Neoplastic growth of cerebral cavernous malformation presenting with impending cerebral herniation: A case report and review of the literature on de novo growth of cavernomas

Background: Cerebral cavernomas are rare vascular anomalies and their expansile growth has been considered to be mainly due to recurrent hemorrhages. They are not generally reported to show aggressive behavior.Case description: A 27-year-old male presented with headache, visual disturbances, and a 17-year history of seizures. He was known to have a temporal lobe lesion on CT scan, consistent with a diagnosis of cavernous malformation but with no relevant family history. Serial clinical and radiological follow-up revealed a progressive increase in the size of the lesion with formation of a growing cyst of 7 cm in diameter, which produced mass effect, resulting in the clinical picture of cerebral herniation. The patient underwent emergency surgical resection with symptomatic relief. There was no evidence of significant hemorrhage at surgery.Conclusion: Cavernous malformations can show expansile growth without any evidence of a presaging hemorrhagic event and, in the manner of a neoplastic lesion, present with raised intracranial pressure and cerebral herniation

Chance-type flexion-distraction fracture of lumbar spine

A case of a twenty years old male who had been hit by a van at the lower back, presented two weeks later with complete paraplegia and double incontinence is presented. Radiological imaging revealed shearing of spine with fracture line slicing through the second lumbar (L2) vertebra going across all the three vertebral columns with complete retrolisthesis of upper fragment. He was managed conservatively with immobilization and rehabilitation

Extradural granulocytic sarcoma causing acute paraparesis

A case of 9 years old female presenting with rapidly progressive paraparesis during remission phase of acute myeloblastic leukemia is reported. Radiological imaging revealed an extradural mass in the upper dorsal spine producing significant cord compression. The patient showed a dramatic neurological recovery after spinal cord decompression and subsequently treated with appropriate chemotherapy and local radiotherapy

Gas-producing brain abscess

A case of a known psychiatric patient who presented with rapid neurological deterioration is reported. Neuroimaging revealed a gas-producing brain abscess in left parietal lobe with a contiguous focus of infection in the adjacent bone and scalp initiated by obsessive scalp scratching. On complete surgical excision of abscess, followed by culture-based antibiotic therapy, a good neurological recovery was achieved with minimal residual deficits at follow-up

Isolated Sacral Metastasis Mimicking a Chordoma Presenting as a First Manifestation of Thyroid Malignancy: Case Report

Fifty-nine years old female presented with the clinical manifestations of lumbosacral plexopathy. MR imaging revealed a large destructive pelvic mass of sacral origin, mimicking a sacral chordoma. Histopathological findings are suggestive of follicular variant of papillary carcinoma of thyroid origin. There was no clinically palpable thyroid lesion or any clinical feature suggestive of thyroid dysfunction. This report describes an isolated sacral metastasis of thyroid origin without prior clinical features of thyroid malignancy. Keywords:  Sacral metastasis, Thyroid metastasis, sacral chordoma, spinal metastasis, sacral tumor, pelvic tumors

Peritumoral cystic meningioma

A case of 39 years old male is described who presented with headache, right-sided focal fits and decreased power in the right hand. CT scan brain showed a left fronto-parietal cystic lesion with centrolateral intramural nodule with homogenous enhancement. At surgery, the extra-axial lesion with cyst containing xanthochromic fluid had a well-defined capsule that could easily be separated from the peri-lesional cortical surface. The dural-based nodule with its cyst wall was resected in toto. The histopathology of mural nodule was reported as meningioma while the cyst wall histology revealed meningothelial cells

