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Study Design Case report. Objective We present the first reported case of spontaneous spinal epidural hematoma secondary to calcium pyrophosphate crystal deposition disease (pseudogout) in a 75-year-old woman. Methods A retrospective review of the patient's case notes was undertaken and the limited literature on this subject reviewed. Results This patient presented with sudden-onset lower limb paresis, sensory loss, urinary retention, and back pain. Magnetic resonance imaging showed an epidural hematoma, which was evacuated. Histologic specimens of the clot showed calcium pyrophosphate dihydrate crystal deposits (pseudogout). Conclusion The importance of histopathologic review of surgical specimens is highlighted when considering the differential diagnosis of apparently spontaneous spinal epidural hematoma.

Introduction Differentiation of brain tumours from normal brain, during surgical resection is, in part, based on their differing mechanical properties. Brain tumours have variable stiffness characteristics. Surgical evaluations on stiffness are, at best, subjective. Ultrasound elastography is a non-invasive method for imaging mechanical properties of tissues such as stiffness at depth. It is hypothesized that this technique may assist in differentiating tumour from the brain in an intraoperative setting. Methods This study evaluated the feasibility of the intraoperative use of ultrasound elastography during brain tumour resection. A total of 24 patients were recruited for the study. Surgical findings on tumour stiffness were compared with the elastogram findings. Furthermore, visibility of the brain-tumour interface on ultrasound echography compared with ultrasound elastography was analysed. Results Ultrasound elastography was found to have a sensitivity of 100% and specificity of 75% at detecting that tumour had a different stiffness to the brain when compared with surgical findings. The technique was also found to have a 100% sensitivity and specificity at the detection of intratumoral stiffness heterogeneity compared with surgical findings. The presence of fluid-filled cysts limited the quality of the elastograms. Ultrasound elastography did not detect the brain-tumour interface as accurately as conventional echography. Conclusion These findings suggest that ultrasound elastography in combination with conventional B-mode ultrasound may be a useful adjunct to differentiate tumour from the brain.

Following craniotomy, the decision to resect a brain tumour is based on (1) the surgeon's interpretation of preoperative imaging, such as MRI, (2) correlating the imaging to the surgical field, (3) visual inspection of the surgical field, and (4) palpation thus providing biomechanical information on tumour and brain. There is a degree of subjectivity in the use of palpation for biomechanical evaluation. Ultrasound elastography is a technique for determining more objective biomechanical information at depth in the form of relative strain, thus indirectly stiffness, within an ultrasound scan plane. In addition, neuro-navigation techniques assist in correlating preoperative imaging to the surgical field. We present two cases where ultrasound elastography with co-registered MRI, using neuro-navigation, was used intra-operatively during brain tumour resection. Correlation with the co-registered MRI was excellent in both patients. Strain contrast between brain and tumour was evident in elastograms produced in both patients; the tumour had a lower strain, hence was stiffer compared with brain. When strain applied was increased slip between tumour and brain was detected. All these findings corresponded with the surgical findings. Ultrasound elastography with co-registered MRI is a promising imaging technique, which can be used intra-operatively to provide biomechanical information prior to resection.