Hydrocephalus of King Charles II of Spain, the Bewitched King.

King of the Spanish Habsburg dynasty and sovereign of the overseas Spanish Empire, Charles II of Spain, was physically disabled, disfigured, mentally retarded, and he proved impotent. He is known in history as El Hechizado (the Bewitched) because both him and the people believed that his mental and physical incapacity were due to a "witchcraft act." Although several authors speculated about different diseases, most of them genetic such as pituitary hormone deficiency, distal renal tubular acidosis, Klinefelter syndrome, fragile X syndrome, or male XX hermaphroditism, the hypothesis of hydrocephalus was not taken into account. We don't have clear elements to hypothesize a certain etiology of Charles II' hydrocephalus; however, we think the herpetic infection he suffered of after his birth should not be ignored

Prognostic factors in atypical meningiom

Atypical meningioma represent an intermediary group between the benign meningioma (grade I) and anaplastic meningioma (grade III), and are known for high recurrence rate and short life expectancy. After modification of the classification World Health Organization in 2007, subsequent studies have tried to find prognostic factors for recurrence and survival, which are inconstant from author to author. This paper aims to present a short review of the most important prognostic factors in atypical meningioma

To be or not to be a neurovascular conflict: importance of the preoperative identification of the neurovascular conflict in the trigeminal neuralgia

The trigeminal neuralgia caused by neurovascular compression is a neurosurgical pathology requiring the preoperative identification as exact as possible of the neurovascular conflict. In this case, neuroimaging is very useful, as it allows not only the determination of the neurovascular conflict of the trigeminal nerve, but also the correct indication of an adequate surgical approach

Myasthenia Gravis – a beginning with no end

Myasthenia gravis is one of the neurological diseases with a relatively recent history, full of mistakes, in which the British and German neurology schools have attempted to find answers when confronted with the unknown. The paper aims at making a historical account of the disease from its discovery in the 16th century, when the first case of myasthenia gravis was medically diagnosed, to the beginning of the 20th century, when the dawn of modern therapy started to show

Mirror, mirror on the wall, who’s the fairest of them all? Atypical meningioma associated with multiple meningiomas

The incidence of multiple meningiomas (MMs) without stigmata of neurofibromatosis or family history of meningiomatosis is rare. MMs with atypical histology are even rarer, since most of them have benign histology. The authors report three cases of MMs, of which the symptomatic meningioma removed was an atypical meningioma (AM). We also review their possible pathogenesis and histopathology. Although there has not been established any MMs management and therapy strategy so far, our recommendation is to treat symptomatic and accessible lesions or growing tumours and also to prefer a conservative approach consisting of the imaging follow-up of asymptomatic lesions

Falx cerebri tuberculoma mimicking en plaque meningioma: Case report

Background: The involvement of falx cerebri in tuberculosis is extremely rare, with only three cases reported so far in the literature. The diagnosis is most often difficult to establish, given the location of the lesion, making surgical intervention necessary for a definite histopathologic diagnosis. Methods: We present the case of a 49-year old female patient who was admitted for a right jacksonian seizure, followed by a right crural monoparesis, without a history of tuberculosis. The lesion mimicked a falx cerebri en plaque meningioma in the imaging tests. Results: A complete surgical excision was performed through a left fronto-parietal parasagittal approach. The histopathological examination revealed a case of cerebral tuberculosis. The surgical treatment was complemented postoperatively with antituberculous therapy. Conclusion: In this article, we emphasize the rarity of the lesion at this level and also presenting similar cases from the literature. Moreover, we also discuss epidemiological, clinical, imaging, therapeutic as well as pathological aspects of en-plaque dural tuberculoma

Orbitocranial penetrating injury by a metallic foreign body: Case report and anatomical considerations

Orbitocranial penetrating injuries (OPI) represent a rare type of head injuries encountered in clinical practice. These appear after falls or motor vehicle accidents and are more frequent among children. We present the case of a male patient with OPI, associated with large frontal hemorrhagic contusion, with minimal periorbital trauma findings related to brain injury. Knowing and understanding the clinical anatomy of the orbit and the patterns of injuries in OPI are mandatory, since failure in detecting intracranial complications may lead to the increase of the neurological morbidity, visual loss and death

Biblical descriptions of spinal neurological and neurosurgical pathology

The Holy Bible includes descriptions of the spine with both neurosurgical and neurological implications and most spinal disorders presented have been briefly described and display a mystical nature. The Holy Bible is a book full of sacred precepts and not a medical encyclopedia as it was written in the context of that age, and in a language that had to be understood by people of that era. This paper aims to give a short presentation of several diseases of the spine mentioned in the Holy Scripture in order to identify the most common disease among the Jews during biblical times and attempts to provide their diagnosis

Where is the contre-coup? Atypical localization of occipital brain contusion

Most traumatic brain injuries with occipital impact cause frontal and temporal contre-coup lesions, while patients with coagulopathies are more susceptible to such lesions. We present the case of a chronic ethylic patient with thrombocytopenia, who was treated for ethanol withdrawal syndrome at a psychiatric service. The head CT scan revealed an occipital contusion with atypical localization and the absence of fronto-temporal contre-coup lesions. In conclusion, it is recommended a head CT scan to chronic alcoholic patients with psychiatric manifestations, especially in the context of systemic coagulopathies related to excessive alcohol consumption. In the case of chronic ethylic patients that frequently display systemic coagulation disorders, the head CT scan is necessary at the first psychiatric manifestations

The Lion Heart of a Neurosurgeon: the Stress during a Life of Neurosurgery

Neurosurgery is a rewarding career choice in which there are many challenges and stress factors that can lower the level of satisfaction and also increase the levels of burnout. The identification and management of common work-related stressors is important for improving the performance of health-care specialists and also for providing high-quality patient care