Ravi Ichalakaranji

Abstract

spinal cord lipomas are rare benign tumours1,7,10,15 and mainly of 2 types. Those usually associated with the syndrome of spinal dysraphism,16,22 where these lesions communicate with subcutaneous lipomas through a defect in the posterior elements of the spine (such as spina bifida, lipomyelomeningocele, myelomeningocele, diastematomyelia, cutaneous lipoma, fistula, pilosity & klippel-Feil malformation) and those  without spinal dysraphism.7 Spinal cord lipomas which are not associated with spinal dysraphism are even less frequent, accounting for 1% of spinal cord tumours.1,15,23 60% are localized intradurally& 40%, extradurally.5,9 Here we present a case of a 22 years male patient came to our hospital with h/o upper back pain, non- radiating type, localized to thoracic spine and his examination showed normal gait with mild spasticity in left lower limb, with no sensory or motor deficits. Rhomberg’s sign was mildly positive. Bilaterally reflexes were equal and normal, with left Babinski sign present. MRI whole spine with plain and contrast showed T1 and T2 hyperintense lesion in dorsal spine extending from D4-D9 intradural intramedullary lesion suggestive of lipoma with no evidence of spinal dysraphism. Patient was subjected for surgical excision and postoperatively patient recovered well with smptom free intervals. Keywords: Intramedullary lipomas, Spinal cord lipomas, Spinal dyraphism, M.R.I spine.

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Abstract

Intracranial hydatid cysts account for 0.5-3% of all the cases of hydatid disease and contribute to 1-2% of all the intracranial space occupying lesions. Rare cases of intracranial hydatid disease have been reported in India. In India, the hydatid disease is more commonly seen in the Kurnool district of Andhra Pradesh, Madurai district of Tamil Nadu and in Punjab. Here we present a case ofa 35-year-old female patient presented to us with diminution of vision, diplopia tempero- frontal lobe which is T1 hypointense and T2 hyperintense measuring 4.5×5.25cms Patient was subjected for surgical excision of cyst. Post operatively patient improved well with no neurological deficits. Histopathology of the lesion confirmed hydatid cyst. Patient was put on oral albendazole 10mg/kg per day and continued for 12 weeks. Patient is on regular follow up with us, with no neurological deficits. and headache since 10 days. Her neurological assessment showed higher mental functions within normal limit and Visual acuity - 6/12 right eye and 6/9 left eye, with normal fundus & right 6th cranial nerve palsy. MRI brain (P+C) done was suggestive of intra-axial well defined cystic lesion in right. Keywords: Intracerebral hydatidosis, Echinococcus, Dowling-Orlando technique, Albendazole

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Abstract

 An Intracranial dural arteriovenous fistulas (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus &/ cortical vein 1. When there are multiple fistulas they are termed as dural arteriovenous malformations and comprise 10-15% of all intracranial arteriovenous malformations1. Here we present a case of52yr old patient who presented to our casualty with history of sudden onset of headache, giddiness, and vomiting, followed by loss of consciousness. Neurological examination revealed impairment of consciousness, no verbal response, with left hemiparesis (E2V1M5). Bilaterally, pupils were 5mm and sluggishly reacting to light. Vitals were stable with B.P. recording of 140/80 mm of hg, and a pulse rate of 80 /min. Pre contrast CT scan showed an intraparenchymal haemorrhage with perilesional oedema in the right frontal region. CT angiography brainshoweda intracranial dural AVF with varix and adjacent intraparenchymal haemorrhage. D.S.A. revealed a Borden type III & Cognard type IV –midline dural Arteriovenous fistula in the regionofmid superior sagittal sinus and along the cerebral falx, with a large venous ectasia/varix along the anterior cerebral falx. Management: Patient underwent afronto parietal rectangular craniotomy Right posterior frontal, parasagittal engorged bunch of focal cortical veins was cauterized. Underlying haematoma was evacuated and the underlying venous ectasia/ varix identified. It was found to be thrombosed. A large draining vein was found which was clipped and any consequent brain swelling was looked for, before finally excising it in toto. Post –op period was uneventful, with the patient gradually improving in sensorium with residual hemiplegia and aphasia. Although recent developments in catheter interventionhas made it the preferred option in most of the cases, surgery is still preferred in some select cases. Keywords:Intracranial dural AV fistula, Superior sagittal sinus, Cognard and borden classification, CT andiography, Digital subtraction angiography 

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