Intracranial Rosai Dorfman disease - A rare differential diagnosis of multiple meningiomas: a case report

Rosai Dorfman Destombes (RDD) disease is a non-Langerhans histiocytosis. The central nervous system is affected in < 5% of cases. We report the case of a 59-year-old man, who began 8 months before admission with headache, diminished visual acuity in the temporal hemifields, hyposmia, and seizures. Magnetic resonance imaging showed three midline skull-base lesions in anterior, media, and posterior fossae. We performed a complete resection of symptomatic lesions using a bifrontal craniotomy. The histopathological analysis determined RDD, therefore, we started steroid treatment. Our case description is due to the diagnosis and location, one of the rarest reported to date in the literature.

Primary spontaneous intracerebral hemorrhage in COVID-19 patients: differences among presentation patterns - A systematic review

OBJECTIVE

The objective of this study was to determine if there are differences between the presentation patterns of hemorrhagic stroke (HS) associated to COVID-19.

METHODS

It was performed a systematic search based on PRISMA guidelines of the cases reported in PUBMED of HS associated to SARS-CoV-2 infection and we added to this sample cases from our own hospital cohort. Patients in the database were separated by groups according to presentation symptoms: if they debuted with neurological symptoms or debuted with pulmonary symptoms.

RESULTS

Seventy cases were included in the study. Patients that debuted with pulmonary symptoms accounted for 68.6% of the cases with an interval between the development of symptoms and the presentation of HS of 15.6 days. We found that the use of anticoagulants during hospitalization, multifocal image pattern, and the elevation of D-dimer, Ferritin, and lactate dehydrogenase levels were significantly associated with the group of pulmonary presentation, whereas the presence of hypertension during hospitalization, and a lower hemoglobin level was associated with the group of neurologic symptoms.

CONCLUSION

Although HS associated with COVID-19 is a clinical entity with increasing evidence, it is necessary to establish that there are two forms of presentation with their own characteristics.

Stereotactic biopsy for intracranial space occupying lesions: Experience in a referral hospital in Mexico

BACKGROUND

Stereotactic brain biopsy (SBB) is used for establishing the histological diagnosis of intracranial lesions that are not amenable for a direct surgical approach.

OBJECTIVE

The objective of the study was to describe our experience having an evaluation of the biopsy sample by a neuropathologist during SBB.

MATERIALS AND METHODS

Retrospective analysis of 140 consecutive patients who underwent SBB between 2014 and 2018 in whom trans-operatory analysis of the sample was performed.

RESULTS

There were 56% men. The mean age was 45 years. Histological diagnosis was performed in 131 of 140 patients (94% overall diagnostic yield). The presurgical radiological diagnosis was correct in 39%. Neoplastic lesions were reported in 108 cases, and 32 were non-neoplastic. We performed craniotomy and resection after biopsy in 14%. We found complications in 6% of patients.

CONCLUSIONS

SBB continues to be a safe, useful, and inexpensive procedure. The diagnostic performance of SBB increases when intraoperative cytological evaluation by a neuropathologist is included in the study.

Incidence of neurosurgical pathology of the spine in population of Mexico City

BACKGROUND

Spine pathologies have been increased in the past years worldwide being important cause of disability which represents significant economic losses.

OBJECTIVE

The objective of the study was to establish the incidence of spinal neurosurgical pathology in a national reference hospital in Mexico City (General Hospital of Mexico "Dr. Eduardo Liceaga").

MATERIALS AND METHODS

A descriptive, observational, retrospective, and cross-sectional study was carried out, using the database of all patients that were undergoing spinal surgery from January 2015 to January 2020. Measures of central tendency and percentages, demographic variables, diagnosis, and affected segment were assessed.

RESULTS

A total of 341 cases were analyzed, the group of patients with degenerative disease represents the main cause of care followed by neoplasms; trauma and special cases of congenital type and reoperations were the less frequent pathologies between the groups. In general, the most affected age group was 51-60 years.

CONCLUSIONS

Within the study population, a wide range of diseases that affect the spine were treated, ranging from degenerative diseases, neoplasms, trauma, congenital, and infectious diseases.

