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Jurjević I, Orešković D, Radoš M, Brgić K, Klarica M. Changes of cerebrospinal fluid pressure gradient in different body positions under experimental impairment of cerebrospinal fluid pathway: new insight into hydrocephalus development. Front Mol Neurosci 2024; 17:1397808. [PMID: 38947218 PMCID: PMC11212498 DOI: 10.3389/fnmol.2024.1397808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/24/2024] [Indexed: 07/02/2024] Open
Abstract
It is generally accepted that hydrocephalus is a consequence of the disbalance between cerebrospinal fluid (CSF) secretion and absorption which should in turn lead to CSF pressure gradient development and ventricular enlargement. To test CSF pressure gradient role in hydrocephalus development, we experimentally caused CSF system impairment at two sites in cats. In the first group of animals, we caused Sylvian aqueduct obstruction and recorded CSF pressure changes pre and post obstruction at three measuring sites (lateral ventricle -LV, cortical-CSS and lumbar subarachnoid space -LSS) during 15 min periods and in different body positions over 360 degrees. In the second group of experiments, we caused cervical stenosis by epidural plastic semiring implantation and monitored CSF pressure changes pre and post stenosis implantation at two measuring sites (lateral ventricle and lumbar subarachnoid space) during 15 min periods in different body positions over 360 degrees. Both groups of experimental animals had similar CSF pressures before stenosis or obstruction at all measuring points in the horizontal position. During head-up verticalization, CSF pressures inside the cranium gradually became more subatmospheric with no significant difference between LV and CSS, as they are measured at the same hydrostatic level, while CSF pressure inside LSS became more positive, causing the development of a large hydrostatic gradient between the cranial and the spinal space. With cervical stenosis, CSF pressure inside the cranium is positive during head-up verticalization, while in cats with aqueductal obstruction CSF pressure inside the CSS remains negative, as it was during control period. Concomitantly, CSF pressure inside LV becomes less negative, thus creating a small hydrostatic gradient between LV and CSS. Since CSF pressure and gradient changes occur only by shifting body position from the horizontal plane, our results indicate that cervical stenosis in a head-up vertical position reduces blood perfusion of the whole brain, while aqueductal obstruction impairs only the perfusion of the local periventricular brain tissue. It seems that, for evolutionary important bipedal activity, free craniospinal communication and good spinal space compliance represent crucial biophysical parameters for adequate cerebral blood perfusion and prevention of pathophysiological changes leading to the development of hydrocephalus.
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Affiliation(s)
- Ivana Jurjević
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia
| | - Milan Radoš
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Klara Brgić
- Department of Neurosurgery, Univesity Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
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Hajra D, Hajra A, Joshi SM. Spinal Cord Tumor Presenting as Idiopathic Intracranial Hypertension- A Report and Quick Review of Literature. Neurol India 2024; 72:420-424. [PMID: 38691491 DOI: 10.4103/ni.ni_797_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/03/2023] [Indexed: 05/03/2024]
Affiliation(s)
- Debasish Hajra
- Department of Neurosurgery, University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Shabin Mann Joshi
- Department of Neurosurgery, University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
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3
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Giannuzzi F, Carlà MM, Boselli F, Caputo CG, Fossataro C, Gambini G, Caporossi T, Vico UD, Rizzo S. Bilateral papilledema associated with retinal hemorrhagic appearance as earliest sign of spinal cord tumor. Eur J Ophthalmol 2023; 33:NP75-NP78. [PMID: 36214152 DOI: 10.1177/11206721221132414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
INTRODUCTION To report a case of a 57-years-old female patient who presented with prominent bilateral proptosis and swollen disks. CASE DESCRIPTION A 57-year-old obese patient admitted to our ophthalmic department complaining of bilateral sense of eye swelling and mild blurring vision. The anterior segment and pupillary reflex were normal on ophthalmological testing. Likewise, eye movements were preserved and she did not report diplopia in any position of gaze. Dilated fundus examination revealed bilateral hemorrhagic papilledema, pre-retinal hemorrhages in both eyes, dot and blot hemorrhages in the peripheral retina. Visual acuity was 20/20 in both eyes. Routine hematological investigations revealed increased both Von Willebrand factor and ristocetin factor and LAC positivity. The lumbar puncture (LP) showed elevated cerebrospinal fluid (CSF) proteins. Magnetic resonance imaging (MRI) with contrast of brain and spinal cord showed signs of intracranial hypertension and the presence of two lesions in continuity with each other respectively located at T12-L1 and L1-L2. Radiologic features were compatible with the diagnosis of ependymoma. A surgical procedure was conducted and confirmed the diagnosis after anatomical pathology analysis. CONCLUSION Although rare, bilateral hemorrhagic swollen disks could be an early sign of spinal cord tumors, in particular ependymomas.
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Affiliation(s)
- Federico Giannuzzi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Francesco Boselli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Carmela Grazia Caputo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Claudia Fossataro
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Gloria Gambini
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Umberto De Vico
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
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Hersh AM, Lubelski D, Theodore N, Sciubba DM, Jallo G, Shimony N. Approaches to Incidental Intradural Tumors of the Spine in the Pediatric Population. Pediatr Neurosurg 2023; 58:367-378. [PMID: 36948181 DOI: 10.1159/000530286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Incidental intradural tumors of the spine in the pediatric population are rare lesions whose management remains unclear. Surgeons must balance the risks of iatrogenic deficits and complications after surgical resection against the risks from progressive growth of the tumor. Moreover, the natural history of an incidental finding can be difficult to predict. Here, we review the literature on incidental intradural tumors of the spine and present considerations for their management. SUMMARY Growth of the tumor or changes in radiographic features are usually indications for resection. Asymptomatic lesions can be found in patients with genetic syndromes that predispose to tumor formation, such as neurofibromatosis type 1 and 2, schwannomatosis, and Von-Hippel-Lindau syndrome, and careful workup of a genetic cause is warranted in any patient presenting with multiple tumors and/or cutaneous features. Close follow-up is generally favored given the heavy tumor burden; however, some recommend pre-emptive resection to prevent permanent neurological deficits. Incidental intradural tumors can also occur in association with hydrocephalus, significant syringomyelia, and cord compression, and surgical treatment is usually warranted. Tumors may also be discovered as part of the workup for scoliosis, where they are not truly incidental to the scoliosis but rather are contributing to curve deformation. KEY MESSAGES Thorough workup of patients for associated genetic syndromes or comorbidities should be undertaken in pediatric patients with incidental intradural tumors. Further research is needed into the natural history of these incidental lesions. Incidental tumors can often be managed conservatively with close follow-up, with surgical intervention warranted for expanding tumors or new-onset symptoms.
