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Wang H, Lin Q, Wang F, Yi Y, Xu X, Jiang J, Deng Q. Case report: A rare case of cerebral herniation during glioma resection in a syphilis-positive patient. Front Neurol 2023; 14:1196431. [PMID: 37638174 PMCID: PMC10447886 DOI: 10.3389/fneur.2023.1196431] [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: 04/01/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Acute intraoperative cerebral herniation is catastrophic in craniotomy and seriously affects the outcomes of surgery and the prognosis of the patient. Although the probability of its occurrence is low, it can lead to severe disability and high mortality. We describe a rare case of intraoperative cerebral herniation that occurred in a syphilis-positive patient. The patient was diagnosed with both glioma and syphilis. When the glioma was completely removed under the surgical microscope, acute cerebral herniation occurred. An urgent intervention in cerebral herniation identified a collection of colorless, transparent, and protein-rich gelatinous substances rather than a hematoma, which is a more commonly reported cause of intraoperative cerebral herniation in the literature. We have found no previous descriptions of such cerebral herniation during craniotomy in a patient with syphilis and glioma. We suspected that the occurrence of intraoperative cerebral hernia might be related to the patient's infection with syphilis. We considered the likelihood of an intraoperative cerebral herniation to be elevated when a patient had a disease similar to syphilis that could cause increased vascular permeability.
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Affiliation(s)
- Han Wang
- Department of Neurosurgery, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Qianli Lin
- Department of Clinical Lab, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Fang Wang
- Department of Clinical Lab, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Yong Yi
- Department of Neurosurgery, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Xiaoping Xu
- Department of Neurosurgery, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Jingcheng Jiang
- Department of Neurosurgery, The Second People's Hospital of Yibin, Yibin, Sichuan, China
| | - Qingshan Deng
- Department of Neurosurgery, The Second People's Hospital of Yibin, Yibin, Sichuan, China
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2
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Dasovic B, Ewa Borys, Schneck MJ. Granulomatous Diseases of the Central Nervous System. Curr Neurol Neurosci Rep 2022; 22:33-45. [PMID: 35138588 DOI: 10.1007/s11910-022-01173-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To discuss the pathophysiology, key clinical features, necessary diagnostic evaluation, and current treatment regimens for granulomatous diseases of the central nervous system. RECENT FINDINGS The diagnosis and management of granulomatous disease of the central nervous system has been revolutionized by advances in diagnostic imaging. Nevertheless, tissue and/or cerebrospinal fluid (CSF) sampling remains necessary to establish the diagnosis in most cases. Establishing a specific diagnosis is critical because treatment selection needs to focus on the granulomatous process centering on either antibiotic or immunosuppressive agents. Particular for non-infectious granulomatous disease more aggressive immunotherapies may help in clinical outcome. There are multiple non-infectious and infectious etiologies for granulomatous disease of the central nervous system. Clinical manifestations result from local structural invasion of granulomas or granulomatous inflammation of the blood vessels and meninges. Rapid diagnosis and specific treatment is essential.
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Affiliation(s)
- Braden Dasovic
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue Maguire Building Suite 2700, Maywood, IL, 60153, USA
| | - Ewa Borys
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue Maguire Building Suite 2700, Maywood, IL, 60153, USA
| | - Michael J Schneck
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue Maguire Building Suite 2700, Maywood, IL, 60153, USA.
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Haddad AF, Young JS, Morshed RA, Josephson SA, Cha S, Berger MS. Pseudo-insular glioma syndrome: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21481. [PMID: 35854917 PMCID: PMC9281470 DOI: 10.3171/case21481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lower-grade insular gliomas often appear as expansile and infiltrative masses on magnetic resonance imaging (MRI). However, there are nonneoplastic lesions of the insula, such as demyelinating disease and vasculopathies, that can mimic insular gliomas. OBSERVATIONS The authors report two patients who presented with headaches and were found to have mass lesions concerning for lower-grade insular glioma based on MRI obtained at initial presentation. However, on the immediate preoperative MRI obtained a few weeks later, both patients had spontaneous and complete resolution of the insular lesions. LESSONS Tumor mimics should always be in the differential diagnosis of brain masses, including those involving the insula. The immediate preoperative MRI (within 24–48 hours of surgery) must be compared carefully with the initial presentation MRI to assess interval change that suggests tumor mimics to avoid unnecessary surgical intervention.
