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Frič R, Heier I, Züchner M, Gjertsen Ø, Rezai M. Cerebrospinal fluid-lymphatic fistula in a child with generalized lymphatic anomaly treated with targeted blood patch - a rare case report and review of the literature. Childs Nerv Syst 2024; 40:1301-1305. [PMID: 38236406 PMCID: PMC10973078 DOI: 10.1007/s00381-024-06287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
Spontaneous intracranial hypotension may result in debilitating postural headaches and severe neurological symptoms due to secondary cerebellar sagging. The most common cause is the cerebrospinal fluid (CSF) leak within the spinal canal. Although previously reported in only a few cases, also paraspinal lymphatic malformations causing vertebral bone destruction may occasionally result in CSF leak to these pathological formations. Here, we present a case of a 9-year-old girl with generalized lymphatic anomaly (GLA) presenting with severe postural headache. Radiological imaging revealed a typical feature of cerebellar sagging. Myelography localized the CSF leakage into vertebral bodies of C7 and Th1, which both were partly involved in pathological paravertebral masses of known lymphatic anomaly, and from there along the right C8 nerve root sleeve into the anomaly. As the C8-nerve root could not be ligated due to the risk of significant neurological injury, we attempted image-guided targeted percutaneous epidural placement of a blood patch directly into the foramen at the affected level. The procedure resulted in obliteration of the fistula and regression of cerebellar sagging, with significant relief of symptoms. Although it is an extremely rare coincidence, patients with paraspinal lymphatic malformations may develop intraspinal CSF leak into these pathological formations. The present case report suggests that besides a direct surgical obliteration of the fistula and sacrificing the nerve root, a targeted percutaneous epidural blood patch may be a possible alternative in the case of a functionally important nerve root.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O.Box 4950, N-0424, Oslo, Norway.
| | - Ingvild Heier
- Department of Pediatric Hematology and Oncology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Mark Züchner
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O.Box 4950, N-0424, Oslo, Norway
| | - Øivind Gjertsen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Mehran Rezai
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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Ricci KW, Iacobas I. How we approach the diagnosis and management of complex lymphatic anomalies. Pediatr Blood Cancer 2022; 69 Suppl 3:e28985. [PMID: 33844431 DOI: 10.1002/pbc.28985] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/29/2021] [Accepted: 02/13/2021] [Indexed: 12/26/2022]
Abstract
Complex lymphatic anomalies (CLA) are congenital diseases of the lymphatic circulation system that are associated with significant morbidity and early mortality. While guidelines for the comprehensive evaluation of the CLA were recently published, the diagnostic approach and medical management are not standardized. This article presents the clinical features of four CLA: Gorham-Stout disease, generalized lymphatic anomaly, kaposiform lymphangiomatosis, and central collecting lymphatic anomaly. We also offer three cases from the authors' practice and our views on diagnostic testing and disease management including supportive care, medical therapies, and other interventions.
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Affiliation(s)
- Kiersten W Ricci
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Hematology and Hemangioma and Vascular Malformation Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ionela Iacobas
- Department of Pediatrics, Baylor College of Medicine, Vascular Anomalies Center at Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
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Maroufi SF, Habibi Z, Dabbagh Ohadi MA, Mohammadi E, Nejat F. Gorham-Stout disease of skull base leading to cranial settling and rhinorrhea: a case-based review. Childs Nerv Syst 2022; 38:695-703. [PMID: 35217940 DOI: 10.1007/s00381-021-05394-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Gorham-Stout disease (GSD) is a rare progressive osteolytic disorder, theoretically caused by lymphovascular endothelial proliferation. Spinal involvement carries a dismal prognosis because of neurological consequences. Lesions of the skull base are extremely rare and entail even more devastating prognosis due to cervical instability and cerebrospinal fluid (CSF) leakage. Due to scarcity of this condition, the aim of this study was to give an overview of skull base GSD and review the cases with such condition reported in the literature. METHODS In this case-based review, different aspects of skull base GSD are discussed, and a sample clinical case of GSD leading to cranial settling and rhinorrhea is presented. The characteristics, symptoms, and managements of all English-language PubMed-reported cases were reviewed, and different features of presentation and methods of treatments were analyzed. RESULTS Based on the literature review, most of the cases encountered serious problems in the course of the disease. Meningitis/CSF leakage was detected in 12 of 26 collected cases, followed by hearing loss/tinnitus/otitis media in 10 cases, headache in 8, and neck pain/stiffness in 8 patients. Despite a variety of treatments, improvement was only observed in 8 of 26 collected cases. The reminders showed either stable condition or worsening and death. CONCLUSION All cases of GSD of the skull base should be evaluated for rhinorrhea/otorrhea and cranial settling, both of them being among the most life-threatening conditions. Since definite treatment, in order to stop disease progression, is sometimes impossible, symptomatic and supportive treatment should be started as possible.