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Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Manhasset, New York, USA
| | - George Jallo
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes-Murphey clinic, Memphis, Tennessee, USA
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5
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Nakamae T, Kamei N, Tanaka N, Nakanishi K, Tsuchikawa Y, Harada T, Maruyama T, Adachi N. Primary Spinal Cord Melanoma: A Two-Case Report and Literature Review. Spine Surg Relat Res 2022; 6:717-720. [PMID: 36561164 PMCID: PMC9747206 DOI: 10.22603/ssrr.2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/05/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, JR Hiroshima Hospital, Hiroshima, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Tsuchikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahiro Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshiaki Maruyama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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May G, Hegde A, Murphy C, St George EJ. Spinal paraganglioma presenting with raised intracranial pressure: a note on the diagnosis and post-operative management. Br J Neurosurg 2021:1-4. [PMID: 34927505 DOI: 10.1080/02688697.2021.2016617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/23/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spinal paragangliomas are tumors of neuroendocrine origin that present with symptoms of mass effect or neurosecretion but rarely involve the central nervous system. Raised intracranial pressure and papilledema are therefore unusual presentations of a spinal paraganglioma. METHODS We review the case of a 54-year-old man who presented with headache and visual disturbance. Fundoscopy confirmed papilledema with normal intracranial imaging. Neuraxis imaging revealed a lumbar intradural extramedullary tumor and pathological analysis confirmed a WHO Grade I spinal paraganglioma. The tumor was resected and post operatively his vison improved with resolution of optic disc swelling. CONCLUSIONS Raised intracranial pressure and papilledema are unusual clinical manifestations of spinal tumors and imaging the entire neuraxis can be valuable.
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Affiliation(s)
- Gareth May
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Ajay Hegde
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Claire Murphy
- Department of Ophthalmology, University Hospital Hairmyres, Glasgow, UK
| | - Edward J St George
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
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7
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Increased Intracranial Pressure Without Hydrocephalus Associated With Spinal Cord Tumor: Literature Review. J Neuroophthalmol 2021; 41:13-18. [PMID: 32826715 DOI: 10.1097/wno.0000000000001026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
ABSTRACT Spinal cord tumors (SCTs) may rarely cause increased intracranial pressure without hydrocephalus (IICPWH). A review of the English literature published after 1970 revealed 29 cases of IICPWH secondary to SCT. The following data were acquired: demographics, tumor characteristics, ophthalmic and neurological manifestations, and cerebral spinal fluid (CSF) features. We summarize the existing literature regarding various theories of pathophysiology, spinal imaging recommendations, and treatment modalities used in managing such patients. Patients with papilledema who also have neurological signs or symptoms of myelopathy or elevated CSF protein particularly in the setting of an atypical demographic for pseudotumor cerebri should raise a suspicion for a spinal tumor and prompt further investigation with a spinal MRI.
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8
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Hu W, Wang C, Wu Q, Chen Y, Gao W, Ying G, Zhu Y, Yan W. Intracranial hypertension due to spinal cord tumor misdiagnosed as pseudotumor cerebri syndrome: case report. BMC Neurol 2020; 20:420. [PMID: 33213405 PMCID: PMC7677777 DOI: 10.1186/s12883-020-02000-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Isolated onset of intracranial hypertension due to spinal cord tumor is rare, thus, easily leading to misdiagnosis and delay in effective treatment. Case presentation Herein, we describe a 45-year-old female patient who manifested isolated symptoms and signs of intracranial hypertension and whose condition was initially diagnosed as idiopathic intracranial hypertension and transverse sinus stenosis. The patient received a stent implantation; however, no improvements were observed. One year later her symptoms exacerbated, and during rehospitalization a spinal imaging examination revealed a lumbar tumor. Pathologic evaluation confirmed schwannoma, and tumor resection significantly improved her symptoms, except for poor vision. Conclusions Space-occupying lesions of the spine should be considered in the differential diagnosis of idiopathic intracranial hypertension, even in the absence of spine-localized signs or symptoms.
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Affiliation(s)
- Wanglu Hu
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Chun Wang
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Qun Wu
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Yike Chen
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Wei Gao
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Guangyu Ying
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Yongjian Zhu
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Wei Yan
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China.
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9
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Sharma GR, Aryal S, Joshi S. Lower thoracic schwannoma presenting as pseudotumor cerebri: a case report. Br J Neurosurg 2020:1-5. [PMID: 32924621 DOI: 10.1080/02688697.2020.1817319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Primary Spinal tumors presenting as increased intracranial pressure is a rare and intradural extramedullary (IDEM) spinal schwannoma with unique presentation of pseudotumour cerebri (PTC) is extremely rare. Here, we describe a case of 48 years old male patient who presented to us with six months' history of headache and visual disturbances and was found to have bilateral papilledema. CT scan of brain was normal and CSF opening pressure on Lumbar puncture (LP) was 30 cm of H2O with raised protein level. His headache and visual symptoms settled down after LP (Lumbo-peritoneal) shunt was performed. Three days postoperatively, patient complained of hypoesthesia and weakness of left leg that became an established complain after 2 weeks. A Lumbosacral MRI was performed with concerns of any postoperative complications of LP Shunt, which revealed IDEM spinal tumour at D11-D12 level. Patient underwent second surgery for excision of tumor. We reviewed the relevant literatures and discuss the possible mechanism of such atypical presentation of spinal tumors.
