Hidrosefalus Pada Anak

Hydrocephalus is a common clinical problem found in pediatric neurosurgical practice. This condition involves dilatation of cerebral ventricular system due to various etiologies. It is classified into two conditions, communicative and obstruction type. Various etiologies cause different clinical features and need different modality of treatments. Ventriculoperitoneal shunt is the gold standard of treatment, but Endoscopic 3rd ventriculostomy is considered as a treatment of choice nowadays. This article concerns all aspect of this condition: epidemiology, etiology, pathophysiology, simptoms and clinical findings, treatment, and prognosis

Unilateral moyamoya disease mimicking intracranial hemorrhage in a pediatric patient: Surgical treatment with encephalo-duro-myo-synangiosis in a progressive disease

Background: Moyamoya disease (MMD) is characterized by progressive bilateral internal carotid artery stenosis and its distal branches. When angiographic findings are unilateral, the diagnosis is considered to be probable MMD. Surgery is recommended treatment of patients with deterioration caused by progressive cerebral ischemic events. Different techniques have been described, and the encephalo-duro-myo-synangiosis (EDMS) procedure is highly recommended for patients with rapid deterioration. A case of unilateral MMD mimicking intracranial hemorrhage in a pediatric patient is reported. Case description: A 14-year-old girl was referred to our center due to a decreased level of consciousness. Physical examination revealed right-sided hemiparesis; however, a brain CT scan showed multiple hyperdense masses mimicking a hemorrhagic lesion. A brain MRI showed a large hypointensity in the temporoparietal, suggesting a vascular lesion. In all children that exhibit encephalitis, vascular events such as MMD should be considered. An emergency surgical EDMS procedure was performed, and the patient regained consciousness and exhibited no TIAs during the follow-up period. A postoperative brain MRI showed an improvement in brain vascularity. Conclusion: After EDMS, a considerable degree of neurological recovery was observed in our patient with rare unilateral MMD mimicking intracranial hemorrhage. We found that the progression of clinical improvement after indirect revascularization in our case was due to EDMS. Surgical treatment with EDMS is reasonable for MMD because it allows for flexible revascularization that adequately addresses the requirement for new blood supply in the ischemic lesion. The EDMS procedure is followed by an observation period to preclude the possibility of the patient developing definite MMD. Keywords: Unilateral moyamoya disease, Encephalo-duro-myo-synangiosis, Ischemi

Micropapillary Adenocarcinoma of the Lung that Metastasized to the Same Site in the Brain Twice: A Rare Case Report and Review of Literature

BACKGROUND: Adenocarcinoma (ADC) of the lung is the most common subtype of non-small cell lung cancer (NSCLC), occurring in ~40% of all patients with significantly higher incidence of brain metastasis compared with other subtypes of NSCLC. Among the five subtypes ADC of the lung, micropapillary predominant ADC may be more likely to metastasize. There are almost no reports of micropapillary ADC of the lung initially discovered to metastasis into the same site in the brain that has been previously operated. CASE REPORT: We reported a 54-year-old woman who was referred to ICU of Dr. Hasan Sadikin Hospital, Bandung, due to a decreased of consciousness. Head computed tomography scan revealed multiple isohypodense lesions in the right frontal with brain edema. She had craniotomy total tumor removal 8 months earlier and diagnosed as brain metastasis due to micropapillary ADC of the lung. She refused to receive chemoradiotherapy. At the operation site, multilobulated lesions were found, and hence, she was operated for the 2nd time at the same site with the first one, exhibited the same histology. Immunohistological shown positive results for thyroid transcription factor (TTF)-1 and cytokeratin (CK)-7; negative for CK-20, led to a diagnosis of micropapillary ADC of the lung. CONCLUSION: Herein, we reported our experience regarding a case of micropapillary ADC of the lung, considered as poorly differentiated ADC and associated with a high-grade lesion that metastasized to the same site that had been previously operated, twice. A definitive diagnosis was possible only through a histopathological examination along with a good communication between the surgeon and the pathologist