Aspergillus flavus-Induced Brain Abscess in an Immunocompetent Child : Case report

Intracranial aspergillosis is an extremely rare manifestation of invasive aspergillosis in immunocompetent children and is associated with high morbidity and mortality. We report a 12-year-old immunocompetent male child who was referred to the King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, in May 2010 after a sudden-onset headache and loss of consciousness. Brain imaging revealed a large right space-occupying occipital lesion and the patient underwent a craniotomy and resection. Histopathology of the lesion revealed necrotising granulomatous fungal encephalitis with many hyphae engulfed by multinucleated giant histiocytes. Two days later, a computed tomography scan showed debulking of the fungal mass and the patient was discharged on oral voriconazole. However, imaging at a six-week follow-up showed progression of the abnormality. A residual or persistent fungal brain lesion was suspected. Further neurosurgical resection of the lesion was performed and cultures showed growth of Aspergillus flavus. The patient was treated successfully with antifungal therapy over the following two years

Spectrum of Skull Lesions in Pediatric Population: A Single Institutional Experience

Background: Pediatric skull lesions are rare. Here, a single institutional experience dealing with such lesions is presented.Methods: A retrospective review of 18 consecutive pediatric patients was done, who were treated for a variety of skull lesions at Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh from 2010 to 2015. The clinical and pathological features, diagnosis, management and outcome were noted and analyzed.Results: In this study, eighteen skull lesions were identified in 10 male (55%) and 8 female (44%) patients, with a mean age at diagnosis of 9.5 years. These lesions were usually benign and most commonly presented as a painless mass (n = 11). Fronto-orbital (n = 6) was the most frequent site encountered in this study followed by temporo-parietal (n = 3) and parieto-occipital area (n = 2). Gross total resection achieved in 15 patients (83.3%) and reconstruction of skull defect was possible in 11 (61.1%) of them. Excluding the malignant lesions, no recurrence was found in this study cohort for a mean follow up time of 2.8 years.Conclusions: Majority of the skull lesions in children are benign. Pre-operative angiography and embolization is helpful to reduce the intraoperative blood loss. Gross total resection with reconstruction is the treatment of choice. Recurrence is uncommon after gross total resection

Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation

The ventriculoperitoneal (VP) shunt is a common procedure in pediatric neurosurgery that carries a risk of complications at cranial and abdominal sites. We report on the case of a child with shunt infection and malfunction. The peritoneal catheter was tethered within the abdominal cavity, precluding its removal. Subsequently, laparoscopic exploration identified a knot at the distal end of the peritoneal catheter around the omentum. A new VP shunt was inserted after the infection was healed. This type of complication occurs rarely, so there are a limited number of case reports in the literature. This report is complemented by a literature review

Cauda equina syndrome as the initial presenting clinical feature of medulloblastoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Medulloblastoma is one of the most common pediatric brain malignancies. The usual presenting clinical features are related to posterior fossa syndrome or/and hydrocephalus. Cauda equina syndrome is a very rare presentation for this disease.</p> <p>Case presentation</p> <p>We describe the case of a three-year-old boy with cauda equina syndrome as the initial presenting clinical feature for medulloblastoma. He was initially diagnosed as having a spinal tumor by magnetic resonance imaging scan. Subsequently, a cranial magnetic resonance imaging scan revealed a posterior fossa tumor with features of dissemination. He had substantial improvement after treatment. This case report is complemented by a literature review related to this unusual presentation.</p> <p>Conclusions</p> <p>Medulloblastoma primarily presenting with cauda equina syndrome is very rare. However, spinal drop metastasis should be considered in the pediatric age group to avoid suboptimal management.</p