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Affiliation(s)
- Gopal Raman Sharma
- Department of Neurosurgery, Dirghayu Hospital and Research Center, Kathmandu, Nepal.,Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Samir Aryal
- Department of Neurosurgery, Dirghayu Hospital and Research Center, Kathmandu, Nepal
| | - Sumit Joshi
- Department of Neurosurgery, Dirghayu Hospital and Research Center, Kathmandu, Nepal.,Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
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10
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Lampros M, Voulgaris S, Alexiou GA. Hydrocephalus in primary intradural spinal cord tumors: a systematic review of the literature in the pediatric population. Neurosurg Rev 2020; 44:2079-2084. [PMID: 32918116 DOI: 10.1007/s10143-020-01386-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022]
Abstract
Hydrocephalus in children with primary intradural spinal cord tumors is exceedingly rare. Herewith, we performed a systematic literature review to address epidemiology, suggested pathophysiological mechanisms, prognostic factors, and treatment of such cases. We performed a systematic review with the best available evidence on cases of pediatric primary intradural tumors of the spinal cord presented with hydrocephalus. The patients were subjected to quantitative analysis on a basis of epidemiological features (age, sex, tumor type and location, clinical presentation, survival, dissemination). The possible pathophysiological theories are discussed in detail. Forty-four studies with a total of 121 patients were included in the study. Astrocytomas were the most frequent tumor (64.5%) type, while most tumors were located in cervical (31.4%) or cervicothoracic region (25.6%). About half of the cases concerned children under 6 years of age. The block of subarachnoid CSF (cerebrospinal fluid) pathways from disseminated tumor cells and the neoplastic inflammation caused by tumor elements advocated to be the major pathogenetic mechanisms. Surgical excision of the tumor and hydrocephalus treatment is usually performed. Primary intradural spinal cord tumors should be considered in children with communicative hydrocephalus of unknown etiology. Onset of hydrocephalus after tumor removal is related to higher mortality.
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Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, Ioannina, Greece. .,Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, Neohoropoulo, 45500, Ioannina, Greece.
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11
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Ala RT, Yener G, Özer E, Men S, Bülbül HM, Yaman A, Söylev Bajin M, Colakoglu BD, Akdal G, Halmágyi GM. Adult Spinal Primary Leptomeningeal Medulloblastoma Presenting as Pseudotumour Cerebri Syndrome. Neuroophthalmology 2020; 45:205-210. [PMID: 34194127 DOI: 10.1080/01658107.2020.1791191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A previously well 34-year-old man presented with severe pseudotumour cerebri. Imaging showed that he had a cauda equina tumour which proved to be a medulloblastoma. There was no tumour mass in the posterior fossa so we assume that this was a primary leptomeningeal medulloblastoma. In patients with somewhat atypical pseudotumour, spinal imaging should always be considered.
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Affiliation(s)
- Rahmi Tümay Ala
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Görsev Yener
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Erdener Özer
- International Biomedicine and Genome Center, Dokuz Eylül University, Izmir, Turkey
| | - Süleyman Men
- Department of Pathology, Dokuz Eylül University, Izmir, Turkey
| | | | - Aylin Yaman
- Department of Radiology, Dokuz Eylül University, Izmir, Turkey
| | | | | | - Gülden Akdal
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey.,Department of Ophthalmology, Dokuz Eylül University, Izmir, Turkey
| | - Gábor Michael Halmágyi
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
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Tsitsopoulos PP, Marinos K, Chochliourou E, Theologou M, Nikolaidou C, Sdougka M, Tsonidis CA. Infantile Atypical Teratoid Rhabdoid Tumor of the Spine Presenting with Acute Hydrocephalus. Pediatr Neurosurg 2020; 55:313-318. [PMID: 33221799 DOI: 10.1159/000511423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Central nervous system atypical teratoid rhabdoid tumors (ATRTs) are aggressive lesions usually presenting during the first 3 years of life. These tumors have a dismal prognosis with most patients dying within 1 year from presentation. Primary spinal location in infants is very rare. CASE PRESENTATION We report a case of a 4-month-old boy who presented with a history of hypotonia, poor head control, and gradually reduced level of consciousness, over the past week. Computed tomography (CT) showed acute hydrocephalus with no underlying intracranial pathology. A ventriculoperitoneal shunt was inserted acutely. Postoperatively, ventilator weaning was unsuccessful. MRI of the brain and whole spine revealed an intraspinal extradural contrast-enhancing heterogenous mass in the subaxial cervical spine extending to the thoracic cavity. A biopsy was taken through a transthoracic approach, and histopathology confirmed the diagnosis of ATRT. Several cycles of radiation therapy and chemotherapy were given but the tumor progressed both locally and intracranially. Eventually, pupils became dilated and fixed. Brain CT scan showed widespread ischemic lesions and an extensive intracranial tumor extension with massive bleeding. The child eventually died 110 days after admission. CONCLUSIONS In infants presenting with acute hydrocephalus where an obvious intracranial cause is not detected, the whole neuraxis should be screened. However, despite aggressive measures and advances in multimodality treatment, prognosis of ATRT remains dismal.
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Affiliation(s)
- Parmenion P Tsitsopoulos
- Department of Neurosurgery, Aristotle University Faculty of Medicine, Hippokratio General Hospital, Thessaloniki, Greece
| | - Konstantinos Marinos
- Department of Neurosurgery, Aristotle University Faculty of Medicine, Hippokratio General Hospital, Thessaloniki, Greece,
| | - Elpis Chochliourou
- Pediatric Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Marios Theologou
- Department of Neurosurgery, Aristotle University Faculty of Medicine, Hippokratio General Hospital, Thessaloniki, Greece
| | - Christina Nikolaidou
- Department of Histopathology, Hippokratio General Hospital, Thessaloniki, Greece
| | - Maria Sdougka
- Pediatric Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Christos A Tsonidis
- Department of Neurosurgery, Aristotle University Faculty of Medicine, Hippokratio General Hospital, Thessaloniki, Greece
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13
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Hironaka K, Tateyama K, Tsukiyama A, Adachi K, Morita A. Hydrocephalus Secondary to Intradural Extramedullary Malignant Melanoma of Spinal Cord. World Neurosurg 2019; 130:222-226. [PMID: 31302270 DOI: 10.1016/j.wneu.2019.07.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hydrocephalus secondary to spinal cord tumors is rare. CASE DESCRIPTION We present a 39-year-old male with gradual-onset headache whose initial diagnosis was cerebral aneurysm and communicating hydrocephalus. The correct diagnosis was primary intradural extramedullary malignant melanoma of the spinal cord. Initial brain magnetic resonance imaging demonstrated slight dilation of cerebral ventricles and a 3-mm unruptured anterior communicating artery aneurysm. He was placed under observation therapy. Two months later he was seen again due to severe headache. There was no intracranial hemorrhage on brain computed tomography scans. As we suspected rupture of the aneurysm, we operated on him for surgical clipping; however, there was no aneurysmal rupture. We found no lesions responsible for hydrocephalus, so we placed a ventriculoperitoneal shunt. His headache subsequently resolved. Nine months later he developed gait disturbance; a large volume of ascites was observed. Gadolinium-enhanced lumbar magnetic resonance imaging revealed an intradural extramedullary mass at the L-1 to S-5 level. Cytology and immunohistochemistry of the cerebrospinal fluid and ascites identified a few atypical cells positive for HMB-45, S-100 protein, and Melan-A. Whole-body examinations detected no primary lesions outside the central nervous system. Our final diagnosis was primary intradural extramedullary malignant melanoma of the spinal cord with cerebrospinal fluid dissemination. CONCLUSIONS Our findings indicate that communicating hydrocephalus may be due to primary malignant melanoma of the spinal cord.
