Primary spinal cord melanoma is a rare central nervous system malignant tumor. Usually it resembles an intradural extramedullary (IDEM) nerve sheath tumor or melanoma. We experienced a patient with upper thoracic primary IDEM spinal cord melanoma who was diagnosed to be with hydrocephalus and without intracranial lesions. Initial symptoms of the patient were related to the hydrocephalus and the primary spinal cord melanoma was diagnosed eight months later. At the first operation, complete resection was impossible and the patient refused additional radiotherapy or chemotherapy. At 22 months after surgery, the patient revisited our institution with recurrent both leg weakness. Leptomeningeal dissemination was present in the whole spinal cord and only partial resection of tumor was performed. The symptoms slightly improved after surgery. Primary spinal cord melanoma is extremely rare but complete resection and additional radiotherapy or chemotherapy can prolong the disease free interval. Hydrocephalus or signs of increased intracranial pressure may be the diagnostic clue of spinal cord malignancy and progression.
Central Nervous System ; Drug Therapy ; Humans ; Hydrocephalus* ; Intracranial Pressure ; Leg ; Melanoma* ; Radiotherapy ; Spinal Cord Neoplasms ; Spinal Cord* ; Spine*

Pituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. The clinical presentation of meningeal irritation is very rare. Nonetheless, if present and associated with fever, pituitary apoplexy may be misdiagnosed as a meningitis. We experienced a case of pituitary apoplexy masquerading as a meningitis. A 42-year-old man presented with meningitis associated symptoms and initial imaging studies did not show evidence of intra-lesional hemorrhage in the pituitary mass. However, a follow-up imaging after neurological deterioration revealed pituitary apoplexy. Hereby, we report our case with a review of literatures.
Adult ; Consciousness ; Fever ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Meningitis* ; Paresis ; Pituitary Apoplexy*

The best treatment for clival chordoma is obtained with total surgical excision, sometimes combined with adjuvant radiotherapy. A cerebrospinal fluid (CSF) fistula is a fatal complication that may occur following extended transsphenoidal surgery (TSS) and adjuvant radiotherapy. We report a case of fulminant meningitis without a CSF fistula in a 57-year-old woman who underwent TSS and multiple radiotherapies for a clival chordoma. She presented to our emergency room with copious epistaxis and odor inside her nasal cavity and had an unexpected fatal outcome. She was diagnosed with meningitis based on CSF culture and blood culture. While treating clival chordomas with adjuvant radiotherapy, clinicians should be aware of the possibility of fulminant meningitis.
Cerebrospinal Fluid ; Chordoma* ; Emergencies ; Epistaxis ; Fatal Outcome ; Female ; Fistula ; Humans ; Meningitis* ; Middle Aged ; Nasal Cavity ; Odors ; Radiotherapy* ; Radiotherapy, Adjuvant

Multiple myelomas (MM) are characterized by monoclonal proliferation of immunoglobulin (Ig)-secreting plasma cells. Central nervous system involvement is a rare complication of MM, and it can present as either an intraparenchymal or a leptomeningeal lesion. A 77-year-old woman was transferred from the dementia clinic in July 2012. She had a large heterogeneous signal mass with central necrosis and with pial involvement in the left frontal lobe with destruction of the frontal bone that was observed on computed tomography and magnetic resonance imaging. Multiple punched out radiolucent lesions were also noted on the skull X-ray. Serum protein electrophoresis revealed an IgA-kappa monoclonal gammopathy. External lumbar drainage was helpful for treating the fluid collection underneath the scalp after an orbitozygomatic craniotomy with duroplasty.
Aged ; Brain* ; Central Nervous System ; Craniotomy ; Dementia ; Drainage ; Electrophoresis ; Female ; Frontal Bone ; Frontal Lobe ; Humans ; Immunoglobulins ; Magnetic Resonance Imaging ; Multiple Myeloma* ; Necrosis ; Paraproteinemias ; Plasma Cells ; Scalp ; Skull

Brain metastasis occurs in 3.9-24% of patients with renal cell carcinoma (RCC), with an average interval from nephrectomy to brain metastasis of 1 to 3 years. A few cases have been reported where brain metastasis occurred after a delay of more than 10 years from the initial onset of renal cell carcinoma. This long interval for central nervous system metastasis from the primary cancer has been recognized as an indicator of better prognosis. Histopathological confirmation and aggressive treatment must be considered in these delayed brain metastases cases, since the patients usually show long survival and good prognosis. We present a case of a 76-year-old woman who developed extremely late multiple brain metastases 18 years after a nephrectomy for RCC.
Aged ; Brain* ; Carcinoma, Renal Cell* ; Central Nervous System ; Female ; Humans ; Neoplasm Metastasis* ; Nephrectomy ; Prognosis ; Recurrence

Intracranial hemangiopericytoma is unusual, and those occurring in the posterior fossa is extremely rare; we report such a rare case of hemangiopericytoma of the posterior fossa. The radiologic findings and gross characteristics of hemangiopericytomas are sometimes quite similar to those of meningiomas. Although extremely rare, the operator should be aware of the existence of this disorder to dexterously manage the aggressive nature and high vascular tendency of hemangiopericytomas. The radiological features and histological findings in this case are discussed in this study.
Hemangiopericytoma* ; Meningioma

