Concurrent multiple intracranial and intramedullary conus tuberculoma: A rare case report

Central nervous system (CNS) tuberculosis commonly manifests as tubercular meningitis. CNS tuberculomas are more common intracranially and less frequently involve the spinal cord. Combination of intramedullary with intracranial tuberculomas is extremely rare. We report a case of concurrent occurrence of intramedullary tuberculoma with multiple intracranial tuberculomas in a young 16-year-old boy, who presented with two weeks history of paresthesias and weakness of the lower limbs and diminution of vision in left eye, who had been treated for pulmonary tuberculosis. Magnetic resonance imaging (MRI) spine showed a well-circumscribed lesion opposite L1, which was diagnosed as intramedullary tuberculoma. As for vision complaint, on cranial imaging, he was found to have multiple round contrast enhancing lesions, which were diagnosed as intracranial tuberculomas based on their typical MRI findings. He had complete recovery with conventional treatment of anti-tubercular therapy and steroids, without any surgical intervention. We suggest that MRI of the brain should be performed in all case of intramedullary spinal tuberculoma because of the possible presence of early asymptomatic/mild symptomatic intra-cranial tuberculomas.

Data on assessment of Acinetobacter sp. on growth and yield parameters of rice under field condition

In this paper, we presented the information on growth and yield parameters of rice genotype (BPT5204 and IR64) in field condition. Investigated strains are related to the research article “Assessment of zinc solubilizing potentiality of Acinetobacter sp. isolated from rice rhizosphere” [1]. The article describes the inoculation effect of Acinetobacter sp. on rice genotypes. The statistical analysis of the experimental data was carried out using social science SPSS software (ver. 16.0 for windows).

Abstract P4-02-12: Tomosynthesis as an alternative to magnetic resonance imaging (MRI) in assessing invasive lobular carcinoma (ILC) multifocality

Introduction

Invasive lobular carcinoma is associated with a higher rate of multifocality than other types of breast cancer. Breast MRI is commonly performed in patients diagnosed with ILC to assess for additional disease prior to formulating a management plan. MRI may be both time consuming and costly and can delay treatment.

Recently tomosynthesis has become an adjunct in the assessment and diagnosis of breast cancer. It is readily available at the time of mammography therefore providing information at the one stop clinic. We proposed that it may be possible to use tomosynthesis to assess for multifocality in ILC in place of MRI.

Method

A retrospective review of all cases of ILC diagnosed at a single regional screening unit over a 3-year period was performed. Patients having surgery as primary treatment were included. Ninety-eight patients were identified, 29 having both MRI and tomosynthesis in addition to mammography and ultrasound scan as part of their assessment. Histological data was used to compare the two imaging modalities. Bland and Altman limits of agreement analysis was performed to assess the difference between MRI and tomosynthsis in these patients. An acceptable difference (the difference in values that is unlikely to influence management) was set at 5mm.

Results

The Bland and Altman limits of agreement analysis produced three graphs to demonstrate the difference between MRI and Tomosynthesis, MRI and histology size and Tomosynthesis and histology size. It shows that the average difference between MRI and Tomosynthesis = 3.8mm (95% limits of agreement: –19.2 to 26.8mm). The percentage of 'acceptable' differences (defined as ≤ 5mm) was 72% for MRI and tomosynthesis suggesting that there is good concordance between the two. Tumours measuring >30mm on MRI are perceived as smaller under Tomosynthesis.

The analysis demonstrated the average difference between MRI and histology values is -1.3 mm (95% limits of agreement = – 33.2 to 30.6)compared with an average difference between Tomosynthesis and histology of -5.1 mm (95% limits of agreement = – 27.7 to 17.5). The percentage of 'acceptable' differences (defined as ≤ 5 mm) was 48% for both MRI vs histology and Tomosynthesis vs histology, suggesting that neither is superior when compared to final histology results.

In three patients there were multifocal cancers identified on histology that had not been detected by any imaging modality. In one patient there were MRI images that suggested a second tumour which was not present on histological examination. The same is true for a patient diagnosed with a second cancer identified by tomosynthesis but not found in the specimen. A third patient was diagnosed with a second tumour by both image modalities but again not present on histology. In one case tomosysnthesis detected a true second cancer that was not identified on MRI.

Conclusion

We believe this preliminary study suggests that tomosynthesis is equivocal to MRI for assessing multifocality in ILC. If confirmed the implications would be a shorter investigative pathway with reduced delays and costs. A larger mutli-centre trial to assess the use of tomosynthesis to replace MRI in patients with ILC is warranted.

Citation Format: Holt RE, Topps A, Lim YY, Gandhi A. Tomosynthesis as an alternative to magnetic resonance imaging (MRI) in assessing invasive lobular carcinoma (ILC) multifocality [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-02-12.