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Affiliation(s)
- Kohei Hironaka
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan.
| | - Kojiro Tateyama
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Atsushi Tsukiyama
- Department of Neurological Surgery, Nippon Medical School Hospital, Kawasaki, Kanagawa, Japan
| | - Koji Adachi
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Kawasaki, Kanagawa, Japan
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Ishaque M, McGinity MJ, Tavakoli SG, Henry JM, Papanastassiou AM. Case of Lumbar Schwannoma Presenting with Isolated Signs and Symptoms of Intracranial Hypertension. World Neurosurg 2018; 119:209-214. [PMID: 30096499 DOI: 10.1016/j.wneu.2018.07.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hydrocephalus and intracranial hypertension are rare signs of spinal tumors when presenting in isolation, particularly with benign tumors. CASE DESCRIPTION Herein reported is a case of a 53-year-old woman who presented with headache, blurry vision, communicating hydrocephalus, and intracranial hypertension. No primary intracranial pathology was identified, and there were no clinical signs or symptoms of intraspinal pathology. Lumbar puncture revealed elevated opening pressure, cerebrospinal fluid protein, and suspected tumor cells in the cerebrospinal fluid, thus prompting spinal imaging. A primary lumbar schwannoma was subsequently determined to underlie her symptoms, which resolved with tumor resection. CONCLUSIONS Clinical suspicion of spinal pathology should be maintained in patients with unexplained intracranial hypertension, even in the absence of localizing signs of spinal pathology.
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Affiliation(s)
- Mariam Ishaque
- Long School of Medicine, University of Texas Health, San Antonio, Texas, USA; Department of Neurosurgery, University of Texas Health, San Antonio, Texas, USA.
| | - Michael J McGinity
- Department of Neurosurgery, University of Texas Health, San Antonio, Texas, USA
| | - Samon G Tavakoli
- Department of Neurosurgery, University of Texas Health, San Antonio, Texas, USA
| | - James M Henry
- Department of Pathology, University of Texas Health, San Antonio, Texas, USA
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15
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Kushel' YV, Belova YD, Tekoev AR. [Intramedullary spinal cord tumors and hydrocephalus: an analysis of the results of surgical treatment in 541 patients]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 81:56-60. [PMID: 28914871 DOI: 10.17116/neiro201781456-60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article addresses the problem of intramedullary tumors (IMTs) combined with hydrocephalus (HC). PURPOSE The study purpose was to explore, based on large clinical material, the occurrence of hydrocephalus combined with intramedullary tumors, possible pathogenetic mechanisms of its development, effect of tumor resection on the course of hydrocephalus, and need and timing of shunting surgery. MATERIAL AND METHODS We present and analyze the data of the largest individual series of patients of all age groups operated on for IMTs of the spinal cord: 541 patients; 586 operations; age from 2 months to 72 years. RESULTS AND CONCLUSION Our findings confirm a potential pathogenetic relationship between IMT and HC. The overall occurrence rate of HC in IMT patients was 6.3%. In patients with benign tumors (WHO Grade 1-2; 449 patients), HC developed in 25 (5.6%) cases; in patients with malignant tumors (WHO Grade 3-4; 84 patients), HC developed in 7 (8.3%) cases. A statistically significant prevalence of cervico-medullary tumors was found in HC patients: 19 (59.4%) cases. According to our data, dissemination of the tumor process is a potential factor of HC development.
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Affiliation(s)
- Yu V Kushel'
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - Yu D Belova
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A R Tekoev
- Burdenko Neurosurgical Institute, Moscow, Russia
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16
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Khoulali M, Haouas MY, Mortada J, Srour R. Tumeurs du cône médullaire et de la queue de cheval associées à l’hydrocéphalie chronique: à propos de 2 cas. Pan Afr Med J 2018; 29:206. [PMID: 30100960 PMCID: PMC6080959 DOI: 10.11604/pamj.2018.29.206.10723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/28/2016] [Indexed: 01/30/2023] Open
Abstract
L’hydrocéphalie chronique associée à une tumeur du cône médullaire et /ou de la queue de cheval est extrêmement rare. Nous présentons deux patients porteurs d’une tumeur médullaire révélée par la triade: démence, troubles de la marche et incontinence urinaire. L’imagerie par résonance magnétique (IRM) cérébrospinale objectivait une hydrocéphalie communicante et une tumeur intradurale siégeant au niveau du cône médullaire et de la queue de cheval. L’exérèse chirurgicale d’un schwannome bénin et d’un épendymome a permis la résolution de la symptomatologie clinique due à l’hydrocéphalie sans procéder à un shunt ventriculaire. Une dizaine de cas de démence et d’hydrocéphalie accompagnant une tumeur spinale sont rapportées. Une variété de mécanismes a été proposée pour expliquer cette association mais la physiopathologie exacte reste mal connue.
