Metameric spinal AVM: Long-term symptomatic relief achieved by embolization of the extradural component

BACKGROUND

Metameric spinal cord arteriovenous malformations (AVMs) are rare lesions characterized by an intradural and extradural component. They are difficult to treat surgically by the endovascular route. We report a case in which symptomatic relief was achieved by embolization of the extradural component only.

CASE PRESENTATION

A 35-year-old woman presented with acute worsening of back pain, weakness in the left leg and urinary retention. Spinal angiography showed a metameric spinal cord AVM with partial common venous drainage of the extradural and intradural components.

CONCLUSIONS

Targeted embolization of the extradural component led to dramatic improvement of the patient's symptoms, probably by achieving venous decongestion. She remains neurologically stable at two years' follow-up.

Botryomycosis

Botryomycosis is a rare chronic bacterial granulomatous disease that usually involves skin and rarely viscera. Main etiological agent is Staphylococcus aureus and less commonly Pseudomonas spp., Escherichia coli, Proteus spp., Streptococcus spp. We here report a case of 32-year-old male with polymicrobial botryomycosis on forehead and on frontal scalp. Culture from lesions revealed growth of S. aureus initially. Partial resolution was achieved with cefadroxyl and clavulanic acid, rifampicin, and linezolid. Subsequent repeat culture revealed E. coli sensitive to netilmycin. Slow and steady resolution was achieved with surgical debridement and combination therapy of injectable netilmycin and oral sufomethoxazole and trimethoprim for a prolonged period.

A Case of Ophthalmoplegic Migraine: Some Observations

We describe a 43-year-old man with a long-standing history of headache and ophthalmoplegia. Brain MRI showed a nodular enhancing lesion at the root exit zone of the left oculomotor nerve. Contrast enhancement on follow-up MRI and clinical symptoms showed a partial resolution on starting prophylactic anti-migraine medications. This was confirmed to be a case of ophthalmoplegic migraine. Here we describe a rare case of OM in an adult patient with its characteristic imaging pattern and the differential diagnosis considered.

Role of diffusion tensor imaging in differentiating subtypes of meningiomas

PURPOSE

Meningiomas are the most common extraaxial intracranial type of tumor, and their management and prognosis depend on their grade and histology. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are two new imaging techniques that have proved helpful in elucidating the microarchitecture of brain tumors. The aim of the present study was to assess the role of diffusion and diffusion tensor metrics in the identification and classification of meningioma grades and subtypes.

METHODS AND MATERIALS

A total of 21 consecutive patients with meningioma were included in this retrospective study, of whom 16 had benign meningiomas (three fibroblastic, 11 transitional/mixed, two meningothelial) and five had atypical meningiomas. Tumor mean diffusivity (Dav), fractional anisotropy (FA), linear anisotropy (CL), planar anisotropy (CP), spherical anisotropy (CS) and eigenvalues (e1, e2, e3) were measured in all cases, and differences in diffusion tensor metrics between atypical, fibroblastic and other benign (transitional, meningothelial) meningiomas were statistically analyzed using the Mann-Whitney test.

RESULTS

No statistically significant differences were found among the mean Dav values for atypical, fibroblastic and other benign meningiomas. Both atypical and fibroblastic meningiomas showed significantly higher mean FA values and lower mean CS values compared with other meningiomas (P<0.01), but no statistically significant difference in these values between each other. Atypical meningiomas showed higher CL values compared with fibroblastic and other benign meningiomas but, again, the difference was not statistically significant. Both atypical and fibroblastic meningiomas showed statistically significantly higher CP values and lower e3 values compared with transitional meningiomas (P<0.01).

CONCLUSION

These results suggest that diffusion tensor metrics may be helpful in the differentiation of atypical, fibroblastic and other benign meningiomas.

Right Third Nerve Palsy Caused by Extra-Axial Cavernoma in a Patient with Multiple Intracranial Cavernomas

We report an unusual case of a 54-year-old man with third nerve palsy caused by an extra-axial cavernoma in relation to the cisternal portion of the oculomotor nerve. In addition to this lesion, the patient had multiple intracranial cavernomas. Interestingly, an initial MRI without T2* gradient sequence missed the multiple cavernomas. A subsequent MRI done after one month showed an increase in size with fluid level within the extra-axial cavernoma.

In vitro and in vivo evaluation of guar gum matrix tablets for oral controlled release of water-soluble diltiazem hydrochloride

The objective of the study was to develop guar gum matrix tablets for oral controlled release of water-soluble diltiazem hydrochloride. Matrix tablets of diltiazem hydrochloride, using various viscosity grades of guar gum in 2 proportions, were prepared by wet granulation method and subjected to in vitro drug release studies. Diltiazem hydrochloride matrix tablets containing either 30% wt/wt low-viscosity (LM1), 40% wt/wt medium-viscosity (MM2), or 50% wt/wt high-viscosity (HM2) guar gum showed controlled release. The drug release from all guar gum matrix tablets followed first-order kinetics via Fickian-diffusion. Further, the results of in vitro drug release studies in simulated gastrointestinal and colonic fluids showed that HM2 tablets provided controlled release comparable with marketed sustained release diltiazem hydrochloride tablets (D-SR tablets). Guar gum matrix tablets HM2 showed no change in physical appearance, drug content, or in dissolution pattern after storage at 40 degrees C/relative humidity 75% for 6 months. When subjected to in vivo pharmacokinetic evaluation in healthy volunteers, the HM2 tablets provided a slow and prolonged drug release when compared with D-SR tablets. Based on the results of in vitro and in vivo studies it was concluded that that guar gum matrix tablets provided oral controlled release of water-soluble diltiazem hydrochloride.