World Neurosurg
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Combined central diabetes insipidus and cerebral salt wasting syndrome after traumatic brain injury (TBI) is rare, is characterized by massive polyuria leading to severe water and electrolyte disturbances, and usually is associated with very high mortality mainly as a result of delayed diagnosis and improper management. ⋯ For combined diabetes insipidus and cerebral salt wasting syndrome after traumatic brain injury, massive polyuria is a major typical presentation, and intensive monitoring of fluid and sodium status is key for timely diagnosis. To achieve a favorable outcome, proper sodium chloride supplementation and cortisone acetate and vasopressin coadministration are key.
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Abscess formation within a glioblastoma has been reported rarely. In the few reported cases, after aspiration to treat a presumed abscess, lesions recurred over a short period and, consequently, glioblastoma was recognized. We present a case of a glioblastoma that developed 1.5 years after successful treatment of a brain abscess. A latency of 1.5 years before symptom development seems overly long, even if the glioblastoma was present at the time of the initial brain abscess. Hence, we consider this a possible de novo glioblastoma arising from glial scar tissue. We also discuss possible mechanisms underlying malignant transformation. ⋯ Development of glioblastoma after treatment of a brain abscess is rare; the pathogenesis is open to speculation. Based on the clinical course, the pathologic findings, and comparison with previous reports, de novo glioblastoma arising from glial scar tissue may be the most likely explanation of the current case. If so, to our knowledge, this is the first report of this condition.
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Controlled Clinical Trial
Endoscopic Third Ventriculostomy Instead of Shunt Revision in Children Aged Younger Than 3 Years.
Endoscopic third ventriculostomy (ETV) is a valuable option in the treatment of shunt failure, but no clinical data exist for young children. The aim of this study was to elucidate the role of ETV in patients younger than 3 years of age with shunt malfunction. ⋯ Patients younger than 3 years with obstructive or communicating hydrocephalus may benefit from ETV in the event of shunt malfunction and have about a 60% probability of becoming shunt free.
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Case Reports
Time-spatial labeling inversion pulse magnetic resonance imaging of cystic lesions of the spinal cord.
Cystic lesions of the spinal cord such as spinal intradural arachnoid cysts (SIACs) and spinal extradural arachnoid cysts (SEACs) contain cerebrospinal fluid (CSF). The pathology of these lesions is often difficult to understand because it is difficult to detect abnormal CSF flow by conventional magnetic resonance imaging (MRI) or myelography. We preliminarily evaluated the usefulness of time-spatial labeling inversion pulse magnetic resonance imaging (T-SLIP MRI) of cystic lesions of the spinal cord. ⋯ T-SLIP MRI is useful for obtaining pathologic information about cystic lesions of the spinal cord.
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Craniopharyngioma is a rare benign intracranial neoplasm that is successfully managed with surgery or adjuvant radiotherapy. The malignant transformation of craniopharyngioma has seldom been reported. ⋯ Patients with a high Ki-67 index and high p53, MMP-9, and VEGF protein levels and a new solid component of craniopharyngioma on MRI may benefit from aggressive treatment and close surveillance.