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Affiliation(s)
| | | | | | | | - Soonmee Cha
- Radiology, University of California, San Francisco, San Francisco, California
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Negro A, Paolucci A, Russo C, Di Stasi M, Guerriero P, Arrigoni F, Bruno F, Pagnini F, Angileri SA, Palumbo P, Masciocchi C, Puoti G, Tortora F, Caranci F. Predictive factors of volumetric reduction in lumbar disc herniation treated by O2-O3 chemiodiscolysis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:89-97. [PMID: 32945283 PMCID: PMC7944679 DOI: 10.23750/abm.v91i8-s.9975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
Purpose: Aim of this study is to assess the effectiveness of O2-O3 percutaneous chemiodiscolysis by evaluating volumetric changes in lumbar disc herniation on magnetic resonance imaging, in order to identify possible pre-treatment factors affecting such changes Methods: Between January 2014 and December 2017, a total of 87 patients with low back pain and 103 lumbar disc herniations with MRI confirmation were considered for O2-O3 chemiodiscolysis. The volume of each herniated disc was determined before and after the treatment. Results: Multiple linear regression analysis showed a strong correlation between post-treatment LDH volume percent change and both pre-treatment LDH volume and pre-treatment EQ-VAS (p<0.05), while age showed only a weak positive correlation with post-treatment LDH volume percent change (p<0.1). No association was found for other factors, such as sex and herniation disc level. Conclusions: In conclusion, age, baseline LDH volume and self-assessed disease severity score could represent three easy accessible outcome predictive parameters to consider when intradiscal O2-O3 chemiodiscolysis is envisaged. Better results after intradiscal O2-O3 chemiodiscolysis were obtained in older patients with higher pre-treatment LDH volume and low-moderate pre-treatment EQ-VAS. (www.actabiomedica.it)
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Affiliation(s)
- Alberto Negro
- Ospedale del Mare - ASL NA1, Neuroradiology Unit,Dipartimento di Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'invecchiamento, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | | | - Camilla Russo
- Advanced Biomedical Sciences Department University of Naples "Federico II", Napoli, Italy.
| | - Martina Di Stasi
- Advanced Biomedical Sciences Department University of Naples "Federico II", Napoli, Italy.
| | - Pasquale Guerriero
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Francesco Pagnini
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Parma, Italy..
| | - Salvatore Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan University, Via Francesco Sforza, 35, 20122, Milan, Italy..
| | - Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Gianfranco Puoti
- Second Division of Neurology. Department of Advanced Medical and Surgical Sciences, Universityof Campania "Luigi Vanvitelli", Naples, Italy.
| | - Fabio Tortora
- Advanced Biomedical Sciences Department University of Naples "Federico II", Napoli, Italy.
| | - Ferdinando Caranci
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
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Jin H, Qu Y, Guo ZN, Cui GZ, Zhang FL, Yang Y. Primary Angiitis of the Central Nervous System Mimicking Glioblastoma: A Case Report and Literature Review. Front Neurol 2019; 10:1208. [PMID: 31798527 PMCID: PMC6863980 DOI: 10.3389/fneur.2019.01208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/30/2019] [Indexed: 01/29/2023] Open
Abstract
Primary angiitis of the central nervous system (PACNS) is a rare disorder resulting in idiopathic inflammation affecting the parenchymal and leptomeningeal vessels confined to the central nervous system (CNS), of which a tumor-like mass lesion is an even rare subtype. We described a case of PACNS initially misdiagnosed as glioblastoma. The patient was a 35 year-old female with right-sided weakness and expressive dysphasia. Brain MRI showed a tumor-like lesion highly suggestive of glioblastoma, therefor surgical removal was done. After a resection and an exhaustive workup, PACNS was ultimately diagnosed. The case illustrates a type of imaging presentation of PACNS that is often misdiagnosed as high-grade glioma. Differentiation between tumor-like PACNS lesions and actual CNS tumors is challenging due to similar MR images. To avoid unnecessary surgical interventions, we summarized previously reported mass-forming PACNS cases in adults from January 1, 2000, to December 31, 2018 and the imaging characteristics of PACNS. Some less commonly used diagnostic methods such as MR spectroscopy may also help clinicians distinguish PACNS from its mimics.
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Affiliation(s)
- Hang Jin
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Changchun, China
| | - Yang Qu
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Department of Neurology, Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
| | - Guo-Zhen Cui
- Department of Hepatology, Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Fu-Liang Zhang
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology, Stroke Center, The First Hospital of Jilin University, Changchun, China.,Department of Neurology, Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
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7
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Denny AM, Das SK. A case of central nervous system vasculitis presenting as a mass-like lesion. Childs Nerv Syst 2019; 35:1223-1226. [PMID: 30610477 DOI: 10.1007/s00381-018-04034-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022]
Abstract
Vasculitis of the central nervous system presenting as a mass lesion is a relatively uncommon occurrence. Even more uncommon is a vasculitis mimicking a demyelinating lesion. We present here an interesting case of a 15-year-old boy who was found to have a mass-like lesion on neuroimaging involving the left subcortical white matter and deep gray matter. The differential diagnosis for this lesion was primary demyelination versus a glial tumor, the former being more favored over the latter. Biopsy of this lesion however revealed findings compatible with a vasculitis, which was unexpected given the neuroimaging findings. To the authors' knowledge, case reports in the English literature of a vasculitic lesion mimicking demyelination are scarce. This case also serves as a reminder of the diagnostic difficulty that arises in a pediatric patient with an initial presentation of mass-like lesion.
