Brain metastases from medullary thyroid carcinoma in a patient with multiple endocrine neoplasia type 2A

Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer occurring in less than 10% of patients with thyroid cancer. Brain metastasis from MTC is exceedingly rare. Only six cases of brain metastasis from MTC have been reported in the literature and none had MTC as a part of multiple endocrine neoplasia (MEN) syndrome. We report a 42-year-old Caucasian male with MEN 2A who presented with neurological symptoms 25 years after total thyroidectomy with lymphadenectomy for MTC metastatic to local lymph nodes. A brain magnetic resonance imaging (MRI) showed a 4-cm cystic mass and a 1-cm nodule in the left frontal-parietal lobe in addition to a 0.8-cm cystic mass in the left frontal lobe and multiple tiny cerebellar metastatic lesions. Partial resection of the cerebral metastasis followed by whole brain radiotherapy resulted in resolution of the neurological symptoms. However, the patient had multiple systemic metastasis from the MTC and he died of systemic complications due to metastatic MTC. To our knowledge this is the first report of brain metastases from MTC in a patient with MEN 2A.

Intracranial complications of temporal bone osteoradionecrosis

OBJECTIVE

To present four cases of life-threatening intracranial complications associated with temporal bone osteoradionecrosis.

STUDY DESIGN

This study was a retrospective case review of four patients combined with a literature review.

SETTING

All patients were treated at Loyola University Medical Center, which is a tertiary care facility.

PATIENTS

The four patients were retrospectively reviewed without demographic constraints.

INTERVENTIONS

All patients underwent preoperative radiographic assessment (magnetic resonance imaging/computed tomography scan), and three of the four patients underwent surgery.

MAIN OUTCOME MEASURE

The role of surgical intervention in the management of advanced temporal bone osteoradionecrosis.

RESULTS

Three patients underwent mastoid surgery after medical treatment of intracranial complications associated with temporal bone osteoradionecrosis. All three patients had dry, epithelialized mastoid cavities. One patient died as a result of meningitis.

CONCLUSIONS

Mastoid surgery should be used in the overall management of patients with advanced temporal bone osteoradionecrosis to prevent secondary intracranial complications.

Lack of evidence for sustained blood acetaldehyde concentrations during alcohol detoxification

Contrary to a published report, blood acetaldehyde concentrations become undetectable in patients 1--2 days following admission for alcohol detoxification. The persistently elevated blood acetaldehydes reported by others probably were due to artifactual formation during analysis. Nevertheless, our admission blood acetaldehyde concentrations are significant enough to support the contention that acetaldehyde has a cytotoxic role in alcoholic disease.