World Neurosurg
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Review Case Reports
Adult-onset leukoencephalopathy with calcifications and cysts: Focusing on hemorrhagic propensity and cysts development.
An uncommon disorder, adult-onset leukoencephalopathy with calcifications and cysts (ALCC) has been recognized clinically for approximately a decade. Its typical radiologic signs and pathologic characteristics have been investigated thoroughly and described fully in a series of cases. However, little attention has focused on the propensity of hemorrhage in this entity, and the etiology of cyst occurrence in ALLC remains uncertain. To the best of our knowledge, there is a lack of relevant articles addressing the relationship between hemorrhage and cyst development in ALCC. ⋯ After analyzing the clinical data about the hemorrhage and cysts in our case and all 15 reported ALCC cases in the literature, we conclude that intermittent hemorrhage and cysts development are 2 outstanding features for ALCC and that hemorrhage is a probable mechanism for the formation and expansion of cyst.
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Review Case Reports
Calcifying Pseudoneoplasm of the Cervicomedullary Junction: Case report and a Literature Review.
Calcifying pseudoneoplasm of the neuroaxis (CAPNON) is a rare, slow-growing tumor of a fibro-osseous origin that may present anywhere in the neuroaxis. Although typically benign, symptoms of CAPNONs typically present secondary to compression and surrounding mass effect. Histologically, the tumor has the characteristics of a foreign body reaction with giant cells, ossification, and the formation of psammoma bodies. On imaging, they can easily be confused with malginant lesions such as chondrosarcoma or chondroblastoma or even more benign pathologies like meningioma. ⋯ Calcifying pseudoneoplasm of the neuroaxis is a slow-growing, benign, noninfiltrative lesion whose pathogensis and natural history remains unclear. It can appear anywhere in the neuroaxis and does not have a prevelant location. Because of the indolent course and relative rarity of this tumor, there are no current guidelines on the immediate and long-term management of CAPNONs. This entity, although quite rare, should be considered in the differential for calcified lesions at the cervicomedullary junction. The consensus for treatment of CAPNONs when symptomatic is surgical resection.
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Hyponatremia is a common metabolic disturbance after aneurysmal subarachnoid hemorrhage (SAH), and it may worsen outcomes. This review aims to characterize the effect of hyponatremia on morbidity and mortality after SAH. ⋯ Hyponatremia is common after SAH, and there is evidence that it is associated with certain poorer outcomes. Larger, prospective studies are needed to assess these findings and provide further evidence.
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Review Case Reports
Integrated genomic characterization of a pineal parenchymal tumor of intermediate differentiation.
Pineal parenchymal tumors of intermediate differentiation (PPTIDs) are rare lesions. The differential diagnosis and management strategy for PPTIDs can be challenging because of the variable prognostic and pathologic characteristics of these tumors. ⋯ Pineal parenchymal tumors reflect a broad spectrum of malignancy potential and prognoses, which mandate better understanding of the disease mechanism for rational therapeutic strategies. We present a case of PPTID and report several mutations and chromosomal abnormalities previously unrecognized in this tumor subtype. Review of the literature highlights a need for surgical resection followed by adjuvant chemoradiation. Further investigation of these novel variants may improve understanding of the pathogenesis underlying pineal parenchymal tumors.
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Vertebrobasilar insufficiency resulting from embolism, atherosclerosis, or arterial dissection has long been a challenge for successful management and outcomes. The main treatment options include medical therapy, angioplasty and stenting, and surgical revascularization. Unlike cardiac or peripheral vascular revascularization, large randomized trials with cerebrorevascularization have not revealed favorable outcomes. In patients who have failed maximal medical therapy, and having persistent debilitating symptomology, cerebral revascularization may still be a viable option. ⋯ Surgical revascularization should be considered in the posterior circulation in the rare subset of patients with VBI, who remain symptomatic despite having a protracted course of maximal medical therapy with large- and medium-sized vessel occlusions and poor collateral circulation.