An audit of head trauma care and mortality

Objective: To analyze the factors contributing to deaths from head trauma by using standardized assessment parameters and to provide a peer-review of head injury deaths with focus on identifying deficiencies and analyzing contributory factors.Design: Descriptive study.Place and duration of study: The study was carried out at the Emergency, Aga Khan University Hospital during January 1998 to December 1999.Subjects and method: One hundred and three patients above the age of 15 years presenting alive to the Aga Khan University Hospital (AKUH) emergency with head injury were included in this study. Identified deaths data was reviewed by the Hospital Trauma Peer Review Committee and consensus arrived at for categorization of deaths. The potential deficiencies in care were identified and final recommendations made. The data was computed on CDC Trauma Registry (V 3.0) and SPSS (V 8.0).Results: Mean age was 31.9 years (n=103) with predominant male population (4:1). Severe head injury (GCS\u3c8) accounted for 21.3 % (n=22) of all cases with a total number of deaths being 12.6 % (n=13). Deaths were categorized preventable in 3 cases with non-preventable and potentially preventable in 4 and 6 cases respectively. Road traffic accidents were the predominant mechanism (n=8) in all deaths (n=13). The time interval in relation to mortality was biphasic, most deaths occurring either within 24 hours or between 3-7 days of injury. Inappropriate pre-hospital treatment, pre-hospital delays and inappropriate mode of transportation without inter-hospital communication were the process-related defects in pre-hospital care with major determinant of deaths outside AKUH (n=5). Prolonged emergency stay, delayed intensive care availability were the process-related deficiencies whereas inappropriate initial resuscitation, inappropriate initial head injury management were provider-related deficiencies in in-hospital care.Conclusion: Transfer of inappropriately managed patients, lapses in inter-hospital communications, delayed transfers were identified as the major pre-hospital factors whereas lack of ICU beds, portable ventilators in emergency room, delays in CT scan facilities were the deficiencies in the hospital services. Opportunities for improvement in head trauma care are needed to focus on initial resuscitation and appropriate surgical management

Long scarf injuries

Long scarf (Dopatta) traditionally worn by females in South-East Asia have been described to make the females prone to sustain specific injuries when they ride pillion on the cycle powered rickshaw or motor bike. Two cases of females have been described

Bionomic Studies of \u3ci\u3ePapilio demoleus\u3c/i\u3e Linnaeus, the Citrus Butterfly, (Lepidoptera: Papilionidae), from Lower Sindh, Pakistan

Biological parameters of Papilio demoleus Linnaeus, the Citrus Butterfly, in Tando Muhammad Khan, lower Sindh, Pakistan are presented. This major agricultural pest was reared on Murraya koenigii (L.) Spreng. (Curry Leaf) and ten different varieties of Citrus sp. (Citrus) plants. The length of the adult mating period ranged 5 to 8 hours. Following mating, females laid 27.7 ± 3.3 eggs. Eggs hatched in 1.5 to 7 days. Mean durations of larval instars were 1.8 ± 0.1 (minimum) and 2.9 ± 0.1 (maximum) days respectively. Pupal duration was 5.5 to 20 days. Biotic factors including predators [praying mantis, ants, Common Garden Lizard (Calotes versicolor)] and parasitoids [Trichogramma chilonis, Pteromalus puparum] played a significant role in mortality in all stages of the butterfly. Survival in most life stages had a negative correlation with temperature. Thirteen generations of P. demoleus per year were recorded. The feeding effect of Curry Leaf and ten different Citrus varieties on butterfly survival was examined. The Growth Index value was highest on Citrus aurantiifolia (Kaghzi Lime) and lowest on Murraya koenigii (Curry Leaf). The effect of artificial diets on adults was studied; only a 15% honey solution increased fecundity rate and survival of the adults

Craniocerebral aspergillosis in immunocompetent hosts: Surgical perspective

Craniocerebral aspergillosis is a rare but dangerous variety of central nervous system infections. Surgery is being widely recognized as the cornerstone of management. Due to the rarity of the disease, difficulty and delay in diagnosis and poor outcome, there is very little in the literature regarding the various surgical strategies that may be adopted in these patients. Early aggressive surgery followed by chemotherapy offers the best chances. Surgical planning would depend upon the type and location of the disease process as well as the condition of the patient. Perioperative care holds immense importance and knowledge of possible complications is essential. Aspergillosis of the central nervous system is difficult to diagnose and equally difficult to treat. Surgery remains the cornerstone of management followed by systemic antifungal medications. Results are better in immunocompetent patients as compared to those who are immunocompromised