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Affiliation(s)
- Seyed Farzad Maroufi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, 1419733151, Tehran, Iran
| | - Zohreh Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, 1419733151, Tehran, Iran.
| | - Mohammad Amin Dabbagh Ohadi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, 1419733151, Tehran, Iran
| | - Esmaeil Mohammadi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, 1419733151, Tehran, Iran
| | - Farideh Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, 1419733151, Tehran, Iran
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Predisposing conditions for bacterial meningitis in children: what radiologists need to know. Jpn J Radiol 2021; 40:1-18. [PMID: 34432172 PMCID: PMC8732808 DOI: 10.1007/s11604-021-01191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
A variety of underlying diseases can predispose infants and children to bacterial meningitis (BM). For the diagnosis, treatment, and prevention of its recurrence, radiologists should be familiar with its predisposing conditions so that they can suggest the appropriate imaging approach. Predisposing conditions of BM can be broadly classified into two categories: infection spread from the adjacent tissue to the cerebrospinal fluid (CSF) space and immunodeficiency. Diseases in the former category are further divided according to regardless of whether there is a structural defect between the CSF space and the adjacent tissue. When a structural defect is suspected in a patient with BM, computed tomography (CT) of the head and magnetic resonance (MR) imaging are first-line imaging examinations. Radionuclide cisternography should be implemented as a second-line step to identify the CSF leak site. In patients with suspected parameningeal infection without any structural defect, such as sinusitis or otitis media/mastoiditis, CT or MR images can identify not only the disease itself but also the associated intracranial complications. The purpose of this article is to discuss the diagnostic approach and imaging findings associated with the variety of conditions predisposing patients to recurrent BM, focusing on the role of radiology in their management.
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Vanishing Act: Gorham-Stout Disease Leading to Dynamic Cerebrospinal Fluid Abnormalities. J Neuroophthalmol 2019; 38:419-421. [PMID: 29016411 DOI: 10.1097/wno.0000000000000577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Simon F, Luscan R, Khonsari RH, Toubiana J, Belhous K, James S, Blauwblomme T, Zerah M, Denoyelle F, Donadieu J, Couloigner V. Management of Gorham Stout disease with skull-base defects: Case series of six children and literature review. Int J Pediatr Otorhinolaryngol 2019; 124:152-156. [PMID: 31195309 DOI: 10.1016/j.ijporl.2019.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/04/2019] [Accepted: 06/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gorham-Stout disease (GSD) is a rare lymphatic disorder which results in bone destruction. Defects of the skull base are difficult to manage, we describe cases to better understand the disease and discuss treatment. METHODS Retrospective study including all patients treated for GSD skull-base defects. Medical records, clinical, imaging and treatment data were studied. A systematic review of the literature included case reports of the diseases for further analysis. RESULTS 6 patients (5 males, 1 female) were included. Mean age at diagnosis was 3.5 years (range 0-10). Follow-up was of 5.2 years. Patients were divided into Naso-temporal (NT) and Vertebro-temporal (VT) groups following anatomical location. NT patients (4 patients) all had petrous defects extending anteriorly, including sphenoid, ethmoidal and mandibular defects. They all had cerebro-spinal fluid leak (CSF) and recurrent meningitis (range from 3 to 7). Two of those patients had sequelae including deafness, paralysis and epilepsy. VT patients (2 patients) all had temporal, occipital bone and cervical vertebrae defects. None had CSF leaks but both died from medullar compression (preceded by tetraparesis in one case). Overall, five out of six patients had type I Chiari malformation. Interferon seemed to be the most efficient medical treatment. Surgery included petrectomy, endonasal surgery for CSF leak management and neurosurgery for medullar management but could not guarantee long-term effects. CONCLUSION Main issues in skull base defects are CSF leaks and medullar compressions. Surgical treatment is necessary in both cases but can only be satisfactory if general medical treatment can stabilise the disease.
