False Localization of Ruptured Intracranial Dermoid Secondary to Subarachnoid Spread of Cyst Contents.

A 34-year-old right-handed female presented to the emergency department with a worsening headache, neck stiffness, intermittent abnormal sensation, and right arm weakness. Shortly after arrival, she had a generalized tonic-clonic seizure. A noncontrast head computed tomography scan revealed a right-sided, low-attenuating, lobulated mass ipsilateral to her arm symptoms. Magnetic resonance imaging revealed an abnormal signal throughout the subarachnoid space and increased fluid-attenuated inversion recovery sequence signal contralateral to the mass. This presentation suggested a false localization sign of sensory and motor disturbance ipsilateral to the mass likely caused by cyst rupture and sebum spread contralateral, causing cortical irritation (evidenced by increased fluid-attenuated inversion recovery sequence signal). During mass resection, sebum was visible throughout the subarachnoid space. The patient had an uneventful recovery from surgery and has been seizure free since the resection with steady improvement of symptoms. This case highlights the importance of avoiding cyst rupture of dermoid cysts.

Giant Leaking Colloid Cyst Presenting with Aseptic Meningitis: Review of the Literature and Report of a Case.

BACKGROUND: Colloid cysts are benign third ventricle lesions that need to be diagnosed correctly because of their association with sudden death. Chemical or aseptic meningitis is a rare presentation of a colloid cyst. METHODS: We present a case of a 69-year-old man with fever, alteration of mental status, and meningismus. Microbiological examination of the cerebrospinal fluid revealed aseptic meningitis. Brain imaging revealed a third ventricular colloid cyst with hydrocephalus. RESULTS: The tumor was resected via endoscopic intervention. There were no persistent operative complications related to the endoscopic procedure. CONCLUSIONS: Chemical or aseptic meningitis is an unusual clinical manifestation of a colloid cyst, complicating the differential diagnosis, especially in the elderly.

Spinal epidermoid tumors: novel approach to aseptic meningitis.

Intraoperative hydrocortisone irrigation of the cerebrospinal fluid pathways may reduce symptoms attributed to aseptic meningitis, which often follow the resection of epidermoid spinal tumors. Here, 20 patients undergoing surgical resection of epidermoid tumors were randomly assigned to two groups: Group I received intraoperative hydrocortisone irrigation, whereas Group II served as a control. No patient receiving hydrocortisone experienced fevers or meningismus, but nontreated patients experienced fevers (100%) and meningismus (78%). Nausea and vomiting were reduced (9%) in the treated versus untreated groups (22% vs. 11%, respectively), whereas none in the treated group noted dizziness, vertigo, or diabetes insipidus. As steroid irrigation significantly decreased the perioperative morbidity of epidermoid tumor resection, indications for intravenous steroids may become more limited, thereby reducing cost.

Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translabyrinthine-transtentorial approach.

OBJECT: The authors review the results of a series of 120 acoustic neuromas that were surgically treated via the translabyrinthine-transtentorial approach between 1986 and 1999. METHODS: The authors retrospectively evaluated a series of 120 acoustic neuromas with extrameatal diameters of 2 cm or greater, 99 (82.5%) of which had diameters longer than 3 cm. Complete tumor removal, as ascertained using computerized tomography or magnetic resonance imaging, was achieved in 110 patients (91.7%). The facial nerve was anatomically preserved in 97 patients (80.8%). The main postoperative complications were cerebrospinal fluid (CSF) leakage through the scalp wound (13.3%) requiring surgical revision in 2.5%, meningitis (9.2%), CSF rhinorrhea (6.7%) requiring surgical revision in 2.5%, and epileptic seizures (the only permanent complication) requiring medication (3.3%). There was no death directly related to the surgery. Long-term follow-up examination of the facial nerve revealed recovery of function to the level of House-Brackmann Grade I or II in 56.2% of the patients. CONCLUSIONS: The results and complications presented in this series are comparable to those reported in the literature. The authors conclude that the combined translabyrinthine-transtentorial approach is a safe route for removing acoustic neuromas with a diameter of 2 cm or greater.

Diagnosis of brainstem abscess in the cerebritis stage by magnetic resonance imaging--case report.

A 52-year-old male presented with a brainstem abscess manifesting as high fever, diplopia, and left hemiparesis. Magnetic resonance (MR) imaging with gadolinium diethylenetriamine pentaacetic acid showed the lesion as a ring-like enhanced mass consisting of a necrotic center with surrounding edema, whereas postcontrast computed tomography revealed no such confirmatory findings. He was treated with antibiotics as the lesion had been detected in the acute cerebritis stage. Serial MR images showed that the lesion decreased remarkably in size. MR imaging can detect brain abscess in the earliest inflammatory stage.

MR features of pachymeningitis presenting with sixth-nerve palsy secondary to sphenoid sinusitis.

Pachymeningitis manifested by localized enhancing dural thickening adjacent to the clivus on MR images of two patients with sphenoid sinusitis and sixth-nerve palsy is presented. This is an unusual complication of sphenoid sinusitis. Prompt diagnosis and therapy may avoid significant intracranial complications.

Intramedullary spinal cord abscess.

We report a patient with a chronic intramedullary spinal cord abscess who suffered an episode of acute meningitis due to rupture of the abscess into the subarachnoid space.

Inflammatory central nervous system involvement in rheumatoid arthritis.

We describe a patient with seropositive rheumatoid arthritis who developed pachymeningitis resulting in optic atrophy. Clinical, histopathologic, and radiologic findings in 18 additional cases of inflammatory CNS disease associated with rheumatoid arthritis are reviewed. The three characteristic neuropathologic findings were rheumatoid nodules, pachymeningitis or leptomeningitis, and vasculitis. In most cases, more than one of these histopathologic processes were found. The typical host was middle-aged with long-standing severe nodular disease. However, contrary to previous reports, CNS disease occurred in a significant number of patients without active synovitis and extracranial vasculitis and nodules. Although no correlation between specific neurologic symptoms and neuropathology was noted, patients with CNS nodules tended to be asymptomatic more often than patients with vasculitis or meningitis. CSF analysis and computed axial tomography were helpful diagnostic tools, but diagnosis was ultimately made only by directed biopsy or at autopsy. Treatment with surgical decompression and/or corticosteroids has proved beneficial in several cases. Inflammatory CNS involvement in rheumatoid arthritis should be considered in any patient with neurologic symptoms in whom infectious and malignant processes are ruled out. An aggressive, invasive approach for diagnostic biopsies seems warranted.