Resection of meningiomas in a different location (sphenoid wing and tuberculum sellae) through a single craniotomy report of a case and review of the literature

Meningiomas are the most frequent extra-axial tumors of the nervous system. Multiple meningiomas are defined as the presence of two or more lesions that appear simultaneously or not, in different intracranial location, without association to neurofibromatosis. Each lesion must be evaluated individually for treatment, which consists in microsurgical resection in most cases. A 59-year-old woman presented with neurological symptoms from different anatomical site. Two extra-axial tumors of different location, at right sphenoid wing and the other in the tuberculum sellae were identified. Microsurgical resection was decided in one-step surgery, using the same craniotomy for both lesions with complete resection.

Hemorrhagic stroke associated to COVID-19 infection in Mexico General Hospital

INTRODUCCIÓN

en la actual pandemia de COVID-19, existe evidencia creciente que ha identificado el neurotropismo del virus SARS-CoV-2 y sus complicaciones neurológicas, incluida la enfermedad cerebrovascular isquémica y escasamente hemorragia cerebral (HC).

OBJETIVO

describir las características clínicas, radiológicas, de laboratorio y pronósticas de los pacientes con HC asociada al SARS-CoV-2.

MÉTODOS

se incluyeron pacientes consecutivos con prueba de PCR confirmatoria para infección por SARS-CoV-2 y HC.

RESULTADOS

en un período de 90 días, en un centro de referencia COVID-19 en México, de 1108 pacientes con infección por SARS-CoV-2, se encontraron 4 pacientes (0.36%) con HC. Tenían una edad de 71(±12.2) años, 2 eran mujeres. Se encontró que dos tenían factores de riesgo cardiovascular previos. En dos casos se encontró el origen en el núcleo dentado mientras que los otros dos correspondieron al tálamo. Tres de los cuatro pacientes murieron. Postulamos que el descontrol hipertensivo, coagulopatía, trombocitopenia y la respuesta inmune inducida por el virus SARS-CoV-2 podrían desencadenar HC en un paciente con riesgo previo.

CONCLUSIONES

la HC se asocia a la infección por SARS-CoV-2 con mal pronóstico cuando se presenta. Los equipos de neurocirugía deben estar preparados para el tratamiento oportuno de estos pacientes.

INTRODUCTION

In the current COVID-19 pandemic, there is a growing body of evidence that has identified the neurotropism of the SARS-CoV-2 virus and its neurological complications, including cerebrovascular disease, focusing mainly in ischemic and scarcely about hemorrhagic stroke (HS).

OBJECTIVE

The objective of the study was to describe clinical, radiological, laboratory tests, and prognostic characteristics of patients with SARS-CoV-2 associated HS.

METHODS

Consecutive patients with a confirmatory PCR test for SARS-CoV-2 infection and a HS demonstrated by head CT were included in the study.

RESULTS

Over a period of 90 days, in a COVID-19 reference center in Mexico, out of a total of 1108 patients with SARS-CoV-2 infection, it found 4 patients (0.36%) who meet criteria. They had an age of 71 (±12.2) years, 2 were women. It was found that two had prior cardiovascular risk factors. Two of the HS originated in the dentate nucleus while the other two corresponded to the thalamus. Three of the four patients died. We suggest that catastrophic uncontrolled blood pressure, coagulopathy, thrombocytopenia, and immune response induced by SARS-CoV-2 could in a specific patient trigger HS.

CONCLUSIONS

HS is associated to SARS-CoV-2 infection with poor prognosis when it presented. Neurosurgery teams should prepare for the timely and appropriate treatment of this patients.

Abdominal trauma: experience of 4961 cases in Western Mexico

Introduction

Trauma is a leading cause of morbimortality in the world. Intraabdominal compartment is the third most affected anatomical region and bleeding from this origin is difficult to identify, therefore the importance to predict possible lesions to the abdominal cavity.

Objective

To describe and analyze the sociodemographic profile and injuries found in patients with abdominal trauma in a western hospital in Mexico.

Method

Consecutive patients included in the local registry GDL-SHOT were analyzed.

Results

From 4961 patients, 91.4% were men, with a mean age of 28.7 years. Regarding the mechanism of trauma, 39.7% were stab wounds, 33% blunt abdominal trauma and 27.3% gunshots. The most affected organs were: small bowel (20.9%), liver (18.2%), and colon (14.2%). The mean hospital stay was 6.95 days with a mortality of 6.74%.

Conclusion

In Mexico, abdominal trauma represents an important cause of morbidity and mortality, especially in young patients. We found an important amount of penetrating trauma.