Search

Schwannomas are common slow growing benign tumors. About 25-45% of all schwannomas arise in the head and neck region. Less than 4% of these tumors are found in sinonasal regions and usually affect nasal ethmoid. There are very few case reports of a schwannoma arising from the sphenoid sinus. We report a case of sphenoid sinus schwannoma treated by microscopic decompression and review the relevant literature.

Spinal aneurysms (SAs) are rare lesions. The clinicoradiological features and the exact degree of their association with comorbid conditions such as arteriovenous malformations (AVMs) and coarctation of the aorta have not been definitively described. The ideal management paradigm has not been established. The authors reviewed literature to determine the clinical patterns of presentation, management, and outcome of spinal aneurysms.A systematic review of literature was performed using 23 separate strings. A total of 10,190 papers were screened to identify 87 papers that met the inclusion criteria. A total of 123 SAs could be included for analysis.The mean age of patients at presentation was 38 years; 10% of patients were aged less than 10 years and nearly 50% were greater than 38 years. Spinal aneurysms can be divided into 2 groups: those associated with AVMs (SA-AVMs, or Type 1 SAs) and those with isolated aneurysms (iSAs, or Type 2 SAs). Patients with Type 2 SAs were older and more likely to present with bleeding than those with Type 1 SAs. The acute syndromes can be divided into 3 groups of patients: those with spinal syndrome, those with cranial/craniospinal syndrome, and those with nonspecific presentation. Overall, 32.6% presented with angiography-negative cranial subarachnoid hemorrhage (SAH). Presentation with evidence of cord dysfunction (myelopathy/weakness/sensory loss/bladder involvement) correlated with poor outcome, as did presentation with hemorrhage and association with other comorbid conditions. Surgery and endovascular therapy both led to comparable rates of complete aneurysm obliteration for Type 2 SAs, whereas for the AVM-associated Type 1 SAs, surgery led to better rates of lesion obliteration. The authors propose a classification scheme for spinal aneurysms based on whether the lesion is solitary or is associated with a coexistent spinal AVM; this would also imply that the ideal therapy for the aneurysm would differ based on this association.The clinical and radiological patterns that influence outcome are distinct for Type 1 and Type 2 SAs. The ideal treatment for Type 1 SAs appears to be excision, whereas surgery and endovascular therapy were equally effective for Type 2 SAs.

A field experiment (2007–2016) was conducted to evaluate the performance of guava based hortipasture system in under rainfed situation in semi-arid condition. The experiment consisted 12 treatments i.e. 2 cultivars (Shweta and Lalit) with pasture (Cenchrus ciliaris + Stylosanthes hamata) under 6-treatment viz., vegetative barrier, staggered trenches (2m x 0.50m x 0.50m), stone mulch in basin (locally available stone in 50 cm radius), guava + pasture (without soil and water conservation), sole pasture and sole guava. The cultivar Lalit produced better yield (20 percent higher) as compared to Cv. Shweta. Over the nine years the average yield of pasture production with staggered trenches was higher (7.0 t DM/ha) followed by vegetative barriers (6.4 t DM/ha) as compared to control (T4). The minimum pasture production (5.3 t DM/ha) was recorded with stone mulch in basin. The pasture production in association with tree was little higher (6.1 t DM/ha) as compared to sole pasture (6.0 t DM/ha).

Management of giant intracranial aneurysms presents unique challenges to the neurosurgical team. Various techniques such as adenosine-induced hypotension, rapid ventricular pacing, and inducing deep hypothermia are described in the literature to effect circulatory arrest for the successful obliteration of giant aneurysms. We describe a novel technique of induced hypotension for clipping a giant aneurysm by using an inflatable balloon across the main pulmonary artery with a successful outcome. This technique has not been described earlier in the literature.

In this report the authors describe a rare case of a fulminant, pyogenic, necrotizing infection of the spinal cord and brain. Necrotizing lesions of the brain and spinal cord are usually infectious in origin and are associated with high rates of morbidity and death. Although the pathogens responsible have been identified in a few instances, the causal factors remain unknown in many cases. An 11-year-old girl developed acute, rapidly progressive paraplegia with bladder involvement and sensory loss below T-10. She had been treated recently for a Staphylococcus aureus infection of the knee joint precipitated by a penetrating injury with organic matter in the aftermath of a cyclone. Although appropriate antibiotic therapy was instituted, the spinal cord infection progressed to involve the entire spinal cord, brainstem, and brain. This fulminant course was marked by a rapid deterioration in the patient's clinical condition, ultimately leading to her death. Magnetic resonance imaging demonstrated a previously undescribed pattern of longitudinal enhancement along the spinal cord, as well as the white matter tracts in the brainstem and brain. The possible route of spread of infection along the neuraxis is postulated to be the potential space along the white matter tracts. Treatment is not standardized due to the rarity of the condition.

