Neuroendoscopic Fenestration of Quadrigeminal Cistern Arachnoid Cyst Presenting with Developmental Regression

Kim Sanghoon,김기홍 대한말초신경학회 2022 The Nerve Vol.8 No.2

Quadrigeminal cistern arachnoid cyst is rare and not usually located in the tectal plate region. Such a cyst may extend to the surrounding area and compress adjacent structures due to cystic expansion. Arachnoid cysts occasionally are associated with hydrocephalus and produce related symptoms. In our case, a 20-month-old boy presented with developmental regression and macrocephaly. Image study of the brain demonstrated a large cyst on the superior portion of the posterior fossa with extension to the supratentorial space and a compressed cerebellum inferiorly and brain stem anteriorly. Lateral and third ventricles were enlarged severely. We performed lateral ventriculo-cystostomy by neuroendoscope via a precoronal approach. Additional third ventriculostomy was performed on the floor of the third ventricle. At 9 months after surgery, the patient showed restored development, and postoperative image showed a reduction of arachnoid cysts and lateral and third ventricles.

Multiple Spinal Metastases of Anaplastic Meningioma: A Case Report

Lee Jong Hyeok,Sung Soon Ki,Oh Bu Kwang,Lee Jun Seok,이치형,Hwang Chung Su,Lee Sang Weon,Song Geun Sung 대한말초신경학회 2023 The Nerve Vol.9 No.1

Meningiomas are primary benign tumors that occur in intracranial and intraspinal regions. Rarely, atypical and anaplastic meningiomas exhibit malignant tendencies and can metastasize. A 56-year-old female patient visited the hospital complaining of a dull headache, mild dysarthria, sudden onset of blurred vision, and mild weakness in the left upper limbs. A homogeneously augmented mass was revealed in the right temporal lobe following magnetic resonance imaging (MRI) and was determined to be an anaplastic meningioma after surgical resection. During follow-up, revision surgery was performed due to the recurrence of the primary tumor. After the revision surgery, the patient complained of new symptoms, which included paresthesia and muscle weakness in the right lower extremity. MRI revealed a mass in the cervical and lumbar vertebrae suspected to have been metastasized. Another revision surgery was conducted on the intracranial primary tumor. The tumor was resected from the cervical and lumbar vertebrae. Histopathology revealed that they were all anaplastic meningiomas. Although anaplastic meningioma is rare, it can cause extracranial metastases. This case shows that multiple spinal metastases of anaplastic meningioma require considerable attention in diagnosis and treatment.

Extensive Central Nervous System Lymphoma Detected at the Time of Diagnosis of Chronic Lymphocytic Leukemia - An Isolated Central Nervous System Richter’s Syndrome: A Case Report

Kim Inkyeong,Ryu Young-Joon 대한말초신경학회 2023 The Nerve Vol.9 No.1

When a central nervous system (CNS) lesion is found in patients with chronic lymphocytic leukemia (CLL), the diagnostic possibilities include CNS involvement of CLL, transformation to a large B-cell lymphoma (Richter’s syndrome [RS]), or the coincidental presence of another tumorous or non-tumorous disease. CNS RS commonly occurs in preexisting CLL with other nodal/extra-nodal involvement, but it is extremely rare to find isolated CNS RS concurrently with the initial diagnosis of CLL. A 73-year-old woman presented with a headache and findings from another hospital of an elevated white blood cell count and intraventricular masses. A peripheral blood smear and a bone marrow biopsy revealed CLL. Brain magnetic resonance imaging with gadolinium enhancement showed a suprasellar mass and a pineal mass within the third ventricle, as well as extensive leptomeningeal enhancement. Whole-body fluorodeoxyglucose proton emission tomography-computed tomography showed no hot uptake except for the brain lesions. Cerebrospinal fluid cytology showed small atypical lymphocytes suggestive of CLL involvement. However, an endoscopic biopsy of the third-ventricle mass demonstrated diffuse large B-cell lymphoma. After 3 months of systemic high-dose methotrexate, all preexisting lesions disappeared, but new hemorrhagic masses were found in the right lateral ventricle and the fourth ventricle. The patient received palliative cranial radiotherapy but died 6 months after the initial diagnosis. Accurate CNS tissue diagnosis and appropriate treatment are critical.