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Affiliation(s)
- Mohamed Khoulali
- Université Mohammed Premier, Faculté de Médecine et de Pharmacie, CHU Mohamed VI, Oujda, Maroc,
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17
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Bilateral papilloedema as the initial manifestation of spinal ependymoma. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2015.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Hydrocephalus: a rare initial manifestation of sporadic intramedullary hemangioblastoma : Intramedullary hemangioblastoma presenting as hydrocephalus. Childs Nerv Syst 2017; 33:1399-1403. [PMID: 28444460 DOI: 10.1007/s00381-017-3415-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intramedullary hemangioblastomas are rare benign vascular tumors, infrequent in pediatric patients. Clinical symptoms vary according to the age of presentation, tumor size, location, and concomitant syringomyelia. This is the second reported case of hemangioblastoma presenting with acute hydrocephalus. CASE PRESENTATION A 3-month-old infant with acute hydrocephalus was asymptomatic after a ventriculoperitoneal shunt was placed. She returned 3 months later with irritability, acute paraplegia, and respiratory distress. Magnetic resonance imaging (MRI) showed an intramedullary T8-T9 tumor with syringomyelia. She underwent surgical resection with good results during the 6-month follow-up. CONCLUSION Intramedullary tumors may present as hydrocephalus and other nonspecific symptoms, with invariably delayed diagnosis in children, but must be considered in suspicious cases.
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19
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Samanci Y, Togay HS, Yakar R, Kabukcuoglu F, Celik SE. Acute hydrocephalus due to a primary malignant peripheral nerve sheath tumor of the cervicothoracic junction: A case report and review of the literature. Neurochirurgie 2017; 63:91-95. [PMID: 28502561 DOI: 10.1016/j.neuchi.2016.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 10/02/2016] [Accepted: 10/31/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The estimated incidence of malignant nerve sheath tumors is 0.001% per year, and only 2-3% of those tumors involve the spinal nerves. We present a rare case of acute hydrocephalus caused by primary malignant peripheral nerve sheath tumor of the cervicothoracic junction. CASE DESCRIPTION A 29-year-old previously healthy male patient, except for a history of two previous surgeries for ulnar nerve entrapment and progressive left upper extremity weakness, presented with acute onset somnolence. The CT and MRI revealed hydrocephalus and periventricular edema. The patient underwent ventriculoperitoneal shunt surgery. Postoperative MRI of the spine revealed a 6×3×3cm intra-extradural lesion at C7-T1 level and multiple metastases in other spinal segments. The patient underwent combined surgical excision and the tumor was diagnosed as a malignant peripheral nerve sheath tumor based on pathological and immunohistological findings. Radiation therapy and chemotherapy were initiated. CONCLUSION Primary malignant peripheral nerve sheath tumor of the spine is a very aggressive tumor with a very high recurrence rate, significant potential for metastasis and very poor overall prognosis. They may present with features of more frequent diseases, such as peripheral neuropathies and may be overlooked as in our case. Thus, suspected cases should undergo a more detailed examination.
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Affiliation(s)
- Y Samanci
- Neurosurgery Clinic, Ministry of Health Istanbul Training and Research Hospital, Kasap İlyas Mahallesi, Org. Abdurrahman Nafiz Gürman Caddesi, 34098 Fatih, Istanbul, Turkey.
| | - H S Togay
- Neurosurgery Clinic, Ministry of Health Istanbul Training and Research Hospital, Kasap İlyas Mahallesi, Org. Abdurrahman Nafiz Gürman Caddesi, 34098 Fatih, Istanbul, Turkey
| | - R Yakar
- Pathology Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - F Kabukcuoglu
- Pathology Clinic, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - S E Celik
- Neurosurgery Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Klarica M, Jukić T, Miše B, Kudelić N, Radoš M, Orešković D. Experimental Spinal Stenosis in Cats: New Insight in Mechanisms of Hydrocephalus Development. Brain Pathol 2016; 26:701-712. [PMID: 26549012 PMCID: PMC8029224 DOI: 10.1111/bpa.12337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/05/2015] [Indexed: 12/25/2022] Open
Abstract
In our new experimental model of cervical stenosis without inflammation we have tested hypothesis that cranio-spinal communication impairment could lead to hydrocephalus development. Spinal and cranial cerebrospinal fluid (CSF) space separation was obtained with positioning of plastic semiring in epidural space at C2 level in cats. Brain ventricles planimetry, and CSF pressure recording in lateral ventricle (LV) and lumbar subarachnoid space (LSS) were performed in acute and subchronic experiments. In all experiments opening CSF pressures were normal. However, in acute experiments, an infusion of artificial CSF into the LV led to increase of CSF pressure and significant gradient pressure development between LV and LSS due to limited pressure transmission. After 3 or 6 weeks spinal cord atrophy was observed at the site of cervical stenosis, and pressure transmission from LV to LSS was improved as a consequence of spinal tissue atrophy. Planimetry of both the coronal brain slices and the ventricles' surface showed that control ventricular surface was 0.6 ± 0.1% (n = 5), and 1.6 ± 0.2% (n = 4) in animals with subchronic cervical stenosis (P < 0.002). These results support the mentioned hypothesis claiming that CSF volume cranio-spinal displacement impairment could start pathophysiological processes leading to development of hydrocephalus.
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Affiliation(s)
- Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain ResearchSchool of Medicine University of ZagrebZagrebCroatia
| | - Tomislav Jukić
- Department of OphthalmologyClinical Hospital Center Zagreb, School of Medicine, University of Zagreb
| | - Branko Miše
- University of Zagreb, School of Medicine, University Hospital for Infectious Diseases
| | - Nenad Kudelić
- Department of Pharmacology and Croatian Institute for Brain ResearchSchool of Medicine University of ZagrebZagrebCroatia
| | - Milan Radoš
- Croatian Institute for Brain Research, School of Medicine University of Zagreb
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21
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Benedetto N, Cagnazzo F, Gambacciani C, Perrini P. Subdural fluid collection and hydrocephalus following cervical schwannoma resection: hydrocephalus resolution after spinal pseudomeningocele repair: case report. J Neurosurg Spine 2016; 25:762-765. [PMID: 27391399 DOI: 10.3171/2016.5.spine16153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The authors report the case of a 31-year-old man who developed neck pain and headache 2 months after the uncomplicated resection of a cervical schwannoma. MR imaging revealed infratentorial subdural fluid collections and obstructive hydrocephalus associated with cervical pseudomeningocele. The clinical symptoms, subdural fluid collections, and ventricular dilation resolved after surgical correction of the pseudomeningocele. This report emphasizes that hydrocephalus may be related to disorders of cerebrospinal fluid flow dynamics induced by cervical pseudomeningocele. In these rare cases, both the hydrocephalus and the symptoms are resolved by the simple correction of the pseudomeningocele.