Retrograde intubation is a well established technique for intubating a patient with difficult airway. Since the first description of retrograde intubation in 1960 several modifications have been reported. However, all techniques require a cricothyroid membrane puncture by a thick needle usually

Study design This is a clinical case report with a review of relevant literature. Objective To describe a case of Larsen syndrome with C3-C4 spondyloptosis and atlantoaxial dislocation in a middle-aged female patient and to discuss management strategies. Summary of background data Spondyloptosis of the cervical spine is relatively rare and is caused by trauma, destruction of the vertebral bodies by tumors, or tuberculosis. Such gross vertebral displacement is usually associated with significant neurological deficits. Larsen syndrome is characterized by multiple joint displacements and can, very rarely, be associated with nontraumatic spondyloptosis of the cervical vertebra. A single case report of C1-C2 joint laxity causing atlantoaxial dislocation in a patient with Larsen syndrome is available in literature. No reports of any patient (with Larsen syndrome or nonsyndromic) who had both cervical spondyloptosis and atlantoaxial dislocation are available in literature. Methods A 36-year-old female presented with chronic neck pain, bilateral hand deformity, and mild spasticity involving all 4 limbs. Cervical radiograph, computed tomographic scan, and magnetic resonance image revealed C3-C4 spondyloptosis and atlantoaxial dislocation. Results A combined ventral decompression of subaxial spine and instrumentation from C2 to C5, followed by posterior C1-C2 distraction arthroplasty and lateral mass stabilization of the subaxial spine up to C6, was done. The cervical deformity was corrected, and the patient remains symptom free. Conclusion Patients with spondyloptosis of the cervical spine can rarely present with chronic neck pain and minimal neurological deficits. An additional pathology, such as atlantoaxial dislocation, can add to the complexity. Circumferential stabilization and fusion would be required in such cases to achieve a good outcome. Larsen syndrome is a rare cause of nontraumatic cervical displacements.

A 42-year-old man presented with frequent minor nasal bleeds since 1 month. He was undergoing chemotherapy for pulmonary tuberculosis. MRI brain revealed a space occupying lesion in the right cavernous sinus extending to sphenoid sinus, with T2 inversion. An initial diagnosis of fungal granuloma was made and endoscopic trans-nasal biopsy was attempted. During surgery, a pink pulsating mass was seen in the sphenoid sinus and the procedure was abandoned. A cerebral CT-angiography done subsequently revealed a giant right cavernous segment internal carotid artery (ICA) aneurysm. He was then referred to our centre and upon admission he collapsed secondary to a major bout of epistaxis. An emergency cervical carotid artery ligation resulted in transient control of epistaxis. Owing to recurrence of bleed, trapping of the aneurysm was done resulting in cure. The present case shows that a giant cavernous ICA aneurysm can occasionally be erroneously diagnosed as fungal granuloma.

Primary intraosseous spinal malignant peripheral nerve sheath tumor (MPNST) is exceedingly rare. MPNST with multifocal origin has been described to occur in the extremities. Such a lesion has not been described to occur in the spine. We describe a case of multifocal spinal MPNST and to review the literature relevant to this rare entity and its management. A 40-year-old immunodeficient patient presented with rapidly progressive paraparesis and mid back ache. Despite aggressive surgical decompression, he developed multiple metastases 3 months after surgery. However, he remained stable for 1 year without any adjuvant therapy. Presently, he has received palliative radiotherapy for spinal recurrence and cerebral metastasis. Multifocal spinal MPNST is a rare lesion. In this instance, the multifocality of the disease and its odd location could be attributed to the immunodeficiency state. The prolonged survival could be due to an improvement in his immune status due to HAART.

To investigate the acceptability and feasibility of using short message services (SMS) via cell phones to ensure adherence to management prescriptions by diabetic patients.Type 2 diabetic patients with 5 or more years of diabetes and having HbA1c between 7.0% to 10% were randomized to the control arm (n = 105) to receive standard care and to the intervention arm (SMS, n = 110). Messages in English on principles of diabetes management were sent once in 3 days, the contents and frequencies varied as per the patients' preferences. The study duration was 1 year. All participants were advised to report for quarterly clinic visits. A comparative assessment of the clinical, biochemical and anthropometric outcomes was made among the groups at the annual visit.Annual review was possible in 71% of intervention group and 63% of control group. SMS was acceptable to the patients and the median number requested was 2 per week. HbA1c and plasma lipids improved significantly in the SMS group.The pilot study showed that frequent communication via SMS was acceptable to diabetic patients and it helped to improve the health outcomes.