Atypical Heterotopic Bone Formation Rear to the Functioning Cervical Artificial Disc Prosthesis Causing Cervical Spondylotic Myelopathy

Choi Ik Joon,최만규,Lee Jun Ho 대한말초신경학회 2023 The Nerve Vol.9 No.1

Although heterotopic ossification (HO) might occur in a substantial proportion of cervical disc arthroplasty-switched spinal segments, it is predominantly discovered at the anterior vertebral edges of the treated interspace. Herein, we present the case of a 63-year-old woman who presented with clinical signs of myelopathy almost 5 years after the implantation of a Mobi-C disc prosthesis for C6-7 soft disc herniation. As shown by magnetic resonance imaging and computed tomography, spinal cord compression and a consequent signal change inside the cord were attributed to bony spurs from HO posterior to the still-moving prosthesis. Initial full posterior decompression through C6-7 bilateral laminectomy added to posterior stabilization almost fully relieved the patient’s functional and sensory changes from myelopathy. However, the device, as well as the ectopic bone deposits, had to be removed, and switching to anterior arthrodesis was necessary due to the imminent aggravation and progression of cervical kyphotic curvature from the still-functioning device. To the authors’ knowledge, such extensive bone accumulation posterior to a functional Mobi-C cervical prosthesis causing myelopathy has not yet been reported in the literature. Conversion to solid fusion would be preferred to posterior decompression for the sake of maintaining cervical curvature.

Paresthesia and Pain in Both Arms when Shampooing One’s Hair: Symptoms of Neurogenic Thoracic Outlet Syndrome

Kim Ji-Yeong,Son Byung Chul 대한말초신경학회 2023 The Nerve Vol.9 No.1

Neurogenic thoracic outlet syndrome (TOS) is a clinical diagnosis based on the reproduction of a patient’s symptoms with a provocation test (arm elevation) after excluding other conditions that might cause similar symptoms. Neurologic symptoms and signs can vary from mild paresthesia and numbness to intrinsic hand muscle atrophy. The main controversy in patients with neurogenic TOS involves neurologic-type complaints of paresthesia, numbness, and pain. However, there is no positive objective test to identify the cause. A 54-year-old female patient presented with numbness and radiating pain in her bilateral arms that occurred every time she bowed her head while shampooing. The patient had a history of two neck sprains due to slipping before the onset of symptoms. In addition to pain and numbness in both arms at arm elevation, pain in the suprascapular and occipital areas was also present. After excluding cervical nerve root lesions and other bone abnormalities, the patient's symptoms disappeared by brachial plexus decompression through a supraclavicular approach. It is difficult to diagnose neurogenic TOS with pain and paresthesia without muscle weakness in the upper extremities. If physicians do not consider the possibility of neurogenic TOS in patients with upper extremity paresthesia and pain, unnecessary multiple treatments may be performed, prolonging patients’ suffering. The exacerbation of pain and paresthesia in both arms and hands can occur immediately after the head is lowered during shampooing. This can be interpreted as a characteristic symptom of a constricted interscalene triangle and brachial plexus compression caused by hyperabduction of the arm.

A Case of Subcutaneous Schwannoma of the Scalp

Lee Seungwoo,Sin Eui Gyu 대한말초신경학회 2023 The Nerve Vol.9 No.1

Schwannomas are benign neural tumors derived from Schwann cells, which surround the peripheral nerves. Here, we present a case of subcutaneous schwannoma of the scalp, with the goal of increasing awareness of the differential diagnosis of scalp masses. A 45-year-old woman was admitted with a palpable scalp mass on the occiput initially noticed 2 years prior. Palpation revealed a 1.5-cm round subcutaneous mass, which was soft and exhibited a movable tendency. The lesion margin was well-circumscribed and contained under the skin. Computed tomography showed a 6 × 12-mm soft-tissue density subcutaneous nodule in the right paramedian occipital region. Thus, an epidermal cyst or lipoma was suspected. The pathological diagnosis (hematoxylin and eosin staining) revealed evidence indicating a subcutaneous schwannoma of the scalp. We report a subcutaneous schwannoma of the scalp, demonstrating that schwannomas can also occur as subcutaneous scalp lesions. Therefore, we suggest that although the treatment of subcutaneous schwannomas does not differ from other soft-tissue masses, a pathological examination should be performed to establish an exact diagnosis in such cases.

Association of Acute Myocardial Infarction with Ossification of the Posterior Longitudinal Ligament in Korea: A Nationwide Longitudinal Cohort Study

Kim Jaehwan,Kim Chai Yoon,Kim Jeong Gyun,Kim Hakyung,Sheen Seung Hun,Han In-bo,Sohn Seil 대한말초신경학회 2023 The Nerve Vol.9 No.1

Objective: This nationally matched longitudinal study aimed to investigate the relationship between acute myocardial infarction (AMI) and ossification of the posterior longitudinal ligament (OPLL) in Korea.Methods: We collected patient data from January 1, 2004 to December 31, 2015 from the National Health Insurance Service Health Screening Cohort. Patients with OPLL were defined as patients with the International Classification of Diseases, Tenth Revision code M48.8 (other specified spondylopathies) and were newly diagnosed through computed tomography imaging. The OPLL group had a total of 1,289 patients. The control group included 6,445 people. Utilizing the Kaplan-Meier technique, The incidence of AMI in both groups was estimated. A Cox proportional-hazards regression analysis was used to compute the AMI hazard ratio.Results: After controlling for age and sex, the hazard ratio of AMI in the OPLL group was 2.065 (95% confidence interval [CI], 1.228-3.474). The adjusted hazard ratio in the OPLL group was 2.209 after restricting the sample for demographics and concomitant medical conditions (95% CI, 1.311-3.721). In a subgroup analysis, the incidence of AMI was substantially greater in the OPLL group, which included women younger than 65 years and without hypertension, diabetes, or dyslipidemia.Conclusion: This nationwide longitudinal study found that patients with OPLL were at higher risk of AMI.