Primary intracranial fibrosarcomas (PIFs) are extremely rare and the origin of these tumors is still controversial. The rarity of primary intracranial fibrosarcomas makes it difficult to diagnose them correctly and establish a standard treatment. The pathologic diagnosis is made by distinguishing findings from light microscopic and immunohistochemistry analysis. PIFs have been known to be very aggressive neoplasms. The extra-axial location of the tumor could provide an opportunity to perform a total resection even if it does not mean a cure. We present a case of PIFs mimicking a falx meningioma in a 17-year-old man.
Adolescent ; Diagnosis ; Diagnosis, Differential ; Fibrosarcoma* ; Hemorrhage* ; Humans ; Immunohistochemistry ; Meningioma

OBJECTIVE: Malignant meningiomas are rare and have worse prognosis than benign meningiomas. We report our experience of a malignant meningioma and review relevant literature in an attempt to investigate the clinical features, treatment, and prognosis of these tumors. METHODS: Fifteen patients underwent surgical treatment for intracranial malignant meningiomas between year 1990 and 2012 in our institution. Anaplastic meningiomas were diagnosed in thirteen cases and papillary meningiomas in two. Fourteen patients (93.3%) received radiotherapy after surgical resection. All patients were followed regularly including clinical-neurological follow-up as well as magnetic resonance imaging. Progression was determined radiographically when there was more than 10% of mass volume increase or when there were onset or worsening of neurological symptoms not attributable to other causes. RESULTS: Six patients were male and nine were women, and their mean age was 56.9 years (range 36-78). The median follow-up was 54 months (range 3-246). According to our study result, the 5-year progression free survival rate of malignant meningiomas was 53.6%. There were 2 cases (13.3%) of postoperative complications. Recurrences were confirmed in 4 patients (26.7%) during follow-up, the median recurrence time was 35 months (range 12-61), and further procedures were performed. Two of the recurred patients were treated with radiosurgery after secondary tumor resection, and other two patients were treated with radiosurgery alone. There was no more recurred disease patients in the follow-up period after then. CONCLUSION: We report the outcomes of the aggressive surgery with radiation of malignant meningiomas. Although the data is limited, we found that radiosurgery treatment had favorable tumor control on recurred patients from our experience.
Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Meningioma* ; Postoperative Complications ; Prognosis ; Radiosurgery ; Radiotherapy ; Recurrence

OBJECTIVE: Although metastasis of hepatocellular carcinoma to the brain is uncommon, it is associated with a very high mortality rate and most patients usually expire within 1 year after brain metastasis. The aim of this study is to identify the effectiveness of the active interventions such as gamma knife radiosurgery or surgical intervention for these patients. METHODS: We retrospectively reviewed the medical records and imaging data of 59 patients with metastatic brain tumors from hepatocellular carcinoma from May 2004 to September 2012. The study included patients with available clinical and radiological data who had been diagnosed with metastatic hepatocellular carcinoma of the brain, confirmed by magnetic resonance imaging. The overall survival time was analyzed and compared according to each risk factor. RESULTS: The mean age at diagnosis of metastatic brain tumor was 52.2 years (14-77). The mean follow-up duration was 13.3 weeks (0.1-117.6). Overall median survival was 4.3 weeks (95% confidence interval, 2.2-6.4). The results from an analysis of clinical factors related to survival revealed that treatment modalities were significantly related to the patient's survival (log rank, p=0.006). Twenty patients (32.8%) experienced tumor bleeding, and the survival time of the patients with tumor bleeding tended to be shorter, although the result was not statistically significant (log rank, p=0.058). Hepatic reserve, by Child-Pugh classification, was grade A in 38 patients (64.4%), grade B in 16 patients (27.1%), and grade C in 5 patients (8.5%), and was significantly related to the patient's survival (log rank, p=0.000). CONCLUSION: Although patients with metastatic brain tumors from hepatocellular carcinoma showed poor survival, active intervention including surgical resection or gamma knife radiosurgery may result in better survival, especially if patients have preserved liver function.
Brain Neoplasms* ; Brain* ; Carcinoma, Hepatocellular* ; Classification ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Magnetic Resonance Imaging ; Medical Records ; Mortality ; Neoplasm Metastasis ; Radiosurgery* ; Retrospective Studies ; Risk Factors

OBJECTIVE: The objective of this study was to describe and characterize the clinical course of treatment for invasive prolactinoma patients using bromocriptine. METHODS: The study group included 23 patients who were treated with bromocriptine for their invasive prolactinomas. Clinical histories, serum prolactin level and pituitary hormone assessments, tumor diameter and signal intensity on sella magnetic resonance imaging (MRI), visual field exams and the dosage of medications were reviewed for each patient. RESULTS: During 30 months (median, range 6-99) of follow-up period, 19 patients treated with bromocriptine alone achieved biochemical remission. Four patients changed the medication to cabergoline due to the adverse effects or observed resistance of bromocriptine treatment. All of five patients who had visual symptoms improved after the course of medication. Four surgically treated patients were not able to discontinue medication because they could not maintain biochemical remission state without medication. Multivariate analysis showed that decreased enhancement on the initial followed MRI after medication and longer follow-up periods were associated with higher radiologic response. CONCLUSION: We reassure that the dopamine agonist is safe and effective for the treatment of invasive pituitary adenomas. Meanwhile, surgery has a limited role on biochemical remission. Decreased enhancement on the initial follow-up MRI after medication may reflect the treatment response. Further study is required to validate the role of MRI or other factors on the actual prognosis.
Bromocriptine* ; Dopamine Agonists ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Pituitary Neoplasms ; Prognosis ; Prolactin ; Prolactinoma* ; Visual Field Tests