A spectrum of both radiosensitive and radio-resistant lesions occurs in the region of the posterior third ventricle (PTV). Most of these are associated with hydrocephalus requiring a cerebrospinal fluid diversion procedure. The present study aims to assess the effectiveness of endoscopic biopsy and third ventriculostomy (ETV) in these patients. Twenty-four patients with PTV lesions with moderate to severe hydrocephalus were managed prospectively. All patients underwent ETV and biopsy of the lesion during the same procedure. The ETV could be performed in all patients, where as in 23, a successful biopsy could be obtained. The ETV was successful in 22 patients; it failed in 2 patients requiring shunt insertion. A positive biopsy was obtained in all the patients (pinealocytoma 4, pinealoblastoma 10, embryonal cell carcinoma 1, germinoma 2, oligodendroglioma 1, astrocytoma 2, tuberculoma 4). All patients were subsequently managed with further surgery, radiation, and chemotherapy either alone or in combination depending on the pathology. One patient with a tumor bed hematoma required clot evacuation. The follow-up period ranged from 12 to 36 months. Two patients died, one during hospital stay with a tumor bed hematoma and another at 6 months follow-up due to extensive leptomeningeal spread. The high yield of endoscopic biopsy (100%) and success of ETV (91%) emphasizes its role in management of the diverse group of PTV lesions in arriving at the optimal definitive management.

A neural network approach is used for detection of structural damage in a helicopter rotor blade using rotating frequencies of the flap (transverse bending), lag (in-plane bending), elastic torsion and axial modes. A finite element method is used for modeling the helicopter blade. Radial basis function (RBF) neural networks are used and several combinations of modes are investigated for training and testing the neural network. Using the first 10 modes of the rotor blade for damage detection yields accurate results for the soft in-plane hingeless rotor considered in this study. Using a parametric study of the blade rotating frequency in conjunction with the neural network, it is found that a reduced measurement set consisting of five modes (the first two torsion modes, the second lag mode and the third and fourth flap modes) also gives good results for damage detection. Furthermore, taking only the first four flap modes also results in good damage detection accuracy. Three rotating frequency sets are therefore identified in this paper for structural damage detection in a helicopter rotor using RBF neural networks.

A case of left parietal calvarial actinomycotic osteomyelitis in a young woman is described. She had no predisposing illnesses. She had delivered a live child at term and presented in the puerperal period. No extracranial focus of infection was identified. She responded well to a combination of surgery and medical therapy and had an excellent outcome. The authors emphasise the importance of establishing a histopathological diagnosis since radiological signs are non-specific and unreliable.

Herpes simplex encephalitis (HSE) is a leading cause of sporadic, nonepidemic viral encephalitis in children and adults. We report a very rare case of HSE with involvement of bilateral thalamus, putamen, upper pons and midbrain, with development of extrapyramidal symptoms which responded to corticosteroid therapy. A 15-mth-old female baby admitted with complaint of fever for 5 days and generalised tonic clonic seizure 10 hours before admission. On clinical examination patient was drowsy, temperature was 39.4 degrees C and vitals were stable with signs of increased intracranial tension. There were no signs of meningeal irritation. Patient gradually become unconscious in the next few hours and pupils were constricted bilaterally with development of atonia in all four limbs and neck muscles. Doll's eye phenomenon was absent.

An obstetric patient who had no significant risk factors developed a spinal epidural haematoma remote from the site of needle puncture (for administration of spinal anaesthesia). The clinical deficits were manifest after recovery from the motor blockade had started a phenomenon that we have termed as a ‘spinal lucid interval’. The patient developed flaccid paraplegia with a sharp sensory level and urinary retention. The patient underwent emergency laminectomy and evacuation of the haematoma. She gradually recovered near normal power and was ambulant independently and had normal sphincter function at follow-up.

Tubercular abscess of the brain is a rare form of central nervous system tuberculosis. These lesions usually occur in the supratentorial compartment. They are associated with a state of immune deficiency. We report two immunocompetent individuals with tubercular abscess of the cerebellum and discuss the management of these lesions.

Ventriculoperitoneal shunt-associated ventriculitis is a serious though under-reported nosocomial complication of neurocritical settings. The treatment of CNS Methicillin-resistant Staphylococcus aureus (MRSA) infections is usually successful with vancomycin or linezolid. Here, we report a case of ventriculitis due to MRSA following a shunt infection, which did not show clinical response to linezolid therapy. With the increasing use of invasive procedures, nosocomial infections have increased exponentially. Exercising extreme care in such CNS procedures becomes very important.

Enterogenous cyst is extremely rare in the supratentorial compartment. Two adult patients with histologically variefied supratentorial entrogenous cyst are described. Light microscopy and immunohistochemistry examination revealed the endodermal origin of the cyst. Enterogenous cyst should be considered in the differential diagnosis of non-enhancing cyst in the supratentorial compartment. Total excision of the cyst wall should be done wherever feasible. Preventing spillage of the cyst contents during surgery is mandatory to avoid postoperative intractable seizures and craniospinal dissemination.