Advantages of Posterior Indirect Decompression Surgery in Thoracolumbar Burst Fractures with Neurologic Symptoms

Lim Jung Won,Park Jin Hoon,Shin Hong Kyung,Joo Jeong Kyun,Lee Jung Jae 대한말초신경학회 2023 The Nerve Vol.9 No.1

Objective: Approximately 90% of spinal fractures occur at the thoracolumbar (T-L) junction and may be accompanied by neurological symptoms, in which decompression and post-fixation are generally performed. However, decompression surgery can aggravate patients’ symptoms due to adverse incidents, such as developing postoperative hematomas or iatrogenic spinal cord injury. This study compared the surgical and radiographic outcomes of patients with T-L junction burst fractures and neurological deficits who underwent direct or indirect decompression.Methods: We retrospectively reviewed all patients who had undergone posterior surgical treatment for T-L junction burst fractures with neurologic deficits. Patients were classified according to the procedure: indirect decompression (group 1) or spinal decompression through laminectomy and facetectomy (group 2). Clinical results and radiologic findings were compared between the two groups for 2 years.Results: Among 57 patients who met the inclusion criteria, 29 were categorized into group 1, and 28 were categorized into group 2. Group 1 had a statistically significantly lower Oswestry Disability Index score than group 2 at the final follow-up visit (p=0.03). In group 1, both the T-L junction angle and wedge angle of the injured vertebrae improved significantly, both immediately after surgery (p=0.02 and p=0.01, respectively) and at the final follow-up visit (p=0.01 and p=0.01, respectively). In group 2, the difference between the pelvic incidence and lumbar lordosis was significantly greater than in group 1 at the final follow-up visit (p=0.02).Conclusion: This study confirmed that symptoms could be sufficiently improved with indirect decompression, which should be kept in mind for cases where it is difficult to perform direct decompression,

Lumbar Calcifying Pseudoneoplasm as a Rare Cause of Cauda Equina Syndrome: A Case Report

De Bonis Costanzo,Chaurasia Bipin 대한말초신경학회 2023 The Nerve Vol.9 No.1

A calcifying pseudo-tumor of the spine, also called calcifying pseudoneoplasm of the neuraxis (CAPNON), is a rare non-neoplastic lesion that can occur anywhere in the central nervous system. Although CAPNON shows tumor-like behavior, it is believed to be benign and of inflammatory-reactive origin. It may cause many neurologic symptoms by compressing adjacent structures. We report the case of a 45-year-old man who presented with cauda equina syndrome. Magnetic resonance imaging revealed a partially calcified mass compressing the spinal cord. Gross total resection was carried out and the patient’s symptoms improved. Histopathology proved that the mass was CAPNON. Although spinal localization of CAPNON is rare, we should know and recognize this entity based on appropriate imaging findings because radical excision has an excellent prognosis.

Spontaneous Shrinkage of a Dumbbell-Shaped Schwannoma in the Cervical Spine: A Case Report

Lee Sang Yoon,Kim Kyung Hyun,Park Jeong Yoon,Chin Dong Kyu,Kim Keun Su,Cho Yong Eun,Jang Hyun Jun 대한말초신경학회 2023 The Nerve Vol.9 No.1

Cervical dumbbell-shaped schwannomas are uncommon and challenging; clinicians often face the choice between performing incomplete tumor resection and sacrificing nerve roots. Aggressive and total resection is the treatment of choice for this tumor, although surgical resection in asymptomatic patients remains a matter of debate. We present a case report of spontaneous shrinkage of a dumbbell-shaped schwannoma of the cervical spine. A 68-year-old female patient first presented in 2013 with a progressive history of pain in the lower back and both buttocks over the previous 10 years. A dumbbell-shaped cervical spine tumor that had a 30-mm maximum diameter with a foraminal obstruction was identified, along with multiple tiny intradural extramedullary tumors in the lumbar spine. The cervical tumor gradually decreased in size during annual follow-up visits through 2015. Magnetic resonance imaging conducted in November 2017 revealed that this dumbbell-shaped tumor had shrunk significantly, leaving only the paravertebral section with a maximal diameter of 14 mm. This case demonstrated a schwannoma that naturally decreased in size with no treatment. Clinicians should consider the possibility of a spontaneous reduction in schwannoma size when making treatment decisions in asymptomatic patients, in whom avoiding unnecessary surgery may prevent nerve root damage.