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Kajtazi NI, Al Ghamdi J, Al Amoudi R, Zakri A, Al Shakweer W, Bafaquh M. Extensive cerebral venous thrombosis after resection of third ventricle colloid cyst. Surg Neurol Int 2023; 14:201. [PMID: 37404486 PMCID: PMC10316143 DOI: 10.25259/sni_348_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/27/2023] [Indexed: 07/06/2023] Open
Abstract
Background The third ventricle colloid cyst (CC) is a benign growth usually located in the third ventricle and can cause various neurological symptoms, including sudden death. Modern surgical interventions may still result in a wide range of complications and cerebral venous thrombosis (CVT) is among them. Case Description A 38-year-old female with an existing diagnosis of diabetes mellitus (DM) and hypothyroidism and a 6-month history of headaches, blurred vision, and vomiting presented to our clinic 3 days after the headaches became excessively severe. Neurological examination on admission revealed bilateral papilledema without any associated focal neurological deficits. Brain computed tomography and magnetic resonance imaging confirmed the presence of a third ventricle CC and associated non-communicating hydrocephalus involving the lateral ventricles. As a result, the patient underwent emergency bilateral external ventricular drainage (EVD) insertion followed by a third ventricular CC excision under neuronavigation through a right frontal craniotomy. Twelve days postoperatively, the patient developed further headaches followed by a generalized tonic-clonic seizure that led to no postictal neurological deficits. Nonetheless, computed tomography venography of the brain revealed extensive thrombosis of the superior sagittal sinus, inferior sagittal sinus, right sigmoid sinus, and right internal jugular vein. A newly diagnosed CVT was treated with intravenous heparin. The patient was discharged with warfarin, which was discontinued after 12 months. Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from chronic mild headaches. Conclusion A preoperative venous study should be performed in all cases to gain a better understanding of the venous anatomy. We advocate meticulous microsurgical techniques to protect the venous system surrounding the foramen of Monro and reduce the amount of retraction during surgery.
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Affiliation(s)
- Naim Izet Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Department of Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Al Amoudi
- Department of Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amna Zakri
- Department of Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wafa Al Shakweer
- Department of Clinical Laboratory Administration, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Kajtazi NI, Bafaquh M, Rizvi T, Sheikh SE, Ghamdi JA, Amoudi RA, Jabbar AA, Shammari KA, Saqqur M, Ghamdi SA, Khoja W, Demchuk A, Senani FA, Luft AR. Ipsilateral weakness caused by ipsilateral stroke: A case series. J Stroke Cerebrovasc Dis 2023; 32:107090. [PMID: 37105128 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION There are few reported cases of ipsilateral weakness following ischemic or hemorrhagic stroke. In these rare cases, ipsilateral weakness is typically the result of damage to uncrossed components of the corticospinal tract (CST) which were recruited in response to previous CST injury. PATIENTS AND METHODS We report a series of six cases of acute ipsilateral weakness or numbness following a hemorrhagic or ischemic stroke from three medical institutions in Saudi Arabia. RESULTS Three of these patients presented with right-sided weakness caused by an ipsilateral right hemispheric stroke, while two exhibited left-sided symptoms and one had only left-sided numbness. In all six cases, the ipsilateral corona radiata, internal capsule, basal ganglia, insula, and thalamus were involved. No concomitant opposite hemisphere or brainstem lesion in none of the patients was evident. Two patients had previous strokes affecting the brainstem and left corona radiata, respectively. Complete stroke workup to reveal the cause of stroke was carried out, however no functional MRI was performed. CONCLUSION Ischemic or hemorrhagic stroke may indeed result in ipsilateral weakness or numbness, though in very rare cases. We assume that the most likely mechanism of their ipsilateral weakness subsequent to the ipsilateral stroke was a functional reorganization favoring CST pathways within the ipsilateral hemisphere.
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Affiliation(s)
- Naim I Kajtazi
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tanvir Rizvi
- Department of Medical Imaging, Neuroradiology, University of Virginia, United States
| | - Souda El Sheikh
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Al Amoudi
- Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Asma Al Jabbar
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Kareem Al Shammari
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maher Saqqur
- Department of Neurology, University of Alberta, Canada
| | - Saeed Al Ghamdi
- Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Waleed Khoja
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Fahmi Al Senani
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Andreas R Luft
- Department of Neurology, Switzerland & Cereneo Center for Neurology and Rehabilitation, University of Zürich, Vitznau, Switzerland
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Kajtazi NI, Manzoor MU, Ghamdi JA, Zahrani HA, Suwaidan FA, Qahtani SA, Bafaquh M. Right cerebellar stroke with a right vertebral artery occlusion following an embolization of the right glomus tympanicum tumor: Case report with literature review. J Cerebrovasc Endovasc Neurosurg 2022; 24:386-392. [PMID: 35818687 PMCID: PMC9829557 DOI: 10.7461/jcen.2022.e2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 01/21/2023] Open
Abstract
A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist.