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Affiliation(s)
- François Simon
- AP-HP, Hôpital Necker-Enfants Malades, Department of Paediatric Otolaryngology, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France.
| | - Romain Luscan
- AP-HP, Hôpital Necker-Enfants Malades, Department of Paediatric Otolaryngology, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
| | - Roman H Khonsari
- AP-HP, Hôpital Necker-Enfants Malades, Department of Maxillo-facial and Plastic Surgery, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
| | - Julie Toubiana
- AP-HP, Hôpital Necker-Enfants Malades, Department of General Paediatrics and Paediatric Infectious Diseases, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
| | - Kahina Belhous
- AP-HP, Hôpital Necker-Enfants Malades, Department of Radiology, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
| | - Syril James
- AP-HP, Hôpital Necker-Enfants Malades, Department of Neurosurgery, Paris Descartes University, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
| | - Thomas Blauwblomme
- AP-HP, Hôpital Necker-Enfants Malades, Department of Neurosurgery, Paris Descartes University, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
| | - Michel Zerah
- AP-HP, Hôpital Necker-Enfants Malades, Department of Neurosurgery, Paris Descartes University, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
| | - Françoise Denoyelle
- AP-HP, Hôpital Necker-Enfants Malades, Department of Paediatric Otolaryngology, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
| | - Jean Donadieu
- AP-HP, Hôpital Armand-Trousseau, Department of Hematology and Paediatric Oncology, Pierre et Marie Curie University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - Vincent Couloigner
- AP-HP, Hôpital Necker-Enfants Malades, Department of Paediatric Otolaryngology, Paris Descartes University, 149 Rue de Sèvres, 75015, Paris, France
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Cerebrospinal fluid leakage and Chiari I malformation with Gorham's disease of the skull base: A case report. Neurol Neurochir Pol 2017; 51:427-431. [DOI: 10.1016/j.pjnns.2017.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/17/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022]
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Patel MK, Mittelstaedt BR, Valentin FE, Thomas LP, Carlson CL, Faux BM, Hsieh DT. Increased Intracranial Pressure in a Boy with Gorham-Stout Disease. Case Rep Neurol 2016; 8:66-71. [PMID: 27194986 PMCID: PMC4868927 DOI: 10.1159/000445318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Gorham-Stout disease (GSD), also known as vanishing bone disease, is a rare disorder, which most commonly presents in children and young adults and is characterized by an excessive proliferation of lymphangiomatous tissue within the bones. This lymphangiomatous proliferation often affects the cranium and, due to the proximate location to the dura surrounding cerebrospinal fluid (CSF) spaces, can result in CSF leaks manifesting as intracranial hypotension with clinical symptoms to include orthostatic headache, nausea, and vertigo. We present the case of a boy with GSD and a known history of migraine headaches who presented with persistent headaches due to increased intracranial pressure. Although migraine had initially been suspected, he was eventually diagnosed with intracranial hypertension after developing ophthalmoplegia and papilledema. We describe the first known instance of successful medical treatment of increased intracranial pressure in a patient with GSD.
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Affiliation(s)
- Manisha K Patel
- Departments of Pediatrics, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA
| | - Brent R Mittelstaedt
- Departments of Ophthalmology, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA
| | - Frank E Valentin
- Departments of Ophthalmology, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA
| | - Linda P Thomas
- Departments of Radiology, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA
| | - Christian L Carlson
- Departments of Radiology, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA
| | - Brian M Faux
- Departments of Pediatrics, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA; Division of Pediatric Neurology, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA
| | - David T Hsieh
- Departments of Pediatrics, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA; Division of Pediatric Neurology, San Antonio Military Medical Center, JBSA, Fort Sam Houston, Tex., USA
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Suero Molina EJ, Niederstadt T, Ruland V, Kayser G, Stummer W, Ewelt C, Rössler J. Cerebrospinal fluid leakage in Gorham-Stout disease due to dura mater involvement after progression of an osteolytic lesion in the thoracic spine. J Neurosurg Spine 2014; 21:956-60. [PMID: 25325172 DOI: 10.3171/2014.8.spine131064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with Gorham-Stout disease (GSD), a rare disease of poorly understood etiopathophysiology, suffer from progressive osteolysis. Destruction of bone matrix is caused by lymphatic vessels, which can lead to CSF leakage if parts of bony structures adjacent to CSF spaces are involved. So far, fewer than 200 patients have been reported in the literature; only 4 of these patients presented with CSF leakage. The authors report the case of a 30-year-old man with GSD and CSF leakage due to dura mater involvement after progression of an osteolytic lesion in the thoracic spine. Neurosurgical intervention, including dura repair, was needed. Experimental medical therapy with rapamycin was started, leading to disease control for more than 12 months. Progression of GSD can lead to destruction of the meninges, causing CSF leakage. The authors review 4 other cases reported in the literature and discuss therapeutic options.
