British journal of neurosurgery
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Review Case Reports
Isolated cervical intramedullary sarcoidosis--a histological surprise.
We present a case of cervical intramedullary sarcoidosis. A 56 year old woman presented with progressive paraesthesia affecting the lower limbs. ⋯ Pathology revealed this to be a granulomatous lesion with features indicative of sarcoidosis. Postoperatively, there was no change in her neurological function and her symptoms improved with steroid therapy.
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The pain of lumbar disc herniation is related to direct compression of the nerve root and to the foreign-body inflammatory response to the herniated disc material. In this study, we attempted to identify disc-related inflammation in trans-ligamentous extruded and sequestered lumbar disc herniation using gadolinium-DPTA-enhanced T1-weighted and short-time inversion recovery (STIR) magnetic resonance imaging. We assessed how these results related to each other, and to patients' clinical status, and to immunohistochemistry findings in disc specimens removed at surgery. ⋯ The study showed that the radiological and immunohistochemical evidence of inflammation in these cases does not correspond with patients' clinical pain profiles over time. It also revealed that STIR and contrast T1W are equally reliable for detecting inflammation in trans-ligamentous extruded or sequestered lumbar disc herniation. In future, studies that focus on physical and chemical mechanisms of pain in lumbar disc herniation in larger series of conservatively and surgically treated patients may clarify the link between inflammation and radicular pain in these types of disc herniation.
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Meningiomas account for 18-20% of all intracranial tumours and often recur despite surgical resection. Hydroxyurea is under evaluation as adjuvant therapy of meningiomas. In the authors' initial report of 17 patients with meningioma, hydroxyurea demonstrated modest efficacy, with a median time to progression (TTP) of 80 weeks. ⋯ Two patients had progressive disease after 10 weeks. Toxicity was mainly haematological. Hydroxyurea has modest activity against meningiomas and should be considered for patients who are poor surgical candidates, have unresectable or large residual meningiomas, or have progressed after surgical resection or irradiation, or both.
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Stab wound of the cervical spinal cord with ipsilateral vertebral artery injury is rare. We report a case of a penetrating injury by scissors to the cervical spinal cord and right vertebral artery. The management is discussed and literature reviewed.
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A rare case of supratentorial intraventricular schwannoma is described. A 16-year-old male with asymptomatic papilloedema was found to have a 5-cm intraventricular tumour arising from the trigone of the right lateral ventricle. A craniotomy and total macroscopic excision was performed.