Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Vitamin B12 deficiency causes haematological, gastrointestinal and neurological diseases. Subacute combined degeneration (SCD) of the spinal cord is characterised by degeneration of the posterior and lateral columns. We report a case of SCD associated with nitrous oxide anaesthesia.
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Spontaneous intracranial hypotension (SIH) is a well-known clinical syndrome associated with the typical magnetic resonance imaging findings of pachymeningeal enhancement, downward cerebral displacement and subdural fluid collections. Atypical clinical presentations are not infrequent and often misdiagnosed. We report a case of SIH presenting with thunderclap headache and CT scan evocative of subarachnoid hemorrhage. We discuss the unusual presentation of this patient and the differential diagnosis of this case.
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Case Reports
Subacute onset of deafness and vertigo in a patient with leptomeningeal metastasis from ovarian cancer.
Ovarian carcinoma is a common gynecological malignancy. Distant metastases usually involve the liver and lung while neurological complications are rare. We describe the case of a 63-year-old woman diagnosed from an ovarian carcinoma with peritoneal seed, which was treated surgically and with chemotherapy. ⋯ Subsequently the patient rapidly deteriorated and eventually died. Involvement of VIII cranial nerve as the presentation of leptomeningeal carcinomatosis in ovarian carcinoma is rare. In the literature at least two other cases presented with deafness, suggesting that leptomeningeal carcinomatosis should be considered in the differential diagnosis when deafness appears in a cancer patient.
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Posterior cranial fossa tumours, not involving the cerebellopontine angle cistern, are a rare cause of trigeminal neuralgia (TN). We describe a patient with a large paramedian tentorial meningioma associated with acquired Chiari malformation who presented with TN. Trigeminal pain resolved after gross total tumour resection and postoperative magnetic resonance images disclosed a minimal residual tumour in the torcular region as well as ascent of cerebellar tonsils. In this article, we investigate the physiopathological hypotheses for this unusual association with emphasis on the role of tonsillar prolapse as neuropathological basis of neuropathic pain in this patient.