RESUMO
Primary Dural lymphoma (PDL) is a rare pathology that occurs in immunocompetent patients. In such cases, these lesions may mimic more common intracranial tumors. We present the case of a patient who presented an intra cranial hypertension syndrome; the brain MRI showed a tissular mass that we took for a meningioma; upon surgical intervention, an occult mass was discovered. Major excision and immunohistochemistry demonstrated PDL. Our case report highlights the rarity of these pathology and the importance of combined surgery and medical treatment, as the latter can be treated with chemoradiation with good clinical outcomes.
RESUMO
Male breast cancer is rare, less than 1% of men's cancers. The tumors occurring in the cerebellopontine angle remain a rare entity. Features suggestive of metastasis are acute onset, rapid progression of symptoms. We report a case of a 72-year-old man had a mastectomy and an axillary lymph node dissection for a breast cancer 22 years prior to this report. The patient was admitted with deterioration of level of consciousness with intracranial hypertension syndrome. The magnetic resonance imaging showed a cystic lesion in the left cerebellar hemisphere and the prepontine cistern. We proceeded to a large tumor resection. On the follow up, the patient presented a delayed emergence. A CT scan showed a small hematoma at the surgical site and triventricular hydrocephalus for which the patient underwent a ventriculoperitoneal shunt. This is the first described cerebellopontine angle metastasis of a male breast cancer and the first described case of a metastatic triple hormone negative breast cancer to the brain.
RESUMO
INTRODUCTION: and importance: Contralateral epidural hematoma (EDH) after decompressive surgery for acute subdural hematoma (ASDH) is uncommon. If unrecognized, this delayed hematoma can lead to devastating consequences. CASE PRESENTATION: A 30-year-old patient with no past medical history, was brought to the emergency after a severe brain injury secondary to an aggression, Glasgow coma scale was 6 (E1V1 M4) with a left anisocoria. The CT scan revealed a left acute subdural hematoma with midline shift superior than 10 mm, and a non-surgical contralateral EDH was also identified. The patient was operated on urgently. Post-operatively, the pupils became equal sized and reactive. A right anisocoria was noticed 12 h later, with a large contralateral EDH on CT scan associated to a gross midline shift. A second operation was performed immediately with a good recovery and the patient was extubated one week post-operatively. CLINICAL DISCUSSION: The most common surgical complications after a decompressive craniectomy for an acute subdural hematoma noted in literature are surgical site herniation, post-operative infections, epilepsy, and subdural effusions with or without hydrocephalus. Contralateral epidural hematoma (EDH) after decompressive craniectomy is also documented (Ban et al., 2010; Nadig and King, 2012) [3,15], however it's rare with only 100 cases, including the present one reported. CONCLUSIONS: Delayed contralateral EDH after decompressive surgery should be anticipated in the presence of contralateral skull fracture and/or intraoperative brain swelling and immediate postoperative scan is indicated. Early detection of this fatal complication and prompt treatment may improve the poor outcome in this group of patients.
RESUMO
Cerebrospinal fluid over-drainage is a common complication of ventriculoperitoneal devices (Ventriculoperitoneal shunt). In terms of hemorrhage, subdural hematomas are usually more frequent lesions than epidural hematomas, which, more rarely, may also be seen after ventricular shunt procedures and may lead to rapid neurological decline and even death unless a surgical procedure can be promptly performed. In our study we report the case of a 5 years old boy with history of congenital obstructive hydrocephalus treated with a ventriculoperitoneal shunt insertion when he was 8 months old. The patient was admitted with sudden deterioration of level of consciousness secondary to tri-ventricular hydrocephalus. He underwent a shunt revision. Two weeks later, he developed a loss of consciousness with a large left extradural hematoma contralateral to the side of ventriculoperitoneal shunt. He underwent an evacuation of the hematoma with a good postoperative outcome. Epidural hematoma, especially controlateral to Ventriculoperitoneal shunt, is extremely rare. The pathophysiology and the possible use of a programmable valve to prevent these lesions are briefly discussed.