Thoracic spine stab injury with pneumocephalus and pneumorrhachiasis: a unique case report and review of literature

Trauma to skull base or sinus is the most common cause of pneumocephalus. There are only few published reports of traumatic pneumocephalus secondary to penetrating injury of upper spine, epidural anaesthesia and lumber puncture. Till date only one case of pneumocephalus and pneumorrhachiasis after thoracic spine stab injury is reported in available English literature that too associated without any neurological deficit. To our knowledge, this is the first reported case of pneumocephalus and pneumorrhachiasis after thoracic spine stab injury with asymmetrical, incomplete spinal cord injury leading to neurological deficit in the patient. The management protocol of such injuries needs to be individualised for better outcome.

Primary non-Hodgkin's lymphoma of the skull with extra and intracranial extension presenting with bulky scalp mass lesion

Primary non-Hodgkin's lymphoma (NHL) of the cranium with extra- and intracranial extension without systemic or skeletal manifestation in a non-immunocompromised patient is extremely rare. These lesions are most of the time misdiagnosed because they mimic other conditions like meningioma. Here, we report a case presented with huge bulky scalp mass which on magnetic resonance imaging (MRI) brain showed involvement of scalp, cranial vault, meninges, and the brain parenchyma, mimicking a meningioma. After gross total resection, biopsy and CD marker study revealed primary non-Hodgkin's diffuse large B-cell lymphoma (DLBCL). Malignant NHL should be considered in differential diagnosis of bulky scalp mass lesion.

Rare variant of misme syndrome – a case report with review of literature

MISME syndrome, also known as neurofibromatosis type-2 (NF2), stands for multiple inherited schwannomas, meningiomas, and ependymomas (MISME) in the peripheral and central nervous system. It is a rare disorder of autosomal dominant inheritance due to mutations of a tumor-suppressor gene on the chromosome 22q12. Clinically, it is characterized by multiple benign tumors arising in both the central and the peripheral nervous system, particularly from the bilateral vestibular nerve in more than 90% of the patients and more than two thirds of them develop spinal tumors. Simultaneous occurrence of bilateral vestibular schwanoma with cervical and lumbar ependymoma without neuro cutaneous marker with weakness of limb as initial presentation is rare finding in single patient. Here, we are reporting a rare case of MISME syndrome harbouring bilateral vestibular schwanoma with cervical and lumbar ependymoma tumors in a 45 year old male patient having no other lesion and neurocutaneous marker with weakness of limb as initial presentation without posterior subcapsular cataract.

Tiger hide appearance: Impaction and prolapse of brain parenchyma through burr holes after evacuation of bilateral chronic subdural hematoma: A rare case report

Burr hole evacuation of chronic subdural hematoma (SDH) with or without drainage system is the most common surgical method among various techniques. There are various complications of burr hole drainage evacuation of chronic SDH, but there is no case report regarding impaction and prolapse of brain parenchyma through burr hole as a complication. Herewith, we are reporting a case of bilateral chronic SDH with prolapse of brain parenchyma through burr holes. Magnetic resonance imaging (MRI) of brain showed a characteristic look and we named it “Tiger hide appearance”. We failed to find such characteristic appearance in MRI brain on reviewing the available literature.

Nasofrontal dermoid with sinus tract upto the tip of the nose: A case report with review of the literature

Nasofrontal dermoid with sinus tract extending to the nasal tip is rare in adults. It is unique in its embryological origin, presentation, and management. Pathogenesis involves the incomplete obliteration of the developing neuroectoderm. A sinus opening with intermittent oily discharge is characteristic. Associated intracranial extension may lead to meningitis and brain abscess. We present a case of a 21-year-old adult having a nasofrontal sinus tract with intracranial extension who presented with recurrent episodes of meningitis and discuss the physical findings with relevance to embryology, elaborating on the importance and means of addressing the intracranial as well as extracranial components for complete treatment.

Incidental frontal lobe mixed density epidermoid tumor in a patient of head injury: A rare case report

The incidence of the epidermoid tumor is approximately 0.2–1.8% of all intracranial tumors. Epidermoid tumors are typically intradural, but extra-axial in location and only rarely found within the brain substance. We are reporting the first case of incidental mixed density frontal epidermoid tumor in a patient of head injury. Difficulty in the preoperative diagnosis and uncommon presentation of the intracranial epidermoid tumor prompted us to report this case.

Growing skull fracture with cerebrospinal fluid fistula: A rare case report and its management strategies

The growing skull fracture (GSF) occurs in younger age group as a sequel of trauma. The most common site of these lesions is parietal region. Here we are presenting a case of GSF of posterior fossa with cerebrospinal fluid (CSF) fistula. As per literature, we have not found a single case of GSF in the posterior fossa with CSF fistula. The aim of this presentation is discussing the unusual presentation of GSF and its management.