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Affiliation(s)
- AnneMarie M Denny
- Division of Pediatric Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada.
| | - Sumit K Das
- Division of Neuropathology, University of Alberta Hospital, Edmonton, Alberta, Canada
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Al-Afif S, Hatipoglu Majernik G, Al Krinawe Y, Esmaeilzadeh M, Hartmann C, Krauss JK. The Role of Neurosurgery in the Treatment of Intracranial Tumor-Like Inflammatory Lesions. World Neurosurg 2018; 124:S1878-8750(18)32803-1. [PMID: 30554001 DOI: 10.1016/j.wneu.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Different inflammatory diseases can manifest as intracranial lesions. They may be indistinguishable from intracranial neoplasms in the clinical setting, imaging studies, or laboratory studies. The value of surgery in the diagnosis and the treatment of such lesions is still unclear. METHODS A total of 3066 reports of histopathologic examinations over a 10-year period were reviewed. Forty patients with an inflammatory intracranial lesion were identified. Clinical, radiologic, and follow-up data were analyzed and the diagnostic and therapeutic value of surgery was assessed. RESULTS We identified 24 women and 16 men (mean age, 47 years). The diameter of the lesion varied between 1 and 5.5 cm (mean, 2.6 cm). The location of the inflammatory lesion was intracerebral supratentorial (n = 18, 45%), intrasellar/suprasellar (n = 5, 12.5%), cerebellar (n = 5, 12.5%), in the brainstem (n = 4, 10%), in the cerebellopontine angle (n = 3, 7.5%), meningeal (n = 3, 7.5%), and at other locations (n = 6, 15%). Seventeen patients underwent surgical removal of the mass lesion, whereas in 23 patients a biopsy was taken. The lesions were classified into 7 groups: specific (infectious) granuloma (n = 10, 25%), unspecific granuloma (n = 7, 17.5%), idiopathic inflammatory pseudotumor (n = 5, 12.5%), demyelinating lesions (n = 5, 12.5%) encapsulated hematoma (n = 4, 10%), organized cerebral infarction (n = 3, 7.5%), and vasculitis (n = 4, 10%). Surgery was judged as valuable in 35 patients (87.5%). CONCLUSIONS The differential diagnosis of intracranial inflammatory lesions involves a wide spectrum. Surgery has a diagnostic and/or therapeutic value in most entities and clinical circumstances. However, attention must be taken to avoid surgery without a therapeutic or diagnostic value for the patient.
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Affiliation(s)
- Shadi Al-Afif
- Department of Neurosurgery, Institute for Pathology, Hannover Medical School, Hannover, Germany.
| | | | - Yazeed Al Krinawe
- Department of Neurosurgery, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Majid Esmaeilzadeh
- Department of Neurosurgery, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Institute for Pathology, Hannover Medical School, Hannover, Germany
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Teaching Neuroimages: Inflammatory CAA. Clin Neuroradiol 2018; 29:379-382. [DOI: 10.1007/s00062-018-0750-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
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10
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Barthélemy EJ, Park KB, Johnson W. Neurosurgery and Sustainable Development Goals. World Neurosurg 2018; 120:143-152. [DOI: 10.1016/j.wneu.2018.08.070] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 12/14/2022]
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Delgado-García G, Méndez-Zurita VA, Bayliss L, Flores-Rivera J, Fleury A. Neurocysticercosis: mimics and chameleons. Pract Neurol 2018; 19:88-95. [PMID: 30282762 DOI: 10.1136/practneurol-2017-001788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neurocysticercosis is the most common parasitic neurological disease worldwide, yet in Europe, it remains relatively uncommon, with many practitioners rarely seeing a case. However, immigration and international travel mean that it is becoming increasingly recognised and diagnosed in developed countries. Being a treatable condition, it is essential to be familiar with the diagnosis and to appreciate its mimics and breadth of its possible clinical presentations.
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Affiliation(s)
| | | | - Leo Bayliss
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Demyelinating Diseases Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Agnès Fleury
- Neurocysticercosis Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico .,Neuroinflammation Unit, Institute of Biomedical Research, National Autonomous, University of Mexico, Mexico City, Mexico
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