RESUMO
Ovarian carcinoma is one among the most commonly diagnosed cancer in women. Most commonly it metastasizes within peritoneal cavity by transcoelomic spread; distant metastasis to central nervous system through hematogenous spread is rare, and intramedullary spread is even rarer. Till date, only six reports have identified isolated intramedullary metastasis to spinal cord in a patient who were considered disease free on follow-up after treatment of primary disease; of which only two were in dorsal spine. The average time for diagnosis of intramedullary metastasis after diagnosis of primary disease was 26 months in previous reports. All were on regular follow-up, and clinicians were misleaded by normal CA-125 levels, and patients were considered disease free. This report is third in world literature case of isolated intramedullary dorsal spinal cord metastasis in a patient of primary ovarian carcinoma who was on follow-up with normal CA-125 levels and was treated with myelotomy and gross total resection of lesion + adjuvant chemotherapy and oral steroids. With our experience, we recommend keeping magnetic resonance imaging neuraxis to be done in follow-up of patients treated for high-grade ovarian carcinoma so that early diagnosis and prompt management can be given to patients that can improve their quality of life.
RESUMO
Encephaloceles, also known as meningoencephaloceles, are a group of neurological disorders characterized by herniation of the cerebral parenchyma along with overlying meninges through openings in the skull bone. They can be seen following congenital defect in neural tube closure or acquired defect in the skull bone. We report a case of acquired frontoethmoidal encephalocele presenting with drug-refractory epilepsy. Interictal FDG PET-computed tomography done for lateralization and localization of seizure focus showed right-sided frontoethmoidal encephalocele associated with hypometabolism in the adjacent right frontopolar cortex, concordant with ictal onset on electroencephalogram.
RESUMO
Syringomyelia is a disorder of the spinal cord usually seen in association with a variety of craniovertebral junction anomalies (e.g. , Chiari malformations, basilar invagination/impression, atlantoaxial instability, etc.). Its natural history is not very clearly understood and a majority of patients present with a slowly progressive neurological deficit followed by sudden rapid deterioration. At present, there is a general consensus to offer surgical decompression in all patients diagnosed with Chiari I malformation with syrinx irrespective of their symptoms in order to prevent delayed neurological worsening. Few authors have reported spontaneous resolution of syrinx with persistent tonsillar herniation without operative treatment. We report one such patient and propose anterior spinal cord fissuring as a plausible cause of spontaneous syrinx drainage. We also propose conservative management for patients with an anterior spinal cord fissure seen in index scans instead of early decompression of Chiari malformation.