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10
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Gorham-Stout syndrome affecting the temporal bone with cerebrospinal fluid leakage. Int J Pediatr Otorhinolaryngol 2013; 77:1596-600. [PMID: 23827687 DOI: 10.1016/j.ijporl.2013.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/02/2013] [Indexed: 11/24/2022]
Abstract
Gorham-Stout syndrome is a rare disorder characterized by progressive osteolysis that leads to the disappearance of bone. Lymphvascular proliferation causes the local destruction of bony tissue. Owing to the low incidence of this syndrome, little is known about its etiology or treatment. We present an 11-year-old girl with Gorham-Stout syndrome that involved right petrous apex in temporal bone and upper clivus, which cause intracranial pressure increase and cerebrospinal fluid (CSF) leakage. The patient required surgical repair of CSF leakage by extradural middle fossa approach with temporal fascia flap. Combined treatment with interferon and propranolol prevented the progression of osteolysis.
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Yasan H, Köroğlu M, Çiriş M, Tüz M. Lymphangioma of the middle ear and mastoid simulating chronic otitis media with effusion. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.pedex.2010.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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A case of middle-ear cavernous lymphangioma with facial palsy. The Journal of Laryngology & Otology 2010; 125:405-9. [PMID: 21205371 DOI: 10.1017/s0022215110002598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Only a few benign tumours of the middle ear have been reported to lead to the development of facial palsy. Here, we describe a patient with middle-ear cavernous lymphangioma and facial palsy. STUDY DESIGN Single case study. PATIENT A 61-year-old man presented with left-sided hearing impairment and incomplete left facial palsy. A tumour was confirmed to be occupying the epi- to mesotympanum and to be joined to the facial nerve. The tumour was removed along with facial nerve tissue, which was resected at its horizontal portion, and the remaining facial nerve was fixed by end-to-end anastomosis. Complete facial paralysis occurred after the operation, but the patient's House-Brackmann grade gradually improved to grade III. Post-operative histopathological examination revealed infiltration of the lymphangioma into the facial nerve tissue, together with mild neural atrophy of the facial nerve. CONCLUSION These findings suggested that tumour invasion was the cause of facial palsy in this patient.
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Abstract
OBJECTIVE To describe the clinical course, diagnostic features, and treatment of a case of Gorham-Stout syndrome involving the petrous apex and causing chronic cerebrospinal fluid (CSF) leak. STUDY DESIGN Clinical capsule report. SETTING Academic pediatric hospital. PATIENT A 12-year-old boy presented with a destructive lesion of the right petrous apex and a 1-month history of headache, nausea, and vomiting. INTERVENTIONS Computed tomographic and magnetic resonance imaging revealed a nonenhancing lytic lesion of the right petrous apex and mandibular condyle. The lesions were bright on T2-weighted imaging with high signal intensity extending into the surrounding soft tissues. Leptomeningeal enhancement and an opening pressure of 0 cm of water on lumbar puncture suggested chronic CSF hypotension. Initial surgical exploration revealed diffuse infiltration of CSF into the soft tissue lateral to the temporal bone. Subsequent middle ear and mastoid obliteration was performed to definitely repair the CSF leak. RESULTS The clinical presentation, physical, laboratory, radiologic, and operative findings are consistent with a diagnosis of Gorham-Stout syndrome. In this case, lymphangiomatosis led to massive osteolysis of the petrous apex with CSF fistula into the surrounding soft tissues and middle ear with chronic intracranial hypotension. CONCLUSION This is the second report of chronic CSF leak resulting from lymphangiomatosis of the cranial base (Gorham-Stout syndrome).
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Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clin Microbiol Rev 2008; 21:519-37. [PMID: 18625686 DOI: 10.1128/cmr.00009-08] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Recurrent bacterial meningitis is a rare phenomenon and generally poses a considerable diagnostic challenge to the clinician. Ultimately, a structured approach and early diagnosis of any underlying pathology are crucial to prevent further episodes and improve the overall outcome for the affected individual. In this article, we are reviewing the existing literature on this topic over the last two decades, encompassing 363 cases of recurrent bacterial meningitis described in 144 publications. Of these cases, 214 (59%) were related to anatomical problems, 132 (36%) were related to immunodeficiencies, and 17 (5%) were related to parameningeal infections. The review includes a detailed discussion of the underlying pathologies and microbiological aspects as well as recommendations for appropriate diagnostic pathways for investigating this unusual entity.