Surface Quenching Induced Microstructure Transformations in Extrusion Foaming of Porous Sheets

In this article, a new technology is described to manufacture open cell thermoplastic foamed sheets with the aid of surface-quenching phenomenon during an extrusion process. As the gas laden polymer extrudate exits the slit die, its surface is rapidly quenched which results in freezing of cells on the surface, while the cells at the core continue to grow and leads to development of open-cellular microstructure at the core. Influence of chill roll temperature was found to be extremely significant in developing porous morphological attributes. Subsequently, synergistic effect of physical blowing agent (N2) content and chill roll temperature was examined for their expansion ratio and foam thickness. Fascinatingly, with reduced chill roll temperatures open-cell microstructure and high expansion ratio was obtained although its thickness was observed to decrease. Further, influence of chill roll rotating speed on foam microstructure and expansion ratio was studied. Lower chill roll rotational speed resulted in development of open-cellular microstructure; while at higher speeds, closed cell morphology was obtained. The results coherently demonstrate that by controlling the chill roll temperatures; open-cellular microstructure can be developed in sheet extrusion foaming process.

Bilateral cerebellopontine arachnoid cyst: A rare entity

Bilateral cerebellopontine angle (CPA) arachnoid cysts (ACs) are very rare: only one case is reported in literature. Pathogenesis of those cysts is unknown; they are thought to be congenital. The presenting symptoms of CPA AC are frequently nonspecific or otological. The management of ACs of the CPA is controversial. We are reporting two cases of bilateral CPA AC with their pathophysiology and review of literature.

Experiences and conceptualisation of spinal intramedullary tuberculoma management

Objective

Spinal intramedullary tuberculoma (SIMT) is rare, accounting for 2/100,000 cases of tuberculosis and only 0.2% of all cases of central nervous system(CNS) tuberculosis. We share our experiences of 11 cases of this entity for improving diagnosis and conceptualize the management of this rare disease.

Methods

The clinical profile, radiological data and management of 11 cases of SIMT which were managed either conservatively or by surgical intervention during last 27 years (1987-2014) were analysed.

Results

Male:female ratio was 1.75:1. Five cases had associated pulmonary Koch's. Most common site was thoracic cord. Two cases had concurrent multiple intracranial tuberculoma. Most common presentation was paraparesis. X-ray myelography was performed in two patients in the initial period of study suggesting intramedullary pathology. In the subsequent nine cases who had magnetic resonance imaging (MRI), seven showed typical "target sign" and conglomerate ring lesion. Out of 8 surgically managed patients, 6 cases improved rapidly and in 2 patients gradual improvement was seen in follow-up. Most common indication of surgical excision was rapid neurological deterioration followed by diagnosis in doubt. Histopathology confirmed tuberculous etiology of the intramedullary lesion in all. Clinical and radiological improvement was seen in all 3 conservatively managed patients in follow-up.

Conclusion

MRI findings of SIMT were specific and proven histologically correct. Surgical intervention may be indicated if there is no response to chemotherapy, the diagnosis is in doubt, or there is a rapid deterioration in neurological function because surgical outcome is good in these circumstances.

Occipital post-traumatic intradiploic arachnoid cyst converted to pseudomeningocele after re-trauma: a rare complication of rare pathology

BACKGROUND

Growing skull fracture (GSF)/pseudomeningocele is a rare complication of head injury in children. Post-traumatic intradiploic arachnoid cyst (PTIAC) is a variant but it is extremely rare. PTIACs are usually asymptomatic or with mild symptoms like headache. The rupture of PTIAC due to re-trauma leading to pseudomeningocele formation has not been seen or reported before.

PATIENT AND METHOD

We present a case of occipital PTIAC where pseudomeningocele developed after re-trauma, and discuss the pathogenesis and management.

RESULT

En masse removal of the ruptured PTIAC was performed along with dural-defect repair. The post-operative recovery was good.

CONCLUSION

PTIAC is an extremely rare occurrence as a variant of GSF. It is usually asymptomatic, but it may rupture with trivial trauma due to a thinned-out outer table and then converts into pseudomengocele. En masse excision with dural-defect repair gives good results in cases of ruptured PTIAC due to re-trauma.

Enhancement of Vegetative Parameters of Brinjal in Proplates by the Application of Bacterial Endophytes - <i>Azospirillum brasilense</i> and<i> Pseudomonas fluorescens</i>

An experiment was carried out with endophytic fixing bacteria Azospirillum brasilense and Pseudomonas fluorescens isolated from brinjal, in different combinations with inorganic fertilizers by seed inoculation of brinjal to observe preliminary vegetative growth at 15th and 30th day and pigment contents in vegetable nursery bed (proplates). A total number of 28 endophytic bacteria isolated from brinjal from three localities (Annamalai University, Karaikal and Putthur). Further the isolates were subjected to various biochemical tests for their species level identification and nitrogen fixing ability was estimated. Based upon their N-fixing ability and IAA production, two strains, one Azospirillum sp. and one Pseudomonas sp. isolate was selected and tested for its performance in brinjal. The seeds treated with 75% Chemical fertilizer + Azospirillum brasilense + Pseudomonas fluorescens (T6) showed maximum plant vegetative characters, followed by others compared with control.