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Affiliation(s)
- Nicola Benedetto
- Neurosurgical Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Federico Cagnazzo
- Neurosurgical Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Carlo Gambacciani
- Neurosurgical Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Paolo Perrini
- Neurosurgical Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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22
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Marzban AN, Saxena A, Bhattacharyya D, Ivanov M. Hydrocephalus and Papilledema in Spinal Cord Tumors: A Report of Two Cases. Surg J (N Y) 2016; 2:e51-e58. [PMID: 28824991 PMCID: PMC5553482 DOI: 10.1055/s-0036-1584584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/26/2016] [Indexed: 01/30/2023] Open
Abstract
Background
The association between spinal cord tumors and hydrocephalus is a rarely reported phenomenon. Diagnosis in this group of patients is difficult as they present with findings of an intracranial pathology and the symptoms of a spinal lesion may be absent.
Case Report
We report two cases of spinal cord tumors presenting with visual disturbance and findings of increased intracranial pressure.
Discussions
Mechanisms describing the relationship between spinal cord tumors and increased intracranial pressure have been explained. Most of the literature reported marked regression of these manifestations after tumor excision.
Conclusions
Spinal cord tumors associated with hydrocephalus and papilledema are rare conditions. The diagnosis of these conditions may be difficult or confusing because the symptoms referable to the spinal lesion may be minimal. Meticulous history taking, examination, and investigations are mandatory to diagnose this entity.
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Affiliation(s)
| | - Ankur Saxena
- Department of Neurosurgery, Salford Royal Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Dev Bhattacharyya
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Marcel Ivanov
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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23
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Aojula A, Botfield H, McAllister JP, Gonzalez AM, Abdullah O, Logan A, Sinclair A. Diffusion tensor imaging with direct cytopathological validation: characterisation of decorin treatment in experimental juvenile communicating hydrocephalus. Fluids Barriers CNS 2016; 13:9. [PMID: 27246837 PMCID: PMC4888658 DOI: 10.1186/s12987-016-0033-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/20/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In an effort to develop novel treatments for communicating hydrocephalus, we have shown previously that the transforming growth factor-β antagonist, decorin, inhibits subarachnoid fibrosis mediated ventriculomegaly; however decorin's ability to prevent cerebral cytopathology in communicating hydrocephalus has not been fully examined. Furthermore, the capacity for diffusion tensor imaging to act as a proxy measure of cerebral pathology in multiple sclerosis and spinal cord injury has recently been demonstrated. However, the use of diffusion tensor imaging to investigate cytopathological changes in communicating hydrocephalus is yet to occur. Hence, this study aimed to determine whether decorin treatment influences alterations in diffusion tensor imaging parameters and cytopathology in experimental communicating hydrocephalus. Moreover, the study also explored whether diffusion tensor imaging parameters correlate with cellular pathology in communicating hydrocephalus. METHODS Accordingly, communicating hydrocephalus was induced by injecting kaolin into the basal cisterns in 3-week old rats followed immediately by 14 days of continuous intraventricular delivery of either human recombinant decorin (n = 5) or vehicle (n = 6). Four rats remained as intact controls and a further four rats served as kaolin only controls. At 14-days post-kaolin, just prior to sacrifice, routine magnetic resonance imaging and magnetic resonance diffusion tensor imaging was conducted and the mean diffusivity, fractional anisotropy, radial and axial diffusivity of seven cerebral regions were assessed by voxel-based analysis in the corpus callosum, periventricular white matter, caudal internal capsule, CA1 hippocampus, and outer and inner parietal cortex. Myelin integrity, gliosis and aquaporin-4 levels were evaluated by post-mortem immunohistochemistry in the CA3 hippocampus and in the caudal brain of the same cerebral structures analysed by diffusion tensor imaging. RESULTS Decorin significantly decreased myelin damage in the caudal internal capsule and prevented caudal periventricular white matter oedema and astrogliosis. Furthermore, decorin treatment prevented the increase in caudal periventricular white matter mean diffusivity (p = 0.032) as well as caudal corpus callosum axial diffusivity (p = 0.004) and radial diffusivity (p = 0.034). Furthermore, diffusion tensor imaging parameters correlated primarily with periventricular white matter astrocyte and aquaporin-4 levels. CONCLUSIONS Overall, these findings suggest that decorin has the therapeutic potential to reduce white matter cytopathology in hydrocephalus. Moreover, diffusion tensor imaging is a useful tool to provide surrogate measures of periventricular white matter pathology in communicating hydrocephalus.
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Affiliation(s)
- Anuriti Aojula
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Hannah Botfield
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - James Patterson McAllister
- />Department of Neurosurgery, Division of Pediatric Neurosurgery at the Washington University School of Medicine and the Saint Louis Children’s Hospital, St. Louis, MO 63110 USA
| | - Ana Maria Gonzalez
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Osama Abdullah
- />Department of Bioengineering, University of Utah, Salt Lake City, UT 84112 USA
| | - Ann Logan
- />Department of Bioengineering, University of Utah, Salt Lake City, UT 84112 USA
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Alexandra Sinclair
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
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24
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Miranda Bacallado Y, González Hernández A, Curutchet Mesner L, Rúa-Figueroa Fernández de Larrinoa I. Bilateral papilloedema as the initial manifestation of spinal ependymoma. Neurologia 2016; 33:194-196. [PMID: 26971061 DOI: 10.1016/j.nrl.2015.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/30/2015] [Indexed: 01/31/2023] Open
Affiliation(s)
- Y Miranda Bacallado
- Sección de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.
| | - A González Hernández
- Sección de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - L Curutchet Mesner
- Oftalmología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
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Samartzis D, Gillis CC, Shih P, O'Toole JE, Fessler RG. Intramedullary Spinal Cord Tumors: Part I-Epidemiology, Pathophysiology, and Diagnosis. Global Spine J 2015; 5:425-35. [PMID: 26430598 PMCID: PMC4577312 DOI: 10.1055/s-0035-1549029] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 02/09/2015] [Indexed: 11/16/2022] Open
Abstract
Study Design Broad narrative review. Objectives Intramedullary spinal cord tumors (IMSCT) are rare neoplasms that can potentially lead to severe neurologic deterioration, decreased function, poor quality of life, or death. As such, a better understanding of these lesions is needed. The following article, part one of a two-part series, addresses IMSCT with regards to their epidemiology, histology, pathophysiology, imaging characteristics, and clinical manifestations. Methods The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results Numerous IMSCT exist with varying epidemiology. Each IMSCT has its own hallmark characteristics and may vary with regards to how aggressively they invade the spinal cord. These lesions are often difficult to detect and are often misdiagnosed. Furthermore, radiographically and clinically, these lesions may be difficult to distinguish from one another. Conclusions Awareness and understanding of IMSCT is imperative to facilitate an early diagnosis and plan management.