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Shivaram GM, Pai RK, Ireland KB, Stevens KJ. Temporal progression of skeletal cystic angiomatosis. Skeletal Radiol 2007; 36:1199-204. [PMID: 17912518 DOI: 10.1007/s00256-007-0378-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 07/31/2007] [Accepted: 08/14/2007] [Indexed: 02/02/2023]
Abstract
Cystic angiomatosis is a rare, benign, multifocal disorder of bone and viscera, in which angiomatous deposits of both vascular and lymphatic elements result in bone lysis and organ dysfunction. We report on a case of late-onset cystic angiomatosis in a Caucasian woman who first presented at age 35 years with a lytic expansile lesion of the proximal humerus, initially diagnosed as low-grade hemangio-endothelioma. This was treated with injection of cement and prophylactic pinning. However, the lesion continued to grow, and, 5 years later, she was discovered to have disseminated bony involvement, initially thought to represent metastatic disease. However, further investigation revealed a diagnosis of cystic angiomatosis, and the patient was treated with bisphosphonates. Follow-up over a 15-year period since her initial presentation at age 35 years has shown osteosclerotic conversion of many of the lesions, with development of numerous pathologic stress fractures that have failed to heal, despite operative intervention.
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Affiliation(s)
- Giridhar M Shivaram
- Department of Radiology, Stanford University School of Medicine, Room S-062A, Grant Building, 300 Pasteur Drive, Stanford, CA 94305-5105, USA
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Pavanello M, Piatelli G, Ravegnani M, Consales A, Rossi A, Nozza P, Milanaccio C, Carbone M, Cama A. Cystic angiomatosis of the craniocervical junction associated with Chiari I malformation: case report and review of the literature. Childs Nerv Syst 2007; 23:697-700. [PMID: 17219234 DOI: 10.1007/s00381-006-0274-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 09/08/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cystic angiomatosis of the skull and spine is an exceptionally rare, benign vascular lesion. Both the vertebral bones and the skull may be affected. Diagnosis and treatment of this disease is multidisciplinary. DISCUSSION Histological examination is ultimately required to make a diagnosis. When the craniocervical junction is involved, the site of biopsy should be carefully selected so as to reduce procedure-related morbidity, including cerebrospinal fluid leakage and spinal deformity. We present a case report of a 4-year-old boy with cystic angiomatosis of the skull base and upper cervical spine associated with a Chiari I malformation and provide a review of the pertinent literature.
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Affiliation(s)
- Marco Pavanello
- Department of Neurosurgery, Giannina Gaslini Institute, Genoa, Italy
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17
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Tomishima T, Saitoh Y, Nishida T, Morris S, Maruno M, Yoshimine T. Lymphangiomatosis of the skull. Case illustration. J Neurosurg 2003; 98:1319. [PMID: 12816282 DOI: 10.3171/jns.2003.98.6.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Takahiro Tomishima
- Department of Neurosurgery, Osaka University Medical School, Suita, Osaka, Japan
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18
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Hoşoğlu S, Ayaz C, Ceviz A, Cümen B, Geyik MF, Kökoğlu OF. Recurrent bacterial meningitis: a 6-year experience in adult patients. J Infect 1997; 35:55-62. [PMID: 9279725 DOI: 10.1016/s0163-4453(97)91001-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ten adult patients with recurrent bacterial meningitis (RBM) of 22 episodes were diagnosed and treated at the Dicle University Hospital from January 1990 to December 1995. Apart from 22 episodes of RBM these patients had an additional 25 episodes treated at other hospitals. The RBM attacks developed after closed head trauma in four patients, asplenia and chronic otitis media in one patient, chronic otitis media and oto-mastoiditis in one patient, chronic maxillary sinusitis in one patient, chronic mastoiditis in one patients, and suppurative foci of facial bones caused by shrapnel pieces and no predisposing condition in one patient. In 10 RBM episodes, Streptococcus pneumoniae was isolated from cerebrospinal fluid (CSF) and/or blood culture, and in one episode Proteus vulgaris was isolated from CSF and otitis media suppuration. In the four episodes both cultures were negative, but direct microscopy showed Gram-positive diplococci on Gram-staining. Three of the patients died from meningitis-related complications.
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Affiliation(s)
- S Hoşoğlu
- Department of Infectious Diseases and Clinical Microbiology, Dicle Universitesi Tip Fakültesi Enfeksiyon Hastaliklari Anabilim Dah, Diyarbakir, Turkey
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Soler R, Pombo F, Bargiela A, Graña J, Arnal F. Diffuse skeletal cystic angiomatosis: MR and CT findings. Eur J Radiol 1996; 22:149-51. [PMID: 8793438 DOI: 10.1016/0720-048x(95)00733-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R Soler
- Department of Radiology, Hospital Juan Canalejo, La Coruña, Spain
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