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Affiliation(s)
- Naim I. Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA,Correspondence to Naim I. Kajtazi Department of Neurology, National Neurosciences Institute, King Fahad Medical City, 59046, Riyadh 11525, Kingdom of Saudi Arabia Tel +966-50-234-3276 E-mail
| | - Muhammad Usman Manzoor
- Medical Imaging Administration, Neurointervention Radiology, King Fahad Medical City, Riyadh, KSA
| | - Juman Al Ghamdi
- Medical Imaging Administration, Neurointervention Radiology, King Fahad Medical City, Riyadh, KSA
| | - Hanadi Al Zahrani
- Physical Medicine, Audiology Department, King Fahad Medical City, Riyadh, KSA
| | - Faisal Al Suwaidan
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA,Critical Care Department, Neuro Critical Care Unit, King Fahad Medical City, Riyadh, KSA
| | - Sultan Al Qahtani
- Medical Imaging Administration, Neurointervention Radiology, King Fahad Medical City, Riyadh, KSA
| | - Mohammad Bafaquh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
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Kajtazi NI, Khalid E, Ghamdi JA, Abulaban A, AlHameed MH. Severe ataxia uncovered Hodgkin's lymphoma: do not forget CT neck when looking for covert malignancy. BMJ Case Rep 2021; 14:e245225. [PMID: 34764117 PMCID: PMC8586887 DOI: 10.1136/bcr-2021-245225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/04/2022] Open
Abstract
A 53-year-old woman without medical problems presented with 5-month history of dizziness, difficulty speaking, severe ataxia, which worsened a day before admission to inability to stand unsupported. An extensive workup was initiated to find the cause of ataxia. The laboratory investigations and imaging of the brain and whole spine revealed no lesions. She was found to have autoimmune thyroiditis, positive coeliac disease antibodies without clinical features and vitamin D deficiency. No intravenous steroids or immunosuppressive therapy was given. Cerebrospinal fluid showed lymphocytic pleocytosis. The workup for the cause of severe ataxia revealed an oropharyngeal lesion with cervical lymph nodes, and the biopsy showed classical Hodgkin's lymphoma of mixed cellularity. She was treated with chemotherapy followed by radiation therapy and made a remarkable recovery, and currently, she is in remission without distant metastases, 5 years after the initial diagnosis. Her neurological status improved, and she remained with mild ataxia.
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Affiliation(s)
| | - Ehtesham Khalid
- Department of Neurology, Ideal Medicare Clinic, Multan, Punjab, Pakistan
| | - Juman Al Ghamdi
- Medical Imaging Administration, Intervention Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad Abulaban
- Neurology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Riyadh, Saudi Arabia
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Kajtazi NI, Nahrir S, Al Shakweer W, Al Ghamdi J, Al Fakeeh A, Al Hameed M. Malignant idiopathic intracranial hypertension revealed a hidden primary spinal leptomeningeal medulloblastoma. BMJ Case Rep 2021; 14:e243506. [PMID: 34321265 PMCID: PMC8319973 DOI: 10.1136/bcr-2021-243506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/04/2022] Open
Abstract
Frequently the cause of raised intracranial pressure remains unresolved and rarely is related to spinal tumours, moreover less to spinal medulloblastoma without primary brain focus. An 18-year-old woman had a 3-month history of headache and impaired vision. Neurological examination revealed bilateral sixth cranial nerve palsies with bilateral papilloedema of grade III. No focal brain or spine lesion was found on imaging. Consecutive lumbar punctures showed high opening pressure and subsequent increasing protein level. Meningeal biopsy was negative. At one point, she developed an increasing headache, vomiting and back pain. Spine MRI showed diffuse nodular leptomeningeal enhancement with the largest nodule at T6-T7. Malignant cells were detected in cerebrospinal fluid. She underwent laminectomy with excisional biopsy, and pathology showed medulloblastoma WHO grade IV. She was treated with chemotherapy and craniospinal irradiation and made a good recovery.
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Affiliation(s)
- Naim Izet Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shahpar Nahrir
- Department of Neurology, King Saud Medical Complex, Riyadh, Saudi Arabia
| | - Wafa Al Shakweer
- Pathology and Clinical Laboratory Administration Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Medical Imaging Administration, Intervention Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Al Fakeeh
- Department of Oncology, Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majed Al Hameed
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Kajtazi NI, Bafaquh M, Ghamdi JA, AlEissa Z, Shmeikh AA, Alsaeed A, Sulaiman T, Vizcaino MA, Al Hameed M, Raghunathan A. An Unusual Case of EBV-Negative Primary CNS Lymphoma of Natural Killer/T-Cell Lineage. Clin Med Insights Pathol 2021; 14:2632010X211065692. [PMID: 34927072 PMCID: PMC8671822 DOI: 10.1177/2632010x211065692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
Extranodal NK/T-cell lymphoma (ENKTL) is a well-defined cytotoxic lymphoma strongly associated with Epstein–Barr virus (EBV) infection, commonly affecting the nasopharynx and upper aerodigestive tract. Primary central nervous system (CNS) involvement is rare, and only 17 cases were previously reported in the literature. Here, we report the case of a 44-year-old male admitted with a 3-month history of personality changes and progressive right leg weakness. Brain magnetic resonance imaging studies (MRIs) revealed multiple rim-enhancing brain lesions bilaterally. An extensive clinical and laboratory workup was unrevealing, and 2 brain biopsies were initially considered inconclusive. Pertinently, no systemic lymphoproliferative disorder was identified. The patient initially experienced remarkable clinical improvement with dexamethasone, pulse methylprednisolone, and rituximab therapy. However, he eventually had rapid clinical deterioration, was found to have increased brain lesions, and died nearly 6 months after the initial presentation. During this time, the second brain biopsy was found to show involvement by T-cell lymphoma of NK-cell lineage, which was EBV negative. No post-mortem examination was done to identify any systemic lymphoma. This case serves to expand the spectrum of lymphomas involving the CNS.
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Affiliation(s)
- Naim I Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Juman Al Ghamdi
- Medical Imaging Administration, Neurointervention Radiology, King Fahad Medical City, Riyadh, KSA
| | - Zahra AlEissa
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Arwa Al Shmeikh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Ali Alsaeed
- Internal Medicine Department, Infectious Diseases, King Fahad Medical City, Riyadh, KSA
| | - Tarek Sulaiman
- Internal Medicine Department, Infectious Diseases, King Fahad Medical City, Riyadh, KSA
| | - M Adelita Vizcaino
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Majed Al Hameed
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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