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Affiliation(s)
- Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
- The Laboratory and Clinical Research Institute for Pain, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Christopher C. Gillis
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Patrick Shih
- The Neurological Brain and Spine Center, Houston, Texas, United States
| | - John E. O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard G. Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
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Rigi M, Almarzouqi SJ, Morgan ML, Lee AG. Papilledema: epidemiology, etiology, and clinical management. Eye Brain 2015; 7:47-57. [PMID: 28539794 PMCID: PMC5398730 DOI: 10.2147/eb.s69174] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Papilledema is optic disc swelling due to high intracranial pressure. Possible conditions causing high intracranial pressure and papilledema include intracerebral mass lesions, cerebral hemorrhage, head trauma, meningitis, hydrocephalus, spinal cord lesions, impairment of cerebral sinus drainage, anomalies of the cranium, and idiopathic intracranial hypertension (IIH). Irrespective of the cause, visual loss is the feared morbidity of papilledema, and the main mechanism of optic nerve damage is intraneuronal ischemia secondary to axoplasmic flow stasis. Treatment is directed at correcting the underlying cause. In cases where there is no other identifiable cause for intracranial hypertension (ie, IIH) the available options include both medical and surgical modalities. Weight loss and diuretics remain the mainstays for treatment of IIH, and surgery is typically reserved for patients who fail, are intolerant to, or non-compliant with maximum medical therapy.
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Affiliation(s)
| | | | - Michael L Morgan
- Department of Ophthalmology, Houston Methodist Hospital, Blanton Eye Institute
| | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist Hospital, Blanton Eye Institute.,Baylor College of Medicine.,Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, UTMB Galveston, UT MD Anderson Cancer Center, Houston, TX, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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27
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Montemurro N, Cocciaro A, Meola A, Lutzemberger L, Vannozzi R. Hydrocephalus following bilateral dumbbell-shaped c2 spinal neurofibromas resection and postoperative cervical pseudomeningocele in a patient with neurofibromatosis type 1: a case report. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 5:136-8. [PMID: 25364327 PMCID: PMC4212698 DOI: 10.1055/s-0034-1387805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 07/02/2014] [Indexed: 11/14/2022]
Abstract
Study Design Case report. Objective To present a rare case of hydrocephalus following bilateral dumbbell-shaped C2 spinal neurofibromas resection and postoperative cervical pseudomeningocele in a patient with neurofibromatosis type 1 (NF1). Methods The patient's clinical course is retrospectively reviewed. A 37-year-old man affected by NF1 referred to our department for progressive weakness of both lower extremities and gait disturbance. Radiological imaging showed bilateral dumbbell-shaped C2 spinal neurofibromas. After its resection, at the 1-month follow-up evaluation, the patient reported headache and nausea. A CT brain scan showed a postoperative cervical pseudomeningocele and an increase in the ventricular sizes, resulting in hydrocephalus. Results A ventriculoperitoneal shunting was performed using a programmable valve opening pressure set to 120 mmH20. After surgery, the patient's neurological status markedly improved. Conclusion Hydrocephalus must be considered a possible complication of cervical spine tumor resection.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ardico Cocciaro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio Meola
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Riccardo Vannozzi
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Amelot A, Faillot T. Hydrocephalus and neurocysticercosis: cases illustrative of three distinct mechanisms. J Clin Neurol 2014; 10:363-6. [PMID: 25324888 PMCID: PMC4198720 DOI: 10.3988/jcn.2014.10.4.363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 07/16/2013] [Accepted: 07/19/2013] [Indexed: 11/17/2022] Open
Abstract
Background Cysticercosis is the most frequent parasitic infection of the nervous system. Most lesions are intracranial, and spinal involvement is rare. We describe here in two cases of neurocysticercosis (NCC) in the brain and one in the spinal cord that illustrate three distinct mechanisms leading to symptomatic acute hydrocephalus. Case Report Hydrocephalus was related to intracranial NCC in two of them. In the first case the hydrocephalus was due to an extensive arachnoiditis to the craniocervical junction, while in the second it was caused by obstruction of Magendie's foramen in the fourth ventricle by the scolex of Taenia solium. For the third patient, hydrocephalus revealed cysticercosis of the cauda equina due to the scolex. Conclusions NCC should be considered as a possible diagnosis for patients suffering from hydrocephalus when they originate from or have traveled in endemic areas, MRI of the spine is mandatory to search for intraspinal lesions.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, AP-HP Hôpital Beaujon, Clichy, France
| | - Thierry Faillot
- Department of Neurosurgery, AP-HP Hôpital Beaujon, Clichy, France
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Halmagyi GM, Ahmed RM, Johnston IH. The Pseudotumor Cerebri Syndrome: A Unifying Pathophysiological Concept for Patients with Isolated Intracranial Hypertension with Neither Mass Lesion Nor Ventriculomegaly. Neuroophthalmology 2014; 38:249-253. [PMID: 27928307 DOI: 10.3109/01658107.2014.886705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 11/13/2022] Open
Abstract
In 1991 we proposed that while the syndrome of isolated intracranial hypertension might have many definite and probable causes, it has nonetheless a single unifying pathophysiological mechanism: namely, impairment of cerebrospinal fluid (CSF) reabsorption. For that reason, we also proposed then that it is best described by a single, unifying, inclusive term, namely, pseudotumor cerebri syndrome. Although it appears that there is, as far as nomenclature is concerned, now international agreement, there is as yet no agreement on pathophysiology and classification. Herein we outline our views on these matters and give our reasons.
