonvulsants/therapeutic use , Brain Infarction/complications , Brain Infarction/drug therapy , Brain Infarction/physiopathology , Carbamazepine/therapeutic use , Electroencephalography/methods , Epilepsy, Post-Traumatic/drug therapy , Follow-Up Studies , Frontal Lobe/physiopathology , Head Injuries, Closed/drug therapy , Humans , Magnetic Resonance Imaging/methods , Male , Tomography, X-Ray Computed/methodsABSTRACT
UNLABELLED: The aim of this study was to determine which variables should be the predictors for clinical outcome at discharge and sixth month after acute ischemic stroke. METHODS: Two hundred and sixty-six consecutive patients, each with an acute ischemic cerebrovascular disease, were evaluated within 24 h of symptom onset. We divided our patients into two groups; 1 - Independent (Rankin scale RS < or = 2) and, 2 - Dependent (RS>3) and death. Baseline characteristics, clinical variables, risk factors, infarct subtypes and radiologic parameters were analyzed. RESULTS: Canadian Neurological Scale (CNS) on admission <6.5 [odds ratio (OR) 22] and posterior circulation infarction (OR 4.2) were associated with a poor outcome at discharge from hospital whereas only a CNS score <6.5 (OR 14) was associated with a poor outcome at 6 months. CONCLUSIONS: Severity of neurologic deficit is the most important indicator for clinical outcome in acute ischemic stroke both at short-term and at sixth month, whereas posterior circulation infarction also predicts a poor outcome at discharge.