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Affiliation(s)
- G M Halmagyi
- Departments of Neurology; Institute of Clinical Neurosciences, University of SydneySydneyAustralia
| | - R M Ahmed
- Departments of Neurology; Institute of Clinical Neurosciences, University of SydneySydneyAustralia
| | - I H Johnston
- Neurosurgery, Royal Prince Alfred HospitalSydneyAustralia; Institute of Clinical Neurosciences, University of SydneySydneyAustralia
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Ahmed R, Menezes AH, Awe OO, Torner JC. Long-term disease and neurological outcomes in patients with pediatric intramedullary spinal cord tumors. J Neurosurg Pediatr 2014; 13:600-12. [PMID: 24702616 DOI: 10.3171/2014.1.peds13316] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECT Radical resection is recommended as the first-line treatment for pediatric intramedullary spinal cord tumors (IMSCTs), but it is associated with morbidity, including risk of neurological decline and development of postoperative spinal deformity. The authors report long-term data on clinical and treatment determinants affecting disease survival and neurological outcomes. METHODS Case records for pediatric patients (< 21 years of age at presentation) who underwent surgery for IMSCTs at the authors' institution between January 1975 and January 2010 were analyzed. The patients' demographic and clinical characteristics (including baseline neurological condition), the treatment they received, and their disease course were reviewed. Long-term disease survival and functional outcome measures were analyzed. RESULTS A total of 55 patients (30 male and 25 female) were identified. The mean duration of follow-up (± SEM) was 11.4 ± 1.3 years (median 9.3 years, range 0.2-37.2 years). Astrocytomas were the most common tumor subtype (29 tumors [53%]). Gross-total resection (GTR) was achieved in 21 (38%) of the 55 patients. At the most recent follow-up, 30 patients (55%) showed neurological improvement, 17 (31%) showed neurological decline, and 8 (15%) remained neurologically stable. Patients presenting with McCormick Grade I were more likely to show functional improvement by final follow-up (p = 0.01) than patients who presented with Grades II-V. Kaplan-Meier actuarial tumor progression-free survival rates at 5, 10, and 20 years were 61%, 54%, and 44%, respectively; the overall survival rates were 85% at 5 years, 74% at 10 years, and 64% at 20 years. On multivariate analysis, GTR (p = 0.04) and tumor histological grade (p = 0.02) were predictive of long-term survival; GTR was also associated with improved 5-year progression-free survival (p = 0.01). CONCLUSIONS The prognosis for pediatric IMSCTs is favorable with sustained functional improvement expected in a significant proportion of patients on long-term follow-up. Long-term survival at 10 years (75%) and 20 years (64%) is associated with aggressive resection. Gross-total resection was also associated with improved 5-year progression-free survival (86%). Hence, the treatment benefits of GTR are sustained on extended follow-up.
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Chung YY, Ju CI, Kim SW, Kim DM. Acute Hydrocephalus as a Complication of Cervical Spine Fracture and Dislocation: A Case Report. KOREAN JOURNAL OF SPINE 2014; 11:74-6. [PMID: 25110487 PMCID: PMC4124928 DOI: 10.14245/kjs.2014.11.2.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 11/19/2022]
Abstract
Hydrocephalus is a well-known complication of head injury, but an uncommon complication of a spinal lesion. Here, we present a rare case of acute obstructive hydrocephalus secondary to a cervical fracture and dislocation. A 60-year-old female patient was transferred to the emergency department with quadriplegia and respiratory difficulty. Imaging studies showed a cervical fracture and dislocation at the C3-4 level. She required intubation and mechanical ventilation. Twenty-four hours after admission, her mental status had deteriorated and both pupils were dilated. Computed tomography of the brain showed acute hydrocephalus; therefore, extraventricular drainage (EVD) was performed. After the EVD, her mental status recovered and she became alert, but she remained quadriplegic and dependent on the ventilator. Two months after injury, she died because of respiratory failure caused by pneumonia.
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Affiliation(s)
- Yoon Young Chung
- Department of Anatomy, College of Medicine, Chosun University, Gwangju, Korea
| | - Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Dong Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
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Son S, Lee SG, Park CW, Kim WK. Acute hydrocephalus following cervical spinal cord injury. J Korean Neurosurg Soc 2013; 54:145-7. [PMID: 24175033 PMCID: PMC3809444 DOI: 10.3340/jkns.2013.54.2.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/27/2013] [Accepted: 08/01/2013] [Indexed: 11/27/2022] Open
Abstract
We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil. Findings on brain computed tomography revealed acute hydrocephalus and subarachnoid hemorrhage in the cerebellomedullary cistern, therefore, extraventricular drainage was performed immediately. Acute hydrocephalus as a complication of cervical spine trauma is rare, however, it should be considered if the patient shows deterioration of neurologic symptoms.
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Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gachon University, Gil Medical Center, Incheon, Korea
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Jeong DH, Lee CK, You NK, Kim SH, Cho KH. Primary spinal cord melanoma in thoracic spine with leptomeningeal dissemination and presenting hydrocephalus. Brain Tumor Res Treat 2013; 1:116-20. [PMID: 24904904 PMCID: PMC4027108 DOI: 10.14791/btrt.2013.1.2.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 09/27/2013] [Accepted: 10/03/2013] [Indexed: 12/11/2022] Open
Abstract
Primary spinal cord melanoma is a rare central nervous system malignant tumor. Usually it resembles an intradural extramedullary (IDEM) nerve sheath tumor or melanoma. We experienced a patient with upper thoracic primary IDEM spinal cord melanoma who was diagnosed to be with hydrocephalus and without intracranial lesions. Initial symptoms of the patient were related to the hydrocephalus and the primary spinal cord melanoma was diagnosed eight months later. At the first operation, complete resection was impossible and the patient refused additional radiotherapy or chemotherapy. At 22 months after surgery, the patient revisited our institution with recurrent both leg weakness. Leptomeningeal dissemination was present in the whole spinal cord and only partial resection of tumor was performed. The symptoms slightly improved after surgery. Primary spinal cord melanoma is extremely rare but complete resection and additional radiotherapy or chemotherapy can prolong the disease free interval. Hydrocephalus or signs of increased intracranial pressure may be the diagnostic clue of spinal cord malignancy and progression.
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Affiliation(s)
- Dong Hwan Jeong
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Chunl Kyu Lee
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Nam Kyu You
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Sang Hyun Kim
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ki Hong Cho
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Infantile holocord cellular ependymoma with communicating hydrocephalus: unusual presentation of a rare case. Brain Tumor Pathol 2013; 31:47-50. [DOI: 10.1007/s10014-013-0145-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 03/03/2013] [Indexed: 11/30/2022]
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